Monday Memo 01/13/2020

The Monday Memo

January 13, 2020                                                                       PITT DPT STUDENTS

Death, Taxes, and Distance Runners Training Through Injury

I’ll start with a simple question that most runners get on a daily basis: “why do you run so much?” A good question nonetheless, but one where the answer truly never satisfies, nor is it one size fits all. Understanding this point is the key to treating the stereotypical distance runner.

I played basketball, soccer, and swam competitively all throughout my childhood, but gave it all up to focus on running track and cross country to earn a college scholarship at Pitt. To me, it was a sport first and foremost, a means to an end that would hopefully evolve into a lifestyle or a hobby that would stick with me through my adult life. To others, running can be an escape, a way to de-stress and retain focus and clarity. It is a form of community; it encourages healthy social interaction for many, and welcomes any individual no matter the experience or ability level. Exercise, weight loss, and various other health benefits also draw people in, but to understand the athlete, you must first ask the question: “why do you run so much?” Without the answer to this question, without understanding the motivation behind the athlete, you cannot understand and appreciate the method to our madness.

Many of us have experienced this exact scenario: runner comes in after initiating a program, they express concern over something they clearly feel is important enough to dedicate their time to looking into, and when you provide your analysis and utter the words “I think you should think about taking some time off,” you’ve lost them. I’d like to play a little unpopular devil’s advocate, as someone who has been told to take time off, and as someone who tells others to take time off. After the dust settles, instead of placing the blame on the runner for not following our recommendation, what if it is our fault for having the conversation the wrong way?  Einstein said that insanity is doing the same thing over and over and expecting a different result, so knowing the chances of success with this particular conversation, why do we still try to shut a runner down six weeks before the marathon?

I don’t have an answer, because the approach will not be a “one size fits all.” When it is definitive that an injury is too severe to run on, and it is evident to the therapist but not the patient, it is our responsibility to not allow that patient to be put in a situation where they could do potentially irreparable damage. When on the fence about shutting them down completely, I firmly believe airing on the side of caution can be as detrimental as running on a muscle strain or tendonitis. Physically they may feel better in a week or so if they take the therapist’s advice, but does that athlete want to come back when they have another set back only weeks from competition? Learn about your athlete and what motivates them, determine how you can help them achieve their goal/motivation, and develop a plan that works for you and the patient.

Just like all your patients, start with the goal, “I want to run the marathon.” If they are running because this race is the opportunity to run with their family member or for a cause they are passionate about, asking them to stop running may be the worse news they have heard in months. If they are trying to qualify for a bigger race or meet a certain time, they have invested countless hours into training and will probably not allow knee pain to keep them from achieving their goal until they are literally unable to walk. In my experience, knowing that my PT wants me to run my race, and understanding they are tailoring our sessions with the goal of getting me to the race, opens doors that can get forever shut simply by immediately suggesting time off.

I am not saying we should allow all our injured runners to run, I simply wanted to provide some perspective as to what the conversation might be like from the other side of the table. Running is a sport that involves a lot of pain and sustained discomfort, so it should come as no surprise that running through injury is very much a part of the sport. In my time at Pitt, I have had two navicular stress fractures, one femoral neck stress fracture, two hamstring strains, a quad strain, a partially ruptured Achilles Tendon, a torn labrum and FAI that required surgery, a concussion, back spasms, and just about every lower extremity tendonitis under the sun. I plan on going out for a 6 mile run later this afternoon, and I fractured my twelfth rib only three weeks ago. Why do I run so much? I run so much, simply because the work isn’t finished yet. I have the same level of dedication as the runner on your treatment table later today. I may be one of the more extreme cases, but just like the majority of your patients who are runners, every running injury I have ever had has come with the goal of getting right back on the horse.

-Joshua Trzeciak, SPT

January 13, 2020 |

Monday Memo 01/06/2020

The Monday Memo

January 6, 2020                                                                       PITT DPT STUDENTS

After Graduation: FAQ’s and How-To’s

For 3rd year students and fastly approaching for 2nd years, there is the unavoidable topic of taking the National Physical Therapy Exam (NPTE) and applying for state licensure after graduation. However, these processes can be very confusing especially if you don’t know what state you want to practice in. After all, many of us are not originally from Pennsylvania or do not plan on practicing here following graduation. Below is a ROUGH (very rough) guideline and information of taking the NPTE and applying for state(s) licensure.

What is the process of taking the NPTE?

In terms of taking the NPTE, there is a whole process that must occur prior to taking the exam that requires multiple agencies and accrediting bodies. For the most part, this process is relatively consistent state to state but there are some minute things that may differ. When registering for the NPTE, your school must validate your graduation, and you must meet all eligibility requirements before the state’s jurisdiction grants permission to allow you to take the test. All of this must happen before you schedule to actually take the exam. Along with the NPTE, there are a few states that require a jurisprudence exam for licensure. This exam is specifically aimed at assessing your knowledge on specific PT practice legislation in your respective state.

After passing the NPTE, am I automatically licensed in that state?

For the most part, yes. By meeting eligibility requirements to take the NPTE, you essentially receive licensure upon passing. But keep in mind that this license is only valid in THAT state. For example, if I took my test in Pennsylvania, I can only practice in Pennsylvania. Let’s say that I wanted to move to Philly but wanted to commute to New Jersey for work, I would still have to apply for licensure in the state of NJ.

What if I plan on doing travel PT? Do I need to apply for licensure separately for all those states?

Unfortunately, yes. And all the application fees that come along with it. BUT there is hope. Recently, many state legislatures have introduced the idea of “compact privileges” for PT licensure. This system allows you to practice in any of the states within the agreement while holding only one state’s licensure. This acts very much like a driver’s license. I may hold a Pennsylvania driver’s license but if I am driving through Ohio, I must adhere to Ohio’s driving rules and regulations. The same holds true for PT licenses as part of this compact agreement.

As of right now, there are 16 states that are officially a part of the agreement, 11 states that have enacted legislation to become a part of it, and 4 states including Pennsylvania, that have introduced compact agreement legislation as a topic. Soon I could work in New Jersey while holding only a PA license. Cheers to no more application fees!

This only begins to scratch the surface of what must be done between now and working a real adult job. But if you are like me and get anxious thinking about all the tedious processes and confusing licensing rules, this is a good foundation to build upon as we approach graduation!

-Sam Yip, SPT

References:

https://www.fsbpt.org/
https://www.apta.org/PTinMotion/2016/3/Feature/MultipleStates/
http://ptcompact.org/ptc-states
January 6, 2020 |

Monday Memo 11/25/2019

November 25th, 2019                                                              PITT DPT STUDENTS

Individualizing Treatment and Instilling Confidence 

A recent patient encounter at my clinical site has influenced my views on the roles we, licensed and aspiring physical therapists alike, play in the day-to-day lives of our patients. One afternoon, my rather apprehensive, timid and cautious patient came into the clinic for a follow-up visit. After working with her for a few visits, I was reminded that patients have various factors – social, environmental, psychological, and cultural – that PT’s must consider when initiating treatment. As we have learned countless times, all patients have their own personal dynamics that influence the physical therapist’s choice in therapeutic exercise, modalities and manual therapy.

After asking the patient how she was feeling that day, she quietly admitted that everything seemed to be going okay. As we spoke more throughout the session, she opened up to me about her apprehension regarding the safety of her bath transfers. As an extremely modest individual, I took her disclosing this information as a moment of vulnerability. Rather than keeping her struggle to herself, she decided to share her concern with me. Quickly, I compiled a few materials from the clinic to simulate the height of the bathtub that the patient needed to navigate at home. After a few trials to find the right height, the bath setup (a blue Airex foam and a hurdle) was complete. I started by asking the patient to transfer as she currently does, forewarning her that I was guarding closely behind, should she lose her balance. Once I was able to identify areas for improvement, I demonstrated the proper technique – visually and verbally – and the patient then replicated.

Not only was this patient better at performing the transfer, she was practically oozing with a sense of confidence and relief. Progress was made both physically and emotionally – the patient exhibited greater confidence than I have seen to date. I attribute the results we attained to her trust in me; my actions to quickly provide a solution proved, through practice, that we would address her concern. I was positive that together, we would perfect the transfer, and I could tell the patient was comforted by my confidence in her. Knowing that she was with someone that believed in her ability, allowed her to also believe in herself. Sometimes, our own confidence in a clinical situation translates to a patient feeling more competent and at ease.

While the set-up may have been make-shift and sub-par, and the situation “simple” for many, this experience left a lasting impression on how I plan to continue to individualize treatment. The current vision of the APTA is to, “transform society by optimizing movement to improve the human experience.” To do so, the APTA explains, “movement is a key to optimal living and quality of life for all people that extends beyond health to every person’s ability to participate in and contribute to society.” For right now, assisting someone to position themselves appropriately to enter and exit the bathtub may be what they need to participate in their normal life with more confidence and independence. Naturally, the patient was also receiving therapeutic strengthening exercises, flexibility and modalities. I recognized this situation as a classic demonstration of the importance of the specificity of treatment; hip strengthening makes your hips stronger, but hip strengthening doesn’t teach you to safely maneuver a bathtub. Sometimes, the practice of initiating a transfer or specific ADL is more important and beneficial for the patient at that moment.

From this, we should be reminded of individualized treatment: an idea that should be central to our care; an idea that can easily be overlooked and forgotten. Never underestimate the importance of something seemingly simple and its influence in promoting safety, wellbeing and confidence in a patient.

APTA.org

-Erica Vuocolo, SPT

November 25, 2019 |

Monday Memo 11/18/2019

The Monday Memo

November 18th, 2019                                                              PITT DPT STUDENTS

Pets and PT

Much like human medicine, veterinary medicine is seeing a shift in practice to more preventative care versus reactive treatment. In 2003, the Canine Rehabilitation Institute established a program of Canine Rehabilitation offering a Canine Rehabilitation Therapist Certification (CCRT) that requires one to be a licensed physical therapist in order to qualify for enrollment. Today, there are two places where you can become certified in canine rehabilitation, the Canine Rehabilitation Institute and the Univeristy of Tennessee. UoT also has certification programs for equine rehabilitation, equine taping, canine fitness training, canine osteoarthritis case management, canine pain management, and nutrition case management 

Canine Therapist, Francisco Maia, PT, DPT, CCRT offered practical insights for those interested in pursuing canine rehab in an interview published by Emma Lam of  CovalentCareers. His advice included: If possible, shadow someone who already works in the field to learn more about animal rehab. Additionally, successful animal rehabilitation therapist needs to know how to educate the family/owner about diagnosis, rehab programs, prognosis, and HEP. Lastly, the rehab concepts are more or less the same as human physical therapy – you just need to learn how to integrate animal anatomy and physiology with your physical therapy knowledge.

Lee, Emma. “How to Become an Animal Rehabilitation Therapist.” CovalentCareers, 17 May 2017, https://covalentcareers.com/resources/animal-rehabilitation-therapist/

-Anonymous SPT

November 18, 2019 |

Monday Memo 11/11/2019

The Monday Memo

November 11th, 2019                                                              PITT DPT STUDENTS

The Importance of Posture in Physical Therapy Wellness and Prevention

            Many of our patients visit us with problems unrelated to a specific mechanism of injury, and our job is to find out and treat their specific impairments.  The current vision statement for the APTA is “transforming society by optimizing movement to improve the human experience”. This is a very powerful statement.  I interpret this as not only helping patients recover from a specific injury, but providing them with the skills and tools that they need in order to function in the safest and most effective way.  Prevention and wellness are important to introduce to patients to assist in preventing further injury.  In our evaluation, we must address the patient’s current movement pattern.  This can include an observation of posture, seated posture, gait, and/or another activity.  This can provide us with significant information of what initial hypotheses we should form, and the testing that should be done to either accept or reject the initial hypotheses.   

            When a person assumes a certain posture, the muscles and fascia will begin to mold to the length that they are resting in.  This can create imbalance and lead to impairment if a normal posture is not assumed.  A person’s posture and movement patterns can either be the result of a previous ailment, or a choice of how to hold one’s body based on comfort, muscle tone, or societal norms.   

            Typical faulty postures include upper-crossed syndrome, lower-crossed syndrome, thoracic kyphosis, lumbar hyper-lordosis, etc.   However, there is one very common posture in today’s society that I would like to discuss.  The sway-back posture.  It is scientifically defined as the hips swayed forward and the rib cage swayed back.  This may also be referred to as the “sitting-man’s posture”.  Physical therapists must understand this posture because our population is becoming more and more sedentary. The sway-back posture is basically a way to stand with less work.  It essentially compresses the spine and over-extends the knee and hip to prop the body in a standing position.  We must encourage others to move more often throughout their day to combat this posture.  Sway-back posture may often times be confused with an increased lumbar lordosis.  This is not the same.  Observe the greater trochanter.  The person with sway-back posture will present with a greater trochanter that is in front of the lateral malleolus from a sagittal plane view but may have a neutral or posteriorly tilted pelvis.  A person with a lumbar hyper-lordosis will present with a greater trochanter that is still directly over the lateral malleolus but is anteriorly tilted in the pelvis.  Also, individuals with sway-back posture may present with weak gluteals, short rectus abdominus, and short hamstrings while the individual with lumbar hyper-lordosis is more likely to present with long hamstrings and abdominals.  Of course, further examination and muscle length and strength testing must be done to confirm this and to guide your treatment plan.  Choose exercises based on your findings.  For example, you may find that a patient with sway back posture has a short rectus abdominus, so you should not prescribe a lot of sit-ups.  Poor posture assumed during an exercise may fail to work the muscles that you are trying to target.  If a patient does not seem to be responding to the exercise program, correcting postural alignment could change the outcome.

            What I hope to see in the future is that physical therapists make a strong effort to understand posture and have enough knowledge to teach a patient how to correct their posture.  Often times the question will come up in the clinic, “is this how I should stand?” Patients may want to know this to avoid further injury or look more aesthetically pleasing.  You should have the most appropriate answers to help them maintain optimal muscle balance and function.  More importantly, as students, it is imperative that we begin thinking about and practicing good posture in our own bodies.  Our profession requires much wear and tear on our bodies, and we must take control to minimize the strain.  We should observe and work with each other during our time here, so that we are prepared to enter the profession as movement experts. 

Check out this link for images and instructions on how to stand properly!

-Cassie Ruby, SPT, NCPT

References:

Fujitani, Ryo, et al. “Effect of Standing Postural Deviations on Trunk and Hip Muscle Activity.” Journal of Physical Therapy Science, vol. 29, no. 7, 2017, pp. 1212–1215., doi:10.1589/jpts.29.1212.

Kendall, F.P., et al. 2005. Muscles: Testing and Function, With Posture and Pain. (5th ed.). Baltimore: Lippincott Williams & Wilkins.

Sahrmann, S.A. 2002. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby.

Romani-Ruby, Christine. “Designing a Program for Swayback Posture.” IDEA Fitness Journal, Test 4, Nov. 2010, p. 88

November 11, 2019 |