Monday Memo 10/16/17

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

October 16, 2017 |

Monday Memo 10/9/17

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

October 9, 2017 |

Monday Memo 10/2/2017

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!
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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

October 2, 2017 |