Beauty. Strength. Poise. Confidence.

The ESPN “Body 10” issue was released online this week and hits magazine stands tomorrow, June 29, 2018. This publication is a real work of art that I look forward to each year - because I love working with athletes and it gives the reader a better appreciation for the differences between bodies. This is a display of athleticism showcasing famous athletes from numerous sports and tastefully posed with beautiful backgrounds. This year’s edition features Seattle Storm point guard - and four-time Olympic Gold Medalist- Sue Bird along with Seattle Reign star soccer player - and also Olympic gold Medalist - Megan Rapinoe.

http://espn.reprintmint.com/galleries/the-body-issue/001-180709-sbmr.html

The first time I saw a Body issue was their 2nd edition when Diana Taurasi posed with a black basketball in 2010. At that time, I had known Diana for about 6 years and had maybe seen her without her hair in a ponytail three times... but her hair was gorgeous and the poses were elegant.  She looked strong and fierce... this is empowering!

http://espn.reprintmint.com/galleries/the-body-issue/001-101018-6-duo.html

What struck me the most from previous issues were the stories the athletes told, the tattoos so many of them have which are art in and of themselves, and, of course, the variation between people and unique human circumstances.  Last year the magazine included Kirstie Ennis, a Paralympian who wears a prosthesis after an above-knee amputation following her helicopter crashing while she was serving as a US Marine in Afghanistan.

http://espn.reprintmint.com/galleries/the-body-issue/001-170717-ke.html

She is rock climbing wearing a prosthetic leg! They've also photographed beach volleyballer Kerri Walsh (Jennings) late in her pregnancy and then again holding her newborn daughter.  The human body is capable of so many feats and is really so amazing, that I feel it is vital to celebrate our unique differences.

This magazine promotes positive body images for strong women. Of course there are strong athletic men included year after year, but there isn’t societal stigma against men having large muscles. So often women don’t want to be muscular- but this gives you a chance to see the beauty in strength.  It gives you an appreciation of the differences between body size, variety of sports that people compete in, and tells you something personal about each athlete.

ESPN doesn’t need any promotion... but if you haven’t yet seen the Body magazine for 2018, start googling and check it out because there is real beauty, poise, strength, confidence, and more beauty in this publication.

Evolution or Creation?

© Creative Commons Zero (CC0)

This post is different than my usual posts... but these are thoughts that are on my mind, and give me a chance to share a little bit about myself. There's a lot going on in the world right now, and my family just recently just shared a major milestone.  With the events occurring in my world, I've been thinking about creation versus evolution, religion versus science. If you know me in real life, you know that I am Jewish... and if you've come across me by reading the blog, you already know I'm a physical therapist.  So I'm a person who has, throughout my life, studied both religion and science.

With regard to Judaism, I would describe my religious observance as family-oriented and tradition-based rather than living and breathing by Judaic law. Since I became a bat mitzvah, (20 years ago!) I have been an occasional synagogue attendee and I do not observe the Sabbath every weekend or keep a kosher home.  To some, this would mean I'm "not as Jewish"... but I regularly apply Judaism to my life in meaningful personal ways. I treat others as I wish to be treated.  I try to honor my parents - like the 10 Commandments tell me to.  There are many ways that my religious upbringing sneaks into my life - and this is a cool thing about religion: you can - and in my opinion, should - make it your own.  Like the saying "the best exercise is the one you will do consistently," I feel that the best way to be religious is to find what works best for you. There are too many ways to interpret biblical texts for people to all pray, believe, and live in the exact same way.  

One way that religion creeps into my life is through prayer.  I don't pray nightly, or even weekly.  Months could go by between prayer sessions, but then I might get into a routine of it, for whatever reason, for periods of time. I'm sure I've probably gone a whole year, Yom Kippur to the following Rosh Hashanah holidays, without finding a need to pray in between.  But there have been a few times in my life when I've faced something that was immensely overwhelming, either positively or negatively, that I could only reconcile my thoughts and emotions with prayer. For example, when my niece and nephew were born, I remember feeling so flooded with love and emotion, I didn't know what to do with myself.  I felt lost in the whirlwind of feelings and ultimately I went to synagogue and cried praying for their health and giving thanks for them. They were so tiny and they immediately became "my everything."  I found clarity through prayer and soon after that wrote that it was the first time I had ever loved anyone or anything more than myself.  It was a huge shift in my perspective on life, and on love.   It is easy for me to see why some religions drop to their knees in prayer...

As far as observance, I celebrate the major Jewish holidays and have developed traditions with friends and family that I look forward to annually.  I make matzoh balls the same way my mom taught me how to when I was a little girl - and there's always some in my freezer in case I'm feeling under the weather because it truly is the best medicine.  Some of my Seattle friends have celebrated at my annual Passover Seders with me for the past four years to sample the gefilte fish and other foods I've been eating only at this time of year for my whole life!  

As part of my childhood, I attended A LOT of Hebrew School alongside my secular education. I can recall times when the message at one school conflicted with the other...  "In the beginning, G-d created the heavens and the Earth."  And then learning about evolution and Charles Darwin in my science classes... the Big Bang!  As a physical therapist who has studied a fair amount of science, it is easy to fall into the habit of believing in evolution and forgetting about creation. But then something happens and I'm reminded of the alternative perspective.  A few weeks ago, my niece and nephew became B'nai Mitzvah. This translates to "children of the commandment," whereas bar mitzvah is "son of the commandment" and bat mitzvah is "daughter of the commandment" and it is somewhat like a celebration of the coming of age as you are now upheld to the responsibilities of the adults in the Jewish community.  During their ceremony, they read this quote from Amos Oz, an Israeli writer:

"I know that the tide is not an independent force, but merely the submission of the water to the movement of the moon in its orbit. And this orbit in its turn is subject to other orbits which are mightier far than it. And so the whole universe is held fast in the clinging grip of strong hands, the forces of Earth and Sun, planets, and comets, and galaxies, blindly erupting forces ceaselessly stirring in ripples of silence to the very depth of black space.” 

He doesn't mention a creator or higher being - but this is used in prayer books around the world.  Just a small paragraph in a prayer book that parallels science.  It surprised me, and I thought it was beautiful.  It made me think of Stephen Hawking's "A Brief History of Time", which I recently read.  Hawking wrote: 

"One can imagine that God created the universe at literally any time in the past. On the other hand, if the universe is expanding, there may be physical reasons why there had to be a beginning. One could imagine that God created the universe at the instant of the big bang, or even afterwards in just such a way as to make it look as though there had been a big bang, but it would be meaningless to suppose that it was created before the big bang. An expanding universe does not preclude a creator, but it does place limits on when he might have carried out his job!"

I don't have any answers... only more questions.  To be honest, I'm not bothered by the absence of answers under these circumstances. As a physical therapist, I embrace the ideas of evolution, but then I see the differences between the patients I'm treating day after day, and I think the beauty of the world and wonderful things the human body can achieve can only be possible with the influence of a higher being. Regardless of what you believe in, we're only here for a short time, so let's be kind to one another.  The world needs more love right now.  

2018 WNBA Season Update - A Race to Stay Healthy!

Throwback to my Connecticut Sun Days with Allison Hightower, Kelsey Griffin, and Tina Charles

The 2018 WNBA Season is heading into its second trimester.  How quickly time flies when you love watching your favorite teams and favorite athletes who play a short 34-game season (plus some pre-season and playoffs) with most teams around 11 games in.  This season is condensed with the upcoming FIBA World Cup being held in Spain starting September 21st, with a USA National Team that will take the greatest stars from all the WNBA Teams resulting in this abbreviated schedule.  The usual length season, which already felt like a whirlwind, is now a hectic schedule with games practically every other day. This week the Seattle Storm played three home games in six days, but recovering and preparation between games becomes a challenge under these scheduling circumstances. And above all that, if a team is influenced by injury, how does this affect ticket sales and the entertainment on the court?

I've spent many years on the WNBA sidelines, but now that I'm a healthcare provider, my perspective on the league is different.  When I started working for the Connecticut Sun in 2007 as their Travel Coordinator and Equipment Manager, I helped out in the athletic training room, but I was in charge of laundry and buses.  My biggest concern for players' health was if their sneakers were giving them blisters. I also needed to remember to pack uniforms for injured reserve players who generally were not listed on the line-up but could potentially play if someone else got hurt.  At that time, teams could keep a player available to fill an injured player's spot... that doesn't exist anymore.  

From a physical therapy perspective - this season's playoff contenders will likely be the teams that can stay healthy despite the crazy schedule.  Rookie players will need to learn how to take care of themselves in ways they didn't have to in college. When I was at UConn, we had meals as a team that offered nutritious options and salads pretty much daily.  It is easy to see that a new grad WNBA player might not know how to cook because they never had to before.  They also need to self regulate their recovery, figure out what works best for them, and start taking direction from new athletic trainers than the ones they've used for the past four years. It's a little bit of a relationship-building game in a really quick span of time, and it's been really interesting to watch how that develops year after year. 

Veteran players will also need to find ways to take the best care of themselves to recover between games.  There aren't many days off and the need to re-fuel, rest, and feel good through massage or chiropractic care or ice baths or foam rolling need to be well managed and consistently available.  The WNBA could not have picked a better season to get a league-wide partnership with Cortiva, a massage therapy training school, to have more massage therapists available in certain cities.  Recovery will be key this season.

Since I wrote my PT School thesis on women's basketball players' injuries at the college and WNBA level, I've been thinking about player injuries in this league for a long time.  Feel free to be the fourth person to ever read that paper in your spare time. I try to follow what's going on around the league with regard to injuries - and have several ways of doing so. This website and this website (and there are several others that are similar) list WNBA injuries and stay fairly current... but the first website lists injuries as a service for people who are betting (gambling) on women's basketball and the second one is a fantasy sports team database.  They generally seem to be getting their information from news articles so it's not certain how reputable any of the sites are.  There are currently injuries listed on 9 of the 12 teams, with several teams listing multiple injuries.  I also follow numerous writers on Twitter who write about the injured athletes for their local teams.  The schedule has been up for discussion quite a bit more this season than in the past. 

What I keep waiting for is a bigger entity to start organizing this information.  ESPN has an NBA Injury Report page, but no WNBA Injury Report page, CBS Sports has an NBA Injury Report Page but doesn't have one for the WNBA - nor does their header even include a link to the WNBA at all!  Research publications in the WNBA are limited, but this 2006 paper examined WNBA versus NBA injuries and acknowledges that, even at that time 12 years ago, the rates in the WNBA were higher.  So why isn't this information more readily available yet?  Part of the problem is that the NBA has an Athletic Trainer's Association (NBATA)  which reports and tracks their injuries whereas the WNBA Athletic Trainers report their injuries to the WNBA, and then nothing happens with that information (or at least it is not published and made available for public consumption).  This is something I, personally, am hoping to remedy in the future.  

I didn't look to the research for specific data on the impact of fatigue on injuries - but I learned in school that there is a likely correlation, particularly with postural muscles which would include the muscles of the calf and also with reaction time where the brain is slower to react when it is fatigued which could impact injuries.  Since ankle sprains are always considered the most frequent injury in basketball players, it's not really surprising that we're seeing a lot of ankle injuries already this season.  Here's to hoping that these injuries are low grade and the athletes will recover quickly and get back to playing - but there's a lot of basketball left to be played by fatigued athletes.

I'm already trying to prepare myself for the dark ages that will come between the end of the 2018 WNBA Season and the beginning of NCAA Women's College Basketball almost two months later... it's going to be rough.  Fortunately there is time to continue enjoying WNBA basketball right now while it's here.  Good luck to all the WNBA Athletes, Athletic Trainers, Strength Coaches, and team personnel this season.  And a friendly reminder - if you're part of the travel party - you need to take care of yourself too!  Hydrate and recover!

Book Alert: Conscious Coaching - by Brett Bartholomew

Quoting a quoted passage- “People won’t care how much you know until they know how much you care.”

I just recently finished reading Conscious Coaching by Brett Bartholomew.

What I really enjoyed about this book is that Brett welcomes you into his personal life to the deepest level.  He had some really challenging obstacles to overcome in his youth which he goes into great detail explaining and makes you want to reach into the book and give him a hug.  I've seen some of his posted videos on social media and he has an engaging personality and a voice worthy of being a radio talk-show host, so it was eye opening to hear of his past and where he has come from.  It also becomes alarmingly apparent that his health issues were severely mismanaged in the healthcare system at the time.  This is tragic and, as a healthcare provider, it made me think about my current patient caseload wondering if I'm doing a good enough job listening to my patients, hearing their concerns, and doing what's best for them... not what I think is best.

One way that I try to remedy this concern is that I ask EVERY new patient the following three questions:

1) What do you think is going on with yourself?  Particularly working at Seattle Children's Hospital where my patients are young kids and often have never had pain or physical therapy before, this is important.  Most commonly - I get very simple answers.  "I sprained my ankle."  "My knee hurts."  Once in a while they have seen another PT or a chiropractor and already have a mindset of "My pelvis is out of alignment."  Asking a patient what they think is going on helps you understand their mindset and helps me determine any beliefs that I may have to address, and leads perfectly into the next two questions.

2) What do you think will help you get better quickest?  If a patient thinks that manual therapy will help them, and I only guide them through an exercise program, the buy-in from that patient is less because I haven't listened to their desires.  This occurs much more often with the older population who has had physical therapy before and has seen what worked in the past.  The younger population generally shrugs at me with a blank look on their face - and I explain how physical therapy works and usually my typical treatment patterns: Range of motion restored first, then strength and stability - along with the concept of progressive overload - which I've previously discussed here. 

3) Have you ever had physical therapy before? This question really should be mandatory for every patient evaluation.  Always.  It gives you the opportunity to explain what you're going to do in your evaluation and in subsequent sessions for those who have never been through PT before.  It gives you a chance to calm any nervous patients - because many of them are anxious and with the children I work with - they've often never had pain before and don't understand that they're about to be touched.  It should go without saying that you have to have permission to touch your patients - so here's an easy way to get that approval.

Back to the book. The global purpose of the book is to help coaches better interact with their clients - to build buy-in.  It comes from a Strength Coach perspective, but can be applied to people interacting with others. Brett breaks the book into three major sections.  The first is a series of ways to identify yourself with 3 stages of Internal Identification: Reflection, Inspection, and Progression.  Included are a series of options for self- testing to determine your personality type including the Myers Briggs, which I had done in PT School and identified me as an ENFJ (Extrovert-Intuition-Feeling-Judging): The Compassionate Facilitator (also considered the protagonist or leader of the pack depending on source).  These pictograms describe my type and appear to be spot-on.  This test, and the others that Brett describes in the book, are meant to help you understand yourself before interacting with others.  Though they all have a fee - I always find it interesting to learn about my own personality qualities and there are tons of abridged versions online that can be taken for free to give you a taste of your own personality.  Along those lines - Brett advises that you "resist the urge to collect resources or data points just for the sake of having them."  I didn't complete all the tests listed to have several personality tests describing me... just the one was sufficient.


This section also examines types of conflict.  "Conflict often leads to conversations that become catalysts for growth by opening up the opportunity for different perspectives and views to be voiced... Conflict keeps us honest."  There can be conflict about a task, when there is disagreement about a task and how to manage it.  There are personal conflicts between people with a need to seek resolution.  And there are different strategies to manage the conflicts that arise.

The next section describes different "Archetypes" or typical descriptions of types of people to help better understand your clients.  Each Archetype is defined with their usual strength and weaknesses, suggested ways of how to optimally interact with that personality type, and then an actual case study describing an interaction with someone of that type.  Every patient or client is different and sometimes it can be very challenging to create an alliance with all those differences.  Reading the book made me consider the complexities of an introvert doing my job on a daily basis - and conversely on how I would feel working in a career that is primarily working alone or that does not regularly interact with others.  I love people and I love talking... those would be challenging!  It also made me wonder which Archetype I would fit into, and if any of my previous coaches or mentors have categorized me and used any of these principles.

The last portion of the book is application and ways to develop trust.  Brett presents 13 Coaching Mistakes to Avoid.  I've faced many of these situations along my career, fortunately avoiding many of them, but the way he presents the concept of "taking things too personally" made me laugh.  He explains "Nobody else wakes up worrying about Brett... refuse to let an action become your identity - you need to understand that experiencing a moment when you have fallen flat on your face or embarrassed yourself does not mean that you are destined to be a lifelong failure."

If you coach athletes - this is a great read.  And if you interact with others on a regular basis, or want to have a better understanding of your own personality and behaviors - you can pick and choose the pieces that apply to you.  Check it out!

What Do Physical Therapists Do? Installment #4: We Return Athletes to Sports Participation

Welcome to the fourth installment of "What Do Physical Therapists Do?" I chose to use this as a recurring segment because there are several common misconceptions about what we actually do, probably because we do so many different things! This 2006 paper noted that over 1/3rd of participants surveyed (college-aged potential physical therapy students) were unaware of PTs' ability to help decrease pain and promote health. That same paper mentions the lack of knowledge of the general public regarding the amount of education required to be a physical therapist and what that training would include. 

Overall, the key underlying action of a physical therapist is guiding our patients or clients back to their optimal function - whatever that function may be.  I often feel like people think our primary purpose is to help people get out of pain, despite the report from the previously mentioned 2006 paper.  While pain relief is a consideration, it's really more about the activities. So this recurring segment looks at various ways we help people get back to their chosen functional activities.  In the past, I've discussed that we strength train (#3) here, we listen to the needs of our patients (#2) here, and we examine body mechanics with different movement patterns (#1) here. 

One of the most common questions I'm asked by patients and their family members is "When can I get back to X activity?"  In this scenario, X can be anything.  Some are obvious functions or activities that aren't surprising... when can I run or exercise, when can I lift my toddler, when can I go back to work, when can I walk without crutches, when will I be able to reach the top shelf of my closet... an endless list.  Some activities have been less obvious (or less sensible)... when can I get back to head-banging at concerts was a surprising question I've been asked by a gentleman recovering from neck pain after a car accident.  It surprised me - but that's what he wanted to do.  And why a teenager who had a severe injury on a trampoline would ever want to get back onto a trampoline shocked me... but they ask! (Side note - if I ever have my own children, I hope to find a way to ban them from trampolines.  SO MANY injuries.)

The activities are frequently sports-related so it is a responsibility of a physical therapist to clear athletes to return to sports. This week, I was fortunate enough to present the new Upper Extremity Return To Sports Assessment that will be implemented at Seattle Children's Hospital to the Sports Medicine Team of Physical Therapists and Athletic Trainers.  The program we developed has not yet been thoroughly tested despite being based on published research, so it's still a work in progress.  It includes a group of tests to assess athletes who have had upper body injuries and/or surgeries as criteria to get back on the field/court.

Seattle Children's Hospital already has protocols for returning kids to sports after ankle and knee injuries, so we had a template to use of what has been helpful in the past.  I like using the lower extremity assessments because they make it easy for a kid and their family to understand that they can go back to their sports when they pass all their tests. There are benchmark goals that help them progress in activity as you go along so having a series of tests at the end fits into the way things progress along the way.  Using tests and goals motivates patients.  For example, with consideration for surgical protocols and healing timelines, I tell kids that they can stop walking with crutches when they can stand on their injured leg for 30 seconds with steady balance and when they can complete 10 straight leg raises without any bend in their knee.  Those are usually components of their home exercise programs and they often know if they're getting better and coming closer to meeting the goal. The goals help motivate them to work on their home exercises and they're measurable.

Did you know that if you are a healthcare provider - of any kind - and you clear an athlete to return to sports prematurely, you can be held liable if they get re-injured?  You can.  Did you know that a physician who clears an athlete back to their sports usually bases this on a tissue healing timeline whereas a physical therapist who clears an athlete back to their sports bases the decision on movement mechanics and other test criteria - such as the tests in this protocol - to make the decision?  Something I find interesting about myself as a healthcare provider is that I rarely tell a patient to stop participating in an activity if they're tolerating it enough - but when it becomes my responsibility to allow them to return to a sport that a physician has discontinued their activity from, I'm much more confident in my decision if they have to complete tests showing they're ready in a controlled environment.

A basic summary of the categories of tests included in the protocol for upper extremity injured athletes returning to sport are as follows:
1) Range of motion comparison between shoulders with consideration for the total arc of motion for internal and external rotation.
2) Strength testing comparison for shoulder internal and external rotation as well as for grip.
3) Endurance testing observing how many push ups can be done with proper form.  There are published normal values for this test by age and gender and, in the USA, this is part of the physical fitness testing conducted.
4) Upper body stability testing including the upper quarter Y Balance Test and the Closed Kinetic Chain Upper Extremity Stability Test
5) Power assessment using a seated shotput test.
6) Biodex testing as available.

Using numerous published papers on each of these tests, criteria were developed and the sports medicine crew at Seattle Children's will start to use the tests to determine if kids are ready to go back to their activities.  There is still not enough published evidence for returning athletes to sport from any injury, so developing a protocol like this is not only challenging, but needs to be supported by clinical judgment.  If you or someone you know is being treated by a physical therapist to get back to playing sports, you should ask them what criteria they use to determine if you are ready.  Feeling good and being pain-free isn't enough and we want to prevent future injury as much as possible.