Wednesday, December 29, 2010
Evidence In Motion continues to redefine and push our profession forward, just wonderful to see and I am excited about how much more can be done. I see too much of our profession in the stone age... let's "move forward"!
Monday, December 20, 2010
NYE Run 12/31/10
CF Mobility Cert 2/4/11
TPI-L1, CSM & Mardi Gras Full or Half Marathon (Have yet to decide) 2/7-14/11
NYC Tri 08/07/11
Tour de Force 9/8/11-9/11/11 (please donate - I should have the donation page setup under my name shortly, it would be greatly appreciated)
Friday, November 26, 2010
I have recently streamlined my RSS reader and wanted to share my favorites with the rest of you lovely people out there, enjoy! In no particular order:
1) MoveItNPs I happen to be a 'contributing author' but Ben Braxley is worth getting to know, read up and join the movement.
2) Eric Galvez --> Mass Kickers Cancer survivorship is no joke, Eric is another great person to get to know so go read!
3) Crossfit and MobilityWOD This is the movement of the future in health/fitness in my opinion. It comes across a little intimidating but with the help of KStar at MobilityWOD and "scaling" this really is for everybody and it is all free. My biggest problem with it is they have so much information it is tough catching up!
4) Chris Johnson PT An endurance athlete himself Chris is leading the way in training/treating this unique population of athletes.
5) Fusion Performance Training A "performance coach"/PT who comes out with some quality material worth reading. He also has The View
6) Mike Reinold Despite his Boston affiliation this man is a leader in progressive sports/ortho PT, keep it going Mike.
7) Optimum Sports Performance Quality content coming from a massage therapist/CSCS
8) Simply awesome PT geek/art stuff: Street Anatomy
9) EIM Team A group that really wants to change things for the better in our profession, always a quality read.
10) Eric Cressey is another leader in fitness specifically in the world of Baseball but his lessons carryover to most other aspects of fitness.
Do you have any blog(s) (other than this one) that you think is of vital importance (please share in the comments below)?
There are a bunch of other PT links that I will try to throw in another post. There is always reading of JOSPT or AJSM as well; lifelong learning is no joke. I have a few non-PT links I frequent but will have to share that at a later date as I have to go catch a flight to Las Vegas where I am taking an Emergency Response Course. Hope you are ready to work off all the damage you did at Thanksgiving dinner :)
Thursday, November 25, 2010
Surgical and Therapeutic Management of a Complete Proximal Hamstring Avulsion After Failed Conservative Approach
What information do you take away from reading a single article other than the main findings?
I like to see which outcome measures were used since there seems to be so much variability throughout the medical field. In this study they used the LEFS which seems to be a very popular scale. They also use the SportCord test which I actually had not heard of before this article (google was not much help to find more information about it, but they do describe the test in the article).
The patient had a Hamstring Repair using an Achilles Tendon Allograft. The article describes a new protocol that is criterion based and considers the basic tissue-healing process. They also add early loading to prevent secondary atrophy. The patient ended up having 25 sessions over 7 months to reach all goals. Despite her great outcomes she chose not to return to softball. The authors emphasized proximal control and lumbopelvic stabilization exercises which was lacking in the literature previously. They mention neuromusuclar control often which is a fairly subjective concept but a critical one that is beginning to be emphasized more often in the literature more recently.
Despite the "low level evidence" this provides it is a very useful article to have in the utility belt as a clinician.
Monday, November 15, 2010
1) The story of how I got to my career
2) General overlook at the very dynamic field that is PT
3) This career may not be for you but make sure you find something you love to do. A great way to do this is to volunteer and intern with as many different fields that could be potential fits for you (I spent time with the following disciplines: chiropractor, orthopaedic surgeon, EMT, athletic training, personal training, physical and occupational therapy)
4) No matter what career path you choose you should still be aware of healthy living and how to save a life (this video is a scare tactic that should drive the point home)
A view of Brooklyn Tech's auditorium from the gym. The auditorium is the second largest in New York State (2nd only to Radio City Music Hall)
Saturday, November 6, 2010
This will be the first year since 2005 that I will not be at the finish line medical tents. I will miss the environment, it is fun.
There are a few debates about what the marathon actually does to/for the body. An orthopaedic surgeon I heard speak recently advocated that no one over 150 pounds should ever run endurance events. Some of the healthiest people I know have run most of their lives. That debate will have to continue. In the meantime, good luck to all the runners tomorrow... Layer up!
I took this picture towards the end of the marathon (About mile 25.5). These guys dressed up like the Blues Brothers and walked right by me at a nice leisurely pace. Begs the question of people doing these marathons for fun. If you have a >5 hour time it seems to take away from the athletic accomplishment. The experience no matter what pace you go seems to be one of the best and I am highly motivated to push my surgically repaired knee to try this marathon next year.
Monday, November 1, 2010
The students seemed to get a good amount of information out of the hour long discussion. While many of the same answers that could be expected were given about lifelong learning, the importance of mentorship, risk management, 'ethics in the real world' I had to get on my soapbox and make sure I advocated for involvement in APTA. My biggest take home message was how each of those students should not only be members but maintain active involvement in the organization. I believe this is the a major way we will grow as a profession. When asked about how the APTA has helped me as a New Professional I had to applaud the APTA again for all the work they do on Capitol Hill which we do not always see. I have been fortunate enough to see it firsthand as a member of the Student Board of Directors a few years ago and having a good friend currently working with APTA.
Great event, thank you again to APTA for inviting me to partake.
Basically I wanted a way to combine two of my interests – building web sites and furthering my Physical Therapy knowledge.
So what I did was go out and interview a whole bunch of rehab experts, and then make those interviews available, free of charge, on my web site PhysicalTherapyContinuingEducation.Org.
Here are some excerpt from a recent interview with Dr Timothy Hewett about his work with ACL Injuries and Prevention.
PhysicalTherapyContinuingEducation.Org: Is there a different mechanism, when comparing males and females, in non contact ACL injuries?
Dr Timothy Hewett: So, what we’ve done is we’ve looked at the mechanisms of how men and women tear their ACLs. Basically, if you look at the mechanisms, in women especially, there are four common components.
As the woman lands her knee buckles inward. The knee is relatively straight when she lands. Most if not all of her weight is on a single foot or single leg. And her trunk tends to be tilted laterally. In other words, her center of mass is outside of her foot base of support.
These mechanisms also occur in men but, for instance, the exaggeration of the positioning of the trunk is much greater in women than men. We’ve published several studies on this. We published last year, in the British Journal of Sports Medicine, a study showing the relationship in women between the amount of trunk lean and the risk of ACL tear.
I’ve also done collaborations with the biomechanics lab at Yale where we’ve showed in varsity athletes, women who are not good at sensing the position of their trunk in three-dimensional space, or allow greater motion of their trunk following a perturbation or disturbance of their trunk, have greater risk of future knee ligament and ACL tears.
Dr Hewett shares a ton of great information in this 46 minute interview. Including expanding on the four different components, the best way to screen for thttp://www.blogger.com/img/blank.gifhe “at risk” athlete, and what interventions can decrease their risk.
I invite you to visit my site at Physical Therapy Continuing Education.Org to listen to or download the entire interview.
Sasha Sibree PT
Physical Therapy Continuing Education.Org
Friday, September 17, 2010
Pictured is a young physician by the name of Dr. Roger Starner Jones. His short two-paragraph letter to the White House accurately puts the blame on a "Culture Crisis" instead of a "Health Care Crisis"..
It's worth a quick read:
Dear Mr. President:
During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.
While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"! During my examination of her, the patient informed me that she smokes more than one pack of cigarettes every day, eats only at fast-food take-outs, and somehow still has money to buy pretzels and beer. And, you and our Congress expect me to pay for this woman's health care? I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture" a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that "I can do whatever I want to because someone else will always take care of me". Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.
ROGER STARNER JONES, MD
If you agree...pass it on.
Friday, September 10, 2010
I am finally settling down from some whirlwind changes.
Finished my 18 month orthopaedic outpatient mentorship.
Took a position at Lenox Hill Hospital working Acute Inpatient Ortho (mostly).
Been busy with seeing a few private clients, working at the hospital and working out.
Started CrossFit (got certified as a trainer)... it is not as crazy as it may seem to some, we will discuss now that I am back.
Signed up for the OCS exam which will get its own post just to mentally prepare for preparing. Trying to do as much as I can. Took a few courses, about to take some more. Exciting times and time management is now the biggest challenge. Bottom line is I love the possibilities and there is a lot going on. I feel like this blogging, despite taking up time will help keep me somewhat grounded to move forward.
It helps that I finally got a brand new laptop... even the HTC EVO could not get me blogging consistently. here we go now...
Saturday, August 7, 2010
From my buddy Nate,
I wanted to call to your attention an email you may have received earlier today from us at APTA regarding student loan forgiveness. It went to all current PT students and all recent PT graduates that have been out for 5 years or less. Can you guys help to spread the word about this email and get students and new professionals to fill out the quick survey (it literally takes less than one minute to complete!). We don’t want people forwarding the email or copying-and-pasting the link, but rather filling it out from the email that they directly received. If you could just spread the word among your new professional and student colleagues to take a minute to fill it out, that would be amazing. The data that is gathered has the potential to be very helpful in our quest for student loan forgiveness opportunities for PTs.
Sunday, July 25, 2010
He was getting down on the floor fixing people, fairly awesome to see living legends at work.
Here is the flickr page with other Mulligan photos
Thursday, July 1, 2010
Monday, June 21, 2010
millette, p.j., wilcox, r.b., o'holler, j.d., warner, j.j.p. rehabilitation of the rotator cuff: an evaluation-based approach. October 2006, 14 (11).
sorry for the lack of proper annotations but typing on the phone is a good excuse right?
fantastic article on rotator cuff rehab, go read it now!
Sunday, June 13, 2010
Saturday, June 12, 2010
my first blog attempt on my HTC evo.
Saturdays I like to work either at acute care or another private practice that is fairly different from my usual practice. this is partly to help me pay off loans sooner, but also I find it very beneficial to see different populations and because the geographic location within nyc is far enough apart the diagnoses tend to be fairly different as well. Something I have been saying since I have gotten into PT is that I will likely never be bored thanks to the plethora of settings and populations that one can partake in.
1) how many of you out there work in varied settings through the week (any profession can answer)
2) the typing on this phone is a little more cumbersome than my old treo which had a physical keyboard compared to this here digital one... it slightly makes up for it with the autofill feature but requires a bit too much editing especially for longer bits of text
Sunday, June 6, 2010
I am getting the new Sprint phone within the next few days
Been staying busy reading, learning, working acute care a few weekends, ortho private practice the rest of the weekends, private patients, triathlon training, trying to put together an irb for a study, all on top of the regular "9-5" gig. It's fun being busy...
Talk to you guys soon.
Sunday, April 18, 2010
The authors concluded, “Cervical manipulation and mobilization produced similar changes. Either may provide immediate- or short-term change.” [manips carry increased risk, which is why I stay away from manips and stick to mobs for c-spine]
“Thoracic manipulation may [also] improve pain and function.”
However, there are no long-term data on effectiveness, and optimal techniques and dose are unresolved.
Adalius Thomas on the Patriots mishandling his injury (the Jets would have never done this;):
There are now 12 screws and a plate in his arm. The Patriots sent him to a facility in Tampa for rehabilitation (Thomas has a home in Florida) in early 2009, but he said the woman he worked with was a massage therapist, not a physical therapist who specialized in helping him recover full range of motion in the arm.
Well over a year later, he said his wrist sometimes still bothers him. Next month, he will go on his own to a place in Pensacola, Fla., to try and get it back to normal.
He wondered why he was not directed toward proper therapy in the first place.
She has a very thorough breakdown of the top 100 life coaching sites.
This got me thinking of another fun list to make... The top 10 research articles for every different body region. I do plan on taking the OCS exam fairly soon and a student at my clinic is going to be working on a project similar to this. So I want to ask for your help:
What are the most important and comprehensive articles that have changed the field/or even your way of thinking about treating patients. Any body part, from any year, any journal, whatever you got... I look forward to hearing your responses and I will be posting my top 10 lists as they come together.
Saturday, April 17, 2010
Monday, April 5, 2010
Monday, March 22, 2010
United States Marathon participation
143,000 in 1980
425,000 in 2008
1980- 3:32:17 - 8:06 pace
2008- 4:16 - 9:45 pace
1980 4:03 - 9:17 pace
2008 4:43 - 10:48 pace
A good percentage of my patients have running related injuries, usually from overuse. Should there be stricter guidelines to qualify for a marathon? How much damage can be done compared to the benefits of running? Risk increased damage to your joints if you train incorrectly for weight loss and cardiovascular benefits?
Please leave your thoughts in the comments :)
There is much more to this debate, I certainly do not have the answers but am going to hold my opinions out (I know that is what blogs are for... oh well) - at least until I do some more research on the topic myself. I personally chose not to run the NYC marathon which is a small dream of mine. I let my gauranteed entry expire because I am not sure if my surgically repaired knee can take the pounding that comes along with training and the actual running of the marathon. This year is all about the triathlong for me which is limited to a fairly simple 10K. I do plan on running the Brooklyn Half May 22, I think it will be a good test for my knee (long term ramifications not yet determined), plus I just love Brooklyn so much I can't say no.
Have a healthy day.
Saturday, March 13, 2010
I signed up for one in September - olympic distance (0.9 mile swim, 25 mile bike, 10k/6.2 mile run)
Will be racing against my boss/mentor, at least one patient, and a relay team of 3 of my co-workers (they will each do one leg of the race)
This is my first tri ever... how exciting
I think this will give me a much better appreciation of this aspect of human performance.
The problem is I have committed at least 6 hours per week for training which also includes travel time to pools and plenty of time planning out my attack of this event.
Riding the bike indoors for now while the weather is not fantastic saves me some time because I get to catch up on shows that I would watch anyway like House, MD or 30 rock, etc.
It is a time struggle more than anything, my body feels back to normal, now to get it better than ever...
PS, I did go skiing for the first time in my life 2 weekends ago and had a great time, picked it up pretty quickly, would love to go back but the snow seems to be all melting... I was certainly able to appreciate how easy it is for traumatic injuries to happen. A good percentage of my patients had skiing injuries. I was fortunate enough to master the fall and escape injury free. Although from over utilizing the beginner form of stopping some may call the "pizza" I had a lot of soreness through my hip internal rotators and adductors.
Friday, February 26, 2010
Also, if people were to come see PT's sooner than later - even before injuries - there is a good chance we would save a lot of money in the long run. Unfortunately, the statistics and research are not there to fully support this statement, but it makes good sense. Injury prevention is absolutely a passion of mine, more to come later :)
Have a healthy day!
It motivated me more as an athlete than a physical therapist. So I am commiting to do a triathlon this September. Still debating if I will join a team, but leaning towards not this year so I can really find my own way via my PT education. For those of you out there interested in participating in this great activity, just make sure you do your research and start small, set realistic goals and go accomplish them. Have fun along the way!
If you are in the NYC area I have three opportunities for you:
1. I found this on Active.com which has some amazing opportunities all the time, just need to find the one that matches your interests:
St.Lukes-Roosevelt Hospital Cardio Disease Prevention Program & Toughman Tri Sport Med/Train Clinic
2. A 5K on a JFK tarmac... take off just like the planes do.
3. On short notice... if you have any interest this Sunday in participating in a panel on being a new professional and making the transition from student at a student conclave in Great Neck Long Island, please let my buddy Allen know (email@example.com). And if you are a student, attend and enjoy!
Even more personal update:
We are having a lovely snow day today in NYC, a great day to train for triathlons... so I am going skiing for the first time in my life up in Vermont. Full report on these festivities to follow. Hopefully no injuries to report.
Also, next week I will begin collecting data on some high school athletes to start tracking injuries and hopefully developing a program to prevent any injuries.
Monday, February 15, 2010
One idea is titled: Eliminate All Student Debt. I thought you might be interested in getting involved and recommend you check it out. You can read more and vote for the idea by clicking the following link:
The top 10 voted ideas will be presented at an event in Washington, DC to relevant members of the Obama Administration, and then promoted to Change.org's full community of more than 1 million people.
There is an opposing view to NOT eliminate student loans which is just silly.
Boo student debt!
Sunday, January 31, 2010
I've created a short survey (8 multiple choice questions) about what tablet PC features are important to healthcare professionals. I'll use the results from the survey to determine which tablet PC is best positioned to rule the halls of healthcare. Even if you've never used a tablet PC, I'd love to get your opinion on what features are important.
Here is the link to the survey:
Tuesday, January 26, 2010
Joshi et al. Collagen-Platelet Composite Enhances Biomechanical and Histologic Healing of the Porcine ACL. AJSM 37 (12), 2401-2410.
Important to note the sample here was 18 pigs (27 knees), all 4 months old and female. The immature population is a good one to study because these injuries do happen in youth quite often and they are the most likely to develop OA down the line. The authors do cite that pig knees are similar to those in humans with subtle differences not yet clearly appreciated.
They did find that the addition of a CPC injection enhanced primary ACL repair in that structural properties of CPC-treated ligaments increase. The big takeaway for rehabilitation is the need to respect the healing stages after such a surgical procedure. This study only looked from 4 weeks through 3 months which does lose out on the very important post-operative inflammatory stage and the full remodeling up to 1 year.
I have seen a few ACL repairs, but have not seen the addition of CPC or PRP to assist the operation. It is important to note that in ACL surgery, a repair and a reconstruction are two different procedures that should be approached with respect to the expected healing process and times.
PS, I apologize to the JETS for posting a pic which seems to jinx (like that darn sports illustrated cover) them every time... there is always next year... :(
Sunday, January 17, 2010
Way overpriced! Food was subpar, weather was terrible, a few museums and the top of the Eiffel tower were closed for repairs (Picasso museum has apparently been closed since mid-2008 with no sign of opening back up any time soon). My two days in Ireland were much more enjoyable.
While I was in Argentina it seemed the majority of injuries I saw in the streets had some kind of arm or wrist brace and then in Paris it seemed the shift was to lofstrand crutches.
Here is an interesting article about the difference in assistive devices available.
For anyone from Paris or Buenos Aires can you confirm for me if there is an increased incidence of lower or upper extremity injuries based on some kind of cultural difference or is it the focus of the healthcare system, a different philosophy in treatment? Anyone from other cities of the world notice any major trends that may be shifted towards one body part? In America Low Back Pain seems to be the most common trend which is seen through obesity on the streets, not that we can draw a clear line between the two.
Now to plan my next international exploration... stay healthy out there!
Thursday, January 7, 2010
Check out the article here.
This statement is what throws me off:
When I asked Dr. Irrgang for studies showing what worked, I was a bit surprised. To put it kindly, they left much to be desired.
The authors review of the research presented makes it difficult to believe these are the articles Dr. Irrgang would show him. Poor intention to treat and drop out rates along with a study that had a sample of 4 seem like items that would not be presented by the President of the Ortho section of the APTA.
Also regarding the guidelines, the author only brings up the currently published heel pain and the ones currently in production. But they also published neck pain and hip pain guidelines.
Why go to a physical therapist for as many as 20 sessions, though, in order to do strengthening exercises? Why not just go to a gym?
Overutilization does seem to be a huge issue with the state of the economy and insurance money getting tight. I always tell patients that "I am not here to cure you, I am here to help you cure yourself." Even if they come in 3 times a week, that is 3-5 hours out of the entire 168 hours of the week. I am confident in the ability to provide someone with the tools necessary to begin/expedite the healing process and it is up to them to carry out and take care of their bodies.
The evidence seems like it is beginning to catch up with what we are capable of. I think the article does bring out the ugly side of PT that is "voodoo PT". I have seen too many patients who have had bad experiences at other therapy offices and I have been offered jobs at a clinic or two that made me report them to the state board for what to me seemed like highly unethical practice. Another subject for another day perhaps... I have to go pack for Paris, ciao!
(This guy probably needed some PT after this French headbutt - hope I can avoid Zedane)
Sunday, January 3, 2010
Here is a seemingly fun way to get out and exercise with your friends:
http://ragnarrelayny.com/ A relay run from Woodstock, NY to NYC.
One thing I can say from reflecting on 2009 is these group activities are very fun to do and exercise is fairly important. I read a lot of the latest evidence/research coming out and I consistently see support for exercise helping almost every aspect of life. The people I meet who exercise a lot on an anecdotal level, they just seem to be very pleased with life (not say those who don't exercise aren't happy, but for most finding the right exercise seems to make things better).
I am going to the JETS game tonight where the forecast is calling for "Freezing your toes off" weather. Then next Saturday I leave for 5 days in Paris, a day in Dublin, a day in Belfast (my excuse for the likely lack of posts over the next few weeks, but I will try :). Hope you guys are resolving to be healthier for 2010 and stick with it--> don't forget to set attainable goals and take necessary steps towards making it happen. Everyone is motivated differently, find yours and "get 'r done".