I became interested in learning about this funny word because I grew up with horses and have seen some of the benefits they provide to people. It wasn’t until recently that I discovered physical therapists can use horses as a type of treatment. I began volunteering at a local farm outside of Pittsburgh where I have learned more about this type of therapy.
Hippotherapy can also be described as Equine Assisted Therapy, or therapy with the help of the horse. The professions of occupational therapy, speech-language pathology, and physical therapy can use evidence-based practice and clinical reasoning to manipulate the movement of the horse in order to achieve a functional outcome for patients. It is most commonly used for children with disabilities, but others who have suffered from a stroke or spinal cord injury may benefit as well. This is usually done with one person leading the horse, and two people walking on either side (one of which is the therapist), next to the patient. Typically, only a saddle pad and surcingle are used instead of an actual saddle so that the patient is not separated from the horse’s movement.
This works because the horse’s pelvis moves in the same three planes as the human pelvis. In other words, sitting on a walking horse sends your brain the same signal as when you are walking. This reciprocal movement activates the central pattern generators of the brainstem; for some, this is the first time the patient’s brain has received the sensory input of walking. This type of therapy is not done in isolation, it is in addition to the patient’s plan of care.
There are numerous movements you can do with a horse to reach a certain outcome with a patient. There is a huge benefit simply of walking in long straight lines on the horse because of the reciprocal movement. If the patient requires more sensory input, the horse can increase its speed or the patient can be placed on the horse facing backward. If a patient has a right sided hemiparesis, the horse could walk in tight circles to the right to increase activation of the right neuromuscular system. The stopping and starting movements of the horse work the patient’s flexors and extensors which can greatly improve trunk control.
I believe having a basic understanding of this type of treatment is important as students of physical therapy. The horse can facilitate neuromuscular movement that our own modalities and treatments cannot, and it may serve a future patient of yours well to remember.
-Mallory Weiss, SPT
A Student’s Reflection on The Scully Lecture
In the Scully lecture, Dr. Delitto discussed a hot topic issue that our country, the opioid epidemic. Each year many people go see their doctor for low back pain (LBP). While some patients get a referral for physical therapy, even more receive pain medications. The question I’m sure many of you are asking is “Why isn’t everyone being referred to PT?” or “Why don’t patients just come see us first?” As physical therapist, it seems obvious that we can best treat these individuals and provide them with the best care, but how do we get everyone else to see it this way?
As I am beginning to realize, it is going to be a slow process of building our brand and getting people to recognize physical therapists as first contact practitioners. Although this won’t happen overnight, we should not take a back seat in the meantime. As young professionals, we now have the opportunity to shape this brand and the profession that we will be working in for years to come. For one, we can use social media to share our experiences as physical therapists and inform others about what we do. This is one of the most accessible resources available to us, one that we are all familiar with, and best of all, it’s free! As physical therapists, we can also make sure to be active in the community, whether it is participating in sports for individuals with disabilities or screening runners at a local race. The more contact we have with people, the better we can educate them about what we do. Individuals who have been to physical therapy are more likely to go to a physical therapist as a first contact provider in the future. Lastly, I encourage you all to become involved with the APTA. As our professional organization, they support us through legislative advocacy, clinical practice guidelines, and campaigns for public awareness.
-Robert Jesmer, SPT
Interpreting Hip Pain
Currently, the 1st year DPT students are approaching our musculoskeletal exam involving the evaluation, assessment, and treatment of the hip. I thought it would be appropriate to post a hypothetical case study of presentation that we may potentially see on our exam or in the clinic.
Case: A patient comes into your clinic for groin pain. He is a 65-year-old independent male. You begin taking his history and discover the following; the pain began two weeks ago, but he cannot recall a specific event that brought on his discomfort and the pain is located in his lateral hip. He also tells you that at first, the pain would be worst after he had been gardening for hours, but now, he notes that the pain comes on even when doing something as simple as getting his newspaper from the driveway. He then tells you that he also has been feeling pain on the medial side of his knee. Upon further questioning, he reveals that he has had trouble sleeping because of the pain.
Using this information, think about what further questions you would want to ask and what tests and evaluation methods you would use to create differential diagnoses for this patient. Depending on what you believe to be a possible diagnosis, determine how you would decide to treat this patient.
-James Tersak, SPT, CSCS
Progressing the Clamshell
No matter the goal, it’s likely that you’re not going to get there after just one session. It takes practice. It takes repetition. It takes planning.
The mark of a good therapist, regardless of your setting, is the ability to properly progress their patients towards their end goal. In order to do so, you need to incorporate progression into the training program.
The most basic form of progression when it comes to resistance training is the manner in which you increase load. For example: Increasing by five pounds each session. A much more difficult concept is to apply progression to movement patterns & muscular development. This is critically important in a rehab setting, where patients may not be able to progress quickly enough to continually increase load.
The Clamshell Bridge is a great way to progress GluteMed strength! As a therapist, odds are high that you’ve prescribed Clamshells more times than you care to count. We can make this simple exercise much more difficult!
- The Clamshell Bridge takes the movement a step further! We’re performing abduction & external rotation of the weight-bearing hip to lift our body up off the ground.
- We’re maintaining isometric GluteMed activation at the top to support our bodyweight, which also allows us to tie in lateral chain core stability in order to maintain proper positioning.
- In addition, we begin to layer in closed-chain shoulder stability and get the benefit of an eccentric GluteMed contraction on the descent!
Add this exercise into your routine the next time you train. Play around with it and get the feel for the movement, it’s nuances, and any potential compensatory patterns that a patient may attempt to use.
If you like it, add it to your list of rehab progressions!!
-Charles Badawy, SPT, CSCS, USAW
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