Monday Memo 7/16/18

The Monday Memo

July 2, 2018                                                                           PITT DPT STUDENTS

Community Resources

 

The APTA’s “Guiding Principles to Achieve the Vision” which supports the APTA’s “Vision Statement for Physical Therapy” highlights the importance of one of the many roles of physical therapists: promoters of health and wellness:

 

“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. The complex needs of society, such as those resulting from a sedentary lifestyle, beckon for the physical therapy profession to engage with consumers to reduce preventable health care costs and overcome barriers to participation in society to ensure the successful existence of society far into the future.”

 

As much as treating impairments is a duty of physical therapists, such is contributing to society by encouraging active lifestyles. Having these conversations (not lectures) with patients contributes to the overall health of our patients but also, as we know, helps to reduce health care costs in the long term. Every patient will reach the end of their journey with physical therapy, and will no longer have a skilled need. It would be easy to say goodbye and never worry about those patients again. However, it is our responsibility to educate our patients on the importance of activity outside of a therapeutic realm.

 

We have the luxury of getting to know our patients on a more personal level, learning their interests and lifestyles. With the combination of knowledge of the individual and knowledge of the surrounding community, we can become excellent auxiliaries and resources. With an individualized approach, we can urge the use and importance of local community resources. This can be as simple as providing information about nearby parks, upcoming city events such as walks or races, or local gym facilities. There are often facilities or local gyms that have adaptive programs for both children and adults.

 

Often, physical therapists can be the primary source of information to help patients become more aware of their local communities and the opportunities it presents. Not only should this be a conversation at discharge, but an educational component throughout the entire course of treatment. Emerge yourself in the community and encourage your patients to do so as well!

 

July 16, 2018 |

Monday Memo 7/9/18

The Monday Memo

July 9, 2018                                                                           PITT DPT STUDENTS

Side Plank Basics
The Influence of Gravity

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The classic Side Plank is a fantastic exercise and you shouldn’t just take my word for it! It has been researched countless times and top researchers, clinicians, & coaches swear by this lateral chain exercise for developing stable trunks all over the world!

 

Without diving into the anatomy, I want to touch on an important concept that can be applied to the Side Plank. That is, using the influence of GRAVITY to progress. In all things movement, our central nervous system recruits muscle fibers to contract & propel our body weight (plus external resistance) against gravity. How we orient our center of mass and direct our movement in relation to Earth’s gravitational pull will play a significant influence on the difficulty of an exercise and the tissue stressed.

This concept is a basic principle that all therapists and coaches who be wise to keep in mind. Understanding the influence of gravity and its effect on the human body is helpful in allowing practitioners to critically analyze a situation and choose a proper exercise strategy that meets its demands. With a static exercise like the Side Plank, it’s extremely easy to visualize this concept and find ways to manipulate gravity in order to achieve a training effect.

Take a look at today’s video to find out how!

 

 

EPISODE 133 | The Lateral Line: Side Plank Basics . No joke, the classic Side Plank is the bees knees 🐝 . And you don’t even need to take my word for it! . 🔎It’s been researched countless time and top researchers, clinicians, & coaches swear by this lateral chain exercise for developing stable trunks all over the world! . @backfitpro @bodybyboyle @coach_brettb @perform_better @thestrengththerapist @cal_strength @mikereinold @dr.joelseedman_ahp @clinicalathlete @quinn.henochdpt @docandjockpodcast @jockowillink . . . Without diving into the anatomy today (we’ll get to that in future episodes), I want to touch on an important concept. . 💡Using the Influence of Gravity to Progress an Exercise💡 . 🔹In all things movement, our central nervous system (CNS) recruits muscle fibers to contract & propel our body weight (plus external resistance) against gravity. . 🔸With a static exercise like the Side Plank, it’s extremely easy to understand this concept & find ways to manipulate gravity in order to achieve a training effect. . 🔹Take a look at today’s video to find out how! . . . 💠BONUS💠 This concept is arguably even more important for the PUSH-UP! No more “Girl Push-Ups…” Elevate those hands! . Questions, comments, concerns? Drop a line in the section below! . #StoutTraining #DPTstudent #Plank

A post shared by Charles Badawy SPT, CSCS, USAW (@coach.charlieb.spt) on

 

July 10, 2018 |

Monday Memo 7/2/18

The Monday Memo

July 2, 2018                                                                           PITT DPT STUDENTS

Teaching the Hip Hinge:

Dowel Rod Hinge Mechanics

 

 

As an avid reader of the University of Pittsburgh’s Monday Memo, you likely understand the importance of mastering a proper hip hinge. A proper hinge is demonstrated when the subject bends primarily at the hips, recruiting the posterior chain while using the anterior core to lock down the ribcage and help provide spinal stability.

 

The Dowel Rod Hip Hinge is an excellent way to help your patients develop this motor pattern! Prescribing this movement as homework to help ingrain proper motor recruitment with frequency allows the therapist to accelerate motor learning, opening up the door for you to load the pattern in-clinic & challenge integrity by adding variables such as strength, speed, power, and instability.

 

Take a look at the video below for a quick lesson on identifying improper hip hinge mechanics and how to mix them!

 

EPISODE 89 | Dowel Rod Hip Hinge Mechanics . As we've discussed in the past two episodes, mastering a proper hip hinge is incredibly important. . A proper hip hinge helps the trainee recruit their posterior chain musculature: Glutes 🍑, hamstrings, spinal extensors. . Developing a strong posterior chain is UNDERRATED & can often help alleviate knee & back pain!💪🏽 . 🚨Here's a quick list of what you DON'T want to do!🚨 . ❌Allow the knees to cave inward . ❌Lift the toes up and roll onto your lateral foot . ❌Extend at the neck, leading to excessive spinal extension & loss of contact with the dowel . ❌Rounding at the back, increasing strain on the vertebral bodies/discs & losing contact w/ the dowel at the sacrum. . . So what makes a proper hip hinge??? . ✅ Screw the feet into the groun, creating external rotation torque that will help the knees travel out over the ankles for optimal force production 💪🏽 . ✅ Hips drive straight back, showing a smooth posterior weight shift 👍🏽 . ✅ Minimal forward knee travel, maximizing the tension on the posterior chain! 📈 . ✅ Maintain three points of contact with the dowel at all times ➡️ This ensures neutral spinal loading throughout the motion! 1️⃣ Back of the head 2️⃣ Between the shoulder blades 3️⃣ On the sacrum, between your butt cheeks! . . Questions, comments, concerns? Drop a line in the section below! . Please like & share this post with a friend who is always complaining of knee or back pain! They likely could use some hip hinging in their life! . #StoutTraining #DPTstudent #PosteriorChainGang #PerformBetter

A post shared by Charles Badawy SPT, CSCS, USAW (@coach.charlieb.spt) on

 

 

 

 

🚨Here’s a quick list of what you DON’T want to do!🚨

 

❌Allow the knees to cave inward

 

❌Lift the toes up and roll onto your lateral foot

 

❌Extend at the neck, leading to excessive spinal extension & loss of contact with the dowel

 

❌Rounding at the back, increasing strain on the vertebral bodies/discs & losing contact w/ the dowel at the sacrum.

 

 

What should we focus on?

 

✅ Screw the feet into the ground, creating external rotation torque that will help the knees travel out over the ankles for optimal force production 💪🏽

 

✅ Hips drive straight back, showing a smooth posterior weight shift 👍🏽

 

✅ Minimal forward knee travel, maximizing the tension on the posterior chain! 📈

 

✅ Maintain three points of contact with the dowel at all times ➡️This ensures neutral spinal loading throughout the motion!

1️⃣ Back of the head

2️⃣ Between the shoulder blades

3️⃣ On the sacrum, between your butt cheeks!

July 2, 2018 |

Monday Memo 6/25/18

The Monday Memo

June 25, 2018                                                                           PITT DPT STUDENTS

Understand Your Athletes

 

Recently, I have had an increasing interest in adaptive sports. Fortunately, through the Physical Therapy department at the University of Pittsburgh, I have had the opportunity to get involved in a new and developing program working with the Pittsburgh Steelwheelers, a local wheelchair basketball team. An exciting part about working with these athletes is that we are able to work at high intensities while using typical, or more often, fun and creative exercises. Today I am going to discuss some major areas that we focus on training for a sport such as this. Also, as we begin to grow this program, we are lucky enough to have students such as the President of the class of 2019, Charlie Badawy, who has worked with the Mighty Penguins training program, along with many of our students, to offer us guiding resources. An example of our major training focuses come from these sources and are briefly discussed below.

 

  1. Trunk
    1. Mobility – Having proper trunk range of motion, in single and multiplanar movements, is vital for performance and injury prevention. Certain motions may be limited due to the nature of the sport, so it is important to screen athletes for deficits or hypermobility and address these issues in your training.
    2. Stability – Creating a solid base is important in everyday activities, but even more so in high-intensity athletic situations. Core stability is a major factor in the change of direction, athletic movements, and fundamental skills of wheelchair basketball, and can be trained for control, strength, and endurance.

 

  1. Upper Extremity
    1. Range of Motion – Proper upper extremity range of motion, especially scapulothoracic and glenohumeral range of motion, is necessary for decreasing the risk of traumatic and overuse injuries.
    2. Endurance – The literature has shown that rotator cuff injuries are prevalent in wheelchair basketball and other adaptive sports that have a large amount of upper extremity involvement. We try to address this by including endurance rotator cuff exercises that use small loads but aim to utilize high rep ranges or even reps for an extended period of time.

 

Understanding your athletes and the demands or their sport will help in guiding your training. Based on physical therapy principles, a lot of our training is not only designed to increase performance but also decrease the risk of injury. We try to address the most common injuries, whether from muscle imbalance, overuse, etc. and incorporate exercises to work on these issues every session.

 

-Jim Tersak, SPT, CSCS

June 25, 2018 |

Monday Memo 6/18/18

The Monday Memo

June 18, 2018                                                                           PITT DPT STUDENTS

 

Clicker Training and Task Analysis

 

A few weeks ago, 2nd-year president Jim Tersak wrote about learning a new skill and the ways in which we can break down practice to learn that skill. Not long after reading Jim’s memo, I heard an interesting podcast discussing the ways in which we learn. I highly recommend checking it out. The episode focused on the importance of the learning environment during the cognitive stage of motor learning, and the effect of an instructor’s feedback upon the learner. First, let’s talk about some basic principles of skill acquisition.

 

Table 1 outlines the principles of experience-dependent plasticity as taught in Neuromuscular PT. As clinicians, we help our patients acquire new skills and refine their movement patterns. It is imperative for us to carefully design the environment in which our patients learn, and control as many aspects of that environment as possible to avoid interference. Whether caused by environment, the student, or the instructor, interference can occur in response to a single experience during skill acquisition and negatively impact future training. In the podcast, Dr. Martin Levy discusses the role that feedback plays when training surgical residents. He explains how external feedback may be misconstrued by students early in the learning process, and that this negative emotional association can impede the ability to learn that skill in the future.

 

To remedy this issue, Dr. Levy has adopted a style of teaching which has long been used by animal trainers: a clicker. He uses a clicker to provide objective, external feedback when instructing orthopedic residents in various skills required for surgery. He prefers the technique because it removes the learner’s desire to be rewarded by the instructor. Instead, the students are rewarded by perfecting the movement. As soon as they perform the task correctly, Levy simply clicks and they move on to the next step. The system is binary: either the learner correctly performed the task or they did not. This allows the student to focus on intrinsic feedback (aka the information received from visual, motor, and somatosensory systems) when completing the training, which is then verified by the external feedback of Levy’s click. This emphasis on intrinsic feedback enables the students to correctly perform surgical tasks under a variety of conditions.

 

The key to appropriately utilizing this technique is to first perform an extensive task analysis on the skill being taught; the clinician must be able to break down the whole task into its smallest components, just like Jim discussed in his memo. Levy teaches each component until it becomes highly skilled, then manipulates his students’ environment to prepare them for real OR scenarios. We must be able to do the same for our patients and for ourselves as we learn. For example, when learning to perform joint mobilizations, our body mechanics are absolutely critical. We can effectively master this technique by breaking down the task into steps:

  1. Patient positioning
  2. Table height
  3. Clinician foot placement
  4. Clinician hand placement
  5. Direction of mobilization, force of mobilization, etc.

 

If we are able to effectively analyze a task to promote our own learning, then we can apply similar logic to educating our patients. By coaching a patient through the foot placement, then ankle, knee, hip, and trunk movement, we can effectively help them master a lateral step-down task.

 

Clickers may not be ideal in a physical therapy setting, and some patients could potentially be offended at the thought of using one. However, we can utilize the key principle that the clicker provides by simplifying our feedback and optimizing our patient’s environment. This allows our patients to focus more fully on the task at hand, so that you can make the environment increasingly more functional after they’ve mastered the basics. A simple ‘yes’ or ‘no’, or even a click, can go a long way.

 

-Joe Dietrich, SPT, ATC

 

References:

https://www.ncbi.nlm.nih.gov/pubmed/26369658

https://www-ncbi-nlm-nih-gov.pitt.idm.oclc.org/pubmed/18230848

https://www.npr.org/2018/06/04/616127481/when-everything-clicks-the-power-of-judgment-free-learning

June 18, 2018 |