Book Alert: Deep Nutrition By Dr. Catherine Shanahan

I just finished reading Deep Nutrition by Dr. Catherine Shanahan.  Fascinating stuff.  And if Kobe Bryant endorses it, as one of the few who was able to play NBA elite level hoops for 20 years, it has to be worthy of a few weeks of my reading time, right?

A few snippets that I found fascinating from this book:

1) Nutrition can affect genetics in later on generations but these may not be permanent changes.  The idea that DNA and genes are a series of light switches turned on or off by what is available is novel to me.  One example in the book describes a 1930 study conducted using pigs that were deprived of vitamin A before they reproduced.  The litter of these deprived pigs were born without eyeballs because the mother had no supply available and vitamin A is essential to formation of the eye.  The blind piglets, however, were fed normal diets that contained vitamin A and they were able to give birth to pigs with eyeballs. Unreal!

2) The science of food is considered with respect to the biochemistry of oils and how certain ones (particularly vegetable oils) are dangerous for consumption. Dr Cate shows how vegetable oils have multiple double bonds in their chains which break apart when heated leaving reactive compounds in our bodies that can wreak havoc on the system. My inner chemistry nerd loved trying to comprehend the complexity that she simplified here.  Additionally, there is a lengthy discussion of the science of all the ways vegetable oils can affect the body- and none of them sounds good!  This book is a challenging read- even with boat loads of science learning behind me, I had to really work to gain full understanding of some of the biochemistry going on- but it is definitely making me think about my food in a new way.

3) Following oil, the book went on to discuss the negative effects of sugar consumption. After completing five rounds of the whole 30, I'm positive that my body hates sugar... though my mind continues to crave it and give in to the temptation of its deliciousness. Discussions of how sugar influences cholesterol levels, diabetes, migraines, erectile dysfunction, and cardiac issues were outlined. I doubt I’ll ever be able to completely exclude my favorite treats from my diet, but the anecdotes and research outlined in this book will certainly make me think more about the treats I’m consuming and whether or not they’re worth it. 

4) Consider food as medicine. If you focus on what we eat as the problem, it might be hard to realize that food is also the solution.  The book looks at a few conditions - particularly concussion, Alzheimer’s, and autism- and discusses how oxidative stress contributes to these diagnoses. Did you know that what you eat after a concussion can impact your potential recovery because certain foods increase oxidative stress on the brain which it is already overloaded with from the injury? I had never thought about it from that perspective, and I treat people who have experienced concussions!  The book outlines "The Human Diet" with the four key components of what you should be eating. 

Overall, I definitely recommend the book but think it’s only fare to mention it felt like hard work to get through some of the heavy science portions. Ultimately I’m so glad I did and will definitely be applying some of the principles I learned to how I eat and cook.

Check it out!  Next up to read: "The Origin of Species."

Running Mechanics Assessment for Physical Therapists

Two days ago - I wrote that Physical Therapists should be looking at mechanics - triggered by a patient coming in needing their running mechanics assessed after a physical therapist said they didn't do this work.  I had every intention of writing my own blog post on some of the key things to look for to assess running - but then Mike Reinold posted a write up  this morning based on Chris Johnson's running training - and they're experts.  So rather than re-invent the wheel - Here's Mike's post from today entitled: "A Simple Approach to Running Mechanics for Clinicians." (Seriously this could not have been more timely!)

Quick Summary:  Chris and Mike are recommending you look at the Four S's: Sound, Strike, Step Rate, and Speed. While this is not exactly the same method that I assess running form - I'm thrilled to see how they do it, and I can't wait to update some of the techniques I've been using.  I'm big on listening to the sound that my patients make - with running, walking, jump-landing, and plyometric activities - so this was not new to me.  I've never seen an app to use for cadence - only learned about using a metronome which I have done on a few occasions.

Ultimately - check Mike's post to learn some simple things you can look at in a runner experiencing pain to try to fix their form.  If you can't fix it so they're pain-free, find someone who's an expert such as Mike and his crew in Boston or Chris who is here in Seattle.

Happy Holidays!

What Do Physical Therapists Do? Installment #1: We Look at Mechanics

Recent scenario evaluating a high school-aged patient: let's call him Bobby and pretend that he's referred with a diagnosis of shin splints. (We can get into "Shin Splints" not being an actual medical diagnosis on a different blog post).  The conversation went something like this:

Abby: Hey, what brings you in today?

Bobby: I'm here for biomechanics testing.  I want to get back to running ASAP.

Abby: That's awesome that you like to run. 

Bobby: I run track and cross country but my leg hurt a whole lot at the end of the last season.  I saw the doctor and he shut me down from running while I did 2 months of physical therapy elsewhere.  When I went back to the doctor, he said he needs the physical therapist to clear my biomechanics so I can return to running.  My physical therapist said they don't do that, so my doctor gave me a referral to come here instead. 

Abby: Wait.  WHAT????

Bobby: Can you test me so the doctor will know I can get back to running?  I feel a lot better.

SO MANY THOUGHTS running through my head.  Primarily - what did your previous physical therapist do if they didn't look at your biomechanics?  Is that really what happened? 

This person came to me after having physical therapy for several weeks because they had experienced pain while running.  He had done all of his prescribed exercises and was now pain free with walking outside of the boot, but returned to the referring doctor for clearance. At no point during the rehab process had he ever been on a treadmill, tried to participate in a return to running program, or been to the track. 

What did I do?  I proceeded to conduct a complete initial evaluation of this patient - no different from any other initial evaluation I would normally do for an injury to that body region. I am a full body-focused physical therapist, so I never examine an ankle injury without looking at the lumbar spine and the hips in addition to the ankles followed by full body motions and balance. 

Bobby's parent: Wait - why are you looking at his back?  And his hips? We already did physical therapy and his leg is what hurts.  And what difference does it make that it hurts his knees when he squats... he doesn't want to squat or lift weights, we're here to get back to running. When is the biomechanics portion of this session?
Abby: Let's do that right now!

Alright... I already know from my examination that there's no way I'm clearing someone for return to running based on intolerance to a double leg squat that doesn't even hit a 90* knee flexion position.  Running is basically repeated single leg squats so if you can't double leg squat, there's got to be a problem with at least one leg in single leg squatting - but, I still need to see how the running looks because I'm going to give them a new home exercise program and need as much information as possible.  Also - the patient came with a specific request - so I'm listening to their demands and being thorough.  The more time spent in evaluation - the more effective the treatment can be later. 

This is the moment when I cut the previous physical therapist some slack and think that they knew this person should not be permitted to return to run but both the patient and parent are pushing for it and so they're sending him back to the doctor.  Who am I to judge another physical therapist I don't even know based on a patient sitting in front of me?  I fear that we, as a profession, are often guilty of blaming our colleagues without considering the whole scenario.  I'm nowhere near an expert - and I also don't have any clue what this kid looked like before 8 weeks of physical therapy.

So I put him on the treadmill and had him run.  Fortunately, it didn't hurt... but it also didn't look good.  I recorded it so I could play it back to him and his parent.  Of course there are really excellent pieces of equipment available and there are physical therapists who are highly specialized experts who work with elite-level runners.  I am not one of those therapists and I don't have any special equipement.  I know the basics of what running should look like and when I watch someone running, I can make modifications to form based on the errors they demonstrate and help them progress back to running when appropriate.

At bare minimum, all physical therapists working in outpatient orthopedics and/or sports medicine facility have the responsibility to learn how to observe and correct basic mechanics of a squat, hinge, and running pattern in order to help their patients.  I'm willing to look the other way if you can't break down throwing mechanics and specialized sport activities like gymnastics moves and ballet positions.  But the squat, hip hinge, and running patterns are essential to far too many athletes and the general population.  There are tons of courses and materials on how to do it - or you should find a colleague who can help you out.  Again - I'm no expert.  I don't spend much time studying running mechanics because the basics are pretty easy to spot once you take the time to learn those. 

I don't know if the other physical therapist ever actually said they didn't do biomechanics assessments.  Perhaps the therapist was a new grad who wasn't comfortable clearing an athlete for return to activity - as this is often a responsibility left to the physician that barred them from participation in the first place.  Regardless - because this has happened multiple times (and potentially has even happened with patients I have seen that then went to a different physical therapist... I would never even know!) - my new reoccurring segment of "What Do Physical Therapists Do" has been launched with Installment #1: We look at Mechanics. In a future post, perhaps I'll even outline some of the common faults to look for - so stay tuned for that!

Take Home Messages:
1) If you are a physical therapist - it is your job to be assessing your patients mechanics - in numerous ways - to make sure they are properly moving. 
2) If you don't know how to assess running form, there are several courses available: on Medbridge or in person, so you can learn the basics.  Truly - the basics help clear up problems in a large number of people.
3) If the basics don't fix your patients' issues, find a physical therapist nearby who focuses on running mechanics and refer.  But you should know that it is a physical therapist's job to be "the movement specialist" and as such - we need to better inform the public of what exactly we do.  You could also record your patient running (with permission - from the back and the side) and get the consensus of your clinic colleagues so you can collaborate and improve your assessment skills. Or re-evaluate the patient using a body-wide system like the SFMA to see if you're missing something.  Or send them back to the doctor to make sure an underlying pathology is not present.
4) Take the time to listen to the patient and target their treatment to the goals they have stated.  I can't always put a patient on a treadmill and watch them run at an evaluation because sometimes that isn't appropriate - but if they're going to return to sports, they're definitely going to do it at some point.
5) Find Physical Therapist colleagues who focus their energies on different areas of expertise and develop relationships with your referring doctors.  For example - I know exactly who to call when I'm looking at an athlete with pelvic floor dysfunction. And I know which doctors I can call and say - hey - I just looked at Bobby - and here's why I don't recommend he return to running at this time.

Let's fulfill the role we are intended for and serve as The Movement Specialists.

(Disclaimer: No identifying or specific patient information is being released here - as this would be breaking the law.  Names are changed, injury is different, and lots and lots of patients want to run.) 

Geno Wins 1000!

This post has nothing to do with Physical Therapy.  You have been warned. 

https://stocksnap.io/photo/0QJJYBAVZ1

This is A goat.

This guy - the guy in the middle of the huddle - is THE GOAT.  Greatest. Of. All. Time.

That's Geno Auriemma - the Women's Basketball Coach at the University of Connecticut.  And today, he won his 1000th game. I've been to a lot of UConn Women's Basketball games and seen a lot of those wins.  Working with that team was a HUGE influence on my path to where I am today.  My parents were there to celebrate my dad's birthday tonight - because my family bleeds UConn blue (except my brother who got lost and went to the University of Vermont - but would probably still cheer for UConn under most circumstances).  Congratulations to Coach Auriemma and to Associate Head Coach Chris Dailey - who has won those 1000 games right alongside him.  Thank you for all the excitement!

Go Huskies!

Year in Review - The best things I did in 2017 to become a better Physical Therapist

December flew by!  I love the end of the year as a time for reflection of the prior year and to make plans for what’s ahead.  I'm a planner.  Here are the top three things I did to help myself become a better physical therapist in 2017 as well as my plan for how I’ll get even better in 2018.

1) I’m three years out of PT School and have worked hard to build a professional support network with particular focus on having great mentors. It was a priority to me coming out of school to find a clinic that would provide this opportunity for me. I also had great mentors in school who guided me in my research plans and in determining my path. These mentors are always available to me and happy (I hope!) to give their input when needed - but they’ve been around for 3-6 years. The absolute best thing I did in 2017 was add a new mentor to my crew.  I have access to new perspectives, resources, a bigger network of professionals - all with different experiences and knowledge.  My original mentors haven’t lost any value- they’re huge influences on me both personally and professionally and I’m immensely grateful to them. But doing this has reinvigorated me to grow as a physical therapist and has provided me with new content to read, classes to consider, different ways to prioritize my continuing education towards certifications, and career and employment advice that ultimately doesn’t impact him. I highly recommend finding mentors that will take the time to put your best interests to heart and help you along the pathway and keep growing your professional network.

2) The second best thing I did in 2017 was to find myself a personal health coach that helped me get on track with work-life balance and develop my own routine.  She's like having a professional closet organizer come in and give me guidance towards organizing my life.  Even coaches need coaching- in lots of ways.  It's not just about a coach for the weight room. She's here to help me get balance and keep me accountable while I'm getting my diet and training into a regular routine as well as helping me with my mental focus.

I’m a huge fan of the idea that people should be doing training programs- not arbitrary workouts. This is something I have been guilty of for years.  I know enough to write a workout but never spent the time to write myself a program with consideration for microcycles or macrocycles working towards a longer term focus with targeted goals. Thus- my past was full of workouts - a habit that yielded plateaus, imperfect compliance, and failure to achieve the goals I have set for myself.  And I got bored with them!  Now, I have a plan and a timeline with an end date and know that as I reach its end, I will either get a coach to plan my next cycle or write a new one myself - but either way - my routine is planned and I know what I'm doing for the next several weeks of training.

So- that’s a glance into my current routine... but how does this help with patient care?  By working on my own training, I’ve seen how longer term planning and focus during sessions has impacted my own body and have started to implement this with patients. For example: I see lots of kids with ankle sprains. In the past, I might have done a session with strengthening, balance, mobility, and plyometrics all together. Now, especially if I’m not sharing the patient and plan to see them several sessions in a row, I might focus a whole session on balance in several ways and the next whole session might be a core training or core and strength focus. I think overall this will help me become more efficient and I’m looking forward to seeing how it impacts my patient outcomes.   Additionally, I've given a lot more thought to the dynamic warm up component of my own workouts and the rehab sessions... that's a post for another day, though!

3) In 2017, I dramatically increased my "reading," particularly because I discovered the world of audiobooks and podcasts. I know- a little late to the party. The experts in the field say you should be devoting an hour daily to learning/reading and many days that just wasn’t possible for me - but with a new longer commute after my job change, I can get an hour of audio time at least 3 days per week. Thus, I've been working my way through all of the existing episodes of “The Ask Mike Reinold Show” and have found that reading shorter blog posts during the day adds up to my hour when I can't sit down and read longer pieces.  Just like my workouts, I wrote myself a reading plan and am reading all the archived blog posts from Tim DiFrancesco (awesome variety of quick reads with the occasional basketball flare) and Lenny Macrina (new blog - with literature reviews! So good!), rather than just arbitrarily reading whatever comes into my inbox - and I have a plan for the next round of podcasts and blogs once these are completed.  Here are some of the great books I read in 2017 (and yes, I do also read novels - because I need to be able to talk to my patients about something, too!).

1. Sports biographies: Sum it up (Pat Summitt - Tennessee Women's Basketball),  Forward: A Memoir (Abby Wambach - USA Women's Soccer), Shoe Dog (Phil Knight - Founder of NIKE), Tuff Juice (Caron Butler - UConn and NBA Basketballer)
2. Unique in sports- Born to Run: a hidden tribe of super athletes and the greatest race the world has ever seen by Christopher McDougall
3. World Biography: Born a Crime (Trevor Noah), I am Malala (Malala Yousafzai)
4. Breathing: Science of Breath
5. Women in science: Headstrong: 52 women who changed Science and the World
6. Currently reading: Deep Nutrition by Dr. Catherine Shanahan (coming soon: blog post for book review!)

Looking ahead to 2018: what do I have planned?

1) I’ve got some shadowing/observation time that I'm arranging with various different practitioners including surgery observation, time with a chiropractor who values exercise, quality time with some experienced and up-and-coming strength coaches, and some amazing physical therapists with various specialties.

2) In addition to the blogs/podcast archives I'm finishing up, I have several new blogs planned to get through - particularly the works of Eric Cressey - which is a whole lot of reading because he's been writing for so long. Also, more books planned:

1. Nutrition: The Omnivores Dilemma by Michael Pollan and In Defense of Food by Michael Pollan
2. Evolution: The Origin of Species by Charles Darwin
3. Coaching: Conscious Coaching by Bret Bartholomew
4. Pain Science: Explain Pain: Supercharged by David Butler
5. Sports Biographies: Pre (Steve Prefontaine), In My Skin - My Life On and Off the Basketball Court (Brittney Griner),They Call Me Coach (John Wooden), From the outside. My Journey Through Life and the Game I Love. Ray Allen. 
6. Women's Basketball: Bird at the Buzzer by Jeff Goldberg

(Purposeful inclusion of UConn Basketball reads - and Eric Cressey is also UConn educated!)

3) Even bigger focus on sports periodization planned for my own training program to begin in March 2018 once my current program is completed.  I'm banking on this getting better from reading so much of Eric's work

4) More blogging.  Because I'm starting to really enjoy my visits to the local coffee shop where I'm becoming a Thursday morning regular and am loving their ginger peach pot of tea. 

NAIOMT Course

So many continuing education opportunities the last few weeks!  I'm starting to realize that the summer time is for kayaking and WNBA basketball and the rainy winter season of Seattle is for reading and continuing education.

About 3 weeks ago I took the North American Institute of Orthopedic Manual Therapy Cervical I course taught by Steve Allen. Prior to this, I've taken their Lumbar I and Thoracic Courses.  NAIOMT offers courses in manual therapy so you can work towards different levels of certifications. The first certification, CMPT- Certified Manual Physical Therapist- requires completion of seven courses: cervical I and II, lumbar I and II, thoracic, upper extremity, lower extremity and then a practical exam. They focus on safety first, differential diagnosis considerations, identifying pathology broken down between contractile and noncontractile tissues, and courses loaded with hands-on learning along with online didactic portions that are evidence-based and actually quite entertaining.  For example, they used videos of an owl's excessive cervical range of motion to compare to the human.  

What I like about these classes:

1) Anatomy reviews are so beneficial as I move through my career. I notice a lot more of the smaller details and am reminded of smaller accessory muscles that contribute to the idiosyncrasies of the human body. When I read articles and watch social media posts for continued learning, it is rarely a review of anatomy except, for example, the occasional Eric Cressey reminder about the importance of the latissimus dorsi. I often feel I should go attend a cadaver examination now to see how much more I would get out of it than I did in 2011.  

2) I have a spine manipulation certification- and these courses are an easy way for me to maintain that status. Washington State allows physical therapists to manipulate the spine (think chiropractics) as well as the rest of the body with a specific protocol outlined to get that certification. As a manual therapy course, these give attention to precautions and contraindications for spine manipulation which are important reminders. I personally don't manipulate the neck almost ever- but the cervical/thoracic junction down to the lumbar and sacro-iliac joints along with the extremities I mobilize all the time and manipulate as needed.  These classes teach me techniques to use that I like and they prioritize safety. 

3) The courses focus on examination and assessment heavily with the notion that if you take a detailed enough history and listen to your patients, they'll tell you everything you need to know to identify the likely pathology pattern they fit into.  And they use a movement screen that is consistent throughout the spine so if you take a neck class and then a low back class- you get the repetition of process and ideas. It's different than the exam I learned in school- which for the most part is what I continue to use with pieces of their exam included. 

What I don't like about them?  Well like all continuing education they're a bit expensive- this one was about $600. They are not frequently offered nearby so I've had to travel pretty far for two of the three I've taken.  Additionally, a lot of the techniques in the level I courses I had learned at school, but many I had not used enough so they were a review and I definitely integrate at least a few of them into my practice each time.

Overall- if you're looking for a class to take (especially if you need all 20 of your annual hours in a crunch- these are 21 hour courses) and are interested in manual therapy- I would definitely recommend NAIOMT. There are lots of other companies who also focus on manual therapy- they're probably also great, just not where my path has taken me.

Let's not debate the research on whether or not manual therapy is a useful tool... I use it in the adult population and primarily the post-op kids I treat and think it's a useful component to my sessions.  That's not what this is about.  This is about what NAIOMT offers and my opinions on their courses.

Any recommendations of courses I should take next year? 

Discussion of the Month - December 2017

A recurring segment is a good idea for a blog, right?   Particularly since the blog is new - and since I'm committed to writing it - but not yet set on my key focuses yet - it's time for a survey.  Please comment any of your thoughts on the first month of the blog.

Things to consider:  What interests you about what I've been writing.  Are you looking for anything in particular? Or just trying to get inside my head?

Please, just give your two cents.  We're all new here.  Opinions wanted.