There are several exercises, which people commonly perform, that may predispose the body to injury. As a physical therapist, who provides care for many patients presenting with cervical spine pathology (neck problems), one such exercise is that of neck circles. While the neck may afford one the ability to complete a full circle, it should not be performed given the risky nature of this movement. When one combines extension, rotation, and sidebending (all motions involved with part of the circular motion), hyperextension and compression of the cervical spine may occur. This may subsequently result in unwanted foraminal closure and nerve root compression. This movement is also very similar to the Spurling’s maneuver, which is an orthopedic examination technique used to assesses for a cervical radiculopathy. So if you suffer from neck pain and/or experience tingling and numbness in the arm, please don’t resort to neck circles, but rather, seek medical consultation from an orthopedist or reputable physical therapist. And always remember what Wu Tang says…you best “Protect Ya Neck.”

ChristopherJohnson

Running is a tremendous activity. Distinct from walking, running involves a moment where both feet are concurrently borne by the air alone. This moment is also temporary and with consequence. When the ground bears the foot again, and no longer the air, the lower limb is asked to attenuate forces on the order of five to six times the body weight of the participant. Sometimes injuries ensue. Tara Parker-Pope and her running colleague, Brian Fidelman, know these things. Today, in the New York Times Well section, Parker-Pope describes how cycling can offer valuable and protective respite from running while maintaining cardiovascular health. And New York City has much to offer even the occasional cyclist. Check out her article, learn about the City’s many bike trails, and your joints will be in your debt.

JonathanJezequel

In his New York Times column Sean Leahy explores how the National Football League (NFL) is using tougher language to help tackle head injuries. This season each NFL locker room with be necessarily adorned with a concise, informative poster (shown right) that will teach players a series of facts about concussions. The campaign is designed to produce heightened cognizance surrounding the serious nature of head injuries, beginning with the players and filtering out to their families and fans. The poster also educates, in general. Did you know that the majority of serious concussions do not involve a loss of consciousness?

JonathanJezequel

The New York Post recently highlighted a study by the American Cancer Society which showed those who sit for long periods of time during the day have an increased risk of death.  The study followed over 123,000 people over 14 yrs and results indicate that men who sit > 6 hrs per day have a 17% higher risk of death and women who sit >6 hrs per day have a 37% higher risk of death.  This study even included those who work out regularly!

Below are 5  things you can do throughout the day to help reverse your risk of becoming a statistic:

1. If taking the bus or subway to/from work, give up your seat and enjoy the trip standing
2. Instead of emailing a coworker in your office, get up and walk to their desk to discuss the issue
3. Take a “standing break” every 15 minutes; enhance this by adding in heel raises or squats to the equation
4. Try eating lunch standing up
5. Find a reason to walk around the office at least once an hour.  Good reasons include: water/coffee break, copying, faxing, etc.

JosephBrence

Over the course of my athletic career, I have played and competed in nearly every sport. I have also dealt with a whole slew of musculoskeletal injuries and associated surgeries, especially at the level of the knee. The sports that tended to cause most of these injuries were tennis, soccer, basketball, and lacrosse. Sports of this nature are unique in that they involve tremendous amounts of starting, stopping, and rotary motion. These particular motions can be dangerous for the knee given its design. The knee is a “hinge” type joint, and therefore, is not well suited to withstand such motions because it is designed to flex (bend) and extend (straighten). As a result, injuries such as meniscal tears and ACL ruptures, to name a few, are not uncommon. More recently, I have been participating in triathlons and I have been pleasantly surprised with how well my knees tolerate the associated disciplines of this sport. Considering the demands of running and cycling in particular, it makes sense that I have been injury free because these activities involve predominantly straight plane motions, which are consistent with the way the knee is designed to function. While I am by no means discouraging people from participating in all types of sport , it is important to know that the knee is definitely more vulnerable when subjected to movement that is not fully consistent with its design.

ChristopherJohnson

There have been many studies done on the positive effects of exercise in prevention of knee osteoarthritis.  However, how exercise actually affects specific structures of the knee joint is not known.  Urquhart DM et al. recently studied this in a systematic review of evidence of key articles on the topic.  What they found: Although physical activity is associated with increased production of tibiofemoral osteophytes, knee joint space narrowing did not tend to increase. In fact, evidence suggests an increase in cartilage volume and decrease in cartilage defects on MRI.  The results from this review reiterate the importance of exercise; especially to maintain knee joint health.  Consult your physical therapist for a physical activity routine that is safe, individualized, and structured to your knee, injury, and body! Follow the above hyperlinked thread to access the full article. Written by guest contributor Kristine Gneiss, SPT.

JonathanJezequel

The Philippine’s ambassador to the US has requested that the US defer the ban on Filipino PT graduates taking the US National Physical Therapy Exam (NPTE).

Last month, the Federation of State Boards of Physical Therapy (FSBPT) suspended licensure test for graduates of Philippines, Egypt, India and Pakistan, stating “systematic and methodical sharing of recalled questions by significant numbers of graduates of programs in the affected countries”.

The Philippine Ambassador to the us, Willy Gaa, noted that only 1 review center is accused of wrong doing, out of many review centers and colleges, was cited of wrong doing (the St. Louis Review Center in Manila.  Gaa has requested a meeting with FSBPT officials. 

There are currently over 1,300 Filipino PTs working in the us.

AdamBanks

Are your notes compliant?  PT’s are running into trouble with Medicare because their notes are not properly signed.  CMS requires all notes contain (1) date, (2) time, (3) authentication and (4) legibility. 

Below are key excerpts from the CMS manual. Read the entire text of the here.

All entries in the medical record must be dated, timed, and authenticated, in written or electronic form, by the person responsible for providing or evaluating the service provided.

• The time and date of each entry (orders, reports, notes, etc.) must be accurately documented. Timing establishes when an order was given, when an activity happened or when an activity is to take place. Timing and dating entries is necessary for patient safety and quality of care. Timing and dating of entries establishes a baseline for future actions or assessments and establishes a timeline of events. Many patient interventions or assessments are based on time intervals or timelines of various signs, symptoms, or events. (71 FR 68687)
• The hospital must have a method to establish the identity of the author of each entry. This would include verification of the author of faxed orders/entries or computer entries.
• The hospital must have a method to require that each author takes a specific action to verify that the entry being authenticated is his/her entry or that he/she is responsible for the entry, and that the entry is accurate.

AdamBanks

Have you recently been diagnosed with a rotator cuff tear involving the supraspinatus? Are you worried that once you are cleared to return to your prior activities without restriction that you will not be able to return to the gym and more specifically perform the bench press. Don’t fret but rather just simply modify your hand position so you are using an undergrip, which is just the opposite of the one shown here. By using an undergrip, the lifter is clearing the supraspinatus tendon from the undersurface of the acromion thereby minimizing the risk of shoulder impingement. I would also encourage the lifter to first become acquainted with the new hand position, use less weight to start, position the hands at a width of ~ 1.5 times the biacromial width, and always get a lift off.  Hope this is helpful…long live the shoulders. For additional information please read the article by Fees M, Decker T, Snyder-Mackler L, and Axe M entitled “Upper extremity weight-training modifications for the injured athlete. A clinical perspective.” This was published in AJSM (1998).

ChristopherJohnson

Before I left the clinic today, a colleague asked me if I had read the recent exhanges between physical therapists and chiropractors on The PT Project. While I have not read all of the comments related to this matter, it is a bit disconcerting that such tensions exist between these two different yet similar disciplines. Being a physical therapist, I would like to get something off my chest and say that I work closely with several talented chiropractors as I do physical therapists. Just like any field, there are practitioners who are excellent at their trade just as there are practitioners, who are less than mediocre. The important thing is that regardless of our approaches and philosophies, our ultimate goal comes down to one thing and that is helping patients, and we are both in a great position to do so. In closing, the only thing that I would like to say to practitioners in either field, who are interested in advancing medicine and helping people, is that “I got nothing but love” for you.

ChristopherJohnson

Do you wonder who our contributors are and where they come from?
Do you have articles written and no platform to publish them?
Are you interested in becoming a contributor?

If so, the PT Project is looking for high quality content and high-quality contributors.  The pay is so close to zero, so we might as well just round it to that.  But what is lacking in pay, is made up in limitless glory. 

Our contributors have found The PT Project as a great place to build on their reputation, create link-backs, and increase their populatirty in online searches. 

We at the PT Project don’t think that the best PTs are in competition, we see that the best PTs compliment each other. 

Please email jon@theptproject.com if you want your voice heard.

AdamBanks

It’s common that athletes, and non-athletes alike, undergo acute anterior cruiate ligament (ACL) reconstruction after they have torn their ACL. New research published in the New England Journal of Medicine this month reveal that functional and strength outcomes after ACL surgery were not supeior to intense PT rehabilitation 2 years post-injury. The outcomes were based on multiple knee injury scales, pain, symptoms, and function in sports/recreation.  There were 121 participants randomized into 2 main groups; rehabilitation and early ACL reconstruction and rehabilitation plus optional delayed ACL reconstruction. To find out more information, click on the link above.

LeeScantalides

In the recent months, I have had a number of patients ask what I thought of Sketchers shape-ups.  My answer: I’m not a huge fan. Heres why:

• Shape-ups appear to “tone” the calf through creating a constant balance deficit for the patient. This causes a constant “ankle response” and forces the calf muscles to work overtime.  I believe future research will show a higher risk of achilles tendonitis in individuals who wear these long term.
• The shoe changes your gait. The shoe assists during all phases of gait, especially from heel strike –> loading response which can decrease your neuromuscular education of muscles active during these phases.  This will make you more relient upon these shoes, and may make it difficult to ambulate without them.   Enough said.
• Sketchers claims are that they will tone the calf, LEs and core.  This ideology allows wearers to think the shoes can replace a fitness program and will prevent problems from developing.

Sketchers claims 4 studies have been performed to prove that they help tone muscle and improve energy consumption.  I attempted to locate these articles and only found reviews on the Sketchers website.  Here are the results of each of the articles:

1. Study performed by 2 chiropractors and a personal trainer.  Study showed weightloss in individuals who wore Sketchers.
2. No authors info provided. EMG study on 10 females.  Results showed increased activity of LE muscles while wearing shape-ups.
3. Again no authors info provided. The results showed increased core activity due to an unstable center of balance.
4. Another study performed by one of the chiropractors from study 1. The results showed increased usage of postural muscles.

All 4 of these studies were funded independently by Sketchers and I was unable to locate any of them in major peer-reviewed databases for a true analysis.

Bottom Line: I am still extremely skeptical about shape-ups.  Proper footwear should not create an unstable surface and no shoe should ever claim to be able replace a proper physical fitness program.

JosephBrence

Tags: brence, shape ups, sketchers

We are launching IPads for medical notes in our practices.  From the second that I first held an IPad, I knew it was a game changer for medical notes. 

As a practice administrator I am always fighting to get “good” notes done on time.  I fully understand that from a PTs perspective doing notes is tedious work however, it is my job as the administrator to make this as easy as possible for the PT, while producing a compliant note.  Note “burn-out” is very expensive to the practice, bad notes don’t get paid, and they clog the billing process with denials and appeals (possibly adding an additional staff member to handle).

I see that the IPad as a “Game Changer” in the way providers interact with the EMR system.   I envision all providers being able to get notes done, real time, in front of the patient in a non – intrusive way.  Notes can be done on the IPad very quickly, almost at a conversational rate.  Patients are quick to adapt to the interaction of a PT talking and clicking away on the Ipad.  PTs can be “heads-up” and still complete a note.

Our practices has tested everything to make note taking easier; dictations (didn’t work as there was so much back and forth with India, Tablet PCs (too heavy and too slow), Assistants (too expensive and burn-out was high), and different software’s (long on promises and short on delivery).

At $500, I am finding that the IPads are actually cheaper than PCs, too.  A fully loaded PC always seems to end up around $1,200 – no matter the teaser price.  The maintenance on PCs is a very real expense, our practice has hired a 3^rd party computer “geek” company, is always upgrading our anti-virus software, and I frequently walk by an employee that isn’t doing anything because their computer “doesn’t work”. 

I have asked a few of our PTs to post their experience with the transition to IPads.   FYI, we are buying the “cheapest” Ipads, we have Wi-Fi set up in the office and I don’t see that we need 3G.  We have been testing an external keyboard, and so far everyone likes the option of using it.

I am not in the pracitce of endorsing a product, however I am very impressed with these two EMRs, www.forcetherapeutics.com and www.WebPt.com for the high quality note that they produce in “real time” and both are IPad capable.

AdamBanks

This past weekend, contributors Luke Bongiorno, Christopher Johnson, and Allison Lind competed in the NYC Triathlon. 

Allison Lind placed 2nd in elite womens division and 40th overall with the time of 2:12:11.

Christopher Johnson placed 19th overall finishing with a time of 2:04:54.

Luke Bongiorno finshed with a personal record of 2:36:17.

AdamBanks

Tags: Triathlon

The most trafficked pages on our practices web-site are the provider profiles. Patients read these profiles, before they come in and after. Here are three things you can do to improve your profile

1. Keep it Fresh: Content that is not update has a tendency to feel stale. Update your profile often, keep dates current (ie, the last thing you mention should not have happened 5 years ago).

2. Buy the Race Photos: If you are an athlete, buy the $30 professional photos that are sold after races. Your patients want to know that you are active; the sweaty pictures with bib numbers are great marketing tools and they make your bio look more interesting and credible.

3. Build an expertise. Choose an event, running, soccer, baseball, golf – and comment on it in your bio regularly.

4. Make exercise sheets. Just like in all of the fitness magazines, people respond to short “lists”. Be creative. Some that we like, 5 tips to better abs, 5 tips to safer running, 5 ways to relieve back pain. Post yours exercises adjacent to your bio.

AdamBanks

Riding the wave of a new rehab and fitness trend can put your career or business in the driver’s seat. Take for instance pilates. I heard of it the 1990s and incorporated it into my treatments in the 2000s. Doing so placed my skill set and PT practice in the forefront, even in a market saturated with PT clinics.  

As a PT practice owner, I’m constantly assessing new equipment and technologies. Some come, some go, while others are here to stay.

When two of my clinic managers (Samantha Schoeneman, a PT and a PMA certified Pilates Instructor and Angela Listug-Vap, a Kaiser-Hayward residency trained manual physical therapist and the only Fellow of the American Academy of Orthopedic Manual Physical Therapists in the state that I practice) approached me about a new exercise technology, called CoreAlign® I admittedly wasn’t that intrigued. However, when I considered who was alerting me to this new technology, I determined to assess it seriously.                                                                                                            

After purchasing several units and extensive training with my staff, we implemented the CoreAlign® into our treatments.  The clinical results, although anecdotal at this point, are promising.  Even my toughest patients have responded well with their rehab programs.  

From observing the results of my patients, I am confident that the decision to invest in this new method will benefit our clientele, while also generating a successful boost to our PT business. 

The CoreAlign® device sports two independent tracks and a workout ladder. The apparatus enables clients to exercise in an upright, functional posture, while addressing muscle balance, alignment, coordination, balance, and strength. Combining the tracks with upright postures is a key element in giving clients an immediate “feel” for proper alignment while doing specific exercises. Resultantly, they are able to make changes that translate into improved function within a single session.

In the same fashion that Pilates exercise caught a significant wave of success in the 90s and beyond, so this new approach appears to be on track to rise to equal, if not greater heights of success. 

For more information on the CoreAlign®, please visit:
www.HoffmanConcept.com

www.AlpinePTmissoula.com

www.BBU.Pilates.com

BrentDodge

For years, there has been varying literature to connect symptoms occurring at the carpal tunnel with symptoms in those in the cervical spine.  De-La-Llave-Rincon et al recently published an article in JOSPT examining a relationship between carpal tunnel syndrome with postural dysfunction/decreased cervical range of motion.  This article examined how a treatment of the cervical spine may have an effect as distal as the carpal tunnel. More conclusive research has indicated proximal grade 5 thrusts to the CT junction can have effects as distal as the lateral epicondyle.

So, if the median nerve has motor and sensory contributions derived from nerve roots of C6-T1 that can become compressed proximally in addition to the carpal tunnel, why not examine/assess the cervical spine in the treatment of individuals with CTS (Even the test for examining neural tension of the median nerve involves lateral flexion of the cervical spine away from the effected side). There are several syndromes that can present with proximal/distal features such as: thoracic outlet, multi-crush and T4 syndrome but could carpal tunnel syndrome actually be a misunderstood diagnosis and have a more proximal player (how many median nerve releases have you seen be relatively non-effective?).

I believe, we should attempt to investigate further into individuals who present carpal tunnel symptoms.  I believe compression of the median nerve may not always be at play directly within the carpal tunnel and that a proximal compression may be playing at least an equal role.  There has been research on regional interdependence in between the low back, hip and knee and I believe there could be similar findings from the cervical spine down to the carpal tunnel.

JosephBrence

Tags: brence, carpal tunnel, cervical spine

The Washington Post ran an article yesterday, commenting on a recent article in the Journal of American Medicine (JAMA) examined the effects of glucosamine for the treatment of chronic low back pain. Glucosamine has been widely thought in the past to help calm symptoms of degenerative osteoarthritis. This article was a double-blinded, randomized , placebo-controlled trial in which subjects were administered glucosamine or placebo for 6-months and then rated rated their pain related disability.  The results: oral glucosamine had no beneficial effects in reducing pain related disability.
 
A similar study in 2007, published in the Annals of Inernal Medicine discovered that a similar suppliment, chondroitin, does not appear to help individuals with hip/knee pain caused by osteoarthritis.
 
The Take Home Message: To diminish an individuals complaints of low back pain, the most effective approach continues to appear to be a physical therapy regime consisting of a combination of manual techniques, neuromuscular reeducation of the transversus abdominus/multifidi and gluteus medius/maximus to reset muscle spindles and postural reeducation.
 
Citations:
Wilkens P,  Scheel I, Grundnes O, Hellum S,Storheim K. Effect of Glucosamine on Pain-Related Disability in Patients With Chronic Low Back Pain and Degenerative Lumbar Osteoarthritis.
JAMA. 2010;304(1):45-52. 
 
Reichenbach S, Sterchi R, Scherer M, Trelle S, Burgi E, Burgi U, Dieppe P, Juni P. Metaanalysis : Chondroitin for Osteoarthritis of the Hip or Knee. Ann Intern Med. 2007; 146 (8):580-590.

JosephBrence

The July newsletter has a few links to older articles.  We are improving our services to ensure top quality emails in the future. 

The correct links:

Which Pillow Should I Use?

The Rotator Cuff…Hanging By A Thread

Disc Regeneration Therapy – A Promising Outlook

Punch Em’ With Everything Except Your Fists 

AdamBanks

1. Punch Em’ With Everything Except Your Fists
2. Arthrofibrosis Guidelines
3. Running in Review
4. “Tennis Leg” – Not Just a Country Club Injury
5. Tight Hip Fexors . . . A Pain In the Neck?