PT Elevated

Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. On our fourth episode of season 2 Julie Fritz, PhD, PT, ATC the Associate Dean for Research College of Heath at The University of Utah joins our hosts Kory Zimney and Paul Mintken discussing back pain, big data and health services outcomes research. Here are some of the highlights: While attending Pittsburgh University earning her PhD Julie worked with the iteration of the treatment-based classification system at the time and a couple of things were going on then, one was clinical care of patients and the other was creating a paradigm or framework that clinical research questions could be hung on.  She still says there is an important role for clinicians to have a framework to organize their thinking and that the evidence should be consistent with the best evidence we have at the time. Based on research there is value in early physical therapy for the care of back pain. Research has shown that with non-pharmacological interventions and focus on education, activity and exercise provided early on, outcomes tend to be better.  "At the core of a profession is a body of knowledge that we agree on. Where we have trouble in physical therapy is we do not know the parameters that are inside and outside that body." Back pain prevention work focuses on the acute to chronic transition. From the physical therapy perspective, it makes sense in terms of the prevention of reoccurrence but recurrence that leads to disablement.   "The type of person I like to collaborate with the most in research is a person who has and articulates bold ideas but holds them with a good bit of humility and is ready to be shown that it is a bad idea."  Julie Fritz Clinical Pearl: "I wish I would have appreciated the power of listening to patients and learning communication styles that were more patient centered. When I work with therapists in the context of clinical studies on strategies like motivational interviewing and I see that young therapists are much better at it than older therapists, myself included, I am envious at the way they are trained in those communications styles. They have a broader perspective of the biosocial approach in general than I know I received."   Helpful research and training: Management of Lumbopelvic Disorders Management of Lower Extremity Disorders Therapeutic Pain Specialist (TPS) Certification Ad Info: Continue your learning past what you hear today, EIM offers certifications that elevate your clinical decision making and help get you to the next level of patient care and expertise. Get 5% off by letting your program advisor know you’re a PT Elevated Podcast listener. Check out your program options here. Connect with us on socials: @ZimneyKJ on Twitter @PMintkenDPT on Twitter @jfritzPT on Twitter 

Chad Cook, PT, PhD, MBA, FAPTA, a professor at Duke University and director for clinical research facilitation, discusses the pros and cons of outcome measures, highlighting the influence of social, psychological, and economic factors on their accuracy. Multiple outcome measures are recommended to determine success. Validity and concerns with outcome measures are explored, as well as the feasibility and limitations of benchmarking in physical therapy.

Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. On our second episode of season 2 Jenn Stone, PT, DTP, OCS, PHC, joins our hosts Kory Zimney and Paul Mintken discussing her specialty area of pelvic health, but specifically for non-pelvic health clinicians. Here are some of the highlights: "The most common things I treat that have a pelvic floor component are things that you probably treat too. Low back pain, hip pain, I work with a lot of people pre and post-pregnancy but other conditions we treat include constipation, pain with some type of intimacy and that can happen no matter what your genitalia are. We work with folks that have erectile dysfunction, because that’s mostly musculoskeletal believe it or not. We work with individuals that have organ prolapse. Even chronic pain conditions such as endometriosis or polycystic ovarian syndrome can have some musculoskeletal components to them." Clinicians are often already seeing pelvic floor patients; they just may not be able to identify them or provide them with the optimal care to get them better. There are many treatment options to care for patients with pelvic floor concerns, where your patient won't have to take any clothes off. Studies suggest that patients don't bring up issues with incontinence or issues with sexuality in clinical settings, because they are afraid they will embarrass their healthcare provider. It's up to the clinician to ask those questions, even if it's just on the intake paperwork. Use the word leakage instead of incontinence, because people relate to having leakage more readily than the word incontinence. The pelvic floor is one component of motor control for the trunk, the abdomen and the pelvis. Leaking typically comes from overutilization or underutilization of the pelvic floor muscles. Some of the top mistakes that clinicians make with patients that need pelvic floor treatment is not asking them questions, making assumptions about which patients need pelvic floor care, pushing off pelvic floor patients to specialists, overprescribing kegels and not paying attention to the patient's breath control when they are doing exercises. Jenn Stone's Clinical Pearl: Looking at patients like they are whole people is incredibly important. Talk to your patients about stress management, mindfulness, fluid intake, fiber intake in addition to exercise, motor control training and musculoskeletal techniques. These extra pieces will help you look at the patient as a well-rounded individual instead of zooming in on them as a hip patient. Our patients are our best teachers. Helpful research and training: 'The core': understanding it and retraining it in individuals Certificate for Advanced Musculoskeletal Management of the Pelvic Girdle Pelvic Health I Connect with us on socials: @ZimneyKJ on Twitter @PMintkenDPT on Twitter Jenn Stone's Bio

Welcome back to PT Elevated! On the brand new season we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. On the first episode, Adriaan Louw, PT, PhD, joins our hosts Kory Zimney, Paul Mintken and JJ Thomas to discuss what else but pain science. Adriaan talks how he was introduced to pain science and how he uses pain science in the clinic alongside every other intervention that he would use. Adriaan Louw's Clinical Pearl: I would tell my younger self as a new graduate is that it's all about relationships. If you build relationships with referral sources and I tell a patient about pain, it's less likely that the doctor will get mad because they know who I am. With patients it's about relationships, therapeutic alliance and trust. It's about relationships with your fellow therapists and colleagues. It's not just about fixing things; the relationship part is so important. Connect with us on socials: @ZimneyKJ on Twitter @PMintkenDPT on Twitter @primalphysicaltherapy on Instagram Primal Physical Therapy website

We have had an incredible first season of PT Elevated! In this season's final episode, we are going back through the clinical discussions we have had throughout the season. Join Kory, JJ and Paul as they talk through the expert guests' clinical perspectives that they thought were most helpful for new clinicians. Here are some of the highlights: Every guest had a systematic approach that was different from the other. The focus shouldn't be on the systematic approach but about using your systematic approach well with your patients. Doing the basics well is one of the most important things to work on as a new clinician, because experts do the basics well. Don't be afraid to have questions. Having questions in your practice is how you learn and grow. Take the time to step back and think, instead of jumping on the first diagnosis that comes to mind. Try to prove yourself wrong. JJ's Favorite Moments from the Season: On Teresa Schuemann's episode, she said that you can't grandma off the couch and teach her power cleans right away, but you can teach someone that is a grandma how to do power cleans and other exercises properly and you should. Along with Derek Clewley's advice to clinicians to be curious. Paul's Favorite Moments from the Season: The idea reflected by many of the guests of "keeping a beginner mind" as a clinician. And the stress that was placed on taking the time to get to know your patients. Kory's Favorite Moments from the Season: The humility of the expert guests, giving up their time to help all clinicians with their expertise. Ad Info: Continue your learning past what you hear today, EIM offers certifications that elevate your clinical decision making and help get you to the next level of patient care and expertise. Get 5% off by letting your program advisor know you’re a PT Elevated Podcast listener. Check out your program options here. More Links: Catch up on all the episodes @ZimneyKJ @PMintkenDPT @primalphysicaltherapy

Mark Gallant, DPT, OCS, FAAOMPT, joins our hosts Paul Mintken and Kory Zimney to talk through lateral hip pain. Dr. Mark works at Onward Richmond, an out of network practice in Richmond, Virginia focused on helping athletes heal quickly and perform better. Dr. Mark is also a graduate of Evidence In Motion's Orthopaedic Physical Therapy Residency and the Orthopaedic Manual Physical Therapy Fellowship. Here are some of the highlights: Alison Grimaldi's JOSPT article, "Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management" on hip pain in 2015 is the key article that can give you a good foundation to learn more about lateral hip pain. Tissues take time to heal. Three visits is not always going give you the time to see your patients get better. The tendon is not going to heal if the patient doesn't eat proper nutrition, get proper sleep and have some sort of activity that they do. The lifestyle aspects are the best place to start. For runners suffering from, doing hip strengthening is not going to change running mechanics, so the first place to start with these active individuals is to look at their running mechanics. Mark Gallant's Clinical Pearl: Excessive data is the enemy. Doing a few tests really well, having a few manual therapy techniques you can do really well and having a few exercises that you can coach really well will be more productive than doing a mediocre job at everything.  Ad Info: Continue your learning past what you hear today, EIM offers certifications that elevate your clinical decision making and help get you to the next level of patient care and expertise. Get 5% off by letting your program advisor know you’re a PT Elevated Podcast listener. Check out your program options here. The last episode of the season will feature questions and comments from you the listener. Send your questions, whether they be episode-specific, clinical or research-related to podcast@eimpt.com. Your question may be featured in the last episode, so include some info about you and your practice. We look forward to hearing your questions! More Links: Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management Contact Mark Gallant @ZimneyKJ @PMintkenDPT @EIMTeam

Derek Clewley, DPT, PhD, FAAOMPT, is an assistant professor at Duke Doctor of Physical Therapy program. He is on the team that worked on the 2017 revision of the Neck Pain Clinical Practice Guideline (CPG) as well as the upcoming revision. His research has spanned across orthopaedic physical therapy, including pain science, dry needling and manual therapy. Clewley joins our hosts Kory Zimney and Paul Mintken to talk through the 2017 revision of the Neck Pain CPG - how the articles were selected to inform the CPG and the process used to create it. Here are some of the highlights: The research that is chosen to inform the recommendations in the CPG goes through a rigorous process to be selected and used. The wealth of research allowed the 2017 Neck Pain CPG to be more definitive and confident in its recommendations, but going forward there will not be these earth-shattering changes to the CPG. Finding clinical decision dilemmas and solving them with the CPG as well as a clinical decision aid is one of the focuses to help clinicians implement the CPG into actual clinical practice. As an entry-level clinician, use the CPG as a foundation to build on for your clinical practice and clinical reasoning. Derek Clewley's Clinical Pearl: Be curious as a clinician. You can feel confident with your skills and the research, but strike the balance of being open and critical to new research and ideas. Be willing to be somebody different five years from now than you thought you would be. Ad Info: Continue your learning past what you hear today, EIM offers certifications that elevate your clinical decision making and help get you to the next level of patient care and expertise. Get 5% off by letting your program advisor know you’re a PT Elevated Podcast listener. Check out your program options here. The last episode of the season will feature questions and comments from you the listener. Send your questions, whether they be episode-specific, clinical or research-related to podcast@eimpt.com. Your question may be featured in the last episode, so include some info about you and your practice. We look forward to hearing your questions! More Links: 2017 Neck Pain Clinical Practice Guideline @djclewpt @ZimneyKJ @PMintkenDPT @EIMTeam

Erik Meira, PT, DPT, has been practicing physical therapy for over 20 years. He mainly treats elite athletes at this point in his career alongside running his own company The Science PT, where he hosts a podcast, writes blogs and teaches continuing education courses. Meira joins our hosts Kory Zimney and Paul Mintken to talk about all things ACL injuries. Here are some of the highlights: Foundational Research for ACL Mechanisms for noncontact anterior cruciate ligament injuries: knee joint kinematics in 10 injury situations from female team handball and basketball Young Athletes With Quadriceps Femoris Strength Asymmetry at Return to Sport After Anterior Cruciate Ligament Reconstruction Demonstrate Asymmetric Single-Leg Drop-Landing Mechanics Compensatory Strategies That Reduce Knee Extensor Demand During a Bilateral Squat Change From 3 to 5 Months Following Anterior Cruciate Ligament Reconstruction Measure your athlete's quad index by thinking of your testing protocol as a combination of hurdles that the athlete needs to cross. One test can't answer everything. Taking a step back to consider if there are any other ways to explain the effects you are seeing in your patients is an important part of growing in your clinical reasoning.  Erik Meira's Clinical Pearl: I just want to do function, but it's important to get back to the simple, basic things and do them very well. Get yourself a hand-held dynamometer that has an inline setup with a push-pull setup. Then, use it for quantifiable, reliable measures. Ad Info: Continue your learning past what you hear today, EIM offers certifications that elevate your clinical decision making and help get you to the next level of patient care and expertise. Get 5% off by letting your program advisor know you’re a PT Elevated Podcast listener. Check out your program options here. The last episode of the season will feature questions and comments from you the listener. Send your questions, whether they be episode-specific, clinical or research-related to podcast@eimpt.com. Your question may be featured in the last episode, so include some info about you and your practice. We look forward to hearing your questions! More Links: The Science PT @ZimneyKJ @PMintkenDPT @EIMTeam  

Nick Rainey, PT, DPT, OCS, FAAOMPT joins our hosts Kory Zimney and Paul Mintken to talk about temporomandibular disorders (TMD). He shares his expertise in diagnosing, treating and how to use the knowledge you already have as a physical therapist to help a large portion of patients with TMD. Here are some of the highlights: Nick Rainey shares how he gained his expertise in TMD through his desire to understand what he felt was an orthopaedic and pain disorder that he could have a real impact on as a physical therapist. One of the main screeners for new patients includes a central sensitization screen to help determine overlapping pain conditions, which is often a factor with TMD patients. There is a bi-directional relationship between the jaw and the spine. Treating the dysfunction is the key in determining whether to treat the spine or the jaw, instead of treating based on where they are feeling pain. The biggest mistake that new clinicians make when looking at a TMD patient is paralysis by analysis. Treat what you see, and don't worry about over-analyzing. Dry needling the lateral pterygoid is really helpful because you can't reach it with your hand. Nick Rainey's Clinical Pearl: Who cares what you do? Who comes after you if you make a mistake? Understanding how Medicare can fine you and what exactly the HIPPA rules are for your state is important for clinicians to understand what their risks are. Ad Info: Continue your learning past what you hear today, EIM offers certifications that elevate your clinical decision making and help get you to the next level of patient care and expertise. Get 5% off by letting your program advisor know you’re a PT Elevated Podcast listener. Check out your program options here. The last episode of the season will feature questions and comments from you the listener. Send your questions, whether they be episode-specific, clinical or research-related to podcast@eimpt.com. Your question may be featured in the last episode, so include some info about you and your practice. We look forward to hearing your questions! Additional Links: Nick Rainey on LinkedIn @ZimneyKJ @PMintkenDPT @EIMTeam

Kyle Kimbrell, PT, MPT joins Kory Zimney and JJ Thomas to discuss using Blood Flow Restriction (BFR) in the clinic. Kimbrell was first exposed to BFR through research and Johnny Owens' twitter and now works as an instructor for Owens Recovery Science in the West Coast Division. Here are some of the highlights: The clinical reasoning behind using BFR with the right patients comes down to a better understanding of the muscle and how it responds to load. One of the best cases for BFR are people that have an osteoarthritic knee. You can make the quadricep work hard and the knee doesn't have to  Getting your patients discharged quickly doesn't mean that you were successful with your patient. Many patients need capacity building and biology building takes time, and BFR helps with building that biology. In building muscles, load isn't as important as making the muscle tired. Convincing your patients that are scared of BFR can be as easy as just telling them that the pressure can be tight, but it will only be for a few seconds. Then, you can underload and give them the highest pressure just to let them see how the muscle feels and be familiar with it. BFR can reduce the time under tension, because it makes your muscles fatigue faster. When your patients starts counting all by themselves, you have the right load for your patient. Ad Info: Continue your learning past what you hear today, EIM offers certifications that elevate your clinical decision making and help get you to the next level of patient care and expertise. Get 5% off by letting your program advisor know you’re a PT Elevated Podcast listener. Check out your program options here. The last episode of the season will feature questions and comments from you the listener. Send your questions, whether they be episode-specific, clinical or research-related to podcast@eimpt.com. Your question may be featured in the last episode, so include some info about you and your practice. We look forward to hearing your questions! More Links: Kyle Kimbrell's LinkedIn @primalphysicaltherapy @ZimneyKJ @EIMTeam