Monday Memo 7/17/17

The Monday Memo

July 17, 2017                                                                           PITT DPT STUDENTS

Concentric & Eccentric Contractions

As therapists, we understand so much about the human body and how it functions. It’s important to realize, however, that in many ways the ultimate goal is to educate the patient who’s coming to us for help.

 

We understand that our muscles act in many ways: statically or dynamically, quickly or slowly, voluntarily or involuntarily. One concept I continually stress to my patients is that of eccentric and concentric contractions. It’s a topic that most of us probably take for granted, but an effective explanation can make all the difference when it comes to patient buy in.

 

Let’s begin with defining three terms:

🔹Isometric Contractions: When a muscle produces force without changing length.

🔸Concentric Contractions: When a muscle produces force and shortens.

🔹Eccentric Contractions: When a muscle produces force and lengthens.

 

These are the classic definitions, and many of us explain this to our patients, but a simple tweak may enhance their understanding.

 

In reality, we can think of the eccentric contraction in an exercise as the deceleration phase and the concentric contraction as the acceleration phase. This adjustment in terminology can allow us to simplify things for our athletes and improve communication over our course of care.

 

Remember, the more effectively you can communicate with your clientele, the more effective of an educator your will be. It’s these little things that can make a huge difference in your success as a clinician.

Charles Badawy, SPT, CSCS, USAW,

Pitt DPT Class of 2019

July 17, 2017 |

Monday Memo 6/19/2017

The Monday Memo

June 19, 2017                                                                           PITT DPT STUDENTS

Personal Training & Physical Therapy

 

The two years I took between my undergraduate education and beginning physical therapy school at Pitt was perhaps the best decision I’ve ever made. I didn’t realize it at the time, but the experience that I received over those 26 months allowed me to develop skills that will be valuable during my career as a therapist. The mentors I cultivated over that time, both in person and online, helped me to recognize that the two professions don’t have to work in isolation. Rather, I think it’s incredibly important to blend the two. Whether you approach it from a patient education standpoint or integrate strength and conditioning protocols into the therapeutic plan, there is an immense amount of value in successfully integrating both aspects into patient care.

At the end of the day, professionals in both fields have very similar goals: To improve the function and performance of the person standing in front of them. Therapists typically work with a population in pain, with the ultimate goal of moving them out of the symptom modulation phase, improving upon the impairments found in the physical exam, and returning the patient to their desired level of participation. The trainer works on the other end of the spectrum to help improve their client’s body composition, performance goals, and overall resilience. At the end of the day, both are attempting to make significant changes in their client’s level of function.

We know that Americans don’t exercise enough. We know that sedentary lifestyles only accelerate our body’s natural degenerative process. We know that a lack of physical activity and progressive overload results in a gradual weakening and deterioration of your body’s tissues, eventually leading to injury/pathology. We know this because as therapists and trainers, we are exercise professionals. We live and breathe this culture of physical activity, but, unfortunately, the majority of our patients do not. It’s important to educate your clients: Inform them of the benefits of physical activity and impress upon them the vast effect it will have on their personal lives.

In addition, encourage active modalities over passive methods during your therapeutic plan. There is always a reason to default to moist heat to warm up body tissue and prepare it for work, but an active warm-up can accomplish this same goal while also increasing calorie burn, circulation, muscular function, and more. If your client is seeing you for a lower extremity injury, show them how to train their upper body and trunk in a safe and effective manner. An injury doesn’t always mean you should stop training and there is plenty of research that shows benefits to the involved limb when you continue to train the uninvolved side.

At the end of the day, physical therapists are experts in the human movement system. We understand the human body, biomechanics, and the effect of physical activity (or lack thereof) on your body. If we want to elevate our profession, our outcomes, and our patients, we need to do a better job of educating them on all things health and fitness. We also need to embody this belief ourselves. Be an example for your patients and practice what you preach. How often are you strength training? Performing some sort of cardiovascular exercise? As cliche as it sounds: Be the change you want to see in the world.

Charles Badawy, SPT, CSCS, USAW,

Pitt DPT Class of 2019

June 19, 2017 |

Monday Memo 6/12/2017

The Monday Memo

June 12, 2017                                                                           PITT DPT STUDENTS

Patient Adherence

 

As is typical with most physical therapy students, I had a very active and healthy lifestyle growing up. I was a competitive swimmer in high school and spent nearly 20 hours a week in the pool training. I got into triathlon, weightlifting, and played intramurals throughout my academic career at Virginia Tech. My personal interests always revolved around physical activity and training, so naturally pursuing a career in health care made sense.

Like many, I figured I would apply to medical school upon graduating, but I slowly started to realize that physical therapy was much better suited for me. This profession gives you the opportunity to analyze a patient’s movement system, determine the best course of treatment, and help initiate their path to recovery. This path may include some passive methods, such as employing the RICE method or prescribing orthotics, but these typically lead us to the more effective and vitally important method that we utilize: active therapeutic exercise.

Your TherEx protocol is the “meat and potatoes” of your therapeutic protocol. This is what will provide true adaptation to your patient’s issue. At least for me, it’s also the aspect of PT that as a clinician you are most excited about. You’re creating an exercise regimen that will help the patient grow stronger, safer, and more resilient, and all they have to do is follow your instructions! What could go wrong?

The answer: A lot.
For instance, the patient may not do it. Unless you have the opportunity to work with the elite athletic population whose paychecks are on the line, you’ll be fighting the constant battle of patient adherence. Your patients are busy. They have jobs. They had kids. They have other interests and other priorities, and completing your 3×10 sit-to-stand protocol is likely very low on the totem pole.

We know how important exercise is. We understand the consequences of working a desk job 50-60 hours a week and coming home to eat a microwaveable meal and sit on the couch for the remainder of the evening. It is up to us to create patient buy-in; and to educate the public on the importance of regular physical activity and adherence to our therapeutic protocols.

This concept applies to all therapeutic settings: in-patient neuro, outpatient ortho, pediatrics, etc. We must work everyday to connect with our patients and show them how improving their functional deficiencies will lead to improved participation in the activities that they truly care about. Our goals and protocols must be patient-centered. They must be dedicated to helping the patient get back to the activities of their choice. This will not only enhance patient adherence, but also result in improved outcomes and reduced healthcare costs further down the road.

 

  • Charles Badawy, SPT, CSCS, USAW,

            Pitt DPT Class of 2019

June 12, 2017 |

Monday Memo 5/22/17

The Monday Memo

May 22, 2017                                                                           PITT DPT STUDENTS

Below is a hypothetical case study: The patient is representative of an impairment/functional deficit that is common in an outpatient physical therapy clinic. Leave a comment with the next steps that you would take if you were the primary clinician: Would you continue with the physical exam? Redirect your focus? Do you feel comfortable prescribing treatment from the given information? What other questions might you ask this patient? Is this a situation where referral may be needed? Why or why not?

 

Patient: 26 y.o Female Graduate Student

Chief Complaint:

  • Right shoulder pain with elevation affecting the ability to perform overhead activities and reach across to grab her seatbelt.

Onset:

  • Over 1 month ago — Occurred while performing dumbbell presses in a strength training group class. Immediate limitations included putting on a shirt and reaching across her body. Pain at the AC joint area.
  • Seemed to get better on its own over the next week or two… Then got worse after a poor night’s sleep. This worsening presented as more of a “constant” pain and stiffness with the patient feeling as though she needed to pop it back into place. Reports “cracking” with movement.
  • Seemed to get better again with time, but 2 days ago the patient was leaning on her elbows and pain flared back up after standing back up and unweighting the shoulder. New onset of pain is in a different place: More lateral to the AC Joint. Pain has decreased over the past 48 hours.
  • Worst: 5-7/10 , Best: 1/10

PMHx:

  • No prior history of shoulder injuries besides bilateral broken clavicles at a young age.
  • Pt has been dealing with headaches since teenage years. Two main types: First is typical with a cervicogenic left-sided “Ram’s Horn” presentation and also has referral to the supraorbital area over the R. eye. She also complains of tension-type headaches that she correlates with dehydration, stress, and posture. Reports that the tension-type headaches are helped with postural exercises (chin tucks).

Exam:

  • Patient appears to be in good health. Slender frame with average or slightly below average muscle mass. Slight forward head posture. Depressed R shoulder relative to L.
  • Full ROM with slight pain at end-range FLEX/ABD; 4/5 on MMT with most movements, but painful with resisted FLEX/ABD/ER.
  • Abnormal scapular mechanics noted with ABD. R side seems to get hung up, especially on descent. Flexion mechanics appear normal, but a “click” or “pop” is felt and heard with both movements on elevation and descent.
  • Special Tests:
    • No signs of instability or apprehension with testing.
    • Clicking felt with Load and Shift to assess anterior capsule/labrum
    • (+) Neers, (+) Jerk for anterior pain, (+) Crank w/ clicking, (+) Hawkins Kennedy
    • (-) RTC cluster, (-) Sulcus Sign, (-) Biceps load test

May 22, 2017 |

Monday Memo: 2/20/2017

The Monday Memo

February 20, 2017                                                                           PITT DPT STUDENTS

 The Three Stages of Rehabilitation

 

A successful rehab outcome is fostered using both an artistic and a scientific mindset. The exact percentage of each will depend on the education, preferences, and bias of the practicing clinician, and that’s what makes this profession both exciting and frustrating. There are no “cookbook” formulas in rehab, which demands years of “trial and error” from entry-level clinicians. Luckily, we have guidelines and the experience of our mentors to help guide us early on in our professional careers.

 

One of the most important concepts that has surfaced for me in my education thus far is the concept of “Staging” a patient. This process guides our clinical decision-making and helps us create an effective and efficient plan of attack. It can be applied to anyone, in both inpatient and outpatient settings, and for every kind of injury or disease. It must be done on Day 1, but must also be continually reevaluated throughout the course of care. Below are brief descriptions of the stages:

  • Stage 1: Symptom Modulation: This patient is most likely in the “acute” stage of their injury, and their medical status could be either volatile or stable. The hallmark of this stage is that symptoms predominate and are highly volatile. The focus should be on alleviating pain and working towards “calming” the condition down in order to open the door for more long-lasting treatment methods.

 

  • Stage 2: Movement Control: This patient will oftentimes still be in pain, but the pain will simply not be as limiting. The functional impairments present can be more accurately attributed to the neurological and/or neuromuscular impairments, so our treatment methods can consist of relatively more “aggressive” techniques aimed at increasing tissue length, strength, or neuromuscular control of the joints in question.
  • Stage 3: Functional Optimization: If you find your patients consistently reaching this stage in their rehabilitation process, you’re clearly doing something right. The patient will likely be in little or perhaps no pain at all, and the focus of your rehab can be on optimizing the patient’s movement patterns, preparing them for return to normal function, and strengthening/reconditioning the physical attributes of the patient.

 

Make no mistake, as much as we would love for this to be a linear process, reality tells us otherwise. Oftentimes, your patient will experience setbacks. They will have pushed their shoulder repair too far playing with their kids over the weekend and show up to clinic on Monday morning with highly volatile symptoms. You will need to adapt and revisit the symptom modulation phase to temper their symptoms. This is what makes our profession so unique and so individual. This is why we as professionals need to be ever vigilant with our clients and constantly monitoring their status. This adaptability is where the “art” of rehab comes into play, guided by these “scientific” principles.

 

Are you using the “Staging” process with your patients? Why or why not? Has it helped improve your patient outcomes? Comment below or reach out to Pitt PT to share your story!

 

  • Charlie Badawy, President: DPT Class of 2019
Social Media Updates
  • #DPTstudent –  WEDNESDAYS , 9-10pm EST!   Check out #DPTstudent page for details!
  • Unite Physical Therapy Students – If you haven’t yet, please check out the “Doctor of Physical Therapy Students” Facebook page. More than 9,500 students have already joined!
  • Our own page! Pitt Physical Therapy, thanks to the Social Media Team, has created an official PittPT Facebook page!
  • #SolvePT (meets on Tuesdays Twitter from 9-10pm EST)
  • Follow @Pitt_PT on Instagram!
February 20, 2017 |