Michael Blair, MSPT

If you’re like me, you understand the importance of exercise, but sometimes find the process to be less-than-exciting.  There are days when I just don’t have it, admittedly, and would rather play basketball.  There is no problem with that.  The trouble starts when the strengthening gets entirely omitted from our weekly routine and we spend the weekend surfing, golfing, hiking, balling, or whatever the recreational activity of choice is. 

Time is the issue.  I am lucky to work in a 9-5 job and currently don’t have children, so my schedule permits me to exercise throughout the week.  I understand that people work late, want to see their children, want to kick back, want to eat at some point, or don’t want to spend money on a gym membership they can hardly find the time to use.  So it seems impossible to meet the demands of 3-5x/week of exercise.  Hopefully over the next few paragraphs we can make it work and come to an agreement, of sorts, that we can do it.  We can find the time.  We may have to get creative, but it’s there.  Making this little commitment can help with minimizing your risk of being another meniscal tear on the basketball courts, another sore elbow swinging a racket or club, or another hiker in your group with patellofemoral pain.

First, let’s understand the problem.  We are staying active later into our lives because of medicine, orthopedic surgeries and enhanced awareness of health and fitness.  There is a natural progression of wear in our bodies that inevitably causes joints to ache,  slow us down, and make us feel stiff.  That process is accelerated when we decrease our muscle strength in the body and increase the force absorbed in our joints.  Think of a car with no shocks.  Those speed bumps would be pretty brutal without them.  Without the muscles absorbing the impact of our steps, the joints accept more.  Some research states that each foot strike in running results in 7x our body weight in force.  You will want some pretty good shocks to handle that for your 4 mile and 1,000 step run, no?  So we can’t simply cut out the exercise portion of our workout because it is essential in prolonging our ability to kick butt at our favorite sport or hobby.

Here are my suggestions.  First, ask for help.  There are physical therapists and personal trainers that specialize in making sure that you know how to properly exercise.  Every sport will have different demands, and a specific exercise program can make the difference between watching your favorite sport on TV or playing until you win the senior’s tournament.  I know it may cost some money, but their sole job is to properly educate you.  The training can be tailored to your needs, whether you want a killer gym program or something you can do at home.  When done properly, you should only need a couple of appointments to get it right.  Then get back to them when you want a change. 

You need to stretch.  You can refer back to a previous article in this newsletter about the benefits and proper methods.  When we “pull hammies” and “tweek our shoulder” it’s often because we didn’t properly stretch before our game.  Stretching should be done daily to loosen our muscles, and ballistically before sport to get the muscle ready for the quick stretch-shortening cycles associated with rapid movement and directional changes. 

We need to train with  mulidirectional motion and plyometric strength.  A lot of injuries occur because we do bench press, bicep curls and squats and expect to be prepared for cutting, kicking, jumping, and chasing down that wide tennis shot.  In the real world, we move in three planes with every activity we do.  If we expect our muscles to execute a killer crossover or get us down those black diamonds, shouldn’t we strengthen them for those movements?  A squat handles a piece of it, but not the turns, the quick transitions in terrain, or even the braking.   Again, if you are unsure how you can train yourself in these multiple planes, speak to someone who can and get the training started. 

All of our muscles operate best when we are solid in our core.  Just like you want the rocks to be stable beneath your feet when you climb a hill, your hip muscles want your pelvis to be stable when they try and lift your leg.  This concept is very important.  There are multiple disciplines that incorporate core exercises into their training.  There is no “best way” to train it as long as you are focusing on stabilizing your spine in multiple planes and  in a variety of positions.  It, again, should be tailored toward your goals and focus on movements you will encounter in both your day-to-day tasks as well as your recreational activities.  

Follow these steps and get the proper training to help continue your weekend hobbies.  If you exercise right, incorporate realistic motions into your routine, and properly prepare yourself before the sport, you have a decreased likelihood of an injury ending your career early.   After all, you’ve got to show your grandchildren the importance of a good jump shot.

Best in Health.

Karen Seade, MPT OCS

Optimize your quality of life, productivity and job satisfaction by incorporating ergonomic concepts while working at your computer!  Ergonomics is the applied science of fitting one’s workspace to promote proper posturing and positioning.  Proper ergonomic design is imperative to prevent repetitive strain that most commonly contributes to the development of neck and back pain, elbow and rotator cuff tendonitis, carpal tunnel syndrome and fatigue.   

Key points to consider for a more user-friendly computer workstation include:

1. Maintaining an upright posture while sitting back in your chair for optimal back support with the head, shoulders, and hips aligned directly over themselves.

2.  Chair height should be high enough for the elbows and hips to be parallel to the ground with the feet rested firmly and flat on the floor.

3.  The top of the monitor should be at eye level.  Add a document holder if intaking data on a regular basis to maintain upright head and neck alignment at all times.

4.  To avoiding forward shearing of the neck and to decrease eye strain, position your monitor no farther than arms length away.

5.  The keyboard should be on a flat surface to allow your shoulder to be relaxed and elbows to be held no more than 1-2 inches from the sides of the body.

6.  The wrists and forearms should be straight and perpendicular to the body.  Position your mouse next too and and at the same level of your keyboard.

7.  Make sure that you have adequate lighting and position your computer so that it is perpendicular to a window rather than facing straight ahead.  If you are lucky enough to have  lots of windows in your office shear window coverings can help cut the glare. 

8.  Use a head set or blue tooth if talking on the phone.  Please avoiding holding the phone between your ear and shoulder!  OUCH!

9.  Avoid repetitively bending down and twisting to reach into below desk file cabinets.  Consider positioning them elsewhere to force you to get up and walk around your office.  

And last but not least..

10.  Clean up your clutter!  It is amazing what a organized desk will do for stress relief and peace of mind. 

There are amazing new products in the marketplace to address situations that are not easily fixed by rearranging our equipment with no need to break your bank.  Be wary of buying products that market themselves as being “ergonomically correct” sometimes the more simple products are just as effective and cheaper.  Stop by SportsMed  or give us a call and let us help make you more comfortable while at work!

Jerri Robertson, MPT

In an attempt to educate on the subject of bursitis, I came upon an interesting dilemma.  How do you make bursitis interesting?  A bursa is simply a fluid-filled sac that resides between muscles and tendons or tendons and bones.  It just sits there.  Watching grass grow could be deemed more exciting;  at least it’s doing something.  But the bursa does have an important function, and bursitis is a common problem that affects people of all ages and activity levels.  Learning what it does can help in understanding how to treat the nagging injury.

The job of a bursa is to reduce friction between two surfaces.  It serves as a cushion between muscles and bones allowing for more fluid motion at a joint. Because of it’s location and function, it’s highly likely a bursa will become irritated as the muscles are used throughout the day. The result is swelling of the bursa and painful, restricted motion.

Bursae are designed to reduce friction, but if we are consistently rubbing on the bursa, eventually, it will reach a point where it can no longer handle the pressure.  An example of this is “subacromial bursitis”, a common cause of shoulder pain, which results from overuse of the muscles surrounding the shoulder joint. The same can occur behind the knee, in the elbow and in the hip.

Symptoms of bursitis are often similar regardless of the cause or location of the bursa.  The result is painful, restricted motion of the joint.  Pain is predominantly localized to the area and is often described as a “burning” sensation. As the day progresses, pain can radiate to other areas. In some cases, you can actually see the swelling of the bursa.

In acute cases, or the early onset of symptoms, treatment is often rest, ice and anti-inflammatory medication, which may be prescribed by your doctor. By rest, I mean avoidance of the activities, which seem to aggravate the symptoms. Your doctor may also prescribe physical therapy.

The most important objective in physical therapy is identifying and treating the underlying dysfunction causing the bursitis. As is mentioned above, bursitis is often the result of muscle imbalance, weakness and poor mechanics with repetitive motion. Physical therapists will focus on reducing the pain and swelling initially and will progress you through a strengthening program to restore the normal joint mechanics.

Bursitis is very common but can be limiting if left alone too long.  When treated quickly, it can easily be remedied, thus, recognizing some of the symptoms is important to a speedy recovery.   Hopefully, this boring little blob will sit quietly in your body and never be a pain, but in the off-chance that it becomes aggravated we hope that you will address it early and work with your MD or therapist to identify the cause and return your bursa to its normal mundane state.

Wishing you good health,

Jerri Robertson, MPT

 Michael Blair, MSPT: 

We’ve all had our bumps, bruises, tweeks, pulls, strains, sprains, and pops.   Almost just as often, we assume everything will be ok if we just ignore it for a few days and let the body deal with it.   A better understanding of what the body is doing while it’s “dealing with it” can make the difference between complete resolution and a nagging injury.   There are certain things that we can do to help in the body’s natural responses and it starts with RICE.

When we are injured our body has a specific method of repair.  The initial phase is termed acute inflammation and is characterized by 4 principal signs: rubor (erythema, or redness of the skin), tumor (swelling), calor (increased tissue temperature), and dolor (pain).  The phase is mediated by chemicals and cellular activity that attempt to clean damaged tissue and remove debris to help prepare for the next phase of healing.  This phase can last up to 5 days with some aspects believed to last up to a few months. 

The strategy that works best at progressing through acute inflammation and not suffering some of its negative impacts such as weakness, stiffness, and pain is rest, ice, compression, and elevation or RICE.  

Resting the injured body part is important because inflammation weakens tissues around the injury as a protective mechanism.  Those tissues are more vulnerable to injury if we do too much too soon. 

Icing can help with pain levels and also helps to reduce the influx of blood going to the injury site which has damaged vessels; kind of like trying to shut the water off in the building when you have a leaky pipe. 

Compression also helps to reduce the amount of blood going to the area and helps our working blood vessels to drain blood through our lymphatic system and remove waste. 

Elevation also helps our veins drain blood out of the injured area towards the heart and prevents it from becoming stagnant.  If blood does not return efficiently clotting can become a concern.  

Remember that acute inflammation is only 1 part of your body’s recuperation. If we manage the initial phase properly we can effectively move on through the next phases of healing and are more likely to prevent chronic pain.  The remaining soft tissue healing process can last from 4 weeks to a few months, but also must be managed appropriately to prevent further aggravation or injury recurrence.  Physical therapy helps to guide you through this process and heal the body correctly the first time, and teaches you how to make sure that any bumps along the road are handled properly. 

Most of my clients come to me between 2 and 3 months after an injury.  Unfortunately, by this point, the injury has become chronic due to re-exacerbation from improper management.  The best way to deal with an injury is to begin with inflammatory control using the RICE strategy at the onset.  Your physician will determine the severity of the injury and can help provide you with pharmaceutical methods to alleviate pain and swelling.  If appropriate, therapy may be advised to guide the remainder of your recovery.  Therapy is most effective when the injury is dealt with in the earliest stages and it is in everyone’s best interest to start the process quickly.  Waiting can only increase the likelihood of reoccurence and keep you from enjoying your favorite hobbies, activities, and sports.

Best in Health

Michael Blair MSPT

Karen Seade PT, MPT, OCS

Implimenting Pilates based exercises into a traditional rehabilitation environment can provide patients a more hollistic approach in correcting underlying physical problems.   As a certified pilates instructor I have seen great success incorperating Pilates within my practice in treatinga variety of patients with chronic pain conditions, arthritis, spine dysfunction and post surgical restrictions.   

Joseph Pilates developed this method of body conditioning in the early 1900s after he was stricken with a weakened system due to having asthma and rickets as a child.   During the first world war he introduced his movement techniques in hospitals where patients needed to strengthen despite being nonambulatory by attaching spring systems to hospital legs in attempt to exercise the body with the effects of gravity eliminated.    Shortly thereafter patients began to recover more quickly than previous methods – it was at this time that he developed his first spring loaded reformer apparatus for exercise execution.  Since then, Pilates  has been widely utilized among dancers, gymnasts, and most recently over the past 10 years in the rehabiliative and health club  sector due its various benefits.   

The essence of Pilates based movement is  to develop a strong postural system where upon healthy movement may thrive.  Exercises focus on postural correction and development of movement awareness in order to create a balanced muscular system for stress reduction, injury prevention and overall physical well being.  
The major principles of Pilates exercise execution all include concentration and control, movement precision, flowing movement and breathing making it a safe and effective technique for those who have sustained injuries.   Pilates body conditioning has many physical benefits including stress reduction, promotion of blood circulation for tissue healing.  Executed movements provide strengthening while muscles are elongated and stretched to improve ROM and total body flexibility.   
Concentration, control and precision promotes movement awareness which is imperative for prevention and correction of physical dysfunction.   With practice, proper postural alignment becomes more instinctual not only improving overall physical appearance but helping to decrease faulty movement patterns associated with injuries stemming from repetitive strain and muscular fatigue.   Incorperation of the breath with movement precision also aids in decreasing emotional stress often associate with chronic pain and conditions such a fibromyalgia.   
While the Reformer and other equiment look quite intimidating, they provide a safer environment for people to exercise while challenging strength, balance, and flexibility training.   Lying on the reformer in a more gravity elliminated position, provides support for the spine allowing a safer environment for people to exercise with degenerative or arthritic conditions.   The equiment also allow for safe therapeutic exerice execution for people who have post surgical non weight bearing conditions.  Allowing earlier return to movement and diminishing the effects of post surgical atrophy and loss of range of motion.     

Last and most notably Pilates body condition focuses on strengthening the “core musculature”.  The core is comprised of four primary structures including the diaphragm, the deep abdominals, lumbar and pelvic floor musculature.  These four components work together to create a corset of stability about the lumbar spine.   The corset increases  intraabdominal pressure to support the spine and to decrease the transference of abnormal forces about this region providing for optimal injury prevention.  
Pilates based exercise is the ultimate mind-body exercise for anyone who wants to strengtheng, lengthen and realign their body to improve physical well being.  It also provides a safe and effective environment for physical therapists to treat patients with balance disorders, arthritis, chronic pain and post surgical restrictions.   These benefits of Pilates proves why it has gained such enormous popularity in the fitness and rehabilitative professions today.

Karen Seade MPT, OCS

We’ve Done It Again!!   – SportsMed LA has been rated above “benchmark” for our physical therapy services as determined by PTPN rehabilitation outcomes measure.  PTPN is the nations first and largest network  provider  whose members are in private practice.   PTPN works with insurance companies, employers, and physicians throughout the United States ensuring that patients seen by one of their independent providers is receiving utmost quality of care.   

PTPNs outcomes program, through FOTO  is a validated index that measures the quality and efficiency of providers.  It specifically tracks patient’s abilities and how they improved throughout their course of treatment as well as how satisfied they were with their treatment.  The results of this study are then compared to the largest database of rehabilitation outcomes measured to rank therapists’ performance and efficiency. 

The categories included quality assurance, credentialing index inspection, patient satisfaction,  outcomes percentile, outcomes benchmark and efficiency benchmark.

  1. Quality Assurance and Credentialing :  Score includes an office’s compliance in areas of care delivery, documentation standards, treating personnel, appropriate billing and patient safety.  Credentialling also reflects an office’s rating in areas of therapist continuing education, equipment used, cleanliness, handicap accessiblity and HIPAA and OSHA compliance.        SporsMed Rated: Above Standard !

2.  Patient Satisfaction:  A calculated measure of patients’ feedback on treatment effectiveness, staff courtesy and wait times.  SportsMed Rated:  Above Benchmark!

3.  Outcomes Percentile:  Each office received a percentile ranking based on their effectiveness and success in patient care when compared to the nation’s largest database of rehab outcomes.  SporstMed Rated:  Above Standard! 

4.  Outcomes Benchmark and Efficiency Benchmark :  Outcomes looked at how much better did patients actually get and efficiency benchamark related this to how quickly patient function was restored.   SportsMed Rated:  Above Benchmark!

As practicing therapists we are elated at these findings and are extremely proud!  Thank you to those who participated in this past years study and we hope to continue exceeding our patient’s and client’s expectations.

Best in Health -  Karen Seade MPT, OCS

Michael Blair MSPT

Sciatica is a term that is often used to describe an old back injury that’s been lingering for years.  I commonly hear the phrase “Oh, my sciatica’s acting up,” as a client, friend, or family member clutches their back or massages their leg and I immediately feel obligated to explain that this is often treatable and requires further investigation. 

Sciatica is a general term that defines a symptom of back pain.  The sciatic nerve is a large nerve that forms from nerves exiting our spinal column and entering each of our lower extremities.  When the back, sometimes hip, becomes inflammed it can aggravate the sciatic nerve and send pain down it’s pathway.  That pain is called “sciatica” for obvious reasons. 

Unfortunately, it doesn’t define anything.  Much like saying, “I have the body aches” when you have the flu, you are simply defining the symptom of another condition.  Four conditions that we commonly treat in our facility that create sciatic symptoms are bulging or herniated discs, sacroiliac dysfunction, degenerative disc/joint disease (DDD)/(DJD), and piriformis syndrome.  Here is a brief description of each of these conditions. 

• Bulging/herniated discs: The discs sit between each of our vertebrae and provide cushioning and  a fulcrum to move around.   They are composed of an outer layer of rings called the annulus and a gel-like substance in the center called the nucleus pulposus.  They act like jelly donuts in that a pressure on one side will create the nucleus to be pushed to the opposite side.  Enough of this pushing can cause the nucleus to push into and eventually through the rings (the dough of the donut) causing bulging and herniated discs, respectively.  This bulge can pinch the nerves as they exit the spinal cord and create symptoms that go into the leg, commonly referred to as sciatica. 
• Sacro-iliac dysfunction: The sacro-iliac joint is where your spine meets your pelvis.  In many cases, a slight discrepancy in position between the two sides of the joint can lead to strains of the ligaments, awkward loading of the joint, uneven muscle pull, or all of the above.  This will lead to pain, inflammation, and possibly sciatic symptoms as the sciatic nerve is formed by nerves that exit through the sacrum. 
• DDD and DJD are basically fancy ways of saying arthritis in your back.  As we age, our discs lose water and height causing the vertebrae to approximate.  The closer the bones are to each other the greater the friction between them.  This friction leads to loss of cartilage, bone spurring (which is essentially a callus on the bone),  and less space for the nerve to pass through as it exits the spinal cord.   Less space means a greater likelihood of being pinched by the bones and irritating the nerve, causing, (you guessed it,) sciatica! 
• Piriformis Syndrome: The piriformis is a muscle that begins on the front side of your sacrum and attaches to your hip bone.  It is responsible for turning your hip outward, known as external rotation.   For a multitude of reasons,  the piriformis muscle can become tense and tight.  The muscle has a unique relationship with the sciatic nerve as it passes directly over it before the nerve continues down into the leg, as illustrated to the right.  In many clients, irritation of this muscle or tension in the muscle can produce sciatic nerve pain and symptoms. 

All of the conditions mentioned above are treatable with a variety of techniques, but they will each require a different treatment plan and can be the result of different mechanisms.  Only a physician can make the diagnosis related to your sciatic pain, but once the origin of your problem is identified, your prognosis is improved and your able to take a more active role in your rehabilitation.  Physical therapy is often an effective way of treating the conditions listed and helping you understand methods to prevent re0ccurence. 

So, the next time your “sciatica acts up” call up your physician and make an appointment to discuss the problem.   With the right course of treatment you’ll quiet the rowdy nerve and put it on a permanent ‘time out.’

Michael Blair, MSPT

Our bodies are designed to shape and adapt to our environment.  As physical therapists, our goal is to teach you how to create the best environment for your body to function in and how to maximize your body’s potential for change.  The muscular system is complex and still not fully understood, but one thing we do know is that strength, agility, and power are all strongly affected by a muscles ability to lengthen and contract.  In order to fully harness our body’s full abilities and prevent strain,  we must consistently stretch as well as strengthen our muscles.

Stretching a muscle regularly can help increase its overall length.  This can decrease tension and compression on our joints, increase our range of motion (flexibility), and improve our muscle’s ability to create strength/power.   Flexibility is key to maintaining our mobility and maximizing our muscle’s function.

Here are some important considerations when performing your stretches.

• Make sure your stretches are appropriate for your activity.  Static stretching is great for elongating muscles and increasing your overall flexibility, but can temporarily weaken your muscles and make them susceptible to injury.  Static stretching is better for post-exercise relaxation, relief of tension, and improving mobility.  Ballistic stretching (where you bounce the stretch at end range) is better for exciting the muscle and getting it ready for quick action necessary for activities like running, jumping, cutting, and throwing. 

• Make sure to hold your stretches for an adequate duration.  Your muscles have a reflex that resists a stretch initially (to prevent you from over-stretching or straining).  You must hold a stretch long enough to dampen this response.  It can take up to 20 seconds for the muscle to relax and, thus, your stretch should last at least 30 seconds to give enough time for actual lengthening.  Studies have not shown a need to stretch longer than that, but feel free if you wish.

• Make sure to stretch consistently and regularly. Studies have shown that the effects of your stretching program will only last about 24 hours.  Therefore, to get the flexibility you are hoping for, you will need to stretch on a regular basis – which means daily.  There are no shortcuts and those that think that a quick stretch every so often is enough are fooling themselves.

• Develop a regular stretching program.  There are a lot of muscles in the body.   Just like you try to strengthen all of them in your workout, you should try to stretch them.  Having a consistent regimen will allow for better efficiency and commitment.  Most people are not born with an innate sense of what to stretch and how to stretch to make the best use of time.   A physical therapist is the best person to help you develop a thorough routine that suits your body’s needs. 

With advances in medicine and health, people are staying more active for longer periods of time.    Staying limber and flexible is an essential aspect of  maintaining the highest level of activity and health for years to come.

I hope this article has given you a few points to ponder and as always, please don’t hesitate to write or call with any questions or comments. 

Remember to stay loose!

Exercise has been proven to have significant health benefits for people of all ages. Unfortunately most exercise is performed incorrectly and it does more harm than good. Physical Therapists, everyday, work with a variety of injuries which for the most part can be avoided.  Here are some basic points to remember:

1. Use proper form: The most important thing to remember when performing an exercise is “quality” over “quantity.” You’ll get more benefit from performing fewer repetitions using proper form than doing more repetitions with poor form. Poor form usually results in compensations and places your joints in compromised positions – leading to injury.  While pushing up that impressive looking weight strengthens ones ego it does nothing tp prevent injury. See #2

2. Warm-up: Before starting any exercise it’s a good idea to start with 5-15 minute warm-up such as walking, jogging or cycling. This prepares the body for activity by increasing heart rate, circulation and the temperature of the muscles.  Improving circulation allows for greater oxygen supply and extensibility of the muscles. It also improves production of synovial fluid, which essentially acts as a lubricant for the joints to help reduce friction. Joints that are well lubricated move more effectively and reduce the risk of injury.

3. Use appropriate resistance:  It takes approximately 6 weeks of training to make true physiologic changes in muscle. Using too much weight or resistance while training is an incredibly common mistake.  An important thing to remember is to not strive to achieve everything in two to three sessions. A good place to start with resistance training, including free weights or machines, is performing 3 sets of 10 repetitions. The resistance used should be such that the last two repetitions are difficult but you’re able to complete the full range of motion.  Once you’re able to complete 3 sets of 10 repetitions without significant fatigue it’s time to progress. If your goal is to gain strength, try increasing the weight using 5lb. increments. If your goal is to gain muscle tone, try increasing the number of repetitions

4. Stretch:  No studies have proven the best time to stretch, however there are a few which suggest that stretching after workouts helps prevent muscle soreness.  During exercise, the muscles are broken down resulting in a production of metabolites that can cause irritation of the tissues and cause soreness and stretching may reduce this. Stretching will improve flexibility so as to not develop tightness and imbalance in any one particular muscle group that may affect your posture.

5. Rest between workouts: Rest between workouts. Training 3-5 days/week is sufficient for strength and cardiovascular exercise. If your body feels tired and your muscles are fatigued, it’s better to take a day of rest. As mentioned above, muscles are stressed and broken down during resistance training. The body needs rest to allow for adequate rebuilding and recovery. Don’t rest and you are quite simply asking for a strain or an injury.  Overtraining also results in damage to muscle tissue resulting in weakening of the muscles rather than strengthening.

By incorporating these ideas, not only can you get the most out of your workout but also maintain your body at a healthier state.   Remember changing your body is a long process that requires consistent training.

Wishing you good health and an injury free workout,

Jerri Robertson MPT

Brian Hohl MPT OCS

Today I was given a copy of a New York Times article titled  “Treat Me, but No Tricks Please”.  The article  by Gina Kolata was written and printed on January 7, 2010. 

The link to the complete article is: http://topics.nytimes.com/top/reference/timestopics/people/k/gina_kolata/index.html?inline=nyt-per.

My first reaction was naturally defensive.  To read something you find so misleading and so poorly researched on a topic you have devoted years to is, to say the least, disheartening.  I knew that I would be hearing about this article for some time so I wrote to Gina Kolata. This is what I wrote:

To Gina Kolata:

“You need a new Physical Therapist. 

The same reaction to your article that my colleagues  are probably expressing to you was the same as mine.  Yet after a few moments I realized that this was actually your personal experience with Physical Therapy – and it does sound on the surface just plain bad.  I can go on about the assessments that should have been done for you and the lack of communication between you and your therapist but by now you have heard all that.  However, since you wrote and published on your experience and used that to lay doubt on an entire profession I feel obligated to respond.

Your implication that the standard of care within Physical Therapy is hot packs, ultrasound, and massage is just lazy reporting and its wrong.  I would be remiss to have your readers believe this without injecting some basics. 

Standards and Processes

First, Physical Therapy is a range of specialties.  One former classmate is a pediatric specialist, the other works exclusively with women’s health issues, another geriatrics.  There are several large divisions dealing with the spectrum of disabilities and ages of which I imagine you have no experience with.  From your article you are referring to one such area – Outpatient Orthopedic Physical Therapy. 

Good orthopaedic Physical Therapy is part investigation.  Along with your physician, we determine the underlying cause of the pain, the weakness, or debilitation.  Determining the best course of correction for you as an individual and for that particular fault is the next step.  We implement the plan.  Finally, we follow up to ensure that the prescribed course of action was indeed providing the intended result.  

THAT is the standard of care. Every single day.

THAT is what every person who walks into any PT office should expect.  Sometimes that means a single session or multiple sessions.  Occasionally, there is not enough progress to warrant continuing care and a person is referred back to the physician.   So as not to be misunderstood – not everyone gets all better.

Research and Justification

It is because everyone doesn’t “get all better” that we conduct research. People and the problems they present with can be complex and it is naive to believe otherwise.  It is the complex nature and multiple variables which confound research methodology. It is this same complexity which makes unbiased and truly valuable clinical research difficult to produce quickly. The final result of all this difficulty is that clincial decision making advances slowly and methodically.  One variable and one hypothesis at a time.  It is not some large conspiracy to hide the profession’s secret knowledge of uselessness.  Writing an article about the difficulty finding funding for the research you desire and want might be more useful to your readers.

VooDoo Products

Finally, from time to time products are presented to market that are just plain crazy.  And yes there are Physical Therapists out there that have neglected and reject their ethics and now push “voodoo” products.  Yet, the vast, overwhelming, and significant majority work hard every day helping solve real world physical problems – from head to toe and everything in between – for all ages.  A great website to review next time is www.quackwatch.com.  I’m sure you will have a legitimate field day finding VooDoo products.

 Gina, I am proud of my profession and I am proud of my colleagues who share the desire to better our clients and patients.  We will continue to see our techniques and efforts make difference.  We will continue our research and we will always improve. 

Good luck with your injury, hopefully you can begin to ask some tougher questions when it comes to receiving care.  If you need some recommendations for the New York area let me know.  I know many great Physical Therapists there.

With Regards,

Brian Hohl MPT OCS – Director of SportsMed/LA

To all my colleagues and professional friends – You do a great job, my research tells me so!