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!

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 (http://kevinwilk.com/) 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 (http://www.bmulligan.com/). 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 (http://drjordanmetzl.com/ - 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!

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 studentpt@gmail.com with your name, background, email & phone #. Also, go to nyrr.org 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!!

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.

http://www.orthosupersite.com/

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!

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.