Monday Memo 11/11/2019

The Monday Memo

November 11th, 2019                                                              PITT DPT STUDENTS

The Importance of Posture in Physical Therapy Wellness and Prevention

            Many of our patients visit us with problems unrelated to a specific mechanism of injury, and our job is to find out and treat their specific impairments.  The current vision statement for the APTA is “transforming society by optimizing movement to improve the human experience”. This is a very powerful statement.  I interpret this as not only helping patients recover from a specific injury, but providing them with the skills and tools that they need in order to function in the safest and most effective way.  Prevention and wellness are important to introduce to patients to assist in preventing further injury.  In our evaluation, we must address the patient’s current movement pattern.  This can include an observation of posture, seated posture, gait, and/or another activity.  This can provide us with significant information of what initial hypotheses we should form, and the testing that should be done to either accept or reject the initial hypotheses.   

            When a person assumes a certain posture, the muscles and fascia will begin to mold to the length that they are resting in.  This can create imbalance and lead to impairment if a normal posture is not assumed.  A person’s posture and movement patterns can either be the result of a previous ailment, or a choice of how to hold one’s body based on comfort, muscle tone, or societal norms.   

            Typical faulty postures include upper-crossed syndrome, lower-crossed syndrome, thoracic kyphosis, lumbar hyper-lordosis, etc.   However, there is one very common posture in today’s society that I would like to discuss.  The sway-back posture.  It is scientifically defined as the hips swayed forward and the rib cage swayed back.  This may also be referred to as the “sitting-man’s posture”.  Physical therapists must understand this posture because our population is becoming more and more sedentary. The sway-back posture is basically a way to stand with less work.  It essentially compresses the spine and over-extends the knee and hip to prop the body in a standing position.  We must encourage others to move more often throughout their day to combat this posture.  Sway-back posture may often times be confused with an increased lumbar lordosis.  This is not the same.  Observe the greater trochanter.  The person with sway-back posture will present with a greater trochanter that is in front of the lateral malleolus from a sagittal plane view but may have a neutral or posteriorly tilted pelvis.  A person with a lumbar hyper-lordosis will present with a greater trochanter that is still directly over the lateral malleolus but is anteriorly tilted in the pelvis.  Also, individuals with sway-back posture may present with weak gluteals, short rectus abdominus, and short hamstrings while the individual with lumbar hyper-lordosis is more likely to present with long hamstrings and abdominals.  Of course, further examination and muscle length and strength testing must be done to confirm this and to guide your treatment plan.  Choose exercises based on your findings.  For example, you may find that a patient with sway back posture has a short rectus abdominus, so you should not prescribe a lot of sit-ups.  Poor posture assumed during an exercise may fail to work the muscles that you are trying to target.  If a patient does not seem to be responding to the exercise program, correcting postural alignment could change the outcome.

            What I hope to see in the future is that physical therapists make a strong effort to understand posture and have enough knowledge to teach a patient how to correct their posture.  Often times the question will come up in the clinic, “is this how I should stand?” Patients may want to know this to avoid further injury or look more aesthetically pleasing.  You should have the most appropriate answers to help them maintain optimal muscle balance and function.  More importantly, as students, it is imperative that we begin thinking about and practicing good posture in our own bodies.  Our profession requires much wear and tear on our bodies, and we must take control to minimize the strain.  We should observe and work with each other during our time here, so that we are prepared to enter the profession as movement experts. 

Check out this link for images and instructions on how to stand properly!

-Cassie Ruby, SPT, NCPT

References:

Fujitani, Ryo, et al. “Effect of Standing Postural Deviations on Trunk and Hip Muscle Activity.” Journal of Physical Therapy Science, vol. 29, no. 7, 2017, pp. 1212–1215., doi:10.1589/jpts.29.1212.

Kendall, F.P., et al. 2005. Muscles: Testing and Function, With Posture and Pain. (5th ed.). Baltimore: Lippincott Williams & Wilkins.

Sahrmann, S.A. 2002. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby.

Romani-Ruby, Christine. “Designing a Program for Swayback Posture.” IDEA Fitness Journal, Test 4, Nov. 2010, p. 88

November 11, 2019 |

Monday Memo 11/04/2019

The Monday Memo

November 4th, 2019                                                                           PITT DPT STUDENTS

The Conversation

There is a conversation that needs to be had all across the world. It is not a pleasant conversation. For many, it can be unsettling and anxiety-inducing. It may create conflict between family members and loved ones. While this conversation is a challenging and dreaded one, it is also an extremely important one.

I am not talking about politics, religion, or climate change; I am talking about wishes for end of life care. Talking about death is extremely taboo in our culture; most of us tend to avoid the topic at all costs. But this conversation is also one of the most imperative discussions we can have with our loved ones. Think of how many horror stories you have heard, seen, or even experienced, about families having to decide what happens to their loved one who has been in an accident or has suffered such severe cognitive decline that they are no longer able to make medical decisions for themselves. How many times have you heard about families fighting over the stress these situations cause? What if I told you this could be preventable—and all it took was one conversation.

I am not here to tell you this conversation is easy. It most certainly isn’t. It is not easy to bring up this discussion elegantly, but I can give you some tips and resources to make it a little easier. Step One: fill out an Advanced Directive yourself. There is no better way to understand and gain appreciation for something than to do it yourself. You can fill out your AD at prepareforyourcare.org. Here, you can watch videos explaining what an Advanced Directive is.  You also can fill out the form, identifying your medical decision maker, along with your wishes for your end of life care if you are no longer able to make decisions yourself. Step Two: Initiate the conversation with your family. Theconversationproject.org is a great resource to use, and even provides a conversation starter kit.   Explain to your loved ones what the Advanced Directive is, and why it is important. Allow them some time to think about their wishes and provide them with the resources they need to understand and fill out their AD. Then, when you all are ready, have a discussion about your own preferences for your care and ask them about theirs. Step Three: Initiate this into your clinical practice. Assess if a patient is open to having the discussion and educate them about the importance of taking control over their end of life care.

As healthcare professionals, we often do not ask our own patients these difficult questions because we do not think it is our place. And that is just the problem—no one thinks that it is their place to ask, so no one does, and the cycle continues, creating more and more of a stigma about talking about death. But what if we normalized this conversation? What if we talked to our patients about their wishes for the end of their life like we talk to them about their discharge plans or their medication regimens? As Physical Therapists, we see our patients more frequently and consistently than any other healthcare provider. We know these people. We know their families. We have relationships with them. So why don’t we encourage and empower them to make these crucial decisions now, while they still have the ability? Why don’t we help ease the burden on the family that comes along with these painful decisions? Why don’t we put the power back in the patients’ hands to decide what they want? I encourage all of us to take responsibility to initiate this conversation when appropriate. All it takes is a simple, “I would like to talk to you about whether you have come up with a plan for your end of life care, and whether you have discussed it with your family. Are you open to having a conversation about this?” Having the courage to initiate these conversations with your patients and your own family can have a huge impact on a person’s final days. You can be the difference in ensuring a comfortable end to a beautiful life. Please, have the conversation.

-Kelly Conners, SPT

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References:

https://theconversationproject.org/

prepareforyourcare.org/

November 4, 2019 |

Monday Memo 10/28/2019

The Monday Memo

October 28, 2019                                                                           PITT DPT STUDENTS

 

The OCA Clinic

As PT students, it is imperative to volunteer at as many opportunities as possible. These volunteer opportunities should spark an interest in you that goes beyond the scope of physical therapy, and should resonate with you as a person as well as a clinician. The OCA clinic served this purpose for me. For those of you who are unfamiliar (as I was), OCA stands for Organization of Chinese Americans which represents the local Asian American population within the Pittsburgh area. For a few decades now, the organization and the 2nd year medical students at the University of Pittsburgh host a pop up clinic every October where uninsured Asian Americans can obtain essentially “free” healthcare from medical students, dental students, and licensed physicians within the organization. These can serve as general checkups, blood tests, dental cleanings, or alleviating general musculoskeletal pain that so many individuals in this population are affected by.

 

By doing this, it serves as a learning experience for student clinicians as well as help an underserved population. This year’s OCA clinic was held on October 14th in UPMC Montefiore. This was the first year that the physical therapy department was able to offer our services, and a few of 2nd years, including myself, were able to help out.

I wanted to use this opportunity to accomplish a few things

  • Help uninsured individuals get better in a fun and interactive way
  • Advocate for the PT profession and our capabilities to other healthcare disciplines and to the Asian American population
  • Problem solve in a chaotic environment with little equipment and little room for exercise.
  • Practice my Mandarin
  • Eat some authentic Chinese food for free (I miss my mom’s cooking)

 

When we first arrived, I was initially intimidated by the number of white coats and unfamiliar faces. We had two students from China assigned to us as translators for communication purposes and they explained to us how PT was a new concept to them because it does not exist in China. The event initially started slow, but many individuals were eventually triaged to us to help with musculoskeletal pain. I do not recall any specific orthopedic doctors or students on staff, so we essentially served as the primary clinician for the patients with musculoskeletal concerns. Sessions were around 20 minutes in length and included a brief subjective history, a few manual techniques and demonstrating a few exercises to do at home. Our patients were genuinely thankful for our input, time, and expertise regarding their treatment and treated us with the same respect that they treated the medical students with. The medical students were thankful for our services and gained a firmer grasp for what it is that our profession does. After all, pain free movement is a language that everyBODY speaks.

 

In the end, our little PT gym saw 19 patients, with the OCA clinic as a whole gaining the attraction of 69 people within a span of 3 hours. 69 people who would not have received care if not for this clinic. In the future, we hope to maintain our connection with Pitt’s medical students in order for us to come back next year with a new slew of volunteers. Since this was the first year that the PT department was involved, it was primarily reserved for PT students with Asian backgrounds. But moving forward, we encourage other SPT’s who are interested to reach out in hopes to have a diverse PT student representation at future events.

 

-Sam Yip, SPT

**Pictured (L to R): 2nd year SPT’s Erin Dong, Jason Yang, Sam Yip, and Deborah Lee

References:
https://www.ocapghpa.org/programs/free_medical_clinic.html

October 28, 2019 |

Monday Memo 11/21/17

Chest-Supported Y w/ External Rotator Emphasis
As a former competitive swimmer, I’m no stranger to shoulder pain. It’s been a problem I’ve had to deal with for a long, long time dating back to my junior year in high school and my first experience with physical therapy. It’s common knowledge in the strength/therapy world that there are three areas that deserve extra emphasis when preventing shoulder injury.

  1. Scapular Stabilizer Function
  2. External Rotator Function
  3. Thoracic Mobility

While the Chest-Supported Y has always been a staple exercise for training stability of the scapular (shoulder blade), there is a very simple tweak to help tie in those external rotators.

 

Enter today’s exercise: The Chest-Supported Y w/ External Rotator Emphasis!

By adjusting your grip and holding the end of the dumbbells that is closer to your pinkie, you create a very unique effect!

 

What this adjustment does is provide a moment arm that provides an INTERNAL ROTATION torque to the glenohumeral joint. In response, your EXTERNAL ROTATORS must work extra hard! In addition, apply TEMPO to these movements, emphasizing a pause at the top and a slow, controlled descent.

 

With this simple tweak, your classic lower trap exercise becomes a potent way to also integrate external rotator function as well. It’s tweaks like these that can create highly efficient & effective (p)rehab programs!

 

For best results, I like to precede this movement exercises that emphasize controlled rotation through the shoulder and thoracic spines, such as Thoracic Bridges, Prone to Supine Primal Rolls, and Kettlebell Armbar Variations!

 

Charles Badawy SPT, CSCS, USAW
University of Pittsburgh – Class of 2019

 

BONUS: This tweak can very easily be applied to other scapular stability exercises such as Prone T’s, W’s, & V’s! Give them a shot!

November 21, 2017 |

Monday Memo 9/26/17

Seeing the Bigger Picture Through the Details

 

As physical therapy students, we are training to become specialists of the human movement system. This means we focus not only on what our patients are doing, but how they are doing it. The key behind a patient’s complaints can often be uncovered by the idiosyncrasies in their movement. Identifying these small changes or patterns in movement can direct us along the map to successful outcomes. It’s the physical therapist who can pick up on these details that makes the difference between an “impossible case” and a treatable one.

 

As counterintuitive as it may seem, sometimes stepping back and removing yourself from can help reveal the details. A great example of this is gait analysis. Most of our patients walk for mobility and many of those who have lost this ability wish to do it again. Observing a patient’s gait and identifying the details that differentiate it from what is expected can be overwhelming. What is “expected” for this patient? Is the hip hike you identified actually related to an impairment at the hip? What about the knee? Ankle? This is where the step back really helps. The detail (the hip hike) has been identified, but how does it relate to the rest of the body? We are specialists of the human movement system, after all. It is our role as physical therapists to recognize the bigger picture as a function of smaller details.

 

Don’t get caught up in the details, but appreciate them and let them guide you.

 

 

Julie Rekant, SPT

Class of 2019 Vice President

September 26, 2017 |