Monday Memo 2/12/18

The Monday Memo

February 12, 2018                                                                        PITT DPT STUDENTS

 

Holly Lewis, a first year SPT, is currently involved with teaching an exercise class to older seniors in the community. I had the pleasure of interviewing her to find out more about what she does every Monday evening.

 

So, tell us a little bit about the program.

 

 Every week, 6-8 participants meet at Parkside Manor, an independent living facility, to instruct an exercise class for the residents. Parkside Manor is a facility for the underserved, community-dwelling older adults. The main goal of this program is to provide simple and functional exercises that will benefit the residents both physically and mentally. Some of the exercises we incorporate are walking, seated exercises, and obstacle courses.

 

How did this program start?

 

Molly Bachmann, a third year SPT, reached out to seek other students in the program to help her. Molly is a Pittsburgh Schweitzer Fellow, which is where she originally came up with the idea for this endeavor.

 

How have the participants been responding?

 

They have been doing really well! A lot of them are more confident with navigating stairs and ambulating on their own. We have people from many different functional levels including Rollators and walkers. We accommodate to all and integrate exercises for any level.

 

What has this experience provided you with?

 

So much. It has made me much more confident leading exercises and working with the elderly. I initially had an interest in working with the geriatric population and this has stimulated it even more.

 

Beyond simply exercising, what are the other goals of this program?

 

A lot of seniors are in social isolation. This gives them an enriched environment and stimulation. We try to maintain the positive outcome they have earned in class by giving the residents education about what they can do outside of class to maintain the benefits.

 

What do you recommend others in the physical therapy community to do to help with enriching the lives of seniors?

 

While working with a patient, it is important to keep in mind that you may be the only person they talk to the entire day. Stay involved and alert. No matter what your experience level, volunteering and getting involved in the community is never a bad idea!

 

What is in the future for the program?

 

The next year in the program, we would really like to add another facility so that the effects of the program may be expanded throughout the community.

 

Special thanks to Holly Lewis for giving her time for this interview.

 

-Layne Gable, SPT

 

 

 

 

February 12, 2018 |

The Monday Memo 2/5/18

The Monday Memo

February 5, 2018                                                                        PITT DPT STUDENTS

Student Spotlight

 

Student: Marcin Szczyglowski, Class of 2019


Q: Hello Marcin: Thanks for joining us today! To get started, would you mind telling us a little bit about yourself: Where did you grow up? Where and what did you study for your undergraduate education?

 

A: I was born in Lansing, Michigan, but grew up in London, Ontario, Canada. I went to the University of Western Ontario for undergrad and studied Kinesiology. My undergrad program was mostly based in physiology and biomechanics, but also included electives in rehab, sport literature, sport law course, and more. I took a 5-year undergrad simply because our curriculum was rather strict and flooded with physiology/biomechanics, but there were a ton of electives I wanted to take.

 

Q: You have a Master Degree, don’t you? Tell us a little about that.

 

A: I completed my Master of Science at the University of Oklahoma. It was a degree in Exercise Physiology with a concentration in Muscle Function and Metabolism. My thesis topic was The Effects of Exercise-Induced Muscle Damage on Critical Torque and Mitochondrial Function. My lab also did quite a bit of work on pain science, ergogenic aids with endurance performance, carbohydrate mouth-rinsing for improved performance, and other various properties of muscle function. We were also jokingly termed ‘The Pain Lab’ because a) we studied pain quite a bit and b) a lot of our studies required strenuous physical testing as well as twitch interpolation, which, if you’ve never done, is not the most enjoyable experience.

 

 

Q: “No pain no physiological gain”, am I right? You’re also a published author. What are the titles of your publications and would you mind giving us a brief description of your involvement/the major takeaways?

 

A: Currently, my thesis is published in the European Journal of Physiology under the title The Effects of Exercise-Induced Muscle Damage on Critical Torque. Critical torque is an analogue of critical power, which is defined as the highest attainable work rate that still results in steady-state aerobic energy production. It is usually expressed as an individual’s exercise intensity, such as critical speed, critical torque, etc., and is arguably the best physiologic predictor of endurance performance. Any exercise above this ‘critical power’ will ultimately result in task failure. Exercise above critical power is thought to have a fixed amount of work (making time to exhaustion, or task failure predictable), and is termed W’. The article covers exercise-induced muscle damage (EIMD) and critical power in depth, however the main discussion points were as follows: EIMD significantly reduced absolute critical torque by ~14% as well as ∫T total, a surrogate for W′, by 33% following EIMD. These findings suggest that EIMD would lead to a decline in CT and ∫T total providing evidence that EIMD likely impacts aspects of both aerobic and anaerobic metabolic functions during exercise.

 

Literally as I was typing this interview up, I was notified that a second research study I was heavily involved in was published in the Journal of Strength and Conditioning Research under the title Carbohydrate Mouth Rinsing Does Not Prevent the Decline in Maximal Strength Following Fatiguing Exercise. CHO mouth rinsing without the need for ingestion is an interesting technique which has been shown to improve performance, whether that be in a time trial, time to exhaustion, repeated sprint bouts, or simply slow the decline of maximal voluntary contractions (so long as the given exercise is short enough in duration that glycogen stores do not become a factor). This is likely due to central mechanisms as opposed to peripheral. Our study added to the notion of peripheral fatigue not being impacted by CHO mouth rinsing. While % voluntary activation of the quadriceps did not differ between conditions or pre-post exercise, indicating peripheral as opposed to central fatigue, we observed no changes in muscle contractile properties vs placebo. To sum it up, while CHO mouth rinsing has been shown to improve performance, this ergogenic effect does not seem to extend to enhancement of high-intensity ‘one-off’ events such as 1-RM or a single sprint.

 

I also presented a poster titled Consistency of the Effects of Caffeine on Strength and Motor-Unit Recruitment at the American College of Sports Medicine Annual Meeting in 2015. Caffeine, in the appropriate dosage (evidence ranging from roughly 3-13 mg/kg bodyweight), has been shown to improve muscular strength and motor-unit recruitment in athletes. This study was conducted on untrained individuals, and did not see the same ergogenic effect suggesting that caffeine has more of a fine-tuning effect on motor-unit recruitment.

 

 

Q: With such an extensive background in Exercise Physiology, the field of Physical Therapy was probably a natural transition for you. What got you interested in the field of physical therapy?

 

A: My undergraduate degree exposed me to physical therapy and rehab quite a bit, but science and research run in my family. I love physiology, which is what drove me to the University of Oklahoma. However, during my undergrad, I took quite a few ‘hands-on’ courses, volunteered in the field of physical therapy, and worked as a personal trainer/strength and conditioning coach at two gyms and for UWO women’s field hockey team. As much fun as research was, I missed this kind of treatment/training interaction. I got the opportunity to shadow the physical therapist for the Sooners’ track and field team and really enjoyed his treatment approach as well as the whole ‘behind the scenes’ atmosphere of collegiate sports. This, along with several long discussions with friend’s back home, swayed me away from doing a PhD in exercise physiology and, instead, a DPT.

 

 

Q: I know that you’re pretty involved in the sport of Powerlifting, so the competitive atmosphere that is collegiate athletics is probably a natural fit for you. What are your best lifts and how long have you been training?

 

A: I got into training powerlifting my sophomore year, and competed for the first time in my junior year. My undergraduate gym had a solid powerlifting culture led by a couple of the trainers I worked with, and I got sucked in. I’ve competed three times (last one in 2015…so I’m washed up). Best lifts (lbs): 505 Squat, 335 Bench (paused), 600 Deadlift. Best comp total: 650 kg / 1433 lbs at 93kg bodyweight.

 

 

Q: Any competitions in the near future?

 

A: Hopefully April (Comeback SZN!), and hopefully breaking a 1500lb total.

 

 

Q: What are your career goals or next steps after your graduate?

 

A: My main short-term goal is to get accepted into a sports physical therapy residency. Long-term I would love to end up working with a sports team, as well as contribute to the movement of therapists working toward bridging the gap between physical therapy and strength & conditioning. Long-long term dream goal? Own a hybrid of a physical therapy clinic and a strength and conditioning gym. Is Szczyglowski Strength too much of a tongue twister?

 


Q: Anything else you’d like to share with the readers?

 

A: Pizza is kind of a boring food, and I don’t understand why people love it so much. Get something better, like a taco or a burger. But if you do get pizza, put some pineapple on it.


Q: Thanks for stopping by, Marcin! Good luck with the rest of the spring semester!

 

Links to studies:

https://www.ncbi.nlm.nih.gov/pubmed/29334582 – CHO Mouth Rinsing

https://www.ncbi.nlm.nih.gov/pubmed/28900719 – Critical Torque

February 5, 2018 |

Monday Memo 1/29/18

The Monday Memo

January 29, 2018                                                                           PITT DPT STUDENTS

Hollowing vs. Bracing: Building the Proper Foundation for Spine Stability

 

Abdominal hollowing and abdominal bracing are two techniques commonly used in the outpatient physical therapy setting to treat both acute and chronic low back pain patients whose symptoms are a result of some degree of spinal instability, or an inability to use their musculature properly to maintain their spine within the “neutral zone.” The mutual goal of these exercises is to teach the patient to reactivate certain muscles of their core with the purpose of increasing stiffness of the spine, enabling it to more effectively withstand potentially compromising loads and positions that can result in further pain and injury. Though both exercises are used to treat the same activation deficits of the spinal stabilization musculature, recent evidence has emerged calling into question the effectiveness of the abdominal hollowing technique in achieving this goal, and even suggests a potentially deleterious effect of the exercise in certain scenarios.

 

The abdominal hollowing exercise, which involves a selective drawing in of the transversus abdominis (TA) muscle to create a “hollowing out” effect in the abdominal region, gained in initial popularity due to evidence that found delayed and diminished EMG activity of the TA in certain patients with low back pain. This research failed, however, to examine the other surrounding musculature of the core, and more recent evidence has found that similar activation deficits were found in additional muscles of the abdominal cavity, suggesting that this delayed and diminished muscle activation is not unique to the TA, but rather pervades the surrounding deep abdominal musculature in certain low back pain patients. Abdominal bracing; which involves a submaximal co-contraction of these affected muscles such as the internal and external obliques, quadratus lumborum, rectus abdominus, transversus abdominis, lattisimus dorsi, and erector spinae, among others; might potentially be better suited to address the widespread activation deficits seen in these patients.

 

Additional research that examined the forces on the spine under varying loads and positions concluded that holding an isometric TA contraction decreased the potential energy of the spine and caused it to fail at lower loads. This evidence runs contrary to the belief that this isolated contraction increases spinal stability and refutes the clinical reasoning behind maintaining this type of contraction during various exercises such as squats. This reasoning was further called into question by a study that compared a stabilization exercise program involving isometric TA holds in conjunction with various exercises such as bridges and bird dogs with a similar program encouraging participants to employ their natural spinal stabilizing mechanisms throughout their exercises. The trial found that there were similar improvements between groups on pain outcomes, but the general, non-hollowing exercise group had greater improvements in self-reported disability scores. The study suggests that encouraging the body to employ its natural stabilizing mechanism by synchronously activating its abdominal cavity musculature may be more effective than isolating specific core muscles at achieving spinal stability.

 

Synchronous contraction of muscles about a joint increases the stiffness of that joint more effectively than contraction of a single muscle crossing the same joint. This principle is especially important when attempting to increase stiffness and ultimately stability of the spine and can be achieved by training the totality of the core musculature to synchronously contract with the abdominal bracing exercise to ultimately enable the patient to maintain this stiffness throughout their daily activities. An appropriate level of stiffness required for safe performance of most non-athletic activities only requires the core muscles to contract at 25% of their maximum voluntary contraction level. The principle of stiffness can and should be extrapolated to high level athletes as well in order to optimize safe and effective performance. A powerlifter, for example, must maintain a very high degree of co-contraction during a squat or deadlift in order to keep his or her spine in a neutral position when under heavy loads. This minimizes the risk for injury to the spine and maximizes performance by providing a solid foundation upon which the more distal joints can operate. Rapid contraction and relaxation of the abdominal brace is also important for athletes requiring more ballistic bursts of speed, such as baseball pitchers, golfers, mixed martial artists, and hockey players. It is essential for these athletes to be able to adequately activate their core musculature synchronously in order to accomplish the explosive movements required by their sports. A mastery of the abdominal brace technique may be particularly useful for returning these patients to their previous level of sport participation and skill.

 

To optimally teach safe and effective movement to our patients, we must replicate in the clinic those motor patterns that are demanded for performance in the real-world setting. This involves synchronous and synergistic activation of all muscles responsible for accomplishing a task, not isolated activity of muscles such as the transversus abdominis, which, when selectively contracted, has been shown to decrease potential energy and load tolerance of the spine. The healthy body activates its core muscles synchronously to prepare for and withstand movement and load on the spine. It is important to encourage that synchrony with the bracing technique to achieve optimal spine stability and performance.

 

-Brooks Kenderdine, SPT Class of 2019

 

 

 

References:

 

McGill, S., PhD. (2010). Core Training: Evidence Translating to Better Performance and Injury Prevention(Vol. 32, Rep. No. 3). Lippencott Williams & Wilkins.

 

McGill, S. (2017). Ultimate back fitness and performance. Gravenhurst, Ontario: Backfitpro Inc.

 

January 29, 2018 |

The Monday Memo: 1/22/18

The Monday Memo

January 16, 2017                                                                           PITT DPT STUDENTS

Student Spotlight

 

Student: Christopher Drager, Class of 2019


Q: Hey Chris. Tell us a little bit about yourself to get started: Where did you grow up? Where and what did you study for your undergraduate education?

 

A: I grew up ten miles south of Pittsburgh in Jefferson Hills, PA. After graduating from Thomas Jefferson High School, I chose to attend Virginia Tech to play football and study Human Nutrition, Foods, and Exercise.

 

Q: What got you interested in the field of physical therapy?

 

A: I’ve participated in team sports my entire life. Competing with and against different players was the most exhilarating activity for me. During a 7th grade football game, I tore my ACL and was restricted from athletic participation for three years. That period really challenged me physically, mentally, and emotionally because I was unable to do what I loved the most. In order to return to sports and really gain a competitive edge, I began reading a lot about physical fitness and nutritional advice and it was that information that got me back on the playing fields and eventually earning a college scholarship. Now that my playing days are over, I chose to use the PT profession to help others break down barriers and accomplish their goals.

 

Q: What else are you involved in outside of school?


A: For the past six years, I have helped coach high school football at my alma mater, Thomas Jefferson High School.

 

Q: Awesome! Did you have a successful 2017 season?

 

A: Yes, we went 11-2 and defeated Montour at Heinz Field for the 4A WPIAL Championship, making it the third consecutive championship season.

 

 

Q: That’s amazing, Chris. Congratulations! What was your favorite memory from this past season?

 

A: By far, my favorite memory was destroying Belle Vernon in the WPIAL semifinals round. After losing to the Leopards in the regular season, we were afforded another opportunity to play them in the playoffs. After a great week of preparation, we held the Leps to one first down, beat them 27-0, and removed their hopes of playing at Heinz Field for the WPIAL title.


Q: What is your favorite thing about coaching a team of youth athletes?

A: I enjoy the camaraderie and competition. Coaching requires you to spend a lot of time with a lot of people. Working together and developing strategies and striving to excel for a cause that’s bigger than the individual…that’s what I enjoy the most.

 

Q: What are your career goals or next steps after your graduate?

A: Over the last few years, I haven’t had many quality options in terms of career choices. Ideally, after graduation I’d love to work as a physical therapist and strength and conditioning coach within the Navy athletics program, but now that the future is showing many different avenues and holds many quality opportunities, I’m just going to savor the moment and take one step at a time.

Q: Anything else you would like to share?

A: I’m grateful Pitt afforded me an opportunity to pursue a new profession. Physical therapy school is giving me the skills to help others (and myself) perform better and be healthier. PT is a rewarding and potentially lucrative profession and I’m glad I’ve chosen to travel down this path!

Thanks again to Chris Drager!

January 22, 2018 |

Monday Memo 1/16/18

The Monday Memo

January 16, 2017                                                                           PITT DPT STUDENTS

Mindfulness in Physical Therapy

As current physical therapy students, we all wrote an essay in order to get into school that detailed what the APTA vision statement for the Physical Therapy Profession meant to us as individuals. As we all still remember that vision statement is as follows “transforming society by optimizing movement to improve the human experience.” When first looking at that statement I am sure what jumps out to us all is “optimizing movement”, where we as future physical therapists will help society by improving an individual’s function so that they can partake in their daily life. What we may miss is that wellness too can help a person improve their human experience. In fact, per the APTA, one of the roles of a physical therapist is to “Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.” Within the physical therapy realm there has been a shift to not only incorporate physical activity but also wellness into treatment. There are many ways in which a physical therapist may incorporate wellness into their treatment of a patient. Rebecca Meehan at the last APTA meeting pointed out that Yoga is one of the many ways that a bridge can be formed between traditional physical therapy and wellness.

 

Yoga when broken down means “to yoke” or “to join”. Where individuals concentrate on joining the mind, body, and spirit. There are many different types of yoga which include but are not limited to Vinyasa Yoga, Hatha Yoga, Pranayama, Bikram, Medical Therapeutic Yoga (MTY), and the list goes on. Meehan explained that MTY, unlike the other forms of yoga, takes existing evidence based practice while also streamlining clinical assessment and management to improve patient satisfaction and outcomes with specific yoga prescription. In this sense MTY encompasses all components of the biopsychosocial model that we all have come to learn in our studies as physical therapy studies. Yoga also incorporates mediation and mindfulness, where meditation is finding the peace within and mindfulness is a type of mediation where one focuses on being present and being actively aware of what you are doing. The breath that is incorporated in yoga helps to achieve this state of meditation and mindfulness.

 

There are many ways that yoga can benefit patients which includes and is not limited to improved balance, improved strength, improved mobility, improved mood, improved fatigue levels, and improved quality of life. Many of these improvements are the very impairments that bring patients to physical therapy in the first place, so it seems like a no brainer that yoga is a great tool to incorporate into treatment. Now you may be asking how do I incorporate yoga into my treatment? To be clear, MTY is a specific license you must obtain. This does not mean, however, that just because you don’t have a MTY license that you still can’t incorporate aspects of yoga into your treatment. For example, you may choose to work on breathing with your patient, an essential component to any exercise. You also may elect to incorporate some balancing poses for that elderly patient who is at an increased risk for falls or a warrior 1 pose for the patient working on lower extremity strength, core strength, and balance.

 

To close, wellness is an important aspect of physical therapy. Yoga is a great way that wellness can be incorporated but it is not the only way. Many tools out there can be used to join physical therapy and wellness and it is just a matter of taking the time to do so. If we as physical therapists are mindful, we can serve as the ones to help patients practice health and wellness.

 

Namaste,

Hillary

 

*If you are interested in partaking in some yoga classes, the Pitt Marquette team hosts monthly Sunday classes at the UMPC Rooney Sports Complex. Stay tuned on the Pitt DPT website for upcoming classes!

January 16, 2018 |