Podcast Update! Research, Stretching, and Vibrators with Guest Dr. Greg Lehman


Are you a physical therapist? Maybe a chiropractor? Chances are you are one or the other if you are listening to Therapy Insiders podcast. Our guest this week, Greg Lehman, is both! If you follow the latest in physical therapy research or best practice clinical practice you’ve most likely have read something by Greg. On this podcast, we delve into his perspective on such things as research, stretching and his life views which resulted in discussions on topics we never expected. If you are easily offended or don’t like curse words, this is not the episode for you. Also, don’t listen with kids around as its gets a bit “salty.” Click here to listen!
Check out our sponsor:
Therapy Insiders is sponsored by WebPT: The ultimate EMR for physical therapists. Not only does WebPT produce incredible EMR software, they also produce awesome content. Don’t believe me? Check out www.webPT.com/value for an upcoming webinar on outcomes and why they are the future for physical therapy growth! Want a free demo? Of course you do! Give them a call at 866-221-1870!
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Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...






Child's Pose as an Assessment


There are 2 problems that I have with a traditional upper quarter screen:
      1.  It takes extra time to look at each individual joint and muscle
      2.  It doesn't show me how each joint and muscle group work in conjunction with the rest of the 
           body during functional movements.

Instead of using a traditional upper quarter screen, I now use a series of yoga postures to perform my clinical assessment. Typically the first pose I have my patient’s do is child’s pose.

Here's a list of objective finding you can gather from placing a patient in child's pose: 
  • Shoulder, hip, and knee flexion ROM
  • Ankle plantarflexion ROM
  • Glenohumeral and scapulo-thoracic compensatory patterns (elevated shoulders, scapular movement and position)
  • Flexion-based spinal abnormalities (i.e. scoliosis, palpate vertebrae) and easily palpate tone of paraspinals and quadratus lumborum
  • Pelvic landmark position in flexion bias (PSIS, inferior tuberosities, etc.)
  • Sacroiliac joint landmark position in flexion bias
  • Rib response during breathing

Whenever I assess a patient in a yoga posture, I always ask for their feedback on what parts of their body feel uncomfortable. This gives me further insight into asymmetries and the patient’s perception of pain or discomfort.

For example, a patient comes into the clinic complaining of neck and upper back pain.  We can use child’s pose to make several assessments:


Figure 1:
  • Ischial tuberosities are not level
  • Global trunk rotation to the right
  • Patient appears to be leaning away from the right hip (possible loss of ROM?)
Figure 2:
  • The patient’s avoidance of full ROM of the R hip is more obvious
  • Appears to be a loss of shoulder flexion ROM
Figure 3:
  • Definite loss of shoulder flexion ROM
  • Forward head posture
  • Excessive kyphosis in mid-lower thoracic spine
From a single pose I know I want to look further into the following findings: 
  • Reason for loss of shoulder overhead motion
  • Thoracic spine mobility
  • R hip mobility
  • Pelvic alignment

By simply putting the patient in child’s pose, I am able to collect these objective findings in a matter of seconds. If I had performed an upper quarter screen, it would have taken much more time to zero in on these findings, and I may have missed the asymmetries present at the hip and pelvis.  Now I have an idea of why the patient’s neck and thoracic spine is irritated. These areas are trying to help the body compensate for lack of motion elsewhere.

Thanks for reading!
Header Image Credit 

About the author:
Christine Walker is a Physical Therapist and Professional Yoga Therapist (candidate) through the Professional Yoga Therapy Institute. She has her own cash-based PT practice in Charlotte, NC. To learn more visit her website or connect with her on Twitter.



Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...






What is the ONE THING that is needed for Physical Therapy to Thrive in Healthcare Reform?


When patients are seeking treatment in an oversaturated health care market, wouldn't they choose the place that has the best outcomes? 

Who would you choose?



This is the key for physical therapy to thrive in healtcare reform and the answer to ONE THING question is 

SUPERIOR RESULTS COMPARED TO OTHER HEALTH CARE PROFESSIONALS

Can you get your patients better, faster, in fewer visits, for a cheaper cost as compared to standard health care?

I recently had the opportunity to lecture at the Florida Physical Therapy Association Student Conclave at Florida International University.  I was very excited for this opportunity to educate and inpsire the PT students about the future of physical therapy and how we can thrive in health care reform.  I also had the opportunity to meet Dr. Sharon Dunn, the APTA president, who actually attended my lecture along with two other APTA Board of Directors.  My goal was to educate the students about future trends in healthcare, the current status of physical therapy, and what we need to do to survive and thrive in the future.  The students asked lots of questions and were very engaged so I thought it was a very postive response.  Dr. Sharon Dunn and the two Board of Directors came up to me after my lecture and both congratulated me on a great presentation.   Dr. Sharon Dunn actually gave me props during her keynote lecture, which caught me off guard and I was truly honored, stating she loved my lecture and that "Ron Miller said it best in a presentation earlier, I believe in physical therapy".  She further stated the importance of evidenced based practice, decreasing practice variance in physical therapy, and for us to show proven short term and long term outcomes that is supported by research.

The main point is, through all of the heath care changes, practice act limitations, decreased reimbursement, poor business strategies,lack of public awareness, lack of marketing knowledge, etc:  we need to have superior outcomes as compared to standard healthcare and other healthcare practitioners!  This will allow us to overcome and hardship or future limitations.  Physical therapy outcomes, in patients that are best fit to respond to physical therapy treatments, needs to exceed physician outcomes, chiropractic, massage therapy, personal trainer, podiatrist, etc.  all other fields of healthcare.

What can you do as a Physical Therapist to make sure you show superior results compared to standard care.  This is what I recommend to new PT graduates.

1.  Get good quick

Find a mentor.   Find a physical therapist that is doing exactly what you want to do and has the advanced training.  Make sure that the mentor is willing to spend time to help review research and to teach you clinical decision making and manual therapy.

If you do not have a mentor then I recommend to complete a residency or fellowship.  This will get you good real quick.

2.  Identify all of the problems with standard care and provide answer to them

See healthcare from the eyes of a patient.  All of the waiting periods to see a physician.  the waiting peroids in the office.  seeing the physician assistant when you wanted to see the physician.  going into a clinic with LBP and being diagnosed with .........(wait)..........ready.........LBP.  The double and triple booking with other patients.  Identify these problems with the patient experience and provide and answer for each one

3.  Make your patient experience far superior as compared to the standard

This is simple, especially as a private practice owner, make your patient experience far superior than standard healthcare.

Regardless whether you own a cash based practice, work for an insurance based practice, work for an hospital based system, when it comes down to it, for Physical Therapy to thrive in the future, you have to show superior outcomes compared to standard care and other healthcare practitioners.

So the main point of this blog is as we go through health care reform that we must show superior results with our patients compared to standard health care.  If we can do this, then physical therapy will continue to thrive in the future of healthcare.

 Are you in the right position to show superior outcomes compared to standard healthcare?  

Have you taken the right advanced training to show great patient outcomes?

Are you in the right system to allow you to do what is best for your patients?

What do you feel we need to do to thrive in the future of healthcare?


Regards,

Ron


Owner of Pursuit Physical Therapy
email:  pursuittherapy@gmail.com
Adjunct Faculty of University of Central Florida



Screening for Cervical Myelopathy



Nxt Gen PT Evidence: Medical screening is one of the most important aspects of clinical care. We must determine who is appropriate for our interventions and who would benefit from a referral.

One condition that we need to screen for is cervical myelopathy. Individuals with cervical myelopathy typically present with a cluster of upper motor neuron signs such as:

  • Unsteady gait 
  • Reflexes > 2+ 
  • Hoffmann’s Sign: Tap the nail of the 3rd or 4th digit with the thumb and index finger relaxed but not touching. A + test is involuntary flexing of the thumb and index finger. 
  • Babinski Sign: a blunt instrument is rubbed along the lateral aspect of the heel to the toes. A + test is dorsiflexion of the big toe and fanning of the other toes. 
  • wasting of the hands, loss of dexterity, nonspecific weakness
If a patient presents with signs and symptoms of cervical myelopathy, it is important to refer to a physician for further assessment. MRI, CT scan or myelography is necessary for confirmation.

Brought to you by Nxt Gen PT Institute of PT

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...






GOAL!

What you perceive today as a struggle is not truly due to the task at hand. It has to do with what the goals of the activity are.
The goal determines how the steps will play out. A worthy goal can bring you through any tough time. If the outcome is not of interest to you, no simple/light task is easy. It's all a struggle if the goal is not meaningful.

Are You Listening.....To Physio Podcasts?




It still surprises me the number of people who still don’t listen to podcasts as often as I would expect. There are a number of very good podcasts out there especially targeted to physical therapists and it seems like more pop up every day. It’s a great way to get exposed to new ideas, people, and information applicable to daily clinical practice. There are also a number of podcasts focused on business, personal growth, and entrepreneurship that I think are all valuable to both current physios and the #FreshPTs and motivated students that are looking to shake up the world. Below are a few of my favorites, in no particular order, along with the links. Most can also be found on iTunes. 
Therapy Insiders is the first of several podcasts from UpDoc Media (@UpDocMedia) and is hosted by Dr. Gene Shirokobrod (@therapyinsiders) along with Dr. Erson Religioso of themanualtherapist.com (@The_OMPT), and Dr. Joe Palmer (@JoeDPT) These three provide interviews with top performers and high achievers in the field of physiotherapy including Chad Cook, Jerry Durham, Tim Flynn, Justin Dunaway, and John Childs. They cover a wide variety of topics outside of traditional clinical practice with a special focus on business and entrepreneurship. One big get in particular was Daniel Pink, keynote at the Private Practice Symposium and author of To Sell is Human. Check it out here: http://therapyinsiderspod.com/podcasts/
Karen Litzy’s (@karenlitzyNYC) Healthy, Wealthy, and Smart podcast was actually the very first physio podcast I came across several years ago. She is a cash-PT business owner in NYC who provides home visits to her clientele. Her podcast also covers a wide variety of subjects but has a sizable focus on chronic pain as well as the cash-based business model and PT advocacy. She’s interviewed such physio luminaries as Lorimer Moseley, Adriaan Louw, and Louie Puentedura, as well as the current CEO of the APTA, Michael Bowers. Karen is also expanding her reach to a larger segment of society outside of just the PT world with her recent interview with Gloria Steinem. You can find it here: http://podcast.healthywealthysmart.com/
The Physioedge Podcast , hosted by David Pope (@davidkpope, @davidphysioedge), an Aussie physio, is rumored to be the very first PT-centered podcast. It covers a wide variety of topics from pain neuroscience education, to dry needling, to tendinopathy. I particularly got a lot of value from his two part interview with Mike Stewart (@knowpainmike) on pain science (episodes 035 and 036) as well as his interview with Adam Meakins, aka “The Sports Physio” (@AdamMeakins) on the shoulder complex. http://physioedge.com.au/podcasts/
Hosted by current Marymount University DPT student and former DJ, Jimmy McKay: The PT Pintcast (@PTPintcast), has climbed quickly up the popularity charts. This is one “pint” that’s actually safe to drive with :) (I came up with that myself). Interviews include such PT-twitter standouts as @DrBenFung, @Jerry_Durham, @therapyinsiders, and @KarenlitzyNYC. Additional episodes include the new President of the APTA, Sharon Dunn (@dunnSdunn2). Even yours truly was featured in episode #14. The interviews are conducted over a pint of beer–how could that not be great? I like the fact that even as a student, Jimmy is getting out there talking to professionals in the field and asking good questions. Recent big gets include Judy Seto, the PT for the LA Lakers, and upcoming with Dr. Kelly Starrett of Mobility WOD and Supple Leopard fame. You can find it here: http://www.ptpintcast.com/podcasts/
After a lengthy build-up and Star Wars-like preview, the Business, Baseball, and Bourbon podcast hosted by Jerry Durham (@Jerry_DurhamPT) debuted on October 22nd. With a soothing, smoky voice clearly crafted over the years with bourbon and cigars, Jerry focuses on shaking up the healthcare system as we know it. We had to wait a surprisingly long eleven minutes before the first swear word was uttered, but it did not disappoint. Yours truly was even given a shout-out at the 16:19 mark! Jerry took aim at “payment” vs. “reimbursement,” highlighted the importance of relationship-centered care, espoused his love of the Bautista bat-flip, and  revealed the inaugural bourbon drink of the month (the “paper airplane”–see your local hipster bartender or find recipe here: http://consumatorium.com/2015/05/paper-plane-cocktail/), I was assured the podcast will be up on iTunes eventually, but for now, you can find it exclusively on the Updoc Media site here: http://updocmedia.com/media_category/business-baseball-bourbon/
Another new podcast on the scene is The Senior Rehab Podcast from Dustin Jones (@DustinJonesPT), Dustin is a former sports medicine physio-turned home health PT who likes to make his geriatric patients lift kettlebells. Did I mention he is also an RKC certified kettlebell instructor? He’s bringing a fresh attitude and approach to helping his older patients improve mobility, strength, and function, as well as getting over their apprehension of lifting heavy things. This podcast is not only for home health physios. Outpatient orthopedic therapists will also find clinical pearls that they can employ directly into their own practice. Check it out on iTunes or here: http://www.dustinjonespt.com/blog/category/podcast Clearly the best episode so far is the latest, of course featuring me along with The Manual Therapist himself, Dr. Erson Religioso (@the_OMPT) on manual therapy for the geriatric population :)
The Physio Matters Podcast (@TPM Podcast) is hosted by UK physio Jack Chew (@Chews_Health), the podcast explores all things physiotherapy, from tendinopathy and pain neuroscience, to managing running injuries and the concept of “core stability.” My favorite episodes so far have been the interviews with Greg Lehman (@GregLehman) (session 16), on the relationship between biomechanics and pain; and the two part episode with Mike Stewart (@knowpainMike) (sessions 4 and 5), on pain neuroscience and how to use metaphors when discussing these challenging concepts with patients. Due to my previously-mentioned concern over my wife’s predilection for the British accent, I listen to this one in the privacy of my car or earbuds! You can check it out here:  http://chewshealth.co.uk/the-physio-matters-podcast/
For those interested in PT that goes beyond the clinic in the form of strength training and performance, The Strength Doc podcast with @JohnRusin may be for you. John started out with a bang with his first interview, nabbing outspoken physiotherapist, strength coach, bestselling author, and owner of one of the first 50 crossfit gyms in the country, Kelly Starrett (@mobilitywod). It’s a nice dive into the world of fitness, nutrition, and performance. Kelly is one of the best thinkers out there on human performance, and although he may not be for everyone, it’s hard not to take away a ton of useful information that you can apply not only to your clinical practice, but to your own training and lifestyle. Other excellent episodes include John’s interview with Stuart McGill, arguably the foremost expert when it comes to spine biomechanics; and physio and strength coach, Charlie Weingroff. Check it out here:  http://updocmedia.com/media_category/the-strength-doc/
Another podcast for those interested in more of the strength-training/performance angle, check out The Rdella Training podcast, hosted by Scott Iardella, (@RdellaTraining), a physical therapist and former body-builder. Scott has a special interest in kettlebell training and Olympic lifting and has a great personal story as someone who recovered from a herniated disc at a young age and found the way to self-treatment and improvement through an active movement and strength training approach. An avid reader, Scott has hosted top performers in the rehab and strength community including Dr. Squat himself, Dr. Fred Hattfield, Dan John, Mike Robertson, and Gray Cook. You can find it here: http://rdellatraining.com/tag/podcast
And one more for those interested not only in performance and mobility, but for those interested in a cash-based business or even alternative programming for the clinic you work in, I present the Dock and Jock Podcast featuring Dr. Danny Matta (@dannymattapt) of Mobility WOD with Kelly Starrett, and Coach Joe of Joe's Barbell. Their motto, "if you have a body, you're an athlete" resonates throughout their discussions and interviews on human performance, mobility, strength training, and business development. Check it out here: http://docandjock.com/episodes/
The Movement Fix podcast is hosted by (dare I say it), Dr. Ryan DeBell, DC. Ryan has a big interest not only in rehab, but also in mobility, strength, and performance, and his content and interviews provide a ton of useful information on all three. Notable guests on the podcast include our own Dr. E, Todd Hargrove, Dr. Quinn Henoch, and Dr. Stuart McGill. Check it out here: themovementfix podcast
Another podcast I recently came across is the BJSM poscast (@BJSM_BMJ). It covers a wide variety of topics related to physical therapy including low carb diets, evidence-based medicine, K-taping, and various sports-performance related issues regarding injuries and return to activity. Interviews are conducted with experts including Gwendolyn Jull and Shirley Sahrmann. One episode I particularly enjoyed is from May 8–“Why patients and docs make poor decisions”–an interview with Dr. Steven Stovitz of the University of Minnesota. Definitely an interesting take on application of evidence informed medicine vs. evidence-based medicine. http://bjsm.bmj.com/site/podcasts/
The Cash-Based Podcast with @DrJarodCarter. This was, I think, the second PT podcast I came across. Although the main target audience is cash-based PT practice owners or PTs looking to go into private practice, especially following the cash-based model, there are numerous takeaways for all clinicians. It is through this podcast that I was first “introduced” to the earthquake that is Jerry Durham. Topics covered that I think are very useful to clinicians and even students looking towards their futures include marketing strategies, niche development, valuing what we do, and general business strategies: http://www.drjarodcarter.com/category/podcast/
The PT Inquest podcast is hosted by Erik Meira (@erikMeira) and J.W. Matheson (@EIPConsult), the podcast covers a variety of topics from sports medicine to chronic pain; ACL rehab and tendinopathy; to research and statistics. It can be viewed almost as an audio journal club. The first episode I listened to has been my favorite by far, episode #65, on interpreting pain research with guest Neil O’Connell. It is certainly one that likely requires several listenings (is that a word?). You can check it out here: http://ptpodcast.com/podcasts/pt-inquest/
The Mechanical Care Forum podcast is hosted by Jason Ward (@JasonWardPTMDT) , a private practice owner in Memphis, TN. This podcast has a particular focus on the McKenzie MDT approach, but it also incorporates manual therapy and pain psychology. I find it very applicable to physios of all backgrounds. Jason does a great job with his interviews exploring both the personal and professional backgrounds of his guests, and their integration of research/evidence into clinical practice. He also gets them to offer up clinical pearls that every clinician can apply right away to their own practice. http://www.mechanicalcareforum.com/podcast/
The Pain Science and Sensibility podcast hosted by Cory Blikenstaff (@ForwardMotionPT) and Sandy Hilton (@SandyHiltonPT) is another one from the PT podcast network (along with PT Inquest and the NAF podcast). Much like the journal-club style of PT Inquest, Cory and Sandy focus on one recent research article on chronic pain or pain neuroscience and reveal how they each incorporate the information into clinical practice. Episode 6 even included a Mont Python reference! Pain Science and Sensibility
After recommendations from several readers and Twitter-ers, including Adam himself, I finally dove into The NAF Podcast with The Sports Physio, (@AdamMeakins). I started with episode 3, as on the surface, it appeared to be the most controversial, Why not, right? I’ve gotten into a couple twitter “discussions” with Adam, so I had a fair idea of what to expect. And he did not disappoint. So far, this podcast has the best opening theme music of any of the PT podcasts. For those of you who aren’t familiar with Adam, aka “The Sports Physio,” (and why aren’t you, as he directly inquires), he is blunt and irreverent and is not afraid to rock the boat and ask the tough questions that challenge “conventional wisdom.” Adam is one of those characters that can sometimes “touch a nerve,” but I think his heart is in the right place. Perhaps that’s because he reminds me a bit of, well….me–except a smarter version with, what my wife would argue, a much sexier accent. I recommend a listen: http://ptpodcast.com/podcasts/naf-physio-podcast/
** Here are a couple other podcasts that I like that are certainly applicable to physiotherapy but have more of a personal development/business/entrepreneurship focus:
The EntreLeadership podcast is brought to us by Dave Ramsey's group and features big players in the world of business, sales, and entrepreneurship. Some of my favorites include the interview with Seth Godin (@ThisIsSethsBlog), Tim Duncan (@timstweets), and Jack Welch. You can find it here: entreleadership podcast
The Inside Quest Podcast is from one of the founders of Quest Nutrition, Tom Bilyeu. Tom has a large passion in leadership in leadership and personal growth. Interviews include the likes of Tim Ferriss, Tony Robbins, former NFL star safety-turned stage performer and entrepreneur Bo Eason, and Carol Dwek, author of the highly influential book, Mindset. You can find it here: http://www.insidequest.com/tag/podcast/

Interested in even more podcasts for more universal connections to self improvement and physical therapy? Check out this post from the guys over at PT Braintrust: “Commute equals classroom”https://ptbraintrust.wordpress.com/2015/09/04/commute-classroom/

As always, thanks for reading.
Regards,
Andrew



Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...