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

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)

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: http://moveitnps.blogspot.com/
MOVE IT!...to 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: http://www.aquaticpt.org/

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
-headache
-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!

Pubmed Everyday!

Pubmed.gov 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 pubmed.gov
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...

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).

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."