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#BadAssMary: Mary McMillan in 8 Memes

Mary McMillan is a founder and the first president of the American Physical Therapy Association. She wasn’t the first person to practice physical therapy, but as Mildred Elson stated in her 1964 McMillan lecture, “She thought in terms of the whole country and foresaw its great civilian need for physical therapy.”

She’s also a bad ass.

Here’s her story, in memes. 

Note: The majority of this re-telling of Mary McMillan’s history has been pulled from her speech in 1946, entitled “Physical Therapy from the Embryo on Three Continents,” and the 1944 annual conference proceedings at which Mary McMillan was awarded an honorary active lifetime membership in the APTA. The proceedings were published in Physiotherapy Review, now the Physical Therapy Journal. 

Mary McMillan was raised in England and completed her studies at the University of Liverpool Gymnasium, where they were offering a 2 year course in physical education. She also took a break from these studies to head to London for further courses in neuroanatomy, neurology, and psychology.

1.

At the outbreak of World War I, Mary applied for a Voluntary Aid Detachment (VAD) unit out of the University of Liverpool. Fortunately for physical therapy in the United States, she failed the medical examination and decided to travel to Boston…during the war, in a convoy, under complete blackout conditions.

After arriving in the US, she met Marguerite Sanderson, another important figure in the development of physical therapy. She was put to work at Walter Reed Hospital, and matter-of-factly states: “That was the beginning of physical therapy in the US Army.” Physical therapy was accorded as a health service in 1917 by the US Army.

Mic drop.

2. 

Dr. Everett Beach, from Reed College in Portland Oregon, wanted Mary to come teach the 200 potential reconstruction aides (the original name for physical therapists) he had signed up for an emergency course to assist with the war effort. Mary immediately applied for a leave of absence from the Army to go where she was needed. When the Army dragged its feet, she threatened to resign. Within 24 hours, she was granted a leave of absence, and left for Portland.

So that’s how that’s done.

3. 

Post WWI, a letter was sent to the reconstruction aides, asking if they wanted to see a professional association built. The answer was a resounding yes. Here are some cool facts about what they built, from Eleanor Carlin’s 1976 McMillan Lecture:

  • “Whether by design or accident…nothing was said about working only under the direction of a physician” (Carlin, p. 1113).
  • Our founders had the foresight to include policy that would allow the development of chapters, and they almost simultaneously founded the Physical Therapy Journal, ensuring that publication was valued.
  • The Association was originally called the American Women’s Therapeutic Association, but charter members realized that this would be alienating to men, and voted to change the name to the American Physiotherapy Association. The first man was elected to national office in 1942.
  • Women entering the profession were required to have a college education.
  • By 1924 the charter members had discussed the standardization of physical therapy through state registration and licensure. By 1971, practice acts had been established in all 50 states (Blair, 1971).

4. 

Mildred Elson, first McMillan Lecturer, first president of the World Confederation of Physical Therapy, and first president of the Wisconsin Physical Therapy Association, quotes Mary McMillan: “What we need is one unanimous effort in order to establish a high standard for our profession and enthusiasm that knows no bounds.”

Elson goes on to say in her 1964 lecture, “Early members at the first convention did not join & say, “What can I get out of it,” they said, “I intend to join to see what I can make out of my profession and to see what I can do to create and maintain standards.” So on that note, you know the APTA is trying to reach 100k members, right? Check it out here.

5. 

After WWI, Mary answered the call from the China Medical Board of the Rockefeller Foundation to work in the Peking Union Medical College in China. Of course, the Rockefeller Foundation knew who she was, and Mary took charge of the Department of Physical Therapy at Peiping Union Medical College in 1932. She first got rid of the “obsolete apparatus” in the gymnasium, then set about finding people who were up to her standards. In her speech, “Physical Therapy from the Embryo on Three Continents,” she states: “This necessitated that some people must be taken off the payroll—it was not an easy thing to do—it hurt me very much to do it, but it had to be done. I was able to replace these people with more modernly trained nurses and a physical education graduate.”

She also set up scholarships to encourage graduates to apply, and partnered with a physician to head the department.

6. 

November 1, 1941, all Americans were urged to evacuate Peking. Mary, along with several others, wound up in Manila (capital of the Philippines) in a roundabout way to get home, with no chance of sailing before December 20. December 7, 1941, Pearl Harbor was bombed. Mary offered her services to the Army Hospital in Manila, where she was one of the first to assist the dead and wounded upon arrival. Christmas Eve, Manila fell to the Japanese. Mary, realizing what was about to happen, “borrowed” a truck, and with 3 women drove to the hospital to recover drugs, instruments, beds, and bedding. These supplies furnished the internment camp hospital at Santa Tomas. Mary slept on a filing cabinet.

7. 

Mary, who referred to her work in the Japanese internment camps as her “swan song” recalled this episode of patient care:

Excerpt from Mary McMillan’s 1946 speech, “Physical Therapy from the Embryo on Three Continents”. © 1946 American Physical Therapy Association. Adapted with permission. All rights reserved.

8. 

Mary McMillan was repatriated in 1943. When she stepped off the boat, she was met by Dorothea Beck, previous editor of the Physical Therapy Review. She continued to be a source of strength and inspiration to the Association until her death in 1959. She assisted with efforts to found the World Confederation of Physical Therapy and was known to show up at parties. Margaret Moore, the 1978 McMillan Lecturer, recalled: “…a lively party with lots of people, loud music, much dancing, and rattling of glasses was taking place at my home. Who should appear at my front door but Molly McMillan…Within 10 minutes, Miss McMillan was in the middle of the group with her shoes off…I treasure the moments with that fun-loving, warm, and lovely lady.”

 

References

Blair, Lucy. “Past Experiences Project Future Responsibilities.” Physical Therapy 52.5 (1971): 493-99. Print.

Carlin, Eleanor J. “The Revolutionary Spirit.” Physical Therapy 56.10 (1976): 1110-116. Print.

Elson, Mildred, ed. “Twenty Third Annual Conference.” The Physiotherapy Review 24.4 (1944): 148-50. Print.

Elson, Mildred O. “The Legacy of Mary McMillan.” The Journal of the American Physical Therapy Association 44.12 (1964): 1066-072. Print.

McMillan, Mary. “Physical Therapy on Three Continents.” The Physical Therapy Review 40.2 (1960): 140-43. Print.

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CSM Inside the Numbers

Busy Crowd

If you were at CSM in San Antonio last week, you know this conference was big – in a variety of ways. The APTA touted record attendance levels. The conference was spread out among a huge convention center, with concurrent sessions in two additional hotel centers. Overflow viewing screens had to be set up in the hallways to accommodate full sessions. The exhibit hall was sold out and always packed. The conference hashtag, #APTACSM was even trending at the #2 spot on Twitter for some time. I guess everything really is bigger in Texas. Let’s investigate the growth of this conference, and who actually attends.

CSM 2017 continued to set attendance records this year and has been growing steadily in popularity in the profession. Reports of total attendance have varied for the conference, with talk of over 14,000 in San Antonio. Erin Wendel-Ritter, Manager of Media Relations and Consumer Communications for the APTA, reported registration was over 11,600* for conference attendees. That is a lot of PTs, PTAs, and SPTs! While the number itself is impressive, how does it break down to actual membership? Dr. Sharon Dunn, President of the APTA, tweeted that the Association is at ~98,000 members, with a drive to get to 100k by the NEXT Conference in June. That equates to roughly 11.8% of members attending CSM. There are a variety of reasons why members do not attend yearly conferences, including registration cost, travel, and time off work.

I think we can be more involved as a profession – 11.8% is good, but we can most certainly do better. As Dr. Dunn notes, it starts with increasing the membership of the APTA. Even if we stay at 11-12% attendance, an annual increase in membership of 3% would increase the attendance by roughly 1,000 registrants in 2018. This is no small task, as the rates of membership among other national healthcare organizations, such as the AMA, have suffered recent setbacks in membership rates. From an overall profession standpoint, in 2014 the Bureau of Labor Statistics reported that our profession encompassed around 292,130 Physical Therapists and Physical Therapist Assistants. From that point of view, CSM draws only about 4% of Physical Therapy professionals to attend. And that does not include students.

The student attendance at CSM 2017 was staggering. At times, it almost seemed like a student conference. Erin reported that student registrants accounted for over 4,100* of the total attendees! Student attendance was 35% of the total conference attendance. I think this is great – sort of. CSM is obviously doing a great job of attracting young professionals to a growing conference. Hopefully, they realize the value in the education and networking opportunities and continue to attend as professionals. Students are the future of our profession, and our profession is arguably the future of healthcare. The downside, however, is that it knocks down the number of actual practicing PTs that are attending this conference. If we take students out of the equation, then only about 7,500 practicing PTs and PTAs were in attendance or about 2.5% of the actual PT workforce.

So where do we go from here? The obvious answer is to encourage membership and active participation in the APTA. We can learn a lesson here from the AMA as well, their membership has started to increase in 2015 after a decade-long decline. How did they do it? By attracting student members and becoming more involved with academic institutions. Another solution is to continue to encourage PT professionals to share their voice on social media, which may create FOMO for those not in attendance. I expect students will continue to play a huge role in the development and growth of CSM as a conference in the years to come, and I hope that they continue to be active as graduate Physical Therapists.

*Initial numbers reported to PT Think Tank at the time of publishing. Final attendance numbers will be released on 3/6/17, at which time this article will be updated.

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Chronic Whiplash: Is it really a Medical Mystery?

neckpain copy

A small while ago, the well-known and widely read periodical, The Atlantic, published a piece entitled, Chronic Whiplash is a Medical Mystery. In the article, the author, Julie Beck, poses the thematic question, “Being jostled in a car accident should only cause a few weeks of pain—so why do some people suffer longer?” Well, that is a good question, isn’t it?

Over the past decade, tremendous advances in the science related to Whiplash and Whiplash Associated Disorders (WAD, as it were) have been achieved. Recently, this science took a giant step forward with the publication of Part I of a two-part special series dedicated to whiplash in the Journal of Orthopaedic and Sports Physical Therapy (October 2016 issue). This issue featured guest editors, Drs. Jim Elliott, Dave Walton, and Michelle Sterling and an editorial by Gwen Jull. Heavy hitters for sure. When it comes to accidents and injuries even if it is the ones that the injures in a truck accident on the highway there are lawyers to protect and get justice. People can check experienced moto accident attorney here if they need help with legal accident procedures.

So, it’s not surprising that some of these researchers took notice of Beck’s article in The Atlantic. It’s also not surprising that to these researchers, whiplash might not be the mystery it may seem to others. And so, without further ado, PTThinkTank.com is proud to publish a response piece to Beck’s article, entitled, “Chronic Whiplash: Is it really a Medical Mystery?” Well, that is a good question too, now isn’t it?

Enjoy the essay from Jim Elliott, Peter McMenamin, and Dave Walton. Thank you, sirs, for the contribution.

Chronic Whiplash: Is it really a Medical Mystery?

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Physical Therapy Metrics

With the widespread use of EMR, more and more data is being collected about the way we practice. A recent post on the Four Hour Work Week by Eric Ries, has me thinking about metrics, specifically PT metrics and how they relate to the care I provide, and the experience my patients have. Eric breaks business metrics down into two types: vanity metrics and action metrics. Vanity metrics is the data that “might make you feel good, but they don’t offer clear guidance for what to do.” On the other hand, action metrics help us make decisions and give us valuable information about our practice. Traditionally metrics in the PT world can generally be broken down into 3 categories: billing, productivity, and referral metrics. More specifically, lets explore how vanity and action metrics relate back to individual (not company wide) practice.

Vanity Metrics: Private practice owners might argue that “no data is bad data” when it comes to tracking patients and therapist performance in the clinic. However, some data points simply do not provide an accurate picture of individual therapist performance, and could be better suited when applied to company performance, or ignored altogether.

  • Visits per case/referral: In my opinion, this data set is the most inconclusive of all metrics commonly tracked to individual PTs in EMR programs. The general rule-of-thumb for most private practices is that the visits per referral number should be between 10-12. This depends on several factors: skill level of therapists; number of post-operative referrals, geographic location, patient population/SES, referral source, clinic reputation, and the list goes on and on. I have found this metric has no bearing on patient outcomes, or patient/physician satisfaction. If you can obtain the same outcomes in 6-8 visits versus 10-12, your patients will be happier, and your referral sources will be impressed. In return, you see a higher volume of new evaluations – which means more and more happy patients.
  • Incomplete metrics: Other metrics that are commonly applied to individual PTs are actually “incomplete,” or too variable to apply to individual performance. For example, scheduling related metrics, such as cancellation and no-show rates, are mostly out of the control of the therapist and do not reflect on the quality of care provided. Obviously, a good clinician that creates buy-in, demonstrates value, and has good outcomes will generally have a low cancel rate. But, cancellation rate does not always reflect productivity – a clinician with a cancellation rate of 4% does not mean they are more effective than a therapist with a cancellation rate of 10% – this variation could easily be due to scheduling, clinic hours, weather, traffic, or an entire host of other variables.

Action Metrics: Action metrics are the data that should be used to evaluate therapist performance and patient outcomes. These metrics help the decision making process, and can demonstrate value to your referral sources and the general public.

  • Plan of Care (POC) complete to Discharge: Perhaps the most under-tracked, but most important data point is patients who complete a POC to discharge. Generally this happens when appropriate care is provided (regardless of number of treatment sessions), goals are met, and functional limitations are eliminated. The therapist and the patient are on the same page, and the patient is happy with the care they receive. And happy patients produce more business – not only by word of mouth and leaving reviews online, but also by telling their physician about the quality of care they received. A high percentage in this metric indicates that the clinician provides quality care and communicates well with their patients.
  • Units/visit: Another metric that is highly variable depending on the patient population and insurance type, but useful nonetheless is units per visit. Tracking units/visit at the provider and company level is beneficial – this serves to make sure therapists are not under-billing; which is all too common in PT practice. It also allows therapists to make sure they are not over-billing, which may make you more susceptible to audits. This metric also allows for more accurate clinic budgeting and forecasting income.
  • FOMs: Tracking change by using functional outcome measures is critical to evaluating therapist performance and patient outcomes. Functional outcome measures should be used with every patient, every time. However, accuracy requires that valid measures are being used, and that measures are used with the correct patient population. Understanding MCID and MDC for each measure is also important. These metrics should also be used to support Functional Limitation Reporting. In addition, physicians and referral sources often use and understand these measures, easing the communication gap while marketing to potential referral sources.
  • New patients per therapist/requested therapist: Another under-tracked and under-utilized metric is new evaluations per therapist. Particularly, patients who request a therapist by name are often more satisfied with the care they receive and more likely to complete their recommended course of therapy. I find this number often correlates with patients who complete their POC to discharge, looping back into the cycle of happy patients and word of mouth referrals.

When extrapolated across a group of therapists in a company or clinic, action metrics provide a more meaningful picture of how valuable our services are. Individually, vanity metrics can be misleading and provide little value as to the value and productivity of a therapist.  Eric Reis encourages us to “measure what matters” – meaning that more data is not always better, and argues that the key to having actionable metrics is “having as few as possible.” It can be tempting with EMR to look at a seemingly endless set of metrics, but narrowing our focus on a few can provide better insight into therapist, clinic, and business performance. How do you use metrics in your clinic? Which ones are used to evaluate individual performance?

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How do I choose a fellowship program?

Photo By Joseph Young via Unsplash

Since graduating from a fellowship program in 2012, I frequently field questions from colleagues and DPT students about the benefits of fellowship education. It’s easy to list the many ways my clinical skills have advanced, how my professional development has accelerated and how I love the field of physical therapy even more now than I did before fellowship training.

What’s not easy is answering the question “What are the similarities and differences between all these fellowship programs?” or “Do you think X,Y, Z program would be a good one for me?”

With 43 accredited fellowship programs how does one even begin? On the ABPTRFE website they are categorized into Critical Care, Hand Therapy, Higher Education Leadership, Movement System, Neonatology, Orthopedic Manual Physical Therapy, Spine, Division I Sports and the Upper Extremity Athlete.

Let’s say you’re interested in an orthopedic manual physical therapy fellowship program. There are still 25 different fellowships to look into. Now I have been to the annual AAOMPT conference five times and have met and had conversations with numerous faculty, alumni and fellows in training from a variety of organizations, yet I don’t think I have more than a passing knowledge on many of the programs.

Visiting the 25 individual program websites in an effort of gain information is tedious at best. Could there be a better way to efficiently consume this information? One that would at least have basic information (duration, cost, # of graduates, etc.) in a central listing to serve as a launching pad?

The challenge of fellowship education should be elicited once you are in a program. Not while you are attempting to gather information about them.

A similar message was brought up recently by DPT student Zack Duhamel, his thoughts are below.

As usual, there is a healthy amount of talk going on in student/new grad circles about continuing education options. This conversation usually goes two places: 1. “I am dead set on (fill in the blank) residency/certification because my CI was all about it and they were super cool!” or 2. I have no freakin clue what is going on in that world. The funny thing about me is that I feel like I can kind of resonate with both of those but I want to draw some attention to a gaping hole in our education and maybe get some help.

I am a third year student, 3 months from graduation and like most ambitious SPTs I really want to learn more and be a great PT, which has inevitably lead me to looking at structured continuing education models. As I started this search I was directed to APTA’s Residency and Fellowship website which basically lists them all but gives very little helpful information. So, I took to the only other place I knew I could get answers…the DPT Student Facebook page and I posted this:

Zach Duhamel FB post photo

This lead to a long string of messages that confirmed that there is a huge need for education about post grad educational opportunities. We, the students, need to know what the heck is going on. What does one group believe vs. the other? Which one is best for me? Are any of them right for me?

I don’t think these questions are being answered well right now. I propose we build a platform to REALLY understand the ins and outs of these programs and groups so that we are not going into them blind but confidently, knowing it is the best fit for us. How can we do this? A few ideas have been tossed around, but I think the best one so far is a short (2-4 minute video) of a representative from each group that answers the same set of 4-5 questions. These questions shouldn’t be ones that we can simply look up, like cost, duration or location, but questions like:

  1. What classification system is used?  Tissue vs. Movement diagnosis
    1. thoughts/ beliefs on ability to dx tissues specifically
  2. What is the treatment philosophy?  
  3. How is the Exam structured?
  4. How has fellowship training changed your practice?
  5. What is the ultimate reason for choosing the Fellowship you chose?

These questions are by no means the only ones to be asked or the right ones but I believe that they drive to the real heart of what continuing education is about. These are the types of questions that students and new grads are asking but that are not getting answered, at least by multiple groups, which makes the decision of what route to go down increasingly difficult.

If you are a fellow, resident or have completed a certification and would be interested in helping make this happen comment below or tweet either of us @AmyPakulaDPT or @zduhammy, and copy @PTThinkTank so we can keep track.

This post is by new author, Amy Pakula. Welcome to PTThinkTank.com, Amy!

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Dr. Amy Pakula graduated from Pacific University in 2008 and completed her fellowship training through the Kaiser Permanente Northern California PT Fellowship program. Amy works in the outpatient orthopedic setting at Momentum Physical Therapy in Bozeman, MT. She has taught continuing education courses to physical therapists in Peru through Health Volunteers Overseas. She has also been a presenter at national conferences and serves as a consultant to the Kaiser Permanente Northern California PT Fellowship program.
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What Problem Does The Human Movement System Solve?

Apparently evolving from the new vision statement, the APTA and the board of directors introduced the “human movement system” as the potential professional identity and rallying cry for physical therapists. The definition of the human movement system is:

The human movement system comprises the anatomic structures and physiologic functions that interact to move the body or its component parts.

Chris Powers, PT, PhD, FAPTA recently discussed the concept of the human movement system on Karen Litzy’s podcast Healthy, Wealthy, and Smart. He stressed it’s conciseness, applicability to educating consumers, and it’s ability to be a unifying theme across practice settings. Dr. Power’s asserts the profession of physical therapy needs an identity, a central theme, and something that applies across patient populations and settings. He describes the human movement system as a system comprised of many systems. “We treat the entire movement system, and in order to do that you have to be an expert in all of the subsystems.”

Matt Sremba, PT, DPT, OCS Paul Mitalski, MS, and myself are interviewed by Adam Van Cleave on the Conatus Athletics’ Podcast regarding the Human Movement System and Role of the Physical Therapist. We think there are issues in regards to the definition and it’s implications. All of us agree with Dr Powers that there are problems within the field of physical therapy spanning education, research, and clinical practice. But, we do not see the creation of a “human movement system” nor the definition as assisting in either solving nor identifying any significant problems.

It’s over ambitious and under precise…this definition allows for a misinterpretation of the physical therapy profession…The first example I’ll give is the word components and how it’s used. In this instance the word is too broad….The word movement is too narrow…do they really mean ALL components of all anatomical systems involved in movement? Because that is what they say. In fact, what system wouldn’t be involved? What system or component of human anatomy doesn’t directly or indirectly contribute to movement? This is too broad. Didn’t narrow the scope…

When you propose a definition that has no bounds you end up not defining anything. And definitions have to be precise. So, this is a lack of precision. On the other hand, the word movement also has a lack of precision, but it’s opposite. The word movement, to me, is too constraining. It’s inconsistent with what the physical therapist does and it limits what the physical therapists does. PTs should have a medical role…for the human whether or not the human is moving. The therapist should be involved in non-movement aspects of the human. -Paul Mitalski, CEO of Conatus Athletics

Sure, this may appear like nit picking, minutia, and nothing but semantics. Is the human movement system really a system? Is this our professional identity? Do we want to create something else that no one knows about? If the physical therapy profession senses there are issues communicating our knowledge and roles to various stakeholders any proposed solution must be clear. Precision in language is needed.

The problems have not been specifically identified or labeled meaningfully. Is the definition for marketing and branding only? One liners and advocacy for physical therapy are not bad. In fact, rallying generally around PTs helping people move is a likely a meaningful cause. And of course, PTs deal in human movement quite frequently. But, we remain skeptical that attempts to create a human movement system will contribute meaningfully to education, research, clinical practice, or advocacy efforts. Further, this definition will not contribute meaningfully to communication. We think creating new systems with broad definitions that demand assumptions may only complicate an already cloudy communication problem.

Are the problems properly identified? And, does the creation of the human movement system and it’s definition address them? Some of the issues we identify (and will discuss further in future podcasts) are leadership, collaboration, and education modifications.

Listen to The Human Movement System with Dr. Chris Powers on Healthy, Wealthy, and Smart as well as our reply The Human Movement System and the Role of the Physical Therapist on The Conatus Athletics’ Podcast. Our goal is to open a dialogue on this topic.

So, what do you think?

Resources
The Human Movement System with Dr. Chris Powers on Healthy, Wealthy, and Smart
The Human Movement System and the Role of the Physical Therapist on The Conatus Athletics’ Podcast
Human Movement System information on APTA website
Rothstein Roundtable Debates Implementation of Human Movement System
Rothstein Debate: Putting All our Eggs in One Basket: Human Movement System on PTJ Podcast
Discussion: The Human Movement System on PTJ Podcast
Shirley Sahrmann explains why PT’s are THE Movement System Specialists on PTPintCast
‘Movement System’ Is Our Professional Identity
The human movement system: our professional identity by Shirley Sarhmann
On “The human movement system: our professional identity…”

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Decoding the Brain: Will Future Physical Therapists Manipulate Hippocampi Instead of Spines?

Interneurons
Image courtesy NIHCD via Flickr

National Geographic Channel is featuring a slick new program:

“Breakthrough: Decoding the Brain” on Sunday, November 15, at 9 pm ET on National Geographic Channel. 

As part of this show’s launch, they’re posing the following question for commentary:

“What if scientists were able to implant or erase memories? For some, like those suffering from PTSD this could be life-changing, or do you think this is scientific innovation gone too far?”

This question is right up our alley!

The Brain and Chronic Pain

The recent meeting of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) in Louisville, KY was a bit unique. Unique, because in contrast to years and years of this conference unsurprisingly featuring scientists purporting the evidence for using manual therapy techniques like spinal manipulation for patients with musculoskeletal pain, this year the conference featured speakers who didn’t use their hands. The conference keynote was delivered by Dr. Peter O’Sullivan, (his cool blog is here) who spoke about his work related to Congnitive Functional Therapy for patients with chronic pain. Other talks revolved around pain science, big data, and a general change in the tenor was noticeable.

Manual therapists have long struggled with patients who have chronic symptoms, as short term gains are quickly realized, but long terms gains are extremely difficult to achieve. So, what prompted the AAOMPT, a scientific academy founded around manual therapy techniques, education, and science, to feature a pallet of speakers speaking about techniques that didn’t involve hands or cavitating  joints? Well, friends, science is always a moving target, and it’s broad, and sometimes you need to look outside your cerebral solar system to learn new things. This is one of those times for physical therapists!

But, perhaps we don’t need to travel too far! This new traditional neuroscience science is now showing up in manual therapy journals like…well, Manual Therapy! In a recent article, entitled, “Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories,” Nijs et al address the concept of movement-related pain memories and exercise for patients with chronic pain. They suggest that clinicians should preempt exercise therapy by first priming the brain via neuroscience education, and then utilizing movements to help the body ‘forget’ those memories associated with those movements and pain. Sounds just like Peter O’Sullivan’s CFT doesn’t it? This work builds on work by neuroscientists who are exploring the role of the hippocampus in generating pain-related memories. This is a wide open field, and the potential of learning how to impact pain related memories is truly astonishing!

Manipulating Hippocampi?

While the concept of having memories erased seems on the surface frightening… (I wouldn’t want to forget that cool downhill bike ride down Mount Snow even though it hurt!)… it does seem that breaking links between pain experiences and memories is one of the keys to managing chronic musculoskeletal pain conditions. Just how we do that best remains to be seen! Will future physical therapists have a cadre of tools that not only allows for mechanical inputs to alter central nervous system activity (spinal manipulation), but also precise strategies to target pain memories and more directly impact cognitive reasoning about pain? I sure hope so!

I’m excited for the new Breakthrough series on NatGeo. It just seems like one of those times when all sorts of science is converging on something…on the true potential of that “3lb mass in our heads!”

 

 

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Debate and Dissent. Do We Need Contrarians?

Debate and dissent are useful in their own right. In the realm of professionals, argument should not be a pejorative. Agreeing to disagree is the start, forming the foundation of the discussion, not the end. Yielding of discourse and the parting of ways is but to avoid the required conflict of progress. Contrary to popular belief, dissent for dissent’s sake and debating just to debate are necessary to sharpen and sculpt the knowledge base and thinking in any realm. We need contrarians.

Time spent arguing is, oddly enough, almost never wasted. -Christopher Hitchens

Hang out with individuals who ask tough probing questions, not those that give you high fives and excessive praise. As Jerry Durham routinely proclaims “if you are the smartest person in the room, you are in the wrong room!” Pursue disagreement.

On the charge that debate, “nit picking,” and argument tarnish the public image of physical therapy, I must protest. Generally, Science and debate are already misunderstood in the public sphere. This problem is not unique to physical therapy that the process of progress appears contradictory and self defeating . Yet, all scientific disciplines evolve through argument. Critique, alternative explanations, and disagreement force the community at large and the individuals therein to analyze current assumptions. Theories, processes, and understanding all require frequent sharpening. Critical analysis and differing viewpoints are the wetstones of inquiry. We can simultaneously argue fiercely within our profession while advocating passionately for it. These two necessities are not mutually exclusive. Further, we must actively seek to address and engage critiques from outside our profession. Physical therapy writ large should engage other health professions and scientific disciplines.

Picture all experts as if they were mammals. Never be a spectator of unfairness or stupidity. Seek out argument and disputation for their own sake; the grave will supply plenty of time for silence. Suspect your own motives, and all excuses. -Christopher Hitchens, Letters to a Young Contrarian

The proposition of challenging and questioning our current understanding is an uncomfortable one. Cognitive dissonance involves feelings of discomfort that we usually seek to avoid. However, consistently aiming to prove ourselves and our professional assumptions wrong is not only beneficial, but necessary. Questioning is not an attack, it’s the process of refinement. The difficult task of reasoning through and critically thinking about our conclusions is a component of strong clinical reasoning. Reflection, as it is proposed, is a hallmark of clinical expertise.

Often, skepticism and critical inquiry are mistaken for antagonism, if not outright cynicism. Although, to some extent professional antagonists are likely to improve our thinking and development. The contradiction is such: disagreement is necessary and debate is fruitful in it’s own right, but constant contrarianism appears to yield little concrete action. Those who dissent by asking the tough, uncomfortable, uncommon questions should improve their counterparts as well as their own thinking. Hopefully all involved in a discussion are at least subtly affected by the exchange. But, there is more at play. The dissenting may positively affect the spectators. Seemingly fruitless and circular discussions in which neither side appears to change are of benefit to those who bear witness. Considerations to ponder, questions to investigate, and new ways of thinking become available.

There’s a small paradox here; the job of supposed intellectuals is to combat oversimplification or reductionism and to say– “well, actually, it’s more complicated than that.” At least, that’s part of the job. However, you must have noticed how often certain “complexities” are introduced as a means of obfuscation. Here it becomes necessary to ply with glee the celebrated razor of old Occam, dispose of unnecessary assumptions, and proclaim that, actually, things are less complicated than they appear. -Christopher Hitchens, Letters to a Young Contrarian

Don’t avoid dissent. Answer the question. Attempt to prove yourself wrong. Disagree and debate. Reflect. Be fierce, but respectful. Admit mistakes. Concede where indicated. Anything less, I contend, is unacceptable. Perhaps you disagree?

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A Personal Endorsement for Eric Robertson #AAOMPT Secretary

Naturally, I’m biased on this matter. So, please consider that as you read this endorsement. But, I also plead that you digest my narrative and what it illustrates about Eric Robertson.

As a #DPTstudent, I was fortunate to be involved in the AAOMPT student special interest group. At the risk of sounding cliche, the experience was transformative. I was exposed to the inner workings of a professional organization, afforded the opportunity to organize events, involved in advocacy, and even saw my beginnings as a blogger. Our student SIG was full of energy and set lofty goals.

Students, often, are eager and idealistic expressing grandiose visions and unconstrained thought processes. This, of course, is positive. A motivated and engaged student does not know impossibility. And, thus can be quite an agent of change, or a least reflection. I’d like to share a story with you about how Eric, without even being formally involved in the student SIG, brought focus and professional growth to the student members one evening.

It was 2009 at the AAOMPT National Conference in Washington DC. The AAOMPT sSIG leadership sat around a table in those classically ill lit and muggy conference rooms, frantically discussing ideas and topics almost at random. Bob Boyles, the AAOMPT sSIG advisor at the time listened to us. It was great times! Eric, who at the time, I had only just met, was also present. Eric also listened to our grandiose plans to save the world, cure hunger, and eliminate back pain. After listening intently, as Eric does, he spoke. With pointed questions and strategic steering he efficiently nudged us towards more meaningful conversation without stifling our enthusiasm nor tempering the discussion. Oddly, I can’t remember at all what he said. I just remember his presence and effect. It was effortless, but profound and has stuck with me as an example of the kind of impact Eric can have in a room.

Eric routinely engaged the students as colleagues, but also challenged in a productive manner. After attempting to write meaningfully for the AAOMPT sSIG he extended an invitation, and opportunity to blog at PT Think Tank, an experience for me that has been a professional highlight.

Over the years, I’ve known Eric to possess a cool demeanor, strong thinking skills, and excellent strategic planning. He’s not afraid to tackle a problem from multiple angles and balances a host of commitments with ease. I know a long time goal of his has been to serve in a leadership capacity within AAOMPT, so his decision was not at all rash. He’s a constant advocate for physical therapy with a knack for concise and clear communication.

I’m indebted to Eric for his guidance along my own career path and the informal, but always beneficial discussions. His unique experiences and point of view could facilitate amazing progress. I recommend him highly and without reservation. His vision, his commitment, and his skills would serve the AAOMPT well. But, don’t take my word for it.