Monday Memo 2/19/18

The Monday Memo

February 19, 2018                                                                        PITT DPT STUDENTS

 

This coming weekend, I will be participating in the Tip Off at Trees 3vs3 Wheelchair Basketball tournament, along with another classmate and DPT program professor. After signing up, I wanted to learn a little more about the sport of wheelchair basketball so I looked into the background of the game. I wanted to write this piece to highlight the history of the sport and the state that it is in today.

 

The game of wheelchair basketball was born in Veteran Administration (VA) Hospitals in Birmingham, CA, Framingham, MA, and the Corona Naval Station, CA post World-War II in 1945-1946. Initially, the veterans at the Birmingham VA hospital competed against the medical staff, but traveled to the Corona Naval Station in 1947 to compete in the first game between two wheelchair basketball teams. Over the next couple years, six teams formed across the country representing various VA hospitals, and in 1948 the National Wheelchair Basketball Association (NWBA) and the first NWBA Tournament were assembled. Time Nugent, lead the way to form the NWBA and went on to become a Hall-of Fame inductee. At the same time, Sir Ludwig Guttmann, organized a very similar sport called wheelchair netball at the Spinal Rehabilitation Hospital in Stoke Mandeville, Great Britain.

 

By 1960, wheelchair basketball had immensely grown in popularity, and was included as one of the 8 sports in the Inaugural Paralympic Games held in Rome, Italy. Wheelchair basketball for women began to rise in the 1960’s, and would officially become its own NWBA division in 1977 after a proposal submitted by Hall-of-Famer, Bob Szyman. Today, the NWBA has grown to an amazing 200 plus teams in its five divisions: Championship Division, Women’s Division, Division III, College Division, and Junior Division. The sport now has an amazing international involvement from hundreds of teams from various continents, governed by the International Wheelchair Basketball Federation (IWBF).

 

The Game

The game itself is played on a regulation basketball court with all of the same dimensions, scoring lines, and hoop heights. The player is allowed two pushes between dribbles while the ball is in their lap or hands, and this can be repeated as many times as they would like. It is called a travel if more than two pushes occur without dribbling. According to the IWBF, a foul is, “An infraction of the rules concerning illegal personal contact with an opponent – the wheelchair is considered a part of the player.” This year, the National Wheelchair Basketball Tournament will be from April 12-15, in Louisville Kentucky.

 

I am excited for the opportunity to participate in this sport, and thankful to the Students for Disability Advocacy – University of Pittsburgh, and the Pittsburgh Steelwheelers for putting on this great event.

 

-Jim Tersak, SPT, CSCS

 

References:

“History.” National Wheelchair Basketball Association, www.nwba.org/.

“Wheelchair Basketball.” British Paralympic Association, paralympics.org.uk/paralympicsports/wheelchair-basketball.

 

 

 

February 19, 2018 |

Monday Memo 2/12/18

The Monday Memo

February 12, 2018                                                                        PITT DPT STUDENTS

 

Holly Lewis, a first year SPT, is currently involved with teaching an exercise class to older seniors in the community. I had the pleasure of interviewing her to find out more about what she does every Monday evening.

 

So, tell us a little bit about the program.

 

 Every week, 6-8 participants meet at Parkside Manor, an independent living facility, to instruct an exercise class for the residents. Parkside Manor is a facility for the underserved, community-dwelling older adults. The main goal of this program is to provide simple and functional exercises that will benefit the residents both physically and mentally. Some of the exercises we incorporate are walking, seated exercises, and obstacle courses.

 

How did this program start?

 

Molly Bachmann, a third year SPT, reached out to seek other students in the program to help her. Molly is a Pittsburgh Schweitzer Fellow, which is where she originally came up with the idea for this endeavor.

 

How have the participants been responding?

 

They have been doing really well! A lot of them are more confident with navigating stairs and ambulating on their own. We have people from many different functional levels including Rollators and walkers. We accommodate to all and integrate exercises for any level.

 

What has this experience provided you with?

 

So much. It has made me much more confident leading exercises and working with the elderly. I initially had an interest in working with the geriatric population and this has stimulated it even more.

 

Beyond simply exercising, what are the other goals of this program?

 

A lot of seniors are in social isolation. This gives them an enriched environment and stimulation. We try to maintain the positive outcome they have earned in class by giving the residents education about what they can do outside of class to maintain the benefits.

 

What do you recommend others in the physical therapy community to do to help with enriching the lives of seniors?

 

While working with a patient, it is important to keep in mind that you may be the only person they talk to the entire day. Stay involved and alert. No matter what your experience level, volunteering and getting involved in the community is never a bad idea!

 

What is in the future for the program?

 

The next year in the program, we would really like to add another facility so that the effects of the program may be expanded throughout the community.

 

Special thanks to Holly Lewis for giving her time for this interview.

 

-Layne Gable, SPT

 

 

 

 

February 12, 2018 |

The Monday Memo 2/5/18

The Monday Memo

February 5, 2018                                                                        PITT DPT STUDENTS

Student Spotlight

 

Student: Marcin Szczyglowski, Class of 2019


Q: Hello Marcin: Thanks for joining us today! 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?

 

A: I was born in Lansing, Michigan, but grew up in London, Ontario, Canada. I went to the University of Western Ontario for undergrad and studied Kinesiology. My undergrad program was mostly based in physiology and biomechanics, but also included electives in rehab, sport literature, sport law course, and more. I took a 5-year undergrad simply because our curriculum was rather strict and flooded with physiology/biomechanics, but there were a ton of electives I wanted to take.

 

Q: You have a Master Degree, don’t you? Tell us a little about that.

 

A: I completed my Master of Science at the University of Oklahoma. It was a degree in Exercise Physiology with a concentration in Muscle Function and Metabolism. My thesis topic was The Effects of Exercise-Induced Muscle Damage on Critical Torque and Mitochondrial Function. My lab also did quite a bit of work on pain science, ergogenic aids with endurance performance, carbohydrate mouth-rinsing for improved performance, and other various properties of muscle function. We were also jokingly termed ‘The Pain Lab’ because a) we studied pain quite a bit and b) a lot of our studies required strenuous physical testing as well as twitch interpolation, which, if you’ve never done, is not the most enjoyable experience.

 

 

Q: “No pain no physiological gain”, am I right? You’re also a published author. What are the titles of your publications and would you mind giving us a brief description of your involvement/the major takeaways?

 

A: Currently, my thesis is published in the European Journal of Physiology under the title The Effects of Exercise-Induced Muscle Damage on Critical Torque. Critical torque is an analogue of critical power, which is defined as the highest attainable work rate that still results in steady-state aerobic energy production. It is usually expressed as an individual’s exercise intensity, such as critical speed, critical torque, etc., and is arguably the best physiologic predictor of endurance performance. Any exercise above this ‘critical power’ will ultimately result in task failure. Exercise above critical power is thought to have a fixed amount of work (making time to exhaustion, or task failure predictable), and is termed W’. The article covers exercise-induced muscle damage (EIMD) and critical power in depth, however the main discussion points were as follows: EIMD significantly reduced absolute critical torque by ~14% as well as ∫T total, a surrogate for W′, by 33% following EIMD. These findings suggest that EIMD would lead to a decline in CT and ∫T total providing evidence that EIMD likely impacts aspects of both aerobic and anaerobic metabolic functions during exercise.

 

Literally as I was typing this interview up, I was notified that a second research study I was heavily involved in was published in the Journal of Strength and Conditioning Research under the title Carbohydrate Mouth Rinsing Does Not Prevent the Decline in Maximal Strength Following Fatiguing Exercise. CHO mouth rinsing without the need for ingestion is an interesting technique which has been shown to improve performance, whether that be in a time trial, time to exhaustion, repeated sprint bouts, or simply slow the decline of maximal voluntary contractions (so long as the given exercise is short enough in duration that glycogen stores do not become a factor). This is likely due to central mechanisms as opposed to peripheral. Our study added to the notion of peripheral fatigue not being impacted by CHO mouth rinsing. While % voluntary activation of the quadriceps did not differ between conditions or pre-post exercise, indicating peripheral as opposed to central fatigue, we observed no changes in muscle contractile properties vs placebo. To sum it up, while CHO mouth rinsing has been shown to improve performance, this ergogenic effect does not seem to extend to enhancement of high-intensity ‘one-off’ events such as 1-RM or a single sprint.

 

I also presented a poster titled Consistency of the Effects of Caffeine on Strength and Motor-Unit Recruitment at the American College of Sports Medicine Annual Meeting in 2015. Caffeine, in the appropriate dosage (evidence ranging from roughly 3-13 mg/kg bodyweight), has been shown to improve muscular strength and motor-unit recruitment in athletes. This study was conducted on untrained individuals, and did not see the same ergogenic effect suggesting that caffeine has more of a fine-tuning effect on motor-unit recruitment.

 

 

Q: With such an extensive background in Exercise Physiology, the field of Physical Therapy was probably a natural transition for you. What got you interested in the field of physical therapy?

 

A: My undergraduate degree exposed me to physical therapy and rehab quite a bit, but science and research run in my family. I love physiology, which is what drove me to the University of Oklahoma. However, during my undergrad, I took quite a few ‘hands-on’ courses, volunteered in the field of physical therapy, and worked as a personal trainer/strength and conditioning coach at two gyms and for UWO women’s field hockey team. As much fun as research was, I missed this kind of treatment/training interaction. I got the opportunity to shadow the physical therapist for the Sooners’ track and field team and really enjoyed his treatment approach as well as the whole ‘behind the scenes’ atmosphere of collegiate sports. This, along with several long discussions with friend’s back home, swayed me away from doing a PhD in exercise physiology and, instead, a DPT.

 

 

Q: I know that you’re pretty involved in the sport of Powerlifting, so the competitive atmosphere that is collegiate athletics is probably a natural fit for you. What are your best lifts and how long have you been training?

 

A: I got into training powerlifting my sophomore year, and competed for the first time in my junior year. My undergraduate gym had a solid powerlifting culture led by a couple of the trainers I worked with, and I got sucked in. I’ve competed three times (last one in 2015…so I’m washed up). Best lifts (lbs): 505 Squat, 335 Bench (paused), 600 Deadlift. Best comp total: 650 kg / 1433 lbs at 93kg bodyweight.

 

 

Q: Any competitions in the near future?

 

A: Hopefully April (Comeback SZN!), and hopefully breaking a 1500lb total.

 

 

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

 

A: My main short-term goal is to get accepted into a sports physical therapy residency. Long-term I would love to end up working with a sports team, as well as contribute to the movement of therapists working toward bridging the gap between physical therapy and strength & conditioning. Long-long term dream goal? Own a hybrid of a physical therapy clinic and a strength and conditioning gym. Is Szczyglowski Strength too much of a tongue twister?

 


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

 

A: Pizza is kind of a boring food, and I don’t understand why people love it so much. Get something better, like a taco or a burger. But if you do get pizza, put some pineapple on it.


Q: Thanks for stopping by, Marcin! Good luck with the rest of the spring semester!

 

Links to studies:

https://www.ncbi.nlm.nih.gov/pubmed/29334582 – CHO Mouth Rinsing

https://www.ncbi.nlm.nih.gov/pubmed/28900719 – Critical Torque

February 5, 2018 |

Monday Memo 1/29/18

The Monday Memo

January 29, 2018                                                                           PITT DPT STUDENTS

Hollowing vs. Bracing: Building the Proper Foundation for Spine Stability

 

Abdominal hollowing and abdominal bracing are two techniques commonly used in the outpatient physical therapy setting to treat both acute and chronic low back pain patients whose symptoms are a result of some degree of spinal instability, or an inability to use their musculature properly to maintain their spine within the “neutral zone.” The mutual goal of these exercises is to teach the patient to reactivate certain muscles of their core with the purpose of increasing stiffness of the spine, enabling it to more effectively withstand potentially compromising loads and positions that can result in further pain and injury. Though both exercises are used to treat the same activation deficits of the spinal stabilization musculature, recent evidence has emerged calling into question the effectiveness of the abdominal hollowing technique in achieving this goal, and even suggests a potentially deleterious effect of the exercise in certain scenarios.

 

The abdominal hollowing exercise, which involves a selective drawing in of the transversus abdominis (TA) muscle to create a “hollowing out” effect in the abdominal region, gained in initial popularity due to evidence that found delayed and diminished EMG activity of the TA in certain patients with low back pain. This research failed, however, to examine the other surrounding musculature of the core, and more recent evidence has found that similar activation deficits were found in additional muscles of the abdominal cavity, suggesting that this delayed and diminished muscle activation is not unique to the TA, but rather pervades the surrounding deep abdominal musculature in certain low back pain patients. Abdominal bracing; which involves a submaximal co-contraction of these affected muscles such as the internal and external obliques, quadratus lumborum, rectus abdominus, transversus abdominis, lattisimus dorsi, and erector spinae, among others; might potentially be better suited to address the widespread activation deficits seen in these patients.

 

Additional research that examined the forces on the spine under varying loads and positions concluded that holding an isometric TA contraction decreased the potential energy of the spine and caused it to fail at lower loads. This evidence runs contrary to the belief that this isolated contraction increases spinal stability and refutes the clinical reasoning behind maintaining this type of contraction during various exercises such as squats. This reasoning was further called into question by a study that compared a stabilization exercise program involving isometric TA holds in conjunction with various exercises such as bridges and bird dogs with a similar program encouraging participants to employ their natural spinal stabilizing mechanisms throughout their exercises. The trial found that there were similar improvements between groups on pain outcomes, but the general, non-hollowing exercise group had greater improvements in self-reported disability scores. The study suggests that encouraging the body to employ its natural stabilizing mechanism by synchronously activating its abdominal cavity musculature may be more effective than isolating specific core muscles at achieving spinal stability.

 

Synchronous contraction of muscles about a joint increases the stiffness of that joint more effectively than contraction of a single muscle crossing the same joint. This principle is especially important when attempting to increase stiffness and ultimately stability of the spine and can be achieved by training the totality of the core musculature to synchronously contract with the abdominal bracing exercise to ultimately enable the patient to maintain this stiffness throughout their daily activities. An appropriate level of stiffness required for safe performance of most non-athletic activities only requires the core muscles to contract at 25% of their maximum voluntary contraction level. The principle of stiffness can and should be extrapolated to high level athletes as well in order to optimize safe and effective performance. A powerlifter, for example, must maintain a very high degree of co-contraction during a squat or deadlift in order to keep his or her spine in a neutral position when under heavy loads. This minimizes the risk for injury to the spine and maximizes performance by providing a solid foundation upon which the more distal joints can operate. Rapid contraction and relaxation of the abdominal brace is also important for athletes requiring more ballistic bursts of speed, such as baseball pitchers, golfers, mixed martial artists, and hockey players. It is essential for these athletes to be able to adequately activate their core musculature synchronously in order to accomplish the explosive movements required by their sports. A mastery of the abdominal brace technique may be particularly useful for returning these patients to their previous level of sport participation and skill.

 

To optimally teach safe and effective movement to our patients, we must replicate in the clinic those motor patterns that are demanded for performance in the real-world setting. This involves synchronous and synergistic activation of all muscles responsible for accomplishing a task, not isolated activity of muscles such as the transversus abdominis, which, when selectively contracted, has been shown to decrease potential energy and load tolerance of the spine. The healthy body activates its core muscles synchronously to prepare for and withstand movement and load on the spine. It is important to encourage that synchrony with the bracing technique to achieve optimal spine stability and performance.

 

-Brooks Kenderdine, SPT Class of 2019

 

 

 

References:

 

McGill, S., PhD. (2010). Core Training: Evidence Translating to Better Performance and Injury Prevention(Vol. 32, Rep. No. 3). Lippencott Williams & Wilkins.

 

McGill, S. (2017). Ultimate back fitness and performance. Gravenhurst, Ontario: Backfitpro Inc.

 

January 29, 2018 |

The Monday Memo: 1/22/18

The Monday Memo

January 16, 2017                                                                           PITT DPT STUDENTS

Student Spotlight

 

Student: Christopher Drager, Class of 2019


Q: Hey Chris. Tell us a little bit about yourself to get started: Where did you grow up? Where and what did you study for your undergraduate education?

 

A: I grew up ten miles south of Pittsburgh in Jefferson Hills, PA. After graduating from Thomas Jefferson High School, I chose to attend Virginia Tech to play football and study Human Nutrition, Foods, and Exercise.

 

Q: What got you interested in the field of physical therapy?

 

A: I’ve participated in team sports my entire life. Competing with and against different players was the most exhilarating activity for me. During a 7th grade football game, I tore my ACL and was restricted from athletic participation for three years. That period really challenged me physically, mentally, and emotionally because I was unable to do what I loved the most. In order to return to sports and really gain a competitive edge, I began reading a lot about physical fitness and nutritional advice and it was that information that got me back on the playing fields and eventually earning a college scholarship. Now that my playing days are over, I chose to use the PT profession to help others break down barriers and accomplish their goals.

 

Q: What else are you involved in outside of school?


A: For the past six years, I have helped coach high school football at my alma mater, Thomas Jefferson High School.

 

Q: Awesome! Did you have a successful 2017 season?

 

A: Yes, we went 11-2 and defeated Montour at Heinz Field for the 4A WPIAL Championship, making it the third consecutive championship season.

 

 

Q: That’s amazing, Chris. Congratulations! What was your favorite memory from this past season?

 

A: By far, my favorite memory was destroying Belle Vernon in the WPIAL semifinals round. After losing to the Leopards in the regular season, we were afforded another opportunity to play them in the playoffs. After a great week of preparation, we held the Leps to one first down, beat them 27-0, and removed their hopes of playing at Heinz Field for the WPIAL title.


Q: What is your favorite thing about coaching a team of youth athletes?

A: I enjoy the camaraderie and competition. Coaching requires you to spend a lot of time with a lot of people. Working together and developing strategies and striving to excel for a cause that’s bigger than the individual…that’s what I enjoy the most.

 

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

A: Over the last few years, I haven’t had many quality options in terms of career choices. Ideally, after graduation I’d love to work as a physical therapist and strength and conditioning coach within the Navy athletics program, but now that the future is showing many different avenues and holds many quality opportunities, I’m just going to savor the moment and take one step at a time.

Q: Anything else you would like to share?

A: I’m grateful Pitt afforded me an opportunity to pursue a new profession. Physical therapy school is giving me the skills to help others (and myself) perform better and be healthier. PT is a rewarding and potentially lucrative profession and I’m glad I’ve chosen to travel down this path!

Thanks again to Chris Drager!

January 22, 2018 |