This weekend, I was given the chance to attend the PPTA conference at Seven Springs resort and listen to a lecture about osteoporosis and bone health. While at the conference, I was amazed by all the different treatments and treatment techniques that could be performed to increase the quality of life for patients with Osteoporosis. However, it got me thinking about other, more everyday treatments, our patients might be carrying out in their daily lives. Thinking of what two of my favorite television characters, Meredith Grey and Cristina Yang, do when they need some therapy and my mind immediately thought of dancing. Having been volunteering for the Yes, You Can Dance class for people with Multiple Sclerosis for the past few months, I couldn’t believe that I hadn’t thought about that sooner.
One of the best decisions I have made in my physical therapy school career thus far has been to volunteer for the Yes, You Can Dance class. It has taught me so much not only about working with people with Multiple Sclerosis, but also myself and my identity as a future physical therapist. Although this class benefits me tremendously as a mentor, the benefits for our students are also insurmountable. Various studies show the carry over of dancing in patients diagnosed with musculoskeletal impairments to increased functional ability. Dancing has also been shown to be the only physical activity that helped to decrease the risk of dementia and improve mood. Each patient is so passionate about dancing and it has been a wonderful experience to see them become better, more confident dancers each week.
As PT’s, we can think of our patients like our dance partner. Just like with a dance, as physical therapists we work together with our patients to accomplish specific goals or specific dances moves to continue with the dance metaphor. Both require having a sense about how your partner/patient can move so you can set them up for success, both in your treatment program or in the dance number you are performing. These activities also require developing the trust of your patient or partner. Without that trust as a dancer, your partner might not be able to perform to the best of their ability for fear that they might fall or that they might make a mistake (but really in dance there are no mistakes, only ‘creative changes’!). Without that bond of trust that we establish as physical therapists, we might not be able to get all the information we need from our patients to treat them to the best of our ability. Great dancers are great because they are passionate about what they do and great physical therapists are no different. Being in a person-centered profession, it is that passion which allows us to establish these relationships and be better clinicians as a result.
-Teresa Toomey, SPT
I became interested in learning about this funny word because I grew up with horses and have seen some of the benefits they provide to people. It wasn’t until recently that I discovered physical therapists can use horses as a type of treatment. I began volunteering at a local farm outside of Pittsburgh where I have learned more about this type of therapy.
Hippotherapy can also be described as Equine Assisted Therapy, or therapy with the help of the horse. The professions of occupational therapy, speech-language pathology, and physical therapy can use evidence-based practice and clinical reasoning to manipulate the movement of the horse in order to achieve a functional outcome for patients. It is most commonly used for children with disabilities, but others who have suffered from a stroke or spinal cord injury may benefit as well. This is usually done with one person leading the horse, and two people walking on either side (one of which is the therapist), next to the patient. Typically, only a saddle pad and surcingle are used instead of an actual saddle so that the patient is not separated from the horse’s movement.
This works because the horse’s pelvis moves in the same three planes as the human pelvis. In other words, sitting on a walking horse sends your brain the same signal as when you are walking. This reciprocal movement activates the central pattern generators of the brainstem; for some, this is the first time the patient’s brain has received the sensory input of walking. This type of therapy is not done in isolation, it is in addition to the patient’s plan of care.
There are numerous movements you can do with a horse to reach a certain outcome with a patient. There is a huge benefit simply of walking in long straight lines on the horse because of the reciprocal movement. If the patient requires more sensory input, the horse can increase its speed or the patient can be placed on the horse facing backward. If a patient has a right sided hemiparesis, the horse could walk in tight circles to the right to increase activation of the right neuromuscular system. The stopping and starting movements of the horse work the patient’s flexors and extensors which can greatly improve trunk control.
I believe having a basic understanding of this type of treatment is important as students of physical therapy. The horse can facilitate neuromuscular movement that our own modalities and treatments cannot, and it may serve a future patient of yours well to remember.
-Mallory Weiss, SPT
A Student’s Reflection on The Scully Lecture
In the Scully lecture, Dr. Delitto discussed a hot topic issue that our country, the opioid epidemic. Each year many people go see their doctor for low back pain (LBP). While some patients get a referral for physical therapy, even more receive pain medications. The question I’m sure many of you are asking is “Why isn’t everyone being referred to PT?” or “Why don’t patients just come see us first?” As physical therapist, it seems obvious that we can best treat these individuals and provide them with the best care, but how do we get everyone else to see it this way?
As I am beginning to realize, it is going to be a slow process of building our brand and getting people to recognize physical therapists as first contact practitioners. Although this won’t happen overnight, we should not take a back seat in the meantime. As young professionals, we now have the opportunity to shape this brand and the profession that we will be working in for years to come. For one, we can use social media to share our experiences as physical therapists and inform others about what we do. This is one of the most accessible resources available to us, one that we are all familiar with, and best of all, it’s free! As physical therapists, we can also make sure to be active in the community, whether it is participating in sports for individuals with disabilities or screening runners at a local race. The more contact we have with people, the better we can educate them about what we do. Individuals who have been to physical therapy are more likely to go to a physical therapist as a first contact provider in the future. Lastly, I encourage you all to become involved with the APTA. As our professional organization, they support us through legislative advocacy, clinical practice guidelines, and campaigns for public awareness.
-Robert Jesmer, SPT
Interpreting Hip Pain
Currently, the 1st year DPT students are approaching our musculoskeletal exam involving the evaluation, assessment, and treatment of the hip. I thought it would be appropriate to post a hypothetical case study of presentation that we may potentially see on our exam or in the clinic.
Case: A patient comes into your clinic for groin pain. He is a 65-year-old independent male. You begin taking his history and discover the following; the pain began two weeks ago, but he cannot recall a specific event that brought on his discomfort and the pain is located in his lateral hip. He also tells you that at first, the pain would be worst after he had been gardening for hours, but now, he notes that the pain comes on even when doing something as simple as getting his newspaper from the driveway. He then tells you that he also has been feeling pain on the medial side of his knee. Upon further questioning, he reveals that he has had trouble sleeping because of the pain.
Using this information, think about what further questions you would want to ask and what tests and evaluation methods you would use to create differential diagnoses for this patient. Depending on what you believe to be a possible diagnosis, determine how you would decide to treat this patient.
-James Tersak, SPT, CSCS
Progressing the Clamshell
No matter the goal, it’s likely that you’re not going to get there after just one session. It takes practice. It takes repetition. It takes planning.
The mark of a good therapist, regardless of your setting, is the ability to properly progress their patients towards their end goal. In order to do so, you need to incorporate progression into the training program.
The most basic form of progression when it comes to resistance training is the manner in which you increase load. For example: Increasing by five pounds each session. A much more difficult concept is to apply progression to movement patterns & muscular development. This is critically important in a rehab setting, where patients may not be able to progress quickly enough to continually increase load.
The Clamshell Bridge is a great way to progress GluteMed strength! As a therapist, odds are high that you’ve prescribed Clamshells more times than you care to count. We can make this simple exercise much more difficult!
- The Clamshell Bridge takes the movement a step further! We’re performing abduction & external rotation of the weight-bearing hip to lift our body up off the ground.
- We’re maintaining isometric GluteMed activation at the top to support our bodyweight, which also allows us to tie in lateral chain core stability in order to maintain proper positioning.
- In addition, we begin to layer in closed-chain shoulder stability and get the benefit of an eccentric GluteMed contraction on the descent!
Add this exercise into your routine the next time you train. Play around with it and get the feel for the movement, it’s nuances, and any potential compensatory patterns that a patient may attempt to use.
If you like it, add it to your list of rehab progressions!!
-Charles Badawy, SPT, CSCS, USAW