New Professional PT

Even though it feels a little spam-ish

2011-11-24T20:07:00.001-05:00

I am coming out of my slumber from this blog to share a website recommended to me.
With the high unemployment rate out there, find yourself a new job right here:

http://jooble-us.com/

seems simple enough to use.
This also goes to those of you who hate your jobs.
The worst thing someone can do is waste 40+ hours a week doing something they do not enjoy just for a paycheck.
I have been fortunate to love practicing PT.
If you enjoy doing it, its never work.

Stay tuned (not nearly as long as last time) for some updates on my latest moves.

Ke$ha Spine

2011-06-13T13:56:00.004-04:00

Saw this in the latest Billboard magazine. Inspired by one of my favorite blogs, #Street Anatomy (link to a great Salvador Dali remake), enjoy.

Podcasts

2011-06-06T20:39:00.003-04:00

In case you have not taken advantage of the many free podcasts that are available here are two of my favorites:

British Journal of Medicine

CrossFit Journal

Great for jogging and commuting!

Let me know if you have any recommendations, just leave them in the comments.

Platelet Rich Plasma (PRP)

2011-05-31T16:01:00.003-04:00

I attended a very thorough talk last week given by Dr. Steven Lee of Lenox Hill Hospital on the topic of PRP.

His main points included the idea that the research is very far behind with very few high or even moderate level research studies to support the use of PRP. The amount of variables that can influence the outcome of this treatment are vast and thus limit the research potential. Despite this lack of research it can certainly be a welcome treatment for those who have failed other forms of conventional treatment for their tendonopathy (not tendonitis, please make sure you speak with a health care professional about the difference). Eccentric training of the affected tendon and cross friction massage which is a much cheaper alternative to PRP as far as re-creating an inflammatory process have some favorable research studies and are worth a "shot" before trying PRP.

I do get concerned when MDs site one research article and are selling the product: http://www.orthopedicsurgerynyc.com/137759/2011/05/31/platelet-rich-plasma-injections-for-tennis-elbow.html#comments

I have not met Dr. Stein but I invite him to discuss his criteria for choosing a candidate for PRP. I have left a comment on his blog and will look forward to his response and update this post as to the outcome of that conversation.

House

2011-05-10T15:42:00.008-04:00

On the most recent episode of house
Dr.: "She is having a heart attack!"
Patient's Boyfriend: "That's impossible, she runs marathons"

Which leads me to where I have been hiding since my last post.
I have been in the process of starting my own CrossFit gym:
empirecitycrossfit.com

The quote regarding marathon runners connects to CrossFit not because all marathoners are at risk for heart disease, but they certainly are not free of it either as the boyfriend was implying, rather it has come to my attention that most people have gaps in their fitness. CrossFit is the most complete fitness approach I have seen to date and I have adopted it as part of my practice to help people reach their full potential in athletic performance.

If you are ever in NYC please come for a free trial class. See our website for schedule and details.
I hope to be continue to post here or back and forth with the CrossFit blog.

I also realize CrossFit is poorly understood (even worse than how physical therapy can often be perceived) thus, invite anyone to engage in a dialogue to foster the correct information about health and fitness becoming available.
I look forward to hearing from you!

My Run Movie

2011-04-04T09:53:00.003-04:00

http://www.myrunmovie.com/

I saw this the other night. Ticket sales went to benefit Livestrong.
It is fascinating when people push their bodies WAY past their "limits".
Back in 1996 there was a man who ran 75 marathons in 75 days from St. Paul, MN to Atlanta, GA. Very interesting documentary. You should all check it out.

Sports Injury Forum Interview

2011-03-25T16:39:00.003-04:00

Take a listen to my interview w/Dr. DeFranco, would love to hear what you guys think!

It is under past archived shows under the date 3/20/11:
http://www.artistfirst.com/sportsinjuryforum.htm

Find A Specialist in Your Area

2011-03-23T10:20:00.006-04:00

Looking for a good Physical Therapist? If you can't come see me in NYC then here is a link to the American Board of Physical Therapist Specialties website that will allow you to search by city and specialty area which is a great start to finding the right fit for you.

OnlineCollege.org Interview

2011-03-22T12:09:00.007-04:00

Check out the interview I did with OnlineCollege.org here.
Hopefully it will give people a better understanding of Physical Therapy. Would love to hear any feedback you may have :)

It is an honor to be on the expert list along with Dr. Scott Ward, president of the APTA and author of Moving Forward (which has just moved over to the APTA website, and unfortunately is not letting me subscribe to their rss feed, step it up APTA!).

PS, I did my 2nd bikram yoga class this morning-->not smart to do it first thing after waking up.

Nutrition

2011-03-21T18:06:00.003-04:00

Was cooking this afternoon and got inspired to get you guys in on the nutrition talk.

I heard an interesting quote recently saying that the science of nutrition is today where surgery was in 1650, ouch. Many debates rage on about what is best for you and your body. Ultimately we need to balance what makes you happy as eating can be a very emotionally linked experience along with how the food will be fueling your body for life.

Any rules you guys like to follow when it comes to food?

Bikram Yoga

2011-03-20T14:03:00.009-04:00

Yesterday I had my first experience with taking a Bikram Yoga class. I found it to be a very interesting experience as I certainly was able to reach new ranges of motion not seen since the time I was a toddler most likely. For those not familiar, this is the form of yoga that is done in a heated environment to increase the therapeutic effect.
If you are going to consider this much physical activity in a heated environment please make sure to hydrate properly and be cleared by a medical professional of any cardiac issues as this can put a strain on your body.
I think, as with most classes that involve your body, your experience will be dependent on a few key things:
1) how prepared your body is for the work involved in the class
2) how the instructor presents the material and helps modify for those not yet ready for the full activity
3) how well the participant knows their own body and is able to steer clear of dangerous activities

3a is the one I have a problem with

In yesterdays class I did object to at least one motion which the instructor tried to convince me was a way to heal my knee. The pose known as utkatasana involved keeping the knees together while the feet were about 6 inches apart and getting into a squat. This invariably places you into an internal rotation/adduction of the femurs. Along with my history of an ACL reconstruction two years ago (which I did inform the instructor about), and my knowledge of the orthopaedic literature claiming this to be a fairly dangerous motion for the cartilage of any knee, I decided to skip that motion. It did not seem worth the risk of further damage to my knee.

that is a highly loaded knee - but she looks so happy...

Overall, I feel like I got a good workout and very good stretch of most of my body head to toe. I did modify a few other positions as I felt necessary. I did get into a good discussion following the class with a gentleman who was overweight and told me about a history of herniated/bulging discs in his back. He stated the first few times he did the class his symptoms seemed to get worse but as of that class he was starting to feel a little better. He also mentioned trying a little bit of physical therapy at some point that did a little to help.

My advice to him as it is to all humans is the following: It is important to try different physical challenges throughout our lives in order to foster improvements in fitness. If there is any issue with the body there are likely a variety of ways to improve the symptoms but very few ways usually to correct the underlying pathology and cause. Before embarking on any new challenge to the body it is important to consult with an expert in the musculoskeletal system. Who fits under the term expert in musculoskeletal health? I would say it comes down to licensed physical therapists and orthopaedic medical doctors. As a consumer to make sure you have a top individual in either of these two fields one way to differentiate the level of knowledge that individual has it to check for board certification in the area, in this case orthopaedics. While board certification is far from the only or best way to differentiate the quality of care you will receive, for most consumers prior to meeting the actual clinician it is probably one of the best ways.

So will I partake in more yoga classes? Most likely. They have given me a one week membership based on my attendance yesterday which I would like to utilize at least one or two times. I also plan to try some of the other disciplines of yoga. So far I have tried vinyasa, bikram and next up will be kundalini which a high school friend of mine teaches.

Go find your next new physical challenge!

Referral for Profit

2011-03-13T23:28:00.002-04:00

If you would like to see how some doctor's value Physical Therapy services please watch this video. He begins to discuss PT the 8:25 mark. Athletic trainers and Chiropractors should not be charging CPT codes for PT services. The presenter is very excited about 60% of the South Carolina PT's being put out of business. Very good responses to the video in the link:
http://www.orthosupersite.com/view.aspx?rid=64629

Public Perception

2011-03-08T17:14:00.002-05:00

Open question to everyone:
What is Physical Therapy/Physiotherapy?
Please respond in the comment section below...

Please sign

2011-03-01T15:54:00.002-05:00

No matter where you fall in the spectrum of healthcare, from never been in the system to a physician, you should read over this petition and then SIGN IT!

http://www.ipetitions.com/petition/stop-popts/

MESH

2011-02-27T23:42:00.002-05:00

Lisa Gansky: The future of business is the "mesh" | Video on TED.com

Great TED talk by Lisa Gansky, got me thinking: how can we "mesh" fitness?
It is very individualized but lets take a look at Crossfit.com
A community based fitness program on the international scale.
Although a little intimidating at first, it is scaleable to children, geriatrics and everyone in between thus allowing a great mesh.
Their philosophy is very transparent, organic, grassroots.
Is it a perfect system? No, but it is one of the best fitness strategies I have seen. But as with my previous post of building a foundation, there needs to be an individualized "ramp-up" program to make sure this like any other program is SAFE!
Go mesh and be healthy!

Creating a Foundation

2011-02-27T23:05:00.002-05:00

Every step you take will put load on various joints in various ways. Every movement you make may be harming you! Should we not move at all? Of course not, we need to be moving all the time: motion is lotion...
We need to learn to move correctly
"Consult your healthcare provider before starting any exercise program"
Have you seen/heard that phrase before?
How many people do you know that actually did that?
People who decide to start working out should save a lot of time and resources by learning to do it correctly.
What is correct working out?
Here comes the philosophical debate.
What is fun and will keep you involved may be better than what may actually get you to be the healthiest/fittest which may not be as fun for you.
The idea of Evidence Based Practice has three components:
1. What the literature/research recommends
2. Practitioner experience/expertise and discretion
3. Patient/client values and preferences

This becomes difficult to sell on a large scale. A magazine such as Mens Health or a workout program like P90X can only be so successful because they most likely are pushing the 2nd piece of EBP (expertise) and sometimes even utilize some of the research but it is up to the patient/client to use their product. This is why to be most efficient and effective a one to one program becomes necessary. If we want to have a true utilization of EBP, to get closer to reaching our full potential of 'how to exercise properly' there should be a qualified professional working with the individual to continuously adapt a program. A goal of most top clinicians should be to foster independence with an exercise program so the individual can take control and be their own coach. The most critical part is that foundation building where we can utilize something like the SWOT method (as applied to the body). Identify weakness and threats to the body to help you reach your goals as expeditiously as possible, as safe as possible with long term (pronounced LIFETIME) insight.
We as a culture tend to be very reactive (I can't fit into my jeans anymore, I should go lose some weight OR my shoulder hurts to the point I cannot lift my arm to brush my hair NOW I should see a medical professional) while we should be proactive!
We tend to be short sighted while we need to look at the full spectrum of health and wellness.

I am going to lecture tomorrow to some high school football players and hope I can foster them to achieve/change their goals in the short and long terms.

Perspectives for Patients

2011-02-23T11:30:00.003-05:00

Thank you JOSPT for another great feature!
In response to a recent reader survey they have added this fantastic feature that will "translate evidence into practice" by allowing patients to have access to the most up to date information in a lay format.
Click here to read more about this FREE feature for all!
Let's keep pushing this profession further!

CSM 2011

2011-02-12T11:26:00.001-05:00

As a student physical therapist I attended all 9 of the national meetings available from the APTA. Since attaining my doctorate in may 2008 this weekend is my first return to a national conference.

I think its a great event for so many reasons. However, it highlights where we are as a profession. The diversity of practice is the strength and weakness of our profession. There are 18 specialty sections and many special interest groups branching from each section, over 50 I would say.

I went to a great talk about branding yesterday. The top 100 image results in Google for the term "physical therapy" was discussed. 42 showed gait training while 4 were related to back specialist and 2 related to performance with a few others in between. I invite you to do this experiment and see how it matches your perception of PT. Perception is everything, no matter your skill level as clinicians.

"We are who Google says we are"

As much as I enjoy some gait training, I as a PT see performance as the bigger picture. We are lacking in the market that is fitness and we should be the top of the food chain as musculoskeletal experts. Selena from EIM has a great post about her takeaway from csm, I will try to link to it when I'm not on my Droid.

A lot of excitement about where we can go but also a lot of frustration for me because of where we are. Stay optimistic and keep moving forward is all I/we can do. Thank you APTA for pushing us forward and thank you EIM for pushing APTA.

Published with Blogger-droid v1.6.7

NOLA

2011-02-08T21:17:00.001-05:00

I am down here in new Orleans, mahony's for the po boys. Sat through day 1 of level 1 of the titleist performance institute. It is a system to help assess athletes that play golf to find movement patterns that may affect their golf game. A large emphasis is placed on the necessity for medical professionals, golf pros, and fitness trainers to work together. They use a lot of principles from the selective functional movement assessment which is a course I took back in august of last year (I like taking courses). So far I have some interesting ideas on how to use the content especially in new York city where golf fitness seems to be lacking, moreso than other types of fitness.

Published with Blogger-droid v1.6.6

Body as Temple

2011-01-18T15:03:00.002-05:00

Pardon the philosophical rant...
Ever since I have heard someone exclaim "My body is my temple!" it has stuck with me. I have tried to seek out the best things to put into my body and tried to invest in the right forms of movement so as to facilitate a healthy body. As important as it is to have peace of mind and spiritual well being it is also crucial to find balance and symmetry in your musculoskeletal system.
We like to indulge in our favorite desserts and comfort foods. Some even feel healthy because they go and do 40 minutes a day on the elliptical 5 times a week. What is fitness? How do you define it?

We are too reactive as a people, not enough proactive behavior. I postulate that a large part of this is from a lack of clear and concise information as to "the right answer". The push towards an "evidence based approach" in medicine and PT helps keep me busy reading up on the latest and greatest to offer the best advice/coaching/instruction.

We only get one body. The sooner we can get it on the right track the easier it will be down the line to "fix" any pathologies or imbalances. Change takes time to create both ways (for the better or for the worse). If you think it is too late for you, you are most likely wrong, there is always something that can be done to improve your condition from a musculoskeletal standpoint. Happiness is the ultimate goal in life, or at least should be. Would adding 5 minutes a day to stretch out (correctly) be a good investment in avoiding having to get a major orthopaedic surgery in a few years? Are you living for the now or for the long term? Do you take better care of your car than you do your body?

Change has to be organic. "You gotta want it" - all the cliches of the world stick around because they hold much truth, will you listen?
---end of pep talk
Go be healthy! If you do not know how to get healthy, ask an expert? Not sure who an expert is... ask me :)

Resolutions

2011-01-18T14:52:00.002-05:00

Who made New Year's Resolutions?
Raise your hands...
Who has already, by the 18th day of the year, broken most if not all of their resolutions?
Am I a cynical New Yorker? You betcha...

Why did your resolution already fail? Did you make it reasonable, achievable, measurable? Are you too busy to get it accomplished? Would you rather not attempt it at all instead of try to set aside 5 minutes a day for your goals?

Let us make January 18th resolutions. Share with the class in the comments so you are now accountable and we can check back in a few weeks to see how you have progressed towards achieving the resolution.

I look forward to hearing from you all! Have a happy new, new year...

Fundraising!

2011-01-07T07:33:00.003-05:00

Happy New Year everybody!
I am participating in the Tour de Force and have a fundraising page setup. It is for a great cause. Please check out the information on the website and to donate just select "Babenko, Eugene" (that's me) under "Riders Name". Any and all donations are greatly appreciated.

http://www.tourdeforceny.com/sections/donation.asp

Stay healthy my friends.

EIM, free stuff!

2010-12-29T22:18:00.001-05:00

Check out the free EBP course:
http://www.evidenceinmotion.com/FreeCourseReg.aspx

Evidence In Motion continues to redefine and push our profession forward, just wonderful to see and I am excited about how much more can be done. I see too much of our profession in the stone age... let's "move forward"!

OCS Countdown, yay pressure

2010-12-29T21:35:00.001-05:00

Upcoming Me

2010-12-20T11:23:00.003-05:00

To get you all caught up on me (and hopefully for you to join me at some of these events) here are just a few of the upcoming plans in the immediate future:

NYE Run 12/31/10
CF Mobility Cert 2/4/11
TPI-L1, CSM & Mardi Gras Full or Half Marathon (Have yet to decide) 2/7-14/11
NYC Tri 08/07/11
Tour de Force 9/8/11-9/11/11 (please donate - I should have the donation page setup under my name shortly, it would be greatly appreciated)

Im Thankful for These Links

2010-11-26T11:04:00.008-05:00

I have recently streamlined my RSS reader and wanted to share my favorites with the rest of you lovely people out there, enjoy! In no particular order:

1) MoveItNPs I happen to be a 'contributing author' but Ben Braxley is worth getting to know, read up and join the movement.

2) Eric Galvez --> Mass Kickers Cancer survivorship is no joke, Eric is another great person to get to know so go read!

3) Crossfit and MobilityWOD This is the movement of the future in health/fitness in my opinion. It comes across a little intimidating but with the help of KStar at MobilityWOD and "scaling" this really is for everybody and it is all free. My biggest problem with it is they have so much information it is tough catching up!

4) Chris Johnson PT An endurance athlete himself Chris is leading the way in training/treating this unique population of athletes.

5) Fusion Performance Training A "performance coach"/PT who comes out with some quality material worth reading. He also has The View

6) Mike Reinold Despite his Boston affiliation this man is a leader in progressive sports/ortho PT, keep it going Mike.

7) Optimum Sports Performance Quality content coming from a massage therapist/CSCS

8) Simply awesome PT geek/art stuff: Street Anatomy

9) EIM Team A group that really wants to change things for the better in our profession, always a quality read.

10) Eric Cressey is another leader in fitness specifically in the world of Baseball but his lessons carryover to most other aspects of fitness.

Do you have any blog(s) (other than this one) that you think is of vital importance (please share in the comments below)?

There are a bunch of other PT links that I will try to throw in another post. There is always reading of JOSPT or AJSM as well; lifelong learning is no joke. I have a few non-PT links I frequent but will have to share that at a later date as I have to go catch a flight to Las Vegas where I am taking an Emergency Response Course. Hope you are ready to work off all the damage you did at Thanksgiving dinner :)

Proximal Hamstring Avulsion Case Report

2010-11-25T10:57:00.004-05:00

Quick review of the following article:
Surgical and Therapeutic Management of a Complete Proximal Hamstring Avulsion After Failed Conservative Approach

What information do you take away from reading a single article other than the main findings?

I like to see which outcome measures were used since there seems to be so much variability throughout the medical field. In this study they used the LEFS which seems to be a very popular scale. They also use the SportCord test which I actually had not heard of before this article (google was not much help to find more information about it, but they do describe the test in the article).

The patient had a Hamstring Repair using an Achilles Tendon Allograft. The article describes a new protocol that is criterion based and considers the basic tissue-healing process. They also add early loading to prevent secondary atrophy. The patient ended up having 25 sessions over 7 months to reach all goals. Despite her great outcomes she chose not to return to softball. The authors emphasized proximal control and lumbopelvic stabilization exercises which was lacking in the literature previously. They mention neuromusuclar control often which is a fairly subjective concept but a critical one that is beginning to be emphasized more often in the literature more recently.

Despite the "low level evidence" this provides it is a very useful article to have in the utility belt as a clinician.

Another Career Day at my High School

2010-11-15T09:25:00.004-05:00

This past Saturday morning I went to talk to young men and women at my high school to give them an idea of what Physical Therapy is all about. My big messages at these events always include the following:

1) The story of how I got to my career
2) General overlook at the very dynamic field that is PT
3) This career may not be for you but make sure you find something you love to do. A great way to do this is to volunteer and intern with as many different fields that could be potential fits for you (I spent time with the following disciplines: chiropractor, orthopaedic surgeon, EMT, athletic training, personal training, physical and occupational therapy)
4) No matter what career path you choose you should still be aware of healthy living and how to save a life (this video is a scare tactic that should drive the point home)

A view of Brooklyn Tech's auditorium from the gym. The auditorium is the second largest in New York State (2nd only to Radio City Music Hall)

NYC Marathon

2010-11-06T22:15:00.006-04:00

Such a great event. So much energy, brings the whole city and so much of the world together.

This will be the first year since 2005 that I will not be at the finish line medical tents. I will miss the environment, it is fun.

There are a few debates about what the marathon actually does to/for the body. An orthopaedic surgeon I heard speak recently advocated that no one over 150 pounds should ever run endurance events. Some of the healthiest people I know have run most of their lives. That debate will have to continue. In the meantime, good luck to all the runners tomorrow... Layer up!

Addendum:

I took this picture towards the end of the marathon (About mile 25.5). These guys dressed up like the Blues Brothers and walked right by me at a nice leisurely pace. Begs the question of people doing these marathons for fun. If you have a >5 hour time it seems to take away from the athletic accomplishment. The experience no matter what pace you go seems to be one of the best and I am highly motivated to push my surgically repaired knee to try this marathon next year.

National Student Conclave

2010-11-01T09:40:00.003-04:00

Yesterday I had a chance to participate in a task panel at the National Student Conclave in Cherry Hill, NJ. The title of the Task Panel was: What You Can Expect As You Transition From Student To Professional Status: A New Professional Panel Discussion. We had a semi-diverse group including a PT only 1.5 years out of school who ha started his own practice in California. Another panelist took part in a PhD program in New Zealand investigating hip OA among other topics.

The students seemed to get a good amount of information out of the hour long discussion. While many of the same answers that could be expected were given about lifelong learning, the importance of mentorship, risk management, 'ethics in the real world' I had to get on my soapbox and make sure I advocated for involvement in APTA. My biggest take home message was how each of those students should not only be members but maintain active involvement in the organization. I believe this is the a major way we will grow as a profession. When asked about how the APTA has helped me as a New Professional I had to applaud the APTA again for all the work they do on Capitol Hill which we do not always see. I have been fortunate enough to see it firsthand as a member of the Student Board of Directors a few years ago and having a good friend currently working with APTA.

Great event, thank you again to APTA for inviting me to partake.

Guest Post: Interview w/Dr. Hewett RE:ACL

2010-11-01T09:33:00.001-04:00

Hi, I would like to introduce myself, my name is Sasha Sibree. I’m a Physical Therapist in Denver, Colorado. BoDPT has kindly allowed me to do a guest blog post, I would like to thank him for the opportunity.

Basically I wanted a way to combine two of my interests – building web sites and furthering my Physical Therapy knowledge.

So what I did was go out and interview a whole bunch of rehab experts, and then make those interviews available, free of charge, on my web site PhysicalTherapyContinuingEducation.Org.

Here are some excerpt from a recent interview with Dr Timothy Hewett about his work with ACL Injuries and Prevention.

PhysicalTherapyContinuingEducation.Org: Is there a different mechanism, when comparing males and females, in non contact ACL injuries?

Dr Timothy Hewett: So, what we’ve done is we’ve looked at the mechanisms of how men and women tear their ACLs. Basically, if you look at the mechanisms, in women especially, there are four common components.

As the woman lands her knee buckles inward. The knee is relatively straight when she lands. Most if not all of her weight is on a single foot or single leg. And her trunk tends to be tilted laterally. In other words, her center of mass is outside of her foot base of support.

These mechanisms also occur in men but, for instance, the exaggeration of the positioning of the trunk is much greater in women than men. We’ve published several studies on this. We published last year, in the British Journal of Sports Medicine, a study showing the relationship in women between the amount of trunk lean and the risk of ACL tear.

I’ve also done collaborations with the biomechanics lab at Yale where we’ve showed in varsity athletes, women who are not good at sensing the position of their trunk in three-dimensional space, or allow greater motion of their trunk following a perturbation or disturbance of their trunk, have greater risk of future knee ligament and ACL tears.

Dr Hewett shares a ton of great information in this 46 minute interview. Including expanding on the four different components, the best way to screen for thttp://www.blogger.com/img/blank.gifhe “at risk” athlete, and what interventions can decrease their risk.

I invite you to visit my site at Physical Therapy Continuing Education.Org to listen to or download the entire interview.

Thanking you,
Sasha Sibree PT
Physical Therapy Continuing Education.Org

Pass It On

2010-09-17T12:13:00.002-04:00

I usually do not pass along, let alone even read, chain letters, however this one caught my eye and I certainly do agree with the need to change our culture...

Pictured is a young physician by the name of Dr. Roger Starner Jones. His short two-paragraph letter to the White House accurately puts the blame on a "Culture Crisis" instead of a "Health Care Crisis"..

It's worth a quick read:

Dear Mr. President:
During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.

While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"! During my examination of her, the patient informed me that she smokes more than one pack of cigarettes every day, eats only at fast-food take-outs, and somehow still has money to buy pretzels and beer. And, you and our Congress expect me to pay for this woman's health care? I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture" a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that "I can do whatever I want to because someone else will always take care of me". Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.

Respectfully,
ROGER STARNER JONES, MD
If you agree...pass it on.

Anybody home?

2010-09-10T23:01:00.002-04:00

If you are still following this blog, bless you... and my apologies!
I am finally settling down from some whirlwind changes.
Finished my 18 month orthopaedic outpatient mentorship.
Took a position at Lenox Hill Hospital working Acute Inpatient Ortho (mostly).
Been busy with seeing a few private clients, working at the hospital and working out.
Started CrossFit (got certified as a trainer)... it is not as crazy as it may seem to some, we will discuss now that I am back.
Signed up for the OCS exam which will get its own post just to mentally prepare for preparing. Trying to do as much as I can. Took a few courses, about to take some more. Exciting times and time management is now the biggest challenge. Bottom line is I love the possibilities and there is a lot going on. I feel like this blogging, despite taking up time will help keep me somewhat grounded to move forward.

It helps that I finally got a brand new laptop... even the HTC EVO could not get me blogging consistently. here we go now...

APTA loan forgiveness survey

2010-08-07T08:47:00.001-04:00

From my buddy Nate,

I wanted to call to your attention an email you may have received earlier today from us at APTA regarding student loan forgiveness. It went to all current PT students and all recent PT graduates that have been out for 5 years or less. Can you guys help to spread the word about this email and get students and new professionals to fill out the quick survey (it literally takes less than one minute to complete!). We don’t want people forwarding the email or copying-and-pasting the link, but rather filling it out from the email that they directly received. If you could just spread the word among your new professional and student colleagues to take a minute to fill it out, that would be amazing. The data that is gathered has the potential to be very helpful in our quest for student loan forgiveness opportunities for PTs.

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Delay picture release

2010-07-25T21:50:00.004-04:00

Here are some pictures of the world famous Brian Mulligan from his course I attended last October. This is my current pace of affairs, 8 months behind...

He was getting down on the floor fixing people, fairly awesome to see living legends at work.

Here is the flickr page with other Mulligan photos

Central Park

2010-07-01T21:13:00.001-04:00

Gorgeous day today. Went for 4 loops, just over 24 miles. Midday so traffic flow was pleasant. Lap 1_16:19_2_16:48_3_18:07_4_16:31 1:07 total

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rotator cuff repair article worth checking out

2010-06-21T20:38:00.001-04:00

millette, p.j., wilcox, r.b., o'holler, j.d., warner, j.j.p. rehabilitation of the rotator cuff: an evaluation-based approach. October 2006, 14 (11).
sorry for the lack of proper annotations but typing on the phone is a good excuse right?
fantastic article on rotator cuff rehab, go read it now!

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my first tri

2010-06-13T18:22:00.001-04:00

time in water 17:39
"transition" 4:10
16 mile bike 51:35
transition 46 seconds
3 mile run 21:31

technically a transition time is only when you are in the transition zone
more to come

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varied practice

2010-06-12T08:02:00.001-04:00

my first blog attempt on my HTC evo.
Saturdays I like to work either at acute care or another private practice that is fairly different from my usual practice. this is partly to help me pay off loans sooner, but also I find it very beneficial to see different populations and because the geographic location within nyc is far enough apart the diagnoses tend to be fairly different as well. Something I have been saying since I have gotten into PT is that I will likely never be bored thanks to the plethora of settings and populations that one can partake in.
1) how many of you out there work in varied settings through the week (any profession can answer)
2) the typing on this phone is a little more cumbersome than my old treo which had a physical keyboard compared to this here digital one... it slightly makes up for it with the autofill feature but requires a bit too much editing especially for longer bits of text

happy weekend!

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Welcome Back

2010-06-06T14:11:00.002-04:00

I am making yet another pledge to increase my blogging now that I have been away for so long...
I am getting the new Sprint phone within the next few days
Been staying busy reading, learning, working acute care a few weekends, ortho private practice the rest of the weekends, private patients, triathlon training, trying to put together an irb for a study, all on top of the regular "9-5" gig. It's fun being busy...
Talk to you guys soon.

Cervical Manips vs Mobs & Adalius Thomas

2010-04-18T21:57:00.002-04:00

New Cochrane review which is reviewed at the CAM report.

The authors concluded, “Cervical manipulation and mobilization produced similar changes. Either may provide immediate- or short-term change.” [manips carry increased risk, which is why I stay away from manips and stick to mobs for c-spine]

“Thoracic manipulation may [also] improve pain and function.”

However, there are no long-term data on effectiveness, and optimal techniques and dose are unresolved.

Adalius Thomas on the Patriots mishandling his injury (the Jets would have never done this;):

There are now 12 screws and a plate in his arm. The Patriots sent him to a facility in Tampa for rehabilitation (Thomas has a home in Florida) in early 2009, but he said the woman he worked with was a massage therapist, not a physical therapist who specialized in helping him recover full range of motion in the arm.

Well over a year later, he said his wrist sometimes still bothers him. Next month, he will go on his own to a place in Pensacola, Fla., to try and get it back to normal.

He wondered why he was not directed toward proper therapy in the first place.

Life Coach Help and "Classic" Articles

2010-04-18T17:13:00.002-04:00

I wanted to promote one of my readers blogs.
She has a very thorough breakdown of the top 100 life coaching sites.

This got me thinking of another fun list to make... The top 10 research articles for every different body region. I do plan on taking the OCS exam fairly soon and a student at my clinic is going to be working on a project similar to this. So I want to ask for your help:

What are the most important and comprehensive articles that have changed the field/or even your way of thinking about treating patients. Any body part, from any year, any journal, whatever you got... I look forward to hearing your responses and I will be posting my top 10 lists as they come together.

2010-04-17T22:36:00.007-04:00

Achieving an "aero" position during a time trial (58 mins for 36 km - about 22 mph average)

Talking at my high school at Career Day, about Physical Therapy (go figure :)

Haiti

2010-04-05T00:47:00.001-04:00

One of my professors from PT school has gone down to Haiti to provide assistance. Please follow along at her blog: liucare.wordpress.com

Marathon statistics

2010-03-22T22:03:00.002-04:00

Interesting stuff, source is Runners magazine, their source I do not have available right now, if you are that interested I am sure we can work together to figure it out :)

Interesting stats
United States Marathon participation
143,000 in 1980
425,000 in 2008

Finish times
males:
1980- 3:32:17 - 8:06 pace
2008- 4:16 - 9:45 pace
females:
1980 4:03 - 9:17 pace
2008 4:43 - 10:48 pace

A good percentage of my patients have running related injuries, usually from overuse. Should there be stricter guidelines to qualify for a marathon? How much damage can be done compared to the benefits of running? Risk increased damage to your joints if you train incorrectly for weight loss and cardiovascular benefits?
Please leave your thoughts in the comments :)

There is much more to this debate, I certainly do not have the answers but am going to hold my opinions out (I know that is what blogs are for... oh well) - at least until I do some more research on the topic myself. I personally chose not to run the NYC marathon which is a small dream of mine. I let my gauranteed entry expire because I am not sure if my surgically repaired knee can take the pounding that comes along with training and the actual running of the marathon. This year is all about the triathlong for me which is limited to a fairly simple 10K. I do plan on running the Brooklyn Half May 22, I think it will be a good test for my knee (long term ramifications not yet determined), plus I just love Brooklyn so much I can't say no.

Have a healthy day.

Triathlons

2010-03-13T18:16:00.002-05:00

apparently, they take a long while to train for...
I signed up for one in September - olympic distance (0.9 mile swim, 25 mile bike, 10k/6.2 mile run)
Will be racing against my boss/mentor, at least one patient, and a relay team of 3 of my co-workers (they will each do one leg of the race)

This is my first tri ever... how exciting
I think this will give me a much better appreciation of this aspect of human performance.
The problem is I have committed at least 6 hours per week for training which also includes travel time to pools and plenty of time planning out my attack of this event.
Riding the bike indoors for now while the weather is not fantastic saves me some time because I get to catch up on shows that I would watch anyway like House, MD or 30 rock, etc.
It is a time struggle more than anything, my body feels back to normal, now to get it better than ever...

PS, I did go skiing for the first time in my life 2 weekends ago and had a great time, picked it up pretty quickly, would love to go back but the snow seems to be all melting... I was certainly able to appreciate how easy it is for traumatic injuries to happen. A good percentage of my patients had skiing injuries. I was fortunate enough to master the fall and escape injury free. Although from over utilizing the beginner form of stopping some may call the "pizza" I had a lot of soreness through my hip internal rotators and adductors.

Great TV piece

2010-02-26T14:42:00.003-05:00

More on high co-pays:

pointing out the ridiculousness of all this

Thanks for the link Mark

Unfair high co-pays

2010-02-26T14:06:00.002-05:00

Please sign the following petition, no matter where you live or what profession you are in. Physical therapy is something that can help everyone in your life, I truly stand by that statement. So something prohibitive such as high co-pays on top of already ballooning health care costs to the consumer need to be stopped:

http://www.thepetitionsite.com/2/FairCoPays-BetterResults-2010

Also, if people were to come see PT's sooner than later - even before injuries - there is a good chance we would save a lot of money in the long run. Unfortunately, the statistics and research are not there to fully support this statement, but it makes good sense. Injury prevention is absolutely a passion of mine, more to come later :)
Have a healthy day!

Of triathlons and snow

2010-02-26T12:05:00.004-05:00

Last Wednesday I attended the 2nd annual traithlon education night in NYC. The webcast of the entir night is available here. Pleae never do a bird-dog like the one in the video - promise me!

It motivated me more as an athlete than a physical therapist. So I am commiting to do a triathlon this September. Still debating if I will join a team, but leaning towards not this year so I can really find my own way via my PT education. For those of you out there interested in participating in this great activity, just make sure you do your research and start small, set realistic goals and go accomplish them. Have fun along the way!

If you are in the NYC area I have three opportunities for you:
1. I found this on Active.com which has some amazing opportunities all the time, just need to find the one that matches your interests:
St.Lukes-Roosevelt Hospital Cardio Disease Prevention Program & Toughman Tri Sport Med/Train Clinic

2. A 5K on a JFK tarmac... take off just like the planes do.

3. On short notice... if you have any interest this Sunday in participating in a panel on being a new professional and making the transition from student at a student conclave in Great Neck Long Island, please let my buddy Allen know (eshmoilia@hotmail.com). And if you are a student, attend and enjoy!

Even more personal update:
We are having a lovely snow day today in NYC, a great day to train for triathlons... so I am going skiing for the first time in my life up in Vermont. Full report on these festivities to follow. Hopefully no injuries to report.
Also, next week I will begin collecting data on some high school athletes to start tracking injuries and hopefully developing a program to prevent any injuries.

Change.org

2010-02-15T01:03:00.002-05:00

Change.org recently launched the 2010 Ideas for Change in America competition.

One idea is titled: Eliminate All Student Debt. I thought you might be interested in getting involved and recommend you check it out. You can read more and vote for the idea by clicking the following link:

http://www.change.org/ideas/view/eliminate_all_student_debt

The top 10 voted ideas will be presented at an event in Washington, DC to relevant members of the Obama Administration, and then promoted to Change.org's full community of more than 1 million people.

There is an opposing view to NOT eliminate student loans which is just silly.

Boo student debt!

PC Tablet Survey

2010-01-31T22:05:00.001-05:00

I received an e-mail about a survey regarding the new iPad - if you have a few minutes I extend the invite to participate:

I've created a short survey (8 multiple choice questions) about what tablet PC features are important to healthcare professionals. I'll use the results from the survey to determine which tablet PC is best positioned to rule the halls of healthcare. Even if you've never used a tablet PC, I'd love to get your opinion on what features are important.

Here is the link to the survey:

http://www.softwareadvice.com/articles/uncategorized/which-tablet-pc-will-rule-the-halls-of-healthcare-1012610/

Collagen-Platelet Composite

2010-01-26T21:06:00.002-05:00

A colleague of mine requested I blog about this article so here it is. A very interesting article about enhancing healing of the Anterior Cruciate Ligament.

Joshi et al. Collagen-Platelet Composite Enhances Biomechanical and Histologic Healing of the Porcine ACL. AJSM 37 (12), 2401-2410.

Important to note the sample here was 18 pigs (27 knees), all 4 months old and female. The immature population is a good one to study because these injuries do happen in youth quite often and they are the most likely to develop OA down the line. The authors do cite that pig knees are similar to those in humans with subtle differences not yet clearly appreciated.

They did find that the addition of a CPC injection enhanced primary ACL repair in that structural properties of CPC-treated ligaments increase. The big takeaway for rehabilitation is the need to respect the healing stages after such a surgical procedure. This study only looked from 4 weeks through 3 months which does lose out on the very important post-operative inflammatory stage and the full remodeling up to 1 year.

I have seen a few ACL repairs, but have not seen the addition of CPC or PRP to assist the operation. It is important to note that in ACL surgery, a repair and a reconstruction are two different procedures that should be approached with respect to the expected healing process and times.

PS, I apologize to the JETS for posting a pic which seems to jinx (like that darn sports illustrated cover) them every time... there is always next year... :(

Go JETS

2010-01-24T09:19:00.004-05:00

Big game...

International Injuries

2010-01-17T08:30:00.005-05:00

Quick thoughts about Paris:
Way overpriced! Food was subpar, weather was terrible, a few museums and the top of the Eiffel tower were closed for repairs (Picasso museum has apparently been closed since mid-2008 with no sign of opening back up any time soon). My two days in Ireland were much more enjoyable.

While I was in Argentina it seemed the majority of injuries I saw in the streets had some kind of arm or wrist brace and then in Paris it seemed the shift was to lofstrand crutches.

Here is an interesting article about the difference in assistive devices available.

For anyone from Paris or Buenos Aires can you confirm for me if there is an increased incidence of lower or upper extremity injuries based on some kind of cultural difference or is it the focus of the healthcare system, a different philosophy in treatment? Anyone from other cities of the world notice any major trends that may be shifted towards one body part? In America Low Back Pain seems to be the most common trend which is seen through obesity on the streets, not that we can draw a clear line between the two.

Now to plan my next international exploration... stay healthy out there!

NY Times and PT

2010-01-07T22:11:00.004-05:00

The NY Times has been fairly kind to physical therapy in the past and now I have an issue with what comes across as slightly negative towards PT.

Check out the article here.

This statement is what throws me off:

When I asked Dr. Irrgang for studies showing what worked, I was a bit surprised. To put it kindly, they left much to be desired.

The authors review of the research presented makes it difficult to believe these are the articles Dr. Irrgang would show him. Poor intention to treat and drop out rates along with a study that had a sample of 4 seem like items that would not be presented by the President of the Ortho section of the APTA.

Also regarding the guidelines, the author only brings up the currently published heel pain and the ones currently in production. But they also published neck pain and hip pain guidelines.

Why go to a physical therapist for as many as 20 sessions, though, in order to do strengthening exercises? Why not just go to a gym?

Overutilization does seem to be a huge issue with the state of the economy and insurance money getting tight. I always tell patients that "I am not here to cure you, I am here to help you cure yourself." Even if they come in 3 times a week, that is 3-5 hours out of the entire 168 hours of the week. I am confident in the ability to provide someone with the tools necessary to begin/expedite the healing process and it is up to them to carry out and take care of their bodies.

The evidence seems like it is beginning to catch up with what we are capable of. I think the article does bring out the ugly side of PT that is "voodoo PT". I have seen too many patients who have had bad experiences at other therapy offices and I have been offered jobs at a clinic or two that made me report them to the state board for what to me seemed like highly unethical practice. Another subject for another day perhaps... I have to go pack for Paris, ciao!

(This guy probably needed some PT after this French headbutt - hope I can avoid Zedane)

Happy New Year/Decade!

2010-01-03T11:38:00.003-05:00

Wanted to wish everyone all the best for the new year/decade, hope it brings new and prosperous opportunities. I resolve (as I have many a time) to focus this blog on what its original intent was... PT and the decisions that go with being a New Professional.

Here is a seemingly fun way to get out and exercise with your friends:
http://ragnarrelayny.com/ A relay run from Woodstock, NY to NYC.
One thing I can say from reflecting on 2009 is these group activities are very fun to do and exercise is fairly important. I read a lot of the latest evidence/research coming out and I consistently see support for exercise helping almost every aspect of life. The people I meet who exercise a lot on an anecdotal level, they just seem to be very pleased with life (not say those who don't exercise aren't happy, but for most finding the right exercise seems to make things better).

I am going to the JETS game tonight where the forecast is calling for "Freezing your toes off" weather. Then next Saturday I leave for 5 days in Paris, a day in Dublin, a day in Belfast (my excuse for the likely lack of posts over the next few weeks, but I will try :). Hope you guys are resolving to be healthier for 2010 and stick with it--> don't forget to set attainable goals and take necessary steps towards making it happen. Everyone is motivated differently, find yours and "get 'r done".

Just Another Manic SUNDAY

2009-12-28T00:42:00.002-05:00

Merry Holidays All! and to all a safe night...

Went to my nephew's sixth birthday party at Chuck E. Cheese (although when you turn six its kind of your seventh birthday party, birth should count right?). Firstly, I sat in the back of an SUV forced to keep my knees very bent... not pleasant. This is something I would advise anyone at all, let alone with knee surgery to avoid, but options were limited... I suppose this makes me a 'do as I say not as I do type of individual', perhaps? My knees were not happy with me after that ride. I am happy to report that I am more than 1 full year out of surgery and other than this long knee flexion exposure I am doing great.

On my train ride home I got a chance to read up on my surgery in the form of this article from the latest AJSM. The difference in their study was they did not look at patella autografts (which I had) and instead they chose hamstring and allografts. They found that over a 2-year period those with allografts and those who partook in higher activity levels had a significantly higher incidence of graft failure. It is worth noting ACL reconstruction failure is very rare and previously has been cited at 3.6% in a 2004 study looking at autografts. Everytime I read another article there seems to be another aspect of care I was not aware of, in this case it was the Marx activity score, meant to measure, well... activity. There are so many different scales clinically, and research based it can be tough to keep up with which is the best. I have been using a lot of the Lower Extremity Functional Scale and Lysholm.

But let us rewind a little. Whilst at Chuck E Cheese an elder gentleman passed out. I volunteered what I could as a former EMT and current PT. Unfortunately he was going in and out of consciousness, so some may dub this critical... although it took the ambulance 45 minutes to arrive, fortunately the FDNY first responders were able to get on the scene and at least provide oxygen. He appeared better by the time the ambulance came but still in need of medical attention, I hope all turned out well for him and his family. This brings up the very important point of always being prepared (thank you boy scouts-although I never was one) and taking the time to become CPR certified to better prepare yourself for medical situations that can strike at any time and anywhere. Get the basics down now to help save a life whenever necessary. eHow to become certified. You are never too young or too old (there may be a minimum age but it understanding the value of calling 911 as soon as a child is able to may be valuable enough).

Lastly, for the day I was able to polish off in all of 20 minutes the following book:

I think this is a fantastic analogy for dealing with change, challenge and fear in life. It is a quick read and helps one reflect. Try to pick out which character you might be and how it can be applied to your life, hopefully you already have your cheese and know how to keep up with it :)

Have a happy and HEALTHY holiday season everyone!

Rainy Sunday in NYC

2009-12-13T11:51:00.003-05:00

I apparently published my last post under my old blog (studentpt.blogspot.com) all about the new blogger posting guidelines, worth checking out.

Here are some articles that were passed on to me that may be of interest to my readers as per the source:

Financial aid for OT's (any OT's out there?)

This is an interesting website that has some very good info and a while back sent me an updated e-mail as part of their newsletter questioning what physio's know about strength and conditioning... hmmm... quite a bit! This is a British website and I am curious to see how different it is out there: http://www.sportsinjurybulletin.com/

Gretchen Reynolds has written some pretty awesome pieces for the Times, check her out here.

And please support a group looking to help those affected by arthritis: http://www.mdjunction.com/arthritis

I'm Back!

2009-12-02T22:32:00.002-05:00

Had a great trip and now it is back to business...

Just saw this great article about neuroplasticity which is a secret interest of mine combined with the ACL which is very dear to my own knee... here is the conclusion, but make sure to check out the whole article and after I get a chance to read it further I may put up a more in depth review... but no promises as I am focused on inflammation right now.

CONCLUSION: The current study reveals that anterior cruciate ligament deficiency can cause reorganization of the central nervous system, suggesting that such an injury might be regarded as a neurophysiologic dysfunction, not a simple peripheral musculoskeletal injury. This evidence could explain clinical symptoms that accompany this type of injury and lead to severe dysfunction. Understanding the pattern of brain activation after a peripheral joint injury such as anterior cruciate ligament injury lead to new standards in rehabilitation and motor control learning with a wide application in a number of clinical and research areas (eg, surgical procedures, patient re-education, athletic training, etc).

http://ajs.sagepub.com/content/37/12/2419.abstract

Going To South America

2009-11-20T04:28:00.002-05:00

Wow, it has been almost a month since my last post... shame on me.
This post is mostly to let you know I won't be around the next two weeks as I am going to South America (Santiago, Chile>Buenos Aires, Argentina>Patagonia region). But I promise to come back refreshed with much more frequent blog posts.

While I am away I will be thinking of adding to my presentation that I am working on for the clinic where I work. The topic is going to be inflammation from a therapeutic standpoint. Recent developments such as platelet rich plasma, prolotherapy, graston technique and not so recent developments such as cross friction massage and even the debate between ice and heat will all be part of this talk. When you have chronic conditions such as a tendonosis where the histology has changed, is the best course of action to recreate an inflammatory process to allow for the body to heal itself with some guidance? What is the role eccentric training can play in all of this... and so much more.

Any thoughts from you guys?

Happy Thanksgiving while I am away!

Lifelong Learning

2009-10-18T09:52:00.005-04:00

The body is always changing, our knowledge base of the body is always changing as well. There is always more to learn, and I knew this going in... Continuing education is an integral part of becoming the best therapist you can be and I am trying as much as I can in this regard.

At the end of August I took the Kevin Wilk (http://kevinwilk.com/) Recent Advances in the Evaluation and Treatment of the Knee & Shoulder. I just could not get enough of this man and took a course that he was co-teaching along with Brian Mulligan (http://www.bmulligan.com/). Both courses were very useful and have given me plenty to consider adding to my "PT tool belt" - some of the things I have already utilized with great success. One of the best things about Kevin Wilk is his emphasis on research and through his course I have begun collecting the "gold standard" articles on many of the topics he has brought up.

This past week I also went to a great district course put on by the Greater New York district of the NYPTA. Dr. Jordan Metzl (http://drjordanmetzl.com/ - are you noticing a trend of website naming?) presented on hip injuries in the adolescent athlete to a room packed with mostly students along with a few practicing clinicians. This event was free to APTA members as are all district meetings. The main take away message from his talk was to not treat adolescent injuries just like an adult injury with similar presentation. So that hamstring strain may not be something the kid should have to play through whereas an adult might be able to, mostly because of those open growth plates that kids tend to have. A very important point that Dr. Metzl drove home in a very clear, concise and entertaining manner. Go to his website to see some very useful evaluation videos.

Now I move forward to the next two weekends where my clinic will be hosting a Stanley Paris based course called S1 (Spine part 1). 5 days (35 hours) worth of the spine should be thorough... but apparently not enough as there are 4 separate parts just for the spine(not all 5 days). Ultimately you can take all the courses (4 spine, 2 extremity and two more) and receive a manual therapy certification: see this .pdf file.

Did I mention I also presented on the ACL to the Brooklyn/Staten Island district of the NYPTA. The above picture is from that, and it was fun I must say.

Learn on!

NYC Marathon Nov. 1

2009-10-01T16:31:00.000-04:00

I am recruiting medical volunteers for the marathon. I have done this the last 3 or 4 years (it's so good I can't even recall how long it has been:) and we always need more volunteers. At that 4 hour mark there is a ton of finishers that are crashing and need our help. If you want to be a non-medical volunteer they also need as many of you as they can get. It is a very thrilling event to participate in. As a side note I was supposed to run it this year until my acl stopped existing.

If interested send an e-mail to studentpt@gmail.com with your name, background, email & phone #. Also, go to nyrr.org for more info on the marathon (they do have a dedicated website to the marathon but I am on my treo right now, sorry mobile blogging). See you there!!

Quick Survey: Clinical Decision Rules

2009-09-30T22:54:00.004-04:00

Presenting an article at work tomorrow, wanted to run a quick survey of who has heard of and who actually uses any/all of the following:

Ottawa Ankle/Foot Rules
Ottawa Knee Rules
Canadian C-Spine Rules
Canadian CT head Rule
Wells Clinical Prediction Rule

Can Exercise Make You Smarter

2009-09-30T22:45:00.003-04:00

One way I stay on top of current literature is through my phone and subscribing to numerous blogs and news sites. I usually share the most interesting articles I find over on the right hand side of my blog (over there >>>>>> [in the navy blue box]). If you look through that list you will often see a new study supporting some benefit of exercise. Ben Braxley, one of the elite New Professionals in the field, was kind enough to forward me this NY Times article along the same lines:

Phys Ed: What Sort of Exercise Can Make You Smarter?

It is a quick read summarizing one main study and a few others that support exercise as a brain booster.

“It would be fair to say that any form of regular exercise,” he says, if it is aerobic, “should be able to maintain or even increase our brain functions.”

Why should exercise need to be aerobic to affect the brain? “It appears that various growth factors must be carried from the periphery of the body into the brain to start a molecular cascade there,” creating new neurons and brain connections, says Henriette van Praag, an investigator in the Laboratory of Neurosciences at the National Institute on Aging. For that to happen, “you need a fairly dramatic change in blood flow,” like the one that occurs when you run or cycle or swim. Weight lifting, on the other hand, stimulates the production of “growth factors in the muscles that stay in the muscles and aren’t transported to the brain,” van Praag says.

Ortho Supersite

2009-09-30T22:35:00.003-04:00

I likely mentioned this site at some point of my blogging life, but the recent "issue" I received via e-mail had a few great snippets worth sharing and inspired me to recommend their newsletter.

http://www.orthosupersite.com/

Some of the articles that piques my interest:
-The increasing number of THA revisions in the United States: Why is it happening?

-Investigators find way to halt excessive bone growth following trauma or surgery

-Pigmented Villonodular Synovitis of the Knee: Diagnosis and Treatment

They constantly have a bunch of interesting ortho related articles including some of the most recent advances in the field which is vital to stay on top of. Subscribing is free... Enjoy!

Weight Lifting in Women w/Breast-Cancer-Related Lymphedema

2009-09-12T13:16:00.002-04:00

I recently read a very interesting article that challenged previously held beliefs in the health care industry. I like challenging the norms, especially when it can get the patient better outcomes. The study pubished in the Aug 13 issue of the New England Journal of Medicine found that

In breast-cancer survivors with lymphedema, slowly progressive weight lifting had no significant effect on limb swelling and resulted in a decreased incidence of exacerbations of lymphedema, reduced symptoms, and increased strength.

The study was made more significant by being longer (1 year follow-up) and being the largest randomized controlled trial to date (sample of 141 patients). Furthermore it was made more generalizable by including nonwhite women and women with a broad range of occupational and educational levels.

An argument is made in the editorial regarding this article that there are potential cost savings, not only by reducing direct health care costs but also by potentially reducing the risk of disability and allowing women to return to work at full capacity.

Exacerbations of the lymphedema was one of the main outcomes and they found that of the 70 patients in the control group there were 195 visits secondary to a flare-up while the weight lifting group that had 71 patients only had 77 visits.

While recently this population had been cautioned against making repetitive arm movements and lifting more than 10-15 poinds, in this study the weight lifting exercises included seated row, chest press, lateral or front raises, bicep curls, and tricep pushdowns as well as a number of lower-body exercises. To bust through the 10-15 pound limit there was no upper limit placed on the weight to which women could progress in any exercise (although they do not specify in the study how high they actually went).

Another element of the study I enjoyed is that the women were not just told to go exercise but given clear instructions with proper biomechanical focus from professionals trained in Lymphedema management at a local YMCA which is very accessible to most individuals in most cities, so this could be a program that would be much more realistic to implement. They also were nice enough to offer a free year of this program to the control group after the study was over.

Continuing Education

2009-09-07T23:34:00.002-04:00

New York State (where I live and work) as of September 1, 2009, requires 36 hours of continuing education every 3 years in order to maintain your license. Here is the news from NYPTA:

Mandatory Continuing Education Update
Physical Therapy Continuing Education Regulations Part 77 of the Commissioners Regulations have been amended to implement Chapter 207 of the Laws of 2008, which requires physical therapists and physical therapist assistants to complete thirty-six hours of continuing education during each three-year re-registration period. The law takes effect September 1, 2009.

The Office of the Professions Link is: http://www.op.nysed.gov/part77.htm

The NYPTA is deemed as an approved provider; and as soon as the proper paperwork is filed and procedures defined, we’ll be forwarding that information to our members.

Journal of Physical Therapy

2009-09-07T23:23:00.006-04:00

One of the benefits of being a member of the APTA (www.apta.org) is receiving the Journal of Physical Therapy. The importance of Evidence-Based Practice cannot be overlooked, and this Journal does a great job addressing so many areas of our widespread field. You can utilize the website for supplemental videos, podcasts, and the clinical bottom line which is an excellent way of summarizing the research that was performed.

Take for instance the Table of Contents of the most recent issue:

(They also have very snazy art on the cover of each issue)

Editorials

PRISMA: Helping to Deliver Information That Physical Therapists Need
Christopher Maher
PHYS THER 2009;89 870-872
http://www.ptjournal.org/cgi/content/full/89/9/870

Reprints

Reprint—Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
David Moher, Alessandro Liberati, Jennifer Tetzlaff, Douglas G. Altman and the PRISMA Group
PHYS THER 2009;89 873-880
http://www.ptjournal.org/cgi/content/abstract/89/9/873

Research Reports

Impact of Physical Therapist–Directed Exercise Counseling Combined With Fitness Center–Based Exercise Training on Muscular Strength and Exercise Capacity in People With Type 2 Diabetes: A Randomized Clinical Trial
J. David Taylor, James P. Fletcher, and Jakesa Tiarks
PHYS THER 2009;89 884-892
http://www.ptjournal.org/cgi/content/abstract/89/9/884

Factors Associated With Surgeon Referral for Physical Therapy in Patients With Traumatic Lower-Extremity Injury: Results of a National Survey of Orthopedic Trauma Surgeons
Kristin R. Archer, Ellen J. MacKenzie, Michael J. Bosse, Andrew N. Pollak, and Lee H. Riley, III
PHYS THER 2009;89 893-905
http://www.ptjournal.org/cgi/content/abstract/89/9/893

Adhesive Capsulitis: Establishing Consensus on Clinical Identifiers for Stage 1 Using the Delphi Technique
Sarah Walmsley, Darren A. Rivett, and Peter G. Osmotherly
PHYS THER 2009;89 906-917
http://www.ptjournal.org/cgi/content/abstract/89/9/906

Strategies to Promote Evidence-Based Practice in Pediatric Physical Therapy: A Formative Evaluation Pilot Project
Joe Schreiber, Perri Stern, Gregory Marchetti, and Ingrid Provident
PHYS THER 2009;89 918-933
http://www.ptjournal.org/cgi/content/abstract/89/9/918

Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore Weight Bearing of the First Ray During the Stance Phase
Reinhard Schuh, Stefan G. Hofstaetter, Samuel B. Adams, Jr, Florian Pichler, Karl-Heinz Kristen, and Hans-Joerg Trnka
PHYS THER 2009;89 934-945
http://www.ptjournal.org/cgi/content/abstract/89/9/934

Job Strain in Physical Therapists
Marc A. Campo, Sherri Weiser, and Karen L. Koenig
PHYS THER 2009;89 946-956
http://www.ptjournal.org/cgi/content/abstract/89/9/946

Clinical Interpretation of a Lower-Extremity Functional Scale–Derived Computerized Adaptive Test
Ying-Chih Wang, Dennis L. Hart, Paul W. Stratford, and Jerome E. Mioduski
PHYS THER 2009;89 957-968
http://www.ptjournal.org/cgi/content/abstract/89/9/957

Development of a Self-Report Measure of Fearful Activities for Patients With Low Back Pain: The Fear of Daily Activities Questionnaire
Steven Z. George, Carolina Valencia, Giorgio Zeppieri, Jr, and Michael E. Robinson
PHYS THER 2009;89 969-979
http://www.ptjournal.org/cgi/content/abstract/89/9/969

Perspectives

Traumatic Brain Injury and Vestibular Pathology as a Comorbidity After Blast Exposure
Matthew R. Scherer and Michael C. Schubert
PHYS THER 2009;89 980-992
http://www.ptjournal.org/cgi/content/abstract/89/9/980

Letters and Responses

On "Effects of forced use on arm function in the subacute phase..." Hammer AM, Lindmark B. Phys Ther. 2009;89:526–539.
Steven L. Wolf
PHYS THER 2009;89 993-995
http://www.ptjournal.org/cgi/content/full/89/9/993

Author Response
Ann M. Hammer and Birgitta Lindmark
PHYS THER 2009;89 995-997
http://www.ptjournal.org/cgi/content/full/89/9/995

Corrections

Santamato A, Solfrizzi V, Panza F, et al. "Short-term effects of high-intensity laser therapy versus ultrasound therapy..." Phys Ther. 2009;89:643–652.
PHYS THER 2009;89 999
http://www.ptjournal.org/cgi/content/full/89/9/999

Scholarships, Fellowships, and Grants

News from the Foundation for Physical Therapy
PHYS THER 2009;89 1001-1002
http://www.ptjournal.org/cgi/content/full/89/9/1001

Interested in Travel PT?

2009-09-07T23:03:00.002-04:00

I am in a great situation right now but travel PT seems like such a great way to experience the sights and sounds of the country as well as provide numerous challenges and learning experiences otherwise not seen. You can share and learn from so many different settings. The prospects are quite exciting.

If you are interested please check out the following community of online travel rehab professionals, it looks to be a very useful resource:
http://www.medtravelerclub.com/

Vertebroplasty Controversy

2009-08-15T15:41:00.002-04:00

A few patients brought this to my attention and I saw this very insightful blog post on the topic. Here is the NYTimes article about it also.

Arthritis is one of the toughest diagnoses to deal with and to combine it with low back pain (another of the more difficult to manage) and you have a recipe for some controversy. Surgery, especially for the back, will be very interesting to follow as the technology changes so constantly and the current methods seem to be less than ideal. My solution... start young, exercise wisely and avoid back problems... easier said than done, eh? Naive? Maybe, but it is the best "treatment" we have at this time. This leads very neatly into my next project of beginning an injury prevention program for high school athletes here in NYC, stay tuned or contact me if interested in participating.

Have a healthy day!

Health Care Crisis

2009-08-04T21:46:00.003-04:00

Is this really what passes for fitness nowadays? 6 minutes a day is going to fix it all... No wonder we have a crisis, fix things congress, please...

SmartPhone Results

2009-08-02T20:53:00.005-04:00

Here are the results to the previous/recent survey I linked to. Interesting stuff, but now I am more confused as to which phone I want to get next. My current phone, the Treo 755p, is becoming obsolete and breaking down fairly rapidly. I think it would be awesome if we could do all of our documentation on a handheld device like the iPhone or Palm Pre. The Palm Pre offers multitasking which can be great if you can pull up a patients x-rays and input data into their medical record. I want to switch to the Palm Pre as my Treo breaks down but they are charging 500+ dollars, even though I have been with Sprint for almost 4 years they cant give me any price break on the phone, while new customers get it for $199... pissing me off a lot of bit. Have to weigh out cost of the plan, quality of the phones, etc. A lot going on... enjoy the survey results, hopefully I can be mobile blogging much more efficiently with a new phone :)
Have an awesome day!

Different Feet

2009-08-02T15:44:00.003-04:00

Reading through a running magazine I saw an advertisement for these shoes that allow for more custom fit than most shoes offer. Check out the fitting video here.

I recently took a Vasyli course about biomechanics of the foot which was very useful. Brian Hoke is an excellent speaker, very engaging and insightful. I highly recommend any course he presents. There is still much reflection and further analysis that I need to do to best implement the information into my clinical practice. Are orthotics more a crutch or a tool for the foot? There seems to be those who believe they can ease everything up the kinetic chain including back pain while others say we can fix the issues with exercise, stretching and some manual therapy. This is the beauty of being a New Professional; learning is a lifelong process, and I am excited for the opportunities that lay ahead.

SmartPhone Survey

2009-07-28T01:24:00.001-04:00

An interesting survey to take if you are involved in a healthcare field:
http://www.softwareadvice.com/articles/medical/which-smartphone-will-own-the-healthcare-market-1072109/

Good Weekend

2009-07-23T23:43:00.000-04:00

On a boltbus up to Boston (as a Yankee fan and New Yorker this trip always feels wrong). The mobile blogging is harder with my 1.5 year old treo 755p... need to upgrade to palm pre or switch to iphone (darn at&t for being so expensive - I pay fairly low rates with sprint).
Making this trip to attend a biomechanics course on the foot given by Brian Hoke of 'when the feet hit the ground' fame. It's a 1 day workshop tomorrow. After that I get to catch up with my godson which is long overdue. Hope everyone has a dry weekend - why is it chilly and pouring down rain at the end of July?

Prolotherapy

2009-07-18T12:49:00.007-04:00

A patient of mine asked about prolotherapy so I did some information gathering. In my blog reader which is actually a useful adjunct to more formal types of literature I found 7 entries dating back to 2007. There was a NYTimes article from 08/07/07 that touted the promises of this intervention. An entry in the CAM report from 01/06/08 had an interesting review/summary of the following article: The Spine Journal, Volume 8, Issue 1, January-February 2008, Pages 203-212 Simon Dagenais, John Mayer, Scott Haldeman and Joanne Borg-Stein.

the authors concluded, it’s not possible to separate the benefits of prolotherapy from the other treatments because “there is no evidence of efficacy for prolotherapy injections alone without cointerventions.”

The best was this youtube video, the part on prolotherapy is towards the end:
Nothing too concrete... so I went to pubmed where there were 59 search results to the term "prolotherapy" including a Cochrane review article from 2007 (highest level of research) that concluded

There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.

I doubt I will (within the confines of my practice act) recommend it to others based on the current literature out there but do any of you have any experiences with this form of treatment, please share in the comments and have a nice day, it is gorgeous here in NYC.

Addendum: Platelet-rich plasma injections seem to be the wave of the future here. We are seeing a lot more of them in NY. I am sure there will be posts coming soon on this topic.

Safety of chiropractic interventions: a systematic review

2009-07-04T20:39:00.007-04:00

^^Interesting story to go with the above picture^^

Please note, this is far from an attack on the chiropractic profession. I know and respect a number of chiro's and look forward to the positive interplay between our two professions through my career.

McMaster Plus has a great FREE service called Rehab+ where you can subscribe to topics of interest. The interaction and unique relationship between Physical Therapists and chiropractors is one that appears very often especially in outpatient therapy practices. This systematic review throws out a pretty significant statistic that made me cringe a little when reading it:

The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations.

Physical Therapy on the other hand has been shown to be much more cost-effective and safer than many alternatives including chiropractic. One example of this is how much malpractice insurance I receive for the low amount I pay... are you ready for this... $3 million in coverage for about $175.00 a year. Some (if not most) doctors pay 6 figures a year. I wonder how much Chiropractors pay?

Addendum to original post: I also stumbled upon this website: http://www.chiropracticstrokeawarenessblog.org/

100th post, what not to do

2009-07-04T12:44:00.004-04:00

I came across this picture in Ski magazine discussing injury risk (click on pic for clearer version). I went ahead and added lines to the thighs and highlighted that the foot is compensating by the outside of it lifting off the ground. This picture is what you should not be doing! The magazine was in fact trying to point this out and offers the following solution if you display this increased hip adduction with squatting: Link Here.

You Tube PT Vid

2009-07-01T21:55:00.005-04:00

Thanks Doc Denniger:

StreetWars

2009-06-27T13:23:00.002-04:00

Non-PT related but I wanted to share this game crazy enough I may have to participate:
http://www.streetwars.net/

StreetWars is a 3 week long, 24/7, watergun assassination tournament that has already taken place in New York City, Vancouver, Vienna, San Francisco, Los Angeles, London, Chicago, and Paris.

At the start of the game you will receive a manila envelope containing the following:

* A picture of your intended target(s)
* The home address of your intended target(s)
* The work address of your intended target(s)
* The name of your intended target(s)
* Contact information of your intended target(s)

Upon receipt of these items, your (or your team's) mission is to find and kill (by way of water gun, water balloon or super soaker) your target(s).

You can hunt your target down any way you see fit; you can pose as a delivery person and jack them when they open the door, disguise yourself and take them out on the street, etc.

If you are successful in your assassination attempt, the person you killed will give you their envelope and the person they were supposed to kill becomes your new target. This continues until you work yourself through all the players and retrieve the envelope with your (or your team's) picture(s) and name(s). Then you win. Cash…but first live in fear.

APTA Virtual Rally This Wednesday

2009-06-22T21:58:00.001-04:00

Save the date for APTA's FREE virtual rally, to be held Wednesday, June 24, from 7:30 pm-9:00 pm ET, and participate in the national health care reform debate from your home, classroom, or office. The rally will include messages from APTA leaders, a presentation on reform proposals, and an interactive town hall session in which participants can ask questions.

The Association supports a number of themes that coincide with the broader health care reform debate, including expanded coverage, payment reform, guaranteed issue, workforce, research, health information technology, and prevention. Join the rally and help strengthen the profession's influence during this important and historic time in health care reform.

To participate in the rally, you will need to complete a free registration. Registration opens Monday, June 22, and can be completed until the start of the rally. If you do not register early, please join the rally on Wednesday, June 24, between 7:00 pm and 7:15 pm. The registration process takes approximately 3-5 minutes.

If you have any questions, please visit the Virtual Rally page on the APTA website or email advocacy@apta.org

For more resources on Healthcare Reform, visit the APTA Healthcare Reform Resource Page at http://www.apta.org//healthcarereform

Thank you all for participating!

(I finish up at 8 pm with patients so I will have to join late but think this is a great idea and look forward to what comes out of it)

Web Anatomy!

2009-06-21T21:51:00.002-04:00

Test your knowledge, have some fun with it:
http://msjensen.cehd.umn.edu/Webanatomy/

Bonus points if you can point out some common workout errors in the pic be-low.

Floyd Landis

2009-06-11T22:32:00.003-04:00

In the defense of the tour de France winner, this article: (being lazy and posting the entire pubmed abstract, sorry... bottom line is science isn't exactly an "exact science")

Clin Chim Acta. 2009 May 22. [Epub ahead of print] Links
Bad Science: The instrumental data in the Floyd Landis case.Blackledge RD.
8365 Sunview Dr., El Cajon, CA 92021, United States.

BACKGROUND: In 2006 Floyd Landis won the world's most prestigious bicycle race, the Tour de France. However, not many days after the race's conclusion it was released to the press that the Laboratoire National de Dépistage du Dopage (LNDD) had found Landis' urine after stage 17 positive for synthetic testosterone. METHODS: This review examines the instrumental data and methodology used by LNDD in the Landis case. The conclusions reached by LNDD were based on results of 2 separate instrumental methods. Subsequent to urine extraction and possibly derivatization, samples were initially screened via gas chromatography/mass spectrometry (GC/MS) using selected ion monitoring (SIM) to measure the ratio of testosterone to epitestosterone (T/E). Final confirmation of exogenous testosterone was determined by measuring the (13)C/(12)C stable isotope ratios in 4 metabolites of testosterone via gas chromatography combustion stable isotope ratio mass spectrometry (GC-C-IRMS). CONCLUSION: T/E ratios determined by LNDD in Landis' stage 17 urine were unreliable due to the combined factors of an unsatisfactory extraction, high GC background, failure to obtain baseline peak separation for epitestosterone, unreliable quantization of the epitestosterone peak due to both peak overlap and because it was barely above background noise, and because only a single ion mass (432) rather than a minimum of 3 was used for SIM (in violation of both LNDD's SOP and WADA procedures). GC-C-IRMS methodology is less well known to the analytical chemistry community, but here too the results obtained by LNDD were unreliable. GC-C-IRMS errors can be briefly summarized as uncertain peak identification, unsuitable standards, and unreliable (and possibly biased) calculation of (13)C/(12)C ratios due to peak overlap as well as LNDD's usage of manual peak integration rather than use of the instrument system software.

PMID: 19465014

Unfair High Co-Pays

2009-06-07T08:19:00.001-04:00

http://www.thepetitionsite.com/1/FairCoPays-BetterResults

We need to make PT as affordable as possible. Let's fix our healthcare system... one co-pay at a time.

Fun Links

2009-06-07T07:20:00.006-04:00

TED talks are always fun!

To everyone with low back pain: Exercise more!

Some very amazing exhibits at the 2009 Science Festival here in NYC, I may try to make it to a few.

My buddy Megan bought the nose body wash dispenser when I posted it, I wonder if she will buy this.

Some awesome wetsuits, when are they going to start making "websuits" - virtual reality for the general public? Speaking of wetsuits, here is a pretty awesome article from the NSCA about improving sprint speed using a wetsuit. NSCA has some great free material including their Performance Training Journal.

This is a little dated but seems like a great opportunity:
The Sports Medicine Team for the AIDS Lifecycle is looking for Physical Therapists, Physical Therapy Assistants, Athletic trainers and students in either field for participation in ALC 8.
AIDS Lifecycle - www.aidslifecycle.org
Sports Medicine Team description (Camp based team) - http://www.aidslifecycle.org/roadies/teams.html#camp
Frequently asked questions - http://www.aidslifecycle.org/roadies/faq.html

For those of you in the California area you should check out this young lady and her guitar playing skills, info on the shows here.

So much going on, trying to stay afloat... most importantly: my patients are getting better, no better motivator!

Golf Swing

2009-05-24T14:52:00.002-04:00

Not my best work... a few glasses of wine in Napa... Jocelyn Lonen tasting with a golf pro. Beautiful view. Also, please look into their gala fundraiser: http://www.golfandgrapes.org/
The grip on the clubs were old and a little worn, hands were sweaty without a glove... but the ball went straight. Just like in PT, all that matters is the outcome :)

I Made the Top 51 and joined a New Community

2009-05-24T12:40:00.005-04:00

Even though I have been almost vacant here in the past few weeks, and for that I apologize, Onward Healthcare has named me one of the top 51 PT Resources. As some of my military friends might say: "Hoorah!" (hope I can use that :)

The list is also a fantastic collection of resources that I encourage you to check out. A lot of fantastic articles and information out there.

I was also very honored to be invited into the HealthBlogger Network: Wellsphere.com

Playin' catch-up

2009-05-10T12:01:00.000-04:00

Been very busy the past few weeks. Went to the HSS sports medicine symposium where I got to hear some of the top shoulder surgeons in the world speak fairly candidly about their ortho thoughts. Work has been going real well, I still am not a fan of the documentation aspect. On the train about to go underground... happy mothers day! more to come soon

Hi Health

2009-04-27T00:20:00.004-04:00

http://our.hellohealth.com/

Pretty awesome health care movement that I hope I had mentioned before... many applications with PT... possibilities... and their HQ is right nearby me here in Williamsburg, Brooklyn

Pass the Peas

2009-04-20T01:00:00.003-04:00

I am sure at some point you have recommended to someone with a bang or bruise, using a bag of frozen vegetables as a substitute for an ice pack, as it conforms better and provides nutrition afterwards, teehee
Apparently CVS has created an ice pack to mimic the conforming power of peas, check it out here.

Already getting blogged about elsewhere, more specifically for kiddies.

Me Swimming

2009-04-20T00:37:00.004-04:00

Last week for our staff meeting, Jamie Barrone (one of Michael Phelps' former teammates) who is now a swim coach came to discuss swim biomechanics. Check out his website and if you want to improve your swimming consider having a session with him: http://www.strokeconsultant.com/

It inspired me to videotape my own swimming to analyze and hopefully improve my efficiency. One of my loyal readers and favorite professors happens to be running in the next lane over for one of the videos.

I am open to feedback, any aspects of my swimming you think I should fix (please keep in mind I have learned a little from the videos already and I have not been using my legs too much secondary to being 4 months post-op). I know there is much work to be done...

Thanks Petey for video taping!

Clinics in Sports Medicine

2009-04-12T23:41:00.002-04:00

In doing some research on swimming, I came across a publication that I had seen previously in my researching of other subjects. This time I happened to notice that all of their issues were theme based. For instance the April issue for this year is all about "Allografts" and the October issue from last year was titled "Shoulder problems in athletes". I think this is a very interesting way to present literature. As a busy clinician you may be more likely to delve into one topic of interest rather than skim through an entire journal of many different topics that may not all interest you. I am still at a stage where I try to read everything I possibly can so I appreciate both formats, but I have noticed that the "themed issues" seem to be an emerging trend in PT related journals. JOSPT has recently had an issue all about the shoulder, NAJSPT had an issue all about MLKI, just to name a few.

I recently spoke with a PT in a residency program for orthopaedics, and he told me he reads a minimum of 45 journal articles a week... they may name the chair he sits in everyday in the library after him, who knows... just some thoughts... back to busy life... Hope you had a great holiday weekend!

APTA Student Competition

2009-03-31T18:18:00.001-04:00

I am pretty sure Claire won't mind if I post this:

Put down the books and pick up your camcorders, it’s time to get those creative juices flowing! The student assembly board is challenging you, any and all students, to tell us why being a student member of the APTA is so important. At this year’s National Student Conclave, we are showcasing a video that will highlight why students should be/need to be/must be members of the APTA, and as the student assembly, we want your input!

We can all agree that being a great physical therapist/assistant is not only about being a great clinician…it is about being an advocate, a leader, a member of the incredible association that works day in and day out to better our profession. Our challenge is for you to help us spread this message to all non-members. SO LET THE COMPETITION BEGIN!

We would like student members to send in a video message about taking ownership of your future in this profession. We want to get your message out! So tell us…tell us how being a student member of the APTA helps you “Own Your Future”…tell us in a video…tell us with a group of classmates or by your lonesome…tell us in any creative way your heart desires…we just ask that you keep it under 30 seconds…and turn it in before July 1, 2009!

WHO: Any APTA Student Member
WHAT: A 30-second “Own Your Future” Video Message
WHERE: To be showcased at NSC 2009 in Miami, FL
HOW: Mail to Claire Melebeck, 744 Ratcliff, Shreveport, LA 71104
WHEN: By July 1, 2009

2009-03-28T18:57:00.005-04:00

Had a hard week of work with two real hard quad workouts. Earlier today got a real good arm workout in. Just did my bike training:

1st 2.5 miles into wind 13:19
Return trip 7:53 with wind
*tires were a little flat which likely slowed the whole process down
And you see the bike I use above - not exactly the best for speed, but the resistance is nice and high which helps those quads I need to keep getting stronger. Felt real good today, almost wanted to do another 5 miles but had to get back here to post this and get my ACL presentation together... Thursday, here I come...

Tomorrow will also be my REAL first swim since the surgery, as I tried last week but spring break was still in effect keeping the pool closed.

Bonus: I apparently entered a contest a while back and received an ESPN hat in the mail, fun... Thanks, ESPN (picture to come)

Terrible Spinal Manip Timing

2009-03-21T12:08:00.003-04:00

The day I present to my clinic on Spinal Manipulation for Low Back Pain is the same day the APTA decides to send out an e-mail that they have released White Papers and a wealth of information on Spinal Manipulations. That would have been usefull information yesterday... (:about 25 seconds into the link)

I did not go into it feeling I had put together as much as I could have mainly because of the huge amounts of information out there. But it seemd it was fairly useful to the majority of my audience which is all I could hope for. Now I will be working on an ACL powerpoint that I will present in two Thursdays and fine tuning the spinal manipulation presentation for a few other PT's I know and eventually we will have a solid presentation for MD's and payors to educate them on how we deal with Low Back Pain.

Other exciting news: A new blog has sprung to help promote and organize the New Professional: http://moveitnps.blogspot.com/
MOVE IT!...to get to that site and contribute. There seems to be a lot of potential energy we have to tap into to help make the future of our profession better than ever, day after day. I am really looking forward to what we can accomplish.

Have a great weekend. I pledge to go swimming for the first time since my surgery tomorrow and report how that went... I highly do recommend the pool for the majority of musculoskeletal conditions: http://www.aquaticpt.org/

VO2 Update and Neck Guidelines

2009-03-10T02:24:00.003-04:00

The last two weeks I have not been as diligent with my exercises as I request my patients to be on a daily basis. For that I apologize to myself. I have heard the phrase: "do as I say, not as I do" uttered by too many a PT and I try to not fit in to this. So as soon as I finish this post I am off to workout my knee HARD! (cue inspirational music now)...

The results of not working out as much as I should have been showed up on my VO2 bike test today. We used a harder protocol of increasing the watts by 50 rather than 25 at each interval and I got up to about 360 watts before we finished although I had some left in the tank, just couldnt keep up the >50 rpm request with that much resistance and fatigue... so my VO2 went down about 4 points which could have more to do with testing error than me, or it could be the incredibly delicious albeit unhealthy food choices and poor exercise adherence I have been practicing...

And I leave you with the Neck Pain Clinical Guidelines I just finished reading. My main thought is "if you are a practicing PT who treats neck patients, you had better read this!" I like the utilization of the ICD-10 associations to create 4 neck pain categories
-mobility deficit
-headache
-movement coordination impairments
-radiating pain

I am looking forward to the updates they promise on the Orthopaedic Section of the APTA website... always something newer and better!

Now to workout!

Pubmed Everyday!

2009-03-08T13:38:00.002-04:00

Pubmed.gov is one of the most useful websites for researching any scientific topic. Slightly more reliable than wikipedia...

But did you know you can have all new articles on any topic emailed right to you without having to do anything. This works great for me when researching a topic like "ACL" for the rest of my life...

So here is how to subscribe to a topic:

1. Go to pubmed.gov
2. Either sign in or register (ABSOLUTELY FREE)
3. Once signed in, perform a search on any topic.
4. After the results come up go to the right of the search bar, there should be a link for "advanced search" and "save search"... click "save search"
5. Name it, pick your options and enjoy

Happy researching... and dont forget to Spring ahead, lose that hour of sleep...

DVT Detection

2009-03-07T13:27:00.002-05:00

A Deep Vein Thrombosis (DVT - basically a clot) could be a very serious condition if unrecognized. In our clinic we recently had an instance of a patient (4 weeks post-op) presenting with a few signs of this possibility and we referred him back to his MD to check it out and it turned out he had 3 small DVT's.

In the November 2008 issue of NAJSPT in an article titled "Multiple Ligament Knee Injury: Complications" there is a very clinically relevant decision rule that we have posted in our clinic as a constant reminder to look out for this complication. The original Clinical Decision Rule was actually developed in this citation:

Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Wells PS et al. Lancet. (1997)

Just as I think everyone, medical personnel and lay people, should be certified in CPR, the detection of DVT should be a critical skill that anyone exposed to a post-operative patient should have. So here are the clinical findings to look for. Each is a point towards the decision rule score, except for the last one which subtracts 2points from the score.

-advanced cancer (w/in 6 mo's of Dx or palliative care)
-paralysis, paresis, or recent plaster immobilization of lower extremity (LE)
-recently bedridden >3 days or major Sx w/4 wks of application of clinical decision rule
-localized tenderness along distribution of the deep venous system
-entire LE swelling
-calf swelling >3cm compared to asymptomatic LE
-pitting edema (>in symptomatic LE)
-collateral superficial veins (nonvaricose)
-alternative Dx as likely, or > than DVT = -2

Total of Above Score
High probability >3
Moderate probability 1 or 2
Low probability <0

Here is a very similar version of this toward the bottom with different references (that came out in 1998 one year after the release of the one I reference, odd to me).

Bike Ride and Career Day

2009-03-01T15:41:00.003-05:00

This is 11 minutes of me riding my bike over the very scenic Coney Island Boardwalk. I think it is actually kind of relaxing to watch

Yesterday I went to Career Day at my high school. One of the few schools that can get 50+ alumni and 600+ students to come in on a Saturday and not involve some kind of sporting event. I had a decent turnout and a bunch of the kids asked about setting up internships/observational hours, so hopefully that can work out

Just finished reading an interesting paper titled "The Pathophysiology of Patellofemoral Pain: A tissue homeostasis perspective" by Scott F. Dye, MD. I have heard some interesting stories about Dr. Dye, including having knee surgery without anesthetic, performed by his father. This paper in particular discusses the "enevelope of function" which looks at the "capacity of the knee in a live person (and by extension, all diarthrodial joints) to safely accept and transfer a range of loads." Useful principle for gauging the idea of pushing someone too much versus not enough. I highly recommend this paper to get a unique perspective on this very complex issue

Another way to describe the envelope of function: "The range of load that can be applied to a knee joint without causing structural or metabolic failure can be termed envelope of function."

I don't like Ed Towns

2009-02-24T22:24:00.000-05:00

Oppose Legislation HR 1137 That Will Weaken Qualification Standards for Personnel Providing Physical Therapy Services in Physician Offices

On Monday, February 23, Congressman Edolphus “Ed” Towns (D-NY) introduced HR 1137. This legislation would overturn the current Medicare “incident-to” rule and recognize athletic trainers as covered providers under Medicare. Please contact your Member of Congress today and ask him/her to OPPOSE this legislation!

APTA strongly opposes this legislation (HR 1137) and supports Medicare’s ability to require qualification standards for therapy services provided “incident to” a physician’s professional services. It is the position of the American Physical Therapy Association (APTA) that physical therapists are the qualified professionals who provide physical therapy examinations, evaluations, diagnoses, prognoses, and interventions. Interventions should be represented and reimbursed as physical therapy only when performed by a physical therapist or by a physical therapist assistant under the direction and supervision of a physical therapist.

Background

In November 2004, the Centers for Medicare and Medicaid Services (CMS) included provisions in the final rule for the 2005 Medicare physician fee schedule that established qualifications and clinical preparation standards for individuals who provide physical therapy services “incident to” a physician’s professional services. These provisions implement requirements adopted by Congress in 1997 to protect patient safety, ensure the appropriate use of Medicare resources, and guarantee the delivery of physical therapy services by qualified physical therapists. Opponents of these regulations were unsuccessful in their attempts to have CMS rescind the rule implemented in May 2005. These organizations also filed a federal lawsuit attempting to force their withdrawal, and a US Court of Appeals upheld a district court decision dismissing the litigation.

Talking Points

Patient Safety - HR 1137 jeopardizes the health, safety and welfare of Medicare beneficiaries by allowing non-qualified individuals to provide therapy services. The “incident to” regulations standardize existing Medicare requirements that physical therapy services must be delivered by qualified personnel in all outpatient settings. There is no evidence that these standards have restricted the delivery of physical therapy in physician offices. Without enforcement of appropriate qualification standards, it would be impossible to ensure that Medicare beneficiaries receive and the Medicare program pays for an appropriate level of safe and effective care delivered by an individual qualified to provide physical therapy.

Cost-effectiveness – HR 1137 is fiscally irresponsible and will cost taxpayers due to inappropriate billing of therapy services by non-qualified individuals. In a report issued in May 2006, the Office of Inspector General (OIG) of the Department of Health and Human Services found that 91% of physical therapy services billed by physicians under the old “incident to” rules in the first 6 months of 2002 failed to meet program requirements, resulting in improper Medicare payments of $136 million. The Inspector General found that the total payments for physical therapy claims from physicians skyrocketed from $353 million in 2002 to $509 million in 2004, and that the number of physicians billing the program for more than $1 million in physical therapy more than doubled in that two-year period.

This follows a report done in 1994 by the OIG that estimated that more than $47 million in unnecessary therapy services were delivered in physician offices under the old “incident to” rules. As a result of the 1994 report, Congress passed the Outpatient Physical Therapy Standards Act of 1997 as part of the Balanced Budget Act. This legislation established a standard for physical therapy delivered in a physician’s office consistent with that in all other outpatient settings, and the regulations promulgated by CMS in 2004 implement these standards in keeping with the intent of Congress.

Quality Care – HR 1137 dilutes the quality of care for Medicare beneficiaries by allowing non-qualified individuals to deliver therapy services. Medicare beneficiaries deserve a consistent standard of care that ensures that providers who deliver these services have attained the level of education and qualification necessary to provide them safely and effectively. Without appropriate personnel standards for individuals delivering highly skilled and recognized Medicare services such as physical therapy, the standard of quality is jeopardized.

What You Can Do

Contact your House Representative and ask them to OPPOSE HR 1137 TODAY!

CALL: Contact your House Representative by calling by calling the Capitol switchboard at 202/224-3121. Remember to ask to speak with the Health Legislative Assistant and ask your House Representative to OPPOSE HR 1137.

EMAIL: Visit www.apta.org/advocacy and click on the Legislative Action Center to send an email to your House Representative.