Last week was the 2012/2013 Orthopedic and Neurologic Residency graduation at the Harris Health System. It was a great experience watching the current residents pass across the stage. Working with them for the past 2 weeks had been a good experience. It was impressive to see how far they had come as clinicians and educators in the field of physical therapy in just one year.

Another good aspect of being part of a reputable residency program is that they bring in a very distinguished keynote speaker. Our was Anthony Delitto. Delitto has done an incredible amount for the field of physical therapy, especially in the area of low back pain. For example he authored the Clinical Prediction Guideline on Low Back Pain. In addition to a keynote address, he gave a 2 hour con-ed lecture following the reception. The lecture focused more on his current initiative- how to reduce the overwhelming cost of low back pain. It was not your typical facts and stats that things need to change. He mentioned one statistic at the beginning: Low Back Pain costs Americans over $85 BILLION each year. This is the third greatest cost in all of healthcare, trumped only by heart disease and strokes. From there, he started talking about what he and his medical system in Pittsburgh, The University of Pittsburgh Medical Center (UPMC) are doing to decrease the costs associated with Low Back Pain. In its simplest form what they did was provide evidence based care. Amazing right? Well, the literature shows that only ~50% of PTs consistency use what is considered evidence based practice. Delitto and UPMC have created algorithms for low back pain that each PT must complete after an evaluation. The algorithm is essentially a checklist making sure you performed certain tests and obtained the necessary information. The algorithm also directed you toward a specific treatment classification in line with what is the highest evidence of care. He has also worked with hospital management and the insurance companies to create a bundling package, that ensures all patients considered for spinal surgery go to physical therapy prior to having surgery. This has significantly lowered costs as well.

Bottom line: He challenged us to think about our current level of practice. Are we consistently using evidence based practice? I am sure your patients are getting better- so do mine- but are you doing it as quickly and efficiently as possible? To be consistently successful we must have a systematic approach to our treatment sessions.

My first month of the sports residency has already been an incredible experience that has produced beyond my initial expectations coming in.  As a collective group, myself, Chris, and Jim thought we would give our followers an insight on our experiences thus far in separate posts. 

Immediately following the board exam I began a 4 day intensive sports seminar course at one of USC's lab/residency classroom, the Movement Performance Institute.  This course is also open to other therapists as a continuing education course.  I was blown away by the quality of the education.  Being my first course taught by USC instructors/alumni, it was a unique learning experience with a lot of hands on practicing.  Additionally, I went through an 8 day orthopedic seminar also hosted by USC.  I think I added more manual therapy evaluation and treatment techniques in those 8 days then I had in my entire PT clinical education.  

Clinic/On-Field Experience:
Currently, I am working in the clinic 20-24 hours a week.  My first week gave me the opportunity to work with a heavily sports based population. Something like 65% of my patients were sports related injuries, from weekend warriors to high schoolers to a few college athletes.  I don't think I realized how many athletes came into the clinic.  My time in the clinic is just part of it though.  I am currently providing practice and game coverage at the high school and college levels which has been great.  It is very busy and what I love most about it so far is that I am actually seeing real sports injuries.  Clinicals only give you so much but to be able to feel that knee laxity with a valgus stress test and see a real sulcus sign for a recent dislocated shoulder is amazing.  Furthermore, developing the skills to evaluate acute injuries on the sidelines though tape and pads is something that I believe will just make me that much more skilled as a sports clinician by the end of the residency.  Taping/splinting, treating acute injuries, working with the athletic training staff, and performing pre participation physicals with sports medicine doctors sums up what my first month of the on-field experience has been.

MD Rounds/Literature Reviews:
Being able to do rounds with the Kerlan Jobe Sports Medicine Doctors has been pretty incredible.  Besides the fact that these physicians are all the team doctors for the Lakers, Clippers, Kings, Angels, Dodgers, Mighty Ducks, LA Sparks, LMU, PGA, and Hollywood Park race tracks, they are truly invested in teaching.  While I have only done 2 weeks of rounds thus far, I can already tell it is going to be an excellent learning experience.  
The literature reviews started this past week for me.  It was mainly an introductory experience but we did do a lot of hands on practicing for the first review topic.  Having the opportunity to review multiple articles on body parts and unique topics, debate them, and find ways to implement them is invaluable.  Furthermore, each week we will practice all the techniques for those topics with critique from the other residents, as well as the USC orthopedic residency program director. 

Lastly, I participated in USC's white coat ceremony.  Being that SLU implemented white coats after my class, it was very special to be a part of.  USC's white coat ceremony inducted the DPT class of 2016, Residency class of 2013-2014, as well as the Residency graduating class of this year.  USC brought in all of their PT faculty and some very well know alumni also.  It was a great way to meet influential physical therapists and get their advice. 

Most of my days are filled from early mornings to late nights and while exhausting, it has been energizing.  Many challenges are to come and I am looking forward to each and every one of them!

Hopefully this will start to give you all an insight into what a sports residency is all about.  Next up will be updates from Chris and Jim.