Getting started with evidence based practice can seem overwhelming. The JOSPT does an excellent job synthesizing and weighting the current evidence for a number of conditions physical therapists treat. Check out the clinical practice guidelines here.
It is often surprising how seemingly basic questions are quite difficult to answer.
A number of months ago, a client of mine informed me that he was considering total hip replacement surgery. This gentleman quite enjoyed playing basketball, football, and softball. He asked if, after proper rehabilitation, he would be able to return to these activities. This seemingly straightforward question proved surprisingly difficulty to answer.
When I first started in PT school (what now seems like centuries ago), “short arc quad” exercises were frequently prescribed for patients with pain around the kneecap. I am surprised at how frequently these exercises are still prescribed. The JOSPT published a great summary of a research article addressing the best evidence in this area. Essentially, to minimize stress on the patellofemoral joint (the joint between the back of the kneecap and the femur), one should perform “short squat” exercises (0-45 degree range) and short knee extension exercises (90-45 degree range).
You can read that summary for yourself HERE.
Step by Step
My two kids face each other in the wagon, a soccer ball and two folding camp chairs on their laps. I have food in my backpack, and I pull them down the sidewalk of Route 135. The road is closed off, so there is no traffic.
I look up and see a man in a three wheel racing wheelchair, pedaling with his arms.
“Here come the wheelchair racers!”
I am consistently surprised at the speed time seems to pass. October 1st of this year will mark the start of our third year in the new office location. In many ways, it feels like this space has always been our home, yet in others, I cannot believe that much time has passed that quickly.
Our first winter at this office was marked by more snow that we have seen in a while. Unfortunately, many Integrative clients found themselves getting acquainted with our then-new office space because they had injured themselves moving snow, or slipping on ice that never seemed to fade. I thought that, not knowing what this winter will bring, that I would review what I discussed with many of you that particular winter: how to minimize injury when dealing with snow.
Six months have past since I have found the time to pen an entry here. What have I been doing? Well, six or seven months ago, it became apparent to me that Integrative Therapeutics was going to have to find a new home. Our old space was no longer working for us on a number of levels. Most importantly, it was constraining my ability to take the practice in the direction I wanted to take it.
This was no small undertaking. Integrative Therapeutics had just celebrated its 10 year anniversary, and we were in the space originally designed and built for the company. We had developed strong relationships with the Longfellow club on many levels, and (perhaps most dauntingly) we had 10 years worth of stuff crammed into every conceivable nook of the office. Most importantly, though, I had to consider the impact of moving on the well established (and hard won) practices of each member of the Integrative team.
You read correctly, and no, I am not exaggerating, even a little.
There has been mounting evidence in the past 20 years that physical inactivity in general, and sitting in particular, are as, if not more, detrimental to your individual and our collective health as smoking cigarettes.
Check out this article, written 10 YEARS AGO in the Journal of Applied Physiology: http://jap.physiology.org/cgi/content/abstract/88/2/774.
I was working with a client this week who had hurt her lower back. As is usually the case, she could not remember exactly how she did it, though it was likely she did it lifting her young son. (Those of you who are parents know exactly what she is going through- raising young children can be surprisingly tough on the body). During the course of the session, she asked if the problem was going to go away.
“Of course”, I responded. “This is a simple strain. You have some joints that are not moving properly, some muscle guarding, a bit of trunk weakness, and a bit of hip stiffness that likely predisposed you to the strain in the first place. You’ll be up and running in 2 weeks or so. “
Central to Japanese martial arts is the concept of Mushin or “no mind”. It is a deceptively difficult concept to grasp. When one has trained to the point where the techniques require no thought, when the patterns of motion are completely ingrained in your being, when one respond without effort, as naturally as taking one’s next breath, one has achieved mushin.
There is a bit of a paradox here: to achieve such a level of skill requires a lifetime of intentional, focused, dedicated training and practice. The goal of all of these focused efforts is to be able to perform without conscious effort. There are close parallels to this paradox in rehabilitation.
I do a lot of exercise program design for people who know they need to exercise, but don’t really want to. (Lots of us fall into this category). Though the years, I have watched too many people start programs with the best of intentions, only to drop them 3 months later out of boredom, injury, or just plain having better things to do. So, I’ve come up with a strategy that works well for turning non-exercisers into exercisers. First, we have to determine whether you are a “home” person or a “gym” person. Me, I’m a home person. My schedule is tight, and I don’t really look forward to exercise, so if I have to go somewhere to do it, it becomes too easy for me to say “no time today, I’ll do it next time.” “Next time” means 3 weeks from now. If I only have to go downstairs in my home, I can’t find an excuse not to, and the exercise gets done. Now, after 25 years, I almost look forward to it.