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Physical Therapist Overcomes Her Own Barriers

Jberg_2
Physical Therapists are renowned for helping those with injuries or disabilities overcome obstacles in the name of higher function.  Amputees, patients with spinal cord injuries, and even those with broken bone rely on the physical prowess of their therapist to help them regain movement and maximize function. 

Lost in this picture, however, are the physical attributes required to be a physical therapist.  Once in college, my advisor tried to encourage me to "find a new career" because I needed an excuse note from phys. ed class as I recovered from multiple knee surgeries.  She told me that I wouldn’t be able to handle the demands of the job of physical therapist if I couldn’t even handle gym class.

I was astounded and thought surely this must be a "bad apple" and ignored her comments.  I thought to myself, "How could a profession based on helping people overcome functional limitations require those who actually do the work to have no room for their own limitations?" 

Well, after practicing for a number of years I discovered two things. 

  1. My advisor was wrong and I was correct to ignore her comments.  Perhaps she had a bad day.
  2. My advisor was correct, and being a physical therapist required a certain degree of physical skills: strength, flexibility, well-stabilized spine, good body mechanics, and so on.

This was a long story to get to my point.  I came across this article about newly minted, Dr. Jennifer Berg, DPT.  Jennifer has a bit of a short arm which ends just above her elbow. 

She likewise ignored her professor’s concerns about the profession’s physical requirements and is graduating today as a new physical therapist.  I admire her courage, because I know how I felt when my physical ability was questions…and I only had a sore knee!  She must be made of some real moral fiber and I’m happy to welcome her to the profession!

ERIC

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A Timely Article, But Still a Pain in The…

So I’m in class today instructing the MCG DPT students of the class of 2010 in the care and treatment of patients with low back pain.  This morning we reviewed how low back pain is often without a specific diagnosis and of the shortcomings of the medical model (pathology-based) in the care of low back pain for this "non-specific" group.  It was almost fitting therefore, when I opened up my Reader during lunch and found this New York Times article about the failings of current treatments for low back pain.

"Great!" I said to myself, "I can bring this up in class."  But, as I read the article, I was disappointed in lack of mention of physical therapy as an intervention.  I guess if the article was about treatment failures, we should be glad to be off the list, but there were some suggestions of more helpful therapies, and we should be on that list.

The article concludes with the nebulous recommendation to "reactivate yourself" from the editor of the journal Spine.  Yes, no mention of physical therapy treatment and the classification of that non-specific group, just a researcher concluding reactivation must be the best thing.

We have a long way to go to get this right!  I recommend letters to the editor of the NYTimes for now.

ERIC

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MyPhysicalTherapySpace Goes RAW!

Last week a very interesting discussion took place on the Orthopaedics Discussion Group on MyPhysicalTherapySpace.com.  The discussion was provoked by the abstract listed after the break, and specifically the following statement:

"The clinical prediction
rule proposed by Childs et al. did not generalise to patients
presenting to primary care with acute low back pain who received a
course of spinal manipulative therapy."

Description of the CPR in question on YouTube

MyPTSpace is a free online community and this debate sure showed how valuable community discussion can be.  This conversation was priceless and reminded me of a recent PT Journal Debate between Tim Flynn and Chris Maher, except in more of a WWE RAW style!

Central to the discussion is the question of whether or not the CPR applies to populations outside of those used to develop and study it thus far.  Just about all of the authors of the studies up for debate checked in.  One important hot topic was the fact that the researchers proposed to study the CPR as "proposed by Childs et al" but only used high-velocity thrust manipulation in a small percentage of patients, as opposed the the 100% utilization in the Childs’ study.  This discrepancy provided fuel for the debate as the question was asked, if the researchers applied the rule correctly.

Many chimed in with comments. Most notably, Josh Cleland provided a list of the points he’s pondering:

"I appreciate the dialogue on
this topic. I think we all can appreciate the efforts put forth by both
the Childs team and that of Hancock and colleagues. Certainly I have a
bit of bias here but after critically and objectively analyzing both
articles I walk away with a few thoughts.
 
1. Perhaps the CPR is only specific to thrust manipulation and not to non-thrust techniques.

2. Perhaps the CPR is only specific to the thrust technique used in the original study and not other thrust techniques.

3. Perhaps the CPR doesn’t apply to patients who are not recruited
from a military setting (we can argue the generalizability of this for
days)
4. Perhaps the exercise used in the Childs study was crucial to success.

5. Perhaps the lack of standardization of techniques is a recipe for failure.

6. The Hancock study does not test the CPR as it was originally developed.

7. Perhaps the rule doesn’t predict response to thrust manipulation
(although the Hancock results to do provide adequate evidence to
suggest this)."

Josh’s summary was generally accepted by all the debaters as a balanced viewpoint.  Though there were some other interesting points made as well…

"However, I do find your “more blind faith” comment a bit patronizing and yes, I have read both papers."

"While the scientific method
is intended to provide control, minimize confounding factors, and limit
our biases, we still bring our biases into our scientific endeavors
(including published papers). With this in mind it is helpful to remind
ourselves that clinicians and researchers will generally agree much
better on data than inferences drawn from the data."

"So- evidence exists to
support the use of thrust manipulation in the management of a
particular subgroup of patients. However, therapists in Australia who
are well aware of the evidence fail to use it (even when they were
instructed that they had to use manual therapy). I expect if we gave
therapists control of which techniques to use here in the US we would
see the same magnitude of under utilization."

"…I’m sorry you apparently don’t like chicken sandwiches.  😉  It might just be an American thing…"

"Given you don’t use plain
language words as they are defined in English dictionaries and others
do not use scientific terms as they are defined in scientific texts it
is unlikely we will ever understand each other, let alone reach
agreement."

This was all great fun and if you want to find out who said what in the above statement, go see for yourself. [Link to Discussion]

And here’s one last quote, which I think should be pondered for a while:

"It might just be me, but one
of the reasons I think that the Hancock study has resulted in this
level of discussion is the rather sensational quality of the statements
within the abstract."

I hope you didn’t mind the long post, it was fun for me!
ERIC

(Click on to read the abstract)

Continue reading “MyPhysicalTherapySpace Goes RAW!”

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Physical Therapists and Fantasy Sports

Arodhomer4391174_yankees_v_tigers_2
Physical Therapists have always been closely associated with the rehabilitation of professional athletes.  Even today, the Google news feed is littered with references to A-Rod and the physical therapist he plans to meet.  The stakes are pretty high when a sports team entrusts you with the health of their $275 million investment!  It’s nice to think of the impact physical therapists have on sports, even if it is in a behind-the-scenes role.

As a fantasy football fan, I regularly use my own knowledge to make judgments about player injury status.  I think it gives me an edge.  I stumbled across this blog by Chris Neault, who ties his love of baseball and PT background to offer fantasy baseball advice.

Of course the reigning queen of fantasy sports physical therapists is Stephania Bell, whose platform on ESPN is just awesome.  She offers her PT injury analysis skills to the world of sports, from the world leader in sports.

It’s impressive to witness a physical therapists actively engaging and contributing to our nation’s sporting health on the national scene. Their expertise not only aids athletes in recovering from injuries but also enhances their overall performance and well-being. A sports masseuse also provide therapeutic massages that helps relieve muscle tension, improve circulation, and promote relaxation to athletes. By working closely with individual athletes, these professionals play a vital part in preventing injuries, and ensuring that they are in peak condition to compete at the highest levels.

While their crucial role in rehabilitating thousands of amateur and youth sporting injuries often goes unnoticed, it’s just as noteworthy as handling high-profile cases like A-Rod’s quad strain. Moreover, obtaining a sport specific training certification could further enhance their ability to address the unique needs of athletes at all levels.

I’m motivated to quote the APTA poster hanging in my office,

“Attention, all weekend warriors.  We’ll (physical therapists) be in bright and early Monday morning to treat your back pain.”

ERIC

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Marketing The Profession?

If any readers of this blog do not read the Evidence in Motion blog, go read this post for some thoughts on how to, and how not to market the profession.

My two-cents can be illustrated in two additional links.

The first, at BEAPT.ORG, is the video embedded below. 

Obviously, this is an APTA marketing video designed to attract people into the profession.  While I admit I skimmed through some of it (10 min was just a bit too long), I was careful to look for anything that remotely resembled a PT treating low back pain.  I did find it at about the 5th minute for 10 seconds or so, without being specifically mentioned.  I don’t know why I thought it would be.  We never treat low back pain, and most physical therapists are not employed in outpatient orthopaedic settings, right?

The second example is a little more on target.  It is an opinion letter written by APTA President, Scott Ward on the USA Today website.  In the piece he mentions high-value issues for our profession and, in plain language, promotes the physical therapists.  This is good grass-roots marketing, though perhaps one without great reach.

ERIC

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Taking the Hard Road

In my life I’ve always held to the mantra that in academics, the easy road is often the wrong one.  I’ve used this thought to drive me through most of my education, especially those times when I was taking extra courses and auditing classes just to cram in as much learning as I could. 

I was inspired and reminded of this approach by Seth Godin’s latest blog post, "Getting vs. Taking," where he writes:

"A few people, not many, but a few, take. They take the best education
they can get, pushing teachers for more, finding things to do,
exploring non-defined niches. They take more courses than the minimum,
they invent new projects and they show up with questions."

The same principle applies not just to students, but for patients as well.  Those patients who enact a truly remarkable recovery have usually gone and taken it, not waited for it to occur. 

I wonder how that can be captured as part of a research study…

Here is a link to an old post I wrote where I considered the pace of work.  [Google’s Frantic Pace]

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Stanley Swims, Floats Research

Paris_on_la_manche

Stanley Paris, swimmer extraordinaire, is undertaking an attempt to become the oldest person ever to swim the English Channel at the tender age of 70.  Details of the swim and his training can be found on his blog, Paris on La Manche.  You’ve just got to love the swimming cap!

Dr. Paris is swimming in support of the Foundation for Physical Therapy, and so by donating some $$ you can help further research efforts for the profession.  [Link via APTA]

Paris, the founder of the University of St. Augustine, one of the founding members of AAOMPT, expert functional anatomist and physical therapist can hopefully add this new feat to his long list of interesting and notable accomplishments.

Good Luck, Stanley Paris!

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Physical Therapist 2.0?

Parkinson
Since I first became aware of Jay Parkinson several months ago, I’ve been trying to reconcile his business model for the delivery of health care with physical therapist practice.

Jay Parkinson, a Brooklyn-based physician, has a nifty web-site which explains his novel model of health care delivery.  Parkinson basically delivers distance-based health care through internet technologies.  For $500 per year, Parkinson can be signed up as your physician (if you live in Brooklyn) and for that fee, you get almost unlimited chat/e-mail/text/video chat contact, and a couple visits in person.  These "e-visits" can take place at your home, your work, your favorite coffee shop, etc.  Parkinson is trying to blend the concept of the very personal family physician of yesteryear characterized by house calls and  personalized contact with today’s massive tech-based communication methods.  The Health Care Blog sums up the model well,

"Jay is not trying to serve the mass institutionalized health care
system, he is trying to service a niche group of young, urban
professionals who for whatever (or for obvious) reasons have opted out
of the medico-industrial complex."

Several important things combine to make this model work.  His patients are self-selected, tech savvy, most likely proactive in their wellness.  They are located in an area which makes travel between patient visits inexpensive.  Parkinson is limiting his practice in terms of numbers (although the economics of $500 x 1000 patients is not too limiting!) to maintain his "personal" touch.  An finally, he has removed his service from the practice-dictating effects of third-party payers. 

Is there a place in physical therapist practice for this very innovative model of care?  In fact, I think there is.  The majority of aches and pains that impact people each day are musculoskeletal in nature.  Each day, I employ parts of my skill set upon my own body to keep in running the right way.  Perhaps others could benefit from that tweaking and tuning as well.  Evidence supports both the massive cost mismanagement of musculoskeletal dysfunction and the importance of early physical therapist access in helping to prevent the development of chronic dysfunction. 

Direct Access to physical therapist services helps enable the implementation of this model, but a profession-wide branding problem might make it difficult to market.  The niche of patients that can maximally benefit from an e-visit needs to be explored.  Yet, from my eyes, this model is very consistent with APTA Vision 2020 and promotes the "PT for Life" concept.  It would take the right market, but Parkinson is on to something that physical therapists should take note of.

ERIC

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New Blog, PT on Forbes, and Grassroots Political Efforts

There’s a new PT blog to mention, with two very interesting posts which need to be highlighted. 

MCG Physical Therapy student, Ben Seagraves’ most recent post sends us to this blog from Rich Karlgaard on Forbes, who outlines how it cost $14,000, 3 specialists and 2 MRI’s before his son was able to access the services of a physical therapist.  Defensive medicine at it’s best! 

Most interestingly, Ben’s blog, "Views from a Georgia Boy" was welcomed to the scene with an interesting commentor on only his third post.  Ben’s post about GA bill HB 1055 provoked a very lengthy diatribe from GATA president Paul Higgs. 

I found it curious that such a comment would show up on what is very obviously a brand new, student-penned blog (not to take away from the blog, but traditionally, it takes at least a week or two to even tell your friends about your blog).  In order to find the post Higgs must have created a blog alert for the bill number, right?  This type of grassroots effort with collaborative technology is some solid stuff.  I would bet that Ben could comment on several hundred PT bills and issues and never get a direct comment from any APTA-ish entity. 

Reaching out and connecting through blogs and social networking is how relationships are being made.  Higg’s actions remind me of the Obama campaign, which has infiltrated almost every social networking site on the planet promoting his campaign.

There is a lesson to be learned here…maybe several, in fact.
ERIC

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Standardizing Practice Through Words

The current issue of the Journal of Manual and Manipulative Therapy (JMMT) is an important issue that all physical therapists and students should check out.  Important, as it contains the results of a task force charged with developing a standardized language with which to describe manual therapy techniques.  JMMT makes this content freely available. 

The editorial from new Editor in Chief, Chad Cook, is intriguing as it suggests the diversity of language within physical therapist practice is representative of deeper philosophical problems:

"Selected textbooks still support the use of archaic concepts such as Fryette’s law, usefulness of palpation of the sacroiliac joint, dogmatic use of the convex-concave rule for all joints, and the assumption that we can gainfully palpate and correct spinal subluxations."

Standardize your language here:
Task force for the American Academy of Orthopaedic Manual Physical Therapists.  A Model for Standardizing Manipulation Terminology in Physical Therapist Practice.

Thanks to Paul Mintken, Carl DeRosa, Tamara Little, and Britt Smith for authoring this important piece of literature.

ERIC