Monday, December 28, 2009

Just Another Manic SUNDAY

Merry Holidays All! and to all a safe night...

Went to my nephew's sixth birthday party at Chuck E. Cheese (although when you turn six its kind of your seventh birthday party, birth should count right?). Firstly, I sat in the back of an SUV forced to keep my knees very bent... not pleasant. This is something I would advise anyone at all, let alone with knee surgery to avoid, but options were limited... I suppose this makes me a 'do as I say not as I do type of individual', perhaps? My knees were not happy with me after that ride. I am happy to report that I am more than 1 full year out of surgery and other than this long knee flexion exposure I am doing great.

On my train ride home I got a chance to read up on my surgery in the form of this article from the latest AJSM. The difference in their study was they did not look at patella autografts (which I had) and instead they chose hamstring and allografts. They found that over a 2-year period those with allografts and those who partook in higher activity levels had a significantly higher incidence of graft failure. It is worth noting ACL reconstruction failure is very rare and previously has been cited at 3.6% in a 2004 study looking at autografts. Everytime I read another article there seems to be another aspect of care I was not aware of, in this case it was the Marx activity score, meant to measure, well... activity. There are so many different scales clinically, and research based it can be tough to keep up with which is the best. I have been using a lot of the Lower Extremity Functional Scale and Lysholm.

But let us rewind a little. Whilst at Chuck E Cheese an elder gentleman passed out. I volunteered what I could as a former EMT and current PT. Unfortunately he was going in and out of consciousness, so some may dub this critical... although it took the ambulance 45 minutes to arrive, fortunately the FDNY first responders were able to get on the scene and at least provide oxygen. He appeared better by the time the ambulance came but still in need of medical attention, I hope all turned out well for him and his family. This brings up the very important point of always being prepared (thank you boy scouts-although I never was one) and taking the time to become CPR certified to better prepare yourself for medical situations that can strike at any time and anywhere. Get the basics down now to help save a life whenever necessary. eHow to become certified. You are never too young or too old (there may be a minimum age but it understanding the value of calling 911 as soon as a child is able to may be valuable enough).

Lastly, for the day I was able to polish off in all of 20 minutes the following book:

I think this is a fantastic analogy for dealing with change, challenge and fear in life. It is a quick read and helps one reflect. Try to pick out which character you might be and how it can be applied to your life, hopefully you already have your cheese and know how to keep up with it :)

Have a happy and HEALTHY holiday season everyone!

Sunday, December 13, 2009

Rainy Sunday in NYC

I apparently published my last post under my old blog ( all about the new blogger posting guidelines, worth checking out.

Here are some articles that were passed on to me that may be of interest to my readers as per the source:

Financial aid for OT's (any OT's out there?)

This is an interesting website that has some very good info and a while back sent me an updated e-mail as part of their newsletter questioning what physio's know about strength and conditioning... hmmm... quite a bit! This is a British website and I am curious to see how different it is out there:

Gretchen Reynolds has written some pretty awesome pieces for the Times, check her out here.

And please support a group looking to help those affected by arthritis:

Wednesday, December 2, 2009

I'm Back!

Had a great trip and now it is back to business...

Just saw this great article about neuroplasticity which is a secret interest of mine combined with the ACL which is very dear to my own knee... here is the conclusion, but make sure to check out the whole article and after I get a chance to read it further I may put up a more in depth review... but no promises as I am focused on inflammation right now.

CONCLUSION: The current study reveals that anterior cruciate ligament deficiency can cause reorganization of the central nervous system, suggesting that such an injury might be regarded as a neurophysiologic dysfunction, not a simple peripheral musculoskeletal injury. This evidence could explain clinical symptoms that accompany this type of injury and lead to severe dysfunction. Understanding the pattern of brain activation after a peripheral joint injury such as anterior cruciate ligament injury lead to new standards in rehabilitation and motor control learning with a wide application in a number of clinical and research areas (eg, surgical procedures, patient re-education, athletic training, etc).

Friday, November 20, 2009

Going To South America

Wow, it has been almost a month since my last post... shame on me.
This post is mostly to let you know I won't be around the next two weeks as I am going to South America (Santiago, Chile>Buenos Aires, Argentina>Patagonia region). But I promise to come back refreshed with much more frequent blog posts.

While I am away I will be thinking of adding to my presentation that I am working on for the clinic where I work. The topic is going to be inflammation from a therapeutic standpoint. Recent developments such as platelet rich plasma, prolotherapy, graston technique and not so recent developments such as cross friction massage and even the debate between ice and heat will all be part of this talk. When you have chronic conditions such as a tendonosis where the histology has changed, is the best course of action to recreate an inflammatory process to allow for the body to heal itself with some guidance? What is the role eccentric training can play in all of this... and so much more.

Any thoughts from you guys?

Happy Thanksgiving while I am away!

Sunday, October 18, 2009

Lifelong Learning

The body is always changing, our knowledge base of the body is always changing as well. There is always more to learn, and I knew this going in... Continuing education is an integral part of becoming the best therapist you can be and I am trying as much as I can in this regard.

At the end of August I took the Kevin Wilk ( Recent Advances in the Evaluation and Treatment of the Knee & Shoulder. I just could not get enough of this man and took a course that he was co-teaching along with Brian Mulligan ( Both courses were very useful and have given me plenty to consider adding to my "PT tool belt" - some of the things I have already utilized with great success. One of the best things about Kevin Wilk is his emphasis on research and through his course I have begun collecting the "gold standard" articles on many of the topics he has brought up.

This past week I also went to a great district course put on by the Greater New York district of the NYPTA. Dr. Jordan Metzl ( - are you noticing a trend of website naming?) presented on hip injuries in the adolescent athlete to a room packed with mostly students along with a few practicing clinicians. This event was free to APTA members as are all district meetings. The main take away message from his talk was to not treat adolescent injuries just like an adult injury with similar presentation. So that hamstring strain may not be something the kid should have to play through whereas an adult might be able to, mostly because of those open growth plates that kids tend to have. A very important point that Dr. Metzl drove home in a very clear, concise and entertaining manner. Go to his website to see some very useful evaluation videos.

Now I move forward to the next two weekends where my clinic will be hosting a Stanley Paris based course called S1 (Spine part 1). 5 days (35 hours) worth of the spine should be thorough... but apparently not enough as there are 4 separate parts just for the spine(not all 5 days). Ultimately you can take all the courses (4 spine, 2 extremity and two more) and receive a manual therapy certification: see this .pdf file.

Did I mention I also presented on the ACL to the Brooklyn/Staten Island district of the NYPTA. The above picture is from that, and it was fun I must say.

Learn on!

Thursday, October 1, 2009

NYC Marathon Nov. 1

I am recruiting medical volunteers for the marathon. I have done this the last 3 or 4 years (it's so good I can't even recall how long it has been:) and we always need more volunteers. At that 4 hour mark there is a ton of finishers that are crashing and need our help. If you want to be a non-medical volunteer they also need as many of you as they can get. It is a very thrilling event to participate in. As a side note I was supposed to run it this year until my acl stopped existing.

If interested send an e-mail to with your name, background, email & phone #. Also, go to for more info on the marathon (they do have a dedicated website to the marathon but I am on my treo right now, sorry mobile blogging). See you there!!

Wednesday, September 30, 2009

Quick Survey: Clinical Decision Rules

Presenting an article at work tomorrow, wanted to run a quick survey of who has heard of and who actually uses any/all of the following:

Ottawa Ankle/Foot Rules
Ottawa Knee Rules
Canadian C-Spine Rules
Canadian CT head Rule
Wells Clinical Prediction Rule

Can Exercise Make You Smarter

One way I stay on top of current literature is through my phone and subscribing to numerous blogs and news sites. I usually share the most interesting articles I find over on the right hand side of my blog (over there >>>>>> [in the navy blue box]). If you look through that list you will often see a new study supporting some benefit of exercise. Ben Braxley, one of the elite New Professionals in the field, was kind enough to forward me this NY Times article along the same lines:

Phys Ed: What Sort of Exercise Can Make You Smarter?

It is a quick read summarizing one main study and a few others that support exercise as a brain booster.
“It would be fair to say that any form of regular exercise,” he says, if it is aerobic, “should be able to maintain or even increase our brain functions.”

Why should exercise need to be aerobic to affect the brain? “It appears that various growth factors must be carried from the periphery of the body into the brain to start a molecular cascade there,” creating new neurons and brain connections, says Henriette van Praag, an investigator in the Laboratory of Neurosciences at the National Institute on Aging. For that to happen, “you need a fairly dramatic change in blood flow,” like the one that occurs when you run or cycle or swim. Weight lifting, on the other hand, stimulates the production of “growth factors in the muscles that stay in the muscles and aren’t transported to the brain,” van Praag says.

Ortho Supersite

I likely mentioned this site at some point of my blogging life, but the recent "issue" I received via e-mail had a few great snippets worth sharing and inspired me to recommend their newsletter.

Some of the articles that piques my interest:
-The increasing number of THA revisions in the United States: Why is it happening?

-Investigators find way to halt excessive bone growth following trauma or surgery

-Pigmented Villonodular Synovitis of the Knee: Diagnosis and Treatment

They constantly have a bunch of interesting ortho related articles including some of the most recent advances in the field which is vital to stay on top of. Subscribing is free... Enjoy!

Saturday, September 12, 2009

Weight Lifting in Women w/Breast-Cancer-Related Lymphedema

I recently read a very interesting article that challenged previously held beliefs in the health care industry. I like challenging the norms, especially when it can get the patient better outcomes. The study pubished in the Aug 13 issue of the New England Journal of Medicine found that
In breast-cancer survivors with lymphedema, slowly progressive weight lifting had no significant effect on limb swelling and resulted in a decreased incidence of exacerbations of lymphedema, reduced symptoms, and increased strength.

The study was made more significant by being longer (1 year follow-up) and being the largest randomized controlled trial to date (sample of 141 patients). Furthermore it was made more generalizable by including nonwhite women and women with a broad range of occupational and educational levels.

An argument is made in the editorial regarding this article that there are potential cost savings, not only by reducing direct health care costs but also by potentially reducing the risk of disability and allowing women to return to work at full capacity.

Exacerbations of the lymphedema was one of the main outcomes and they found that of the 70 patients in the control group there were 195 visits secondary to a flare-up while the weight lifting group that had 71 patients only had 77 visits.

While recently this population had been cautioned against making repetitive arm movements and lifting more than 10-15 poinds, in this study the weight lifting exercises included seated row, chest press, lateral or front raises, bicep curls, and tricep pushdowns as well as a number of lower-body exercises. To bust through the 10-15 pound limit there was no upper limit placed on the weight to which women could progress in any exercise (although they do not specify in the study how high they actually went).

Another element of the study I enjoyed is that the women were not just told to go exercise but given clear instructions with proper biomechanical focus from professionals trained in Lymphedema management at a local YMCA which is very accessible to most individuals in most cities, so this could be a program that would be much more realistic to implement. They also were nice enough to offer a free year of this program to the control group after the study was over.

Monday, September 7, 2009

Continuing Education

New York State (where I live and work) as of September 1, 2009, requires 36 hours of continuing education every 3 years in order to maintain your license. Here is the news from NYPTA:

Mandatory Continuing Education Update
Physical Therapy Continuing Education Regulations Part 77 of the Commissioners Regulations have been amended to implement Chapter 207 of the Laws of 2008, which requires physical therapists and physical therapist assistants to complete thirty-six hours of continuing education during each three-year re-registration period. The law takes effect September 1, 2009.

The Office of the Professions Link is:

The NYPTA is deemed as an approved provider; and as soon as the proper paperwork is filed and procedures defined, we’ll be forwarding that information to our members.

Journal of Physical Therapy

One of the benefits of being a member of the APTA ( is receiving the Journal of Physical Therapy. The importance of Evidence-Based Practice cannot be overlooked, and this Journal does a great job addressing so many areas of our widespread field. You can utilize the website for supplemental videos, podcasts, and the clinical bottom line which is an excellent way of summarizing the research that was performed.

Take for instance the Table of Contents of the most recent issue:

(They also have very snazy art on the cover of each issue)


PRISMA: Helping to Deliver Information That Physical Therapists Need
Christopher Maher
PHYS THER 2009;89 870-872


Reprint—Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
David Moher, Alessandro Liberati, Jennifer Tetzlaff, Douglas G. Altman and the PRISMA Group
PHYS THER 2009;89 873-880

Research Reports

Impact of Physical Therapist–Directed Exercise Counseling Combined With Fitness Center–Based Exercise Training on Muscular Strength and Exercise Capacity in People With Type 2 Diabetes: A Randomized Clinical Trial
J. David Taylor, James P. Fletcher, and Jakesa Tiarks
PHYS THER 2009;89 884-892

Factors Associated With Surgeon Referral for Physical Therapy in Patients With Traumatic Lower-Extremity Injury: Results of a National Survey of Orthopedic Trauma Surgeons
Kristin R. Archer, Ellen J. MacKenzie, Michael J. Bosse, Andrew N. Pollak, and Lee H. Riley, III
PHYS THER 2009;89 893-905

Adhesive Capsulitis: Establishing Consensus on Clinical Identifiers for Stage 1 Using the Delphi Technique
Sarah Walmsley, Darren A. Rivett, and Peter G. Osmotherly
PHYS THER 2009;89 906-917

Strategies to Promote Evidence-Based Practice in Pediatric Physical Therapy: A Formative Evaluation Pilot Project
Joe Schreiber, Perri Stern, Gregory Marchetti, and Ingrid Provident
PHYS THER 2009;89 918-933

Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore Weight Bearing of the First Ray During the Stance Phase
Reinhard Schuh, Stefan G. Hofstaetter, Samuel B. Adams, Jr, Florian Pichler, Karl-Heinz Kristen, and Hans-Joerg Trnka
PHYS THER 2009;89 934-945

Job Strain in Physical Therapists
Marc A. Campo, Sherri Weiser, and Karen L. Koenig
PHYS THER 2009;89 946-956

Clinical Interpretation of a Lower-Extremity Functional Scale–Derived Computerized Adaptive Test
Ying-Chih Wang, Dennis L. Hart, Paul W. Stratford, and Jerome E. Mioduski
PHYS THER 2009;89 957-968

Development of a Self-Report Measure of Fearful Activities for Patients With Low Back Pain: The Fear of Daily Activities Questionnaire
Steven Z. George, Carolina Valencia, Giorgio Zeppieri, Jr, and Michael E. Robinson
PHYS THER 2009;89 969-979


Traumatic Brain Injury and Vestibular Pathology as a Comorbidity After Blast Exposure
Matthew R. Scherer and Michael C. Schubert
PHYS THER 2009;89 980-992

Letters and Responses

On "Effects of forced use on arm function in the subacute phase..." Hammer AM, Lindmark B. Phys Ther. 2009;89:526–539.
Steven L. Wolf
PHYS THER 2009;89 993-995

Author Response
Ann M. Hammer and Birgitta Lindmark
PHYS THER 2009;89 995-997


Santamato A, Solfrizzi V, Panza F, et al. "Short-term effects of high-intensity laser therapy versus ultrasound therapy..." Phys Ther. 2009;89:643–652.
PHYS THER 2009;89 999

Scholarships, Fellowships, and Grants

News from the Foundation for Physical Therapy
PHYS THER 2009;89 1001-1002

Interested in Travel PT?

I am in a great situation right now but travel PT seems like such a great way to experience the sights and sounds of the country as well as provide numerous challenges and learning experiences otherwise not seen. You can share and learn from so many different settings. The prospects are quite exciting.

If you are interested please check out the following community of online travel rehab professionals, it looks to be a very useful resource:

Saturday, August 15, 2009

Vertebroplasty Controversy

A few patients brought this to my attention and I saw this very insightful blog post on the topic. Here is the NYTimes article about it also.

Arthritis is one of the toughest diagnoses to deal with and to combine it with low back pain (another of the more difficult to manage) and you have a recipe for some controversy. Surgery, especially for the back, will be very interesting to follow as the technology changes so constantly and the current methods seem to be less than ideal. My solution... start young, exercise wisely and avoid back problems... easier said than done, eh? Naive? Maybe, but it is the best "treatment" we have at this time. This leads very neatly into my next project of beginning an injury prevention program for high school athletes here in NYC, stay tuned or contact me if interested in participating.

Have a healthy day!

Tuesday, August 4, 2009

Health Care Crisis

Is this really what passes for fitness nowadays? 6 minutes a day is going to fix it all... No wonder we have a crisis, fix things congress, please...

Sunday, August 2, 2009

SmartPhone Results

Here are the results to the previous/recent survey I linked to. Interesting stuff, but now I am more confused as to which phone I want to get next. My current phone, the Treo 755p, is becoming obsolete and breaking down fairly rapidly. I think it would be awesome if we could do all of our documentation on a handheld device like the iPhone or Palm Pre. The Palm Pre offers multitasking which can be great if you can pull up a patients x-rays and input data into their medical record. I want to switch to the Palm Pre as my Treo breaks down but they are charging 500+ dollars, even though I have been with Sprint for almost 4 years they cant give me any price break on the phone, while new customers get it for $199... pissing me off a lot of bit. Have to weigh out cost of the plan, quality of the phones, etc. A lot going on... enjoy the survey results, hopefully I can be mobile blogging much more efficiently with a new phone :)
Have an awesome day!

Different Feet

Reading through a running magazine I saw an advertisement for these shoes that allow for more custom fit than most shoes offer. Check out the fitting video here.

I recently took a Vasyli course about biomechanics of the foot which was very useful. Brian Hoke is an excellent speaker, very engaging and insightful. I highly recommend any course he presents. There is still much reflection and further analysis that I need to do to best implement the information into my clinical practice. Are orthotics more a crutch or a tool for the foot? There seems to be those who believe they can ease everything up the kinetic chain including back pain while others say we can fix the issues with exercise, stretching and some manual therapy. This is the beauty of being a New Professional; learning is a lifelong process, and I am excited for the opportunities that lay ahead.

Thursday, July 23, 2009

Good Weekend

On a boltbus up to Boston (as a Yankee fan and New Yorker this trip always feels wrong). The mobile blogging is harder with my 1.5 year old treo 755p... need to upgrade to palm pre or switch to iphone (darn at&t for being so expensive - I pay fairly low rates with sprint).
Making this trip to attend a biomechanics course on the foot given by Brian Hoke of 'when the feet hit the ground' fame. It's a 1 day workshop tomorrow. After that I get to catch up with my godson which is long overdue. Hope everyone has a dry weekend - why is it chilly and pouring down rain at the end of July?

Saturday, July 18, 2009


A patient of mine asked about prolotherapy so I did some information gathering. In my blog reader which is actually a useful adjunct to more formal types of literature I found 7 entries dating back to 2007. There was a NYTimes article from 08/07/07 that touted the promises of this intervention. An entry in the CAM report from 01/06/08 had an interesting review/summary of the following article: The Spine Journal, Volume 8, Issue 1, January-February 2008, Pages 203-212 Simon Dagenais, John Mayer, Scott Haldeman and Joanne Borg-Stein.
the authors concluded, it’s not possible to separate the benefits of prolotherapy from the other treatments because “there is no evidence of efficacy for prolotherapy injections alone without cointerventions.”

The best was this youtube video, the part on prolotherapy is towards the end:
Nothing too concrete... so I went to pubmed where there were 59 search results to the term "prolotherapy" including a Cochrane review article from 2007 (highest level of research) that concluded
There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.

I doubt I will (within the confines of my practice act) recommend it to others based on the current literature out there but do any of you have any experiences with this form of treatment, please share in the comments and have a nice day, it is gorgeous here in NYC.

Addendum: Platelet-rich plasma injections seem to be the wave of the future here. We are seeing a lot more of them in NY. I am sure there will be posts coming soon on this topic.

Saturday, July 4, 2009

Safety of chiropractic interventions: a systematic review

^^Interesting story to go with the above picture^^

Please note, this is far from an attack on the chiropractic profession. I know and respect a number of chiro's and look forward to the positive interplay between our two professions through my career.

McMaster Plus has a great FREE service called Rehab+ where you can subscribe to topics of interest. The interaction and unique relationship between Physical Therapists and chiropractors is one that appears very often especially in outpatient therapy practices. This systematic review throws out a pretty significant statistic that made me cringe a little when reading it:
The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations.

Physical Therapy on the other hand has been shown to be much more cost-effective and safer than many alternatives including chiropractic. One example of this is how much malpractice insurance I receive for the low amount I pay... are you ready for this... $3 million in coverage for about $175.00 a year. Some (if not most) doctors pay 6 figures a year. I wonder how much Chiropractors pay?

Addendum to original post: I also stumbled upon this website:

100th post, what not to do

I came across this picture in Ski magazine discussing injury risk (click on pic for clearer version). I went ahead and added lines to the thighs and highlighted that the foot is compensating by the outside of it lifting off the ground. This picture is what you should not be doing! The magazine was in fact trying to point this out and offers the following solution if you display this increased hip adduction with squatting: Link Here.

Saturday, June 27, 2009


Non-PT related but I wanted to share this game crazy enough I may have to participate:

StreetWars is a 3 week long, 24/7, watergun assassination tournament that has already taken place in New York City, Vancouver, Vienna, San Francisco, Los Angeles, London, Chicago, and Paris.

At the start of the game you will receive a manila envelope containing the following:

* A picture of your intended target(s)
* The home address of your intended target(s)
* The work address of your intended target(s)
* The name of your intended target(s)
* Contact information of your intended target(s)

Upon receipt of these items, your (or your team's) mission is to find and kill (by way of water gun, water balloon or super soaker) your target(s).

You can hunt your target down any way you see fit; you can pose as a delivery person and jack them when they open the door, disguise yourself and take them out on the street, etc.

If you are successful in your assassination attempt, the person you killed will give you their envelope and the person they were supposed to kill becomes your new target. This continues until you work yourself through all the players and retrieve the envelope with your (or your team's) picture(s) and name(s). Then you win. Cash…but first live in fear.

Monday, June 22, 2009

APTA Virtual Rally This Wednesday

Save the date for APTA's FREE virtual rally, to be held Wednesday, June 24, from 7:30 pm-9:00 pm ET, and participate in the national health care reform debate from your home, classroom, or office. The rally will include messages from APTA leaders, a presentation on reform proposals, and an interactive town hall session in which participants can ask questions.

The Association supports a number of themes that coincide with the broader health care reform debate, including expanded coverage, payment reform, guaranteed issue, workforce, research, health information technology, and prevention. Join the rally and help strengthen the profession's influence during this important and historic time in health care reform.

To participate in the rally, you will need to complete a free registration. Registration opens Monday, June 22, and can be completed until the start of the rally. If you do not register early, please join the rally on Wednesday, June 24, between 7:00 pm and 7:15 pm. The registration process takes approximately 3-5 minutes.

If you have any questions, please visit the Virtual Rally page on the APTA website or email

For more resources on Healthcare Reform, visit the APTA Healthcare Reform Resource Page at

Thank you all for participating!

(I finish up at 8 pm with patients so I will have to join late but think this is a great idea and look forward to what comes out of it)

Sunday, June 21, 2009

Web Anatomy!

Test your knowledge, have some fun with it:

Bonus points if you can point out some common workout errors in the pic be-low.

Thursday, June 11, 2009

Floyd Landis

In the defense of the tour de France winner, this article: (being lazy and posting the entire pubmed abstract, sorry... bottom line is science isn't exactly an "exact science")

Clin Chim Acta. 2009 May 22. [Epub ahead of print] Links
Bad Science: The instrumental data in the Floyd Landis case.Blackledge RD.
8365 Sunview Dr., El Cajon, CA 92021, United States.

BACKGROUND: In 2006 Floyd Landis won the world's most prestigious bicycle race, the Tour de France. However, not many days after the race's conclusion it was released to the press that the Laboratoire National de D├ępistage du Dopage (LNDD) had found Landis' urine after stage 17 positive for synthetic testosterone. METHODS: This review examines the instrumental data and methodology used by LNDD in the Landis case. The conclusions reached by LNDD were based on results of 2 separate instrumental methods. Subsequent to urine extraction and possibly derivatization, samples were initially screened via gas chromatography/mass spectrometry (GC/MS) using selected ion monitoring (SIM) to measure the ratio of testosterone to epitestosterone (T/E). Final confirmation of exogenous testosterone was determined by measuring the (13)C/(12)C stable isotope ratios in 4 metabolites of testosterone via gas chromatography combustion stable isotope ratio mass spectrometry (GC-C-IRMS). CONCLUSION: T/E ratios determined by LNDD in Landis' stage 17 urine were unreliable due to the combined factors of an unsatisfactory extraction, high GC background, failure to obtain baseline peak separation for epitestosterone, unreliable quantization of the epitestosterone peak due to both peak overlap and because it was barely above background noise, and because only a single ion mass (432) rather than a minimum of 3 was used for SIM (in violation of both LNDD's SOP and WADA procedures). GC-C-IRMS methodology is less well known to the analytical chemistry community, but here too the results obtained by LNDD were unreliable. GC-C-IRMS errors can be briefly summarized as uncertain peak identification, unsuitable standards, and unreliable (and possibly biased) calculation of (13)C/(12)C ratios due to peak overlap as well as LNDD's usage of manual peak integration rather than use of the instrument system software.

PMID: 19465014

Sunday, June 7, 2009

Unfair High Co-Pays

We need to make PT as affordable as possible. Let's fix our healthcare system... one co-pay at a time.

Fun Links

TED talks are always fun!

To everyone with low back pain: Exercise more!

Some very amazing exhibits at the 2009 Science Festival here in NYC, I may try to make it to a few.

My buddy Megan bought the nose body wash dispenser when I posted it, I wonder if she will buy this.

Some awesome wetsuits, when are they going to start making "websuits" - virtual reality for the general public? Speaking of wetsuits, here is a pretty awesome article from the NSCA about improving sprint speed using a wetsuit. NSCA has some great free material including their Performance Training Journal.

This is a little dated but seems like a great opportunity:
The Sports Medicine Team for the AIDS Lifecycle is looking for Physical Therapists, Physical Therapy Assistants, Athletic trainers and students in either field for participation in ALC 8.
AIDS Lifecycle -
Sports Medicine Team description (Camp based team) -
Frequently asked questions -

For those of you in the California area you should check out this young lady and her guitar playing skills, info on the shows here.

So much going on, trying to stay afloat... most importantly: my patients are getting better, no better motivator!

Sunday, May 24, 2009

Golf Swing

Not my best work... a few glasses of wine in Napa... Jocelyn Lonen tasting with a golf pro. Beautiful view. Also, please look into their gala fundraiser:
The grip on the clubs were old and a little worn, hands were sweaty without a glove... but the ball went straight. Just like in PT, all that matters is the outcome :)

I Made the Top 51 and joined a New Community

Even though I have been almost vacant here in the past few weeks, and for that I apologize, Onward Healthcare has named me one of the top 51 PT Resources. As some of my military friends might say: "Hoorah!" (hope I can use that :)

The list is also a fantastic collection of resources that I encourage you to check out. A lot of fantastic articles and information out there.

Physical Therapy Job Resources

I was also very honored to be invited into the HealthBlogger Network:

Sunday, May 10, 2009

Playin' catch-up

Been very busy the past few weeks. Went to the HSS sports medicine symposium where I got to hear some of the top shoulder surgeons in the world speak fairly candidly about their ortho thoughts. Work has been going real well, I still am not a fan of the documentation aspect. On the train about to go underground... happy mothers day! more to come soon

Monday, April 27, 2009

Hi Health

Pretty awesome health care movement that I hope I had mentioned before... many applications with PT... possibilities... and their HQ is right nearby me here in Williamsburg, Brooklyn

Monday, April 20, 2009

Pass the Peas

I am sure at some point you have recommended to someone with a bang or bruise, using a bag of frozen vegetables as a substitute for an ice pack, as it conforms better and provides nutrition afterwards, teehee
Apparently CVS has created an ice pack to mimic the conforming power of peas, check it out here.

Already getting blogged about elsewhere, more specifically for kiddies.

Me Swimming

Last week for our staff meeting, Jamie Barrone (one of Michael Phelps' former teammates) who is now a swim coach came to discuss swim biomechanics. Check out his website and if you want to improve your swimming consider having a session with him:

It inspired me to videotape my own swimming to analyze and hopefully improve my efficiency. One of my loyal readers and favorite professors happens to be running in the next lane over for one of the videos.

I am open to feedback, any aspects of my swimming you think I should fix (please keep in mind I have learned a little from the videos already and I have not been using my legs too much secondary to being 4 months post-op). I know there is much work to be done...

Thanks Petey for video taping!

Sunday, April 12, 2009

Clinics in Sports Medicine

In doing some research on swimming, I came across a publication that I had seen previously in my researching of other subjects. This time I happened to notice that all of their issues were theme based. For instance the April issue for this year is all about "Allografts" and the October issue from last year was titled "Shoulder problems in athletes". I think this is a very interesting way to present literature. As a busy clinician you may be more likely to delve into one topic of interest rather than skim through an entire journal of many different topics that may not all interest you. I am still at a stage where I try to read everything I possibly can so I appreciate both formats, but I have noticed that the "themed issues" seem to be an emerging trend in PT related journals. JOSPT has recently had an issue all about the shoulder, NAJSPT had an issue all about MLKI, just to name a few.

I recently spoke with a PT in a residency program for orthopaedics, and he told me he reads a minimum of 45 journal articles a week... they may name the chair he sits in everyday in the library after him, who knows... just some thoughts... back to busy life... Hope you had a great holiday weekend!

Tuesday, March 31, 2009

APTA Student Competition

I am pretty sure Claire won't mind if I post this:

Put down the books and pick up your camcorders, it’s time to get those creative juices flowing! The student assembly board is challenging you, any and all students, to tell us why being a student member of the APTA is so important. At this year’s National Student Conclave, we are showcasing a video that will highlight why students should be/need to be/must be members of the APTA, and as the student assembly, we want your input!

We can all agree that being a great physical therapist/assistant is not only about being a great clinician…it is about being an advocate, a leader, a member of the incredible association that works day in and day out to better our profession. Our challenge is for you to help us spread this message to all non-members. SO LET THE COMPETITION BEGIN!

We would like student members to send in a video message about taking ownership of your future in this profession. We want to get your message out! So tell us…tell us how being a student member of the APTA helps you “Own Your Future”…tell us in a video…tell us with a group of classmates or by your lonesome…tell us in any creative way your heart desires…we just ask that you keep it under 30 seconds…and turn it in before July 1, 2009!

WHO: Any APTA Student Member
WHAT: A 30-second “Own Your Future” Video Message
WHERE: To be showcased at NSC 2009 in Miami, FL
HOW: Mail to Claire Melebeck, 744 Ratcliff, Shreveport, LA 71104
WHEN: By July 1, 2009

Saturday, March 28, 2009

Had a hard week of work with two real hard quad workouts. Earlier today got a real good arm workout in. Just did my bike training:

1st 2.5 miles into wind 13:19
Return trip 7:53 with wind
*tires were a little flat which likely slowed the whole process down
And you see the bike I use above - not exactly the best for speed, but the resistance is nice and high which helps those quads I need to keep getting stronger. Felt real good today, almost wanted to do another 5 miles but had to get back here to post this and get my ACL presentation together... Thursday, here I come...

Tomorrow will also be my REAL first swim since the surgery, as I tried last week but spring break was still in effect keeping the pool closed.

Bonus: I apparently entered a contest a while back and received an ESPN hat in the mail, fun... Thanks, ESPN (picture to come)

Saturday, March 21, 2009

Terrible Spinal Manip Timing

The day I present to my clinic on Spinal Manipulation for Low Back Pain is the same day the APTA decides to send out an e-mail that they have released White Papers and a wealth of information on Spinal Manipulations. That would have been usefull information yesterday... (:about 25 seconds into the link)

I did not go into it feeling I had put together as much as I could have mainly because of the huge amounts of information out there. But it seemd it was fairly useful to the majority of my audience which is all I could hope for. Now I will be working on an ACL powerpoint that I will present in two Thursdays and fine tuning the spinal manipulation presentation for a few other PT's I know and eventually we will have a solid presentation for MD's and payors to educate them on how we deal with Low Back Pain.

Other exciting news: A new blog has sprung to help promote and organize the New Professional:
MOVE IT! get to that site and contribute. There seems to be a lot of potential energy we have to tap into to help make the future of our profession better than ever, day after day. I am really looking forward to what we can accomplish.

Have a great weekend. I pledge to go swimming for the first time since my surgery tomorrow and report how that went... I highly do recommend the pool for the majority of musculoskeletal conditions:

Tuesday, March 10, 2009

VO2 Update and Neck Guidelines

The last two weeks I have not been as diligent with my exercises as I request my patients to be on a daily basis. For that I apologize to myself. I have heard the phrase: "do as I say, not as I do" uttered by too many a PT and I try to not fit in to this. So as soon as I finish this post I am off to workout my knee HARD! (cue inspirational music now)...

The results of not working out as much as I should have been showed up on my VO2 bike test today. We used a harder protocol of increasing the watts by 50 rather than 25 at each interval and I got up to about 360 watts before we finished although I had some left in the tank, just couldnt keep up the >50 rpm request with that much resistance and fatigue... so my VO2 went down about 4 points which could have more to do with testing error than me, or it could be the incredibly delicious albeit unhealthy food choices and poor exercise adherence I have been practicing...

And I leave you with the Neck Pain Clinical Guidelines I just finished reading. My main thought is "if you are a practicing PT who treats neck patients, you had better read this!" I like the utilization of the ICD-10 associations to create 4 neck pain categories
-mobility deficit
-movement coordination impairments
-radiating pain

I am looking forward to the updates they promise on the Orthopaedic Section of the APTA website... always something newer and better!

Now to workout!

Sunday, March 8, 2009

Pubmed Everyday! is one of the most useful websites for researching any scientific topic. Slightly more reliable than wikipedia...

But did you know you can have all new articles on any topic emailed right to you without having to do anything. This works great for me when researching a topic like "ACL" for the rest of my life...

So here is how to subscribe to a topic:

1. Go to
2. Either sign in or register (ABSOLUTELY FREE)
3. Once signed in, perform a search on any topic.
4. After the results come up go to the right of the search bar, there should be a link for "advanced search" and "save search"... click "save search"
5. Name it, pick your options and enjoy

Happy researching... and dont forget to Spring ahead, lose that hour of sleep...

Saturday, March 7, 2009

DVT Detection

A Deep Vein Thrombosis (DVT - basically a clot) could be a very serious condition if unrecognized. In our clinic we recently had an instance of a patient (4 weeks post-op) presenting with a few signs of this possibility and we referred him back to his MD to check it out and it turned out he had 3 small DVT's.

In the November 2008 issue of NAJSPT in an article titled "Multiple Ligament Knee Injury: Complications" there is a very clinically relevant decision rule that we have posted in our clinic as a constant reminder to look out for this complication. The original Clinical Decision Rule was actually developed in this citation:

Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Wells PS et al. Lancet. (1997)

Just as I think everyone, medical personnel and lay people, should be certified in CPR, the detection of DVT should be a critical skill that anyone exposed to a post-operative patient should have. So here are the clinical findings to look for. Each is a point towards the decision rule score, except for the last one which subtracts 2points from the score.

-advanced cancer (w/in 6 mo's of Dx or palliative care)
-paralysis, paresis, or recent plaster immobilization of lower extremity (LE)
-recently bedridden >3 days or major Sx w/4 wks of application of clinical decision rule
-localized tenderness along distribution of the deep venous system
-entire LE swelling
-calf swelling >3cm compared to asymptomatic LE
-pitting edema (>in symptomatic LE)
-collateral superficial veins (nonvaricose)
-alternative Dx as likely, or > than DVT = -2

Total of Above Score
High probability >3
Moderate probability 1 or 2
Low probability <0

Here is a very similar version of this toward the bottom with different references (that came out in 1998 one year after the release of the one I reference, odd to me).

Sunday, March 1, 2009

Bike Ride and Career Day

This is 11 minutes of me riding my bike over the very scenic Coney Island Boardwalk. I think it is actually kind of relaxing to watch

Yesterday I went to Career Day at my high school. One of the few schools that can get 50+ alumni and 600+ students to come in on a Saturday and not involve some kind of sporting event. I had a decent turnout and a bunch of the kids asked about setting up internships/observational hours, so hopefully that can work out

Just finished reading an interesting paper titled "The Pathophysiology of Patellofemoral Pain: A tissue homeostasis perspective" by Scott F. Dye, MD. I have heard some interesting stories about Dr. Dye, including having knee surgery without anesthetic, performed by his father. This paper in particular discusses the "enevelope of function" which looks at the "capacity of the knee in a live person (and by extension, all diarthrodial joints) to safely accept and transfer a range of loads." Useful principle for gauging the idea of pushing someone too much versus not enough. I highly recommend this paper to get a unique perspective on this very complex issue

Another way to describe the envelope of function: "The range of load that can be applied to a knee joint without causing structural or metabolic failure can be termed envelope of function."

Tuesday, February 24, 2009

I don't like Ed Towns

Oppose Legislation HR 1137 That Will Weaken Qualification Standards for Personnel Providing Physical Therapy Services in Physician Offices

On Monday, February 23, Congressman Edolphus “Ed” Towns (D-NY) introduced HR 1137. This legislation would overturn the current Medicare “incident-to” rule and recognize athletic trainers as covered providers under Medicare. Please contact your Member of Congress today and ask him/her to OPPOSE this legislation!
APTA strongly opposes this legislation (HR 1137) and supports Medicare’s ability to require qualification standards for therapy services provided “incident to” a physician’s professional services. It is the position of the American Physical Therapy Association (APTA) that physical therapists are the qualified professionals who provide physical therapy examinations, evaluations, diagnoses, prognoses, and interventions. Interventions should be represented and reimbursed as physical therapy only when performed by a physical therapist or by a physical therapist assistant under the direction and supervision of a physical therapist.
In November 2004, the Centers for Medicare and Medicaid Services (CMS) included provisions in the final rule for the 2005 Medicare physician fee schedule that established qualifications and clinical preparation standards for individuals who provide physical therapy services “incident to” a physician’s professional services. These provisions implement requirements adopted by Congress in 1997 to protect patient safety, ensure the appropriate use of Medicare resources, and guarantee the delivery of physical therapy services by qualified physical therapists. Opponents of these regulations were unsuccessful in their attempts to have CMS rescind the rule implemented in May 2005. These organizations also filed a federal lawsuit attempting to force their withdrawal, and a US Court of Appeals upheld a district court decision dismissing the litigation.
Talking Points
Patient Safety - HR 1137 jeopardizes the health, safety and welfare of Medicare beneficiaries by allowing non-qualified individuals to provide therapy services. The “incident to” regulations standardize existing Medicare requirements that physical therapy services must be delivered by qualified personnel in all outpatient settings. There is no evidence that these standards have restricted the delivery of physical therapy in physician offices. Without enforcement of appropriate qualification standards, it would be impossible to ensure that Medicare beneficiaries receive and the Medicare program pays for an appropriate level of safe and effective care delivered by an individual qualified to provide physical therapy.
Cost-effectiveness – HR 1137 is fiscally irresponsible and will cost taxpayers due to inappropriate billing of therapy services by non-qualified individuals. In a report issued in May 2006, the Office of Inspector General (OIG) of the Department of Health and Human Services found that 91% of physical therapy services billed by physicians under the old “incident to” rules in the first 6 months of 2002 failed to meet program requirements, resulting in improper Medicare payments of $136 million. The Inspector General found that the total payments for physical therapy claims from physicians skyrocketed from $353 million in 2002 to $509 million in 2004, and that the number of physicians billing the program for more than $1 million in physical therapy more than doubled in that two-year period.
This follows a report done in 1994 by the OIG that estimated that more than $47 million in unnecessary therapy services were delivered in physician offices under the old “incident to” rules. As a result of the 1994 report, Congress passed the Outpatient Physical Therapy Standards Act of 1997 as part of the Balanced Budget Act. This legislation established a standard for physical therapy delivered in a physician’s office consistent with that in all other outpatient settings, and the regulations promulgated by CMS in 2004 implement these standards in keeping with the intent of Congress.
Quality Care – HR 1137 dilutes the quality of care for Medicare beneficiaries by allowing non-qualified individuals to deliver therapy services. Medicare beneficiaries deserve a consistent standard of care that ensures that providers who deliver these services have attained the level of education and qualification necessary to provide them safely and effectively. Without appropriate personnel standards for individuals delivering highly skilled and recognized Medicare services such as physical therapy, the standard of quality is jeopardized.
What You Can Do
Contact your House Representative and ask them to OPPOSE HR 1137 TODAY!
CALL: Contact your House Representative by calling by calling the Capitol switchboard at 202/224-3121. Remember to ask to speak with the Health Legislative Assistant and ask your House Representative to OPPOSE HR 1137.
EMAIL: Visit and click on the Legislative Action Center to send an email to your House Representative.

Monday, February 23, 2009

Blog Roll

I have not updated my links on the right side over there in a long while -->

So here is the easier way for me to update all this, these are the PT relevant (plus a few other fun) websites I follow using either Blogger (through this blog) or through Google Reader (RSS feed reader):

My Top Picks in no particular order:

1a) Exercise-ology
1b) View from Sports Center (not related to ESPN)

2) Mike Reinold

3) Seth Godin

4) Street Anatomy

5) TED blog

6) where I work... not a blog

7) One of the best PT practices I have had the pleasure of associating with

8) A Day in the life of a PT student

9) "The future of manual physical therapy is in your hands"

10) Clinical Reflections

11) Some of the discussion boards on


13) Neurotonics

14) NPA Think Tank

15) Physiopedia

16) Orthopedic PT

The Top Health Blogger himself Tim Richardson
17a) PT Diagnosis
17b) Bulletproof PT

18) PT Rover - nothing new in a while...

19) Physio Info-blog - also not much in a while...

20) Physiospot Musculoskeletal

21) Rehabcare blog

22) Medical News Today -> Rehab & PT

23) SCI Info News Blog - any of the latest breaking news on SCI

24) PT Etcetera Blog

25) Sports Injury Clinic - Research - seems to be something wrong with the RSS feed, because they have recent articles but it doesnt get sent to my RSS for some reason :(

26) Toni Talks about PT Today - is it just me or does Toni seem very bitter and cynical in all of her posts

27) - and all the other wonderful PT tweeters out there...

28) (Un)edited Tales - she has even less PT content than me, but she also seems to be in NYC so the food suggestions are very useful

29) Moving Forward

30) Rookie PT

31) S.46: Medicare Access to Rehab Services Act of 2009 - the best part is the "111st Congress" - they didnt notice the need to change it to 111th

Any I missed (it wasn't on purpose)? Please share!

Bike V02 Max Test

This is a seemingly great explanation of the V02 max testing.

*Not me in the picture above, but very similar setup with the same mask and livestrong bracelet...

I got my test in this morning before work, so I probably did not go to my "max" as one should for most accurate readings. But I wanted to be able to walk around at work. My numbers were very comparable to the running test I did back in October before the ACL surgery. The V02 max was about 49, which equates to a 53-ish with the running, which is where I was, and max HR was 168. The problem was my carbon dioxide I was breathing out never crossed the oxygen I was breathing in (at least the levels didn't on the graph, they physically had to have crossed). For that reason, I will be re-taking it next Monday, perhaps I will videotape it for your viewing pleasure. Also, this test was a 25 watt interval, meaning every minute the resistance went up by 25 watts, whereas because I displayed some steady vitals the test may be more accurate with a 50 watt protocol, meaning I reach my "runnin' on fumes" phase much quicker.

I am excited to continue strengthening my quads, and use this type of data to utilize my training as I begin to cycle and swim much more.

Educata Continuing Ed.

I was passed on this blog tip for continuing education, the list of their faculty is a pretty darn impressive who's who in the PT world. The opening line to the e-mail made me smile so I thought I would share:
I enjoy reading your BLOG -- and your out-of-the-box perspectives. Fun!
Thanks Monica!

By way of introduction, EDUCATA ( had its public debut earlier this year, to rave success. There are reasons why it stands out:
- Top-of-the-line educators (you may know some of them, actually, as they routinely speak at PT conferences)
- Strength of the technology platform, which is fully interactive (visuals, video, audio; pause-resume capabilities; baseline knowledge test at start of course; evidence of learning at exit at end of course; ability to interact with the instructor; certificate vaulting; courses in increments of 1 contact hour and up; etc.)
- Accreditation with the licensing boards of most states where CEUs are required

There is also a press release that was sent to me which is in .pdf format. I wanted to share through GoogleDocs but that would require that you have a Google account and I send you the invite to the .pdf... which is kind of silly, but I understand not allowing sharing of any and all .pdf's... I think?

The press release should actually be on the website tomorrow, but Adobe does let me copy and paste text, so here goes (it looks a lot better via .pdf

Page 1 of 2
For press inquiries, contact:
WCPT: Brenda J Myers, Secretary General
+44 (0)207 471 6765
EDUCATA: Monica Berndt -- Marketing
+1 323-256-1855
EDUCATA and the World Confederation for Physical Therapy Partner to Provide First Global Online Continuing Education For Physical Therapists
Interactive Web 2.0 platform brings latest education and technology to physical therapists around the world
(Calabasas, Calif. February 24, 2009)— The World Confederation for Physical Therapy (WCPT) and EDUCATA, the first company to offer a global continuing education platform for physical therapists, have partnered to provide online courses starting in February, 2009. The WCPT is an international professional organization whose members are national physical therapy associations.
“We believe that there is a tremendous need for physical therapists around the world to stay current on the latest advances and have convenient access to educational opportunities for ongoing professional improvement,” said WCPT President Marilyn Moffat, PT, DPT, PhD, FAPTA, CSCS. “In many countries, costs and distance barriers make it very difficult for therapists to get access to ongoing training and education.
Educata brings this vital educational experience directly to the physical therapist online,
wherever and whenever it is convenient, at a reasonable cost.”
EDUCATA Co-Founder/CEO Marilyn Pink, PT, PhD said, “We’re honored to work with the WCPT to make continuing education available and feasible for physical therapists globally. Our goal is to raise the bar in the international arena for evidencebased clinical practice.”
Page 2 of 2
Dr. Pink, who has over 20 years of experience in healthcare and sports medicine as a clinician, educator, scientist and businesswoman, says that Educata was created to give physical therapists knowledge to enhance patient/client interventions through a cutting-edge technology platform that is user-friendly, convenient and low cost. Also the founder of a web, evidence-based healthcare and fitness company, Dr. Pink has published and presented over 150 peer-reviewed articles and international lectures on managerial, clinical and scientific topics.
EDUCATA Co-Founder/CFO Michael Weinper, PT, MPH, has over 35 years of experience and expertise in clinical practice, management, consulting, administration and program development. He is founder and principal in Progressive Physical Therapy, a private practice therapy group with five locations, and founder of Physical Therapy Provider Network (PTPN), the first specialty managed care organization in the preferred provider organization (PPO) environment with networks in 23 states.
EDUCATA offers a broad spectrum of courses covering the areas of orthopedics and cardiovascular/pulmonary to geriatrics and oncology that are taught by top-ranked educators and experienced clinicians who are researchers, authors and instructors at professional scientific conferences. It combines visuals, audio and video, and other interactive technology to provide a rich, highly engaging learning environment.
About Educata: is a unique, interactive, Web 2.0 continuing education platform that delivers online learning for health professionals. Physical therapists and other medical professionals are the focus of the first launch. Subsequent launches will target additional professions requiring continuing education. To find out more about EDUCATA, go to or contact Dr. Marilyn Pink at 805-495-7477.
About World Confederation for Physical Therapy: The World Confederation for Physical Therapy (WCPT) is an international non-profit professional organization founded in 1951. WCPT is a confederation of national physical therapy associations supported by subscriptions from its 101 member organizations and through them it represents over 300,000 physical therapists worldwide. For more information about WCPT, email or visit

Follow Me

in case you didnt have enough stuff to read and follow...

web 2.0, gotta love it (strike that - anyone know how to do that on blogger?), gotta keep up with it

Attempted Bike Vlog

This did not turn out that well... next time I will have to not be on the bike... I also recorded the rest of the 2.5 mile boardwalk ride... its quite scenic. I figure it will be very different soon, and it is a very beautiful route... I will get that video up whenever it finishes uploading... tick tock

Street Anatomy

They have a great blog that I always enjoy checking out... here is an addition for them from the streets of nyc

Sunday, February 22, 2009

Another Lazy Sunday

Got about 4 hours of biking in yesteday, very leisure like. I was going to go swim today, but decided to rest up for my V02 bike test tomorrow. This will be a big test for my endurance since I have not been going too hard in training yet. The knee is feeling much better, at about 9 weeks I had my first experience of descending stairs without pain.
Preparing a little for one of our mock evals tomorrow that we do every monday, we will be thoroughly reviewing the shoulder. Exams, normative values, etc. Interventions to follow.
Also, in putting together a presentation on spinal manipulation, I found this great guest editorial in JOSPT with this answer as to what to tell a patient when they ask why spinal manipulation therapy worked:

...the spinal manipulation caused transient and widespread forces to be
absorbed through the treated area. These forces produced a barrage of input into
the nervous system, evoking responses between the spinal cord and the cortex. A
likely explanation for the successful outcomes achieved in this particular
patient could be pain inhibition and changes in motneuron pool activity,
although non-specific effects due to placebo and patient expectation could not
be ruled out.

Tuesday, February 17, 2009

PT in the NYTimes

Check out todays Science Times with Physical Therapy and the Camaraderie of Healing
one step closer to helping our health care system... hopefully...

Saturday, February 14, 2009

Post Op Week 8 and 1 Day, aka VD

Happy Valentines Day ya'll (watched Friday Night Lights recently, hence the "ya'll" - great show though)

Another bike ride today, here are times:
3:50 - house to boardwalk (BW) warm-up
12:10 (8:20) - 2.5 miles of BW - had a pretty strong backwind, felt great
24:20 (12:10) - 2.5 miles back - had to fight that wind that helped me get an 8:20, twas a good challenge
27:54 (3:54) - cool down

Total distance: 6.27 miles (10.09 km for the rest of the world :)

I am trying to set up a V02 max bike test so that I can really start training properly. I still have my big old clunky mountain bike. I want to start taking some pictures and video of all this fun stuff to share with you guys... the tearing down of Coney Island is a sad reminder on every ride though, there are a ton of blogs covering it (here is just one), but sad to see every time out there, it's still a beautiful ride.

Tomorrow I will try to go swimming for the first time... I went in a hot tub when I visited Atlantic City last weekend, and while it was relaxing, all that heat is not great for the knee...

Now on to clinical thoughts, the actual original intent of this blog!

This past week my case load grew quite a bit which is always great for stability and my own comfort, rather than just jumping around picking up random patients from other therapists. Got to see an orthotic evaluation including the mold of the feet being made, they get shipped out to the company that makes the orthotics and the patient gets support and improved function just like that, it's a beautiful process (minus the foot smell, just kidding).

A main point that keeps coming up and I think is a common issue with many newer practitioners is "too much versus too little". Coming out of school you have a million different possibilities in mind, and often times you want to screen for every one of them and other times you may not screen enough and end up missing something. There is a fine balance with huge implications on the time you have in the day. Also pushing a patient through an extra set or few reps versus not challenging the muscles enough, the balance of good vs. bad pain vs. soreness. This all requires the most intricate of understandings of muscle physiology, periodization of training, healing response, that person's psychological profile, among other things. Even typing this gets me excited about the job I get to do every day... I wish I was a little more eloquent with my vernacular most days, but I hope my passion for the human body and all the musculoskeletal stuff going on comes through to you... all that heart, lungs, bowel stuff, just not as exciting.

Speaking of passion for PT, check out this blog from India:

Lastly, I am pretty upset I did not get to go to Las Vegas for the Combined Sections Meeting of the APTA, I hear it was a pretty amazing conference with tons of learning and fun... I am gonna try not to miss too many more, so hopefully no more surgeries for me :(

hope you didn't pay too much for those roses today... i paid $5 a rose... got them for my momma

Saturday, February 7, 2009

Post-Op 7 weeks 1 day

Just rode my bike on the boardwalk for the first time since the surgery and it felt great despite (maybe because of) the sub 45 degree weather. I get such a great quad workout on my mountain bike, with high resistance most of the way. Eventually I may take up actual cycling with one of those super light bikes that go real real fast, it seems like a bit of fun. So here is my own times for today for record keeping.

5 - warm up lap around my neighborhood that led me back to my house to get gloves and a neck warmer (smart call)
3 - time from house to boardwalk
12:40 - length of boardwalk (2.5 miles)
10:00 - roundtrip of boardwalk (another 2.5 miles, was going down wind)
3:40 - cool down in neighborhood to get back to house including intermittent backwards pedaling

I am really motivated to start getting more steady workouts in as well as a solid amount of article reading, topic prep for the near future. We have one particular student at the clinic I am collaborating with to present the latest on core training and manipulation for low back pain, with two other clinicians presenting on the medical/surgical side of things. Should be fun. Have a healthy weekend people :)

Thursday, January 29, 2009

TED Blog: Running on high-tech legs: Aimee Mullins on

TED Blog: Running on high-tech legs: Aimee Mullins on

Posted using ShareThis

TED Talks are pretty darn entertaining... I highly recommend perusing the site to find something that interests you, there is a wide variety of topics and once you find your topic you will find something interesting about it. Go now!

I also wanted to share this site:

It seems like a pretty awesome utilization of the world wide web... making the world a better place? maybe...

I came across a pretty interesting chapter in a textbook that breaks down a lot of mnemonics/memory tools for a bunch of different PT related ideas. One example is the 12 cranial nerves... if you are in a medical field I assume you can recall at least one version of this... or the 8 carpal bones... I will share a few of my faves a few posts from now but for now I would love to hear some unique ones or just your faves... :-D

PS: today is 6 weeks since my surgery, back to work, starting to push a little more with my workouts, especially now that my commute is down to five minutes.

Tuesday, January 27, 2009

While I Ice...

I am laying on a treatment table with the laptop we use for our documentation. I am in the clinic, icing my knee after a long day of running around and making people feel better, it really can be such a rewarding day at work... every day... how cheesy, I know... I am a little bit on fumes since the last thing I ate was a single french fry I stole from one of the front desk staff during lunchtime since one patient showed up late so I saw him through my lunch hour, before that was a turkey/cheese sandwich at 6 am... its almost 7 pm... I try not to give you the ins and outs of my day but "whoomp there it is"

Anyways, this is my first entry since returning to work following my thoroughly documented ACL surgery. It has been a little tough being on my leg pretty much all day, which PT pretty much requires. The first week I had my old 3 hours of commuting each day which did not help the swelling which was already pretty bad just from the actual work day. I decided to invest money into my knee by subletting a place within 5 minutes of work so as to walk and save myself 2 hours and 50 minutes a day of sitting on the bus or train. Of course the day after I move in one of my best friends calls me to tell me I could move in to his place which is about a third of the rent but still a bit of a travel time... decisions and timing... thats life.

Back to clinical interest; I have had the chance to slowly wean back into a pretty full workload. I am keeping track of my patients every day, getting re/more familiarized with all the referring physicians, diagnoses (some real interesting ones including radial tunnel entrapment, thoracic outlet syndrome, thunder clap headaches, tension headaches, restless leg syndrome as a co-morbidity, greater trochanter of the humerus and fibular fractures, to name a few... and of course quite a few of the very popular ACL!)

With my shortened commute I can actually be well rested for once and dedicate that would-be travel time to improving my quad strength which is my main impairment at this time - going down stairs is still a little difficult because that requires good eccentric quad control. Obviously still a bit of swelling hence why I am icing the knee. Speaking of icing, my time is up here, which ends this post, ciao my beauties :)
I'm hungry...

Saturday, January 17, 2009

President-elect Obama has a seemingly progressive website where you can actually vote for ideas...

Under "Open Government" there is a "Citizen's Briefing Book" where you can share your own idea of how you want to see this country changed and vote up or down others ideas... I tried finding PT related stuff

This one isnt getting many votes (only at 30 points, each vote is 10 points, not quite there yet):

Require physical therapy before purely elective surgery

This is a well thought out way to save us 225 mil$ (careful with the language, this is a vote to "Defund" it so it is anti-nccam which makes sense to me)

Defund the National Center for Complementary and Alternative Medicine (NCCAM)

This is one of the most popular ones:
The reason that our country pays more for health care than anywhere else in the world and still has poor health outcomes is that the system is run by profit-seeking insurance companies. Health insurance should not be a for-profit field.

Bottom line is if you care about this country and you believe that the new Prez will actually be influenced by these votes, take advantage of the social network here, web 2.0... should be an interesting 4(8)[12] years coming up...

Thursday, January 15, 2009

What We Are Worth

Interesting website that tells you how much you should be paying for various medical procedures, here's a few relevant ones:
  1. Approximately 15 minutes of therapy or treatment. $51
  2. First visit for PT evaluation. $135
  3. Follow up visits for PT evaluation. $72
  4. PT with ultrasound therapy. $22
  5. They did not have a listing for ACL surgery...
  6. "leg" MRI. $552
  7. x-ray knee. $37
Ultrasound is the real interesting one since it isn't very evidence based... read all the comments too

How much would you pay? More/Less...

Sunday, January 11, 2009

POD #23

So this could be my last week of "Vacation"... my walking is pretty normalized, my biggest concern at this point is taking any (figurative) steps backwards (I am all for taking actual backwards steps). Since working as a PT means being on your feet most of the day, swelling is my enemy. Should be interesting how that plays out when I am back full-time.

This weekend I indulged a little more than I probably should have. Friday night was my high school football dinner. As a coach I felt slightly obligated to make an appearance. Of course we always have a good time. And this was the weekend I sent back my Gameready, I would buy one if I had an extra $2,350.00 laying around! The combination of sub par icing along with increased mobility led to a slight increase in swelling, boo!

Another interesting aspect to this operation is the scar. Scar tissue is a natural and necessary part of healing, but you also do not want too much... a fine balance must be matched. So I was looking into products for treating the scar, chicks dont necessarily dig scars on the knees...
mederma keeps popping up as a recommended treatment, so I decided to investigate further; three articles came up in pubmed regarding this cream:
  1. Petrolatum-based topical agents constitute standard therapy in the management of postoperative wounds. In this side-by-side, randomized, double-blinded, split-scar study, the onion extract gel [mederma] did not improve scar cosmesis or symptomatology when compared with a petrolatum-based ointment.
  2. Despite the authors' inability to demonstrate a reduction in scar hypertrophy, the improvement in collagen organization noted in the Mederma-treated scars suggests it may have an effect on the pathophysiology of hypertrophic scar formation.
  3. Snake oil for the 21st century.
This is another interesting study I no longer have access to (my university cut my access since its been 6 months after graduation - gonna have to have a talking with them).

Vitamin E was another highly touted remedy for scars but here are a few interesting articles regarding that issue:
QUESTION: A few of my patients have been told to use vitamin E cream after surgery or repair of a laceration. What is the evidence for this suggestion, and is this treatment suitable for all patients? ANSWER: Vitamin E is the main lipid-soluble antioxidant in the skin. Several anecdotal reports have suggested that topical use of vitamin E cream can reduce scar formation. Current evidence from the literature, however, does not support that proposition. In fact, studies report some adverse effects with use of vitamin E. Further research is needed before application of vitamin E cream becomes the standard of care.

-Without scientific basis, health professionals continue to recommend vitamin E for use on scars. Such recommendations should not be made in the absence of evidence-based medicine.

This study shows that there is no benefit to the cosmetic outcome of scars by applying vitamin E after skin surgery and that the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar. In 90% of the cases in this study, topical vitamin E either had no effect on, or actually worsened, the cosmetic appearance of scars. Of the patients studied, 33% developed a contact dermatitis to the vitamin E. Therefore we conclude that use of topical vitamin E on surgical wounds should be discouraged.

Scar-free healing with gene suppression

New mechanical insights into wound healing and scar tissue formation

How'd you get that scar?

That's all for now... I am going to the pharmacy tomorrow to make up my mind on scar ointments... the evidence hasn't helped me much and the stories I have heard from colleagues and friends have been mixed... anyone want to share their experiences?