Another month has left me

Where did it go? The month of November, did I have it? did I blink? where did it go? I remember coming and going to Rockhurst and teaching, I remember going to the clinic and treating patients, I remember receiving word that my paper written with Julia Chevan from Springfield College and Daniel Vreeman from Indiana University and Regenstrief Institute was accepted for publication in the Journal of Physical Therapy Education, I remember my twin boys turning 5 months old, and I even remember thinking that it was November already after thinking that October went by so quickly but I don't remember how November has come and gone and this being my one and only blog of the entire month.

I need to get better about, well, about everything. Sometimes I feel so spread thin. I did get a new app for my iPhone. It is a to-do list. I am hoping that it will help me become more organized and feel like I can be on top of things better than I am today. We will see in the next weeks if I am doing any better.

I hope everyone had a great Thanksgiving weekend.

Extreme Makeover Home Edition

I really enjoy when I get to watch Extreme Makeover Home Edition. I am deeply moved by the sense of community and the giving attitudes of the people that volunteer their time and efforts for helping someone else. This past week's episode was especially gratifying. A police officer was shot in the line of duty resulting in a spinal cord injury. The show and volunteers built the officer and his wife and family a home and barn that was wheelchair accessible allowing him more mobility and function than he could achieve in his previous home. What made this show even better than usual was it highlighted his physical therapists who had been working with him since his unfortunate accident. It was great to see the love and admiration among this gentleman, his family, and his therapists and to hear how important they were and are in his life. I must admit I was teary by the end of show (which is my usual reaction to all of these shows).
It is great to hear of people helping people whether that is through volunteering to help build a house or teaching people to ride horses or doing a good job as a therapist.

Bigger than Life

While I was driving to work early this morning I thought of a dear friend of mine from junior and senior high school. She used to remind us, "to be Bigger than Life." She was always an optimist, a leader, and a motivator. At the time, I really didn't understand what she meant by being bigger than life. As I have gotten older and hopefully a little wiser, I think I am better understanding what she meant and I think there are different interpretations of her favorite saying:
In our every day life sometimes we start feeling consumed by it all, we have chapters to read, notes to study, skills to practice and that is just for school, then we have our work to do and if that isn't enough we have to go home and fix dinner and take out the trash. I believe that we often get lost in all of those 'life' things. Perhaps what Stephanie was saying was to rise above it all...be bigger than life.
But, there are also a lot of very beautiful and big things in life: think about the Pacific Ocean or Central Park or the Rocky Mountains. There are huge and wonderful things out there in each of our lives. Perhaps Stephanie was saying that we need to strive everyday to be even bigger than those big wonderful life things.
When I was in college I had a hard time gaining weight (those days are far behind me now. My roommates and I used to have "get big weekends" where we would eat hardy and work out as much as we could in order to get stronger and gain weight and get big. We worked hard at improving ourselves physically. I think we can use the same notion to get big mentally or spiritually or emotionally.
I don't know why "be bigger than life" flashed into my noggin this morning but I admonish you to have a get big weekend so that you can work on being bigger than life in the area that you might want or need the extra effort. I hope you come back next week a little bigger.

Impressive students

I am really impressed with the students I am currently teaching. They are really on task. Now I realize that it is still early in the semester but I really think these guys are going to go strong throughout the entire semester. They are working hard through every lab we have. Not only do they do what I ask them to do with their assigned partners but they consistently do the task with several other students. We have told them how important it is to practice a task many times with many different people and they have certainly taken this recommendation to heart and do so on a daily basis.
Hooray for students that listen! Hooray for students that practice time and time again! Hooray for all of us that will be associated with hard working, skilled practitioners in the not so distant future!

Practical Exams

Well, we had our first practical exams this past week. A practical exam is an exam where the students have to not only answer questions orally but they must also show manual skills they have learned in class. There is no doubt about it, these are very stressful tests and I have seen many a student fall to pieces because of the amount of stress. On the flip side, the practical exams are a great place for learning. We are often able to find out if students really understand a concept or if they are able to articulate their knowledge or show that they have mastered a skill...this is all, of course, depending on whether they can get passed the stress thing.
I really get a charge out of when a student can make sense out of signs and symptoms and make great choices and then show me they have been practicing by nailing a manual skill. While most students get pretty nervous the large majority of those that spend the time studying and practicing really do well. I often tell students that if they work hard, more than likely things will work out...a pretty good lesson for most things in life.

From certain surgery to happy camper

I had a great day in the clinic yesterday. My very first patient of the day is doing extremely well. He came in with neck and radiating arm pain and paresthesias of less than 30 days. Looking up did not aggravate his symptoms. He was still working and not afraid of working or doing other activities due to his neck and arm pain (although he wanted to make sure that what he was doing was not going to make anything worse). He had limited neck extension and his thoracic spine was stiff and flat. He told me that the neurologist he went to told him that he would have to have surgery to help him with his pain and especially the numbness and tingling he was having in his arm. He did not want to have surgery and asked the surgeon if there were any other options. The surgeon told him plainly that that surgery was his only option. Luckily, the patient decided that he would try physical therapy first and he called the surgeon and asked if he could do that and the surgeon reluctantly gave him a script for physical therapy but told him that physical therapy would not help him and that he would see him in a month when they could schedule his surgery.

Well, it has been less than a month and my patient is very close to being completely free of his symptoms. He occasionally gets some neck pain but his arm pain and paresthesias are gone. He told me yesterday that he was really scared when the doctor told him that surgery was the "only solution." When I saw him on first visit I knew that I could help him. Why did I know? Because I followed a clinical prediction rule that states if the patient has at least 4 of 6 matching criteria my success with thoracic manipulation and cervical exercises goes from flipping a coin (54%) to 93% success rate. He matched and I was certain I would help him. And I have. It is great to have a day like I did. It is really good for me when I can use evidence to guide me to be solid physical therapist and even better for my patient who avoided a costly and risky surgery that may or may not have even helped him. He is a happy camper and so am I.

PT Friday!!

I meant to post last Thursday but as usual I did not get to it. I had such a great week last week and the two labs on Thursday were particularly superb.
Nothing really big or exciting happened, we didn't discover anything new or come up with a better way of doing something, we didn't cure cancer, or find out the way to abolish all back pain. We just had a normal everyday lab, learning about the cervical spine. What was great was how the students went through the lab. We were working on our palpating skills and assessing the movement of different joints of the cervical spine. These skills while appearing to the onlooker as a simple task, are, indeed, quite difficult. The students very quickly realized that it was more difficult than they thought at first go. I was so impressed with how honest they were about having a difficult time but more so how diligent they were at trying to acquire the skill. They tried and tried and then they would try and try on a different person. It was really great to see struggling and perseverance and the determination and resolve they had at becoming great therapists. If the rest of the semester continues like Thursday did it is going to be an awesome one. Here's hoping everyday is Thursday or as my students call it, PT Friday (they do not have classes on Friday, so Thursday is their Friday).

Another start to a great year

And they're off...
It is hard to believe we are a week into another year. Well, the students really only had class on Wednesday and Thursday so it was only truly just a half week but it really went well. In the seven years I have been teaching I have only encountered a good first week. Students are renewed and resolved to do well that first week as are professors and instructors so this makes for an enjoyable classroom. The real test happens in the weeks to come, when people get tired and not so motivated.
Like I do every year I pointed out to my students that they need to take advantage of having a new semester where they have a clean slate and the ability to "start over." Regardless of how things have gone in other years and semesters, because they are at the beginning they have the opportunity to excel and make the semester however they want it. We seldom get chances like this where we are able to start from scratch.
As it is with every year I am anxious and excited to see how things turn out, to watch growth and learning and to see novice student physical therapists turn into skilled physical therapists who have the ability to think for themselves and make a difference in the lives of so many...What a great job I have.

Experience, sleep, experience

One of the topics I suggest when prospective physical therapist students ask me for advice on writing letters of intent for physical therapy school is to talk about their experiences. Now I realize many will not have much experience in physical therapy but I am not talking about that. I am talking about experience with people or with injuries or events that have made them view life differently. Experiences help us to relate to others better, to understand them more, to identify with them and, in my opinion, help us become better physical therapists.
The reason I am thinking about this is because of my lack of sleep. We were blessed with two (count them, two) new arrivals two months ago today. Needless to say, I am not getting much sleep at all. I am again keenly aware of how much sleep or lack thereof influences all aspects of life. In the clinic, I routinely ask how my patients are sleeping after surgery or injury because I realize that if they are not sleeping they are not feeling well and are not healing as well as they could otherwise. Even though I have not had a recent surgery or a recent injury, this lack of sleep makes me feel....well, not very good. Because of my experience, I have a renewed appreciation for my patients who are not getting the sleep they need and how this can influence their days (and nights) and I think this awareness helps me be more in tune to the needs of my patients (as long as I am not falling asleep on them ;) ).

Sweet dreams....

Healthcare Reform

There is a lot of discussion about healthcare reform these days. A lot of it is a bunch of fearmongering telling us that a national healthcare reform will be bad for us as a nation. I love the argument that we are going to have a third-party, government bureaucrat get in the way of our doctor and and treatments...HELLO people...really?? I guess those people haven't heard of our system now where the insurance companies are calling the shots, not the doctors and physical therapists who know how long a patient needs to be seen or what procedures are necessary. I am not saying that there are not physicians and physical therapists who would abuse the privilege but to allow insurance companies to call the shots is definitely not a better solution. Hard to understand how people can think that we have good healthcare in America today...they must have missed the part about how far down we rank when compared to other countries around the world.
Anyway, I saw a great interview on PBS last weekend. I urge you to watch online at: click here.

Welcome to the World

I have been a little busy lately which can account for my lack of blogging. My wife was put in the hospital for pre-eclampsia for two weeks and on the 18th my twin boys were born by cesarean section. They have been in the neonatal intensive care unit since then and we don't have an idea when they will be released. The boys are doing pretty well. They have never been on oxygen but they are both on feeding tubes and are in the isolettes (also known as incubators). I am constantly amazed at these tiny guys. They are so small 3 lbs 11 oz and 4 lbs 4 oz, yet they have all their parts and are moving. Memories of my pediatrics classes from PT school keep popping in my mind as I watch these guys. Babinski reflexes, ATNR, moro, palmar grasp all the things that I thought I had forgotten seem to still be in there...somehow.

The Graceful, Powerful, Amazing Human Body

I had the great privilege of attending my two daughters' dance recital held at KU over the weekend. They were absolutely great. It was especially interesting to see how hard work and practice evolves as they girls develop. In the program, they had the little 2-3 year olds with their short, awkward, mechanical movement about as cute as can be and then showcased the older girls 17-18 year olds that have taken that choppy movement and turned it into this elegant, graceful, powerful display of control...Nothing short of amazing. As I watched I was hit again and again at how incredible the human body is. Even though this sentiment crosses my mind many times on a daily basis as I am working on person after person, my focus and perspective is at a much granular level as I think about muscle tissue and joints (something like not seeing the forest for the trees). The dancers gave me a nice reminder of how beautiful movement is and I don't think this is illustrated better anywhere than it is in a dancer. It seems like I have always been surrounded by dance and have been a great appreciator of it. It must have started in my home of five sisters and has continued through a good majority of friends, girlfriends, my wife, and now my daughters. I have been associated with many amazing dancers from local productions of the Nutcracker ballet, to community musical theatre, to national dance groups, to a couple of Laker Girls, to Broadway and seemingly much of everything in between.
I do regret not taking the opportunity of working with the New York City Ballet as a student physical therapist. I was given the chance and I was fearful and didn't feel qualified to do it since I wasn't a dancer myself...in hindsight, I wish I would not have given in to my fears and had taken the chance of working with such accomplished masters of movement...take home message: Don't let fear get in your way of opportunity.
Today, take the time to appreciate the amazing human body in its grace and power.

Telehealth or Telephysical Therapy or TelePT

The US Department of Health and Human Services defines telehealth as:
"the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration." I don't think the terms Telephysical Therapy or TelePT really exist until now (somebody make a note that I coined the phrase April '09) but they would be the use of electronic information and telecommunications technologies to support long-distance clinical physical therapy care and patient and professional physical therapy-related education. I have always thought that telehealth brings some great advantages to people who are long distance from health care. I had my doubts about how this might work for physical therapy but a couple of weeks ago I had the opportunity to find out using my family as guinea pigs. My wife's brother-in-law lives 1200 miles from us. He recently called inquiring about some pain he was having in his mid-back. We spoke over the phone where I took a general medical history and inquired about his pain. As he was explaining his ailments to me, I quickly realized that he had a rib dysfunction that I could easily treat using a manual technique. If we had lived in the same city I would have had him come over to my house and treat him. Since I have a Mac and ichat, I was able to talk and see him as he described and pointed to his pain. I was able to watch him move and I even taught his wife to provide a manual technique which two weeks later has still abolished his pain.
I am a true believer. There are many people around the world that do not have access to healthcare that can be successfully treated long distance through the use of telehealth and telePT. What do you think?

School of Rock, Grades, and Job Recommendations

I was watching School of Rock with my kids the other day. What a great movie! Jack Black plays a character, Dewey, who becomes a substitute teacher in order to pay his rent. There is a character in the movie named, Summer (she is the one in the picture above showing her rock and roll horns). Early on in the movie, Summer consistently tries to get gold stars which correspond to good grades, she is only motivated by good grades. Dewey, point blank, tells her to stop being a grade grubber.

It is the time of year when I start getting phone calls from potential employers asking for recommendations about students. I try to impress upon my students that potential employers never ask about grades...they never have, they never will. What they want to know is "how does the student behave?" It is about professionalism. They want to know whether or not they will have to babysit or worry about how the student will speak to a patient or what the student will wear...At Rockhurst we stress the importance of professionalism. The students have often complained about the amount of classes and time spent on professionalism, however, after the students have graduated and worked for a while they start to understand how important the time spent on professionalism really was and is.


I just got off the phone with a potential employer. Some of the questions asked were: Will this student take initiative, Am I going to have to motivate the student, How will the student interact with physicians, How does the student respond to criticism. Not once did the employer ask about grades. So what is the take home message from my blog today? I think Austin Powers said it best (remember to use your best Austin Powers accent..."Oh, behave." Work hard, actually make an effort to learn, practice the golden rule, respect others, and forget about the grade. But guess what? If you do all those things...you will probably get an A anyway.

Soft Tissue Mobilization and Massage Snobbery

My co-workers in the Physical Therapy Clinic in which I work every Friday like to tease me about being a "Food Snob." I like to call myself a food connoisseur it sounds so much nicer but food snob is ok and a lot easier to spell. Mirriam-Webster defines connoisseur as:

1. Expert; especially: one who understands the details, technique, or principles of an are and is competent to act as a critical judge
2. one who enjoys with discrimination and appreciation of subtleties.

I am not a picky eater. I will eat just about anything and I like most things, however, for me to really say that something is great...well let's just say it takes a lot to impress me enough to say that.

I had a massage yesterday and I realized that I am a massage snob/connoisseur too. I love getting a massage but it takes a lot for me to say when one is great. Today in lab we practiced massage. I tried to impress upon the students what makes a great massage. Two things that are very important to me are 1) confidence and 2) being mentally in the massage. Yes, good hands are important and touch and speed and pressure but you can have all of those things and without having confidence or thinking about the tissue then all those other things really lose their punch. Think about it... someone might have a really good touch but if you notice that they are thinking about other things, it just ruins an otherwise really good massage.

I believe those two attributes are important to the success of most things we do. What do you think? Are you a connoisseur? Let me know....

Perceptions: Time and Pain

I can't believe another week has passed by. I am sure you have probably already realized this in your own life but since I am often "Master of the Obvious" MOTO...the older you get the faster time seems to pass. I remember as a kid waiting for something like my birthday. The anticipated event could be only a day away yet seemed like several weeks. Now, several weeks seems like a day. I am curious as to why we perceive things in this manner. Perhaps it has something to do with our current knowledge. As we grow into adulthood things are less and less new and become much more mundane and redundant. Or perhaps we are able to focus better on tasks at hand and therefore time gets lost in the background. What are your ideas?

Speaking of perception. Perception is very important in physical therapy. First perceptions of our patients sets the stage for how treatment might go. If we go into an evaluation and the patient perceives us as a therapist lacking confidence and competence our job is generally much harder. Now not only do we have to evaluate and determine a diagnosis and treatment but we have to work harder to gain the patient's trust that we can be effective at doing so because of those first perceptions that we did not have confidence or competence. Or what if the patient perceives his/her pain to be something much more than it is? I think about the Fear-Avoidance Beliefs Questionnaire or the FABQ. It is a survey given to patients to determine the perception of patient's back pain and how it influences their fear and/or avoidance of work. The FABQ has been shown to be predictive of outcomes. So in other words, the patient's perception of his/her pain can influence how well they will do...interesting, right? So part of our job is to help the patient with perceptions. We must educate and dial down fears to change perceptions, a task that is not always very easy. Until next time......

Practical Exams

Last week we had practical exams in lab. A practical exam is an exam where the students have the "opportunity" (I think the students would probably choose a different set of words to describe it!) of showing off their learned manual skills. Besides the psychomotor skills the students have to demonstrate their ability to think on their feet and make rational decisions. Almost everyone gets pretty nervous for these types of tests but the students did well. In these sets of exams we had the students go through 5 different stations including: Positional strength and Range of Motion/Neurodynamic Testing, Taping, Soft Tissue Mobilization, Exercise, and Joint Mobilization. We had a different proctor at each station and had 5 pairs of students testing simultaneously. It was quite the sight to see with a lot happening at once. This is one of my favorite practical exams as it is the closest thing to really treating a patient in a clinic that we have...it brings in most of the elements and the environment is similar to being in the clinic with all the noise and activity. I don't know if the students have the perspective at this point to appreciate the exam but it is nice to see the students growing and learning and demonstrating this to us.

Research Day

Last Friday our third year students (Class of 2009) had their research day. Each student group gave a presentation highlighting the research they have been doing for the past three years. The presentations followed formats that most professional conferences do. 15 minutes of presentation followed by 5 minutes of questions from the audience. The students did a great job. It was great to see the growth of the students from three years of hard work. I truly believe that many of the students will have the chance of presenting their research on the national stage, some have already been accepted. Congratulations to all of you...very impressive.

This week is Spring Break at Rockhurst. A couple of our students and a faculty member (Jim Dronberger) took advantage of the time off to go on a service trip to Guatemala. This is one of several annual service trips that students (and faculty) at Rockhurst can participate in. Both Jim and one of the students have been on this trip previously. What an opportunity to go and serve those that are less fortunate. No matter what you are doing for your Spring Break, I hope it is enjoyable.

Exercise: More Than You Bargain For

On Thursday in lab we discussed and practiced therapeutic exercises. We discussed the importance of form and making sure that the patient does not use compensatory or poor movement patterns that could lead to potential injuries in the future.



Coincidentally on that same day National Public Radio (NPR) broadcast a couple of very interesting pieces on exercise. You can hear them here. One of the pieces shared how a 10 minute exercise break helped students who were on task less than 50% of the time be on task more than 70% of the time. Pretty impressive, eh? The other story spoke about exercise breaks in the work force. One company found that by giving employees three 5 minute breaks during the day, the employees productivity actually increased with a 30 minute increase of productivity. So the company actually got back more than the time they gave away. Not bad!

Take home message? Exercise not only provides enhancement of movement by improving strength, endurance, and motor control but can also improve attentiveness and productivity.....Share the good news...and get moving or as the American Physical Therapy Association says, Move Forward.

New York Times Article about Physical Therapy

There was a nice article in the New York Times about Physical Therapy. Check it out here. It describes the author's experiences with physical therapy and was very complimentary. We, physical therapists, have a great job. We get to spend time with people which is very different than going to see a physician where the norm seems to be 5 minutes or so. We have the time to explain procedures, explain what we are doing, put patients' minds at ease, develop healthy relationships, and help people reach their potential. Needless to say, I am proud of what we do and proud to be associated with the caliber of people that most physical therapists are. While none of us is perfect, I think the majority try each day to be really good at what they should be doing and our patients have the opportunity to reap real rewards because of it.

CSM Recap

I have returned from the Combined Sections Meeting of the American Physical Therapy Association in Las Vegas. It was great. I was privileged to give two presentations. The first was on using the Wii and other technologies in Physical Therapy. It was very popular as there were 200 in the room and I was told at least 200 were turned away (quite unhappily). I have been very amused at the therapists who belittle the use of Wii in therapy claiming that it is not 'evidence based.' These people have such a limited view on the world and do not get it. No one is claiming that we should have our patients only use the Wii and do nothing else for physical therapy. It is a piece of therapy just like joint manipulation is a piece of a thorough treatment plan. If we can use the Wii to promote doing exercise or to increase participation or to take notice or to increase balance or to improve movement patterns or to have fun while doing good things for our movement then the Wii is a good thing and should be used as an aspect of our treatment.

The other presentation I gave was about some research that Justin Tepen, DPT (a former student) and I did on vocabulary use. I was very happy at the amount of times I heard different presenters talk about the need for standardized vocabularies regardless of their topic. Physical Therapists need to understand how important vocabulary is especially in light of the $20 billion information technology monies from the newly passed stimulus package. If we are do not get our act together we will not see much of that money headed our way nor will we be very successful with Electronic Health Records that are starting to emerge.

It was a busy weekend for me. I attended a continuing education course on the Lumbar Spine. As physical therapists we are required to attend a certain number of continuing education courses to help us keep current with our knowledge. The course was presented by the International Academy of Orthopedic Medicine (IAOM). I always enjoy the courses by this group because they are very thorough and they do not claim to be the "one and only" best way to practice physical therapy. Every time I hear someone pitch that this technique is the only or the absolute best way to do something, I get very skeptical and with good reason. There are many ways to practice physical therapy and get good results and each patient is different from the next that requires thoughtful and varied techniques.



I am looking forward to next week because I am going to Las Vegas to the American Physical Therapy Association Combined Sections Meeting. This is an annual event where PTs from around the country gather to discuss and share research and help forge the future of physical therapy. I will be presenting about using gaming devices in physical therapy like the Nintendo Wii and the Playstation EyeToy. I am also presenting some research on the use of vocabulary in physical therapy documentation. I really look forward to it. Many of my students are making the trip. It is fun to spend time with them in a different setting and to get to know them on another level. I hope to see you in Las Vegas.

Bloggin, bloggin, bloggin

I apologize for the long stretch without blogging. I am back with a vengeance now...

Classes have started up again for the spring semester. It is great to be back in class. The second year students have returned from their first clinical affiliations. This is where they go out and start being physical therapists for real, rather than just talking and learning about it. It is always fun to hear about how things went. Some have fun stories to tell, others relay interesting and complex patients. I think the majority had a great time getting out and doing physical therapy. They learn so much being out in the real world and many start to appreciate all that they had learned in class so it is nice thing.


I am working hard getting ready for my presentations at the American Physical Therapy Association (APTA) Combined Sections Meeting (CSM) held in February in Las Vegas. This is an annual conference for the APTA. It is a lot of fun and recommend going if you have a chance. It is great to meet up with physical therapists from around the country and world and share and learn from one another. And especially to hear about the cutting edge research in the field of physical therapy. I will be presenting on the Nintendo Wii and Vocabulary Use in Physical Therapy Documentation.