What do Physical Therapists Do: Installment #3 - We Strength Train

© creativecommonsstockphotos - ID 96113980

In the first installment of "What Do Physical Therapists Do? We Look at Mechanics," I described an experience with a patient who came to Seattle Children's with doctor's orders to do a biomechanical assessment to clear him for return to sport and discussed how it is our job to be "movement specialists."  In the second installment, "What Do Physical Therapists Do? We Listen," I touched upon the biopsychosocial model and the importance of considering the psychological stressors in addition to the internal biological influences on pathology.

Today I'm back with the third installment: "What Do Physical Therapists Do? We Strength Train."  I don't mean that we necessarily pump iron... although I do like to lift heavy things from time to time. Earlier this week, for example, I carried my ~50 pound kayak overhead about 1/4 of a mile to put it into the water... some overhead pressing would probably make that a bit easier.  It would be even cooler if I could suitcase carry it - but so far I'm not able to.  Some of my PT coworkers lift. Others do yoga, or ride horses, or ski, or hike, or play hockey, or lacrosse.  In general we're an active group which helps us to better understand how the body moves.  I once had a clinical instructor tell me that I should try out (or at least watch) any activity available so I could best understand where frequent injuries in that activity could come from and see the things the body is capable of.  It led me to take a snowboarding lesson and watch sumo wrestling - talk about immensely different ways for the body to move!  But that's not what this is about... I'm talking about what we do for our patients.

A common (and essential) physical therapy treatment is exercise.  Exercise covers a wide variety of topics, so the focus today is on strength training.  I'm not here to debate whether or not soft tissue work improves mobility of tissues or has neurological effects or changes the chemical composition of body tissues.  I believe all of these things happen to some extent and know there is debate in the literature on this topic.  Regardless of how soft tissue treatments are applied and what is happening in the body, after some mobility work is completed we need to load our patients. Here's why this is a problem:

Physical therapists guide their patients in strength training exercises but, in my opinion, we barely touch on the basic principles of resistance training and we certainly did not apply them sufficiently in PT school.  Earlier this week, I passed the Certified Strength and Conditioning Specialist (CSCS) exam by the National Strength and Conditioning Association (NSCA). "Certified Strength and Conditioning Specialists are professionals who apply scientific knowledge to train athletes for the primary goal of improving athletic performance."  Some of my patients are not participating in athletic endeavors, but all humans are athletes and all athletes are humans - so we need to treat them as such.  (I can't remember where that line came from - it's not mine, though).  So physical therapists serve a similar role as strength coaches in many ways.

While preparing for the CSCS exam, I was overwhelmed by how much I didn't know. When checking the literature for articles about physical therapists and strength training, I came upon this 2016 article entitled "Periodization and physical therapy: Bridging the gap between training and rehabilitation."  The paper also presented the basics of resistance training and the similarities and differences between physical therapy rehabilitation programs and strength and conditioning programs.

Both physical therapists and strength coaches apply the General Adaptation Syndrome.  "Physical activity is better described as a physiological stressor... when physical activity is properly dosed in individuals who possess the physiological capacity to respond acutely, homeostasis is restored."  The idea is that the body has a baseline set point that it normally operates at and a threshold beyond which it cannot properly recover.  Exercise is one type of stressor following which the body moves away from its set point, towards a threshold, and needs to have processes available to return to baseline.  There are baseline settings for numerous things in the body, all of which can be influenced by exercise including: fluctuation in blood pH, stimulus of hormonal changes and immune responses, changes to the cardiovascular and respiratory systems, altered hydration status, potential tissue damage... the list of is extensive.  The body is generally amazing in its ability to adapt and respond to this variety of changes to return the body to its resting state.   However, if the stresses are too high, injury, illness, or death (at extremes) can occur.  The goal from physical therapy and from strength training is to operate within the boundaries of applying stress so the body can adapt to and recover without over-reaching.

How do you structure this into patient/client programs in a way that makes their threshold improve so they can do more work or lift more weight over time?  Both Physical Therapy and Strength Training use the concept of progressive overload described in Essentials of Strength Training and Conditioning as "progressively placing greater-than-normal demands on the exercising musculature - applies to training to increase bone mass as well as training to improve muscle strength."  For example, we start with a movement pattern such as the squat, and we train it as a movement with just body weight and then progressively load it with dumbbells or barbells and we fluctuate the variables of our training volume and intensity so that the body has time to adjust and adapt and learn.  This means that the homeostasis set point and the thresholds from the general adaptation syndrome are flexible and can be improved with the possible exception of someone who has reached their full genetic potential.

With consideration for progressive overload, strength trainers design training programs for their clients.  In my opinion, based on my observations in numerous clinics over the past 3.5 years, this is where the two fields diverge and physical therapists don't use the same principles.  When planning for resistance training, we can consider four target outcomes: 1) strength gains, 2) improved power, 3) muscle hypertrophy, 4) muscular endurance.  Programming for a specific target outcome means varying the volume (reps/sets), the load (percentage of maximum able to be lifted), frequency of training, and rest breaks.   To target these outcomes, those variables have been studied and summarized as follows:

Target Outcome	Reps per set	Sets	Percentage of 1RM	Rest
Strength	< 6	2-6	> 85	2-5 mins, full recovery
Power	1-2 or 3-5	3-5	depends but >75	2-5 mins, full recovery
Hypertrophy	6-12	3-6	67-85	30 sec - 1.5 mins
Endurance	> 12	2-3	< 67	< 30 sec

Also important to consider is Matveyev's model of Periodization which considers the preparatory phase (basically off-season), transition period (changing over from off-season to in-season), and competition periods, but the preparatory period is broken down into three more sections: hypertrophy and endurance early on, moving into a basic strength phase, and then more of a sport specific strength and power phase.  So understanding how to vary the volume and align it with time on the field or court is essential.  But in the PT clinic, we don't usually program or progress in this manner.  We may consider similar rep schemes and progressive resistance, but we don't typically use loads of this magnitude because we're rehabbing people who either can't or should not yet be lifting loads of that intensity.  At the end of the day, we're all loading up our patients/clients.

Lastly, consider teaching a person a new task such as a squat.  At first, regardless of reps and sets selected, the initial changes that person will experience will be the brain learning how to squat.  This is the same for any activity - your body needs to learn the pattern and get the neurons linked together before you can experience significant muscle gains, improvement in function, and changes in strength.  They may feel stronger or that the task is easier, but these initial changes are neuromotor.  In the context of pain, people move differently and their neuromotor patterns change.  So, since about 99% of the patients I treat are in pain, I'm basically coaching them to make neuromotor changes and as they go through that work, their symptoms resolve, and they're done with physical therapy (because insurance dictates this).  Thus, they have so much remaining potential for strength gains, endurance training, hypertrophy, power, agility, and all the physiological benefits that remain for a strength coach to guide them.  I'm a little bit jealous that I don't generally get to observe these adaptations in my patients, but I get to see them in my own training.

SNF Side Hustle

I've been working my way through Eric Cressey's older blog articles (as well as a collaboration he did with Mike Reinold called Optimal Shoulder Performance) and came across this post written in 2005 in which he debunks weightlifting myths.  In the post Eric recalls: "Dr. Jeff Anderson, Director of Sports Medicine at the University of Connecticut, said to me once: 'If you live your life the right way, you'll likely find yourself in an orthopedist's office at some point. If you live it the wrong way, you'll likely end up in cardiologist's office instead.'"  "Doc A" unfortunately passed away last year, but he was a great physician and all-around nice guy.  Reading his quote reminded me of my experience observing this in real life.


When I first graduated from PT School, alongside my job in outpatient orthopedics, I also worked as a per diem PT in a skilled nursing facility (SNF).  (#sidehustle). I was mostly scheduled to evaluate patients who arrived to the facility on a Friday and, because of insurance mandates, needed a weekend evaluation for admission. I regularly observed Dr. Anderson's statement, but it is only now, reading the quote, that it seems so much more simplified and realistic.  A day at the SNF would have a patient schedule of about six patients, an hour to 90 minutes for each one, often looking like this: 

1) Frail lady with osteoporosis, 82 years old, who fell and broke her hip.  Many of these patients would also present with a urinary tract infection and confusion. (primarily orthopedics)
2) Type II diabetic, obese, sedentary man in his 60's who just had a total knee replacement (orthopedics with cardiology risk factors/co-morbidities).
3) Man, 76 years old, life-long smoker, worked a manual labor job for his whole life, who recently had a stroke or a heart attack. (cardiology or neurology)
4) Younger woman, early 20's, detoxing from drug overdose. (could fall under several categories - I'm not exaggerating, here.  I really did see a lot of patients who were either detoxing or recovering from an overdose or had an accident that involved drugs or alcohol.  The first time I saw track marks left an impression.)
5) Overweight woman, 55, using supplemental oxygen with debilitating back pain and depression. (orthopedics with cardiology and psychological co-morbidities)
6) Homeless person who is malnourished and recovering from pneumonia. (also a variety of categories)

If the patient had been newly admitted to the facility, they may not have been out of bed for several days.  This 2007 paper outlines the effects of bed rest on the cardiovascular system, the muscular system, and the skeletal system but a basic summary is that everything gets worse when you stay in bed for too long.  What the paper doesn't explore is how self aware people are when they have been on bed rest.  These patients had frequently walked themselves into a hospital or were brought via ambulance within the past two weeks.  They sometimes have lost a little bit of sense of time, but they were able to walk not too long ago, so of course they can stand and walk.  I'd estimate about 25% ultimately weren't able to hold up their weight requiring me to hold them up when they got lightheaded from orthostatic hypotension or when their knees buckled from disuse of their quads.  Want to know another awesome benefit of standing and getting out of bed for the first time in several days?  The gravitational effect on your gastrointestinal tract! That's right, many of these patients would stand for the first time in several days and take a few steps and would need to be at the commode in under 14 seconds.  I was pooped on 1 out of every 2 shifts I worked. 

I would finish my day, exhausted from lifting people to help them transfer in and out of bed and onto the commode.  More than physical exhaustion, I would be a wreck from the intense emotional drain of trying to motivate people suffering from pain and limited endurance to go for walks and exercise.   This type of work really got to me.  The gains were small from day to day and I was only there once or twice a month so I never got to see the patients improve.  I had only worked there for a few months when I found myself finishing my day, sitting in my car, unable to get going because I was too busy wondering what the end of my life could possibly look like. 

According to the CDC, heart disease was the #1 cause of death in the USA in 2015 accounting for 23.4% of deaths that year.  When broken down by age, unintentional injuries/accidents was the most common cause of death in people younger than age 45.  This includes a fall as a cause of injury in addition to numerous non-orthopedic accidents such as drowning or smoke inhalation.  I don't think Doc A was referring to death in his conversation to Eric, but that's how my brain got here, and I like the idea that if you use your body so much that you develop orthopedic issues, you could be preventing some of the co-morbidities associated with cardiovascular pathology. 

The world really isn't so black-and-white and these outcomes aren't so dichotomous.  There are very active people running on a regular basis, who die unexpectedly from a cardiac event.  Can you lead a lifestyle that decreases your risk of cardiovascular pathology?  Yes, and it doesn't inherently mean a future of orthopedic issues is coming your way.  Can you take good care of your body with exercise and prevent arthritis/bodily breakdown?  Yes and it doesn't dictate you're going to have a stroke.  What does this mean?  It means try to eat a healthy diet and exercise regularly because in the end, we only get one life to live and one body to use, so we should make the best of it! 

Real Athletes Poop Their Pants - And love the Jonas Brothers?

It was the summer of 2007 and I was working as the Travel Coordinator and Equipment Manager for the Connecticut Sun WNBA Team.  I had just graduated from UConn so maybe all the time I spent studying meant that I was a little behind on my pop culture.  One game the ball kids were going crazy with excitement about the half time show performers: The Jonas Brothers.  I had never heard of these guys, but they were so excited so I managed to snap a photo of the ball kids and the Jonas Brothers together.  In 2008, the Jonas Brothers were nominated for the Best New Artist Award at the Grammy's... so they must have been pretty good.

#TBT - the Jonas Brothers (Kevin, Joe, and Nick) and the Connecticut Sun Ball Kids (Carly, Maggie, and Clare)

Interesting fact about Nick Jonas: he was diagnosed as a type I diabetic at age 13 in 2005 - not long before that photo was taken.  The Jonas brothers as a band were pretty big from 2007-2011.  In 2015, Nick Jonas co-founded the group "Beyond Type I" whose mission is to educate, advocate, and provide resources to those who face diabetes.   This past week, Beyond Type I featured one of my closest friends on their website telling a story about her experience with Type I Diabetes as a long distance runner.  Her post has been re-posted in its entirety below, but before we get to her humor - here are five things you should know about Type I Diabetes.

1) The difference between Type I and Type II Diabetes:
Type I Diabetics are unable to make sufficient insulin in their pancreas to regulate their blood sugar.  The function of insulin in the body is to bring sugar into cells so it can be used for energy.  Without insulin, sugar remains in the blood which can harm organs and even be fatal.  Type I Diabetes is not curable, but through constant attention to diet and supplemental insulin, people can live full lives with the condition.  This differs from Type II Diabetes in which a person has built up resistance to insulin at their cells over time but whose pancreas still makes insulin.  Type II can be reversed through dietary changes and exercise.

2) Signs/symptoms of Diabetes:
With both Type I and Type II diabetes, it is common to experience increased urination, increased thirst,  and dry mouth.  Type I diabetics may also experience fatigue, abdominal cramping, nausea, vomiting, and a breath smelling like acetone which are less commonly seen with Type II diabetics. 

3) Insulin supplementation:
Type I Diabetics use supplemental insulin to regulate their blood sugars because they are unable to do so naturally or by diet and exercise.  They have to constantly track their sugar levels and consider the impact of anything they eat and the effect it will have on their body. Because they supplement with insulin, they can also experience hypoglycemia (too low blood sugar.)  Signs/symptoms of too low blood sugar include sweating, shakiness, light headedness, confusion, and fainting.  Because of the severe impact of low blood sugar, if you happen to come across someone with an ID bracelet identifying that they are diabetic, it is potentially lifesaving to give them sugar and call 911. 

4) Global Issue
While 90% of diabetics are Type II, the trend has been increasing for Type I by about 2-5% per year.  The frequency is not evenly distributed around the world.  For Type I Diabetes, Finland has a high frequency, the US has a moderate frequency, and China has a low frequency.  Interestingly, the above linked paper also notes that none of the regions had more females than males with Type I Diabetes but I only know four people with Type I Diabetes and they're all women. It is important to recognize that there are essential differences between the two conditions and that because Type II is so much more common, you need to be aware of which type you're reading about because the information usually does not apply to both types.  Diagnosis, treatment, and medications differ between Type I and Type II. 

5) Genetic Disposition
Multiple genes have been identified to relate to Type I Diabetes, but 40-50% of family linked cases relate to chromosome #6 and variations in Human Leukocyte Antigen which is a regulator of the immune system.  In the USA, 1 in 20 Type I Diabetics have a family member with the condition compared to 1 in 300 from the general population.  Identical twins are seen to have >60% and fraternal twins 6-10% occurrence of Type I Diabetes.  Children diagnosed before age 5 are suspected to have a higher genetic predisposition in their family than those diagnosed later in life.

Enough of the serious business and back to the reason for this post.  The following article first appeared on the "Beyond Type I" site here on April 11, 2018 and was written by my friend Cat Carter (reproduced with her permission).  She has run 29 Half Marathons - at least half of those since she was diagnosed with Type I Diabetes.  I like to claim that her running habit is my fault, as her first half marathon was in Providence, RI, with me.  If she ever commits to running one in Seattle, I'll get back to training to do another one - but until that time, I stair climb and I don't run.  After Providence, she kept running them and I sat in a chair in the corner of Koon's Hall at UConn for the next 3 years. There has been extensive debate about how and when we met, but we've been friends for at least 15 years and I lived with her for all of PT School - so if she can suffer through the terrible person I was when hungry and sleep deprived, she's gotta be worth getting to know.  Enjoy her post!

With Cat Carter before the Providence, RI Half Marathon

I run half marathons for many reasons. a) I enjoy the physical and mental challenges each race offers. b) Runners are some of the friendliest folks around, so although I prefer to train alone, I have met some of the kindest and coolest people at races and in my running clubs. c) My internal motivation is super in the toilet, so it’s a safe bet that I won’t exercise without a race on my calendar. d) The world is full of blissfully ignorant fools. Harsh and unkind words, I know. But seriously, how often do you hear ridiculous diabetes jokes? How many instances can you think of when the media, a politician, or another individual or group with influence and power spread blatantly wrong information about the disease? I run to prove them all wrong and spread our Truth.

And e) I like medals. I like how they look hanging on my wall. I like how they sound when they clink together. And I love the memories and feelings of accomplishment each one of them evokes. I’m not at all above doing a race for the bling. I did a race in Amish Country one time because its medal was a horseshoe. A horseshoe. It was awesome. And my amazing wife was inseminated without me there because I was doing a race that had a shark finisher medal. (Yes, you read that right. Who knew it was going to take on the first try? I mean, really, what are the odds? Mama loves you, Liam, and I promise I won’t miss any other critical moments of your life.) So when I found a race for which the medal was a grilled cheese sandwich (a local race no less – you go, Connecticut!) you bet your ass I was all in.

Unfortunately, that particular June day in 2016 turned out to be rather rainy. Now normally I don’t hate running in the rain. It’s not the worst thing ever. Sure, putting all of my (diabetes tracking/treating) devices in waterproof bags is less than ideal and a royal pain in the ass, but it’s manageable. While we’re here, how many of you hate that word? “Manageable.” Ugh, gross. It’s almost as bad as “moist.” If I hear one more person say, “Hey, don’t worry, diabetes is manageable,” I’m going to come unglued. I think the world needs a quick tutorial on the meaning of “manageable.”

Aaaaaaaaaaaaanyway. I’m going to reel myself back in. Where were we? Yes, the grilled cheese race. Okay, so there I was plugging along mile after mile when I felt something … below. Like, below, below. In the bottom of my pants below. So I did what any human being who thinks they’ve just pooped their pants would do: I panicked internally for roughly three minutes. Which I know doesn’t sounds like a long time, but do me a solid – pun intended – and take a pause for three minutes. While taking that pause, imagine you’ve just pooped your pants, you’re in a very public place, and you have absolutely no idea where the nearest restroom is. Now, can we agree that three minutes is on the same level as an eternity?

Here was the major problem – not only was the medal a grilled cheese sandwich, but all finishers also got a real grilled cheese sandwich with chocolate milk. I was wicked hungry, and I really wanted that sandwich, but you cannot just roll into the food line at the end of a race with poopy pants. You will make exactly zero friends doing that. So I summoned the courage to nonchalantly check the damage, and much to my relief it wasn’t poop … but my Omnipod. That slippery little sh*t.  My pump! I never thought I’d be excited to learn my pump fell off, but at that moment in time I was damned near ecstatic. It was the first race I’d done in the rain since diabetes, and I didn’t even think to reinforce my pod. Stuck to my upper buttocks, it must have lost its adhesion in the *moist* conditions and slid down. Thankfully I had a pen in the car I could use post-race for my coveted sandwich, now only a short 2 miles away – crisis averted.

In closing, real athletes poop their pants. I’ve read about it on the Internet, so it must be true. See here, here, and here. What did I tell you? It’s totally, 100% a thing. So if I thought I pooped my pants and didn’t slow down (or cry!) … I must be a real athlete, too. Go. Me. And if you’ve ever pooped (or peed) your pants while getting your diabadass workout on, then go, you, too!

Social Media Impact on my PT Practice

with Mike Reinold!

with Lenny Macrina!

I love social media.  If you've been following the news lately, you probably know that Mark Zuckerberg, Facebook CEO, has been testifying in front of Congress regarding improper use of data and basically explaining how the internet works.  Through social media, it is possible to interact with millions of people, watch silly cat videos, become a viral sensation, or watch my nephew on the ski slopes and my niece at her dance recital all the way across the country.

One thing I really like about social media is that I have the opportunity to interact with famous people.  For example, I wished Justin Timberlake a Happy Birthday.  He probably didn't see it because he has 49.4 Million Instagram followers, but I was able to do it.  There's a slight chance that he noticed my comment out of the 38,391 comments there. I recently read an article (but now can't remember where) that outlined the impact of the various ways you could interact on social media platforms.  A high percentage of followers may see a post, less will "like" it, but only a small fraction will comment on it, and even a smaller percentage will somehow directly connect, separating from the herd.

Slightly less famous than Justin Timberlake, (38 Million Facebook followers), are Mike Reinold (106,918 Facebook followers) and Lenny Macrina (1,788 followers on Facebook), co-owners of Champion PT and Performance (50,000 followers for the company) in Boston.  They're also the hosts of "The Ask Mike Reinold Show" podcast, and if you've read any of my previous work, they're major influences on how I practice physical therapy.  The connection here is that these guys do a lot of research, treat a lot of patients/clients, and own a business while regularly using various social medial platforms to spread their knowledge and have been able to impact me in this way.

Last week I attended Lenny's "Evaluation and Treatment Algorithm for Medial Elbow Pain" course at the Pacific Northwest Orthopedic and Sports Medicine Symposium in Portland, Oregon.  Because I've previously interacted with Lenny directly via Facebook and indirectly through their podcast,  he recognized me when he walked into the room.

SOAP BOX: To ALL student physical therapists and new grad physical therapists (and PTAs, and any other rehab/sports professionals), you need to follow this crew. NEED!  If you're interested in gymnastics at all - follow Dave Tilley.  If you're interested in Crossfit, follow Dan Pope.  If you're interested in golf - follow Mike Scaduto.  If you like UConn Basketball or want online personal training guidance, follow Kiefer Lammi, their Director of Fitness.  If you work with baseball players, they've developed Elite Baseball Performance. If you treat shoulders and knees - these guys are for you. And if you're a parent of a youth athlete, they're an awesome resource for that also. 

Moving on... I've previously written about how important it was for me to get a new mentor in this post.  But mentors don't necessarily need to be people you know or spend time with in real life.  They don't even need to be your teachers or coworkers.  I have mentors I can call or email at any time who filled those roles, but then there's Mike and Lenny - who really don't know me beyond the brief moments photographed above, but who I respect in the field of physical therapy and whose work I try to read consistently to improve my practice.

In addition to Lenny's Elbow class last week, I've taken the time to go through their podcast episodes - which are really great - and have had two of my questions answered in them: Episode #107 and Episode #109 so you can check them out.  The episodes are short and formatted as three questions and their answers.  I also just completed Mike's Shoulder Seminar. I happened to be attending Lenny's Elbow course while I was finishing the seminar and the two paralleled each other nicely.  Both have had an immediate impact on my treatments.  Following all the recent learning I've had from this crew, here are the four changes I've recently made in how I practice PT.  (Keep in mind - the two courses I took were intended for the upper extremity).

First - side-lying external rotation and prone row exercises were previously absent from my treatment sessions and home exercise programs.  Not any more! The Shoulder Seminar included the research supporting their use such including EMG studies on the muscles being used.  This paralleled with Lenny's course showing how he implements these exercises into his routines.

Second - rhythmic stabilizations and PNF patterns have often been in my treatment sessions in the past, but I've ramped up their volume considerably.  Where before I may have done 2-3 rounds of 30 seconds of rhythmic stabilizations and a set of 10 reps of resisted PNF D2 at occasional visits, I've now started doing the stabilizations in A LOT more positions with more total time spent on dynamic stability.  I'm not just doing this because Mike and Lenny said to... at Lenny's course we had lab sessions doing these treatments to each other so (thanks to my partner and fellow Seattle PT Bruk Ballenger) I felt the impact of doing these on my own shoulder.  These are really fatiguing!

Third - upper extremity weight bearing progressions.  I've never had someone standing at their treatment table with their hands on the surface with low loads of weight bearing in that position.  I like it for a gentle joint compression or co-contracting activity without the shoulder flexion in a quadruped or standing with the arm against the wall closed kinetic chain activity.

Fourth - I've been working with some coworkers at Seattle Children's Hospital on a return to sport testing protocol for patients following rehab for upper extremity injuries.  We've had numerous discussions about the components to include, but The Champion crew uses a hand-held dynamometer (HHD) for measurable strength testing.  Fortunately, I studied under HHD guru Dr. Richard Bohannon at UConn and Seattle Children's already uses it in our lower extremity testing.  Manual Muscle testing just isn't sufficient enough to identify the subtle but potentially significant differences in strength.

So, I've learned a lot from this crew, and I found them via Facebook and other social media means.  I'm looking forward to getting started on Mike and Lenny's knee seminar in the next few weeks, and if any of the Champion PT and Performance Crew comes across this post, please know how grateful I am for all that you do.

My Three Favorite Things About Working With Dancers

Spectrum Prop

I have to be honest... I don't know a thing about dance.  Somewhere there are photos of eight year old Abby in a pink tutu from the only recital I was ever in.  (If I get more than two comments on this blog post, I'll find the photo and post it on here to replace the creepy doll prop -->). That day I stood on the stage bawling my eyes out.  It's shocking to me now since I love being the center of attention, why couldn't I just dance the number!? Somehow dance was not for me.  I loathed the outfit. The tights were itchy. I loved (and still love) wearing sneakers so being barefoot grossed me out a bit.  And my balance was poor, so I kept falling over.

My first job as a physical therapist landed me in a clinic with Boyd Bender, Physical Therapist for Pacific Northwest Ballet.  It was a privilege to work with him, and I was able to attend two of their performances to see what physical therapy looked like in that setting.  Some of the dancers of PNB and other local dance groups would also come to our clinic to see him.  If his schedule couldn't fit them in, sometimes I got to treat them... which is how I came to meet the dancers of Spectrum Dance Theater.

My top three favorite things about working with this particular group of professional dancers:

1) They have the best body awareness.  This likely applies to all dancers, but I feel it differs from athletes of other sports.  Keep in mind that my permanent job is working at Seattle Children's Hospital in pediatric sports medicine.  Sometimes kids who are new at sports haven't fully developed their coordination skills yet and need guidance on how to properly breathe or roll over so they can start to integrate their body systems and function in the world.  They might trip over their feet or have poor hand-eye coordination or have difficulty coordinating activities across their mid-line.  But not dancers.  These athletes know their muscles and what they feel like on a regular day.  They know when things feel "right" and they're very in-tune to when something's "off."  The night before I'm scheduled to head to the beautiful Madrona neighborhood of Seattle to meet with them, I get an email listing their current concerns.  Never before in my career have I had a patient or client say to me - "I pulled my sartorius yesterday doing an arabesque." Or "my left shoulder subluxed while lifting my partner yesterday and it relocated on its own so can you just check it out and give me some suggestions for what to do so I can lift again today."  My personal favorite so far, "I stubbed my toe and I don't think there's anything you can do about it, but I'm pretty sure it's causing me to have a cramp in my calf and can you check it?" Compare these to the usual response I get, "my leg hurts" and you can recognize why treating them is so great.

Awesome view of Mount Rainier from Madrona, Seattle, WA next to Spectrum Dance Theater 

2) They're smart! I can't generalize this to all dancers - it may just apply to the Spectrum group. This is a team of performers taking interest in being informed about issues of the world, or at least the issue of their current show. Perhaps Donald Byrd, Spectrum's Executive Artistic Director, might just recruit intelligent people willing to support the company's mission "Dance as an art form and as a social/civic instrument."  But the diversity in the group and their varied educations and upbringings make them more culturally aware and socially responsible.  It doesn't hurt that he has two dancers from Connecticut, making my home state proud!

This week, I spent a few hours treating the dancers before their performance of "H.R.3244" at Washington Hall in Seattle.  (Shows continue April 8th, 10th, and 11th - check it out!)  From the show notes, "H.R.3244 is the bill number for the Victims of Trafficking and Violence Protection Act of 2000 passed by the US Congress and signed into law on October 28, 2000. It states 'to combat trafficking in persons, especially into the sex trade, slavery, and involuntary servitude, to reauthorize certain Federal programs to prevent violence against women, and for other purposes.'"  The performance represents the emotional response to human trafficking - both informing the audience about the legislation while reminding us that this problem continues to exist today - and demonstrating the emotions it can evoke with hope to elicit conversation and action.  Following the show, several of the dancers had the opportunity to explain their research processes to learn about the issue and find a way to identify with their roles.  It was wonderful.

Spectrum Dancers and Executive Artistic Director, Donald Byrd, in a panel discussion after the show

3) Their ability to move covers all varieties of movement and the whole spectrum of emotions. (Like what I did there?)  Pick an adjective- they can embody it.  And they're not using words!  The first time I went to PNB for the ballet of Don Quixote, I didn't realize that it was different from a musical play... and kept wondering when they would start speaking!  That's how little I know about dance.  But about human movement?  I know a little something about movement and they can be so many different things - Smooth versus Rough, Flowing versus Rigid, Light versus Dark, Superficial versus Deep, Cerebral versus Visceral, Explosive versus Contained.  This is the human body as an art form.

The last production I saw from Spectrum was (IM)Pulse, a reaction to the Pulse Nightclub shooting in Orlando and to victims of hate crimes based on gender identity.  I had seen several of the dancers in the clinic for neck pain and finally asked them what was going on with the choreography to make them present the way they were.  They were basically dancing out seizures with rapid head movements several times throughout the show.  I had to see the performance and immediately understood the relationship between the choreography and the conditions I was seeing on the treatment table, and it really did elicit an emotional response to the social issue on display.

https://spectrumdance.org/impulse-review-city-arts/

So I'm finally learning a little bit about dance.  I have a long way to go.  Maybe if they like having me around, they'll give me a chance to take a class or two to feel how they really move and learn a few things.  To be fair, it would probably take many more than just a class or two.  But maybe I'll have a similar reaction to dance as I did to yoga!