Physical Therapist, Portland OR 🤝, Entrepreneur 🤔, Husband/Father 😍
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“A lot of a little makes a lot.” - Grandpa Hank
I use this term often with patients to describe: •how positive change happens. It’s slow, it takes perseverence, and takes patience.
•how conditions present typically in the clinic. Most patients don’t know why they hurt, or how their problem started. This describes the idea of cumulative microtrauma, with a tipping point likely causing the finally-painful onset.
It also describes how to build long-lasting patient relationships: .
•tell patients they can email you or call you anytime for advice, even after discharge. •teach skills throughout the day that can help patients with long-term management.. •call your patient 30 days post-discharge to see if they have any questions or concerns. Do it again in 3 or 6 months. •remember details about patient’s lives, such as their family, work, favorite foods, etc. Initiate conversations about them.
Nothing is better than warm referrals, such as patient’s friends, family members, co-workers. Build your practice through doing the little things for your patients, and the benefits will far exceed the little time spent doing these little things. Try to remember...... “a lot of a little makes a lot.”
#physicaltherapy #physiotherapy #patientcare #physicaltherapist #exercise #change #perseverance #chronicpain #chronicillness #patience
What patients value most out of their doctor........ coming in 1st is being a good listener
One of the greatest parts of the physical therapy profession is that we get time with our patients. Time to listen, time to learn about them, the whats and whys, and time to help make true change!
#physicaltherapy #physicaltherapist #physio #physiotherapy #listen #patientcare #ptschool #chronicpain #chronicillness #change #subjectiveobjective
Ever get this face when describing core training to a patient/client? .
You need multiple ways of describing core training to patients, depending on gender, age, occupation, education, etc.
1. First, patients need to learn to move their pelvis freely, and find a comfortable middle-ground starting point.
2. Teach how to breathe with good diaphragmatic movement, and good rib expansion. Pts with chronic pain are chronically poor breathers.
3. Use your cues for firing the gentle transverse abdominis. The tip is the word ‘gentle’!! ‘Gently draw the belly button towards the ground, maintaining your neutral pelvic position.’ ‘Gently scoop your abdominals from the bottom-up, without drawing your belly button north and while maintaining good belly breathing.’ 4. From there, the game is lever arms, with what the pt can control, without pain, and with progressive functional emphasis.
#physicaltherapy #physicaltherapist #physiotherapy #lumbar #chronicpain #core #corestrength #coreworkout #exercise
Ergonomics 103. Final TIPS!!! 1. Use duel screens? Whichever screen you use >/= 51% of time goes directly in front of you. The other monitor just next to it on left or right.
2. Do you sit in the corner of an L-shaped desk? It is hard getting close enough to have good posture sitting there. Two options: use a keyboard tray and adjust the monitor distance closer since the tray pushes you away from the desk, OR move your deskspace away from the corner and start fresh.
3. Use bifocals? Bifocals have you reading out of the lower part of the lens, forcing you to poke chin up to view the screen. Get readers for the ideal distance and use them specifically for computer use.
4. Unsure of armrests? Your armrests should adjust inward and angle in/out also. If not, and if you are a narrow frame, you may wish to have them removed.
5. Lighting? Sometimes poor lighting or outside glare forces you into bad postures to read the monitor. Purchase a monitor sunshade or look to improve lighting to help with this.
6. Set yourself reminders to stretch, posturally adjust, and give yourself frequent reasons to get up often. It takes time to train your body- it needs reminding until it’s habitual.
7. Ergonomics also includes work culture and work stress. You want an workplace that will help you be healthy and strive for safety, and one that allows you to relax and enjoy being at work each day.
8. Have pictures of you taken at your desk, and give them to a trusted health professional, so they can help you fine-tune it all!
#ergonomics #workplace #safetyfirst #physicaltherapy #physicaltherapist #physiotherapy #wellness #posture
Cul-de-sac fitness w/ kids............
This agility test should be included in the Return-to-sport criteria for athletes. Thinkin' we need some randomized controlled trials initiated! .
#physiotherapy #physicaltherapy #agility #returntosport #rehabilitation #quickness #acl #aclrecovery #familyfun
Reduce Cancellations & No-Shows and See your patients through to discharge
•do you have a high % of pt cancels, no shows, or drop offs on your schedule?
•increase the patient's 'value' of their appointment and decrease those rates by:
1. Verbalizing a clear path of what therapy is going to look like with you and your clinic. Discuss the pt's role through the process, and how you will work as a team together
2. Letting the pt know you are always available between visits, and even post-discharge, thru email or phone for questions/concerns
3. Setting goals/expectations at the end of each visit, for the next visit
4. Giving a clear home program which the pt understands, that addresses objective problem areas that, if improved, moves the pt closer towards their functional goals
5. To start each visit, reflect on the previous session, answer any questions they have, reassess pertinent findings, and set visit goals and expectations and new benchmarks. •
•If your cx/NS rates are high, take a positive, reflective look at the WHY. Try to not pin it on the pt, and say they were non-compliant. Ask yourself, "what could I have done better?"
#physicaltherapy #physicaltherapist #physiotherapy #physiotherapist #healthcare #patient #value #takecontrol #lowbackpain #neckpain #chronicpain
Ergonomics 102. •ergo 101 post described getting you and your chair right, prior to fixing your desk ergonomics. Think of "find your ideal posture, then build your environment around that ideal".
•Next, scoot in to the desk, and check the desk height......
•Can you maintain your relaxed shoulders and 90 deg elbow bend at that desk height? You may need to adjust your chair height if the desk is tall. That will bring your feet off the floor, though, so get a foot rest so your feet can be supported correctly.
•Do your arm rests stop you from scooting in close to your desk? If so, you'll need a keyboard tray to use instead of the desk.
•when in your ideal posture, your keyboard & mouse should be placed where you do not have to reach. •the monitor should be directly in front of you, approx. an arm's length away and the top of the monitor at eye height. WHY? We read most from this distance, and when we 'chest up, shoulder relax, and chin nod' it puts our vision to the middle of the screen, where we read the most from.
•Lastly, if you read from documents, get a document holder. If you use the phone often, get a headset!
#ergonomics #ergo #physicaltherapy #physicaltherapist #posture #lowbackpain #neckpain #chronicpain #shoulderpain #carpaltunnelsyndrome
Ergonomics 101. Teaching people how to assess their own workstation.
•start away from your desk. Get your chair right, and find your 'ideal' sitting posture.
•the feet need to be flat on the floor- it's hard to be stable without a stable base.
•cues for sitting posture: neutral pelvis, lift chest, relax shoulders, gentle chin nod (gets your eyes looking fwd).
•mold the chair around this posture. •TIPS:
1. if you have a neck history, don't let the chair-back tilt backwards. The farther your chair tilts back, the farther your eyes are from your screen, meaning you push your head fwd.
2. Your armrests should only gently touch your forearms when your shoulders relax in good posture. If you are slender, you may need armrests that shift and tilt inwards. •after maximizing your chair and posture, scoot back in to your desk and mold that desk area around this 'ideal' posture.
#ergonomics #ergo #physicaltherapy #physicaltherapist #posture #lowbackpain #neckpain #chronicpain #ergonomic #workstation
Chronic pain curve I originated years ago, published in the Practical Pain Management Journal last year. •
It describes posture, stretching, feel good interventions, and how people who have chronic pain differ from people who don't have chronic pain. I use this frequently, early in treatment, helping set expectations of how we will begin managing their chronic symptoms. I almost always use it if we are working on ergonomics, or working to improve something the pt does for extended time daily. •
The middle of the curve is 'perfect' posture. I never tell people they need to be here. The majority of the curve is 'ideal' posture, and the extreme outliers are BAD posture and FEEL GOOD positions. •
People with CHRONIC PAIN: their pattern is typically poor/unaware posture, then going into a feel good act (stretching, heat, ice, self-manipulation, etc (including massage, chiro, acupuncture/pressure, etc)). These interventions are not harmful, but what happens after? Pts go right back into the bad posture/lifestyle position, then back into 'feel good' position, and back/forth. What determines where they are on the curve? PAIN. Pts wait to hurt, b/c that's where their minds are trained in to focus. Now, they're in a vicious cycle where they seek relief 'extremes', and go back/forth in a REACTIVE way. •
People WITHOUT CHRONIC PAIN: aren't perfect (: They slouch all day long. They go from poor posture, maybe to then a stretch in the feel good extreme (reaching arms overhead, getting up and walking, etc), then posture in the 'ideal' portion of the curve, back to slouching, ideal, stretch, etc. If you asked someone w/o chronic pain how they were sitting 10 min ago, they wouldnt know. Their body naturally moves due to position-sense. Remember all the structures in our body constantly telling our brain where we are in space. Their body is atuned to POSITION, NOT PAIN. This is a PROACTIVE way to live, vs being reactive to pain and be in constant worry of the next pain cycle. •
To have your body 'aware' without having to think about it takes 10-15K reps. Train to recognize position, not wait for pain! #retrainthebrain #chronicpain #physicaltherapy #physicaltherapist #lowbackpain
I need to get to teaching my daughter to keep her core tight and back straight during wheelborrow racing!! It hurts me watching her form....... then I remember she's 4, and she'd just tell me 'well I beat you, dad' anyways!!
#corestrength #educate #physicaltherapy #core #plank #oceanside #familyvacation #familyfun
The best compliment from a patient is when they refer a friend, family member, and/or co-worker to me for my help with their musculoskeletal issues too!! Building your practice this way greatly improves job satisfaction! If you have a positive experience with somebody, you likely will enjoy that person's friends and family also. #physicaltherapy #physicaltherapist #bethechange #directaccess #apta #jobsatisfaction #customerservice #referrals
Many chronic patients come to me frustrated when they have a 'setback' in their rehab, wondering if they will ever get better!
I tell them that sometimes a regression IS a progression! That they are getting more active! They are becoming less fearful or anxious to try new things! I focus on what they can do, and reassure them of the path we are taking to get them back to their goals!
Most progressions will have regressions, or we aren't pushing the envelope enough. We need to sometimes find our 'wall', to know how to get to the point of breaking that wall down to get to the next one!
#chronicillness #chronicpain #rehabilitation #physicaltherapy #physicaltherapist #positivevibes
As little as a 2-3 degrees of knee extension deficit in the affected knee, compared to your 'good' leg, has been shown to result in lower long-term (approx 80%) functional outcomes. >90% the population has knee hyperextension, most between 5-6 deg hyperextension. Assessing for these subtle differences is vital to determining your initial care planning for these patients.
Donald Shelbourne describes assessing knee extension by grabbing the big toe vs the distal tibia. This gives you a better endfeel sense, letting you feel when the beginning resistance happens.
TIP: I prefer also palpating the knee joint line with my proximal hand, allowing me to feel the screw-home mechanism occurring at end-range knee extension, when assessing passive knee extension.
The subtle loss of knee extension causes compensated standing patterns, and a 'deconditioned' knee, affecting patellofemoral stress, and jeopardizing areas above/below the knee region.
Mobilizations to the tibiofemoral joint to regain knee extension prior to implementing a full strength program allows normal patterning when standing and walking, and begins 'normalizing' patterns through the leg. Then the strengthening can help maintain long-term change.
#KneeExtension #RegionalInterdependence #DeconditionedKnee #PhysicalTherapy #PhysicalTherapist #Physical_Therapy #ChronicPain #PatientCentered #acl #kneereplacement #knee
Ergonomics- an art of building your work environment around your postural 'ideal', rather than molding yourself to your environment. It's not about being perfect with posture, but rather having an environment that allows you to posture in your 'ideal' as much as your body requires. Give your body a chance to win!
#ergonomics #retrainthebrain #neckpain #chronicpain #physicaltherapy #patientcentered #physicaltherapist #manualtherapy
Every story has a tipping point. Most acute pain is due to cumulative microtrauma, with a final tipping point which results in pain. Acute pain is like an iceberg, most of its contents are hiding and unseen unless you seek to find it! 'Treat the pain, find the dysfunction, treat the entire person!' #Tippingpoint #Regionalinterdependence #ChronicPain #PhysicalTherapy #PatientCentered #PhysicalTherapist #ManualTherapy
Chronic pain is a fight or flight state of being, which includes chronically poor breathing and large-muscle guarding. The journey towards success begins by learning to relax, and understanding that you're going to be OK. "Learn to manage well!" #Relax #ChronicPain #PhysicalTherapy #PatientCentered #PhysicalTherapist #ManualTherapy