Function

One of the main goals in Physical Therapy is the restoration of function. Here are some milestones we are looking to achieve with total hip and knee replacements (respectively).

Source Norkin, C. C., White, D.J. (2003). Measurement of joint motion: A guide to goniometry (3rd ed.). (not exactly the proper way to cite, but its the best I got at 5:34 AM and yes I realize and I want those who do not know that a textbook is a secondary source since they are citing other resources and bringing it all together, but convenience is good too)

Hip flexion range of motion (ROM) required for functional activities:
-walking on level surfaces: 0-44°
-ascending stairs: 47-66°
-descending stairs: 66°
According to Magee, ideal functional ROM of the hip include 120° into flexion, 0° of abduction, and 20° of lateral rotation (or external rotation - I wish they would just call it one thing!)
-sitting in a chair: 112°
-putting on socks: 120° flexion, 20° abduction, 20° lateral rotation (sartorius muscle!)

Knee flexion ROM necessary for functional activities:
-walk on level surfaces: 63.1°
-ascend stairs: 92.9°
-descend stairs: 86.9°
-rise from chair: 90.1°
-sit in chair: 93°
-tie shoes: 106°
-lift object from floor: 117°
-putting on socks: 117°

I was going to put pictures of all these so you could all get a visualization along with these but instead I wanted to put me pitching broken down versus Brandon Webb of the Arizona Diamondbacks, enjoy :-D

PS, this is not my best biomechanics ever, I opened up my hips too early and pointed my lead knee inwards as the two most obvious problems, see if you can find some more (click on image to enlarge)!

PEAT

So I am finally registered for my licensure exam, have to take it by September 9 or I lose my money... I am pretty behind on my studying-particularly of those obscure areas of PT that I don't see much at my job or any of my previous clinical experiences (I am an experiential learner)

Off to take the supposed 'most realistic' practice exam available in the form of the PEAT which is offered by the FSBPT (the same org. that administers the real exam)... at the end you get a thorough breakdown of your weak areas... but they can never tell you how good of a guesser you are. This will be my first full in-depth practice exam, which should set me up nicely for the next six weeks or so of intense studying... hello starbucks!

America's Past-time

I wanted to share with you an experience or two I had this weekend... that is after all what this blog is for.

My mom wanted me to send one of her friends to an "orthopedist" for her back pain. I talked with this woman on the phone. As she described the types of physical therapy she had tried, I asked if she happened to know whether or not they were owned by medical doctors... and lo and behold she had been to a few POPTS. There she had received the opposite of quality care that I believe PT is about. Along with being cramped by the mass of patients/clients, all she received was some electrical stimulation, hot or cold packs, and maybe massage. No one ever really evaluated her or explained what could be going on with her. She discreetly explained to me it felt like they were out to make money and had little to no concern for her condition.

I explained to her that this is an unfortunate aspect of the health care field, especially one that gives physical therapy a poor image in the consumer's eyes. There were three to four clinics I recommended to her in Brooklyn that would be convenient for her to get to and where I know she will get quality care, a thorough evaluation of her condition, with the focus being on her and not her wallet (or purse?). This is a conversation I have had in the past with many patients who had already found the quality care of the clinics I happened to be working (affiliating?) at/with. The APTA and a few states in particular (South Carolina comes to mind) have been trying to battle what is now referred to as "referral for profit" (this phrase was thought to better capture the issue we are dealing with here).

Take a look at some of the documents the APTA has on this and a litany of other issues we are facing in this wonderful profession... It stinks that as a PT - and I think I speak for more than just myself - you genuinely want to help people feel better, function better... and have to deal with so many other professions looking to just make money (not to pigeon-hole entire professions, but I call it like I see it kids) as well as dealing with the tremendous cost of education to help people out. I did not get into this profession to make money, whats more is I did not get into it to battle with Chiro's, Athletic Trainers, Personal Trainers, MD's, physiatrists, and the list goes on... So for now, I will keep doing all I can do to help out as many patients/clients as I possibly can and hope that my and many other PT's efforts on the lobbying front come through so that health care can be more transparent and we can alleviate some of the ridiculousness that goes on in our health care system. At this point I am just ranting and need to pull back so I leave some room to study for my licensure exam...

Speaking of the licensure exam, I did take another break from completely studying this weekend as I volunteered at the MLB All-Star Fan Fest which was held here in NYC! Above and below are two of my fun pictures from the event, if you get a chance to come by this year or in the future, I highly recommend it. There are a few PT related things... i.e. the physical challenges that people have not been warming up for and thus I have heard "my arm is killing me" or "ouch, my hammie". The challenges include batting cages, throwing a baseball for video analysis (which is very cool) and for speed, fielding fly balls, a home run derby, a race from 3rd base to home that they time (my best times which are sad were 4.50 and 5.80 backwards - its 30 yards, so I am not yet ready for the big leagues :(

Until next time... stay healthy!!!

Delayed post

Express bus blogging just isn't the same as the train for some reason... Could be because the blogger website isn't working right now on my phone (neither is myspace, oh no-sarcasm). So I am blogging into my email server to allow this to get published at a later time.

Been pretty busy with orientation to work, went to the poconos with my sister's family, been training aka running for two upcoming races, going to be volunteering at the all-star fan fest this week which should be tons of fun.

We had the hospital-wide orientation monday and tuesday, which included fire safety, benefits review :), cultural competency, harassment (not education about it, they actually harassed us... JUST KIDDING), a few other fun points of interest and the heart of excellence training program which every new employee goes through and consisted of 'team building' exercises and a focus on the qualities that make a quality employee within the healthcare field. Of course as a big PT nerd I was ready with the APTA Core Values:

Accountability
Altruism (which was the first time in any of the orientations this was said)
Compassion/caring
Excellence
Integrity
Professional duty
Social responsibility

It was a worthwhile experience. And I was sad to find out that I could not be a medical interpreter for the hospital because although I speak Russian I cannot read or write it whiich is a prerequisite for the 60 hour training program (I came to America when I was 3 and haven't had many chances to read or write it despite living so close to Brighton Beach. But they seem to have a quality program and overall the hospital seems to do most things right which is probably why they (we) are ranked NUMBER 1 in US News & World Report for Orthopaedics and #3 for Rheumatology.

Off to get my PT on, talk to ya'll later, have a healthy day!

Poconos

Lot happened since my last post. Many mobile mistakes that caused losses of entries, hope it doesn't happen here...

So we will go backwards a little:
Today, had a pretty great day, I am up to 11 patients a day and saw one of them twice (not gonna go too far into the details of my whole day just yet)... got my first pay check as a PT and goodness gracious great balls of taxes, they took out a small fortune for taxes, that is just frustrating as heck (hope I get some of that back when I file my taxes, c'mon uncle sam!)

Yesterday, I served jury duty, sat in the waiting room with free wi-fi, had my laptop, was there 8:30-2:30 with an hour for lunch in there, they didn't need me so I can't get called back for 8 years, yay kings county! Found out I'm gonna be a godfather ('never go against the family...' brando)

Basic review of the course I took this weekend, it was pretty awesome, simple as that, the instructor(s) was(ere?) awesome. Did my VO2 testing and have started a structured running program based on the results. I believe my VO2 max was about 48 whereas Sean Avery of the NHL-NY Rangers (i think he may have just signed somewhere else) (he was tested by the same guy as me a week earlier) he was a 58 - but he trains for a living! Anyway, I got this great new program and I am siged up for two awesome races (one end of August and another a month later)...

Gonna stop here so I can focus on walking through Coney Island to get home - isn't it nice following my every move :)

addendum, haha, forgot that I named this post because I am going to the place in the title for the weekend with my sister, brother-in-law and the 2 and 4.5 year old kiddies for some major studying for the boards... Happy 4th everyone!