The Student​ Physical Therapist
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    • Newsletter
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  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
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Why Two People With The Same Pathology May Not Present The Same

6/26/2017

1 Comment

 
One of the difficult aspects of applying current research for treating various pathologies is that not everyone experiences an injury the same. Not only do we have to incorporate injury-based research, but we also should consider aspects of pain science research. Each component of the pillars of evidence-based practice should be incorporated in patient management.

Have you ever wondered why two patients with the exact same diagnosis can present completely differently? While one might retort that the severity of pathology (amount of arthritis or tendon degeneration), imaging studies regarding pain science have found that often presenting with a worse experience can easily present with minimal pathoanatomical findings. Pathology does not equal injury and hurt does not equal harm.
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When an individual experiences pain, there are many different factors that go into it. Pain is actually that, an experience. Have you ever noticed how a baby looks to their parents to see how to react when hurt? Or how an individual might describe their pain differently based on the setting? Past experiences (their own or family members), social expectations, individual expectations, fear and much more can influence a patient's injury experience. Because of that, we cannot address every patient with "achilles tendinopathy" the same. We must incorporate their individual expectations, beliefs, and stressors into consideration when managing their care. While it can be upsetting that we aren't able to treat based on pathology alone or even regularly apply pathology-based research to our care, we are fortunate to understand WHY not all people experience an injury the same way. By further developing our understanding of pain science, we will hopefully be better able to treat our patients in the most efficient and successful way.

-Dr. Chris Fox, PT, DPT, OCS
1 Comment

June 20th, 2017

6/20/2017

0 Comments

 
As part Optim Manual Therapy's COMT Program, we have weekly case discussion sessions online. Below is a sample of a recent session on a patient with chronic low back pain. How would you have handled the case differently? While we include the typical didatic material, manual assessment/treatment techniques, OCS prep, online courses, and exercise prescription, regular mentoring is the essential component that sets us apart. It helps to develop clinical reasoning and decision making. Check out www.optimfellowship.com for more information or feel free to reach out to me.

-Dr. Chris Fox, PT, DPT, OCS
0 Comments

Mirror Therapy in the Orthopedic Population

6/12/2017

0 Comments

 

"How is my leg doing that?"
"This is so weird."
​"It feels like my stronger knee."

These are common comments I hear from patients when using Mirror Therapy in my Orthopedic practice. The beauty of using the mirror is that we are tricking the brain, and both the patient and I know it! I tell patients before we begin a session, "we both know your uninvolved leg is doing the movement, but it will feel look like your involved leg, and it will work!"
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How to Perform

To perform Mirror Therapy, patients place their intact/uninvolved extremity in front of a mirror. Doing this visually super-imposes the hidden/involved extremity (Ramachandran et al 1996). In the video to the left, the woman has chronic right knee pain. Therefore, the mirror faces the left knee (super-imposing the involved right knee.) 

What is Mirror Therapy?

Mirror Therapy has been used in the neurological population for quite some time. Fortunately due to a deeper understanding of pain science, we have also been able to transfer this intervention into the chronic pain population. Through the use of a mirror, this rehabilitation technique creates illusory visual feedback of the involved extremity (Sathian et al 2000). From the cortical level, we are identifying and correcting any misinformation between our visual and proprioceptive systems. In other words, we are reorganizing how the brain perceives the movement! 
​Watch the video below from David Butler which explains mirror therapy in greater detail.

Conclusion

Mirror Therapy is not an isolated intervention. Other graded motor imagery exercises and graded exposure to sensitize stimuli is also important. When performing Mirror Therapy, be dynamic! Change the environment- sounds, clinic environment, light, etc... Additionally, be patient and progress slowly! Chronic pain does not develop overnight. Typically multiple sessions and hours of retraining is required to retrain the brain. 
​-Jim Heafner PT, DPT, OCS 
0 Comments

Side Effects of Statins

6/10/2017

0 Comments

 
It has been long thought that elevated cholesterol served as an increased risk for heart attack or stroke. Frequently, doctors prescribe statins to lower cholesterol, and they have been shown to be effective in doing so. That being said, there are many side effects that must be considered: liver damage, hyperglycemia, neurological side effects, and muscle pain/damage. For this article, I want to highlight its effects on muscles.

About a month ago, I had a patient s/p partial meniscectomy. On one of the follow up sessions, he mentioned he started getting full contractile muscle spasms in his forearms. While I had been familiar with calf pain and spasms as side effects, the violent contractions this patient described was unusual, so I had him call his cardiologist, who had recently changed his statin medication dosage. The patient was instructed to go see his cardiologist and have some tests performed. When the patient returned a week later, he informed me that his doctor had hospitalized him, running many different tests. His symptoms had gotten so bad his entire body when into contractile spasms that would even force his spine into various motions. Eventually, it was determined that the statins were the cause of the muscle spasms and the medication was then adjusted, resulting in reduction in symptoms.
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Now I recognize it is difficult to know every single side effect of every drug. The best option is to either know the general side effects of each class of medication and look up each drug as you scan a patient's medication list. Over time, you will become more familiar with each drug's possible interaction, but with how commonly statins can present as "muscle pain," I recommend recognizing when a patient may have related side effects.

-Dr. Chris Fox, PT, DPT, OCS 

For more advanced examination and treatment techniques, check out The Insider Access Page. Our goal is to help you improve your clinical reasoning, exercise prescription, and manual techniques.
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If you are looking to improve upon your clinical skills, orthopaedic knowledge and clinical decision making, consider joining OPTIM's COMT program. With OPTIM, you can expect a residency-like learning experience without breaking the bank, all while learning from highly skilled physical therapists. Check out optimfellowship.com for more information!
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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test