Monday Memo 5/28/18

The Monday Memo

May 28, 2018                                                                           PITT DPT STUDENTS

A Sample of Pediatrics 

I am currently in the pediatric setting for the first time for my first 6-month clinical rotation. Over the past month, each day has been vastly different. Not only are the patients and their diagnoses different from session to session, but the patients’ behaviors vary each session, and sometimes even within session, as one can imagine with ages 0-18. I certainly have not been bored!

 

I believe physical therapists are naturally adaptable humans; we have to be in this health care environment, no matter the setting. As I’ve observed so far in the last month is that in pediatrics, especially, adaptability is vital. You have to be on your toes, and I mean the very tips of your toes, at all times. It certainly has made every day exciting and has allowed me to quickly develop my skills in a new setting.

 

With a new setting and experience, comes new diagnoses. One in particular that we learned about in the classroom is Reflex Neurovascular Dystrophy, or RND. In short, it is a condition that leads to pain in the musculoskeletal system in children, females typically affected more often than males. In this short month I have seen a large number of children that are being treated for this condition. Each presents differently, with varying locations of pain and wide ranges of pain. Despite medical tests showing normal results, the pain that these children are experiencing is absolutely real, and cannot be helped with pain medication. The pain can be so intense that these patients are limited from their previous activities such as sport, ADLs and even school.

 

Physical therapy and aerobic exercise is effective, but to treat RND, a psychological approach in combination with PT needs to be taken. While they are referred to psychology, everyone on the medical team needs to be on the same page and take the biopsychosocial approach to treatment. Pain is not discussed during PT except for initial evaluation and recurring reevaluations. These patients are educated on pain management and stress reduction strategies to “power through the pain”. As a PT, it is important to establish a comprehensive program of aerobic and general strengthening and conditioning exercises, but perhaps most importantly, to educate the patient and family to tackle this condition together. It is more common that one may expect, and is something that can recur throughout the lifetime. Even if you are not working in pediatrics, being aware of this diagnosis is helpful, because inevitably, the child is going to grow up to be the adult we see in all settings. It is vital to establish a program and psychologically informed PT strategies so that this chronic pain can be dealt with throughout the lifetime and won’t hinder the patient from living a full, active life.

 

So far the experience has been unique and I’m excited to continue to learn so much more.

May 28, 2018 |

Monday Memo 5/21/18

The Monday Memo

May 21, 2018                                                                           PITT DPT STUDENTS

PTs as Leaders

Leadership dons many colors. There is no singular quality that defines it, and no distinct formula that produces the individuals who exhibit it. The act of leading is a multifaceted endeavor imbued with nuance and shaped by instinct. As budding leaders in the field of physical therapy, these are ideas that should not be readily forgotten – especially in the ever-evolving landscape of healthcare – and as such, particular attention should be given to the foundational traits that allow us to have the greatest impact among our colleagues and those we rehabilitate. As we look to “transform society by optimizing movement to improve the human experience”, it is essential that we commit ourselves to visionary thinking and refining the skills required to communicate those thoughts.

 

Leadership is many times firmly associated with the qualities most representative of delegation. While unfortunate, this is not without merit as leading requires the ability to coordinate many individuals and unify an effort in the direction of one common goal. In physical therapy we see this most commonly in the collaboration between therapists, assistants, rehab aides, and administrative staff. However, to see leadership solely in this capacity is both an incomplete and one-dimensional assessment. The act of delegation is simply a conduit for the communication of a greater vision, and without vision the operation ceases to exist. Whether it be for a single patient or an entire cohort, a leader in physical therapy cannot affect change in absence of innovative thought. Patient care is a dynamic process because the patients are inherently dynamic themselves. They are fluid in both their internal and external environment, and the only way we can accommodate this is if we are fluid as well. We cannot afford to be static and we most certainly cannot expect to apply cookie-cutter methodology to every patient of the same ailment. We must be malleable and adaptable so that we can best execute the overarching goals of our care and meet the needs of the individual.

 

Equally important to the formation of this vision is how we choose to communicate it. Patient care is a complex network of various healthcare professionals and the community in which the patient exists. The success of our care is ultimately dependent upon how we articulate our course of action and the interventions we utilize. How we construct that communication comes first from the insight we glean from the patient profile. From here we can begin to devise how we conduct our patient interview and collect the information necessary for formulation of a plan of care. Further synthesizing that information is entirely dependent upon our ability to listen to not only the patient’s story, but also its subtext. To put it simply, our insight only goes as far as our willingness to listen, and its quality only as strong as our empathy. We may guide the patient through their rehabilitation, but they ultimately guide our treatment decisions. Through this marriage of insight, active listening, and empathy we can develop the clearest picture of our patients and a much more linear, streamlined approach to communicating their care.

 

Though a leader in physical therapy is not limited these skills in practice, they are essential foundational pieces on which to build our influence. By situating these elements within our scope of care, we will not only initiate a transformation, we will also pioneer progress.

-Holden Sakala, SPT

May 21, 2018 |

Monday Memo 5/14/18

The Monday Memo

May 14, 2018                                                                           PITT DPT STUDENTS

Two Runner Specific Pelvic Stability Drills

 

Most serious runners know the importance of strong glutes, but may not understand how they complement & interact w/ the hip flexors! It’s accurate to describe these muscle groups as being antagonistic, because they perform opposite functions, but this is too simplistic in my opinion.

 

In reality, these muscle groups complement one another in functional movement! We can think of one group stabilizing & locking down the pelvis, allowing a strong, stable platform for the other to produce force!

 

Let’s dive into this concept w/ two stability drills that focus on this concept of “pelvic stability” from opposing ends.

 

EPISODE 114 | Two Runner Specific Pelvic Stability Drills . Most serious runners know the importance of 💪🏽 glutes, but may not understand how they complement & interact w/ the hip flexors! . It's accurate to describe these muscle groups as being antagonistic, because they perform opposite functions, but this is too simplistic imo. . In reality, these muscle groups complement one another in functional movement! . We can think of one group stabilizing & locking down the pelvis, allowing a strong, stable platform for the other to produce force! . Let's dive into this concept w/ two stability drills that attack it from opposing ends. . . 1️⃣Supine Psoas March . Here the hip flexors work to maintain pelvic position as we extend the other hip using our glutes. . If the glutes were left unchecked, they would pull the pelvis into a posterior tilt & limit the amount of force we can apply to the ground in gait. . Instead, the band activates our hip flexors, allowing them to produce a contraction that maintains stability. . In the case of weak & dysfunctional hip flexors, we may see compensation patterns from the other stabilizing muscles, such as the muscles in our lower back, in which we would likely see arching of the lumbar spine. . Taking this a step further, this drill can carryover to backside running mechanics, or our ability to exert force to the ground & propel forward. . 2️⃣Glutebridge Psoas March . Here we see just the opposite! . The sustained glutebridge provides a constant contraction that stabilizes our pelvis as we drive our knee to our chest using our hip flexors. . W/out functional glutes, the hip flexor contraction would spill our pelvis forward into an anterior pelvic tilt. . This is often the case in runners who fail to recognize the importance of strength training & can lead to back pain, muscle strains, & an inability to reach their full potential. . Applying this to the gait cycle, this is truly a frontside mechanics drill. The importance of driving your knee forward is often overlooked, but good luck generating any sort of speed on hills or during a true sprint w/out effective strong hip flexors. . #StoutTraining #DPTstudent #PerformBetter

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

 

1. Supine Psoas March

  • What’s happening:
    • Here the hip flexors work to maintain pelvic position as we extend the other hip using our glutes. If the glutes were left unchecked, they would pull the pelvis into a posterior tilt & limit the amount of force we can apply to the ground in gait. Instead, the band activates our hip flexors, allowing them to produce a strong isometric contraction that maintains stability.
    • Applying this to running, this drill can provide carryover to backside running mechanics, or our ability to exert force to the ground & propel forward. We’re training our hip extensors to contract in a dynamic (concentric/eccentric) fashion with this drill.
  • What to look out for:
    • In the case of weak & dysfunctional hip flexors, we may see compensation patterns from the other stabilizing muscles, such as the muscles in our lower back, in which we could see arching of the lumbar spine. The trainee will likely feel the movement less in their anterior core and more so in their lumbar erectors if this is the case.
    • In addition, the trainee may drive into excessive lumbar flexion. The trainee may still feel the exercise in their hip flexors and anterior core, but they’ll likely lack the sensation of stiffness and power in the hip extensors of the extending leg.

Glutebridge Psoas March

  • What’s happening:
    • Here we see just the opposite! The sustained glutebridge provides a constant isometric contraction that stabilizes our pelvis as we drive our knee to our chest using our hip flexors. In contrast to the Supine Psoas March, we’re now training our hip flexors to contract dynamically! They produce a strong concentric contraction as you drive knee-to-chest and contract eccentrically to fight the band with the return to the starting position in a controlled manner.
    • Applying this to the gait cycle, this is truly a frontside mechanics drill. The importance of driving your knee forward is often overlooked, but it will be difficult generating any sort of speed on hills or during a true sprint w/out effective strong hip flexors.
  • What to look out for:
    • Without functional glutes, the hip flexor contraction may spill our pelvis forward into an anterior pelvic tilt. In addition, the trainee will likely have difficulty simply maintaining the starting position. In this case, it would likely benefit the individual to choose another drill, such as a Glutebridge March and/or Single-Leg Glutebridge variations, paired with hip flexor strengthening that don’t demand the same type of performance from the glutes.

-Charlie Badawy, SPT, CSCS, USAW

 

May 14, 2018 |

Monday Memo 5/7/18

The Monday Memo

May 7, 2018                                                                           PITT DPT STUDENTS

Student Spotlight

 

Students: Bobbie Kolarik and Emily Baumann, DPT Class of 2019


Q: Hey Guys. To get started, would you mind telling us a little bit about yourself: Where did you grow up? Where and what did you study for your undergraduate education?

Bobbie: I bleed black and gold! Pittsburgh born and raised! I went to Allegheny College for my undergraduate where I majored in Neuroscience and minored in English.

 Emily: I grew up in New Jersey 20 mins from NYC and came to Pitt for my undergraduate, which is a BS in Rehabilitation Science. Even though I’ve lived in Pittsburgh for a while I don’t bleed black and gold yet like Bobbie.

Q: You guys were/ are both involved on a rugby team. Tell us a little about that. How’d you get involved?

B: I was committed to playing softball at Allegheny, but it was as a walk on status (long story, but I had a spot on the team). However, my final year playing in high school was challenging and I kinda lost my passion for it. I signed up for rugby at the activity fair….not to be a total dork, but I was looking for the Quidditch booth ( “Q” and “R” are super close in the alphabet…). I signed up at the rugby booth with no real commitment (plus Allegheny did not have a Quidditch team at the time….I believe they do now).

….I went to one practice and literally fell in love….I will start my 8th season this year.

E: I remember wanting to play for the LONGEST time- since I first found out rugby was a sport in middle school, but I always just stuck to being a goalkeeper in soccer. My first real exposure to the sport was when I visited my sister at college and watched her team play- I was definitely hooked. Unfortunately, I tore my ACL just before college started, but fortunately I’m too stubborn to let that stop me. I still joined the club rugby team at Pitt and acted as the cheering crew for the first semester. Then when I was fully recovered, I played with them for the duration of undergrad. I always try to seek out local teams though- I played when I was studying in Ireland, while living in Anchorage, and for the first year of PT school with Bobbie on a local Pittsburgh team. I just made the tough decision this past fall to retire, but who knows if that will be permanent.

Q: What position do you play and could you describe it for those of us who aren’t as familiar rugby?

B: Rugby is unique in the fact that the number on the back on your jersey determines your spot. There are 15 people on the field per team. Numbers 1-8 are forwards, who are simply thought to do the “heavy lifting.” Numbers 10-15 are the backs, who are simply thought to be the “fast or quick players.” I know I forgot number 9….who is the scrum half. This is the link between the forwards and backs and is thought to be “the quarterback of rugby.” While I have played all the positions, I mainly play in the forwards. Currently, I play number 2 A.K.A the hooker (I realize how that sounds…) But the position is called that because in the scrums, it is my job to “hook” the ball back to my team to gain possession.

E: I’ve also played multiple positions but I’m always a forward because I run about as fast as a snail. Most of the time I’m a prop because in the scrum I support the hooker (let the jokes continue) and “prop” up the scrum to keep it from collapsing. A scrum is one of the most recognizable things about rugby- it’s when 8 players from each team form a sort of battering ram and push against each other for control of the ball after a penalty. The other notable thing people think of with rugby is our lineouts which happens when the ball goes out of bounds. It’s similar to a throw-in in soccer, but with rugby you have players jumping and being lifted high into the air by their teammates to fight for possession of the ball. My jumping is as pitiful as my running so I do the lifting.

 

Q: Rugby is known for being a tough sport, tackling with fewer pads involved. Any comment on this?

B: I think all sports have their dangers and rugby is no different. However, if you practice and use the right technique, the dangers drastically decrease. Rugby tackling is very different from football tackling and honestly, over half the tackles I watch in football would result in a penalty in rugby. There are no pads, so I think generally people realize they have to be smart about play to avoid injury. That being said, I have had some nasty bruises in my days. The only equipment you need is a mouth guard and boots (soccer cleats). But you can opt to wear a scrum hat, which I do.

E: I agree that Americans get really deterred when they hear no pads because they immediately think of football tackles which are pretty different from rugby tackles. New players aren’t even allowed to practice in full contact until they learn how to tackle and fall with proper techniques that emphasize safety over power. Obviously when you slam your body into another person you’re going to have some bruises no matter how perfect your form is, but the only injury I even sustained while playing happened because I had sloppy form. There’s a lot of hard work behind the scenes that is focused on playing safe. Many of the official rules are specifically in place to prevent dangerous play and it’s the referee’s primary job to make sure those are followed.

Q: As future physical therapists, how do you think your involvement in the sport will contribute to your future practice?

B: I think it is important to have passions outside of PT. I love rugby and I wish I had found it out sooner to be honest. Rugby, like PT, allows me to continue to challenge myself physically and mentally. I have had the pleasure to treat a couple patients who play rugby and I enjoy thinking up TE that they can use during rugby. It also has cross over to other sports like soccer and football, so I can emphasize with those patient populations and create programs that are functionally fun.

E: The culture surrounding rugby has often been described as cult-like, but you’d be hard pressed to find people more open and accepting. The sport inherently requires a team of players who are diverse in their abilities; the muscly and strong forwards are just as important as the speedy and agile backs. Though the banter between the two sides would lead you to question if we even play the same sport, we welcome these differences and challenge each other to improve and achieve our goals as players. I think this translates really well to my future as a PT where no two patients will be alike and it’s my job to assess their strengths, abilities, weaknesses, and limitations no matter how different they may be and then help them improve to achieve their own goals.

Q: Any competitions in the near future?

B: Our team plays year-round basically. We have games this spring and USA rugby has not yet released our main competitive fall season. When the dates are in, we can post them around if people are interested.

E: Yeah come out for a game or two! It’s a ton of fun to watch and the players are always chatty and willing to answer questions about the game.

Q: What are your career goals or next steps after your graduate?

B: Is undecided still an option here?? I did one inpatient stay my first year and liked it more than I expected….But I also have been working for UPMC for 6 years as a rehab aide in an outpatient setting and I love that….Can I just say I love PT here?

 E: I’ve gravitated towards outpatient ortho with past rotations but I don’t have a particular preference for PT settings. I reeeeeally dig the idea of travel PT though. Getting paid to travel around the country and do a job that I love? Yes please!


Q: Anything else you’d like to share with the readers?

B: Don’t let Rugby intimidate you!! Its super fun and if anyone ever wants to come to a practice to just try it….you are always welcomed!! J Don’t knock it till you try it!

E: Not just rugby- don’t knock any sport until you try it. People who have been playing for years make it look easy and it can be disheartening when you’re not immediately a great player. That being said, rugby has an awesome group of people who are more than happy to put in the time and effort to make sure you’re safe and having fun while playing.

May 7, 2018 |