It Takes a Village

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© Sgame

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Happy Thursday, blog followers!

Warning: In this week's blog post, I'm being selfish.  I'm making a situation that has nothing to do with me, entirely about me.  But it's OK to do that if you admit it up front, right?

This past week, I received some terrible news. The instructor of my weekly Turbo Kick class, Meg, informed our class that she is moving away.  I’m sure she’s making all the right decisions for her family, but to me, this was crushing, devastating, drop me to my knees in tears while unnecessarily over-reacting, punch me in the gut, painful news. I didn’t see this coming. I’m not prepared.  Do I have enough time to get used to the idea of a new instructor coming in?  It took me SO LONG to psych myself up into attending her class in the first place! And it just can't be the same with another instructor.  Say it ain't so!

So, this week I'm writing about the village of people I've assembled to help me get my health in order as well as the positive impact of attending group exercise classes. This was a great reminder that you might be changing someone else's life without knowing it.  Sometimes I forget this when I'm working with my patients.  I have no clue how I've impacted people other than with their physical therapy, but I hope I've helped others the way Meg has helped me.

I joined the YMCA in August 2018 as part of my elaborate and carefully plotted plan to combat my eating disorder and body image issues, which I first discussed here.  I had been in severe denial about what was going on in my life, blissfully ignorant to reality, and had started seeing my therapist at the same time.  I decided to create a small village of people to help me with my journey: a therapist, a dietitian, someone to revamp my physical fitness - who ultimately became Meg - along with some family and close friends. I was entirely unmotivated to move my body - which I was currently hating - and I was sick of my training routine. I wasn't looking for group classes when I joined, hoping could manage my physical health myself, but considerd I might need another person in my village to oversee that, too.

I was initially opposed to group classes because I experienced a particularly uncomfortable CrossFit situation when the instructor told me that "a girl of my size should be lifting a lot more weight." To some extent he was correct - I could squat and deadlift a lot more than I was using there.  But at that time I hadn't been training much and knew the planned workouts included high repetitions and the volume was too much for me to load up the barbell as they recommended.  They pushed me to lift more, I pushed back saying I wasn't ready, and it was ultimately an embarrassing and painful situation.  It is specifically why I treat my own patients meeting them where they are - not where I want them to be.  So I had that experience, plus, I hate the idea of people seeing my body moving.

2008 CT Sun Yoga Class

Those reasons led to apprehension for group classes with the exception of yoga. In 2008 I went to a group yoga class with the Connecticut Sun and have been able to continue with yoga intermittently since then. I wrote about my recent return to yoga here, but, as I previously wrote, I only do hot yoga where I get high (or delirious) from oxygen deprivation that I basically can't tell anyone else is in the room.  Group exercise class?  For sure the others would notice that I'm fat, that I can't jump, that I will get tired, that I sweat a lot and breathe heavy, and that I'm not very coordinated.  Now, many months later, I'm here to tell you none of this occurred.  It was all in my head!

In October 2018, after walking by Meg's class on several preceding Mondays, I finally talked myself into trying her class.  I told myself that I knew the music was good and that I had to complete the class but that if I absolutely hated it, I would try one different class before swearing off group classes for the rest of eternity.  Dramatic much? Thankfully, Meg ran up to me that first day, super spunky and upbeat, introduced herself saying that her class was super fun and that it didn't matter if I knew any of the steps, just keep moving however I wanted to. I've been hooked ever since.

Here’s why Meg’s departure hit me like a ton of bricks.  I was in a deep dark hole of emotions and confusion when I started this journey and quickly learned that I needed to ask for a lot of help. I built my village including three smart, beautiful, strong women to help me pick myself up off the floor and put my pieces back together.  My therapist and dietitian knew each other, use similar approaches for treatment, and know all about my issues. I don’t think they intend to be sympathetic towards me, but sometimes they are, and sympathy isn't what I want or need.

But Meg is different.  She's not sympathetic towards me because she has no reason to be. She doesn't know why I'm in her class or what I'm dealing with. She barely knows anything about me, really, and that's just how I liked it. She's empowering and motivating because that's in her nature. And yes, it's her job, but there are other instructors in there with totally different vibes. I've walked by their classes a bit, too, wondering if I should add to my routine. Choosing her class was not a mistake. She welcomed me in, kick started most of my Mondays since October with high energy, a positive attitude, motivation, and joy. I purposefully attend her class right before going to see my therapist because turbo kick is basically a class where you can punch and kick your problems in the gut and my G-d I needed that.  It also lets out a lot of energy, which calms me and helps me organize my thoughts before saying them out loud.  When I started pairing turbo kick with therapy, I was really struggling to see my therapist because it was so vulnerable. Dance fighting with a room full of strangers is vulnerable, too, but way more fun than one on on conversations in a room with a couch and too many boxes of tissues.  I can’t actually tell which “treatment” has helped me more over the past six months, but I can tell you what this class did for me.

First- a group class has other people working towards their own goals- but the goals can be kept private as you work towards them together. I don’t know if people in the class are trying to lose weight, get stronger, let off some anger issues, or hear some current music. I don't know if they secretly wish to be a performer on a stage - but instead work as an accountant because they need to pay their bills. I don't know if they want to learn ways to protect themself if they were attacked, because truthfully, I would definitely use the moves I've learned there if someone came at me. I don’t actually care why they’re there. It doesn’t matter. We’re all going to do the same moves and at the end be disgustingly sweaty and high five each other with a sense of accomplishment towards our own goals.  I can go deadlift and have an awesome lift on my own, but there won't be anyone to high five me when I'm done. And because people start recognizing each other, it really does start to feel like community. Like if you missed a week, someone might ask if you were OK, or if you went on a nice vacation. Sometimes you just need that!

Second- all my concerns about other people watching me were entirely unfounded.  Nobody else is looking at what I'm doing in this class. They don't care. Once we get started, I barely even notice there are other people in the room, except to watch out for kicking my neighbor and to follow Meg instructing the moves.  Everyone is trying to get the steps right for themselves.  The rule is to keep moving even if you don't know the steps... but sometimes I know the steps and choose to do something different. For example, I CAN do burpees... but I hate them... so when there’s a burpee in the routine, I do jumping jacks or squats or whatever I want. Because for me, the whole point is to move. Not get better at burpees. Once I stopped exercising to lose weight and started doing it because it made me feel good, things in my life started to get a whole lot better. It’s still a struggle to make myself move regularly, so I attend a weekly dance party with some uppercuts and roundhouses thrown in and I actually feel like I’m prepared to conquer the week - whatever it may throw at me.

Third- and probably most important for my personal journey- the room is lined with a wall of mirrors. For the first several weeks, it disgusted me to see myself in the mirror. I was sure others could see how gross my body was. When I was diagnosed with my eating disorder, my testing suggested that I didn't have any body image issues. This was apparently very wrong. I've learned it was/is a huge problem. Prior to facing my issues, I didn't realize I was avoiding mirrors.  We have them at work, too, and I didn't even notice how much I put my back to them.  If I lifted at the gym, I didn’t want to see myself doing it. I don’t have a full length mirror at home and have never had one since I moved to Seattle.  I didn't actually realize how much I had been avoiding looking at myself until one class I caught myself in the mirror while doing a punching move and realized holy crap! That's me!  That's my body! It's doing all these things.  It's working hard and feeling pretty good. I’m actually able to tolerate looking in the mirror and smile at myself a little now.  That may not sound big... but for someone who went from not knowing what their body looked like at all and hating her own skin to tolerating her body and appreciating the things it’s capable of, I think it's huge. I’m sure somewhere down the road, there will be a time when I might like my body- and maybe even love it. That's not where I'm at right now, but I’m sure that the road started with the mirror in turbo kick.

And so, while I am sad to know my village is evolving, I’m eternally grateful for the role Meg played in it at the beginning.  Can't wait for the next Turbo Kick class.

Wishing Stewie a Speedy Recovery!

My heart hurts to write this week’s blog post. 

A few days ago, WNBA Most Valuable Player – and Seattle Storm superstar – and former University of Connecticut standout – and all-around philanthropic and kind person - Breanna Stewart - ruptured her Achilles tendon playing basketball overseas.  Since my social media feeds are filled with a combination of women’s basketball gurus and physical therapists/strength and conditioning coaches, there were A LOT of posts on my feed about her injury and the political implications of it.  If you're not squeamish, you can watch this video of her injury:

breanna stewart landed on brittney griners foot during the euroleague title game and looked in serious pain

not clear if it was ankle or knee but she was helped off the floor and put no weight on it pic.twitter.com/AO8ecTLtgJ

— dynamo kursk fan account (@WEREONLIVE) April 14, 2019

(Note: she injures the other leg - not the one that lands on Brittney Griner.  And it has now been publically announced that she has ruptured her Achilles on multiple news outlets, by the Seattle Storm, and by Breanna Stewart herself.)

So many people have focused on the fact that her income in the WNBA requires her to play overseas and that if the pay scale was more equitable to what the NBA players make she wouldn’t need to play overseas for more income (meaning WNBA players should earn the same percentage of league income as NBA players – not that they would have equal salaries to the men). I get it. I understand the value of that conversation.  I understand many of the challenges the WNBA faces limiting their ability to increase the salaries of their players.  I should also mention that I serve as the Seattle Storm team physical therapist, a role I have served in a volunteer capacity for the past four seasons.  I would have taken a pay cut to make it so Stewie could have avoided this injury, because in my professional opinion, it's the worst, but alas, I have no funds to defer to even share with her.  Instead of looking at the political implications for the WNBA players and their finances, I’m going to look at her injury from the physical therapist perspective to share why this injury means she's not going to be seen in a Storm jersey this season. 

Just a few days ago, Dr. Tim Hewett at the Mayo Clinic posted this video of an Achilles tendon rupture. 

How does a Human Achilles Tendon Rupture ...? Here's how ... check it out @MayoClinic Materials & Structural Testing Core @mayoclinicsport ! pic.twitter.com/qM9ZoXJ2Oq

— Tim Hewett (@Hewett1Tim) September 22, 2017

In real-time, it happens much faster with a high force while the foot is plantarflexed (toes below the heel, as occurs when jumping off the ground) and is generally described as feeling like you were shot in the back of your heel.  The video of Stewie's injury certainly looks like it matches the usual description.  When I wrote my thesis for PT School, a survey of WNBA and NCAA (Former) Big East Women's Basketball Players, only two people playing in the WNBA had recovered from Achilles Tendon Ruptures.  That's good news because it shows that people recover from this severe injury which is so much less common in elite athletes than the ACL tear we more frequently see.

Some additional elite-level women's basketball players who returned from Achilles tendon ruptures (I'm sure not an exhaustive list):
1) Nykesha Sales who tore hers in her senior year at UConn in 1998 and then returned to play nine WNBA seasons including six WNBA All Star Game appearances
2) Tamika Catchings - who tore hers in the 2007 WNBA playoffs and returned to play for the Indiana Fever in 2008 as well as in the 2008 Olympic Games
3) Liz Cambage - tore in the Australia vs USA exhibition game leading up to the World Championships in 2014 and ultimately returned to her national team and WNBA
4) Riquna Williams - ruptured abroad in Dubai in 2016 and returned to play for the LA Sparks
5) Brittany Boyd - tore hers in 2017 and returned to the New York Liberty
6) Chiney Ogumwike tore her Achilles in 2016 in China and returned to the Connecticut Sun Lineup in 2018
7) And of course, there are NBA players too.  Kobe Bryant tore his Achilles and made it back to the NBA, for about 1.5 more seasons.  Fellow Uconn Husky Rudy Gay (weird - he's the 3rd Husky on this list!) made it back with decreased minutes.   DeMarcus Cousins tore his last summer and a whole article was written on all the players who had injured their Achilles tendon and how many had made it back to the NBA.  The odds were ok... not great... but none of those dudes were Stewie.

For rehabilitation from a surgery, there are often protocols used by physical therapists as guidelines to progress someone recovering from an injury.  Protocols are helpful ways to communicate between a surgeon and a physical therapist because the surgeon was actually able to see the extent of damage done and how complicated the repair or procedure was.  So, for someone who is young and healthy like Breanna Stewart, her protocol may allow for a faster progression than perhaps the 65 year old dentist I rehabbed from an Achilles repair two years ago because her tissue quality should be better than his.  If, however, Stewie had been having aches and pains in her Achilles for years prior to this injury and her tendon quality was not in good shape, it's possible the surgeon would recommend a slower return to activities because of the health of the materials he was working with.  Regardless, there are standard healing times for different types of tissues that will need to be followed.

Numerous protocols exist online as guidelines to rehab from an Achilles Tendon Repair, but truthfully, they should all take into account the basic properties of healing and the input of the surgeon based on their findings.  For example, this protocol from the University of Wisconsin has the START of running (in a straight line) at 4 months post surgery.  That does not mean jumping, cutting, hopping on one foot, turn around jumpers, or doing any sort of awesome acrobatics that Breanna Stewart customarily performs in basketball games.

This protocol from Mass General Hospital starts with two weeks in a cast, then about twelve more weeks in a walking boot, before transitioning to a shoe.  Then, it allows for start of run/walk intervals at about five months post op with jumping and sport activities from six to eight months after surgery.  There's quite a bit of variability between these programs - but in my experience, nobody is getting back to sports, especially at an elite level like Stewie, in less than six months.  Tendon just needs that much time to heel and an annoyingly slow progression  in loading it to get back to previous level of activity.

Stewie posted a few things on social media heading into surgery today.  I'm sure she knows the road ahead is long, but that she's got a lot of good things on her side, most notably her age and support system.  That and she's a fighter.  Wishing Stewie a speedy recovery and can't wait to see her on the Storm Sidelines this season as she works her way back to the court for 2020.

UConn and the Storm: Me, Breanna Stewart, Kaleena Mosqueda-Lewis, Coach Auriemma, Sue Bird, Coach Dailey

In the Blink of an Eye

Still Smiling After 12 Weeks at Seattle Children's

Thirteen weeks ago, I was a physical therapist, treating my caseload on my own, going about my usual day-to-day activities at work and at home, minding my own business.  Then, on January 15th, a PT Student from the University of Connecticut arrived.  My first student.  From my Alma Mater.  And now, in the blink of an eye, she's gone.  How is it already April?! I wrote about becoming a clinical instructor and some of the expectations for her affiliation here but now that she's gone, it's time to reflect on that experience.

It's funny how sometimes you become something because someone else made it so.  You become a mother because you have a child.  You become a boss when you have employees. You become a basketball player when the coach picks you to play on the team.  I guess you can be a basketball player without making the team, sort of... but it isn't the same.  I was a physical therapist before... but my student made me into a Clinical Instructor, a new role that changed my perspective and helped me to grow, and came at just the right time in my career.  Can you be a teacher if you don't have any students?  Does a tree falling in the woods make a sound if there is nobody to hear it?

For about the past six weeks, I basically sat back and watched... or stayed outside the room completely... as my student worked with the patients we had seen together for the previous six weeks. I attended the initial evaluations and we discussed each patient, how the treatment sessions went, the status of each person, her thought processes, what went well and what could have been better. But for many weeks, she did the patient care and documentation and I worked on a bunch of projects I had lined up.  Just before her affiliation with me ended, I read this post from Physical Therapist Phil Plisky entitled "What I Wish Physical Therapy Students Knew About Their Faculty (and all PTs for that matter)."  I immediately sent it to her, loving the fact that it outlines key truths that new physical therapists really should know:
1) We don't know everything.  Really, we don't!  OK, I probably know a little more than she does. But there is so much I don't know... and I learned from her, too!  More than she will ever know.
2) Our patients DON'T all get better.  Sometimes eight to twelve weeks in the clinic might not be enough to really see it, but this happens.  Sometimes it means we can't figure it out... fortunately I am surrounded by a team of excellent PTs that if I feel like someone isn't making progress, I can share them and get another perspective.  Sometimes the patient refuses to do what is recommended, which is insanely frustrating, and they are the barrier to their own recovery.  Sometimes it just happens, for any number of other reasons.  Fortunately, most do get better, but the ones who don't stick with you.

But more importantly, Phil outlines the three keys to becoming a better PT:
1) Did I prepare for each patient session as much as I could?  One attribute you can't really teach is putting in the extra effort to prepare.  My student beat me to work every single day, had questions ready for when I got in, and I'm sure was looking things up that she didn't know.  She asked for articles or resources to learn about treatment techniques and evaluation methods.  She asked for opportunities to learn from different providers - like watching surgery or spending the morning learning about biofeedback or with speech therapy. In my opinion, preparedness is a habit that doesn't change - something you value or you don't.  It influences how you approach your day, week, and career.  I still come early to prepare for my day, I still look at my patient caseload in advance to review diagnoses of new patients in case I'm unfamiliar with something.  Some people don't feel this is essential.  I couldn't go without it, and I was glad to see that she was a preparer.
2) Did I care/give 100% to each session?  In this profession it would be odd to find someone who doesn't care about others, but, to treat everyone you come across with dignity and respect and to care constantly is sometimes challenging.  One time we were working with a teenage boy who was grunting responses, rolling his eyes, and being flat out rude.  It wasn't a good day for him, and I found it entirely annoying.  But that doesn't mean we stopped caring about him or his session.  In fact, I asked him if he wanted to leave, and when he chose to stay, we just poured on extra caring and moved forward with the session.
3) Did I reflect?  Personally, I had major imposter syndrome as a new grad PT.  Reflection was essential to understand that people weren't just getting better because of chance, they were getting better because they followed suggestions I made on how to move differently or load themselves in new ways that made them feel better. As a student, it has to be insanely difficult to work with patients all day long, focusing hard on caring and giving 100% and preparing and not messing up... only to later find time to reflect on each and every single patient interaction, parent interaction, coworker interaction, CI interaction.  That's a lot to think about.  Mentally exhausting.  I do think this is essential for growth, for identifying strengths and weaknesses, to find what has been working for you and what has not.  That's why I'm reflecting on being her clinical instructor now.  And that's why we had weekly meetings to encourage her to reflect on the previous week, set goals for the upcoming week, and to figure out areas we should focus on.  We did a lot of reflecting... both together and independently... and I think it made all the difference.

So I sent her the article and she wrote back.... "you already taught me all this." I guess she had been listening to me all along. (New Grad PTs - you really should click on the link and read his post... it's brief but so valuable and he's far more articulate about it than I am).

Reasons why having a student was really great:
1) First and foremost, having this particular student made me a better physical therapist.  Without question.  I don't know if this would have happened with a different student.  Maybe.  That's luck of the draw - and I won this hand with a royal flush.  I give her all the credit for my growth over the past three months.  She made me think about my patient care decisions by asking questions.  Sometimes I'd just ask her the same question back, but sometimes I really had to think about what was being asked. In her first week, we worked with a kid with "tight hamstrings" and I chose to give them strengthening exercises rather than stretching exercises, which is something I do a lot with kids - but that I sometimes approach differently with adults. When she asked me why, I couldn't immediately explain my rationale.  That wasn't good enough for me and it shouldn't have been good enough for her or for the patient.  So I had to consider my own reasoning, for that decision - and for all my other decisions - and that meant personal growth.

2) She made me think about what I value as a physical therapist.  If you had asked me five years ago as a new grad PT what was most important for patient care, I think I would have said getting rid of people's pain. If you had asked me two years ago, I think I would have said getting people back to their favorite activities or to their prior level of function.  Now, I think it is most important to connect with patients and form a therapeutic alliance.  Some people won't ever get rid of their pain, so to make that the goal sets those people up for failure.  Some people won't get back to full prior level of function - and that may be ok, or it may be the hand they were dealt.  I no longer want to use that as the barometer of success.  We as PTs have to be OK with these outcomes because that's how the human body works - and we have to be supportive of patients who experience those changes.  Now I aspire to encourage self efficacy, self confidence, and personal empowerment, particularly with teenage girls.  I feel that I have been a successful physical therapist if I find a way to connect to my patients, to build trust, to encourage them to change habits and find ways to move that make them feel good.  If I can't connect with a patient, I want to find them a physical therapist in my office who can.  I measure success differently now.  I don't treat patients the same way as I did five years ago.  I don't use the same words to describe what I think is wrong, I don't use the same treatment techniques, and going through this process, I could see my own personal growth.

3) She gave me a chance to watch someone else treat my patients.  In my clinic, there are lots of therapists treating their patients in the same space simultaneously.  I frequently have the chance to overhear conversations or treatment techniques between other PTs and their patients, but I'm focusing on my own patient right in front of me, and without knowing the context for the other patients, it doesn't make much sense to try to eavesdrop.  I already knew that my coworkers and I did things differently.  But when someone else is working with your own patient right in front of you, and that's who you're focusing on, it gives you a chance to see similarities and differences of treatment styles and to appreciate that we really don't need to be doing it the same way to be effective.

During her first week, I was honest with her that I didn't want her to be a copy of me, that her treatments could look very different than mine, and that would be OK as long as there was a reasonable thought process behind her choices. I truly wanted her to find her own style and beliefs.  I think we achieved this.  Physical therapy may be based on science... but really, it's a form of art.  My form of PT is a bit loud, somewhat aggressive, sometimes even competitive, and usually a bit silly.  Hers is a bit more quiet, patient, serious, and conservative. I doubt mine will change because I've come to love being a goofball all day long, but hers might change as she keeps doing it.  Even if it doesn't, both ways work.

4) It's really not that much extra work. Sure, some of the days were a bit longer.  And I am super lucky to work for an awesome organization that values these experiences and gave me time each week for meeting with her.  I really wanted to have a student in the past and the timing couldn't have been better - for personal and professional reasons - so I didn't mind it.  But above all that - every practicing physical therapist graduating in the past eight years needed several clinical instructors to get there - so maybe we should all embrace the opportunity to provide this service and help out our schools for the next group coming through.  It feels good to give back, particularly to UConn, because they gave me so much. Sure, the grading system for student PTs, the CPI, is a major pain... but we made it as fun as we could and in the scheme of things, it's no big deal.

5) Lastly, I got SOOOOO much done while she was here that wasn't patient care: I studied for and took the Sports Certified Specialist PT Exam including about forty hours of Medbridge continuing education videos, I prepared for and presented at a physical therapy conference, I wrote a case study and submitted the manuscript for publication to the Journal of Orthopaedic and Sports Physical Therapy, and I started working with the new Seattle Children's Hospital North Pain Clinic that took a lot of learning and early growing pains - all in her twelve weeks.

Reasons why I might take a few years before doing it again:
1) I started to miss my patients!  Being a PT is a big part of my own identity and that was gone for a while.  I get to play games all day and joke around with kids.  I play basketball and soccer and hop scotch and talk about Harry Potter and The Little Mermaid and unicorns and NBA Basketball or March Madness. Part of me was apparently missing the past several weeks.  I'm glad to have it back.

2) My level of physical activity dramatically decreased for the past several weeks because I wasn't doing exercises with patients, standing all day, moving around like I usually do.  I was confined to a chair, making extra trips to the bathroom across the building just to get up and move, sometimes pacing around the office because I needed to do something else, and I think I became a distraction to the office (more than usual).  I gained weight, which is a big problem for me.  I didn't sleep well because I wasn't moving around enough.  My exercise routine got messed up.  But now that I'm back to my usual routine, things are already getting back on track, and I could have managed this situation better, I just hadn't anticipated it and once I let the situation take control, I didn't do a good job turning it around.  That's on me to keep track of in the future.

3) I don't know that the next student would come close to how great this one was.  And I'm putting it in writing...for her to see... and everyone else to see.  As my last words as her clinical instructor... cheering for her as she launches her PT career.  And I'm pretty sure I might have been a major pain in the neck for my own CI's, so there's got to be some karma coming if I take more students in the future.

4) I really hate saying goodbye.  I'm too sentimental and my emotions get in the way. In fact... I didn't really even say goodbye this time.  I took her to the most stressful possible outing - watching UConn Women's Basketball in the Final Four - and then I gave an awkward side hug and ran away.  That's probably not a reason to hold off on having another student.

Anyways, best of luck to my student as she graduates and takes the PT Licensing Exam... and to all the other new grad physical therapists.  Congratulations on finishing three intense years of learning, and welcome to the real world.  It truly is better on this side of things.  And the years seem to go by in the blink of an eye.

Jack of All Trades...

Master of none?  Of some?  Of one?  Of a few?

One of the great things about being a physical therapist is the variety of things available to you.  Numerous settings are available to work in - schools, hospitals, nursing homes, clinics, sports teams.  You can work with a narrow age of ranges like birth to three years old or the geriatric patient or the whole spectrum of age, gender, and a variety of levels of ability, disability - both physical and intellectual.  In my office alone, there are physical therapists who primarily focus on sports/orthopedics, others who primarily focus on developmental rehabilitation, and a specialized physical therapist who works on infant feeding.  Variety is the spice of life, right?  

Some days, the list of diagnoses between all the patients on my schedule looks a lot like: knee pain, knee pain, ankle sprain, knee pain, knee surgery... repeat.  The mechanisms of these injuries for knee pain and ankle sprains might vary - soccer, soccer, gymnastics, jumping, soccer, soccer - or not that much maybe. Some days that’s just how it is.  Not a whole lot of variability in the body region where pain is occurring. Not a lot of variety in age groups.  I've had days where I've seen only girls between age 12-15.  And I generally see eleven patients in a day, so that's a lot of "luck" to have so much congruency between patients. 

Because of how sports seasons work, there’s a tendency to see clusters of athletes from the same sport at once - like soccer players when their season is starting, baseball players at a different time.  We don't see many football injuries in middle of December, and it's rare to see a skiing injury in August. Teammates bumping into one another at the clinic is not usually a good sign, particularly if they have the same type of overuse injury, but it definitely happens.  Last winter, when 3 swimmers from the same team showed up with shoulder pain, it seemed imperative to reach out to the coaching staff and see if we could help the whole crew.  

So while I really do love days like this because I’m a sports physical therapist and I love helping kids get back to playing their favorite sport, there are days that are also quite different.  Days where the diagnoses on my schedule look like this: chronic regional pain syndrome, post concussion syndrome, post-op meniscus repair, broken humerus, knee pain, scapular dyskinesia, ankle sprain, osteomyelitis of the shoulder post irrigation and debridement, post-illness deconditioning.  When this happens, there's also a much wider spectrum of mechanisms of injury - like for these - skateboarding, soccer, trampoline park, fell off jungle gym, marching band, swimming, "my brother tripped me down the stairs", insidious/unknown, cancer.  The injuries and conditions can be much more variable and require a lot more knowledge and skill to treat. I love this, too, but it makes me think a lot about my strengths and weaknesses as a PT.  At the end of the day, all of them are trying to get back to something, usually a sport or activity of some kind, which means guiding them through restored function in more important things like going up and down the stairs or getting off the toilet- but after that boring stuff (kidding), we get to play soccer or basketball or hop scotch in the clinic. 

I’ve been thinking a lot about this second type of day and had this blog post almost entirely drafted when Lenny Macrina, who I've previously written about here and here, posted this on his twitter: "Hey PTs, if you could treat one only type of patient presentation for the rest of your career, what would it be?" (Side note, I'm currently running for the office of President of the Lenny Macrina Fan Club).

In high school we took career placement testing that suggested I should become a farmer.  In my head I thought - that's the most regimented routine EVER.  Up at sunrise with the chickens, milk the cows, maybe some change with seasons but overwhelmingly very similar day to day.  No thanks! I never considered being a dentist because I didn't want to look at people's teeth all the time.  Gross. I definitely didn't want to be a podiatrist, because I really don't like feet. Gross times a million. I didn't want to do any sort of work that was repetitive in nature. So thankfully, I don't get stuck treating tons of ankle sprains, and when the occasional one does, I make sure they're good about washing before I get near them.  I always knew I needed variety, which is what this post was about in the first place... and had to respond to Lenny's tweet: "Why Lenny?!?! This week my upcoming blog post is about days where all the patients have similar body part ailments or conditions versus days where they're all over the board.  Variety is the spice of life! I'd go nuts with the same all day."

I really, really love the variety. but I also recognize that by seeing this variety, does this mean that I've become a jack of all trades, capable of doing something to help everyone but not being really good at helping anyone in particular?  Is this a problem for PT practice that we don't really have to specialize much beyond our setting of practice?  

For me, there are certain patient types and conditions that I'm really interested in.  I primarily focus my continuing education on those areas.  Some injuries and conditions are simple to evaluate, simple to treat, quick to get the patient back to their normal self.  Some just aren’t. And, as I think I’ve said before, though physical therapy is based on science, there is definitely an art to it.  There is an art to connecting with people, encouraging behavior change and convincing people to exercise who normally wouldn't.  But beyond the connections, there is a real need to have a good understanding of the human body, the relevant components to a person's injury and to the needs of their activities, and to how the body heals. 

There are basic skills any physical therapist would use to evaluate the majority of their patients. We would assess their range of motion and strength and probably palpate some body regions to assess irritability of the tissue and mobility of a joint, and then maybe some special tests to identify certain tissue structures that may be involved.  And then we have to be more specific, like I mentioned earlier, in further assessment techniques and treatment options based on the needs of that individual person. 

So... should every PT be treating a case load that has so much diversity in diagnoses and patient presentations?  Should I be?  I do... but... should I?  Is it OK that I'm a Jack of All Trades?  

I'm here to say that I think this makes us even better.  If I only treated post-op ACL reconstructed patients every single day - but their sport or daily life needs vastly differed - and their concomitant injuries included many other things like meniscus pathology or PCL injury or traumatic fracture, I don't think I'd be as good at rehabilitating that patient population as if I worked with patients with all kinds of hip, knee, ankle/foot injuries playing a variety of sports.  And truly, a patient with an ACL injury is one of my favorites - but it's because of the duration of recovery and connection to the patient that I like it, along with the ability to use a whole lot of different treatment tactics with them! If I only saw kids with concussions, my vestibular rehabilitation skills would definitely improve - without question - but at what cost?  What would be lost by specializing in a specific patient population?  

So, the next time I need a physical therapist for myself, I’m going to ask them what they like to study and learn more about.  Do they choose to do continuing education on hip pain, while I'm experiencing hip pain, that they may have seen the most recent evidence of what they should consider for my care?  And also, do they treat a variety of patients, or only people with hip pain.  But most importantly, do I like them?  Can we connect at all?  Because truthfully, a lot of the time, I don't think it matters quite so much what we know or study or who we've treated the most, but how we interact with our patients and empower them to move forward.

Jack of All Trades, Master of None?  Fine by me.