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OPEN YOUR MIND!

2/11/2018

There are a lot of controversial tools in physical therapy that have recently stimulated some great online conversation. Much of the debate appears to surround the use of tools/techniques for myofascial release. Personally I do not find myself buying into much of what is out there because the research behind it is mediocre at best... but then again... much of what we do as physical therapists is not backed by good, solid, unbiased research.

Recently I found myself at a course for the use of a tool I did not fully believe in. While I was still not completely sold on the device by the course's end, clinical pearls were practically raining from the sky: palpation techniques, body mechanics, patient positioning, draping methods.

Exposing yourself to different aspects of physical therapy can help increase other practical skills. Simultaneously, your empathy game will improve with patients who had direct experience with that physical therapy tool. Open your mind to different concepts no matter what the the current research says. Besides, you never know what the next control trial might find.

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Pelvic Assessment: Alone and Behind Closed Doors

2/4/2018

Many of us have been acquainted with the stories of Larry Nassar's pelvic "treatments." This brought to light how important it is to protect our patients during internal pelvic assessments and treatments. Some ideas I have seen implemented include audio recorded rooms. Personally, when behind closed doors, I now give patients a 2 way radio to hold; the second radio stays with the front desk. I encourage patients to contact the front desk via radio at any time he or she feels in danger.

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Introducing the Physical Therapist Assistant (PTA)

1/28/2018

For those who work along side physical therapist assistants (PTAs), at some point, a patient you work closely with may wind up on your colleague's schedule. Patients should be made aware, before their next session, that they will work with someone else. In the past, I have found that transitioning providers goes much smoother for everyone when the ice is broken in advance.

When acquainting patients with PTAs, I typically say something to the extent of, "I would like to introduce you to Jim. He is the physical therapist assistant who will work with you next time." This is a pretty standard introduction that can be modified to introduce a physical therapist. If there is concern over Jim's credentialing as a physical therapist "assistant," I typically will offer that "Jim is great at what he does and we work very well together. Before your next appointment, he will be well familiarized with your case. However, it is always your right as a patient to chose your provider so if you are more comfortable working with me or someone else, we can see what other appointment options we have available."

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Complimentary Calls

1/21/2018

For any variety of reasons, the time will come that a patient will have to cancel an appointment. If the open slot cannot be filled by another patient, what do you do with that time? It may be helpful to check in with patients remotely. Sometimes patients have questions or concerns that they are uncomfortable reaching out about between appointments. Generally, I make direct phone calls because I believe it adds a more personal touch, however, email may work just as well.

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Clinic Atmosphere!

1/7/2018

Physical Therapists appear to be outgoing by nature (tooting my own horn). However, at times, that light heartedness gets lost in the clinic. Even though we work with clients who may be in pain, it is important to maintain a positive friendly atmosphere. I fight the monotony by coming up with fun questions that reverberate across the clinic and spark discussion. One of my personal favorites is "if an apple a day keeps the doctor away, what kind of fruit keeps the physical therapist away?" Try using this question the next day you go into clinic, you will be amazed by the creative answers people come up with!

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Flip-Flops During Pregnancy?

12/31/2017

Too often do individuals who are pregnant experience lumbosacral pain; many of which wear flip-flops. With said people, we can work tirelessly performing therapeutic exercises, manual therapy and neuromuscular re-ed. However, the thing I find to offer the most immediate symptomatic relief is modification of footwear from flip flops to sneakers. Remember that during pregnancy ligaments are much more lax, thus joints are more prone to alignment alterations. Early education about proper footwear may help decrease the likelihood of developing pain in the lumbosacral region during pregnancy.

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Save the Home Exercise!

12/24/2017

Many of us seem to remember numerous superfluous details of patients' personal life (ie. number of kids, name of pet, favorite Pokémon, etc.), but why is it so hard for us to remember the home exercise program (HEP)? Not recalling the HEP gets tricky when a patient reports “I lost the copy you gave me” (I would have lost it too). Typically I will suggest keeping an electronic copy in their file so you can quickly print it out. If you still are using some form of paper system, keep an extra hard copy in his or her file so you can easily photocopy it.

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Vexation on Vacation

12/17/2017

From time to time, patients with chronic pain come along who, after seeing you for only a few sessions, leave for an extended vacation. To prevent regression, sacral wedges and other self mobilization tools may be useful once musculoskeletal needs of a patient are identified. I suggest identifying said needs, then reviewing self mobilization techniques prior to the prospective patient's departure.

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Same Gender Presence during Treatment

12/10/2017

When working internally with someone of the opposite gender, I typically suggest having a person of the patient's identified gender present; albeit not a requirement. In my experience, patients tend to be more comfortable in the presence of someone who can relate to the associated complications of his or her anatomy during internal pelvic treatments. The third party does not require a healthcare background, typically someone from the front desk will suffice.

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To Befriend or Feared

12/3/2017

My fellow physical therapists, we worked hard for our doctorate status, however, do our chronic pain sufferers need to think they are at the "doctor's" office every session? Generally speaking, when a patient comes in for some form of chronic pain, they have seen a medical doctor or two in their search for an answer prior to pursuing conservative management. If a patient is due to visit your clinic for treatment on a weekly basis, potentially for months on end, should we not be a first name basis? My thought process is that a patient seeing me as "Dr. Vernola" reinforces the implication of illness, further, reinforcing pain perseveration. To all patients, my introduction is "hello, my name is Dr. Vernola but you can call me Nick. I am the physical therapist working with you today." The above introduction informs patients of my qualifications, instilling confidence, while decreasing the potential for rumination over the fact that he or she is at a "doctor's" office each session. Despite the daily gulp I take to swallow my pride, it makes the occasional "thanks 'doc'" from a grateful patient that much sweeter.

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