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 |

Monday Memo 1/8/18

Movement Analysis

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Human movement is amazing as there is always more to it than meets the eye. For instance, a squat is more than just a squat. It’s the ability to coordinate:

 

🔹Total Body Stabilization

 

🔸Hip Movement

 

🔹Knee Movement

 

🔸Ankle Movement

 

🔹Breathing & Abdominal Pressure

 

🔸External Load Management

 

The above list isn’t comprehensive, but it serves it purpose. It shows us that movement is composed of smaller parts, or base components, that work together to create the final product. When we analyze dysfunctional movement, it’s important that we identify in which component the dysfunction shows up. When we do this effectively, we’re provided insight into where we need to intervene or, at the very least, what to break down for further evaluation.

 

This concept really shines in the motor control phase of rehabilitation, as it can be applied to everything from the most simple to the most complicated movement pattern. Breaking a movement down into separate components allows us to utilize drills that work on specific areas of dysfunction. With intelligent programming, a training effect should take place, and we can re-test and shift our focus towards integration.

Take a look at the video below for one example:
 

MOVEMENT ANALYSIS | SUPPLEMENTAL DRILLS:

  1. Single-Leg Rockback

🔹 We can use this drill to improve our backside mechanics. The rock helps us load the posterior hip on our “support leg” while moving into deep hip & knee flexion, ankle dorsiflexion, and toe extension. At the same time, the opposite leg should be cued into active triple extension (hip/knee extension & ankle plantarflexion) to ingrain propulsion mechanics and aid in tensioning the system. Taking away the rear toe support by adding in the leg lift takes away some external stability & fully loads the support leg.

  1. Transitional Kneeling Drill

🔸 This drill helps us improve our frontside mechanics and mainly focuses on the swing phase. We want to encourage as much pure hip flexion as possible, avoiding compensatory hip abduction, rotation, or contralateral trunk lean that allows for circumduction in the swing phase. Once the leg has completed the swing phase and is acting in support, we can modulate our foot placement and anterior lean to increase or decrease the hip extension stretch we receive on the rear support leg.

 

 

The bottom line is that movement is nuanced. It’s complicated. But it can always be broken down into simpler, easier to digest, components.

 

  • Charlie Badawy SPT, CSCS, USAW

 

January 8, 2018 |

Monday Memo 1/1/2018

A Place To Play

 

Growing up, the playground was the place to be. This is where memories were made, friendships were created, champions were born, and competition wove its way into our innocent lives. I think that most people have some sort of positive memory associated with playing as a child and I believe that it is very important for creating a positive association with exercise, movement, and physical activity. This is why I believe it is important for everyone to be given the chance to participate in play. Recently, I came across and article of NFL quarterback, Drew Brees, in partnership with his foundation, creating an all-inclusive playground in New Orleans. I have never heard of all-inclusive playgrounds before this, so I looked into them a little further after reading the article, and what I found brought me tremendous joy as a student of physical therapy.

 

Essentially all-inclusive playgrounds aim to provide a safe, inclusive, and entertaining environment for children of all motor and sensory ability levels. A few of the companies that provide the equipment for these playgrounds have certain standards and considerations that help shape their goals for their products. Miracle Recreation uses four, “Must Haves,” when designing their equipment:

 

  1. Accessibility – There needs to be an ADA approved route to the playground
  2. Equal Opportunity – All children should be able to participate in ground level AND elevated play
  3. Variety – Offering a variety of play experiences can help children incorporate all senses.
  4. Integration – The play area should feel like a cohesive community where sensory rich play opportunities are included among the activity

 

Other organizations such as inclusive playgrounds.org by Playcore Inc. have a set of seven principles that they strive to achieve:

 

  1. Be Fair
  2. Be Included
  3. Be Smart
  4. Be Independent
  5. Be Safe
  6. Be Active
  7. Be Comfortable

 

A more in-depth explanation of their principles can be found on their website. One such playground can even be found here in the Pittsburgh area in Upper St. Clair’s, “The Clubhouse.” I encourage anyone who is interested to look further into these playgrounds, and support your local area in trying to increase the number of these facilities. Everyone should be included and everyone deserves to play.

 

-Jim Tersak, SPT, CSCS

 

January 1, 2018 |