http://tinyurl.com/3oc96vo

Does this really count as news? I’m probably the best Jeopardy player I know, so I was sorta disappointed when I found out “Who sleeps in the nude” was the answer to “Alex Trebek?” I guess he is on the same level as the Emperor in “The Emperor’s New Clothes”. We should all come to accept the fact the Alex’s clothes are so futuristic that we cannot even see them (if someone were to get their hands on such clothes wouldn’t it be A.T.?).

The fact that Alex ruptured his achilles chasing after a hotel-room intruder means that maybe he should get a little more activity in his daily life, and maybe he is human. Alex has a nice little 6 month stint in rehab coming his way. Don’t worry though, he can sit around and ask people for their final answers without worrying about his job security (wouldn’t that be nice).

What are the main goals of Alex Trebek’s physical therapy?

1. Let the surgery heel
2. Progressively re-establish tissue length
3. Ankle stability/proprioception
4. Lower extremity strength
5. Re-establish full body movement patterns

If there was a time to break into Alex’s hotel room, now would be it. You’d have to bet all your money that he wouldn’t be up to chasing you throughout the halls of the Holiday Inn though.

Did I ever think I’d hear about Alex Trebek sleeping in the buff making headlines? No, and just for the hell of it, that is my final answer.

Always Evolve (with your clothes on),

Mike

http://tinyurl.com/4xkecqy

There were a few things that struck me as alarming throughout this piece. I know I am a physical therapist, and with my patient population I deal with osteoarthritis (OA) on an hourly, not daily, basis, but I guess we in the medical community are doing a poor job of spreading the word regarding the benefit of exercise for OA. Not only does exercise spread synovial fluid (our joints’ lubrication) so our achy parts feel better, it provides mental relief too. Exercise allows people to be, and more importantly, feel empowered, leading to less depression that often comes along with inactivity, because people no longer feel in control of their own lives. (http://tinyurl.com/4x2kg8r, http://tinyurl.com/3pdhmwt, http://tinyurl.com/3po6lo6, ad nauseum)

” A majority of the women (56.5 percent) and lots of the men (40 percent) were inactive. That means they got no exercise that would count as moderate (like brisk walking) or vigorous (biking or running) for at least 10 minutes anytime in the course of a week.”

This made me almost throw up the foot long buffalo chicken sandwich I had just eaten from Subway. Or maybe I almost threw up because I had just eaten a foot long buffalo chicken sandwich from Subway. That averages out to like 50% of the population with arthritis getting about no exercise in their day. I think of my grandma when I think of people with arthritis. Her knees are the size of basketballs; they need to be replaced more desperately than Gaddafi. But almost every day she is out working in her garden, or going for walks with her neighbors. She knows she has pain, and she knows she will hurt while she does it, BUT she knows that she will ultimately feel better after the fact. Why does she know this? Because she has an awesome grandson who is a PT. The point of this being that she knows this because she is educated/was told about it. Education is the key to empowerment, and I think that somehow we are missing the boat if this many people are getting that little exercise A WEEK!

Second big point that I took away from this article is related to, “Turns out their exercise levels were a lot lower than found in previous studies in which people self-reported on their activities.” Is this the typical American way or what? In actuality, we do almost nothing, but when self reporting, we over-estimate how much nothing we do. I wish I was told how much activity these people really think they got. I know I learned about this back in Psychology 101, or 210, or 30000000 when I took it, but I do know that we as a collective whole tend to over-exaggerate things when there’s no way to prove otherwise (See Donald Trump’s self-reported net-worth).

Like I said earlier, education is the most important part to helping solve this conundrum. Regardless of where you live, a doctor is usually the gate-keeper to getting medical care. It is up to these professionals to inform patients that not only will the latest anti-inflammatory possibly work, but cardiovascular exercise, resistance training, changing your diet, and just overall moving more will reduce your osteoarthritis pain. That’s step one. Step two, once we see these people as physical therapists, personal trainers, chiropractors, etc is to educate them some more. Patients are more willing to see the validity of what their MD’s told them if it is hammered into their consciousness even more (and if the MDs didn’t do it in the first place, now it has been done).

Unfortunately this article neglects to mention us other health care professionals’ role in decreasing these patients’ pain. Regardless, I think we need to help spread the word that a little movement is actually good for your joints, and can actually lead to a better, more active, and more fulfilling life in the “long run” (pun intended).

Always evolve (through education),

Mike

http://tinyurl.com/3fw5n6p

The first thing I thought after reading this was that I should put it into the educainment section of my blog. Then I had a few drinks compiled with some Captain and thought better of it. How could I pass up the opportunity to write about such a great topic while also enjoying a few drinks with a college favorite?

I used to work in an only orthopedic hospital, comprised of mainly, knee, shoulder, and hip replacements. What a fricken trip this was. Most of my memories are of the male patients smoking cigarrettes, or flashing nurses, and myself pounding Monster energy drinks infused with powder energy drink mix from the local grocery store (insert department head sneer when I passed said energy drink through my nose onto the PT department wall). Let me tell you, precautions are shoved up your ass so far in these types of hospitals it isn’t even funny. Every doctor has their own precautions too (this is a small topic of contention between PTs and MDs that doesn’t get much attention). One might say no adduction, external rotation, and flexion of the hip, while the next surgeon with the same surgery will have no precautions. What a mess. So let me tell you, I am so glad at least Captain Morgan can lend a hand when it comes to putting these dislocated hips back in their place! I thought he was only good for making me want to dislocate my hip while leaning over a toilet…. nevermind.

After reading this article, does anyone else find it weird that a medical Doctor saw a significant connection between his hospital’s practices and a mythical imbibing figure? I usually look to fairy tails and comic books for my rehabilitation inspiration and ideas. You know Winnie the Pooh kinda shit (I dont even know what that means. like I said, I’ve got a little Captain in me).

“One day, while watching a Captain Morgan’s commercial, it just struck me that that’s the position we do,” says Gregory Hendey, a professor of clinical emergency medicine at the University of California, San Francisco.

That’s what she said.

“Hip dislocation happens when the head of the thighbone — the femur — slips out of its socket in the hipbone. Car accidents are the most common cause, according to the American Academy of Orthopedic Surgeons. People with hip replacements are also prone to them, as are athletes who play high contact sports like football.”

I had one patient on my shift at this hospital dislocate their hip (thankfully not while I was working with them), and they said it was even more painful than the pain prior to their surgery. When this happens, these patients might find themselves back on the surgeons table, unless this Captain Maneuver is attempted. Even though this is not a common occurrence, I am really glad that the good ole’ Captain is making it happen when it comes to educating Doctors on a new method of reducing these hip dislocations.

“Other techniques for fixing hip dislocations can be precarious. Consider the Allis Maneuver, which requires the doctor to straddle the patient on a gurney, then bend the affected leg 90 degrees, while keeping the other leg down. The doctor then lifts the leg and applies force to the hip, popping the leg bone back into the hip socket. Doctors can injure their backs or fall off the gurney, the study said.”

Which page of the Karma Sutra can I find this on? When this Allis maneuver or the Captain Maneuver are the options I gotta say let’s take a shot and hope for the best. Yes, pun intended.

“Once they start using the Captain, they never go back,” he says.

I once had a room-mate in college that uttered these exact words before blacking out.

I am glad that our medical Doctors continue to look for alternate techniques to advance the medical profession, but do we really need to look to fictional alcoholic cartoons for ideas? Thank you NPR for keeping health-care light, and making people slightly more interested in orthopedics! See you at the bar.

Always Evolve,

Mike

http://tinyurl.com/3hbcppo

I know you’ve seen him. You may even want to be him (although, I don’t know why). Walking through the gym with his ripped Everlast cut-off on. The Shruggernaut is who I am talking about. Upper traps so big they block sound waves from getting in his ears. I think I may have even seen some granola eating Birkenstock wearing spelunkers repelling down his massive traps. You know what’s weird though, I have no problem with this guy besides the fact that he puts 4 45 pound plates on each side of a Universal bar and does “front” shrugs. Get some dumbbells, or a trap bar, get your shoulders back and chin packed, and let the shrugs fly.

This dude’s muscles aren’t the problem. It’s the actual shrug as an exercise that I have the problem with. And to go further, I have no problem with shrugs in a non-rehab setting (unless they are done like this, or like this). In Olympic lifting, they actually provide great benefits for the high pull portion of a clean, etc. But why on earth would a physical therapist have a patient who does not do Olympic lifts do a shrug?

Most likely conditions in which patients are asked to perform shrugs:

• Neck pain
• Shoulder pain
• Mid Back pain

I don’t think I have ever treated a patient with any one of these issues that doesn’t score at least a 4+/5 on a manual muscle test.

quasimoto

Their shoulders are half way up to their ears usually! If you test these people and there is a significant upper trap/shrug weakness, and you think doing more shrugs will fix it, you need to re-assess. Chances are it’s a bigger problem in the Spinal Accessory Nerve which innervatesthe upper trap. Think about it, in today’s society where over 50% of the population spends like 6 hours a day sitting at a computer shrugging,do you think when this person comes in with neck/shoulder/mid back pain they need to shrug more?

I’m not alone in feeling this way. Think about your big toes. You probably haven’t done this in a while, besides when slamming them into a wall or door. A lot of my friends tend to get out of line, and go a little wild sometimes. I call these guys “fun-ions” but most people call them bunions. It’s not their fault, it’s in their genes to get a little crazy. Even though I get to hang out all day with my four other friends, sometimes I can get stuck in a rut, you know, lose a little mobility. Mike’s other dear friend, his knee, hates when I do this.

But I digress. When it comes to keeping Mike balanced and centered, I’m the man (unless you’re talking mental balance, then caffeine takes the reins). Every step Mike takes crosses my path. I’m the “gait” keeper of normal gait mechanics (what a pun!). If I’m not on board, then no one gets on board; Mike’s knees, hips, and back don’t stand a chance.

Do me a favor. Stand up (yeah, I know you’re sitting). Stand on one foot with all of your toes on the ground. Now, really concentrate on your big toe. Feel how much pressure is actually being put on this toe. It’s a lot.

Mike has come to find out over the past month truly how important I am. I’m pretty fricken important. I am Mike’s big toe and I keep him on his feet.

Always Evolve,

Mike

Me in 50 years

I knew I would be changing venues and patient populations roughly one year ago. I knew I worked in a physical therapy dream world (for those who like sports medicine) back in Boston where my typical patient was a high school or college aged athlete who wanted to get better. The biggest challenge with these patients was their over-eagerness to get better too soon. I calculated the average age of my patients the other day; 78.4 years old. 78! I know that the 65+ age group is the fastest growing sector of the population but this was not what I was used to, or developed my skill set on. Then I began to think….I shouldn’t treat these patients any different than my sports medicine patients. And, more importantly, I was quick to realize that treating these patients differently just doesn’t work. Below I have listed my top 5 misconceptions that PTs have about treating older adults.

1. They are fragile: Only about 55% of the people we treat over the age of 50 have osteoporosis. There is no reason to assume that every older adult we treat cannot handle heavy loads. If done properly, it’ll help increase their bone strength. (Random fact – While weight bearing exercise does not increase the density of the bone, it DOES makes it get thicker; therefore adding to the bone’s strength).

2. They are not strong: I’m not talking manual muscle testing strong. I’ve got 94-year-old female osteoporotic patient that can throw down a 5/5 manual muscle test on her quads. I’m talking STRONG. Like let me bust out 3 sets of 10 squats. Once again, many of us are guilty of “taking it easy” on our older adult population (more likely the 75+ range), but how can we truly know how strong any patient is if we do not push them. Sorry guys, the SAID principle applies to older adults too. Just because they love prune juice doesn’t mean they can’t do a weighted deadlift. And yes of course you have to take movement quality into account.

3. They don’t want to try “alternative” methods of rehabilitation: I routinely use yoga, Pilates, and kinesiotape on my younger patients because they are typically more accepting to these newer ideas of rehab. It’s hard enough to get older adults to even want to do a straight leg raise! FALSE. This is the stuff I hear or have seen. Absurd I say. Mildred and Gertrude love telling their fellow book club mates about the fancy blue tape I put on their back, or that they can now “perform a really good upward frog, or downward dog, or some tomfoolery pose” with excellent form.

4. They do not want to work hard: Older adults have had a tough life. Either they worked their asses off recovering from the Great Depression, or they fought for this country in any one of the foreign conflicts over the past 40-50 years. So why the hell would they want to perform a plank or farmer’s walk. If you look around my clinic, and I am not the only one to notice this, I can guarantee that the hardest working patients I have are 80+. It is sad to say, but this generation of people knows that to get results you have to work your ass off. You have to put the work in to get things to work out for you. They do not rely on a magic cure, or pill. They put in effort.

5. They will not listen to younger health care professionals: I am 27 but look like I am about to graduate from high school. I get these comments all the time, but I also know what I am talking about when it comes to rehab; and although these patients usually bring their own ideas to the table (thanks WebMD) it is because they just want to get better. They are willing to listen to a health care professional regardless of their age, because they know that we know more than them (hopefully) about their medical situation.

It’s funny that our true respect for our elders has decreased in this country to the point where many rehab professionals consider this patient population unable to perform like their younger counterparts, or too fragile to work hard. I think if we push the limits of our older patients we will all see what hard work is.

In closing, watch this. He is 72 years-old, and that is 100 pounds in each hand.

Always Evolve (even when you’re old),

Mike

I am trained to provide physical therapy diagnoses, and determine whether or not someone needs to pursue further medical treatment that I cannot provide (and even read x-rays and basic MRIs) but patients are required to go to doctors offices prior to coming to get treated. The military actually works with true direct access, and it works amazingly! PTs order x-rays and meds, do tons of wound care (even though I would not want any part of this), and can see their patients without having them see a doctor first.

I get asked DAILY by patients why they needed or need to go to their doctor’s office to be told to come to PT, especially when California is supposed to have direct access. My answer is, “I have no idea”.

Think about the cost of going to your doctors office. I know how much they really get from insurance companies (it’s not close to what most people think), but anyways, think of all the money that is paid every year for those visits just so people who know they need PT can get into PT. It’s a lot. If a patient with knee or back pain came to PT first and the therapist saw that the patient wasn’t getting better, the therapist would know to refer the patient to a medical doctor. Chances are that same MD would have sent the patient to PT in the first place. But if that patient goes to PT with TRUE direct access, and gets better, that was one trip to the doctors that was saved, medical dollars that were saved, the doctor’s time was saved and they can provide care to those who truly need it, and all parties end up much happier.

Always Evolve,

Mike

So I basically disappeared for the past 2 months. Oops. I’m so happy that I continued to get e-mails, comments, and subscriptions from you guys. So my reading lately has been more of a recreational sort, but I have been busy in the clinic applying my skills and helping as many people as I can. Just in case you guys are curious as to what’s really been going on at mikescottdpt.com here’s the rundown.

1. Took levels 1-3 kinesiotaping courses. I was soooo skeptical going in to the first two courses because I could not find any significant research backing its use. After learning some beginner and intermediate techniques I have to say I am more apt to believe what brands like KT Tape and KinesioTex Tape offer. I have to say I have been getting good results with taping SI Joints, anterior knee pain, ITBs (especially on myself!!!), and biceps tendonitis/RTC.

2. I started running like crazy, hence the taping of my own ITBs. A new co-worker is training for the 2012 Olympics in the 800 meters, and I decided to be her pace bunny for her training hahah. This was a great excuse for me to get some new kick ass Nike Frees.

3. I have been told I do not reach out to my reader’s enough to figure out what they want. So, this is a call to all of you.. if there is something that you want me to discuss, or answer, I want you to e-mail me at mikescott.dpt@gmail.com

So in the months to come, I want to ramp back up my content, I want to kick some butt in the clinic, and I want to hear from you guys. Once again sorry for the hiatus!

Always.. yes always Evolve,

Mike

Condition: Cause(s)

Plantar Fasciitis: Hip tightness, calf tightness, thoracic kyphosis, weak glutes

Ankle Sprains: Weak hip abductors

Anterior knee pain (I hate this “diagnosis”): Hypomobile ankles, weak hips, tight hips, increased anterior weight shift (rounded shoulders)

HS injuries: Weak glutes

Low back pain: Tight hips, weak glutes, weak core/poor motor control, poor breathing patterns, stress, depression

Shoulder pain: Thoracic spine restrictions, weak core/poor motor control, periscapular weakness, cervical spine restrictions

Tennis Elbow: Poor shoulder mechanics –> from all those things I just mentioned under shoulder pain

Neck Pain: Thoracic/Lumbar spine motion, poor breathing patterns, prolonged positions

For those of you who know this, believe this, and practice this way I hope you agree with what I have listed. If you can think of some more conditions and their common causes feel free to leave them in the comments section. If you have come here looking for answers, I hope you have gotten a good sense that the physical therapy profession is changing and that if you are receiving care, it should take your whole body into consideration.

Always Evolve,

Mike

10. Conditions in which you cannot reverse, but only acutely improve quality of life – MS, Parkinson’s, ALS, etc

9. Overbooked PTs

8. Friends, family, and WebMD – Not literally WebMD, but patients coming in and saying that they read “yadda yadda yadda” on some site, or that their neighbor or sister did “x” when they had pain.

7. In reference to exercise programs; Doing as much as possible, not as much as necessary.

6. Patient’s actually don’t want to get better – To some of you this may sound crazy, but there are patient’s out there who gain something from being “injured” ie, attention, worker’s comp, etc.

5. Inconsistent performance of home exercise programs – This really means people not doing their home exercise programs. When a PT says “can you show me how you’ve been doing [exercise A] at home” and it is followed by a blank stare, do people think we don’t know what’s going on?

4. Continuing to do what caused the injury/pain/condition - Me: So your shins only hurt when you run? Patient: YesMe: Okay, so for the next couple of weeks I don’t want you to run Patient: Why? And for PT’s continuing to do what is not working.

3. ONLY treating the site of pain

1b. Lazy patients – For some reason when people are told they should go to PT, they hear “Go to physical therapy. These people will massage you and do tons of work which requires you to do absolutely nothing. Oh yeah, also, if they make you exercise you should definitely complain.”

1a. Lazy PTs – PTs who just diagnose and treat based on what they have done in the past or what they learned in school. See my hummer’s post. Also, not enforcing good form at all time.

Always Evolve,

Mike