PT Elevated

PT Elevated Podcast is a clinically focused podcast for physical therapists and other rehab providers. We may occasionally talk about big ideas and nerd out on research, but our ultimate goal is to provide knowledge and tools that you can apply in the clinic right away. We want you to learn something that helps you elevate your practice and increase your confidence. Let’s get started.

Treating Chronic Pain with Clinical Hypnosis| Ali Navidi 03/30/2023

Faculty Development | Angela MacCabe 03/24/2023

Override Health | Jennie Shulkin 03/10/2023

Override Health | Jennie Shulkin Jennie Shulkin is a lawyer, co-founder and CEO of Override Health, a multi-specialty chronic pain program. She was a division one athlete in college that suffered two traumatic brain injuries. Soon after she developed a complex chronic pain syndrome affecting multiple parts of her body. As best she could, Jennie continued living her life – pushing through Harvard Law School and building a career in law. All the while, she carried the burden of the agonizing, time-consuming, expensive, and both physically and emotionally painful journey of seeking pain relief. When each medication, intervention, and various other treatments failed, the treating providers shrugged, sent her away, and often told her she was "out of options." Adding to the frustration, many of the doctors, physical therapists, and psychologists Jennie consulted treated her chronic pain no differently from acute pain and were therefore ineffective. Additionally, most had little interest in or time to communicate with other providers working with Jennie. The result was fragmented care, inconsistent messaging, and contradicting plans of action. Jennie wanted a better way. Joining forces with her father, she began creating a solution that she and others in pain needed but did not exist elsewhere: a comprehensive, team-based approach to care that is implemented by providers who really understand chronic pain. Jennie lives with pain every day. But she has learned to stop cure-seeking – to stop putting life on hold until a pill, procedure, or doctor brings about the magic fix – and has found more effective ways to interact with the pain and build a fulfilling life. That is why Jennie and her father founded Override Health. Listen and learn more about the program. Helpful research and training: Website Ad Info: Since you’re listening to this podcast, there’s a pretty good chance you’re the type of clinician who is always learning. One great way to learn more and earn CEUs is Evidence In Motion’s huge selection of courses. Choose from topics ranging from MSK management and pelvic health, to dry needling and pain science. Get back to hands-on learning by finding an in-person weekend intensive. Or if you prefer online learning, opt for a virtual lab or online option. You can save 10% on courses as a PT Elevated Podcast listener. Just use the promo code PODCAST10 at checkout. You can find the promo code and a link to courses in the show notes. Helpful research and training: on LinkedIn on Facebook on Twitter on Instagram on Twitter on Twitter EIM Website - /episode/index/show/clinical/id/26194347

Is Residency Right for You? l Stephanie Pascoe 03/04/2023

Post-Professional Training Options | Mark Shepherd 02/24/2023

Integrating Functional Dry Needling | Edo Zylstra 02/17/2023

Occupational Therapy and Chronic Pain | Megan Doyle 02/10/2023

Building Clinical Reasoning Skills | Zachary Walston 02/01/2023

Behavioral Health with Rehab Providers | A.J. Steele 01/27/2023

Topics in The PT Profession Today | Tom Denninger 01/21/2023

What is Lifestyle Medicine? | Jen Uschold 01/13/2023

PT Elevated – Align 2022 | Season 3 Wrap 08/18/2022

PT Elevated – Align 2022 | Geriatrics| Heidi Moyer 08/16/2022

PT Elevated – Align 2022 | Geriatrics| Heidi Moyer Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season some of our speakers are guests who will be live in-person at the EIM this August 26-28 in Dallas, Texas. On our eleventh episode of season 3, Heidi Moyer, PT, DPT, GCS, CEEAA a Board-Certified Clinical Specialist in Geriatric Physical Therapy (GCS) and a Certified Exercise Expert in Aging Adults (CEEAA) joins us! Heidi is the Program director for Evidence In Motion’s Geriatric Certification Program currently. She has previous teaching experience with EIM, Illinois Physical Therapy Association, and for conferences such as National Student Conclave and Combined Sections Meeting. Heidi is an active APTA Geriatrics member, serving as a leader in multiple roles for APTA Geriatrics with the State Advocate Program and Balance and Falls Special Interest Group (BFSIG) as well as for the Illinois Physical Therapy Association, where they are the active chair of the IPTA Geriatric Special Interest Group (GeriSIG). We are so lucky to have her joining us at the Align conference this year! Heidi’s Align Session Preview: Heidi will be presenting at the conference during lab 6, “,” alongside Teresa Schuemann, PT, DPT, ATC, CSCS, SCS & Jennifer Stone, PT, DPT, OCS, PHC. The lab is hands-on and interactive. Its goal is to look at the maximization optimization of management and assessment and screening over of athletes across the life span. They will be looking at how you can optimize the performance of athletes across the lifespan, starting at the screening process, then assessment and management. Heidi will be talking about the importance of plyometrics in training older adults and particularly in athletes that are in a plyometrics sport. As well as looking at the senior fitness examination and how you can integrate that in your practice to give you a guidance to how to manage older adults that are athletes. This lab will be presented twice on Friday, once in the morning, once in the afternoon and once on Sunday, in the morning. Here are some of the highlights: In this episode Heidi expands on her experience working in geriatric physical therapy and becoming a geriatric certified clinical specialist. Heidi does say that you do have to be a jack of all trades because you are not just studying one body system or one joint in the body when looking at our older adults. The geriatric population can be present anywhere. She says her favorite geriatric topic to look at is health promotion and wellness and trying to get people moving long after we discharge them. She is very interested in keeping the geriatric population active and healthy. She also is interested in the topic of ageism. Whether that is self-ageism or ageism reflected from someone else. Heidi completed her through the geriatrics academy through the American Physical Therapy Association (APTA). It consists of 3-weekend intensive that included, assessment, interventions, and lastly special populations. There was then a written exam and a practical exam. The whole focus was to provide hand-on skills to be able to get access to outcome measures and get facetime with experts in the field within APTA geriatrics to learn about some of these test and measures that are not taught in entry level DPT programs. Heidi says it was a great way to get clinical skills, to see changes in management with her patients, trace progress closely and more. Heidi says medication reconciliation is within the scope for physical therapists to perform for patients and serves as a safety net to make sure the medications are doing what they are supposed to do. Heidi works hybrid home health currently and the medication reconciliation is her least favorite part. Heidi expands on career negative habits she picked up on and has broken over the years of practicing in the clinic, the fall risk assessment and handling patient falls, using the available assessment tools and more! Heidi’s Clinical Pearl for Physical Therapist working with Pharmacist– “If you have an interest in older adults and working with the geriatric population jump on the continuing education train. While the entry level DPT curriculum is obviously good enough to get us pass the exam, it is not sufficient to be an excellent clinician when working with older adults. If geriatrics is your passion or if you are in a setting where you do not have a choice and you must see patients of Medicare age, get into some continuing education classes, and make yourself comfortable. We are dealing with human lives and livelihoods and quality of life. We do not want to take that lightly. Do not be afraid to learn more, you are going to have to if you want to work with older adults.” Helpful research and training: Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout. You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials: on Twitter on Twitter , Website /episode/index/show/clinical/id/24075114

PT Elevated | Pharmacy Information for Physical Therapists | Veronica Riera-Gilley 08/09/2022

PT Elevated | Pharmacy Information for Physical Therapists | Veronica Riera-Gilley Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season some of our speakers are guests who will be live in-person at the EIM this August 26-28 in Dallas, Texas. On our tenth episode of season 3, Veronica Riera-Gilley is a holistic pharmacist and owner of and Functional Medicine Pharmacist with . Her passion is to maximize health with minimal medication. She is Board-Certified Geriatric Pharmacist, Advanced Mind Body Medicine Practitioner, Certified Lifestyle Coach, and Adaptive Yoga Instructor who helps people embrace healthy living, aging, and dying. In 2004 Veronica earned her Doctor of Pharmacy from Southwestern Oklahoma State University in 2004. Her journey into pharmacy began with the death of a close family friend. The family friend suffered a traumatic brain injury and was then put on a long list of medications. The side effects of the medication were not tolerable for her. She spoke to her physician and said she could not continue like this and was told that this was her new normal and to deal with it. She was given no guidance and continued the medication and shortly after she died of suicide. Veronica became a pharmacist because she wanted to be the healthcare professional that this family friend really needed, someone that could be the voice of reason and say that there are always other options, other ways to do things. That there are safer ways of using medications than others. Sometimes the answer is more medication and sometimes it is no medication at all. That is why Veronica is a pharmacist she wants to be that health care provider for patients who are sick and tired of being sick and tired and want to find a way outside of the pill box. In this episode they expand on what holistic healthcare is and what being a holistic pharmacist is, medication, when it is necessary and when it isn’t, how clinicians can benefit from utilizing a pharmacist and more! Here are some of the highlights: Holistic healthcare looks at the whole person and we treat not just the symptoms but the root cause of the problem. Functional medicine is that framework to ask that question of why are you having this symptom? Conventional medicine has often prescribed in medication a pill for every ill. Functional medicine says why are you having this symptom and what is the root cause? How are we going to treat that? It is not always something that comes back to a nutrition deficiency or some other physiologic thing going on in the body. Sometimes it is a emotional or spiritual. The holistic approach to health care is looking at the whole person not only at their physiologic needs but their spiritual and emotional needs as well and giving credit to all of it. When Veronica was in pharmacy school, she was taught that Lifestyle and nutrition is the core of health. When lifestyle and nutrition failed, they were told to use medication. She gets excited when a patient comes in with an ailment that requires them to be on a long-term medication. Veronica says we need to be having the deep prescribing conversations with our patients, this is the planed and supervised process of discontinuing or reducing dosages. She says we should be having these conversations with our patients because most of these medications are band aids and not cures. They are buying us time to make those lifestyle changes are bodies are asking us to make. Poly pharmacy is using multiple medications at once. The greater the medications you use at once the greater the likelihood of having medication related harm or drug interactions. Veronica says she thinks It is important that we find ways for patients to reduce their medication burden for their long term safety. Food as Medicine and Functional Medicine gave her more tools in her toolbox to help her guide her patients on how to reduce her medicine needs and improve their health without reaching for more pills. Listen and learn how Veronica works with patients to reduce medications they are on. Veronica’s Clinical Pearl for Physical Therapist working with Pharmacist– “I want to give a shout out to all our physical therapists and occupational therapists. I think that you are some of the professionals with the best skills to help our patients with gaining the skills that they need to reduce their medication needs. Learning how to move their bodies more efficiently and how to improve their cardiac health and manage their pain are all skills that you have to offer our patients and help them navigate life with a lower medication burden. So thank you for having a different skillset to bring to our patients that they really need to be able to have maximum health with minimum medication.” Helpful research and training: Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout. You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials: on Twitter on Twitter , LinkedIn , Website /episode/index/show/clinical/id/24008433

PT Elevated| Pilates and Movement | Brent Anderson 08/02/2022

PT Elevated| Pilates and Movement | Brent Anderson Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season some of our speakers are guests who will be live in-person at the EIM this August 26-28 in Dallas, Texas. On our ninth episode of season 3, Brent Anderson, PhD, PT, OCS, PMA®-CPT, owner and Founder of Polestar Pilates and Co-founder of Runity.run joins! He is a former dancer and been a PT for over 30 years. He is also a world lecturer and educator. He first opened Anderson Physical Therapy (APT) in Sacramento, CA. It was one of the first physical therapy centers specializing in Pilates based rehabilitation and performance enhancement. By 1994, a second APT facility was integrating Pilates into rehabilitation, dance medicine, cross-training, and wellness. Rehabilitation and Pilates practitioners from around the world visited Sacramento to observe and study this exciting new treatment approach. By 1997, Brent moved his practice to Miami, FL from 3,000 to 12,000 square feet of space. A Doctor of Physical Therapy and orthopedic certified specialist for more than 13 years, Brent is a leading authority in performing arts medicine and Pilates-evolved techniques for rehabilitation. He lectures nationally and internationally at symposia as well as consults with professional dance companies, schools, and observatories throughout the world. In this episode Brent expands on his extensive background between teaching and business. They discuss movement how Brent uses Pilates in that aspect, the benefits of getting into active movement, general misconceptions about pilates people have and more! Here are some of the highlights: Brent says sometimes he thinks the number of hats we wear has a direct correlation with how old we are. If we have stayed active, if we are pursuing new information then it is like our hats will continue to grow.” Brent danced semi-professionally years ago, while he was in physical therapy school at UC San Francisco 35 years ago, he was taking dance class and his dance teacher told him about pilates. She told him to check it out the new dance medicine center at St. Francisco Hospital and he fell in love with it immediately. He met his partner Elizabeth who was his partner in Polestar pilates for 10 years. They traveled around and introduced pilates to the rehabilitation world. Brent then moved to Sacramento to have his own physical therapy practice. At that time, they introduced pilates education in a formal education way to be able to be certified in pilates in 1992. Polestar Pilates is in 67 countries with 16,000 graduates today. /episode/index/show/clinical/id/23937955

PT Elevated| Behavioral Medicine| Dan Rhon 07/26/2022

PT Elevated| Behavioral Medicine| Dan Rhon Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season some of our speakers were guests who will be live in-person at the EIM this August 26-28 in Dallas, Texas. On our eighth episode of season 3, Dan Rhon, PT, DPT, DSc, PhD joins! Dan is currently a physical therapist, professor and research director for the . He graduated from Baylor University with his master’s in physical therapy, followed by a DPT from Temple University and DSc from Baylor University. He completed a clinical fellowship at Brooke Army Medical Center (orthopaedic manual physical therapy) and a postdoctoral research fellowship at the University of Utah. He has served as the Director of Research, Department of Physical Medicine & Rehabilitation, Madigan Army Medical Center, and both the Director of Physical Therapy and then the Director of Clinical Outcomes Research at the Center for the Intrepid, Brooke Army Medical Center. He has over 50 publications indexed in Medline/PUBMed and he has received collectively over $10 million in research funding from the National Institutes of Health (NIH) and the U.S. Congressionally Directed Medical Research Program (CDMRP). Dan currently does primarily research in the military health system & a couple of academic programs mentioned above. In this episode they discuss some of the impactful trials Dan has led, like comparing cortisone injections in physical therapy in patients with shoulder pain and knee osteoarthritis. They also discuss the new trial Dan is undertaking looking at lifestyle and behavior change and how it is at the core of our health and holistic health and what it is. Dan says after you have been in clinical practice for a while you know that change and behavior is extremely difficult to get to happen by just saying something and telling people to do something. When you run a trial, you are trying to get the patients to respond in a certain way and be compliant because this is the care that you believe is optimal and you just need them to do it. But equally as challenging is you try to get clinicians to deliver certain type of care. Listen and find out things Dan believe play into behavior change and what he thinks about educating patients to promote behavior change & more! Here are some of the highlights: Dan says after you have been in clinical practice for a while you know that change and behavior is extremely difficult to get to happen by just saying something and telling people to do something. When you run a trial, you are trying to get the patients to respond in a certain way and be compliant because this is the care that you believe is optimal and you just need them to do it. But equally as challenging is you try to get clinicians to deliver certain type of care. Listen and find out things Dan believe play into behavior change and what he thinks about educating patients to promote behavior change. Dan’s Clinical Pearl – “The focus on the psychological piece with our patients and understanding that. I think every clinician should almost be a psychologist. We all need models to work under, but I do not think I appreciated the communication piece, the therapeutic alliance, the spending a little less time if I must prioritize my time, on an exam and spend a little bit more time listening to a patient and just how powerful that piece of it is. Becoming less mechanical tends to pay off more in the long run. I didn’t realize how powerful that connection was earlier on and realized as I get patients that are not getting better, what I could do better and what I am doing wrong. Just trying to understand patients and where they are coming from a little bit better.” Helpful research and training: Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout. You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials: on Twitter on Twitter , on Twitter , Runs account on Twitter , Website /episode/index/show/clinical/id/23868972

PT Elevated| Shoulder Research | Lori Michener 07/19/2022

PT Elevated| Shoulder Research | Lori Michener Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season some of our speakers join us as guests that will be live in-person at the EIM this August 26-28 in Dallas, Texas. On our seventh episode of season 3, Lori Michener, PT, PhD, ATC, FAPTA, joins to discuss the high-value treatment she has conducted for shoulder pain. Lori has been a professor at the for 7 years and is also a director at the . At the beginning of her career, Lori trained as an athletic trainer and a physical therapist then went into college athletics and taught for six years in a typical undergraduate institution. She taught athletic training and pre-med, pre-physical therapy, and pre-occupational therapy students. She says it was a great opportunity for her to learn how to be a teacher. She then went back and got her PhD in biomechanics and orthopaedics at Hahnemann now Drexel University and taught for 15 years at Virginia Commonwealth University. Now she has been in Southern California for the last 7 years at the University of Southern California. In this episode, they focus on why she chose to focus on the shoulder for her speciality area of study. They also discuss the decision of pursuing a Ph.D. and how she came to the conclusion to do so and more! Here are some of the highlights: Lori says no matter what area you are interested in if you have questions about pursuing a Ph.D. reach out to her and she is happy to talk about it. She says it took her about 2 years to come to the decision that she wanted to get her Ph.D. The advice she gives to anyone looking to pursue their Ph.D. program is to explore a lot of different programs because they are all different. Paul asks Lori what outcome measures she thinks we should be using to measure our patients with shoulder pain? Lori lists several tests she has used and for what over the years: The Penn Shoulder Score (PPS) – a condition-specific self-report measure. It is a 100-point scale that consists of 3 subscales, including pain, satisfaction, and function The American Shoulder and Elbow Surgeons Shoulder Score (ASES) which is a mixed outcome reporting measure. It has 10 questions but some of the questions can be limited depending upon the patient's abilities. Shoulder Pain and Disability Index (SPADI), which is a self-administered questionnaire that consists of two dimensions, one for pain and the other for functional activities. The pain consists of five questions regarding the severity of an individual’s pain. Functional activities are assessed with eight questions designed to measure the degree of difficulty an individual has with various activities of daily living that require upper-extremity use. The DASH outcome measure – the disabilities of the arm, shoulder, and hand questionnaire is a 30-item questionnaire that looks at the ability of a patient to perform certain upper extremity activities. The questionnaire is a self-report questionnaire that patients can rate difficulty and interference with daily life on a 5-point Likert scale. Patient Satisfaction Score– a direct question, how satisfied are you with the use of your shoulder presently? 100 is full, 0 is not satisfied. Some of these outcome measures use legacy measure, some are specific questionnaires if your legacy measure does not capture that and then some anchor patient acceptable symptom state or patient satisfaction with the use of your body part that is injured. Lori’s Clinical Pearl – “I wish I would have known that connecting with the patient is more important than what you’re doing with the patient. I don’t think there is a magical set of exercises or manual therapy you can do, how you connect with the patient and deliver care is more important. I try to remember that when I walk in the door, I am in patient mode and the shield is up and I am present with the patient. Your behavior and how you are doing it can change how the patient responds.” Helpful research and training: . Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout. You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials: on Twitter on Twitter on Twitter on Instagram , Website /episode/index/show/clinical/id/23791223

Align 2022 - From Player to Patient to PT | David Bruton 07/12/2022

Align 2022 - From Player to Patient to PT | David Bruton Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season we will have some of our speakers as guests who will be live in-person at the EIM this August 26-28 in Dallas, Texas. On our sixth episode of season 3, guest joins! David is an Align Conference keynote speaker this year! He is a former professional football player in the NFL for 8 years 7 with the Broncos and 1 with the Washington Football Team, from 2009-2016. David played at the University of Notre Dame where he graduated with two degrees, political science, and sociology, in 2009. He is a member of the CU Physical Therapy Scholarship Board, Founder of Bruton's Books, and an advocate for change. He graduated from the University of Colorado DPT program in December 2021 and owner of Between the Lines Physical Therapy, helping people return to their game! In this episode they focus on what led David to decide to become a physical therapist, why physical therapy always played a huge role in David’s life, his unique role having experienced concussion protocols playing in the NFL, and speaking about them to the senate and more! Here are some of the highlights:David has always enjoyed reading especially when he was injured and couldn’t practice in the NFL. He always enjoyed a good book that expanded his mind. In 2015 he wanted to expand his volunteer role in the NFL community with literacy and he wanted to have an impact at the ground level with something that was more his passion. He wanted to be involved in the project. Since he established and founded his foundation, , they have been able to conduct multiple projects to create opportunities for Colorado’s Youth. Their mission is to help low-income children in grades K-3 become strong readers through tutoring and providing books to underfunded schools, libraries, and classrooms. David has opened his own clinic, . Where they are always, “Focusing Between the Lines,” and truly know what it’s like to compete “Between the Lines.” They say, “This gives us a unique perspective on what physical therapy means to the patient, and more importantly, how we as a team, can deliver effective treatments and therapies to get you back in your game. Trust our team to help get you back in peak performance.” They offer performance care to take your game to the next level, preventative care so you can stay ahead and prevent injury and physical therapy to recover and return to your game. David’s Clinical Pearl – “One of the biggest things as a new grad that I learned is that your evaluation does not have to be 100% complete in that first session. Keeping in mind you don’t have to get everything right on the first time. Keep a working hypothesis and be able to evolve it and work on it throughout the evaluation. Accept the improbable, be ready to react and adapt.” Helpful research and training: , Website Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout. You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials: on Twitter on Twitter , on Twitter , on Instagram , on Twitter , Website , Align Conference Website , Website /episode/index/show/clinical/id/23721752

Align 2022 - Spirituality and healing | Jessie Podolak and DeAndre Caldwell 07/06/2022

Align 2022 - Spirituality and healing | Jessie Podolak and DeAndre Caldwell Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season we will have some of our speakers as guests who will be live in-person at the EIM this August 26-28 in Dallas, Texas. On our fifth episode of season 3, guest and join us. This episode will dive into the concept of spirituality and pain and how that might fit into practice. They both will be speaking at the Align conference in August. Jessie is the Program Director for EIM’s Pain Science Fellowship, and she owns and operates her community’s first direct-pay physical therapy practice, seeing a variety of patients with acute and chronic pain conditions. DeAndre is a physical therapy program manager at ChristianaCare Rehabilitation Services in Smyrna, DE. He is passionate about treating those with low back pain and chronic pain. They focus their discussion on DeAndre and Jessie’s Align conference speaker topic, “Beyond Taboo: Accessing Spirituality to Enhance Healing,” integrating that into the clinic, the biopsychosocial model and more! Here are some of the highlights: DeAndre talks about the biopsychosocial model and how it is interesting that spiritual is not part of it, it seems like it is missing. Often someone’s spiritual make up is part of them. When you talk to patients you can hear it is engrained in them, but it is now engrained in us to not talk about politics or religion at work or at school from childhood. DeAndre thinks what happens is when patients get to the clinic that way of thinking is still there so they are bringing themselves but part of them is missing so they aren’t being their authentic selves because they have a feeling they can’t talk about certain things in the clinic. He says that goes for clinicians as well. When asked how they integrate spirituality into the clinic Jessie says integrating open ended questions for patients like, “Where do you draw strength from?” can help. She says we are so used to asking clients for impairments and what is wrong and what are you struggling with? But when we lean into green flags like questions, What is good in your life? Where do you have hope? What gives you hope? Even asking patients what their goals are, Jessie says she usually asks patients about goals and asks for a fun goal and a functional goal and sometimes she says clients will say things that will shock you and you have to maintain that unconditional positive regard for the human before you? DeAndre’s Clinical Pearl – “The power of coming to work your authentic self, show up as who you are. There is a scripture that says do not hide your light under a bushel. Be yourself and let your light shine and if that light is reflected, great you guys can explore that, if not, either way you are still going to have a good interaction. Just let your light shine and be your authentic self.” Jessie’s Clinical Pearl – “I hope all our young clinicians are already doing this but take care of yourself, recognize this is a part of our health. Take care of our physical health and mental health because we cannot pour from an empty cup. One of the things that has filled my cup is connection to other people and to something bigger than myself. Get to know yourself, you deserve to take the time that it takes to sit with people that you love, that build you up and with a creator that loves you.” Helpful research and training: Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout. You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials: on Twitter on Twitter , on Twitter , Align Conference Website , Align Conference Website , Website /episode/index/show/clinical/id/23651072

Align 2022 - Upper Extremity Functional Testing | Rob Manske 06/29/2022

Align 2022 - Upper Extremity Functional Testing | Rob Manske Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season we will have some of our speakers as guests who will be live in person at the EIM this August 26-28 in Dallas, Texas. On our fourth episode of season 3, guest , who is a Professor and former Chair in the Doctoral Physical Therapy Program at Wichita State University in Wichita, Kansas joins us. In addition to his full-time faculty appointment, Rob is a physical therapist and athletic trainer for Ascension Via Christi Health and serves as a Teaching Associate at the University of Kansas Medical Center Department of Rehabilitation Sciences in Kansas City, and the Department of Community Medicine for the Via Christi Family Practice Sports Medicine Residency Program. Most importantly Rob continues to practice weekly – spending approximately 10 hours per week treating a variety of knee and shoulder conditions! Rob graduated from WSU in 1991 with a Bachelor of Arts in Physical Education, a Master of Physical Therapy degree in 1994, and further earned a Master of Education degree in Physical Education in 2000. He received his DPT from the Massachusetts General Institute of Health Professions in 2006. Rob has been an APTA Board Certified Sports Physical Therapist since 2002. Rob is also a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association, and a Certified Athletic Trainer (ATC) through the National Athletic Trainers Association. Rob has been nominated and received numerous awards for excellence in teaching at the local, state, and national levels – receiving the APTA sports award in 2018. To date, Rob has edited/published 12 books, multiple chapters, articles, and home study courses related to orthopedic and sports rehabilitation They focus their discussion on shoulder disorders, lab techniques, special and functional tests, Rob’s Align Conference topics & more! Here are some of the highlights:Rob shares how he felt right when he got out of physical therapy school for the first time in three years, he was really struggling to feel like he was helping people to feel better. He thinks the beauty of the PT profession is if you keep trying and learning, as you get older you become better and more skilled and not so frustrated as you were early on in your career. Mark also says doing fellowship helped him tremendously. Rob says today physical therapy students have more information to learn than when he was in physical therapy school and that students are overloaded and when they graduate it takes them a couple of years to figure out what they are doing. He says as a student you must be intentional and learn the order of things and suggests that you need to do that work best for you as a clinician, like how to problem solve and learn what questions to ask your patients. You must learn how to listen. The biggest mistake that clinicians make is not listening to their patients Rob stresses. Rob says he learned the ability to have a sound clinical examination process and all the things he didn’t learn in school that they are teaching now by continuing to practice, reading about clinical reasoning, and continuing working. Rob thinks the return to sport testing is not done as often as it should be for upper extremity patients and there are a lot of them offered that could be done. Rob’s Align Session Preview: Rob will be talking about special testing, and how it gets a lot of criticism specifically shoulder special testing. He helped Dave Magee on the latest edition of the , Rob admits he may be a little biased toward special testing. He says if you look at a lot of different special tests that are done throughout the body, they really are not that great at speciosity. They are better at detecting sensitivity and ruling out the bad things. According to Rob shoulder issues probably are not going to kill you so shoulder special tests are there to help aid him to the conclusion of the root cause of the patients. issue is. He will expand upon those test types at the Align Conference. Rob’s Clinical Pearl – Everybody has a certain way that they treat things, my way of treating is not the only way of treating to get somebody better, it works for me, and your way works for you and if your patient is getting better, I think that is great. I’ve learned you must listen to the patient; you must determine what is not working, and you have to be able to self-reflect on what you are doing with the patient and what they are doing and if it is working or not. The older I get the way more conservative I am. I am very systemic and start off very simple and work to a more complex approach with my patients. I would rather not set my patients back weeks to try to gain a week. Listen to your patient. Be nice, and be kind to your patients. You should see it as an honor that patients come see you. People that are hurt and in pain are coming to you to try to help them. Even if you do not agree with the patient, you can still be nice. Truly want to help the patient. Patients know if you are there just to get a paycheck and you are going through the motions or if you really care about them and want them to get better. If you really care about people, you want your patients to get better, that means you like your patients and I think then you are going to be a way better clinician and more likely a way happier satisfied one! Helpful research and training: , EIM Course , EIM Course , EIM Course , EIM Program , EIM Residency , Program Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout. You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials:, on Twitter on Instagram on Twitter on Twitter , Align Conference Website , Website , Website /episode/index/show/clinical/id/23580665

Align 2022 - Clinical Decision Making | Mark Jones 06/13/2022

Align 2022 - Clinical Decision Making | Mark Jones Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season we will have some of our speakers as guests who will be live in-person at the EIM this August 26-28 in Dallas, Texas. On our third episode of season 3, guest , BSc (Psyc), PT, M App Sc, who is an Adjunct Senior Lecturer in the University of South Australia with 35 years’ experience teaching undergraduate and postgraduate physiotherapy joins us. Mark graduated from the University of Florida with a B.S. in Psychology and then completed his Physical Therapy studies at the University of Iowa. Having developed an interest in manual therapy Mark travelled to Australia to study Manipulative Physiotherapy and after completing his Graduate Diploma in 1985 under Geoff Maitland he completed his master’s degree by Research in 1989. The title of his thesis was “Facilitating Students’ Clinical Reasoning in Physiotherapy Education”. Mark has a special interest in biopsychosocial health care and the teaching and assessment of clinical reasoning in physiotherapy. He has conducted and supervised research in the areas of clinical reasoning and musculoskeletal physiotherapy with over 90 publications including three editions of the text “” and the text “”. His latest text “” was published in 2019. Mark has presented 30 Keynote Conference presentations and has taught professional development courses in clinical reasoning and musculoskeletal physiotherapy across 26 countries. They focus their discussion on the conversation of clinical decision making and reasoning that is the focus of Mark’s Align Conference discussion. Mark has dove deep into the technique of clinical reasoning to grow and develop it. Here are some of the highlights: Mark gave a little insight on how he got interested in clinical reasoning - In 1985 when Mark said he was studying clinical reasoning it was not considered as much as it is now in physical therapy programs. He studied with Robert S. Maitland in Australia and was very intrigued by the thought process he taught without it being overt. Robert didn’t have students think about their thinking, he gave them principles to follow. Mark came across the work Arthur S. Elstein, who wrote what probably still is considered the seminal study and paper in clinical reasoning in medicine, he immediately saw that applicably to physiotherapy. Everything that Arthur said about that process that people go through and how important your knowledge is to the success of that process, the concept of patterns, Mark connected that to what physical therapist did. He did his master’s degree surrounded around that. Looking at educational strategies to strategize reasoning. I began to theorize what this would look like in physiotherapy - “I found out that good clinicians have always reasoned. It would be arrogant to suggest that it was not always here. The beginning of Physios, there was reasoning always inherent in what they did. We didn’t think about our reasoning back then, it wasn’t explicit. Maybe that was what I with others contributed to the process. I started theorizing and writing about it suggesting things as to what this would look like in physiotherapy. In our program we started thinking about what it should be because every program that teaches then must start making decisions on the process you want to facilitate and judgements you think are important.” Mark’s Align Session Preview: “Physios are noisy.” Mark shares that he will share a podcast and a book at the conference in his lecturer that expands on this quote above. Mark’s Clinical Pearl – “My Favorite definition of an expert is somebody who has a lot of experience, they know a lot, they do what they do well, and they can communicate their reasoning well. But they also know what they don’t know. They do not have to have a supervisor look at them anymore, they can be on their own and recognize if they didn’t understand information or know what a medicine was. They have that mediative congeniality and that is why they have become an expert; they have become aware of their limitations, and they act on it. Ongoing learning cliché is very true, to all of us and our students but it is also being honest. They call it intellectual humility to recognize what you don’t know.” Helpful research and training: “” “ Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout. You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials: on Twitter on Twitter Align Conference Website , Website /episode/index/show/clinical/id/23416928

Align 2022 - Pain Mechanisms | Keith Smart 06/08/2022

Align 2022 - Pain Mechanisms | Keith Smart Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season we will have some of our speakers as guests who will be live in-person at the EIM this August 26-28 in Dallas, Texas. On our second episode of season 3 we welcome , DSc (Hons), Physio, MSc, PhD, who is a keynote speaker at our Align Conference happening this August! Keith is a physiotherapist who worked clinically as a physiotherapist in several hospitals in the United Kingdom and Ireland. He specialized in the field of ‘musculoskeletal physiotherapy.’ He completed his research master’s degree in 2004 and a PhD in 2010, during which he was the primary investigator on a number of research projects that investigated physiotherapists clinical reasoning of pain, and mechanisms-based classifications of low back pain. He has since acted as a co-supervisor to a number PhD candidates as well as undergraduate and masters-level physiotherapy students. He has also undertaken several systematic reviews related to pain. He is now a full-time academic physiotherapist at University College Dublin but maintains a small clinical caseload as a Clinical Specialist Physiotherapist within the field of musculoskeletal physiotherapy and orthopaedic triage at St Vincent’s University Hospital, Dublin. He has ongoing research interests related to pain and advanced practice physiotherapy. They focus their discussion on the conversation of pain mechanisms that is also Keith’s speaker topic of discussion at the Align Conference, and he expands on what his speaker discussion will also cover at the conference and more! Here are some of the highlights: Keith published a series of 3 influential papers about 10 years ago on mechanisms of pain and broke them down to how we might be able to categorize where our patients fit in those categories. They discuss how he got interested in pain science initially and what about his findings surprised him. On a broadscale Keith tells how he used questionnaires, clinically when assessing pain and why. Listen in to hear more surrounding the topic of pain mechanisms. Keith’s Align Session Preview – Keith will be presenting virtually in August at the Align Conference; he is looking forward to it! He will be presenting on the broad topic of pain mechanisms, keeping it clinical. He hopes to be able to explain to the attendees what some of the limitations and shortcomings of mechanisms-based patients of pain are. Also, what that looks like in clinical practice, how we might begin to distinguish between different types of mechanistic categories of pain and how we might tell them apart in our patients. What implications that might have for our assessment treatment and prognosis of patient’s pain. Keith’s Clinical Pearl – “Embrace the complexity, but don’t be intimidated by it. Anyone who tells you that they know everything is almost certainly lying. Being a physical therapist and treating patients in pain is a challenge but it is also a privilege. Embrace the complexity and do your best.” Helpful research and training: Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout. You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials: on Twitter on Twitter on Twitter , Align Conference Website , Website /episode/index/show/clinical/id/23366978

Align 2022 - Whiplash and Neck Pain | Julia Treleaven 05/31/2022

Align 2022 - Whiplash and Neck Pain | Julia Treleaven Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season we will have some of our speakers as guests who will be live in-person at the EIM this August 26-28 in Dallas, Texas. Our first episode of season 3 welcomes who is a keynote speaker at our Align Conference this August. Julia is a senior lecturer and researcher at the University of Queensland in Australia and a part of the head and neck research unit. She has been researching whiplash and neck pain since 2000 and in 2004 completed her PhD focusing on the neck’s influence on sensorimotor control. She has continued her research in this area and now is also looking at the role of neck dysfunction in those with headache, dizziness and post-concussion due to concomitant whiplash-type injury. She has over 100 publications in this area, written several book chapters and is an author of the recent book “Management of neck disorders- an evidenced based approach.” Julia works part-time as a physiotherapist in a private practice managing patients such as those with, whiplash, cervicogenic dizziness and post-concussion syndrome. They focus their discussion on sensorimotor control and what Julia's speaker discussion will be focusing on at the Align Conference and more! Here are some of the highlights:Julia discusses how important it is to understand why sensorimotor control is important in the head and neck. She discusses the different tests that can be used to find and diagnose a problem and find out where it may be coming from and if the neck or head is involved or not. Julia says today, "We are understanding more how to assess patients to decide whether the head or neck is involved or not." She talks about how to handle joint restrictions and more! Julia's Align Session Preview – She will be going over the Clinical Assessment of Sensory Motor Control in the neck and tests that she thinks might be useful clinically to help differentiate if it is coming from the neck or the vestibular system. Then some ideas of how to integrate that into training for patients as well. Julia's Clinical Pearl – “Really think about your examination: what you are feeling, what you are seeing? Try not to rely so much on pain, then try to put it together, does it make sense? If it is not making sense then you probably have missed something or you need to assess if there is anything else you can look at. If it is making sense, then fantastic! Really just focusing on what you are feeling and seeing and if it is making sense." Helpful research and training: Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout. You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials: on Twitter on Twitter , Align Conference Website , Website /episode/index/show/clinical/id/23286218

It's All About Relationships | Season 2 Recap 03/16/2022

Live at APTA Combined Sections Meeting 2022 l Kory Zimney & Paul Mintken 02/23/2022

Physical Therapy Mentors & Movers l Tim Reynolds & Bryan Guzski 02/08/2022

Physical Therapy Mentors & Movers l Tim Reynolds & Bryan Guzski Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. Our ninth episode of season 2 welcomes Dr. Bryan Guzski and Dr. Tim Reynolds who are the authors of the book . Bryan is a physical therapist who practices at the University of Rochester Orthopaedic Spine & Sports Center and recently just stepped down as the residency program director. He graduated from Ithaca College and then did a post orthopaedic residency and spice fellowship at Cayuga Medical Center. Tim is a physical therapist by trade who went to Ithaca College for his Doctorate. He then did a post orthopaedic residency and spine fellowship with Cayuga Medical Center as well. Currently he teaches anatomy and physiology at Ithaca College. Here are some of the highlights:"This book is a compilation of stories, throughs, and advice from over 75 leaders in the fields of physical therapy and movement science. From researchers and expert clinicians, to innovators and business owners, their answers to thought-provoking questions provide personal and professional guidance for the next generation of rehabilitation professionals." Bryan and Tim started this book idea when they were going through residency together. They saw the same names recurring. They were also reading an interview style book called, "Tools of Titans," by Timothy Ferris and thought it would be great to have a book like that, centered around physical therapy. In 2018 they drafted a list of interviewees and a list of questions and fired off emails and one thing lead to the next and they published this past year. Common Themes Bryan & Tim Recognized from interviewing leaders in our field for their book: Failure The questions they asked were more human related about failure, good and bad advice and favorite interests and less focused on their interviewees treatment paradigm & focus. "It was interesting to hear some of the big leaders in the profession discussing past failures, such as not getting into physical therapy school on the first try or failing clinicals." Mentorship The importance of mentorship and the importance of investing in yourself. "Mentorship is an investment in yourself. If your are looking at who you want in your clinical mentorship circle, focus on who is practicing the way you want to be and how can you provide value to them so that they are able to provide value to you." There were opinions on specializing right out of school via residency or becoming a generalist and seeing a lot of different things that several PTs they interviewed had different views on. Tim's Clinical Pearl – “When I did my spine fellowship program it wasn’t the advancement in my manual skills or treatment paradigms or pattern recognition, it was Jason Cherry who is a professor at Ithaca College who introduced me to the concepts of motivational interviewing and that has been what my clinical focus the last two or three years has hovered around, the power of words. Being mindful of the power of word choice, being able to take advantage of that placebo effect, and being able to communicate more effectively with a patient. If I had the chance to go back and talk to myself coming out of school in 2014 my response would be, it is okay that you do not have these manual skills yet. Try to work on some of these “strong” skills, communication, and the power of words.” Bryan's Clinical Pearl – “Don't underestimate the power of momentum. If you are interested or passionate about a particular area and find yourself wanting to know more and learn more about this one thing, dive into that and lean into that. That will lead to more momentum, where you have new conversations with new people and that is where doors start to open, and you can continue to grow from there. Learn into momentum and do not underestimate the power of it." Helpful research and training: Ad Info: Since you’re listening to this podcast, there’s a pretty good chance you’re the type of clinician who is always learning. One great way to learn more and earn CEUs is Evidence In Motion’s huge selection of courses. Choose from topics ranging from MSK management and pelvic health, to dry needling and pain science. Get back to hands-on learning by finding an in-person weekend intensive course near you. Or if you prefer online learning, opt for a virtual lab or online option. You can save 5% on courses as a PT Elevated Podcast listener. Just use the promo code PTELEVATED at checkout. You can find the promo code and a link to courses in the show notes. PROMO CODE: PTELEVATED Connect with us on socials: on Twitter on Twitter on Twitter on Twitter /episode/index/show/clinical/id/22068695

Acute & Chronic Low Back Pain l Steve George 01/26/2022

Acute & Chronic Low Back Pain l Steve George Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. Our eighth episode of season 2 welcomes Dr. Steve George who is in the department of Duke University’s Orthopaedic Surgery and a member of their Clinical Research Institute. His primary charge is research where his focused has been in musculoskeletal pain conditions, cohort studies, clinical trials with low back pain and more! This week he discusses acute and chronic lower back pain as it is related to recent changes to the newest clinical practice guidelines that were recently released. Here are some of the highlights:Clinical practice guidelines are guidelines provided to assist in clinical decision making, not to take the place of clinician judgment. The new Clinical Practice Guidelines for back pain are a revision to the 2012 release focused primarily on intervention updates. Things to remind your students and learners are these are guidelines they do not necessarily override the 2012 guidelines. “I still think there is value in structuring your decision making around things and it’s great when there is a lot of evidence to support them, you just have to temper it to support them when there isn’t as much evidence. I think the exercise in structuring your thinking is still super valuable especially for those people just getting started in the area. Clinicians need to understand that you have to have flexibility in decision making because nothing in their findings were clearly superior and they know that happens with back pain studies. There isn’t a huge difference in results in exercise or manual therapy trials for back pain in some areas of medicine if they saw these small differences, they would wonder what we were studying but we live in small to moderate effects and that makes decision making a little bit more challenging.” Steve shared the search Process for updating the Clinical Practice Guidelines: Process1. Research Questions -They decided to keep the questions for the clinical practice guideline update broader because they are covering a lot of area. 2. Gathering search terms -They had the original search terms from the 2012 clinical practice guidelines and updated where needed. -Focused on randomized trials -Only looked at studies with PEDro scores 6 or higher -Focused on trials where a PT was either delivering the treatment or they were in a PT environment. 3. First Draft -Put together and sent out for external reviews 4. Submit final version -Designed an Infographic and the summary of recommendations Our hope is that people can use this as fuel to get an idea of what they want to do in their local health systems, in trying a new approach. It was good to see some new themes popping up in this update like pain neuroscience education, cognitive functional therapy, and the prognostic risk stratification. A lot of this is moving away from the diagnostic model of treating back pain and moving into this management model that can be informed by prognosis. Steve's Clinical Pearl – “I think remaining curious is so important. Asking good question and if you do not get good answers to your questions keep asking them. That is what drove me from moving from a clinical career to a research career. I was not the smartest person in the clinic. I was never voted most likely to do research, but I think when I got out and practiced, I think what bothered some of the people I worked with is just being curious and wondering why we were doing things one way. The focused curiosity. Secondly, I grew up in the non-patient centered era, but I learned so much from listening to my patients and viewing it as a bridge of my expertise with what their experiences were. Listening to your patients. Be curious not only about the patients that got better but the patients that did not.” Helpful research and training: Ad Info: If you want to keep learning past what you hear today, Evidence In Motion offers certifications that elevate your clinical decision making and take you to the next level of patient care and subject matter expertise. I encourage you to check out their website and explore your different options. What’s cool is that you can get 5% off by letting your enrollment advisor know you’re a PT Elevated Podcast listener. Details and links to find the certification for you are in the show notes. I encourage you to check it out. Connect with us on socials: on Twitter on Twitter /episode/index/show/clinical/id/21877157

Pain Manual for Educational Programs | Craig Wassenger 01/19/2022

Pain Manual for Educational Programs | Craig Wassenger Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. On our seventh episode of season 2, Dr. Craig Wassenger, PT, PhD, who currently works in the Tuffs University School of Medicine hybrid DPT Boston program will be telling us about the pain manual that was published by the Pain Special Interest Group within the Academy of Orthopaedic Physical Therapy that he was instrumental in producing. Here are some of the highlights: The pain manual Craig and his colleagues produced is an expansion of the International Association for the Study of Pain (IASP). The IASP has a curricular outline for teaching pain to physical therapists. It has a list of topics that should be included in physical therapist education. Around three years ago Craig and his colleagues led by Mark Shepherd were able to join and make something out of the IASP, “Collectively as healthcare professionals we have learned a ton about pain in the past two decades and I do not think that the content that has been included in physical therapists’ education has been able to keep pace with that. As we learn more through psychology and neuroimaging particularly of the brain, we can understand more from a basic science perspective then the application of that content to clinicians treating patients daily and it really has not been done, so this is an attempt to bring those things together as well as an understanding of educators and physical therapists on that topic.” Although the pain manual focuses on education there is a role for clinicians to take content from it. “The way that I look at it from an educator’s perspective, is we had this guideline document which was the IASP outline, and it was just a list of stuff telling what you should be teaching. I think of that as if you have a recipe that being your ingredients list, but you didn’t really know what to do with it. We tried to take the list of ingredients and add the recipe to it. Here are some things that you can do, here is how you put it together, here are examples of how we have put it together to try to help educators pull that information. If you are an experienced cook for that recipe, like an experienced educator you can take what we offered and then mold it to fit your specific needs, just like the way that an experienced cook would do.” “In addition to just having an extrapolation of the checklist of content from IASP we offer and provide examples of learning activities both active and lecture for educators to incorporate into their classes. The manual is also supported by asynchronous content, so we have partnered with the APTA and the APTA learning center, so the developers of the manual put together lectures to get faculty current on all topics. The document has supported material from an asynchronous learning site so they can see how we present the details as well as opportunities and examples of assignments that could be used within class as homework for students on the educator’s side of things.” On pain Craig says, “I think the best way to do it is to have integrated pain content with an additional stand-alone course.” One of the challenges with pain both logistically within the association and from an educational perspective is that it crosses all clinical areas. The pain specialist group is housed within orthopaedics but the course is not only a orthopaedic thing, it is all clinical areas and when you don’t have a focus point around it, it gets diluted across a lot of different areas. That is why I think it needs to be integrated across lots of different courses. But have a place where it is centered and have the focus time to evaluate it and study it as a student. Also provide that opportunity to our post graduate students as well, primarily talking about DPTs.” The pain education manual is housed on the Orthopaedic Academy . We’ve also partnered with APTA, and have prerecorded lectures for educators and people that are more audio or visual learners. In teaching about pain Craig says, “Pain science is centered around patient education. I use a scaffolded approach to that because it is one of the key things that I cover within the course and one of the main assignments I have with all the universities that I teach this course at. First step is understanding the background information, the research, the content, to substantiate what the education should be centered around, and it comes down to the psychosocial contribution to pain as well as what we understand now around the nociplastic pain and the changes in the central nervous system that are not very well understood by many healthcare providers or the public. The students watch me delivering it to a patient and we watch the interactions and break down the interaction. They then have a practice session with each other. Our training is improving, and this is one step to try to make it better and provide resources but there are still gaps that we recognize. I’m hopeful other healthcare providers do too. There is a role for us to contribute medical, nursing, and pharmacist education and all the other healthcare providers that we and our patients interact with to try to bolster this. I’m hoping there is a shift in the criteria that we are using for our accreditation and or licensure because unless a change is forced it is hard to make people change. Craig’s Clinical Pearl: “One thing I wish I knew when I started clinical practice was that I didn’t have to have all the answers. You come out of school you’ve spent so much time studying and learning all this content and you’ve had expert clinicians and educators telling you all this information and there is so much you must learn. You take your board exam, and you pass it and then you get a patient in front of you, and you don’t have the clinical instructor to lean on and you may or may not have a mentor and I just felt like I had to know it all. You certainly do not know it all. You’ll never know it all or have all the answers. But that is one thing to not worry about and this will tie back into the pain manual to show that there are resources available for you to help you. My strong recommendation even if it isn’t a formal process is to get a mentor and learn much as you can from them. Lastly, it certainly is not all about knowledge it is a whole lot about relationships, people, trust, caring and those other things that are hard to teach but are maybe more important than all the content we talk about in PT education.” Helpful research and training: Ad Info: How many of you are thinking about or preparing to sit for your board-certification exam? Achieving board certification can be a strenuous process, and the right prep course can mean the difference between a passing and failing exam score. PT Elevated sponsor, Evidence In Motion, offers test prep courses for OCS, SCS, and GCS, with over 95% pass rates! As a podcast listener, you can get 5% off a prep course now. Find the promo code and more info in the show notes. You got this! Connect with us on socials: on Twitter on Twitter /episode/index/show/clinical/id/21820421

Determining Physiological Distress with Yellow Flag Assessment Tool |Trevor Lentz 01/12/2022

Determining Physiological Distress with Yellow Flag Assessment Tool |Trevor Lentz Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. On our sixth episode of season 2, Dr. Trevor Lentz, PT, PhD, MHA, who is in the department of Orthopedic surgery and in the Clinical Research Institute at Duke University, discusses yellow flags and fear in physical therapy. Currently, his primary focus is in research, first on how to improve value of care in physical therapy and health policies and secondly in yellow flag screening, understanding physiological distress and the impact it has on things like returning to sports, getting back to work and function after orthopedic injury. Here are some of the highlights: Trevor and his colleagues developed the OSPRO yellow flag assessment tool. It was developed because the need for it in the clinics with the frustration they were facing. They knew there were a lot of different psychological characters that may be important to evaluate evaluate but the problem was evaluating efficiently. The OSPRO-YF assessment tool looks like a traditional psychological assessment tool but works very different and there are a couple different versions. The assessment calculates what patients would score on 11 different psychological questionnaires. The tool improves the efficiency of screening and allows clinicians to administer these tools in an efficient way. When developing the OSPRO-YF Trevor and his colleagues looked at 11 different questionnaires (130 different questions overall) that they had patients fill out. It enabled them to have a question pool that they could pull from. It also told them information about how a patient would score on those individual questions. It was a factor analysis, identifying which items told them the most information about some of these underlying constructs. It would allow them to estimate these scores most efficiently. The OSPRO-YF is designed as a screening to identify patients that may require additional psychological work up. Trever says they do not advocate making treatment decisions based on those numbers alone. It is recommended to take the information and use it to make conversation with the patient about how they are feeling, what they are thinking about pain or their condition and that will help make decisions. “To determine what treatments to provide patients we are actively conducting research to understand how exactly to interpret this.” “I think that the fear avoidance of beliefs, I’ve always conceptualized as a term that would encompass the term like kinesiophobia which is a more specific term that focuses on the fear of movement. I think that there are several different types of fear patients can display, fear of pain, movement, injury. All of those I conceptualize under fear avoidance beliefs and in my clinical experience I tended to see that you could have patients that were extremely afraid of reinjury but not necessarily afraid of pain.” Trevor Lentz Clinical Pearl: “The biggest thing I could recommend is the value in looking at recovery and rehabilitation from a biopsychosocial perspective. One of the things I found helpful both on the research and clinical side, is getting to know your providers outside of physical therapy. Developing relationships with the physiologists that are working in that field and your orthopedic surgeons and others to understand how they are portraying this information to patients. How they are talking with patients about their condition and their recovery. It is helpful to hear their perspective both ways and for you as a physical therapist to be able to inform them on the types of things you are encountering within clinical practice and how you feel they could be helpful within this whole rehab process. Making sure you are really listening to the patients. That was something that people coming out of school recognized as important and understanding goals and values and beliefs, but I truly didn’t recognize that until I got a little further out and started doing a lot more work around physiological distress that sometimes to get into those conversations with a patient about their physiological needs you really have to listen and dig a little bit. I think that is very important and falls within our scope of practice and something that I think we should be doing." Helpful research and training: Ad Info: How many of you are thinking about or preparing to sit for your board-certification exam? 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The Evolution of Manual Therapy| Louie Puentedura 01/05/2022

The Evolution of Manual Therapy| Louie Puentedura Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. On our fifth episode of season 2, Dr. Louie Puentedura, a Professor in the Department of Physical Therapy at Baylor University and an EIM faculty member discusses the evolution of manual therapy. Here are some of the highlights: Louie was trained and worked as a physical therapist in Australia until 1995 when he came to the United States primarily because of problems he could see in the field of manual therapy. He now is a full-time clinical professor at Baylor University. "Recently there was an update to the clinical practice guidelines for the treatment of acute and chronic lower back pain that recommended manual therapy and exercise. Not for manual therapy alone and not for exercise alone but for manual therapy and exercise combination." “I think that the take home message is that most patients will benefit if they are given a combination of education, manual therapy and exercise. Even patients experiencing chronic pain that you are attempting to convince that their pain is not because of a certain structure in their back, can benefit." "A lot of the research tends to suggest that manual therapy is not very effective but if you look at that research, they haven’t tested or done experiments on manual therapy. They have a hard time defining what manual therapy is. Is it thrust? Joint techniques? Or is it non-thrust mobilization? Many of the researchers lump it altogether and say it is all the same." Louie looks at Clinical Prediction Rules as a guide to determine if a patient needs a thrust manipulation versus a non-thrust. He says the style of treatment nowadays is much more about empowering the patient and making sure they achieve self-efficacy and self-care. Back in the 80s that was not what was being promoted. "It was all about; you have come to me because I can fix you. I might need several visits to fix you, but we will get you there." "In that process of trying to promote a safer way of trying to manipulate the neck – I hope I’ve made it less scary to manipulate the neck. But I also hope that therapist who do manipulation thoracic techniques to the neck they are learning how to do it appropriately and safely." Louie Puentedura Clinical Pearl: "One of the things that has stuck with me over the years is that early on I wanted to be just like my mentors. I had people like Jeff Maitland, Robert Mckenzie, Bob Elvey and all these people to look up to and I would watch them treat people. The first few years out in clinical practice I didn’t feel like I was making any progress. What I realize now that I’m much older is that the little bit of practice that I do every day, accumulates over the years. It's really only after many years that you start to feel very confident and skilled at what you do. It just takes time to practice. That is what we are supposed to do as PTs, keep learning, practicing, keep getting better. Once you stop doing that and stay where you are, you are not growing and maybe you shouldn’t be in that practice anymore." Helpful research and training: Ad Info: Since you’re listening to this podcast, there’s a pretty good chance you’re the type of clinician who is always learning. One great way to learn more and earn CEUs is Evidence In Motion’s huge selection of courses. If you prefer to stay home and save on travel, they’ve got self-paced and faculty-led online courses and virtual labs. Or you can opt for a hybrid option with their in-person weekend intensives. Choose from topics ranging from MSK management and pelvic health, to dry needling and pain science. You can save 5% on courses as a PT Elevated Podcast listener. Just look for the promo code and links in the show notes. Connect with us on socials: on Twitter on Twitter on Twitter on Instagram /episode/index/show/clinical/id/21673616

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