“Most people rarely experience balance when standing, but actually maintain a constant state of imbalance. Simply because you don’t fall down doesn’t mean you are balanced; try not moving any muscle when you stand and see how long it takes for you to fall down. You make constant, and usually unconscious, correction to manage your loss of balance. When something is balanced it is at rest; it needs no managing. So you are invited to make a distinction between managing off-balance ad being balanced. You may not always be balanced, but you should know the difference.

We must always endeavor to be freely balanced, which is empowered by being relaxed and opening at the joints, so that our body may be at rest even in motion. We must always “stand on our own feet” and never lean on or depend on someone else to maintain our balance. This is a profound point and requires a great deal of consideration. It is very subtle and yet can make a great difference in our abilities if fully understood.”

–Peter Ralston–

Learn to Perform the Tyler Test | Chris Johnson PT from NYSportsMed & Physical Therapy on Vimeo.
Posterior shoulder tightness is a common impairment in the context of shoulder pathology and dysfunction. Surprisingly, however, very few clinicians utilize The Tyler Test as part of their evaluation for assessing and quantifying posterior shoulder tightness. Tyler et al. (JOSPT 1999) originally documented this method and showed it to have high intrarater reliability (0.92-0.95) and good interrater reliability (0.80). The simplest approach to interpreting the degree of posterior shoulder tightness is as follows:

Tight – when the brachium is above horizontal (as seen in the video).

Normal – when the brachium falls parallel to the table.

Loose – when the brachium falls beyond parallel.

The exact step by step approach for performing the Tyler test is listed below. I hope this video serves as a good demonstration of this assessment technique. Happy Holidays!!!

1. Position the patient in sidelying with the nontested extremity under the patient’s head.

2. Have the patient flex their hips and knees to 45 and 90 degrees, respectively to stabilized the body.

3. Align the acromion of the tested extremity perpendicular to the plinth.

4. The examiner shoulder face the patient and grasp their elbow at the epicondyles or their forearm.

5. Passively abduct the shoulder to 90 degrees while maintaining neutral rotation.

6. Stabilize the scapula into a position of retraction with the free hand.

7. While maintaining the scapula, lower the shoulder into horizontal adduction maintaining neutral rotation.

8. Lower the humerus until motion ceases or rotation of the humerus occurs.

9. Record the distance from the top of the plinth to the medial epicondyle.

References:

1. Clinical Examination of the Shoulder by Todd Ellenbecker 2004 Elsevier Saunders

2. Tyler et al. Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement AJSM 2000

3. Tyler et al. Reliability and validity of a new method of measuring posterior shoulder tightness JOSPT 1999.

http://www.chrisjohnsonpt.com

I wanted to share this email, which I recently received from an acquaintance, because it makes me wonder what we, as physical therapists (PTs), must do to become the first line of defense in the context of musculoskeletal injuries. While I recognize that acupuncture has its place in medicine and oftentimes compliments our work as PTs, it is frustrating that a physical therapist would not be the “go to” healthcare professional in this instance.

“I sprained my ankle a few weeks ago and I keep re-injuring it. I’ve been getting acupuncture which I *think* is helping, but the truth is it’s still pretty sore.  Do you think it would be beneficial to get an x-ray?”

Unfortunately, this individual could have been well on their way to recovery had they connected with a good PT in conjunction with their acupuncturist from the outset. This example is not an isolated incident. We as physical therapists MUST increase awareness about what we do and how we do it with regards to treating injuries and being the first line of defense against recurrences. With our extensive training and experience, we are fully equipped to have an immediate impact on most musculoskeletal injuries. I would appreciate hearing everyone’s thoughts on how we become the first call in situations like this.

Onward,

Chris

One of the most common questions people and potential patients ask me once they learn that I am a physical therapist is, “What kind of PT do you do?” Rather than say a blend of intensive manual therapy, sound neuromuscular re-education, evidence-based therapeutic exercise/activities, and proper, though infrequent use of modalities, my simple answer is, “the kind that gets people better.” I would be curious to hear how other PTs respond to this question without going into a diatribe as I know it is a difficult question that is often posed to you.

This post goes out to all you new physical therapy graduates. I hope this advice will help guide you on your professional journey. I have been incredibly fortunate when it comes to my experiences and mentors over the years so this is a simple way to give back. Below is a list, in no particular order, of what has helped me and I am confident will help you reach your goals in the wonderful world of physical therapy. Drum roll please…

1. KNOW THY PATIENT – Arguably the most important factor when it comes to helping patients in the clinic is how well you know the person you are providing care for. Collecting a thorough and accurate history as well as knowing what each individual patient exposes their body to on a daily basis is critical. I’m talking about everything ranging from vocational demands to exercise habits to donning a tshirt to drinking a glass of water to picking one’s nose to sexual positions.

2. SPEND TIME WITH A MASTER CLINICIAN – Before I even started physical therapy school, I worked in Dr. Lynn Snyder-Mackler’s lab at the University of Delaware and gained exposure to how she conducted her clinical examinations and research data collections. Let’s just say that I was spoiled. After completing PT school, I then had the good fortune of working at the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), where I fell under the tutelage of Dr. Malachy McHugh and the NISMAT staff. I am forever indebted to these indviduals as they have shaped me as a clinician and researcher and I hope you have the same opportunities.

3. DEVELOP YOUR MANUAL SKILLS – Nowadays, there is a huge emphasis on good manual skills and this should come as no surprise. All of the top notch clinicians that I know and respect possess exceptional manual skills. In particular, I would encourage you to become an expert in treating myofascial trigger points as well as owning joint mobilization and spinal manipulation. Once you become savvy in these areas, watch the referrals roll in. If you are looking to learn spinal manipulation and live in the NYC area, feel free to reach out to me as well. You can also attend a seminar that Luke Bongiorno and I teach that will get you competent in resolving trigger points and performing sound mobilization/manipulation.

4. STAY CURRENT WITH THE RESEARCH – Everything in medicine comes with a date. Let’s not forget that we used to cast people after ACL reconstruction and the arthroscope was considered the “tool of the devil.” Staying up to date with the medical literature is therefore critical and has never been easier. If you don’t have the financial means to subscribe to medical journals, at least follow various PT websites and blogs. For example, Mike Reinold runs a great blog that serves to provide the reader with current information and allows you to interact with other PTs and allied health professionals. Bruce Wilk also has some great articles on his website that I would encourage you to read, especially if you take care of endurance athletes. I try to give people free information on my personal website too that I hope you take the time to check out. Let’s not forget about The PT Project too people!

5. MOVEMENT, POSTURE, & STRUCTURE – This quote by Thomas Meyers says it all… “Movement becomes habit, which becomes posture, which becomes structure.”

6. PERFORM THE EXERCISES YOU PRESCRIBE – One of the biggest pitfalls that I see in our profession is that PTs often fail to perform the exercises that they prescribe. By performing the exercises, you will become more acquainted with the details associated with each exercise as well as common mistakes that can be made. It will also help you provide a better model of performance and allow you to more clearly explain the exercise.

7. INTERACT WITH FOLKS OUTSIDE OF THE PT WORLD – I have spent time with massage therapists, chiropractors, strength and conditioning coaches, skateboarders, yogis, break dancers, martial artists, etc. I must admit that I have learned just as much if not more from these individuals about movement and performance than I would have ever thought possible.

8. KEEP A PT JOURNAL – Keeping a PT journal is one of the most important things I do in an attempt to sharpen my clinical thoughts and reasoning. Some examples of the things I jot down in this journal are patterns that I observe in various patient populations, mistakes that I have made, or exercise progressions that come to mind. Reflecting on your time in the clinic is critical!

9. CALL YOUR PATIENTS – “People don’t care how much you know until they know how much you care.” Nothing will compliment your work in the clinic more than a simple phone call to your patients. I have never had a patient get upset by me calling them. In most cases, they were thrilled (maybe that’s pushing it) to hear my voice when they were having a stressful day. It will also serve to remind them to stay consistent with their work/home exercise program outside of the clinic.

10. SHADOW AN ORTHOPEDIC SURGEON – I had the amazing experience of spending nearly 10,000 hours shadowing Dr. Michael J. Axe of First State Orthopedics as part of a graduate assistantship that I was awarded during PT school. This experience was beyond awesome. It specifically helped me understand the patient perspective and also served to bridge communication between patient, doctor, and therapist. This was particularly valuable in the case of post surgical rehabilitation. And don’t let orthopedic surgeons intimidate you because after all, we are all human!

Wishing you a career of good fortune and longevity.