I recently was fortunate enough to attend the team concept conference put on by the sports physical therapy section these past few days.  I have gone to CSM multiple times before, but this was a much better conference for my speciality area.  The quality of speakers alone was worth the time.  In the past, I had listened to many of these speakers at CSM and through continuing education courses.  However, the information at the conference this year was much better than the past courses/CSM.  

While some of the information was definitely a review due to my residency preparation and obsessive amount of continuing education I have done, there was quite a bit new on surgical rehabilitation.  I especially liked the new information on rotator cuff, SLAP, and articular cartilage surgical considerations/rehabilitation for athletes.  One of the things I have always said is that physical therapy school does not allow students/new professionals enough surgical understanding.  Especially in the case of athletics and return to play we don't do a very good job.  Hearing doctors speak to these surgical considerations and followed up by physical therapists considerations and return to play was excellent.  

In addition to the surgical rehabilitation, it was great to attend some of the breakout courses.  Kevin Wilk and Russ Paine did a great job on different shoulder evaluation and treatment options.  Additionally, I really enjoyed the performance enhancement breakout course taught by Dan Lorenz, Sue Falsone, and Rob Panieriello.  Lastly, for the current residents that came and spoke with me, it was a true pleasure.  Special thanks to Devyn Moore (UMPC) and Brett Burton (St. Lukes).  It was great to hear up and coming sports residents talk passionately about sports physical therapy.  For those of you in sports physical therapy, I really encourage you to attend TCC next year and participate in the Team Mates networking event to meet others in the field.  

- Brian

As stated in a previous post, I recently completed my orthopaedic residency with Scottsdale Healthcare. One of the prime focuses of orthopaedic residencies is preparation to sit for the Orthopaedic Certified Specialization Exam (OSCE). This is accomplished with lectures from various perspectives. In one of the final lectures, we discussed case examples with multiple choice answers to determine what we thought the answer should be and then how we thought it should be answered for the OCSE.

To some, these may sound one in the same. However, with completion of the residency we have come to an understanding how evaluating and treating our patients with considerations of any movement impairments that lead to the injury is essential. Unfortunately, this is different from how much of orthopaedic physical therapy (in school, on the NPTE, and the OCSE) is typically taught. As Jim stated in an earlier post, we need to move from a pathoanatomical perspective to a kinesiopathological perspective when treating our patients. If you review your notes from school or any material for preparation for the NPTE or OCSE, you may notice that orthopaedic pathology is listed by the injured tissue and, thus, intervention and evaluation techniques are directed at that injured tissue. For example, the pathoanatomical model may direct you to treat tendinopathy with eccentric exercises or a herniated disc may be treated with mechanical traction. The kinesiopathological model instead would direct the clinician to evaluate and treat based on movement impairments that lead to the tissue irritation. This is the equivalent of treating the original cause of the symptomatic tissue, instead of just treating the symptomatic tissue.

During my final few days of the residency, I took some time to decide if it was appropriate to sit for the OCSE. This may sound like a "no-brainer" at first glance, but I wasn't sure it was worth getting specialized in material that was primarily based on the pathoanatomical model. Unfortunately, with how long the process is for question development for the OCSE and research in general, much of the material on the exams is outdated by at least a few years (this does not even take into account the frustrations of focusing on higher levels of evidence). In the end, I decided it would still be beneficial to pursue orthopaedic specialization. While a large portion of the exam is focused on the pathoanatomical model, some still includes a look at movement impairments and the original cause to injuries. Additionally, there is a view in the physical therapy community that those with an OCS are experts in the orthopaedic area. It never hurts to be aware of and appropriately apply information from the OCS as much of it is still clinically relevant. Basically, we must always remember where we come from. We should be aware of the previous methods of treating and evaluating injuries, so that we can critically assess what should and should not be incorporated in our care. It can be difficult reviewing and memorizing material that you likely won't apply clinically, but it has a beneficial result of raising the status/awareness of the clinician in both the patient and health care community upon successful completion.

-Chris

Several months ago, I read a blog post by The Manual Therapist about continuing education. He emphasized how beneficial any course could be, meaning that if you can take even 1 thing from the course and apply it regularly to your practice, the course was worth it. I took this concept to heart this weekend.

Several months ago, I was offered a free spot in the course Clinical Strategies for the Restoration of Posture, Balance, and Gait. In an orthopaedic setting, we regularly see people with these impairments. Even though I would have preferred a topic that was more orthopaedic- or manual-based, I would not shy away from a free opportunity to gain some skills at restoring those common impairments.

I was talking with the instructor before the class began and he mentioned how he used to be a manual therapist but no longer does any segmental mobility testing. With me completing an orthopaedic residency with an emphasis on manual therapy, obviously I became a little wary. I figured I would continue to listen during the lecture, of course, as potentially there would be some explanation as to how he performs his exams. The lecture started off reviewing some of the founders of physical therapy and their contributions. I noticed there was a large emphasis on Neuro-Developmental Treatment (NDT). Given my affinity for the Selective Functional Movement Assessment (SFMA), I was definitely interested in learning more about using the developmental sequence in my treatment and assessment techniques. It turned out the instructor was teaching us about the Feldenkrais Method. The technique focuses on relaxing the body and "resetting the nervous system." This is done by using repeated movements, recalling past experiences connect to current impairments, retraining breathing and how eye-sight effects movement throughout the body. There is much more to the theory, but these are some of the areas highlighted by our instructor. When I was in physical therapy school, we learned about NDT techniques such as Bobath, of which I was extremely resistant towards at the time due to the lack of high-level evidence and mechanical reasoning. I could tell at the beginning of the lecture that I was a developing some resistance towards the content, similar to that which I had for Bobath-esque content, so I had to remind myself to keep an open mind and look for some gems to use in the clinic.

As I stated earlier, there were a variety of treatment and assessment techniques demonstrated in the course. The instructor started off how he starts off treatments for his own patients - with a relaxation technique. He places the patient in supine with towel rolls under the knees, supporting the lateral side of the ankles for hip control, under the elbows and in the the hands. The goal is to lower the tone throughout the body. I can see this being beneficial for any patients that show resistance towards manual therapy and are easily tensed up. It is from this state, the instructor stated, that the nervous system is allowed to "reset." Unfortunately, the course felt more like a clinician trying to show us a "bag of tricks" to use related to the Feldenkrais Method, as opposed to truly learning the school of thought. We then proceeded to review some postural training methods. I actually found they could be useful for quite a few patients. For example, have the patient slouch and test should strength. Follow that up with re-testing in proper posture. It is likely that the patient will notice a significant change in strength. Another significant component of treatment under this method is core re-training. This includes the diaphragm, multifidi, pelvic floor, and transversus abdominus. A big focus was placed on teaching diaphragmatic breathing, followed by training techniques for the other 3 components of the core. These muscles are trained progressively from supine to standing - something most orthopaedic physical therapists do already. Another interesting topic that we discussed was the relation of eye movement to cervical motion. If you place your hands on your upper cervical vertebrae posteriorly and simply look in various directions, you will feel movement under your hands. Whether that is true spinal motion or cervical muscle tensioning does not necessarily matter as it clearly plays a role in the cervical spine. I have actually seen it used for METs of the upper cervical spine before.

As you can see, there was some use to the course as it pertains to incorporating material into my examination and plan of care with various patients. However, I had a difficult time grasping the concepts of Feldenkrais Method. I questioned the examiner frequently on topics, such as why he though he could ignore segmental mobility, why he thought stretching was never appropriate, and the contradictory nature of some of his explanations. He would try and cite studies to justify his techniques, but there was no true relation to the actual Feldenkrais Method. There were interesting anecdotal examples of using a past experience like dancing to help a stroke patient walk without impaired gait (the patient competed in dance when younger) or a person unable to speak relearn how to participate in conversation by singing (she sang regularly when younger). While the instructor was unable to convince me that sufficient research existed to show the effectiveness of the technique, I am unable to prove that it doesn't work. It's possible that an entire school of thought cannot be taught in a 1-day course and I must either learn more about it or see it in action, before I make any official opinion of the course. Nevertheless, I definitely was able to find several pieces I will be able to incorporate into my practice regularly, making it worthwhile. Perhaps, when my traditional methods of treatment are not working, especially when significant psychosocial involvement is present, I will incorporate some of what I learned this weekend in order to trial it.

-Chris

One of the less prominent aspects of residencies is that of community involvement. While areas like research, teaching, and mentoring may highlight a residency, the ability to interact with the community in a non-clinical setting can have just as much of an impact. This involvement can range from doing free screenings to helping out at an athletic event to presenting at a career fair. In all and more of these ways we are educating the community about health-related concerns and growing awareness of physical therapy as a profession.

Several weeks ago, I participated in a high school career fair as part of my orthopaedic residency. I had participated in several events like this in the past with little interest shown by students. This latest event was much more enjoyable in that both students and teachers were regularly coming up to us and asking questions about various aspects of physical therapy as a profession. A key to this success was having something to attract the students. For us, it was a balance assessment and spine model. We had a blue foam pad and a bosu to show different limits of stability with eyes open vs. eyes closed, feet together vs. feet apart, and adding movements to these positions. Both the students and teachers were amazed at how much difficulty they had with maintaining a static position on the blue foam pad with their eyes closed. This allowed us a chance to explain the 3 primary components of balance: eyes, vestibular, and sensori/proprioception. It was really rewarding to see the passion that already existed in some of the students as they were excited to work towards a potential career in physical therapy. Several students were already asking about beginning volunteering hours or finding a job as a tech!

Overall, the career fair was a very enjoyable experience. While we can have a significant impact on people's lives in the clinical setting, the opportunity to reach out to the community for education allows us to increase awareness of what physical therapy has to offer to the public. I recommend that if you are interested in volunteering at a physical therapy booth for some type of event (race, career fair, etc.) that you have some sort of activity for the participants to experience as this provides a draw and conversation starter.

Chris

I actually couldn't have been happier with the ortho course. The instructor basically broke down the diagnosis and treatment of everything hip/groin/pelvis related. Additionally, he used diagnostic ultrasound imaging to show which muscles were being used with variations of exercises. This can be extremely beneficial for educating patients on proper motor control. Probably the most interesting component of the lecture, however, was the discussion of the "rotator cuff" of the hip. These muscles include: iliacus, gluteus minimus, lower gluteus maximus, and deep rotators of the hip. The gluteus medius, while important, was compared to the deltoid of the shoulder. Basically, we should be establishing control of the core and hip "rotator cuff" prior to focusing on the larger muscles.

Overall, I learned quite a bit from the course. Even though this conference wasn't the same as those at the national level, the quality of courses was outstanding. I recommend taking a closer look to consider attending some conferences in your respective states. Chances are you will find a course where you will learn some very interesting concepts.

Congratulations to all the newly licensed PTs out there! Last week the results of the NPTE came out, so we thought we would offer our advice and perspective on preparation for the exam. In December last year, our school had us take a practice exam without any studying. This allowed us to determine where our strengths and weakness were. You should definitely makes a schedule and stick to it. Having deadlines to meet ensures getting through the material.

Chris: I started studying back in February for the boards, beginning with my class notes (I often over-study for tests). I took a few subjects and made (long) study guides from my class notes. I went through all my notes in Modalities, Cardio/Lymph, Pulm, Neuro, and Functional Equipment. The study guides I made contained all the information from each of those subjects that wasn't absolute common sense to me. I then went through the O'Sullivan text and added any information to my study guides that I hadn't previously covered. Come graduation, I now had all the information for those subjects on study guides I created so that I wouldn't have to return to the O'Sullivan book for those subjects. I highly recommend focusing the majority of your time studying on the "Big 3" - Musculoskeletal, Neuro, and Cardiopulm/Lymph. About 75% of the test covers those subjects. I was fortunate in that I barely had to study ortho, so if you find you're strong in a certain area you may be able to partially ignore a section as well to focus more on the other two. I mainly looked through the O'Sullivan book to learn about tests and diseases that we weren't taught in school. Something I do want to point out is that the ortho material on the boards and in the O'Sullivan text is outdated information. Recent evidence in the area is definitely the exception on the exam, so I recommend familiarizing yourself with older treatment/exam methods. Knowing I was weak in Neuro and Cardiopulm/Lymph, I frequently covered that material and read information about the diseases from other text books. The NPTE study guides do a great job listing various diseases/treatment methods for you to know, but only provide some information. Reading background information from pathology books and books like O'Sullivan's Physical Rehabilitation definitely helped me gain a much better understanding. I even went so far as to review Neurscience (anatomy and physiology). This made any neuro questions much easier for me. Once I had some confidence in each of the major areas, I spent some time just to freshen up on the smaller areas of the exam - Integumentary, EBP, Professional Behaviors, etc. These areas are covered less on the test but they still count!

I also studied with or did some Q&A with friends probably at least once a week. I frequently found that we were all finding additional information that the other hadn't covered. Lastly, one of the the most important things to do is take practice exams. I took 2 of O'Sullivan's between graduation and the boards and read the questions/answers for a third. This really helped me to understand why certain answers were right. I learned things like in acute ortho injuries, the O'Sullivan authors recognize modalities as a treatment of choice frequently. You learn to pick up little clues about each question that prepare you for the actual test. Another obvious benefit of taking practice exams is learning where your weaknesses/strengths are after each test. This is important, because you can alter your studying to focus on another area afterwards. You will likely be asking yourself: should you go with Scorebuilders or O'Sullivan. The general consensus I have heard (I did not look at Scorebuilders) is that Scorebuilders has many more graphs and pictures, while O'Sullivan is outline format. Additionally, lower O'Sullivan practice test scores are linked to passing the NPTE compared to Scorebuilders. I actually preferred this as I would rather be over-prepared. I walked out of the boards feeling pretty confident in how I did. I was actually shocked at how much simpler the NPTE questions were compared to O'Sullivan's. One of the reasons I felt confident is that I went into the test knowing that I was going to get questions wrong. Everyone does. This isn't like school where you need to get an "A." Questions will be thrown out and the scores will be adjusted. Like Brian, I took the night before off and just watched a movie (Braveheart) to get my mind relaxed. Overall, I would say I studied at least 3-4 hours a day (often more), but I definitely had days off and took a couple vacations in the months leading up to the exam. In the 2 weeks before the test though, I upped my studying significantly like Brian.

Brian:  If you're about to sit down to start studying for boards soon or even a year away and feel like you have to re-learn neuro and/or cardio/pulm again - I was there too. If you're the world's worst written test taker and you're freaked out about that for the boards - that was me as well.  If you're about to sit for the NPTE and you haven't passed a single O'Sullivan practice exam - again, that was me.  The point is that the mental aspect of the boards is very real and can be detrimental to your studying/focus if you do not get a handle on it.  There is probably a good chunk of students that rarely have to worry about the mental aspect of test taking as much as others do but with the boards I think pretty much everyone freaks out at one time so don't worry, that part is pretty normal.  

Now Chris did a pretty good job of outlining study strategies so I will touch on only additional things to consider.  

- Start studying months ahead of time, even if its just once a week for a few hours.  It makes a difference even if you think you forgot everything you studied come graduation.  
-  Focus on your weak areas.  For me that was cardio/pulm and neuro, not ortho.  Integumentary? Yeah I studied that everyday because I didn't remember anything from that.  
-  The hardest thing to do is sit down and study for a test months away when we are used to cramming for test after test.  Study a few hours each day in the beginning weeks and towards the end (2-3 weeks before) I would turn it up to 6-10 if you can to make sure you get as much in as you can.  
-  Don't just take the practice tests and look at the score, analyze it too.  Figure out where you have improved and where you haven't.  Then from there focus on the poor sections and "maintain" the strong ones.  
-  You cannot memorize and know EVERYTHING, so don't worry. But know the big concepts down cold and try to fill in the smaller details.  
-  Study in groups or with a friend if you do not understand a concept. They can help you get through that sticking point.  
-  For a guy that hates to ever waste time and always feels like he needs to study or get ahead, the best thing I did was chill out the night before the test.  I watched a movie and listened only to my positive music/speeches.  
-  Unless you're like Chris who knew he dominated the test, you're probably like myself or Jim who felt we failed the test afterwards (and during too - but take breaks and reset your mind for positive motivating thoughts).  Don't dwell on that.

Jim:  Much of the information I have to add has been touched on above from both Brian and Chris, but I do have a few additional comments to make. First, I want to say that it is possible to work on a temporary license while studying for the board exam. It was difficult and mentally taxing at times, but do not rule out this option if you want to start working right away. The key is time management! Second, I cannot stress enough the importance of taking practice exams and analyzing each question: both incorrect and correct answers. I took 5 practice exams and looked through every question thoroughly. Multiple times I found myself answering questions correctly but using the wrong clinical reasoning skills. Additionally, make note of specific topics that need to be reviewed in greater detail. Find these mistakes early so you can perform better on the next test. Analyzing every question of each test was a long process, but understanding the "textbook" answer is essential to passing the NPTE. Finally, I want to discuss the importance of using multiple resources. I used both O'Sullivan and Scorebuilders as my review books, but also had class notes, textbooks, websites, and more at my disposal to delve deeper into topics that needed further explanation. No resource is all inclusive, so use as much as possible. 

              Study hard with intention. The satisfaction of passing the exam is worth the effort!

During my final clinical rotation, I was located at an outpatient ortho setting where I was required to do an inservice for the employees. After observing a few of the PTs perform their examinations with a set system focused on the area of symptoms, I knew what I wanted to do my inservice on: the Selective Functional Movement Assessment (SFMA). The more experience I obtain in the ortho setting, the more I have come to realize the potential contribution other joints have on the pathology and the importance of including them in our examinations. Sometimes it seems pretty obvious when a distal or proximal joint is affecting the patient's symptoms, but we should be checking these joints on a routine basis with our examinations. The SFMA is not to be confused with the Functional Movement Screen (FMS), also created by Gray Cook. The FMS is a screen for musculoskeletal risk of injury that can be performed by any fitness professional. It consists of seven movements graded on a scale of 0 - 3. Any provocation of pain requires referral to a medical professional. The SFMA is a method of orthopedic examination, which often involves painful movements, that can only be performed by a licensed medical professional. The SFMA provides a baseline that can show any changes in movement patterns following treatment. It is an objective method that some may utilize instead of goniometric measurements. The most significant part of the SFMA is that it's a standard sequence the takes into account the whole body. The reason the standardized sequence is so important is that it lowers the likelihood of us leaving something out, missing the possibility for potential regional interdependence.

The SFMA's grading system is similar to that developed by Cyriax. Cyriax's grading consists of:

-Strong and Painless (normal)
-Strong and Painful (a minor lesion in the tissue)
-Weak and Painful (a major lesion in the tissue)
-Weak and Painless (a neurological issue)

The SFMA grading system is:

-Functional and Non-Painful (FN)
-Functional and Painful (FP)
-Dysfunctional and Non-Painful (DN)
-Dysfunctional and Painful (DF)

Functional movement corresponds to unlimited and unrestricted movement that a patient is able to complete with one breath cycle at end range. If breathing alters the movement, it is dysfunctional. FP is a marker for pain that can be reassessed throughout treatment. Typically, corrective exercise would not be appropriate here, because movement is within normal limits. DP has both limited movement and pain. It is key to breakdown these movements to find the source of each. Corrective exercises aren't used here either. DN is simply limited movement. Again we can break down the movement to find the source of the limitations. This is the key to utilization of corrective exercises and where we should focus our treatment. Changes here may lead to changes elsewhere. When a patient has multiple DNs, they should be addressed in a top-down format (cervical before shoulder, etc.). If a patient has a DN as a result of permanent restriction, surgery, etc., the DN should be discounted. There are three main things we should consider regarding the SFMA results: limitation, asymmetry, and redundancy. Choose the pattern with the greatest limitation. Asymmetrical limitation should be addressed before symmetrical limitation. The SFMA has built in redundancy to ensure the true motion of a joint.

Just as goniometric range of motion measurements are not a diagnosis, SFMA scores are not a diagnosis. They are simply a marker for both movement and pain that we can regularly check for changes to see the effect of our interventions. We should focus our interventions on FP and DN. The SFMA consists of several Top Tier Tests that can be broken down into additional patterns based on the findings to help determine the source of the limitation. The Top Tier Tests include: Cervical Patterns 1, 2, 3; Upper Extremity Patterns 1, 2; Multi-Segmental Flexion; Multi-Segmental Extension; Multi-Segmental Rotation; Single-Leg Stance; Overhead Squat. Given an abnormal finding, such as FP, DN or DP, for one of the Top Tier Tests, we go into the Break Out Patterns. The Break Out Patterns look at each separate joint in an standing active position, supine active position, and supine passive position. This puts various loads on the movement to determine if the limited movement is due to deficits in mobility, stability, or both.

The Cervical Top Tier Tests consist of three movements in standing: cervical flexion (chin to chest), cervical extension, and cervical rotation/sidebending combined (chin to mid-clavicle). If these result in FP, DN, or DP, proceed to the Cervical Break Outs. These consist of several movements in supine: active cervical flexion (chin to chest), passive cervical flexion (chin to chest), OA cervical flexion test (20 degrees), active supine cervical rotation (80 degrees), passive cervical rotation, C1-C2 cervical rotation test, and cervical extension. These movements allow the clinician to determine which part of the cervical spine is leading to dysfunction. This is just an example of how a Top Tier Test is broken down. For a patient, it is necessary to do a full SFMA examination based on the patient's findings. This may mean only having to perform one set of Break Outs or Break Outs for each Top Tier Test. Note: I am not credentialed in the SFMA. These explanations come from Gray Cook's Movement. For more information on these topics, I recommend either reading Cook's book or attending the courses on the matter. Also, check out this interesting case by The Manual Therapist that shows the usefulness of the SFMA in identifying regional interdependence in patients!

-Chris

Reference:
Cook, G. (2010). Movement. On Target Publications.

Last night I had the privilege of attending a unique presentation from the famous sports physical therapist George Davies!  Being on a clinical rotation near Armstrong Atlantic State and my CI knowing Davies personally, I was able to attend his lecture, as well as meet him.  My experience was one I will remember for a long time as I learned so much about the knee in the lecture.  More importantly though, I saw the passion from Dr. Davies.  It was inspiring to hear him talk so passionately about research, special tests, and his experiences with athletes.  

Following the lecture portion, which went over the best knee special tests, the attendees had the opportunity to go to the lab portion to practice.  Dr. Davies went through his knee exam and instructed us through it as we practiced.  Not only did he review the evidence behind the tests but he explained the anatomy and physiology behind the tests as we practiced.  His ways of examining the knee were much different overall then the way I learned in school, which was interesting to consider.  However, with over 40 years of experience, its hard to argue too much against the way he does knee exams!  

Overall, my experience was incredible.  Its one of those educational experiences that reminds you about your passion for physical therapy.  Dr. Davies provides continuing education courses and I would highly recommend attending one of his courses if you have the opportunity.  Especially if your into sports physical therapy, make sure to read some of his research!   

-Brian

For those of you who attended National Student Conclave last month we think you would agree it was a great experience.  The three of us each had different experiences but all agree on one thing: it was worth the time and investment.  

Brian:  I thought NSC was awesome!  Some of the opportunities at NSC are simply not offered in school and being my last year I was able to learn a lot of valuable information.  For one, I thought the resume reviews were great.  They were conducted by physical therapists and that helped a lot because I know now how to tailor my resume toward PT jobs/residencies better.  Then there were the education sessions.  For those of you that are into sports I think you'll agree that Erik was a great speaker and had some good advice.  I really liked how he showed his journey but more importantly his mistakes.  Additionally, he explained the CSCS the best I've seen and the reasons it opens doors as well as why it is for those who want to get into sports physical therapy.  I also went to the Owning your own Private Practice session and learned a ton while networking with private practice owners at their reception that night.  Another thing I did at NSC was attend the early riser breakfast and listen to the APTA president, Paul Rockar, speak.  I personally have been an APTA member for quite some time but Paul really spoke to some issues that are very relevant to our future as physical therapists.  I know my colleagues Chris and Jim caught the bug that weekend and will become APTA members soon, which is a great thing.  Finally, I went to both the residency & fellowship and interviewing tips sessions.  The residency session was helpful for those who don't know much about the benefits and application process and I would recommend going to that one next year for the 1st and 2nd year students reading this.  My experience was invaluable and I really enjoyed making all the contacts and networking that went on at NSC.  I highly recommend going to NSC to anyone that may be interested next year!


Chris:  It was a long 14 hour drive from St. Louis to Arlington, but it was definitely worth it. Going into NSC, I admit I was not as excited as I was for CSM, because the classes were not focused on the clinical aspect as much; however, I cannot say enough about the experience I had there. The first morning I had my resume reviewed. We were fortunate in that the prior week, we had our resumes reviewed briefly as well by our school's Career Services. Getting a review from a PT perspective was extremely important. I learned some tips I had not heard previously and discovered how to modify my resume to what the employers of PT are seeking. I too went to the ortho and sports classes. It was interesting to hear an alternative route to building your name in the sports field. As I learned in the residency course, one of the key advantages to attending a sports residency is the networking that leads to high level careers. Erik explained his non-traditional path that shows it isn't necessary (although it is extremely beneficial!). I saw a similar pattern at the Private Practice session. With a couple of different speakers, we were able to hear various options for building a private practice, beginning from as little as 6 months to as much as over a decade of experience. The exhibit hall left the decision up to the attendees on how to mold your own experience. There were services like employers, residencies, fellowships, APTA section booths, and more. I probably made my way through almost every booth to hear what they had to offer, especially the employers and residencies/fellowships. I viewed each of these as a short "interview." They are as much as you make of them. Not only do you get to have your questions answered about the organization but you can practice your own interviewing skills. I was fortunate to have one of the residencies present to which I'm applying. Being able to speak one-on-one with one of the faculty helped to confirm my decision for selecting that specific residency. One of my highlights of NSC, however, was meeting Dr. Flynn. Dr. Flynn has been a significant contributor to the field of physical therapy, especially with his text on evidence-based examination. Being able to speak with one of the leaders in our field for a few minutes was extremely rewarding. If you have the time, I suggest attending NSC earlier in your PT education, as it can help guide the rest of your education and career.

Jim:  
NSC helps rejuvenate your passion for Physical Therapy. The combination of meeting new people, learning new information, and being surrounded by hundreds of other student therapists reminds you why you first entered the profession. One of my favorite aspects of the National Student Conclave was getting to know more student PT's from all over the country. Hearing other people's experiences and interests, allows me to be more creative in my own clinical practice. It was great to see so much unity among us young professionals. Additionally, I enjoyed the specialty educational presentations. I attended the lectures on Aquatic Therapy, Neurology, and Orthopedics. Aquatic therapy has always been an interest of mine, so hearing about the diagnosis' commonly seen, intervention selection, and reviewing the evidence was very beneficial. The speaker, Beth Patterson, discussed utilizing buoyancy and hydrostatic pressure in your favor & special manual techniques that can be performed in the water. She concluded by mentioning the incredible business potential behind opening an aquatic practice. After aquatics, I attended the Orthopedic lecture which discussed the management of special spinal conditions and low back pain in the elderly. She opened the lecture with an influencing introduction about getting involved in the APTA and to joining specialty sections. By joining a specialty, you will find an area of PT that you enjoy and be surrounded by other colleagues who have the same passion as you. In conclusion, I highly recommend attending the National Student Conclave. The experience reminds you that PT is greater than what is being taught at your school alone. It is a worldwide profession that thrives on working together towards a common good.