Monday Memo 9/18/2017

The Monday Memo

September 18, 2017                                                                           PITT DPT STUDENTS

James Tersak, SPT, CSCS

Joint Motion End Feels

When completing an evaluation, a Physical Therapist is equipped with many assessment skills that are necessary to construct a comprehensive diagnosis of a patient. These skills include techniques that are used as parts of physical examinations, one of them being the ability to interpret joint motion end feels. A joint end feel is the sensation felt by the examiner when the end of the available range of motion is reached. There are a few types of end feels, and once identified, each can be used to guide your examination process. The end feel types include:

  • Empty – end range is not reached due to excessive pain of the patient
  • Soft – end range reached due to soft tissue
  • Firm – end range reached due to resistance of the capsule or ligaments
  • Hard – end ranged is reached due to bone on bone contact

For example, if a range of motion deficit was discovered when assessing passive hip flexion with the knee extended, a physical therapist would be able to interpret the end feel of the joint to hypothesize what could be a possible cause. If the end feel was hard (bone on bone) as opposed to soft (soft tissue), the therapist would hypothesize that the decrease in range of motion is due to some sort of impingement in the hip rather than hamstring tightness.

Interpreting end feels is a simple technique, but it can be very valuable when examining and treating a patient.


September 18, 2017 |

Monday Memo 9/11/2017

The Monday Memo

September 11, 2017                                                                           PITT DPT STUDENTS

Physical Therapy Abroad

This summer I had the opportunity to travel to the town of Chichicastenango, Guatemala for my 6-week full-time clinical.  An American physical therapist started the program there and now they have a Guatemalan PT on staff as well. Therapy services were provided free of charge as many of the patients would not be able to afford it otherwise.

One thing I really enjoyed about this clinical was the variety of patients I got to see. The program was started to treat children with disabilities, so the majority of patients were pediatric with the most common diagnoses being cerebral palsy, spina bifida, and Down syndrome. We saw adults with neurological diagnoses such as traumatic brain injury, spinal cord injury, and stroke. We also saw patients with orthopedic problems like back pain, meniscus injuries, arthritis, and one man with a transfemoral amputation.

Most patients were seen in the clinic, but at times we would see patients in their homes if it was difficult for them to make the trip in. Not much is handicap accessible in Guatemala, which is different from most places in the U.S. Many people have to traverse rough terrain or steep stairs just to leave their homes. Paths are often narrow and uneven, which makes using a wheelchair or walker difficult, if not impossible. This creates unique challenges for a physical therapist and requires creative thinking and problem solving.

I also had the opportunity to travel to some other areas to see patients. One was a smaller town where ASELSI has started a clinic, and the other was a rural village in the mountains where they are in the process of starting one. That village took us nine hours to get to even though it was only about 100 miles away. Due to the rough conditions of the roads we were driving only 5-10 mph for much of the trip. It was definitely eye opening and it seemed that the more rural and further from access to medical care we got, the more serious the disabilities were.

There are so many unreached children and adults living with disabilities in Guatemala that could be much more functional and have a higher quality of life if they had access to physical therapy. I am thankful I was able to have a small part in treating some of those patients.

I had been to Guatemala three times before, but only for about a week each time. This time I learned more about the culture and saw more of what daily life is like. I was able to build relationships with the staff, those I lived and ate with, and others I met along the way. It was an incredible experience and I learned a lot about PT and about Guatemala. I have fallen in love with the people and country of Guatemala and I hope to return soon.

-Laura Smith, SPT


September 11, 2017 |

Monday Memo 8/28/17

The Monday Memo

August 28, 2017                                                                           PITT DPT STUDENTS


Charles Badawy SPT, CSCS, USAW

Intentionally or not, our society is CONDITIONED to be afraid of moving. As we age, gathering our bumps and bruises along the way, we’re told we’re broken:

  • Ruptured discs.
  • Rotator cuff tears.
  • Knee arthritis.

We’re often told these things just happen:

  • They’re a product of age.
  • We’re told to stop:
  • Stop bending over.
  • Stop picking things up.
  • Stop using your arms.
  • Stop running.

These people are right, but they’re also very, very wrong. Injuries and tissue pathology are in fact a consequence of being a human. If you’re doing it right, you’re going to get hurt sometimes. Impersonate your favorite Peter Griffin GIF, rub some dirt in it, and get back to work. More often than not, injuries are temporary. They knock ya down, but not out. Much like a good relationship, it’s important that you respect the injury, give it time to calm down, and then approach it from a different angle.

However, that different “angle” is, and will always be, movement. Blown disc so you can’t bend forward? Bend backward for a little while instead! Move your shoulders, hips, knee, and elbows! Move your neck! Torn labrum? Pull. A lot. Strengthen your back and posterior deltoids until the pain goes away. Knee Pain? Bike instead of run, then get to work on those glutes and hamstrings, because I can almost guarantee you they’re weak. The end goal after an injury is obviously to regain function. This in itself demands that we perform the movement that is painful or the movement that isn’t working properly. We want to regain that ability. And we can.

Let’s cover this very briefly to avoid a novel:

1. First, you need to stop hurting. Nothing will work if you’re in pain.

2. Then, and really at the same time, you need to keep moving. Find movements you can tolerate and keep the tissue active.

3. Slowly, and methodically, load the tissue. Teach it to be resilient again. This is how you heal. This is how you stay young. This is how you retain the basic functions that make us human.

Movement is medicine folks, so get moving.


August 28, 2017 |

Monday Memo 8/14/17

The Monday Memo

August 14, 2017                                                                           PITT DPT STUDENTS

What is Functional Training?
Charlie Badawy, SPT, CSCS, USAW


There are so any answers to this question. Some people say kettlebell movements. Some say emphasize rotation and diagonals. Others are convinced you simply need to get stronger and “function” will improve. In reality, everyone is right and every is wrong.


Functional training is not a garbage term. It’s very real, but also very ambiguous. Functional training for a Strongman or Nordic Games competitor will look nothing like that of a ballerina or gymnast. The functional demands of one individual are wildly different than that of another, which is what should drive variation in our training and rehab approach.


I propose that this isn’t necessarily true for the general population. The average joe. Yes, we are all special snowflakes, but we operate very similarly when it really comes down to it. Sure, some of us may have some occupation-specific requirements that should guide the rehab and training approach. However, when it really comes down to it, there are three tasks we most of us must be able to do:
1. Get up off the ground
2. Walk
3. Pick up & manipulate objects


We need to be able to change position and rise from the floor in case we fall. Whether we’re teaching proper transfer mechanics or Turkish Get-ups, we’re accomplishing this goal. 

We already know the importance of restoring proper gait mechanics, but what about using loaded carries to strengthen those mechanics once in place or target individual weaknesses?


Lastly, life simply wouldn’t be any fun if you didn’t have the ability to manipulate and interact with your environment.


These are foundational abilities that humans should possess and there are so many different ways of training them! We should scale to the individual in front of us – Utilize progressions or regressions appropriate for their level of physical preparedness. At the end of the day, when we stop doing these things, we really stop living.



August 14, 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 |