Car or Driver

This morning, the driver in front of me was clearly texting. In fact, at times she seemed so distracted I thought she might have been blogging. I’m amazed at how much driving while texting influences attention and motor control. Swerving into oncoming traffic seemed to be her specialty, but missing stop lights ran a close second.

Imagine if an officer stopped this woman and began inspecting her car for defects. Her tires might be a bit out of alignment. That could explain the swerving. She didn’t stop at that light so her brakes might be a problem too. These are all possible reasons to explain her erratic driving behavior. But of course we all know better. The issue was not with the car, but the driver.

This had me thinking about how we assess and manage so-called aberrant movement patterns in the clinic or gym. A student physical therapist and I were watching a patient who was performing a standing squat. The student observed that the excessive internal rotation of the patient’s leg was due to a “weak hip abductor”, and subsequently began recommending strengthening exercises. After a brief discussion of motor control behavior, we took a different approach by simply showing the patient how to perform the movement without the internal rotation.

It was amazing how much “stronger” she became in 30 seconds! Not only did the squat look better after the instruction, the patient continued to do well despite an increase in load. Weak muscles should have gone the other way, with movement deteriorating under fatigue. The issue was not with the muscle, but the nervous system controlling them.

I thought this was a small but important example of where we often go wrong with our patient’s or athletes. We are much better prepared to address problems with the joints, muscles, and bones (the car) than deal with the integrated nervous system that runs the show (the driver).

Rotating the tires and keeping the brakes in shape are good ideas for a healthy car, but they don’t explain most automobile accidents. Similarly, keeping healthy muscles and joints is a great idea, but it rarely explains much of the movement we see from our patients or athletes.

Dig deeper and you’ll often find it’s more driver and less car.

Pain in the Orthopedic Clinic

So I’ve been exploring new avenues to share ideas.  I’m finally catching up to the curve in finding websites like Slideshare and Physiopedia.

I recently uploaded a presentation I’ve done for my local TPTA district.  The presentation has gone well and I thought it might be worth sharing here.  I received a request for a voice-over on the presentation so I will work on that!  In the meantime, I hope you enjoy the presentation.

Finding the Flow…

I can always tell when I need a break from writing my doctoral teaching project. I drift off into fascinating (but tangential) lines of research. Despite the obvious drawbacks of getting me off task, the long-term benefits end up being well worth it.

The other day I was in the middle of a run that, for some reason, just felt great.  I was running moderately faster than normal, my pulse was lower than average, and I felt as though I could do just about anything.  It was truly an experience I wish I could have bottled.  I began to wonder if the high I experienced had ever been investigated on any scientific level.  Naturally it has and the information is both fascinating and has implications for physical therapists and conditioning coaches.

Today’s tangent comes from an amazing TED talk from Mihaly Csikszentmihalyi. I won’t go any further into my personal analysis as I think it stands on it’s own two feet quite well.

We implicitly attempt to match challenge with skill during most conditioning and therapeutic programs, so there’s nothing revolutionary about that.  But explicitly looking for ways to optimize these interactions may lead the individual closer to experiencing the kind of movements that are not only pain-free, but enjoyable, and sustainable!

Are there ways to help our patients find the flow?

What Running Teaches Me About Movement

I hope my life never reaches the physical or motivational tipping point where I lose the passion for running.  Over the last six years, I’ve developed great friendships, revisited my roots in exercise physiology, and improved my health dramatically.  I can honestly say this simple activity has transformed my life.

Can you tell I’m a bit fired up?

One of my favorite stories from this weekend running the Half at the Austin Marathon came from my friend who is a pretty strong runner.   Upon finishing his first marathon on Sunday, he could not believe how many from the “AARP Brigade” (his words) were passing him up on some particularly difficult stretches of the course.  Another great thing about running…it’s humbling!

As much as I get caught up in the wonder and enthusiasm of a good race, my mind inevitably circles back to the fields of rehabilitation and movement science.  Watching people of all shapes and sizes make their way through 26.2 miles of running is a goldmine of information from areas of motor control, barefoot/minimalist running, fatigue, and common running-related injuries.

I hope to expand on some more of these ideas in later posts, but thought I’d at least get a few of them out there while they are on my mind.  Feel free to comment or provide feedback.

  1. It may already be cliche’ by now to say we are born to run, but cliche’s only get that way if they’re true.  Whether we were designed to run on concrete for 26 miles or more is debatable of course, but our legs are capable of moving us through space with incredible reliability and durability…if we allow them through proper training.
  2. If you want to improve your running form, run faster.  Feel free to run on a treadmill in front of a video camera and have someone who thinks they know what’s happening tell you what to do.   But practice running faster (within reason) and you’ll get the kind of feedback no “specialist” could ever match.  If you must run in front of a camera, please do it in Delaware where folks know what they are talking about.
  3. Running in minimalist shoes such as the Vibram Five Fingers, Nike Free’s, or even just plane barefoot is here to stay for many good reasons.  But enthusiasm should never trump logic, and runners too often leave their brains at the door when it comes to their own training.  Poor training leads to predictable results no matter how you are shod.
  4. Static stretching before running or any other physical activity accomplishes nothing worthwhile and may actually reduce force potential during athletic events.  Please stop as soon as possible.

There are others that didn’t make the cut such as “If you have a newborn, stick to training for a nice 10K”.  I also learned that some mens’ nipples are apparently directly connected to their aorta.  Some guy was bleeding so badly from his right nipple at mile 25, I thought he was going to need a transfusion.  Disturbing stuff.

In all seriousness, I think running is a great avenue for studying movement.  Running can also reveal a great deal about injury and why people move less as a result.  However, in pursuit of answers to why people get injured running, I think we’ve missed out on an even more interesting question:  Why do so many people NOT get injured?

We often focus on injured runners in the hopes of designing better rehabilitation programs and injury prevention strategies, but that seems misplaced.  Think about what we could learn if we spent more time focusing on the un-injured runner!  It might start transforming our inadequate notions of prescribing footwear or illustrate just how normal  “pronated” feet and “tight” hamstrings really are!

Just some food for thought.  More soon!

Texas PT on the Morning News!

Hey all.  Just found out a Texas physical therapist, Dr. Denise Gobert, will be doing an interview on a local ABC affiliate Saturday morning with the intent of discussing direct access for physical therapists.

The interview will air Saturday February 19th at 7:40am on KVUE.  Good luck Denise!

The Residency Model in Physical Therapy

Medical education in the United States changed forever 100 years ago.

In 1910, Abraham Flexner published a scathing report on the state of medical education in the US.  The now famous Flexner Report became a pivotal document paved the way for medical education to produce some of the worlds finest physicians.

One of the most notable aftershocks of the Flexner report came in the form of a wedge between the science-based medical community and fringe providers (including goldfish salesmen).  If you wanted to become a physician, you had to fall in line with modern medicine or you were out of the club.  Of course fringe providers still remained, but the reforms produced by the Flexner Report facilitated a culture of accountability that reduced the likelihood a goldfish salesman would ever get mixed up with a legitimate physician.

What’s interesting is that this process took an incredible amount of time to play out.  The Flexner Report was published approximately 60 years after the American Medical Association decided medical education was worth monitoring.  In 1900, the only thing you needed to become a physican was a high school diploma and four years of a medical school curriculum which had minimal standards for completion.  In 2000 you need competitive grades at a four year college, a strong MCAT, and participation in extracurricular activities.  And that’s just to be considered for entry!

While nowhere near the state of early 20th century medical education, the education of entry-level physical therapists is also undergoing fairly significant reform.  Like medicine, this change is happening slowly.

Or is it?  One of my most respected colleagues earned his certificate in physical therapy a little over 30 years ago.  We rapidly advanced to the BPT in the 80’s, had a temporary fling with the MPT in the 90’s, and now have achieved intergalactic oneness in the form of the DPT.  Yet despite the promise and flair the DPT brings, many feel the current educational model for physical therapy is not sufficient to meet the demands of modern clinical practice.

There is little doubt physical therapy education has never been better.  Students in DPT programs have a scope of knowledge ostensibly broader than their MPT or BPT colleagues, but is it good enough?  If it isn’t enough, what would be enough?

Let me answer the question with another:  Is four years of medical education enough to practice internal medicine?  Orthopedics?  Neurology?  Of course it isn’t and that’s precisely why residencies were born. Now no one in their right minds would go see an orthopedist or dermatologist unless he/she were board certified.

The medical profession transformed itself through residency and board certification with Flexner as the catalyst.  It’s time for us to undergo a similar evolution.

See you next week!!

Beck AH. The Flexner Report and the Standardization of American Medical Education. JAMA: The Journal of the American Medical Association. 2004;291(17):2139 -2140. 

Post a Week Challenge: I’m in!

I’m Posting every week in 2011!

I’ve decided I want to blog more. Rather than just thinking about doing it, I’m starting right now. I will be posting on this blog once a week for all of 2011.

I know it won’t be easy, but it might be fun, inspiring, and awesome. Therefore I’m promising to make use of The DailyPost, and the community of other bloggers with similiar goals, to help me along the way, including asking for help when I need it and encouraging others when I can.

If you already read my blog, I hope you’ll encourage me with comments and likes, and good will along the way.



Back on the Air: Podcast #4 is Up!

Well gang it has been a while since my dulcet voice met cyberspace so I figured I’d get off my butt and publish this great talk I had with a few local and quite remarkable physical therapists.

I had a chance to sit down with residency director  Brian Duncan PT, OCS, FAAOMPT along with two graduates of his program Dana Tew, PT, DPT, OCS and Sarah Zehler, PT, DPT OCS.  We discuss topics pertaining to the emerging model of post-graduate residency training for physical therapists.  Their enthusiasm for learning and drive to make our profession better is infectious and I hope it comes across to you as well as it did during our conversation.

Residency programs in physical therapy will no doubt continue to gain momentum as we continue our pursuit of direct access and, more importantly, earn our way into being front line providers for conservative musculoskeletal care.  If you are interested in a residency program and/or board-certification (and I hope you are), visit the APTA’s residency/fellowship page and get started today.

Our profession needs strong clinical leaders like Brian, Sarah, and Dana.  YOU can be one of them!

Listen to this episode

Community involvement…does this really matter?

Another Friday night in Crosby and I find myself going to another Cougar High School football game.

Most of the time, I stand on the sidelines with nothing more to do than watch a good high school football game. Sometimes I’m more useful than that and actually help with an injured player.

Are these outings critical to the success of our clinic? Probably not. But the opportunity to give freely of our time to the community that gives so much to us is a priviledge.

We spend a lot of time developing clinical skill. Over the next few weeks, see if you can find a way to give your skills away to the community. It may feel forced initially, but it get’s easier!

So does it really matter? Absolutely. Have a great weekend everyone.


Why Bother?

If you visit our clinic at any point throughout the year, chances are you will find one or more student physical therapists.  They often come from one of the several Texas physical therapy programs.  They come with a variety of knowledge, skill, and perceptions about the practice of physical therapy. 

We do a lot for the students and take it as a matter of pride to ensure they have a meaningful experience at our clinic.  Interestingly, the more we seem to put into our clinical education, the more we as instructors seem to grow.

If you are a physical therapist and wish you spent more time reading the latest evidence from peer reviewed journals…take a student.  After several good questions, you’ll find a renewed interest in the latest evidence supporting (or even refuting) your approach.  The student will make  you a better provider.

If you regularly take students, but openly admit to either not relishing the process or don’t feel that you are a good instructor…please stop taking students or allow a colleague to spend time with them.  Believe it or not, these folks pay good money for your time.  They want your knowledge and deserve our best.

I’ve heard experienced PTs say they “hate” taking students.  Ironically, many of these same PTs lament the state of our profession and wish we “had more responsibility”.   If they could only see the contradiction.

Why bother?  It’s only the future of our profession.  The best way to see your career and our profession truly “Move Forward” is to give the gift of your knowledge and experience freely and with passion. 

If you can’t bother.  Don’t.


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