Ortho Marketing Juggernaut

As many Physical Therapists already know, the medical establishment gets all the press. We have lived in their shadows for too long. Our potential to reduce costs to the healthcare system is so very limited by our lack of public awareness. The APTA seems to recognize this and does have a marketing initiative. The American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) also acknowledges this and even has, as part of their mission: “The AAOMPT will be the resource for promoting orthopaedic manual physical therapy in the United States.”

How have we done? Terrible in fact. Our efforts have been fractionated, we have no central funding source for this, the APTA does not have the budget to lead the way, and we are left to come up with trendy little media bits like Blackberry Thumb. But even that can be sabotaged by a crafty orthopaedic surgeon. By and large, consumers have no idea what good Physical Therapy is, nor that they can freely access our services.

On the other end of the spectrum is the well funded American Academy of Orthopaedic Surgeons. (AAOS) They have a wonderful marketing campaign which I hear every day as they have radio spots on the nationally broadcast ESPN radio!

At first glance, one might tend to wonder why orthopaedic surgeons need to market at all, as they already have control of the musculoskeletal healthcare marketplace. However, Microsoft advertises its product and so does Google. Reinforcing a solid market position is part of the good business practices of a leading organization.

Perhaps Physical Therapists can learn a thing or two from our well paid musculoskeletal brethren. Let’s take a look a the AAOS marketing campaign, powered in part by healthcare marketing powerhouse Priority Publications: (I encourage you to investigate the links below!)

*To start, the AAOS has a major marketing
focus on their website, including a media resource site for members.

*The AAOS has a dedicated consumer
information website, orthoinfo.org, which is a far cry from the little button the APTA has
on their website for consumer

*The AAOS even has an awards program for their best member marketeers.

*The AAOS regularly…like every other
day…issues press releases to the AP and others for mass media distribution, like this one.

*The AAOS has a celebrity spokesperson, in Joan Rivers!

*AAOS has a library of public service
which are free to
members to use as they wish.

*AAOS has a national radio and TV campaign
featuring their celebrity spokesperson.

*The marketing goal of AAOS is:
“…will be recognized as the authoritative voice for good musculoskeletal
health” Click here for their strategic plan.

Summary: They have the same, albeit more detailed goal as the AAOMPT, a huge budget, a detailed national marketing campaign already in place, and the hold on the market already. Are we in trouble?

Well, there is a nice grassroots effort gaining momentum from the AAOMPT, the APTA has just hired a new CEO (whose background in stronger in lobbying than marketing,) and well, we might just invent a new marketing gimmick like we’ve done in the past. One problem with the AAOMPT’s goal is their ability to enact it. They represent only a smattering (read: small, tiny bit) of our nation’s Physical Therapists (although perhaps the most important smattering!).

My point is that grassroots efforts, while important, are a long way away from where we need to be. The Physical Therapy profession needs to organize their efforts or be left in the dust. We currently do not even come close to competing with the Ortho Marketing Juggernaut.

This national advertising topic is of great interest to me. As such, this post begins a series of posts I will present on ideas related to a national marketing campaign for Physical Therapy: PT Publicity Project. Enjoy and comment when you feel inspired to!

How Much Is That Stress Fracture Worth?

About $1.3 million!

That’s how much in grant money a Physical Therapy professor from The University of Delaware was awarded to study the prevention of these stress fractures. Irene Davis, PT, PhD, the director of the university’s Running Injury Laboratory and director of research for Drayer Physical Therapy was awarded the grants from the NIH and the Dept. of Defense.

Stress fractures are a real cost and challenge to the military. Its not uncommon for a soldier that suffers a stress fracture to be off-line for 6 months or more. Considering the enormous cost of training soldiers and the high frequency of stress fracture occurrence, I’d say the DOD is getting a real deal on this!

The study is really quite interesting, incorporating biofeedback and gait re-training to reduce impact forces during running at levels much greater than what a cushioning sneaker could provide. Remember, just because we all learn how to run does not imply we all know how to run correctly.

Stay tuned for more on this topic, I have a feeling that this could be one of those studies where I walk into work at the Army clinic one day and I’m met with a biofeedback device that I have no idea what to do with!

I'm Officially Sensitive!

As some of you may know, I recently was involved as a tester in a research study at USC. As testers, we were required to perform repeated muscle tests on subjects quadriceps using 4 different types of tests. I was reviewing the final manuscript and found the following paragraph:

“The sensitivity of both the isometric and dynamic manual muscle tests found in the current study was much lower than would be desired for an adequate screening test. This finding was also most likely contributable to the overwhelming tendency of tester two to find no difference in strength, on both the isometric and dynamic tests, when one was detected by the Biodex dynamometer. When analyzed separately, the sensitivity of manual muscle testing as determined by tester one (Se range of 56% to 100%) was much greater than that determined by tester two (Se range of 11% to 33.3%). This means that tester one was much more likely than tester two to correctly identify those individuals with quadriceps weakness. “

I was tester one.

This is good, as I performed the data collection in fear that I would be proved to be a poor muscle tester.

To be fair, I also had a high level of false positives, finding a difference when one was not detectable on a machine. Maybe I’m more sensitive than the machine???

In all seriousness, part of my training was unique in that I had a couple of instructors who placed a large emphasis on developing expertise in palpation skills. I was guided and praised often in this area and I am proud of my ability to feel different movements with a high degree of sensitivity. I was very lucky to have teachers so focused on palpation skills.

I wonder what the other professions or even other schools do to improve a student’s ability to sense movement.

What Are You Looking For?

Perhaps you may have noticed, perhaps not, but for the past several weeks, a new functionality has been added to this blog. I created my own custom search engine using Google Custom Search. The premise behind my search is that I attempted to combine a mix of high quality consumer and professional information sources into one comprehensive rehabilitation search.

I browsed through many sites and it is a work in progress. My hope is that when you search for something like, “back pain, “the results you get will be from high quality, evidence-supported web sites. Google has been steadily improving their medical search as well, but the search results are still targeted to a wide audience.

Run your own test search. Pick a condition like, “TMJ,” and search Google Regular and my search and compare the results. I would love any feedback or site suggestions you might have on this. Enjoy!

Who are the Experts in Musculoskeletal Care?

This interesting article published in Military Medicine, a smallish peer-reviewed journal asked just that question. The investigators administered a standardized examination that assesses knowledge in managing musculoskeletal conditions to uniformed Physical Therapists. They then compared the results to other healthcare providers. The results:

  1. Orthopedic Surgeons
  2. Physical Therapists
  3. Everyone else.

Everyone else consisted of: medical students, physician interns and residents, active duty military physicians, and all physician specialists except for orthopedists.

As as side note, Physical Therapists who were not trained in the Army system or had not attended their specialized training did not as well as those therapists who had.

The lack of musculoskeletal education for generalized physicians is well documented. This study tells us a couple things: Not all healthcare providers are the same. The Army is very proud of its program.

As a first hand observer of this issue: I concur.

Why this Plica makes me sad…

Today a patient came to see me with knee pain that she’s had for over 6 months. She had been to see a variety of care providers at different locations around the globe. Radiological imaging was performed and the resounding result of all her previous exams and imaging was “Nothing Found.”

Usually I get defensive when a patient with this background comes in, as it triggers my “scammer alert” instincts. Upon interviewing this patient it immediately became clear that she was in legitimate pain and was frustrated that “no one can see it, feel it or tell me what’s wrong, but I just know it hurts.” Game on!
The interview revealed she could run 2 miles very quickly, but has some pain after, stairs frightened her, and sitting in meetings really hurt. My physical exam lasted all of about 3 minutes, including several special tests to rule out any injuries not suggested by her history. She had a patella plica. (And here.)
This is a small fold of soft tissue that everyone has between the kneecap and femur. In some cases, it becomes angry and hurts. It is not uncommon and is really a simple diagnosis to make. Her treatment would include some basic stretching and strengthening, and a referral to an orthopedist for a steroid injection. With any luck we can avoid surgery. Her prognosis is good.
So what makes me sad about this plica? The fact that no less than 5 physicians examined this knee without findings and this poor girl was labeled as a scammer. This story underscores the importance of seeing a musculoskeletal expert for musculoskeletal pain.
Who are these experts? Physical Therapists and Orthopedic Surgeons. That’s it.

Can Exercise Help Breast Cancer?

Perhaps not directly, but a recent BMJ article says it can help in improving physical function and quality of life measures in patients with early stage breast cancer. Some of the physical measures noted were a 12 minute walk test and a measurement of shoulder mobility. Interesting to note, the physical measures improved right away, but it took some time for the quality of life measures to show an intervention effect.

There have been a series of studies (and this one) recently dealing with the issue. I find the concept refreshing, as it really makes sense to get some supportive literature behind some good integrative care. Perhaps with enough of this type of literature, a woman diagnosed with breast cancer will be able to receive treatment not just for her cancer, but also for her receding quality of life and upper limb function…and have it reimbursed!

Trade your back pain for one in the neck!

This week the Radiological Society of America released a snippet from their recent annual conference concerning the “best biomechanical sitting posture .” Media outlets quickly spread the word to all of us that according to, Waseem Amir Bashir, MBChB, clinical fellow in the department of radiology and diagnostic imaging at the University of Alberta Hospital, Canada, the best anatomical sitting posture is a reclined position of about 135 degrees.

I am both totally in agreement and totally abhorred.

This is a classic example of what pines me when the media covers scientific exploits. In this study, the researchers used a nifty type of positional MRI machine that allowed subjects to move freely as they were imaged. The joint spaces were then measured and it was determined that 135 degrees of recline was the position that produced the least amount of forces in the low back. They added that low back pain treatment should be treated at the initial stage to avoid the consequences.And they concluded that sitting upright might not be the way to go. In this, I agree. The best position for your spine is actually standing, upright sitting being the worst with respect to intradiscal forces, or the force that your spine experiences from gravity. However, to make a statement is dangerous.

You can try this out to get rid off neck pain. “This may be all that is necessary to prevent back pain, rather than trying to cure pain that has occurred over the long term due to bad postures,” Bashir continues.

This postural study cannot take into account muscle support, associative reactions in the cervical spine and physiologic effects from compressed organs. What about adaptive shortening of anterior cervical muscles from a head held in a prolonged flexed position? I can picture the company now that runs out and spends to put all their workers in this reclined position only to lose all of them to severe neck pain in short time.

Please talk to a professional before any seating is purchased. Remember, the media are not scientists or health care practitioners and so we cannot really hold them too accountable for such reporting, can we?

If you’re really in a press for seating guidelines, here we go: Sit up straight and comfortable with some lumbar support, change positions often, find a reason to get up and stretch. Simple.

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