Monday Memo 4/15/19

The Monday Memo

April 15, 2019                                                                           PITT DPT STUDENTS



Resistance Training, Headache, and Cervical Spine Pain


Headache and/or neck pain associated with musculoskeletal disorders pose a significant problem not only to patients who report these symptoms but to society as well. The high prevalence of these disorders contributes to decreased productivity and increased time-off in workers (Schwartz et al., 1997). Many of these patients benefit from progressive resistance exercise to address cervical, periscapular, and glenohumeral musculature. However, there is much variation in the selection of resistance exercises, and innumerable factors to consider when seeking to drive adaptation in these patients. First, consider the FITTE principle:

  • Frequency
  • Intensity
  • Time
  • Type
  • Enjoyment

Above all else, clinicians must find a way to dose an appropriate volume – sets and reps – to drive positive adaptation that is enjoyable to the patient or client. There is research to support that exercise volume is a larger driver of hypertrophy than frequency of exercise or even intensity (Figueiredo et al.). However, pertinent contextual factors must be accounted for such as a patient’s current fitness level, lifestyle, occupation, previous level of activity, and training history. These factors play a large role in response to exercise, and the clinician must appropriately modify exercise dosage to account for them. Andersen et al. studied the effects of frequency of resistance training and found that, when weekly volume was consistent, patient outcomes did not differ between experimental groups for individuals with cervicogenic headache.

This means that the clinician and patient can tailor a program to fit the patient’s schedule and lifestyle. As clinicians we often hear, “I don’t have enough time to do my home exercises.” By carefully interviewing patients, it is possible to identify and agree upon the appropriate frequency for their program that will drive change and fit their schedule. For example, a patient may be willing to exercise 3 times per week for 20 minutes at a time, whereas another may only have two days per week to work out. The patient with only 2 days could then perform two 30-minute workouts.         Andersen et al. found that even 2 minutes a day of resistance exercise was enough to reduce neck/shoulder pain and tenderness! This short dose of exercise may be enough to get an otherwise sedentary patient to engage in physical activity. However, as discussed previously, volume is important to drive hypertrophy and develop strength in our patients. Once 2 minutes a day becomes manageable, the volume may be increased based upon patient tolerance. Let’s go over some exercises and progressions to address neck and/or shoulder pain. These are not all-inclusive.

  1. Seated cervical retraction + isometric sidebending:

Sample dose: 3 x 10; 10” 2 x 15 with isometric hold.

  1. Quadruped cervical retraction

Sample dose: 3 x 10; 10” 2 x 15 with isometric hold.

  1. Quadruped Y/T

Sample dose: 4 x 12; can add isometric holds or hand weights for progression.


  1. Blackburns Circuit

Sample dose: 6-10” holds in each position for 2 “laps.” Perform 3-4 sets.



-Joe Dietrich, SPT, ATC



Andersen, Lars L.a,*; Saervoll, Charlotte A.a; Mortensen, Ole S.a,b; Poulsen, Otto M.a; Hannerz, Haralda; Zebis, Mette K.a. Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: Randomised controlled trial. Pain. Volume 152(2), February 2011, p 440-446

C.H. Andersen, R.H. Jensen, T. Dalager, M.K. Zebis, G. Sjøgaard and L.L. Andersen; Effect of resistance training on headache symptoms in adults: Secondary analysis of a RCT. Musculoskeletal Science and Practice, 2017-12-01, Volume 32, Pages 38-43.

Figueiredo, V.C., de Salles, B.F. & Trajano, G.S. Volume for Muscle Hypertrophy and Health Outcomes: The Most Effective Variable in Resistance Training. Sports Med (2018) 48: 499.

April 15, 2019 |

Monday Memo 4/8/19

The Monday Memo

April 9, 2019                                                                           PITT DPT STUDENTS





What is SBIRT, you may be asking? It’s a process consisting of screening, brief intervention, and referral to treatment. It is an evidence-based tool to assess and intervene with patients with suspected substance abuse or at risk behaviors.

As physical therapists, we should expect to encounter these patients often. Many of our patients may be prescribed pain killers that may modify their symptoms temporarily, but lead to dependence. It is within our scope of practice to screen for these at-risk behaviors and, if the patient consents, to have a brief conversation delving deeper. This may not always be the easiest conversation to have, but an important one nonetheless.




A therapist may be able to pick up on possible at-risk behaviors while taking a patient’s history. If found, there are useful tools for further screening, including the Alcohol Use Disorders Identification Test (AUDIT) and The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).


Brief Intervention


Once at-risk behaviors are identified, the therapist should use their clinical judgment to determine how to discuss with the patient steps to change. Motivational interviewing allows the clinician to learn important details while letting the patient drive the conversation. Two acronyms to guide brief intervention are FLO and OARS. FLO stands for feedback, listening, and options. It is important to give the patient feedback, show them that you are engaged and listening, and allow them to explore their options. OARS stands for open-ended questions, affirmations, reflective listening, and summary. Asking open-ended questions allow the patient to share freely in a non-threatening environment. Affirmations are important to encourage positive ideas. Reflective listening and summary are used to demonstrate understanding.


Referral to Treatment  


If the patient expresses interest, there are several available resources to share with them:

SAMHSA’s Treatment Routing: 1-800-662-HELP

PA Single County Authorities:

Overdose Prevention Resources:

Alcoholics Anonymous: 1-212-870-3400

Narcotics Anonymous: 1-818-773-9999

Tobacco Free Quitline: 1-800-QUIT-NOW

Rather than shy away from these conversations, it is our responsibility as physical therapists to explore options and actively listen to our patients without judgment. Patients are more likely to open up about their behaviors when they feel heard.


-Katie Schuetz, SPT

-Layne Gable, SPT



April 8, 2019 |

Monday Memo 4/1/19

The Monday Memo

April 1, 2019                                                                           PITT DPT STUDENTS




Have you ever looked at the hands of someone over the age of 75? They tell a story. You may notice spots left by days spent in the sun, callouses left by years of hard work, or scars from an old sports injury. Those hands have clapped for performances and held the hands of others. They have allowed their person to engage and interact with the world, but these hands tell another story. They tell the story of the future. You may also notice atrophy where plump muscles were once prominent, thinning skin prone to bruising, and swollen joints struck daily with the pain of arthritis. And we can see all that in the hands. What about the rest of the person? We have a whole body, and save tragedies, we are all destined to age. How do we approach these aging bodies and the souls inside them? How do we offer the respect deserved by years of life experience on earth? Atul Gawande offers a unique and moving take on the subject of aging in his novel, Being Mortal: Medicine and What Matters in the End.


Throughout the novel, Gawande, a physician, explores the obstacles many elderly people face as they begin to require more assistance with everyday life and, ultimately, the trials and tribulations of end of life planning and the emotions that go with it. Dr. Gawande acknowledges times he failed to have the ‘hard conversations’ and is open about the learning process he had to go through to better serve his patients, even in a well-established career. His take on assisted living homes and hospice care as avenues to facilitate life, rather than usher in death, is particularly powerful. The purpose of these institutions should be to allow people to decide how they want to LIVE their final days to the fullest, not how they want to die.


I believe physical therapists can gain a lot from this novel in dealing with the geriatric population. We are taught to push and encourage our patients to better themselves and improve, but what about the octogenarian who is simply, not into it or just done? I think we have a unique opportunity there to effect change, and this is where patient-centered treatment and goal setting comes into play. Of course, as Dr. Gawande learns in his book, it is important to be honest and realistic, but that does not mean you cannot improve the quality of life in terminally ill patients.  He notes, “Our ultimate goal, after all, is not a good death but a good life to the very end.” Every patient should have the opportunity to share their goals with their therapist. We cannot simply assume that all older adults are content living out their lives playing Bingo. We as a society need to respect and appreciate that every older adult has had a long life to decide what they do and do not like to do. As a physical therapist, take note of those activities and find ways to incorporate them into treatment in interventions that provide an appropriate challenge, while being enjoyable and specific to the patient.


The next time an older patient sits down in front of you, take a look at their hands, ask them their story, and listen to their goals for life.


“In the end, people don’t view their life as merely the average of all its moments—which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story.” -Atul Gawande


-Katie Schuetz, SPT



Gawande, A. (2014) Being Mortal: Medicine and What Matters in the End. New York, NY: Metropolitan Books.

April 1, 2019 |