Monday Memo 11/11/2019

The Monday Memo

November 4th, 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 |

Monday Memo 11/04/2019

The Monday Memo

November 4th, 2019                                                                           PITT DPT STUDENTS

The Conversation

There is a conversation that needs to be had all across the world. It is not a pleasant conversation. For many, it can be unsettling and anxiety-inducing. It may create conflict between family members and loved ones. While this conversation is a challenging and dreaded one, it is also an extremely important one.

I am not talking about politics, religion, or climate change; I am talking about wishes for end of life care. Talking about death is extremely taboo in our culture; most of us tend to avoid the topic at all costs. But this conversation is also one of the most imperative discussions we can have with our loved ones. Think of how many horror stories you have heard, seen, or even experienced, about families having to decide what happens to their loved one who has been in an accident or has suffered such severe cognitive decline that they are no longer able to make medical decisions for themselves. How many times have you heard about families fighting over the stress these situations cause? What if I told you this could be preventable—and all it took was one conversation.

I am not here to tell you this conversation is easy. It most certainly isn’t. It is not easy to bring up this discussion elegantly, but I can give you some tips and resources to make it a little easier. Step One: fill out an Advanced Directive yourself. There is no better way to understand and gain appreciation for something than to do it yourself. You can fill out your AD at prepareforyourcare.org. Here, you can watch videos explaining what an Advanced Directive is.  You also can fill out the form, identifying your medical decision maker, along with your wishes for your end of life care if you are no longer able to make decisions yourself. Step Two: Initiate the conversation with your family. Theconversationproject.org is a great resource to use, and even provides a conversation starter kit.   Explain to your loved ones what the Advanced Directive is, and why it is important. Allow them some time to think about their wishes and provide them with the resources they need to understand and fill out their AD. Then, when you all are ready, have a discussion about your own preferences for your care and ask them about theirs. Step Three: Initiate this into your clinical practice. Assess if a patient is open to having the discussion and educate them about the importance of taking control over their end of life care.

As healthcare professionals, we often do not ask our own patients these difficult questions because we do not think it is our place. And that is just the problem—no one thinks that it is their place to ask, so no one does, and the cycle continues, creating more and more of a stigma about talking about death. But what if we normalized this conversation? What if we talked to our patients about their wishes for the end of their life like we talk to them about their discharge plans or their medication regimens? As Physical Therapists, we see our patients more frequently and consistently than any other healthcare provider. We know these people. We know their families. We have relationships with them. So why don’t we encourage and empower them to make these crucial decisions now, while they still have the ability? Why don’t we help ease the burden on the family that comes along with these painful decisions? Why don’t we put the power back in the patients’ hands to decide what they want? I encourage all of us to take responsibility to initiate this conversation when appropriate. All it takes is a simple, “I would like to talk to you about whether you have come up with a plan for your end of life care, and whether you have discussed it with your family. Are you open to having a conversation about this?” Having the courage to initiate these conversations with your patients and your own family can have a huge impact on a person’s final days. You can be the difference in ensuring a comfortable end to a beautiful life. Please, have the conversation.

-Kelly Conners, SPT

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References:

https://theconversationproject.org/

prepareforyourcare.org/

November 4, 2019 |

Monday Memo 10/28/2019

The Monday Memo

October 28, 2019                                                                           PITT DPT STUDENTS

 

The OCA Clinic

As PT students, it is imperative to volunteer at as many opportunities as possible. These volunteer opportunities should spark an interest in you that goes beyond the scope of physical therapy, and should resonate with you as a person as well as a clinician. The OCA clinic served this purpose for me. For those of you who are unfamiliar (as I was), OCA stands for Organization of Chinese Americans which represents the local Asian American population within the Pittsburgh area. For a few decades now, the organization and the 2nd year medical students at the University of Pittsburgh host a pop up clinic every October where uninsured Asian Americans can obtain essentially “free” healthcare from medical students, dental students, and licensed physicians within the organization. These can serve as general checkups, blood tests, dental cleanings, or alleviating general musculoskeletal pain that so many individuals in this population are affected by.

 

By doing this, it serves as a learning experience for student clinicians as well as help an underserved population. This year’s OCA clinic was held on October 14th in UPMC Montefiore. This was the first year that the physical therapy department was able to offer our services, and a few of 2nd years, including myself, were able to help out.

I wanted to use this opportunity to accomplish a few things

  • Help uninsured individuals get better in a fun and interactive way
  • Advocate for the PT profession and our capabilities to other healthcare disciplines and to the Asian American population
  • Problem solve in a chaotic environment with little equipment and little room for exercise.
  • Practice my Mandarin
  • Eat some authentic Chinese food for free (I miss my mom’s cooking)

 

When we first arrived, I was initially intimidated by the number of white coats and unfamiliar faces. We had two students from China assigned to us as translators for communication purposes and they explained to us how PT was a new concept to them because it does not exist in China. The event initially started slow, but many individuals were eventually triaged to us to help with musculoskeletal pain. I do not recall any specific orthopedic doctors or students on staff, so we essentially served as the primary clinician for the patients with musculoskeletal concerns. Sessions were around 20 minutes in length and included a brief subjective history, a few manual techniques and demonstrating a few exercises to do at home. Our patients were genuinely thankful for our input, time, and expertise regarding their treatment and treated us with the same respect that they treated the medical students with. The medical students were thankful for our services and gained a firmer grasp for what it is that our profession does. After all, pain free movement is a language that everyBODY speaks.

 

In the end, our little PT gym saw 19 patients, with the OCA clinic as a whole gaining the attraction of 69 people within a span of 3 hours. 69 people who would not have received care if not for this clinic. In the future, we hope to maintain our connection with Pitt’s medical students in order for us to come back next year with a new slew of volunteers. Since this was the first year that the PT department was involved, it was primarily reserved for PT students with Asian backgrounds. But moving forward, we encourage other SPT’s who are interested to reach out in hopes to have a diverse PT student representation at future events.

 

-Sam Yip, SPT

**Pictured (L to R): 2nd year SPT’s Erin Dong, Jason Yang, Sam Yip, and Deborah Lee

References:
https://www.ocapghpa.org/programs/free_medical_clinic.html

October 28, 2019 |

Monday Memo 10/21/2019

The Monday Memo

October 21, 2019                                                                           PITT DPT STUDENTS

 

Is Travel Physical Therapy Right for You?

            Travel physical therapy can conjure a lot of different ideas in our heads. Some may find the idea of travel PT exhilarating picturing jumping into a new setting every couple of months, traveling from city to city, getting a chance to tour the countryside along the way. Others may find the idea frightening and prefer a sense of groundedness and home. Many however, are in between but find the idea of traveling physical therapy overwhelming and are unaware where to start the process. In order to combat some of that fear and level out some of the expectations I have gathered some important information regarding the basics of travel PT, the importance of selecting a trusted recruiter, the financial benefit, and some practical challenges such as licensure.

Normally, the first step in travel PT occurs when there is a facility in need and with the use of a staffing agency/recruiter they find a traveler to fill the position. The average length of a contract for a position is 13 weeks (about 3 months). Due to a plethora of different reasons there are many openings available across the country right now for travelers. In order to ensure you get the right fit it is vital to get the right recruiter. Wanderlust PT (a recommended resource by APTA) has a variety of different recommended recruiters listed on their website. Once you have chosen a recruiter you can discuss what type of position you are interested in, such as outpatient, inpatient, SNF, pediatric facilities, etc., as well as what area of the country you are interested in working. It is important to remember that popular travel states such as California and Hawaii are non-compact states and therefore, positions here may take longer to secure as you must not only apply for a license but compete against more physical therapists.

Along with licensure and red tape challenges many times travel positions are in places where the facility is understaffed or secluded meaning you would be the only PT on site. Therefore, it is important to know what type of staff support will be there when you walk into the clinic for your first day. Especially as a new graduate, you want to make sure you are in a facility that has adequate support staff and may even be able to supply you with a faculty member for mentoring. These types of questions should be posed to both your recruiter and again further down the road during the interview process.

Although it is important to ensure you are getting the support you need in the clinic, we all know too well the significance of paying back student loans. Travel physical therapy has a clear financial benefit when compared to the traditional PT market. According to one article published by APTA “typical travel physical therapy jobs can pay 15%-20% more on average than permanent positions. Add to that benefits which often include insurance (health, life, dental, and vision), licensure reimbursements, a housing allowance, travel reimbursements, referral bonuses, and a bonus for completing a 13-week assignment.” Not to mention that some of those benefits such as the funds allocated for housing and meals are considered per diems and therefore are not taxed.

The relevant and helpful information and travel PT could be a volume of books. If the idea of travel PT inspires you, then I suggest researching some of the resources listed below, watching some of the wanderlust webinars, and reaching out to past Pitt PT alumni who have gone on to travel PT.

-Janet Mitchell, SPT

 

References:

https://wanderlustpts.com/

The Medical Nomads- Podcast by Dylan Callier, PT, DPT

http://www.apta.org/PTinMotion/2019/8/Feature/TravelingPTs/

http://www.apta.org/PTinMotion/2008/2/Feature/TravelingPTs/

October 21, 2019 |

Wine Night

Image result for wine glasses pictures

You are cordially invited to…

WINE NIGHT

All proceeds benefit the Foundation for Physical Therapy Research

This fundraising event includes a wine tasting, food, and raffles!

Date: Nov 8, 2019

Time: 6:00-8:30pm

Location: Bridgeside Point 1

100 Technology Drive

Pittsburgh, PA 15219

Cost: $30 per person

Wine: Sponsored by J&D Cellars

 

Register below!
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Any questions, please contact: pittmarquettechallenge@gmail.com

UNABLE TO ATTEND? You will be missed. Image result for make a donation

October 15, 2019 |