Fund #GetPT1st Now!

Many of us have enjoyed the benefits of the efforts of Sean Hagey in coalescing the profession behind #GetPT1st. Some folks were a bit skeptical about it in the beginning, but their skepticism faded as #GetPT1st stayed focused on its message and continued to deliver content that you, I, and our fellow PT’s have shared with colleagues, friends, and family.

Here’s the crazy part: Sean managed to rally the profession while working his regular job and devoting extra hours (and finances!) to the #GetPT1st campaign…his “pet project”!

Let’s rally behind Sean. Check out his video and donate by clicking here.

Who could have predicted #GetPT1st 5 years ago? Certainly not me. #GetPT1st turned into a powerful medium to spread the value and power of physical therapy, and I strongly encourage you to take part in the movement.

What’s not to like? Do it for your patients, do it for your profession. This might just be the most fulfilling money you’ve spent is some time.

Join me in supporting Sean by funding #GetPT1st here.

 

Premature Accumulation

I once heard a well-known founder of a Physical Therapy specialization certification program state that some clinicians who passed the Certification Exams prepared merely for the exam, and the process of preparation didn’t necessarily make them better clinicians. This made me wonder about those individuals who have accumulated a string of acronyms after their name, but weren’t able to efficiently integrate their achievements. It also reminded me of those clinicians with 1, 2, or no certifications who applied their learnings and are, consequently, more integrated & effective in the clinic.

Letters, titles… For what purpose? Why & for what goal? How has it changed you & your outcomes?

Most clinicians sacrifice time & energy to attain their titles with the intention of sharpening & expanding their clinical skills with the goals of achieving better patient outcomes, and, consequently, greater job satisfaction – among other things.

The decisions of which philosophy and framework of practice to pursue often bottleneck down to whether or not “the juice is worth the squeeze”. “The Juice” is usually some blend of curiosity, cost, continuing education credits (poor reason, but it is unfortunately the only reason for some), and clinical application.

One route some clinicians travel involves certain Clinical Specialties requiring sitting for a computerized exam. One example is the OCS – Orthopedic Clinical Specialist.

Allow me to rant about the OCS for a bit. Feel free to skip ahead…


The OCS is a regurgitation of dated material. I know this to be true because I was preparing for it last year. Although I decided to put it off until some time in the future, I appreciate the amount of time & effort it takes to memorize the required information for the test. Now, why anyone would want an OCS rests mostly on 2 legs: 1. Public Perception 2. Requirement for APTA Credentialed Residency programs. I find both of these reasons false & inadequate. Let me explain.

When it comes to public perception, it misleads the public into thinking those without an OCS are incapable to evaluating and addressing orthopedic concerns. This is blatantly false considering that a majority of our training in PT school is geared toward orthopedic assessment & treatment. Moreover, memorization and regurgitation DO NOT equate to better clinician reasoning skills. This might be one reason many (but, not all) folks are not better clinicians after attaining an OCS.

As it pertains to APTA Credentialed Residency Programs, the last thing you want as a requirement is rote memorization. It should be geared toward clinical reasoning and patient outcomes. An OCS does a mediocre job on this. How can studying for 1 weekend exam compensate or replace the achievements/efforts of year(s) of dedication and practice? It simply can’t. However, it is a nice recurring revenue generator to require Mentors have an OCS in order for a Residency to be APTA credentialed.


Given the benefit of retrospection and conversations with colleagues who have taken a fair number & variety of Continuing Education courses, I feel fairly confident with what I’m about to say.

If the contents of the course do not add to your clinical effectiveness or efficiency, then it probably wasn’t worth your time & investment. Additionally, if it didn’t inspire you to become a better (how ever you define better) Physical Therapist, then it most certainly wasn’t worth your time.

Maybe you’ve just experienced a life-altering Continuing Education course, and you’re excited about representing a movement that drives you to practice at the peak of your licensure. Now you’re nervously excited about the certification exam and are wondering if you really should pursue it.

Ask yourself: What are those letters after your name worth to you? To your patients?

Maybe the answer is, “those letters mean nothing to me. All I want is to learn the content, help my patients, and improve my clinical practice.” If that’s your response, then congratulations! You just saved yourself a shitload of stress and expenses by avoiding the brain-bending experience of studying for a certification exam.

If your response is, “I want to know that I’m applying the content effectively and at the highest level possible” then the letters might be worth the effort. If you believe the letters will provide you with leverage in clinical outcomes and evangelizing the Physical Therapy Gospel of the potential to live functional lives with zero-to-minimal involvement of pharmaceutical drugs and surgery, then the juice might be worth your squeeze.

The practicality of accumulating letters can distill down to a signaling mechanism that shouts “I know what I’m talking about!” Or maybe it says “I still haven’t found what I’m looking for!” (say it again with your best Bono impression). Maybe s/he is a genuinely curious individual with a passion to learn & grow as a professional.

Me? Well, I would go with the “Bono option” – I still haven’t found what I’m looking for… In retrospect, my certifications (so far) have been a boon to my clinical practice and experience. It’s been a cumulative and catalytic accumulation that provided me with a foundational conceptual framework on which I can mold my future professional growth.

I’m sure you’ve met individuals with an alphabet soup of letters after their name who do not practice at the top of their licensure/certifications. Even worse, they might have completely abandoned the teachings of these certifications, but continue to grace their business cards with these aching acronyms. False advertising, perhaps. Or… a premature accumulation of efforts with nothing to show for it other than limp advertisement.

A possible cure for this premature accumulation: finding a framework that you believe can last the test of time. This is significantly more valuable than a random accumulation of certifications.

P.S. – As many of you are well aware, I enjoy reading books. Early March 2016 saw the first edition of my Quarterly Readings Newsletter. It is an update on some of my favorite reads of the quarter. Email me with “I love to read!” in the subject line, and I will add you to the email list. 

Mea Culpa

2016 exploded onto the scene, and there’s no looking back. A couple milestones await for me in the next few months. One of them is a Physical Therapy Class Reunion. No, I’m not going to mention how many years have passed, but let it suffice to know that I’m more excited about our profession now than ever.

Emotion and Experience were vital components to my growth as a Physical Therapist thus far, and they will likely continue to play their vital role for the foreseeable future. Emotion and Experience are also vital components of our growth as human beings. Perhaps the Environment we grew though, and will continue to grow in/through, is an equally (or more) significant determinant in our Emotional and Experiential growth.

Either way, here are some thoughts that are crossing my mind in this period of critical change. I hope you find them as useful as I do.


Don’t shy away from asking yourself “What the fuck am I doing with myself?” Don’t shy away because there’s no wrong answer to this question. The reality is a very small percentage of you (no, it’s probably not you) are following a life-plan penciled perfectly in high school. Asking yourself this question is more about self-correcting than proselytizing. It’s a series of continual adjustments based on your long term vision.

Entertain yourself. It’s more fun than you can imagine.

Don’t shy away from intentionally disappointing someone if you know that there’s a high probability that the bread is about to fall jelly-side down. This doesn’t mean you have to be memorably offensive. Saying “no” effectively without crushing relationships is a skill worth developing.

Don’t worry about what people think of you. This simple life-hack will free your mind more than almost anything. Also, it clears your lens on life by allowing you to see how clever or transparent people truly are. You’ll be tempted to gain and keep the recognition of those smart people you think you identify with. The reality is you’re probably fooling yourself into building a self-image that is ultimately painfully unsustainable.

If you aren’t any closer to your desired lifestyle this year than the last year, then hop on that horse and make it happen. It’s incredible how 1 year turns into 3, and before you know it you’ve been treading water…at best. This simple fact will continue to boggle your mind in real-time and in retrospect. Some smart guy once said: “The best way to predict the future is to invent it.” He might be right.

Health is wealth. Yup, the oldies were right. Health truly is wealth.

Consider the impact of all the non-renewable resources in your life. “Time” deserves to be very high on that list.

One of the few constants other than Time is Change. Don’t be afraid to change. It’s going to happen anyway, so why not take the wheel rather than handing it off to people you don’t really know – employers and their management teams, especially their management teams. Don’t be afraid to take the wheel and change lanes.

Sleep. Sleep because feeling well-rested is a glorious feeling.

Don’t “grow up”. I’m still not sure what that term means, but avoid it as much as possible. The “grown-ups” tell me it’s overrated.

Be nice. The world is getting smaller every year…which means Karmic paybacks happen quicker and/or with greater intensity today than yesterday.

Simplicity is priceless. If you can’t explain what you’re doing to a 12 year old, then you’re carrying around unnecessary baggage. Lighten the load, and clear your plate down to the bare essentials. At the very least, simplicity makes it easier to smile.

You can’t outrun your fork.

And, if you’re riddled with indecision, then apply the Regret Minimization Framework.

As many of you are well aware, I enjoy reading books. Early March 2016 saw the first edition of my Quarterly Readings Newsletter. It is an update on some of the more interesting reads of the 3 months preceding publication of the email Newsletter. Email me with “I love to read!” in the subject line, and I will add you to the email list. 

How to Study for Physio Specialty Certification Exams

Having been through 2 certifications (so far) in my career, I thought I should provide current & aspiring certification candidates a birds-eye peek into my study routine. Each section listed below can become more involved based on your learning habits and learning strengths. So, if you have thoughts, questions, or opinions on any of them, then feel free to leave a comment to help make this a more productive post.

Certification can be quite stressful and overwhelming. You have to give it everything you’ve got. Might as well use all 5 senses! Here we go…

See.

  1. If you can rent DVD’s or stream videos of the course, then definitely do so. You’ll become more familiar with the techniques and clinical reasoning process by watching the instructors. Not only will this help you didactically, but it’ll also get you used to seeing the teachers who may be testing you. This way you’ll be (relatively) less intimidated when you’re in the testing room with him/her. Visual familiarity calmed my nerves by giving me a read on their facial responses and general movement patterns. Not only did this help me respond better during testing, but it also allowed me to get a sense of their psychological atmosphere, which cued me to choreograph my performance to fit their disposition at that particular period of time.
  2. Another way to utilize your visual input to sharpen your skills is by watching your study partners. For this reason alone, it might be worth your while to work in a group of 3. Another option is to use mirrors. Since one major way we learn is by watching others, it is important to choose an appropriate partner for visual feedback.
  3. Diagram everything as much as you can. I’m a visual learner, so this helped me immensely. Sequences, lists, groupings… even the page of contents.

Hear.

  1. Audio record the DVD’s or streaming video. Put them onto your iPod or smartphone so that you can access them quickly during your commute or review it audibly before bed.
  2. Record yourself reading or reasoning through the manual. This would be a much more personalized means of audibly reviewing material.
  3. Verbalize the material by yourself before talking it out with your study partners.

Smell & Taste.

  1. Build routines into your study. A certain coffee or tea. The smell of a location: bookstore, study partner’s home, etc. Then, imagine or recollect the same smells or tastes as you’re reviewing materials independently or with a study buddy. Make a joke about it. Connect it to whichever material you’re having a tough time recalling. The more sensory neurotags you create around your study content, the better the odds of performing under pressure.
  2. Have some dry finger foods while you study. I have no idea why this made the study process more productive, but I covered more ground and made sharper connections while my hands kept popping food into my face.

Touch.

  1. Kinesthetic awareness. If your certification includes a hands-on portion, then you should develop an awareness of what it feels like when a technique is done correctly and incorrectly. Feel for the sense of effectiveness both as the tester and tester’s partner. Be able to tell when your partner is on the right track when s/he is working with you. Provide constructive and precise feedback. The more precise your feedback, the sharper you develop your kinesthetic awareness. This in-turn can guide your performance during testing.
  2. Work on as wide range of people as possible. If possible, work on either the instructor and/or others who have recently passed the certification. Also, have them work on you so that you get a physical sense of how it feels when done right, and how they use their body/hands/etc.
  3. Re-write the manual in your own words. I know. It’s a bit strange to put this under “touch,” but the physical act of writing somehow helped coalesce the material better for me. I tried typing, but it wasn’t as effective. Also, writing allows you to draw arrows, smiley faces, or whatever else you’re into, to make connections and highlight important sections requiring further attention.

As, mentioned earlier, you can make this a more productive discussion by leaving helpful advice in the comments section.

Good Luck!

Cinema

P.S. – As many of you are well aware, I enjoy reading books. Early March 2016 saw the first edition of my Quarterly Readings Newsletter. It is an update on some of the more interesting reads of the 3 months preceding publication of the email Newsletter. Email me with “I love to read!” in the subject line, and I will add you to the email list. 

Interview with Ramona Horton

Ramona Horton, MPT is a pelvic physical therapist who teaches for Herman & Wallace Pelvis Rehabilitation Institute. She is passionate about the impact of visceral and fascial components as they relate to functional activities.

If you share my curiosity about the impact of viscera on your patient’s function, then you’ll enjoy this interview as much as I did.

Connect with Ramona on twitter @PelvicViscera. Enjoy!

Let’s start this off at the beginning of your day. What do you usually have for breakfast?

During the week always the same thing, a small serving of mixed raw nuts.  I am a protein gal the nuts manage to fill me up and give me a good slow burn until lunch time.

What led you into the wonderful world of Physical Therapy?

My own knee surgery at the age of 16 combined with the fact that a career in the medical field was the only thing that attracted me.  I was contemplating the nursing field, and took a job as a CNA in order to get exposure to health care, rehab just became the obvious choice. 

How did you get interested in Pelvic Dysfunction? And, how did this lead into your passion for Visceral Mobilization?

My PT training was through the Army-Baylor program, I was all in for orthopedics and sports medicine until October of 1990.  I gave birth to my second child, an adorable but behemoth  9lb 9oz baby boy.  His delivery, a VBAC (vaginal birth after cesarean) was very traumatic on my pelvis, I sustained pudendal nerve injury and muscular avulsion.  When I queried the attending OB-GYN about my complete lack of bladder control his response <insert righteous indignation here> and I quote “do a thousand kegels a day, and when you’re 40 and want a hysterectomy, we’ll fix your bladder then.”    As for the desire to study visceral mobilization, that reflects back to my PT training through the US Army which was 30 years ago, when the MPT was just getting started.  It was an accelerated program to say the least, we received a master’s in physical therapy with 15 months of schooling.  Given the very limited time line, which included affiliations and thesis, the emphasis in our training was on critical thinking and problem solving, not memorization and protocols which in 1985 was not the norm.  I can still hear the words of our instructors “You have to figure it out, I am not going to give you a cook book”.  

Following my initial training in the field of pelvic dysfunction 1993, as I started treating patients I had a problem, I could not wrap my head around how I was to effectively treat bowel and bladder dysfunction….without treating the bowel and bladder?  I knew that there was more to this anatomy than just pelvic floor muscles and the abdominal wall, but at the time that is what was being treated.  Once I started learning VM principles and applying the techniques to my patients I saw a vast improvement in my outcomes.  I realized that the visceral fascia is a huge missing link in this field and that somewhere along the line the physical therapy community forgot one simple fact.  We are not hollow, the visceral structures attach to the somatic frame through ligaments and connective tissue and have an influence on the biomechanics of said frame.  

Why is the adoption rate of Visceral Mobilization so low amongst Physical Therapists who aren’t pelvic specialists?

Most likely several reasons, first they do not deal with dysfunctions that have visceral structures involved the way pelvic health therapist do.  The second being a paucity of higher levels of evidence on the effectiveness of VM for musculoskeletal conditions.  The third and most difficult issue to deal with is the broad based claims that VM can be an effective treatment for issues ranging from acute trauma to emotional problems.  One website called VM “bloodless surgery”.   The problem simply is when anyone purports their technique to be a virtual panacea for all that ails mankind, without adequate evidence to back up the claims, the clinical world raises its collective antennae.  These critical remarks are coming from a practitioner, published author and educator in the VM field. The reality of evidence based medicine is talk is cheap, research is not.

Could you share an anecdote/story of the effects Visceral Mobilization in clinical practice?

A male patient many years ago that was experiencing constant right flank pain that made physical activity almost impossible and the pain increased during urination.  He had been evaluated by the chief of the urology department at the medical school and was sent to me for biofeedback with a diagnosis of pelvic floor dysfunction and bladder-sphincter dyssynergia based on urodynamic testing.  His symptoms began 3 years earlier while experiencing hematuria, most likely due to a kidney stone but that had not been confirmed.  His exam revealed clear cut muscular guarding with tissue changes in his right psoas, quadratus and gross restriction of the renal fascia.  I went rogue, and did not initiate the biofeedback, instead treating his restricted renal fascia which encompasses the ureter.  He returned for his first follow up about a week later reporting that 3 days following PT evaluation and initial treatment, while urinating he experienced a strong sensation in the area that I had been working felt a rush and had immediate resolution of all pain.  The best part is what he told me next “trust me, this was not a placebo effect because I thought you were a quack”  reporting that he was quite irritated that I had not initiated the biofeedback as his urologist had requested and he was planning on cancelling his follow up appointments and going to another therapist.  He was so pleased with the outcome, that he wrote a letter to the CEO of the hospital about his experience, encouraging them to assist in furthering my field of study.  

You’ve just traveled back in time and are sitting face-to-face with your 25 year old self. What advice would you give yourself?

Learn to get over it

Fascial Mobilization has been another touchy topic for some Physical Therapists. Why do you believe Fascial Mobilization is such an important aspect of clinical practice?

Most importantly because fascia is ubiquitous, it is EVERYWHERE throughout the body and it contains a vast neurological network to include nociceptors, mechanoreceptors and proprioceptors just to name a few.  The fascia was that stuff that we all dissected out of the way in anatomy lab so we could learn the assigned structures that soon would have a pin with a number stuck in it that we needed to know for a lab practical.  We need to move beyond the “myofascia” and understand that the fascial system has multiple layers in the body starting at the panniculus which blends with the skin, the investing fascia surrounding muscles and forming septae, the visceral fascia which is by far the most complex and the deepest layer of fascia, the dura surrounding the central nervous system.  All fascial structures, regardless of layer or location have their origin in the mesoderm of early embryologic development.    

Why do you think there are more cases of Endometriosis today than 10+ years ago? Given the hormonal component (estrogen dominance) involved, how do you counsel your patients on what you can do for them, and what they can do for themselves?

I am pretty straight with these patients about their options as far as hormone suppression goes, surgery, pain control and fertility. I also advise them to take a very good look at their household and eliminating endocrine disruptor chemicals in their environment.   

Favorite books & authors? (these don’t have to be PT-related, but they certainly could be…)

I am hooked on The Outlander Series by Diana Gabaldon

Tell us about your relationship with Herman & Wallace. How did this start? And, what are the biggest challenges to creating a course?

I did my initial pelvic dysfunction training with Kathy Wallace and Holly Herman in 1993.  While  attending a course on pudendal neuralgia in Seattle in 2007 Kathy Wallace was there as well.  We got talking about our practices and as the topic of VM came up, when she learned of my level of education on the subject, she asked me to consider writing a course for H&W.  

For me, the biggest challenge is trying to decide what information to leave out.  I am terrible about trying to cram in way too much content, too many techniques and too many clinical pearls in a limited amount of time.  Students can only absorb so much, and I have a tendency to overwhelm them with information.

If you could have dinner with any famous individual who is no longer with us, then whom would you choose? Why?

Sorry, I can’t pick one.  For me, the great dinner would be with Jesus, Mohammed, Gandhi and the Buddha and I would ask them how they feel about mankind killing each other in their name and how we can make it stop.

Ramona, thanks for this great interview!

Connect with Ramona Horton on twitter @PelvicViscera

Hope you got as much out of this interview as I did.

Cinema

P.S. – As many of you are well aware, I enjoy reading books. Early March 2016 saw the first edition of my Quarterly Readings Newsletter. It is an update on some of the more interesting reads of the 3 months preceding publication of the email Newsletter. Email me with “I love to read!” in the subject line, and I will add you to the email list.