Last week I was speaking with a medical doctor from Michigan who plainly stated, "I do not see why physical therapists need a doctorate degree to exercise people." It was in this moment that I could have ruined that relationship OR made it stronger. Trust me, I thought about answering it in a demeaning manner, but I didn't. I respectfully gave her an answer that changed her understanding of our profession. If you have been a physical therapist or PT student for any appreciable amount of time, you have likely encountered this question: "Why do Physical Therapists need a doctorate degree?" Answering this question can be frustrating, especially when it is being asked by a referral source. However, knowing the answer to this question is important & how you answer it can change people's viewpoint of what physical therapist's do. 

To answer my question above, I educated the doctor that we need our doctorate degree to ensure that the patient is appropriate for exercise. I need to make sure that my patient's shoulder pain is truly musculoskeletal pain and not cardiogenic pain. I then went on to explain that physical therapists do more than exercise. We specialize in regional interdependence, joint dysfunctions, neuromuscular disorders, and pain science. Additionally, our doctorate degree allows us to have direct access. In many states, physical therapists can now see a patient without needing a physician's referral. Several studies have shown that direct access can lower costs, expedite care, and decrease usage. A 2015 PT study out of San Antonio, Texas found that individuals immediately seen by physical therapists had lower costs and underwent fewer tests than those with a delayed referral to PT. Research is emerging on the benefits of direct access for physical therapy.      

When someone asks why Physical Therapists need a doctorate degree, view it as a learning opportunity. People do not understand what physical therapists do. Having a concise answer to this question is important. Teach them! 

Jim 

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The Student Physical Therapist recently partnered with OPTIM Physical Therapy for the Murph Challenge. 

"The Murph Challenge is the Official Forged® annual fundraiser, benefiting the LT. Michael P. Murphy Memorial Scholarship Foundation. This is a CALL TO ACTION - Rise to the occasion. Take the Challenge. Help make 2015 the biggest year yet!"

Let’s Move Forward as a profession by taking the Murph Challenge. Register under OPTIM Physical Therapists so we can support the challenge as a profession. Let's see how many physical therapists we can get to support this great cause! 

Check out OPTIM's website to learn how to register for the challenge.
 



 

The most important thing I have learned since finishing physical therapy school is that we always must act with purpose.  What I mean by this is that as a health care professional it is my duty to treat my patients with the highest quality and integrity.  Part of what that includes is making sure I do the very best I can for my patients.  With the abundance of changes in the physical therapy world it is important to me to reflect on how my patient's are doing each week.  

Every week I spend a few hours reviewing what went on with my patients and how my treatment plan needs to evolve in the upcoming weeks.  What I have learned from this over the past few years is that this process has become a integral part to my growth as a physical therapist.  Some weeks I spend more time on communication and others I spend more time on different exercises or manual therapy interventions.  It would be very easy to just sit back every week and not update or think about the small changes week to week with treatment plans.  But I believe it is very important to spend some time reflecting each week to not only improve as a heath care professional but to give the highest quality of care to our patients.  Below are the 5 questi ons I ask myself each week.

1.  What did I do well with this week?
2.  What did I do poorly with this week?
3.  Are my patient's on track to where I anticipated they would be after the initial evaluation and treatment plan?
4.  Who or what needs to be updated/changed?
5.  What knowledge or skill do I need to improve for this certain patient?

Try to reflect each week on your patients and yourself.  You will benefit greatly.  

-  Brian

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Physical therapy schools do a great job teaching students the fundamentals of physical therapy. Students learn a wide variety of topics leaving them with knowledge spread across many different specialty areas. This is both good and bad, We are trained to be general practitioners. Being a general practitioner means you can practice in any setting with a baseline level of competence. Since the human body is so complex (and our knowledge of the brain and central nervous system is continually evolving), physical therapy school does not have opportunity to teach us to be a specialist. There is simply not enough time in 3 years. The purpose of this post is not to discuss the downsides of physical therapy school, but to discuss the need to continue developing our skill sets after physical therapy school.  

What is the best way to specialize in your area of interest?
After PT school, Chris, Brian, and I all attended orthopedic residency programs. These programs were intense 1-year programs teaching us to be experts in neuromuscular diagnosis, examination, and treatment. Key concepts of my program were pain science, exercise prescription, manual and manipulative therapy, and intervention selection. Since the residency program was my full time job, I could finally spend 100% of my attention on neuromuscular and orthopedic concepts. Prior to the residency, these orthopedic topics were simply wrote memorization put into practice.

A residency or fellowship program may not be for everyone. Residencies cost a considerable amount of time and money. Fortunately, you can still train to be an expert without attending a residency.  Today there are many other advanced programs to choose from. Online learning opportunities are now giving students higher level learning experiences. Medbridge is a great example of this. Other programs offer continuing development using online didactice learning and in person lab sessions over the course of 1 or 2 years. Whatever your interest, I highly recommend finding yourself an advanced learning program. If you are failing to prepare yourself for the future, you are preparing to fail. Get out and specialize.

Jim

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The quality of lumbar spine movement and a patient's willingness to load through their spine is key to any lower body functional movement- squat, single leg balance, running, or even sit to stand. An inability to load through the spine alters the joint mechanics above and below the spine. In these instances other joints must change their role to compensate for altered lumbar mechanics. For this reason it is important assess lumbar spine cardinal plane range of motion with every lumbar and lower quarter evaluation (hip, knee, and ankle). 

When I say 'assess range of motion,' I do not mean using a goniometer or inclinometer to check their degree of movement. I am looking to see if a patient has functional or dysfunctional motion. For example, when a patient flexes forward, do they own that movement. Is it painful? Do they have a uniform spinal curve? Can they touch their toes? Where does the motion come from- thoracic, lumbar, hips, or combined?

When assessing lumbar spine AROM, it is essential to focus on the following components:

1) Order of the movements- If the patient is not acute, I prefer to assess flexion, then extension, then sideglides (sidebending), and finally rotation. If they are acute, check least painful to most painful.   
2) Loss of movement- Do they have full range of motion? Early on it is acceptable to use a measuring device, but in reality, the answer is much more objective. Yes or No? 
3) Pain or stiffness present during the movement- Be sure to ask when the pain arises and where the pain is located.
4) Aberrant movements- These include shaking, catching, or uncoordinated muscle contractions. Clinically look to see if the patient has to use his hands to press up from a flexed position. Do they move in one plane or 'wiggle' their way into the movement. In rotation, do they flex or extend as they rotate? 
5) Ownership of the movement. This means reaching full range in a fluid, stress free manner. Clinically look to see if the patient confidently moves through the entire range. Assess if they have to use momentum to reach full range of motion.
6) Uniform spinal curve. With lumbar flexion, does the patient have reversal of their lumbar curve? With extension, is the patient hinging excessively from one level? 

The above is my check system when assessing lumbar range of motion. Do you do anything different? Would you add anything? 

-Jim Heafner

Okay, so this post doesn't have much to do with evaluation or treatments in the clinic.  Instead, I want to talk to you about why you must network.  This is probably a topic you don't often put much thought into but you should.  Having a good network of people can be a career changer.  Here's why....

1.  Networking can get you more clients.   It's true and quite easy.  Take just one doctor for example.  Lets say you get a direct access patient who needs to be referred out.  You could easily just send a note to the doctor and send the patient on in.  The problem with that scenario is that you just lost a potential referral source.  Instead, try going to the patient's MD appointment.  Introduce yourself and have good working knowledge on both the patient's condition and the doctor's background.  I promise you, if you make the doctor's day easier, he/she will be happy.  Following up can turn into a good relationship for you and a doctor.  

2.  Networking can boost your name.  How do the best in there respective fields get consistent (and sometimes famous) patients?  Well, sometimes they are just that good.  But sometimes, they are just a good talker.  My advice is master both.  Become very good at your craft and also learn how to sell.  I'm not talking about being a salesman, but instead showing a patient how much better they have become and how passionate you are.  This is where having a good asterisk sign during treatments can be effective and shows patient's constant improvements.  Furthermore, when patient's bring up other friends or family members that have been injured, simply ask them if you can be of service.  Soon you will be bringing in a new patient for every one you discharge and thereby building your name/brand.  

3.  Networking can be lucrative.  The more you talk with your patients and potential referrals the more likely you will have a chance at earning more money.  How you say?  Well, there is corporate wellness, speaking engagements, teaching, etc.  Someone somewhere is looking for a physical therapist to speak to their fitness class or corporate wellness group.  Always be open to other endeavors outside of the clinic.  

-  Brian