It's Been Awhile

I have been real busy learning up as much as I can... actually in between patients right now at my temporary outpatient ortho clinic (last patient had bilateral knee arthritis, the spot right now is a no-show, and the next patient has degenerative disc disease of the lumbar and cervical spine).

The more I learn, the more I realize how little I know... but I love outpatient practice, this really is my passion... when I was in the hospital I enjoyed it but it still felt like a job, a 9-5 (or 8-4 as it were). It isn't work if you are enjoying yourself and I am... I think I need to drop the muscle of the week thing as it doesn't seem too useful for anyone, maybe I will get back into it when I am a little more settled in.

November 10 I start work full-time so my schedule should be more regular and I can really get cooking... I already have to set up my continuing education for the next year, a lot to learn, and it will never stop... I hope my excitement is coming through... back to my patients, have a great day everyone!

Two quotes for the day

With all the political hoopla coming down to the wire I found (in the process of cleaning out my closet) a few quotes I wanted to share:

We need a PT culture that cultivates and promotes activism. Thomas Jefferson said:

"We in America do not have government by the majority. We have government by the majority who participate."

Being a PT and not being a member of the APTA, is like being a driver and not having your driver's license... -Greg Johnson, IPA course

That's all I got right now... I am doing a lot of reading... back to it!

Muscle of the Week - TIbialis Posterior

I thought I would try to bring this feature back to this blog... as I get much more immersed in "ortho PT culture"

So lets start it up with the muscle I recently injured (likely strained), the tibialis posterior (sometimes known as the posterior tibialis)

Origin: interosseous membrane, posterior surface of tibia inferior to the soleal line, posterior surface of fibula

Insertion: tuberosity of navicular, cuneiform, cuboid, metatarsal 2,3,4

Innervation: tibial nerve L4-5

Action: inversion and plantarflexion

This muscle stabilizes the arches of the foot
It functions during gait...and eccentrically controls the amount of pronation (@ the subtalar & midtarsal joints)

MRI interpretation

One of the high school football players where I part-time coach sent me a question regarding his MRI reading. While I am not a radiologist I was glad to help him interpret this statement:

The anterior talofibular ligament is thickened with decreased T2 signal intensity representing chronic sprain.

The rest of the MRI was "normal" as per the report/player.Quick anatomy lesson... we are talking about the ankle here...
Anterior means the front... talofibular ligament is how most ligaments are named, putting together the two bones that the ligament is connecting, in this case the talus (half of the major ankle joint) and the fibula (the skinny bone on the outside of your leg)
Decreased T2 signal intensity representing chronic sprain... T2 refers to the type of MRI taken; on T2 water/liquid shows up white representing well vascularized structures like a healthy ligament (as seen in the MRI above, the red arrow is pointing to a normal ATF ligament - that is a view of a slice from above most likely). When there is "decreased signal intensity" this means the ligament has been without vascularization or fluids for a while (chronic) and may have become more solid than normal.

Lastly a sprain is damage to a ligament (strains refer to muscles) and comes in varying degrees of damage. It seems our football player has not had any major tear/rupture, so play ball!

Kinesiotaping in Brooklyn

To: My injured brethren, sisters and family

From: Richard "Imhotep" Symister, MSPT, CSCS

Re: Kineostaping

Date: October 8, 2008

Greetings.

Within the past year, many of you have expressed concerns regarding aches, pains, strains and undiagnosed orthopedic injuries. Recently I have had the opportunity to study and use a relatively new procedure call kinisiotaping (If you tuned into the Olympics this year, you may have seen the some the Japanese volleyball players sporting this tape --- http://kinesiotaping.com/olympic-watch.php).

Kinesiotape functions to accomplish a few things:

1. correct muscle function
2. improve circulation of blood/lymph
3. decrease pain
4. reposition a subluxed joint

On the Saturday 10/25, I will be performing FREE kinesiotaping to anyone interested. The more the merrier, since this will allow me to assess the efficacy and performance of the kinesiotape, while also hopefully relieve some of your pain symptoms.

If you are interested in participating, call me @ (917) 751 7634 and we’ll discuss whether or not I think kinesiotaping might help you.. There is no obligation and, again, the service is completely FREE!

If you'd like more info on kinesiotaping, check out:

1. http://www.kinesiotaping.com/what-s-kinesio.php#
2. http://www.expertvillage.com/video/47464_chiropractors-kinesiotape-demonstration.htm

And please, if you know of others who may benefit from this procedure (dancers, musicians, athletes, weekend warriors, etc.) feel free to pass this along.

Richard Imhotep Symister, MSPT, CSCS

Co-Director

Brooklyn Body Works Physical Therapy, P.C.

190 Union AveBrooklyn, NY 11211

(718) 387 7420

Bbwphysicaltherapy.com

"We get your body working better!"

Inury and a New Beginning

Last Saturday I ran in my 3rd half-marathon of this year (and of my life - above pic is from the Urbanathlon)... I have been a bit distracted with all my job search/board prep amongst other things... I hadn't been running too much leading up to this half-mar because the Queens half-mar I ran left me with runner's toe, so I rested to try not to lose the toe nail...

So on Saturday I was running the race with my buddy Dan (in the midst of fireman training in DC aka he runs a lot). He had beaten me in the last two half-mars so I really wanted to get him in this one. I was running pretty well with him up to mile 12 (of 13.1), I had plenty of energy and know that I have more of a kick at the end than he does so I was smiling that I had him... and then just before mile 12 (at which point my time was 1:37) I felt a little twinge in my left calf, tried to fight through it but it started to feel like it was gonna rip off/cramp so I stopped and Dan took off...

I tried to stretch... tried to rub it down... I knew it wasn't a cramp but was hoping it was, because the alternative was a contractile tissue lesion aka something wrong with the muscle or tendon... I ended up trying to suck it up and jog out the last 1.1 miles but every push-off felt like it was gonna do much more damage so I walked the rest of the way, but did get a pseudo-jog going for the last few hundred feet since they had the cameras and all the crowd... couldn't just walk across the finish line... sad thing is my time was still better than the Queens one where I wasn't hurt, go figure... got ice on it as soon as I could, and then there was a long walk to the train and subway/bus ride home... I did not have my PT hat on for all this as much as I should have, but my reaction was to rest, ice, compress, elevate (RICE), gentle stretch, heel cushion to shorten the injured muscle.

Today was the first day I really went anywhere, it just so happened I was going to attend an in-service on kinesio taping (the tape that all the olympians had on in Beijing). So 3 other PT's conferred with me that it was in fact a posterior tib injury and I got a little heat and e-stim (which I am not a huge fan of but realize it has some benefits). We tried the kinesio-tape but it had minimal effect, albeit nothing about my injury is what kinesio-tape is really indicated for...

Funny thing is I had previously signed up for the Staten Island half-mar this coming Sunday which would be 8 days removed from this injury... I really want to do it so as to help qualify for next years NYC marathon but will not push it so as to make things worse...

The good news is I did get the job at STAR PT and will be accepting this position... yay!

Job Juggles

As indicated by the picture... I am all up in the air...

With the risk of one of my potential employers knowing about my other possibilities, I share the following with you, because I believe in transparency for health care and in my personal/professional interactions.

Currently I am doing some part-time work (about one day a week while I get oriented) at Brooklyn Body Works - an outpatient practice in Williamsburgh, Brooklyn. I have committed to cover two full weeks at the end of October while one of the owners/PT's is on his honeymoon. So this commitment has to factor in to my decisions. I personally feel inclined to "keep my feet wet" with my manual therapy skills and stay sharp with examination/interventions, because as great as reading non-stop and studying is, it simply is not the same as working with real patients and all the curveballs that happen in real life.

The rest of my time is spent on working out and studying for the board exam which I will not take until I am fully prepared this time (that $400 price tag warrants that if nothing else).

But I have to figure out what I am doing with my life... so I have been juggling out the options out there.

So last week I interviewed at two places on the same day, knowing little about either as they were both recommended by a colleague (STAR) and a professor, respectively.

The practice that was recommended by the professor actually offered me a position the next day and wanted me to start pretty soon. It seemed like a good work environment and I know my professor enjoys working there. But it would have been a similar commute as HSS which was nutty long. With no disrespect to them I was more excited about the position that my colleague recommended. So I unfortunately had to decline the offer they made to me and I had a follow-up observation day with STAR PT so I can get to know them a little better and vice versa. It was a great day that I spent there, I very much am excited about the possibility of working in such a warm and friendly environment with a large emphasis on mentorship (they are actually in the process of setting up an ortho residency which is something I really want to do). Bottom line is they let me know they were interested in working with me and I will be meeting with them next week to discuss details.

Now for the other options which mainly circle around the fact that I could use a little change from NYC:

• An ortho residency in Jacksonville, FL which I am waiting for my letters of recommendations to get returned before completing the free application, so I add an option with no real risk...
• Moving to Boston with one of my best friends, his wife, and their son (my godson). There is going to be a job fair next Friday and I have reached out to a few people I know in Boston as to available positions and housing. Oddly enough one of the practices that just got back to me is also named STAR PT (cue dramatic music)... Now, I am a pretty die hard Yankee and Jets fan and a New Yorker through and through so Boston has a natural rivalry with me, but I am capable of looking past that as I hear overall it is a great place to live.
• Traveling PT... which would probably have me moving around to a few different cities throughout the US every few months. I am waiting to hear back from one of my other colleagues who has taken part in this type of unique experience to discuss some pros and cons (he is from Boston so he can't fully be trusted... but I will also get some valuable info about that silly town)

It's def. better to have a ton of options than very few or none at all... bottom line is I need to find the best mix of continuing my evolution as a clinician with the highest potential for my own quality of life... because a happy Bo is a productive Bo

I am excited for what comes next but still have that darn licensing exam hanging over my head...