2018 Year in Review

The last blog post of 2018! Since I started writing in November 2017, Abby's World has had 14,000 visitors.  I still don't like the title... Some posts were really popular... four posts had over 400 readers, others had less interest... and that's ok.  I think it's safe to say that I'm still figuring things out a bit to narrow down the scope, but I'm enjoying the variety of topics right now.  Thank you, so much, to everyone who has stopped by! I hope you've learned something and that I've been helpful to you in some way.

Today's post will serve as recap of 2018 - both personally and professionally - and a look back at some of my favorite posts of 2018.  As for 2019, I don't think I'm going to write a plan or set goals - other than to keep writing.

The Seattle Storm and UConn Connection

My 2018 biggest moments:
I'll start with the Seattle Storm winning the WNBA Championship, which I wrote about here.  I was so fortunate to be able to attend WNBA Finals Game 3 in Washington, D.C. with my brother, and still love basketball despite my poor skills at playing the game. I'm already looking forward to next season and it's still several months away.

Dear Evan Hansen, New York City, July 2018

As great as the championship was, my family celebrated a huge milestone this year.  In May, my niece and nephew became B'nai Mitzvah, which is a Jewish coming-of-age or right of passage.  They're thirteen years old, now!  The actual events for the B'Nai Mitzvah were incredible and I'm so proud of them for their accomplishment and hard work, but more special was the opportunity to celebrate them each in their own individual way.  I asked them a few months before-hand what they would want most, and I love how different they are and what they chose.  I celebrated my niece by taking her, my sister, and my mom to see the musical Dear Evan Hansen in New York City.  If you haven't heard much about this story, I encourage you to check it out, particularly if you have teenagers in the house. I'm so glad we could do that together, and that it was what she wanted to do - with her aunt, mom, and grandma.  I celebrated my nephew at the Denver Broncos versus Seattle Seahawks game in Denver, CO.  He's been a Broncos fan since birth because he liked the color orange and had always wanted to see their stadium.  As a sports fan myself, I really loved watching him experience something he had wanted to so much... and the rivalry of rooting for opposite teams but in a mature manner.  It was a chance to spend time with my favorite people as they head into teenage-hood and, soon, adulthood.  Next year they'll both attend Cheshire High School, the same school I graduated from fifteen years ago.  I remember holding them when they were born and all of these events were a flood of pride and emotions.   Because of them, I spent more quality time with my family in 2018 than I had since I moved to Seattle.  That was the best part of 2018.

Seattle Seahawks @ Denver Broncos, September 2018

Some of my other favorite things from 2018 that have nothing to do with Physical Therapy:
I saw the Goo Goo Dolls perform their 20th Anniversary celebration of Dizzy Up The Girls.
I rode in a helicopter for the first time. Total trip time was about 3 minutes.  It was awesome.
I read the first five books of the Harry Potter Series and watched the first three movies... my first time for all of that.  Don't worry, book six is in progress and I'll finish all of it in 2019.
I read a lot of books in 2018, actually.  Some really deep, sciency stuff.  Some much lighter and more relaxing.  I have come to embrace the audio book for commutes. I read The Origin of Species which I wrote about here and definitely do not recommend others read, but feel like I can read anything if I could get through that.
I got addicted to yoga.  And then dropped out of yoga.  I miss yoga.

My 2018 Physical Therapy Continuing Education was primarily focused on three areas.
1) Orthopedics from Mike Reinold, Lenny Macrina, and Eric Cressey.  I took Mike's shoulder seminar, which I wrote about here, Lenny's knee seminar which I wrote about here (and his elbow course), and Eric's shoulder course which I wrote about here.  I'm so grateful that there are mentors willing to share their expertise and knowledge online, and who also have made trips out to the West Coast for me to learn from in person.

2) Chronic Pain, primarily from Lorimer Moseley and Adriaan Louw.  I've written about those experiences here - from reading Explain Pain, and here from reading Explain Pain Supercharged and from meeting Lorimer Moseley at his presentation at the University of Washington.  Starting in two weeks, I'll be working with the Seattle Children's Pain Clinic as part of a collaborative team to help kids experiencing chronic pain.  I'm looking forward to putting all that learning to good use.

3) Strength and Conditioning.  I passed the CSCS (Certified Strength and Conditioning Specialist) exam in 2018, which I wrote about here and took a Medbridge Education Course instructed by Sue Falsone on this topic as well.  This has definitely made an impact on how I treat patients, specifically by loading them more and manipulating rep/set schemes a little bit more than I did in the past.  A few PTs have asked me if I thought this process was worth it, and for my patient population and side gigs, I feel that it is definitely useful.  I work in Pediatric Sports Medicine so my patient population is mostly athletic and getting back to sports.  They've generally never worked with a strength and conditioning coach or a physical therapist and don't understand any of the key basics of movement or how the body works.  I love having this background knowledge to educate them!

I feel like I spent a lot of time working towards growing as a physical therapist in 2018, but when I look back, it wasn't even close to what was most important.

Looking forward to 2019:  I'd be lying if I pretended that 2018 was perfect. Social media sometimes has that impact...  nobody posts their tears and struggles on Facebook and Instagram.  I certainly only post the happy times and the beauty I see around me. In truth, 2018 was a hard year.  I'm not sure 2019 will be easier... but there will be more family time and more hard work and growth.  And for all that, I'm grateful.

Happy New Year!

Anatomy Semantics

I got an email from someone who has recently gotten into a regular workout routine, trying to get into better shape with some weight loss and increased strength.  He was wondering if I would look at the program he's been using for a while and make some recommendations on how it could be improved for better gains.  The program was made from snippets he put together from men's health magazine.  So we set up a phone call to go through the program.  I've previously written a little bit about strength training in this post, entitled "What do physical therapists do? We Strength Train."

Biceps - Two Muscle Bellies 

The strengths of the program he already had going were three:
1) He was regularly participating in exercise and the workouts were planned and programmed with ways he could progress them.  In my opinion, the best training program is one you will do consistently.  But once you've got consistency down... all programs are not created equal.
2) Pretty much all the body parts were covered in some way.
3) He had learned to squat and deadlift.  Though we've previously worked on his form via Skype when he was having some pain doing it.  I had him using a broom in his house to hip hinge and weight shift and change his set up and we had a blast doing that probably two years ago.

The key weaknesses that I noticed were:
1) The program was separated out into six different days: arms, shoulders, chest, back, legs, and core.  He spent 1 hour focusing on that body region when he did that training day, and he strength trains about 3 times per week.  Because of that, each body region was only getting targeted twice per month - and that was only if no days were missed due to scheduling complications.
2) There were several single muscle exercises including wrist curls and wrist extensions or hamstring curls that would be fine for some training goals, but really didn't optimize him reaching the goals he stated.  In my opinion, these take up time and energy from bigger bang-for-your-buck activities.  They have a place - and I use them with patients sometimes - but in general I'm team multi-joint exercise.

Triceps: Three Muscle Bellies

3) There were no single leg activities.  I use single leg exercises a lot with patients and have also written about the seven key movements a la John Rusin here. squat, deadlift, lunge, upper body push, upper body pull, and carries.  One of those key movement patterns is the lunge... and this program didn't include those. I really like single leg activities because it gives you a chance to work on balance which also incorporates the core and because it changes the stability demands that aren't present with a double leg exercise.  Also, life requires us to operate on one leg fairly often - going up/down stairs, walking, a curb, getting in/out of the car, playing sports... it's functional to train on one leg.  And when I mentioned this, he noted that he didn't like single leg exercises because of poor balance... soooo obvious solution.
4) It was a very high volume program... three sets of 15 for each of five different exercises that he then repeated a second time through.  He probably got some cardiovascular system development from this scheme, and maybe even some muscle toning, but felt that he wasn't making considerable strength gains, which makes sense.  With a volume like that, you're not recruiting enough muscle fibers.

Since he has no background in strength training or anatomy, we discussed some of the key concepts of training.  Ideas like the three planes of the body, push versus pull, horizontal versus vertical actions, pairing exercises a little more purposefully to either alternate body parts: like a bicep curl to a triceps extension or to overload the same one in different ways.  And then he said - "Oh ya, I've been meaning to ask you about that.  I recently was thinking about muscles while working out and wanted to know more about the semantics of the names biceps, triceps, and quadriceps. Bi = 2, tri = 3, quad = 4... of what?!" This was the moment. 

Quadriceps: Four Muscle Bellies

This was the moment when I realized that there have to be loads of people who go through life never studying anatomy or how the body works.  Working in pediatrics, I generally assume my patient population has not yet learned about anatomy.  Most haven't. Some know a little from playing sports.  But I've taken at least seven anatomy classes in my life and didn't think it was possible for an adult to have gone through all of their schooling (he has a bachelor's and two master's degrees!) without ever taking anatomy. I don't know how to write computer code or how to wire a light fixture or fix a leaky sink... why should I expect that everyone understands basic anatomy?  We're all capable of learning these things... but we don't all know them.  Talk about being a bit close-minded!

This was the moment I realized how much education it takes to be a physical therapist.  This is the moment I gained new appreciation for how people can really hurt themselves when they don't know enough about the human body and try to load it - whether intentionally through training, or unintentionally overloading through sporting activities or daily activities that their body isn't prepared for.  This was the moment when I realized that personal trainers, strength coaches, physical therapists, and anyone else suggesting exercises to clients or patients needs to understand how the body works and the concepts that the clients should understand to be more independent in helping themselves.

And so I taught him about the difference between the biceps, the triceps, and the quadriceps.  The body actually has two different biceps muscles - the biceps brachii in the arm and the biceps femoris in the back of the thigh. "Ceps" comes from the latin word caput which means head, and so each of these muscles has multiple heads.  The biceps of the arm has two heads - also often referred to as muscle bellies.  The triceps on the back of the arm has three muscle heads.  And the quadriceps of the front of the thigh has four muscle bellies.  I had to send him pictures to show what I was talking about because just saying the words was meaningless.  These muscle clusters are named as a group because they work together to elicit the same action. For example, the quadriceps, as a group, straighten the knee.

Combine the new basic knowledge of what a muscle looks like with those key concepts we already discussed such as the three planes the body can move in - front to back, side to side, and a rotational plane and how muscles work in certain directions and how important it is to consider all the directions for a well-rounded program.  We discussed some of the basics of muscle growth - and how there are muscle fibers that are more meant for endurance like high repetitions - which is what he had mostly been doing, but also muscle fibers that focus on strength and need to be more overloaded with heavier weight to use those, which had been missing in his routine.

I really enjoyed this conversation because it opened my eyes to the reality of the world... how could I have thought so many people understood these concepts which just come so much more naturally to me!?  I can't wait to take the opportunity to help more people better understand how their body works.  I also enjoyed the opportunity to educate someone so they can make changes to their workout program and develop a plan that could be more effective, and that they can modify independently.  I'm not an expert in training programs, but now he has three options of workouts and can hit each body region at least four times per month, he has a better understanding of how to change reps/sets and that there's a reason to choose these, that he probably was under loading himself, and that above all else, he has found the number one key to training: consistency.  Just by training regularly and making it part of his weekly routine, he's already miles ahead of everyone on the couch.

Can't wait to see what kind of results he gets!

Becoming a Clinical Instructor

UConn PT at the Golden Gate Bridge, (Thanks, EL!)

It's finally happened.  The University of Connecticut Department of Physical Therapy must have experienced a temporary moment of insanity because they're sending me a student!  A moldable young mind on her path to becoming a physical therapist with aspirations of working in pediatric orthopedics... and since I was willing to take her, they found a way to get a contract with Seattle Children's Hospital.

Connecticut is a small state with five PT schools, so pretty much all of my classmates had to do at least one rotation out of state because there aren't enough spots for everyone to stay close to home for all those students.  And if you have specific interests like pediatrics, your options are even less.  It provided for opportunities to learn about different cultures around the country and different methods and random meet ups with classmates.  I had two rotations in Connecticut, one in Albuquerque, NM, and one in Denver, CO... and my classmates went to New Hampshire, Massachusetts, Arizona, Florida, California, Texas, Utah, New York... and maybe even more places I can't remember! 

I'm super excited to mentor a student. It feels like a way to give back to my alma mater while also having the opportunity to learn from someone who's reading current research and will have their own perspectives on optimal patient care.  I recently read a post in a Physical Therapy Facebook Group from someone about to take their first student and they were looking for advice in how to prepare.  I've also been asking around and reflecting on my own clinical experiences and instructors. I can easily think of some things that went well for me and others that weren't so great.

So, in preparation for her arrival, here are four things I'm hoping to focus on to help her have the best clinical experience possible... and then after she's all done, we can come back and see how it went!

1) Feedback:

I personally don't take feedback well.  Positive or negative.  I don't really like having much praise and I don't like hearing what I did poorly. On one of my clinical rotations, my CI gave me feedback in front of a patient that didn't sit well with me, and when we discussed it later on, privately, I burst into tears. (One of the comments on the Facebook Group was to prepare for tears because a lot students cry from the stress... but I'm not so sure). Talk about a moment severely lacking in professionalism! Embarrassing. As such, I am very aware of the importance of private feedback - unless there is a safety issue.  But being aware of that importance and being able to save feedback until a later time doesn't always occur.

Part of being a clinical instructor is helping a student develop their clinical thought processes for how they evaluate and treat patients.  Feedback is a necessary component of that, and sometimes has to be done in front of the patient - but it can be done in a right way that doesn't scare the student or patient.  From what I've observed by coworkers who have had students, there is definitely an art form to being a good clinical instructor. 

And the feedback goes both ways!  Taking a student gives me more opportunities to have my methods questioned and receive feedback about how I interact with patients and find new ways to improve my own skills. This article discusses bi-directional feedback and explains how when both the student and instructor give feedback to one another, the experience is optimized for both people and there is enhanced learning. How to give the feedback is of course an important consideration.  And when.  Because providing feedback too quickly limits opportunities for students to make mistakes.  And people tend to learn best from their mistakes... as long as the patients aren't going to get hurt.

2) Communication: 

Obviously this aligns with feedback, but deserves its own space.  With my own clinical rotations, I didn't feel like I learned most from treating the patients.  I learned far more from discussing why I chose the interventions I used, studying about techniques or conditions I was unfamiliar with, observing interactions between providers and patients, and trying different things.  Fortunately, I'm a talker, so discussing cases and thought processes came fairly easy to me. Conversely, listening is the bigger challenge for me.  I'm hoping that being an instructor will help me work on my active listening skills, particularly not interrupting mid-conversation.

UConn PT at the Grand Canyon

Communication also includes outlining expectations.  This includes small things like the schedule we'll follow and how to address patients and parents up to more critical considerations such as the sufficient knowledge for patient care.  Preparing for weekly follow up sessions to discuss progress and goals for the upcoming week was essential for my success.  Scheduled meetings are useful, in my opinion, to regularly check in, develop goals, refer back to expectations, and measure progress. I like organization and efficiency, so my instructor who was not very efficient was more challenging to learn from than the more organized CIs.

Also, as I've now had a few PT jobs and seen numerous ways to "skin a cat", I'm becoming more comfortable with the fact that physical therapists can treat differently and still be impactful.  There are exercises or techniques I don't use or I don't like... for whatever reason... but that doesn't mean others can't use them if their reasoning makes sense.  Sometimes I share patients with a coworker and we do things in very different ways... but as long as the patient continues to get better, I have to be willing to recognize that there are multiple roads to recovery.  

3) Practicing skills:

One of the best pieces of advice I got from a clinical instructor was to find a system that I could do well to use for evaluating patients as a starting point.  I could vary from that system as I got more and more comfortable, but I had to have a fall-back in case the patient didn't progress the way I would expect them to.  For me, that system was the SFMA, Selective Functional Movement Assessment, and I still sometimes fall back onto it (or parts of it) now! I wrote about that experience here.  I practiced the assessment on my roommates and on my clinical instructor and read the book on how it worked and also used it on a large number of patients.  Then, towards the end of my rotation, I was able to evaluate patients without using the SFMA, unless I wasn't sure what was going on, and then easily went back to what I felt I was good at.

In addition to evaluation techniques, in the pediatric population I don't find myself using a lot of manual therapy - but there are certain times when I feel it is necessary.  When I was learning manual skills, I needed my instructor to do them to me and have me do the technique back to them.  This way, I could get feedback on my positioning and pressure, but I would also need to use it fairly soon in order to have any retention.  I know that we used down time to practice various special tests, but if I didn't end up needing them for a whole week, it was hard to recall that knowledge later on.  

4) Providing Resources:

One of the suggestions made on the Facebook post came from a student suggesting to provide a few articles that demonstrate some of the mindset and practices the instructor uses.  I found this interesting, because only one of my instructors gave me resources at the beginning of my affiliation and that was, without question, my best experience.  I have some ideas of articles that I've read that have been impactful to my practice, but I don't know that I feel a need to start off that way.  I'd rather see if we think similarly first and share them if we don't, I think... but in the month until she begins, I'm going to give this some extra thought.  

Key resources don't just include papers to read.  I work with a group of incredibly talented practitioners including my sports physical therapist team, but multiple other types of providers share our space.  There are opportunities with other types of rehab specialists as well as providers outside our space but within the company relevant to PT practice that will also help a student grow. Should my student have interests in learning about additional experiences, I'm hopeful that I will be able to help arrange those opportunities. 

Overall, I'm excited to learn as much as I am to teach.  Especially since I'm getting a Connecticut Husky.  I hope she brings a hoodie to take a picture of in front of the Space Needle!

"Long Term Cost of Quick Fixes"

Earlier this week, I attended the Seattle Pediatric Sports Medicine quarterly symposium entitled "Long Term Costs of Quick Fixes." I've previously written about that group with regard to their ACL Injury Prevention program here and here. This symposium was a panel of 4 elite athletes discussing their careers and injuries and some of their interactions with healthcare providers.  It made me think of all the sports movies, like Varsity Blues, with scenes of an injured athlete with a needle about to enter their body to get them back on the field right away. For me, the highlight was seeing Seattle Storm co-owner and Rowing Olympian Ginny Gilder! It's always fun attending networking and educational events and learning of the connections between people you know and the people you meet.

Ginny Gilder, Kerry Carter, Seth Orza, and Peter Shmock

Here's a little bit about each of the elite athletes who were included along with some insight to injuries they sustained and some quotes they said which stood out to me.

1) Ginny Gilder -  An Olympic Silver Medalist in Rowing in the 1984 Summer Olympics and also qualified for the 1980 games that were boycotted.  She attended Yale University, has launched multiple companies, all civic-minding and many empowering young women.  She is currently one of the owners of the Seattle Storm - so I was super excited to run into her, and she wrote a book called Course Correction: A Story of Rowing and Resilience in the Wake of Title IX reviewed as "Wild meets Boys in the Boat, a memoir about the quest for Olympic gold and the triumph of love over fear."  Guess what's now on the top of my reading list for 2019!?!

Injuries: Ginny told about her experience breaking a rib and having a cortisone injection to the intercostals to calm things down and being told by the physician to take some time off from rowing, only to be on the Charles River in Boston on a beautiful sunny day and knowing she just had to be on the water, getting into her boat for a casual row, and ultimately feeling a pop in her ribs that she knew was because of not listening to the advice she had been given.   She also commented on back pain that has been chronic and requires continued care today.  The common theme throughout the presentation was that at the elite level, athletes do whatever it takes to compete, sometimes ignoring advice for the long term.

Quotes:
- "Young athletes depend on competent adults to make decisions for them.  As a parent, you may not know how to deal with your kids injuries.  Parents just don't have the knowledge/experience to make all these decisions."
- "Ask parents why they encourage their kids to do sports?  What role sport is playing in setting up their child for success."

The controversial Goldman's Dilemma was also referred to, though not by name.  This was a study done in the 1970's where athletes were asked if they had the option to take a drug that would promise them the highest level of success, would they take it even if they knew it would kill them in five years.  It was a component of the anti-doping legislation that would later come out because at that time, the surveyed athletes would frequently respond that they would take the drug for the success.  Later editions of the study found different results, but some of the commentary focuses on the differences of how an elite level athlete thinks and operates compared to the general population.

2) Kerry Carter - played fullback for the Seattle Seahawks in 2003-2004 and the Washington Redskins in 2006 as well as in the Canadian football league. (I didn't actually know that Canada had a professional football league!)  He currently works as the Vice President for Football Operations for a company called Atavus Rugby and Football - whose CEO is Karen Bryant, former President/CEO for the Seattle Storm.  Kerry's responsibilities at Atavus include teaching football coaches how to teach football players proper tackling and they use scientific metrics to try to prevent injuries.  When asked about the other sports he played, he said volleyball - which is a rare combination for a football player.

Injuries: Kerry described an ACL tear, a shoulder labrum tear, a shoulder AC joint injury, and others that were not as severe, but that he went through multiple surgeries and worked hard each time to get back to the field.  He also discussed some of his lingering aches from those past injuries, and could describe some of the tactics his teammates used including one who had a pharmacy in his locker and would pop tons of pills daily to be able to tolerate the rigors of football.

Quote: "The thing I wish I knew when I was hurt was if there were other options available.  But to be honest, I may not have chosen any alternative that would have taken me longer to get back on the field."

3) Seth Orza - a principal ballerina for Pacific Northwest Ballet and a 20-year professional dancer.  Seth discussed that he also runs and conditions and lifts weights in addition to a 90 minute daily warm-up routine with the dance company and about six hours of rehearsals per day.

Injury: Multiple episodes of back pain.  He said "my back exploded at age 14" and he actually didn't receive healthcare for it, though he's not entirely sure why.  He spent some time in bed and then was able to return.  Since that time he has had additional back injuries and multiple PRP treatments to his knees, and he gave considerable credit to his PT, (my former coworker) Boyd Bender.

Quote:When discussing elite level sport or performing arts: "You're going to get injured, but it's a matter of how you deal with it, who you trust and surround yourself with, and whose advice you take to get through it."

What struck me with Seth's input was the words he used to describe his back injury - because this has come up in presentations that focus on the biopsychosocial model and how much impact words have.  Seth is in his mid 30's and the imagery of his back exploding at age 14 has been reinforced into him for 20 years... but maybe it doesn't impact him!

4) Peter Shmock - An Olympian Shot-Putter who competed in the 1976 games and also qualified for the boycotted 1980 games and now works in Seattle as a high performance coach.  In the late 1990's, he was the weight training coach for the Seattle Mariners and Pacific Northwest Ballet and has trained a long list of elite-level athletes.

Injuries:  Peter was the only one of the group who reported that he hadn't had any major injuries because of the innovation of legendary track and field coach at the University of Oregon and for the USA team, Bill Bowerman, who believed in recovery and a more holistic approach.  If his body didn't feel right, his training or competing was modified and he felt this was essential to his performance.

Quotes:
- In consideration for those he trains - "What is enough for you today?"
- In consideration for athletes who tell him they think they need to just keep doing more, rather than modify their training - "Do you want to do mindless work? Or do you want to improve?"
- "Train or rehab with intent and at a sustainable rate."
- "Be an advocate for the kid you're working with.  The problem with parents/coaches is that they often don't know how to advocate.  They only know go hard or go home."

As a healthcare provider for children and young athletes as well as for elite athletes, I took many important pieces from this presentation and had a great time.  Looking forward to seeing what the group puts together in 2019!

Words My Mom Doesn't Want Me To Use

Many Words of Mental Health

This post is long overdue.  So are many, many others that are similar that I've half-written but are not completed and haven't published because I hate dealing with my own vulnerabilities and weaknesses. That's right.  Hate.  A word my mother banned me from using as a kid because it is so intense.  I remember her telling me that if you use the word hate regarding another person, you mean that you want them dead.  I'm sure I probably had used it towards my twin brother for hitting me... and ultimately I got in trouble for using a bad word rather than him getting in trouble for physical violence.  Of course I didn't want him dead... just to quit it with the wet willies. So hate is an intense word and I don't take that lightly. But it's appropriate right now.  The alternative would be saying that I can't do it... I'm unable... but that portrays weakness... and I'm perfect so I won't use that word.

Perhaps you've heard of the author Brene Brown.  I may have mentioned her in a past post, but honestly I can't remember.  She has written several books on various topics including, according to her website, "courage, vulnerability, shame, and empathy."  She has this quote on her home page: "I believe that you have to walk through vulnerability to get to courage, therefore...embrace the suck."  Ha! Suck is another word my mom wouldn't let us use as kids... funny how both of those words came up and a blog post was born.  I hate facing my own vulnerability so much that I was incapable of reading Brene Brown's book, Daring Greatly.  I tried. Multiple times.  I checked it out of the library, read the first chapter over and over again because I couldn't process it, and when I got the notice that it was due, I returned it.  My roommate really liked it and others by this author, and usually I agree with her taste in books, so I watched her Ted Talk on YouTube - which was OK... or tolerable - and checked the book out again.  Couldn't read it.  Physically incapable.  So I returned it and tried the audio book, but I never made it past her discussions of vulnerability.  It's dangerous to black out while you're driving but I felt like I tuned out the book and the whole world.  Specifically regarding Daring Greatly... and a few blog posts.... I can't walk through my vulnerability to get to the courage.  I'm a coward. Maybe I'll try to Dare Greatly again in 2019.

I've been writing this blog for many reasons... all of them selfish.  I'm not writing for you... I'm writing for me.  While I'm glad others are reading it, I don't actually care when a post only has 20 readers versus the more popular ones that have hundreds of views.  Oh!  There's another phrase I drove my mom crazy with as a kid... "I don't care."  She'd ask what I wanted for dinner... this was probably around 7th grade... and I'd say I didn't care.  But that's when I was trying to stop eating red meat so when meatballs or lamb chops showed up on my plate... I absolutely did care!  So many life lessons... thanks, mom!

Mom

Selfish or not - I'm hopeful that something I say helps other people.  I'm hoping some young physical therapists check out some of the continuing education courses I'm doing or some PT students learn from the mistakes I made earlier in my career. It would be awesome if suggestions I make help decrease some injuries in youth athletes or help people cope with their chronic pain.  When those more vulnerable posts do finally sneak onto the published side of the blog, I absolutely hope someone benefits from them... but I'm getting out what I'm putting in.  I won't pretend I'm doing this to be generous.  This blog has a much bigger purpose that has not yet reached full transparency.  Yet.

So why today's blog post?  A friend is in pain. Maybe not the physical pain that I treat in the clinic or chronic pain that I've written about so many times on this blog.  I'm not sure.   But there is suffering.  Sadness.  Emotion.  I got a phone call today and was told that they had decided to self-admit for inpatient mental health services a few days ago.  Only a very small number of people know and for some reason, I'm on the short list.  They wanted to know what I thought.  Talk about vulnerability.  Courage.  Strength. 

I think that others may be struggling who might need to hear this too. To be honest... when I'm having a down day... I need to hear these things myself.  Despite all my jokes, laughter, and smiles... I do have down days.  So here's what I think, and also some of what I told my friend.  And I'm sharing with whoever reads this... because it's the start of facing my own vulnerabilities.

1) Mental Health, per dictionary.com, is a) psychological well-being and satisfactory adjustment to society and to the ordinary demands of life; b) the field of medicine concerned with the maintenance or achievement of such well-being and adjustment.  Wikipedia says it's the absence of mental illness.  EVERYONE has a mental health status. And it isn't some concrete place that you're always going to be in. It's a fluid construct. There are times in life that are more stressful or more sad or overwhelmingly happy...  and your psychological well-being changes during those times. That doesn't make it pathological - or mental health illness.  But just by looking at someone - you really can't tell if a person has a pathological mental health or not.  Just like you can't tell I'm Jewish by looking at me... there's no sign on my forehead telling you these things you can't see.

Remember Robbin Williams?  He was a comedian and all around funny dude... and all you ever saw publicly as a fan of his movies was happy, jovial, doing voices Mrs. Doubtfire or Genie from Aladdin.  But underneath the skin was a dark place that most people couldn't have known about.  I refuse to believe he was sad all the time on the inside while happy all the time on the outside.  But I have no way of knowing.  And so - everyone has a mental health status - but more importantly - you never know what's going on with other people under the surface unless you ASK.

2) They are not alone.  I don't know what specific mental health circumstances my friend is going through. It's none of my business if they don't want to tell me.  I can be a supportive friend without details. Maybe other people react differently? What I do know from recent reading about mental health illnesses is that there are a long list of them - potentially including: anxiety, mood disorders, depression, body dysmorphia, PTSD, eating disorders, personality traits, social anxiety, diagnoses like schizophrenia or bipolar disorder, gender and sexuality issues... and TONS of people experience these problems. Unfortunately, this friend isn't the only person I know having some struggles right now.  The people I love are hurting... which hurts me, too. And so I told my friend about my own recent mental health journey and we couldn't understand why neither of us had discussed these things before now. Well... actually I don't talk about it because of that V word I talked about above... you know the one. Maybe that happens for a lot of people?

3) There's a lot of darkness going on in the world right now.  The news is sad. You can't go on social media without seeing really big issues - global warming, separation of children at the border, economic policy, gun control, starving countries, natural disasters.  All those big issues can make an individual feel pretty small and less important. But less important is NOT unimportant.  The holidays are coming up.  I'm personally looking forward to seeing more photos of children looking at Christmas Trees and Menorahs, families having meals together, and drowning out some of the bigger stuff.  Let's bring it all a little smaller, find ourselves a little bit, take a deep breath, and focus on the positives and things we can control.  Even if it's just for the month of December.

I can promise there will be more where this came from.  If you feel there is a negative tone to this post, you should know that in my head there is only optimism.  hope.  healing.  and love.

Book Alert: The Omnivore's Dilemma (and The Jungle)

I recently read The Omnivore's Dilemma: A History of Four Meals, by Michael Pollan.  I had been meaning to get to it for several years, probably since I read Upton Sinclair's The Jungle which fascinated me.  Both books I would recommend to people who are interested in learning about food in the United States.  They're very different.  The Jungle was written in 1906 and goes into great detail about the living and working conditions for workers in the meat-packing industry.  It was appalling and an interesting way to learn a piece of American history.  I'm certain that if I was a meat-eater when I had read it, I wouldn't have been afterwards, despite how much the industry has changed (I hope!) since that time.  Most days I wish I was a vegetarian but I just can't get myself to do it.  You've been warned!

In The Omnivore's Dilemma, Michael Pollan examines four different pathways to a meal.  He considers the sources of ingredients and what the go through to make it to your fork.  It starts as a story about corn and it’s impact on our food supply as well as contributing to the obesity epidemic, economics, and politics. Fun fact: There are about 45,000 items in a typical grocery store and 25% contain corn.  Looking at a chicken nugget: the chicken while it was alive was fed on a corn-based diet. Once the chicken is used for meat, the nugget is held together with corn starch, then breaded in corn and fried in corn oil.  My favorite quote from the book: "If you are what you eat, we are mostly processed corn." 

Corn evolved to be able to grow under a very wide variety of weather and soil conditions. Because it is used for so much, farmer's were almost forced into growing it and ultimately had difficulty feeding their families because they devoted all their land to corn instead of a variety of animals for meats, vegetables, and fruits.  When the cost of corn decreases, the government helps subsidize farmers so they can stay afloat.  I won't lie - I didn't understand all the political implications that were described, but I did comprehend that the government and politics are intermingled into farming and into our food and that makes things complicated for everyone.  

A huge portion of the corn that is grown becomes high fructose corn syrup (HFCS), a sweet form of refined sugar.   A lot of it goes into soda. A farmer gets the tiniest fraction of pay for the corn and the beverage companies get a much larger percentage for what they make from it.  In 1980 Coke changed from sugar to HFCS because corn is cheaper than sugar. Pepsi followed in 1984, and people couldn’t tell the difference in taste.  After a better understanding of how corn is the basic substance of so much of our food, meals from four different food chains were examined. 

First: The industrial corn chain followed to McDonald’s: With the advent of fast food, a family can eat separate meals while still eating together. Separate meals generally means larger portions. The nugget is the reason chicken is more popular than beef in America.  A meal for 3 people from McDonald’s was analyzed for how much corn was used to make it. The six Chicken McNuggets that Pollan’s son consumed used enough corn to feed a handful of people. And the 4,510 calories of the whole family's meal required processing that could have supplied tens of thousands of calories of corn to feed starving communities.  The cost of production of the products we eat is higher than the energy we're getting out of our meals.

The second meal is of mass-produced farming to stock our grocery stores.  This portion was interesting because it looks at some of the imbalances with fuel requirements to produce the food where that fuel could be used in an alternative means.  Similar to the energy cost of making the Chicken McNuggets only looking at the feeding of the animals that are then sold at the grocery store.  Pollan goes to a cattle farm and observes the conditions there, but he meets quite a bit of resistance from facility owners trying to protect their secrets. 

The third meal was based on organic farming. Pollan spends time on a smaller farm learning about the animals and their grass feed and even how to kill a chicken and prepare it. He cooks a meal from the chicken, corn, and eggs of the farm. It was interesting to learn that there are farmers who won't send their produce far from where it is raised, because they're not using anything to preserve the meat so the quality would be poor if it was shipped cross-country.  Pollan's experience participating in the chicken butchery was fascinating... like a new version of The Jungle - but so much safer for the workers and so much less gruesome for the animals.

The fourth meal was a hunter-gatherer-home grown meal. He learns how to forage for mushrooms - which doesn’t sound too hard until you’re holding a mushroom, unsure if eating it will kill you or not since they can be poisonous.  Then growing a garden and getting a hunters license and learning to shoot so he could hunt for the meat.  He kills and prepares a pig and makes the whole meal from ingredients he had grown or scavenged or hunted on his own. 

Overall I really liked learning about the different ways food can end up on the table.  If time constraints and money were no issue - it would be amazing to have a meal every night that was grown in my backyard.  I definitely couldn't hunt an animal and then eat the meat... I can't even fathom the idea of going fishing and on the few occasions when I've made lobsters and cooked them, I've felt terrible about my meal.  But I could see myself milking a cow to make my own cheese... because I love cheese and that doesn't hurt the cow.  If only there was enough time.

I'd recommend both of these books, just like I previously recommended Deep Nutrition here.  There are some other nutrition/food books on my list coming up, too, but any recommendations for what I should read next? 

Seattle Children's Inaugural Sports Medicine Symposium: Mental Health

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© Abidal

 

| Dreamstime.com

On November 14th, Seattle Children's Hospital held their Inaugural Sports Medicine Symposium with the topic of Mental Health Care for Athletes.  As I briefly mentioned in my Blogiversary post, here, Mental Health is something that interests me and that I have been learning more about because of its relationship with chronic pain (which I have previously written about several times.)  It is also something I've been learning more about regarding my own mental health practices, lately, which I hope to explore in the blog in the future.

The Symposium was a multi-disciplinary event including the orthopedic physicians and surgeons and their PAs, the sports physical therapists, and the athletic trainers from Seattle Children's Hospital.  In my almost 2 years working at Seattle Children's, it has historically been a rare occurrence for all of these providers to be in one place at the same time - but we're treating the same conditions and working together on so many patients, that it was neat to have this opportunity. 

There were two speakers at the event discussing various topics from mental health.  First, Dr. Cora Breuner, a physician at Seattle Children's and a professor at the University of Washington with expertise in pediatrics, adolescent medicine, orthopedics, and sports medicine discussed some of the critical components of evaluating patients with consideration for finding mental health or substance abuse red flags.  She was listed as one of Seattle's best doctors in 2018 (and several previous years!) by Seattle Magazine, and her presentation was engaging, informative, and entertaining. 

From her presentation, I learned two new acronyms to include in my evaluations which I previously had only included small parts of, but now have better understanding for the importance of going into more detail.  These are mental health screening tools meant for the adolescent population and which fit into the biopsychosocial model of care nicely. The acronyms: HEEADSSS and CRAFFT examine the adolescent's personal life while CRAFFT is a screening tool for substance-related risks such as drugs or alcohol that fits into the HEEAADSSS assessment. 

HEEADSSS breaks down into: Home, Education, Eating, Activities, Drugs, Suicidality, Sex, and Safety.  There are a few different versions when I searched for better understanding of this acronym - where some of the dual letters are combined into groups.  Let's look at these in a little bit of detail.  Every time I sit down with a patient, and usually they have a parent with them, my first job is to make them comfortable and try to connect with them.  If I'm going to treat you and help you manage your pain, there's a chance I'll need to touch you or have you move your body in ways that are new to you - so I need to earn the kid's trust.

Ever try to make friends in Seattle as an adult?  It's hard!  Want to make friends with a teenager in less than 5 minutes?  Find out what they like and make sure they know you're talking to them - rather than their parent - and you might have hope!  Fortunately I have a wide array of interests and background- so I can talk a little bit of sports, a little bit about music, a little bit about Harry Potter, a little bit of Disney Movies, and a little bit of "I also went to high school once so I can relate to your hatred for Spanish Class" to try to connect with these teenagers!  I always ask components of the HEEADSSS assessment because it's an easy way to break the ice with a kid.  Here's some of what I already would typically ask: Home: Who brought you to the appointment? Who do you live with? Do you have any pets? Are you nice to their little brother or sister?  Education:   What grade are you in and what school do you attend? Do you have friends? What are your favorite classes?   Activities: What do you do for fun? Any sports, musical instruments, clubs or after school activities/hobbies.  How about a job?

You might notice that I've left out some of the essential topics with my usual line of questioning.  I rarely ask about Eating, and I don't think I've ever asked about Drugs, Suicidality, Sex, or Safety.  That doesn't mean these things have never come up... I've had more than one patient in my career (adult and under-aged) tell me they're using some sort of marijuana product for their pain control.  I've worked with a few patients who have had issues with suicide in their history and who bring it up as something to be aware of in their past.  Discussing eating habits is a great way to assess the basic health understanding of the child and family or to gauge an understanding of the basic needs of the patient.  I'm glad I can give out snacks to kids who may not have enough to eat. 

Questions about drugs should include the use of alcohol, marijuana, or any other substance to get high in the past year.   Those drug questions are followed by the CRAFFT acronym which stands for: Car, Relax, Alone, Family/Friends, Forget, Trouble.  These are specific questions:  Have you ridden in a Car where the driver (which could be you) was high?  Have you taken drugs to Relax?  Do you ever use drugs or alcohol Alone?  Do any of your Family or friends tell you to cut back on your use of drugs or alcohol? Do you ever Forget things because you were using drugs or alcohol?  Have you ever gotten into Trouble while using drugs or alcohol? This assessment can be scored to determine high risk of substance abuse.  It was also discussed that kids are much less likely to have these conversations in front of their parents - and they're also more likely to talk about their friends than themselves - so asking your patient if any of their friends use these substances might get you more information than starting out asking them about personal use. 

With kids who may have some mental health issues that need to be considered as a component of their care, adding these areas will be vital and incredibly challenging at first.  But as healthcare providers, we have a responsibility to look out for these teenagers who may not have any other way to get help if they're in need. There were some interesting and startling statistics presented regarding some of the high risk behaviors.  Particularly memorable to me were: 1) In a survey of high school-aged kids, 94% of the ones who used drugs or alcohol started between ages 11-15.  2) In a survey of high school-aged kids, less than half had engaged in sexual intercourse, but only 60% of those had used a condom. 3) Condoms only prevent pregnancy about 82% of the time.  That's a B- grade. So too many kids are having unprotected sex and even those who are trying to be protected don't have the best stats on their side. 

Dr. Breuner also discussed the importance of recognizing the rights of a teenager.  In the state of Washington (this could vary where you live), a teenager can have their mental health records kept confidential starting at age 13 and their reproductive health records kept confidential at age 14.  This means that a healthcare provider can discuss this information with the child and does not have to inform the parents - or anyone else - unless the child is being hurt or is hurting themself or another person.  The information should be documented in their medical record but is not to be released to the parents.  We need to be educated so we can serve as resources to teenagers who need help.

The second speaker was Sport Psychologist Dr. Elizabeth Boyer, owner of Northwest Performance Psychology.  Dr. Boyer gave numerous examples of ways that injury can influence mental health.  We see this in the clinic often - where an athlete is working to get back to their sport and is sad or depressed or fearful... for a wide variety of reasons.  Athletes who are injured often feel like they have let their team down.  They may lose confidence and could become more isolated from being separated from their teammates and friends.  They should go to practice!  Maybe not every single day, particularly if they need to be doing regular rehab appointments, but we can easily encourage injured athletes to attend a practice every week and be part of their team.

A key takeaway from this presentation was that developing some mental health skills for recovery can also help improve athletic performance.  Skills like imagery - where you visualize drills in your head - or goal setting - in the short and long term - can both help with recovery and with performance.  While we always set goals for our patients in the clinic, the patients should have more say in their own goals rather than having a therapist select things that may seem arbitrary.  And reminding patients of their goals throughout the treatment so they can see their progress is also a useful tool. 

Lastly, Dr. Boyer mentioned the importance of self-care as a healthcare provider.  I love my job.  Every day.  I can't believe how blessed I am.  But sometimes I forget how much of myself I'm giving to others and how little I'm giving to myself.  Sounds like I need to find some different options for that for the new year... more focus on my own mental health will only help me better serve the patients I'm working with, and keep myself going. 

And with that, a Happy Thanksgiving to all my readers.  I hope you'll take the chance to care for yourself this holiday season.  And to care for those around you. 

Warm Up Like You Mean It

Photo Credit: Seattle Pediatric Sports Medicine
I'm front-right, and I need to work on my landing.

High school and college basketball season is here!!!!!! (YAY!) I'm so fortunate to have many friends who coach or work in high school and intercollegiate athletics.  This post is for all of you.  It's tinted towards basketball, but it could apply to any sport. 

Working in pediatric sports medicine, I notice clusters of injuries which coincide with the change in sports seasons.  This is, of course, a generalization, but it seems that there are patterns. Some examples: shoulder overuse injuries in swim and baseball season, concussions as football gets underway, "shin splints" in cross country runners who may have ramped up too quickly, and ankle sprains with soccer and basketball.

So now that the sports seasons are changing and I'm expecting to start seeing basketball players in the clinic, I thought it was time to hop on my soap box suggesting the use of a dynamic warm-up as an injury prevention tool. It has recently come to my attention that some of the local high schools are so overbooked on their gym time that the athletes are expected to warm-up on their own before they're allowed access to the court.  The team does not warm up together unless the captain organizes the group beforehand.  To me, that means it isn't mandatory.  It isn't a priority.  If teams only get 2 hours of on-court time per day, they'll use the time to focus on sport-specific activities, no time wasted on preparing their bodies.  I get it, but I don't approve.  I think you might end up with a team that knows a few extra plays, but you also might have a few more injured players on the bench.  Is it worth it?  There's quite a lot of research on the benefit of ACL injury prevention programs, including the 2018 National Athletic Trainer's Association Position Statement written by an awesome group including my mentor, Dr. Lindsay DiStefano, which can be found here.  (That paper includes the components you should include in your injury prevention program... no worries ... they're going to be briefly summarized below.)

I've previously mentioned that an injury prevention program is the same thing as a performance enhancement program here.  Most of these programs are targeting prevention of ACL injuries, but there is no reason to believe they couldn't help prevent other injuries, as well.  The Seattle Pediatric Sports Medicine Group's ACL Injury Prevention Program and the FIFA 11+ programs were both designed to be used as a dynamic warm-up.  Note that I'm using three different names for the same thing: Dynamic warm-up, if used properly, is the same thing as an injury prevention program, which is the same thing as performance enhancement.  (There are many other programs out there, but these are the two I'm most familiar with and have seen teams use most frequently. Ignore that they're set on a soccer field... it doesn't matter!). 

Let's back up for a moment.  What is a dynamic warm-up?  A dynamic warm-up is a progressive increase in the intensity of exercise placed at the beginning of a training session to prepare the body for the work it will do.  It targets increasing the cardiovascular system and getting the blood flowing as well as progressively increasing the use of the musculo-skeletal system and the nervous system to optimize the body for movement.  There are numerous publications that recommend doing this for a variety of reasons.  Like this article for injury prevention, and this one to optimize power. You've probably learned that you shouldn't skip meals leading up to Thanksgiving Dinner (though many people wrongly think this means more room for extra desserts, you're better off having some breakfast earlier in the day and regular eating the day before.  You're welcome.)  Why would you go from sitting in school all day long to sprinting up and down the basketball court without preparing your body?

Great, so now that we've determined that you're going to include a warm-up in your teams' practices and before games, why not decide how to design the warm-up for optimal performance?  This really can't be just about going through the motions.  It needs to be intentional.  It needs to be focused.  This is a great opportunity to develop a plan that team captains can lead early in the season so you can help teach individuals who might need more help with some of the movement patterns.

No more sitting in a circle stretching and chatting about last night's episode of Grey's Anatomy. Focused, purposeful movement.  There are SO MANY activities you can include if you're not able or willing to use one of the programs already designed for you due to the amount of time they may take.  I urge you to consider one of those programs, but alternatively, take the components from those programs and use them interchangeably.  If you structure your practices so you know what things you're going to work on, you can also structure your warm-ups so you know what you're going to work on in that time. What good is running a play for your shooter if they're not yet getting off the floor with their jumps?  What good is spending an hour teaching your team how to get a pass into the post if your center doesn't understand the benefit of getting low (in their squat pattern) to back down their defender and take it to the hole.  I'll say it one more time for the people in the back, injury prevention IS performance enhancement and a dynamic warm-up is an easy way to fit this into your daily routine.  If you help develop your athletes into just that - better athletes - they'll have more skills available to them to apply to whatever sport they're playing.

Components you should consider using in your warm-up.
1) mobility/flexibility (walking stretches)
2) strength (of the hips and core as well as the upper body) which can be done using:
3) movement patterns (squat, lunge)
4) jumping (plyometrics)
5) balance
6) agility (cutting/change of direction)
According to the NATA position statement, you should be using at least 3 of the above categories.  The prepared programs use all of them.

I don't have data to support this claim, but in general, I would say that most of the injured teenage girl athletes I see in the clinic do not jump or land in an "optimal fashion".  They're generally strong, but need to be stronger for the demands of the sport they're playing.  They often can't squat without falling over and I don't think I've seen any who can control a single leg squat.  As a coach, if you don't know how to teach these things to your players or why they're important, you could ask a local physical therapist to come in and screen your athletes and give you some pointers.  Or call me and we can chat about them!  Seriously... any time.  If this post prevents one high school basketball player from injury, I'll be happy.  Or if this post changes the way a coach organizes their practice to include more of the above components, I'll be elated.

As a reminder -
Every jump shot is, in fact, a jump and a landing.
Most rebounds are, in fact, a jump and a landing.
Jump-landings are, in fact, related to the squat.  If you do it on one leg, it's more related to a single-leg squat.
Defensive stance and the "triple threat" position are, in fact, related to the squat.
If you are standing on one leg for any reason - landing from a rebound, trying to save a ball from going out of bounds - you need to be able to balance.  Most teenagers can easily stand on one foot on a firm surface and balance steadily without a problem.  But if they have had an ankle sprain, it gets much more difficult.  If they're turning their head - like they would for an outlet pass or to avoid a defender - it gets much more difficult.

I'll go back to the discussion of getting the high school girls into the weight room another day, but for now, strength training could be as simple as a few sets of squats and a few lengths of the court with walking lunges and a few side planks - all with body weight - to focus on movement patterns and strengthening.  That could easily be a huge part of their warm-up before playing basketball.  (If you're preparing for a strength training workout, the dynamic warm-up should more closely mimic the motions of the exercises to be completed, but for a sports practice, there's a ton of variety available that will be relevant and beneficial). 

Last thought on these warm-ups.  Something that makes my mind go nutty is watching a team practice where they spend a good 15 minutes warming up, and then the coach has them circle up and stand still to discuss the upcoming practice, ultimately cooling them back down.  Prepare your team's mindset before the warm-up so you can transition right from the warm-up into business.  You can't avoid it during games when you substitute a player from the bench and they've been sitting for the whole first half.  That player is cold and has to use the game to warm up. Hopefully the energy of the game has kept the blood pumping a bit.  Hopefully they do some jumping up and down on the sidelines when your team makes a great play, to keep them warmer.  But on a daily practice routine, you can keep them warm and ready to go.

Any questions?  Let me know if I can help.
Here's to a great basketball season with zero injuries for your team.  And lots of offensive rebounds.  Those are my favorite.

(Go Cheshire Rams! Go UConn Huskies!)

Happy Blogiversary!

I can't believe I've been writing this blog for a whole year!  It's a Blogiversary! I really love any occasion to celebrate... so a year of personal growth and writing seems like as good an excuse as any other!  My first post, published on November 5, 2017, can be found here.  It was an introduction to "Abby's World" and what my three initial topics of interest were: 1) Physical Therapy-related education, 2) the Female Athlete, and 3) Injury Prevention. Looking back on the past year of blogging, I'd say I mostly stuck to my PT education, writing about courses I was taking, patients/athletes I was seeing, conditions I was learning about.  I threw in some posts about female athletes or women in sports and a little bit about injury prevention, too.

What better way to celebrate an anniversary than to use a photo of my parents on their 50th wedding anniversary?!  Aren't they just the cutest?!

This past year I've experienced considerable growth - both personally and professionally.  The blog has basically served as a tracking device for my professional growth. I've really enjoyed writing these and it has helped me stay organized and a bit more accountable to learning something or reflecting.  I anticipate more of the same in the upcoming year, maybe expressing more of my personal growth as well.  Vulnerability is a personal area of struggle, so going more into the personal realm is a bit terrifying to me.  I've written outlines of several posts that I haven't been able to share yet... but hope to find that courage in the future.  I'd love to hear more from those of you who have been reading to better understand what you've found useful.  Sometimes I just think I'm sharing my thoughts to a giant black hole.  Who are you, readers?

And so, I present The Top Seven Things I've Learned from One Year of Blogging.

1) Time management.  I wanted to make sure the I never went more than 10 days between posts.  I didn't go back through all the dates, but I'm pretty sure I was successful.  Somewhere early along the way, I read that if you want to build a blog with a big following, you need to be consistent with posting on the same day of the week.  But - my goals weren't to build a big following - and consistency wasn't always possible.  I did find myself prioritizing time to learn more each week so that I could keep my blog posts regularly coming, and I published 63 posts in the past year... just a little bit more than once per week!

2) I really like lists.  Again, I didn't go back through my previous posts to write this one, but I noticed a while back that about half of my posts are in list form... just like this post.  I've always liked
"To Do" lists... but didn't expect this.  What does it mean?!  Is this how my brain operates?  Funny enough - it just might be! In PT School, we took a learning styles assessment early in the program.  It suggested that people learn in one of three ways: visual learner, auditory learner, or kinesthetic learner.  I scored 33% on each one which was SUPER UNHELPFUL and ultimately made me feel like I needed to learn everything in two ways to really grasp the concept (that's still only 66%).

I was recently advised to take another assessment of my learning type, but this one had a fourth option: the reading/writing learner.  I came out as 91% of this "other" type... I wish I had known during PT School, though I think that's how I ultimately was studying anyways. Yeesh!  The characteristics listed for a reading/writing learner are someone who keeps boatloads of notebooks and who writes and re-writes study guides.  That's me!  Of course I don't really look back at them, but I can't get rid of a huge chunk of my college notes... I just can't!  I certainly wasn't someone who drew pictures or charts very much (visual), or who tape-recorded my lectures to re-listen (auditory) and I don't actually think I learn much at all from acting things out (kinesthetic).  One of my PT School classmates would be contorting himself in the desk at school trying to figure out biomechanics by moving his own body... I was trying to recreate my study guide or flash cards in my brain. I think that discovering techniques that helped me learn have increased my understanding of why I write lists - and was a big self discovery find over this past year of blogging.

3) You never know who might be reading!  I went to a course on the elbow presented by one of my favorite mentors, Lenny Macrina, that I wrote about here.  That post was all about the impact that social media has had on my practice as a PT.  What I didn't mention on that post, though, was that while I was at the class, I ran into a PT I had met around Seattle a few times, who told me he had been reading my blog! I've had coworkers comment to me at work about it.  Family members have reached out and asked questions or shown support.  A former co-worker at UConn told me she sent my blog posts about pain to her mom and they really resonated with her and helped her feel better.  WHAT?  So, thank you to everyone who has read some of my posts and mentioned them back to me... there have been so few comments posted, but I can see the numbers of people who are checking it out... and I am grateful for all of you, and hopeful that I'm helping you in some way.

4) I have a lot of interests and I learned a lot this past year!  I don't think I was really motivated to learn before working at Seattle Children's.  Maybe that's the typical pattern for a new grad... still suffering from school burnout and needing to learn the ropes of how to structure a day in the clinic, interact with patients, write notes, stay on time... basic things.  And then you start to feel like you're not really a new grad anymore and can focus on ways to grow beyond getting better at basic skills.

I started writing this blog about eight months into my time working at Seattle Children's Hospital when I was starting to feel more confident in my skills as a physical therapist and ready to start learning about conditions I didn't know enough about.  Prior to then, I had only treated one patient with a concussion, I had never used iontophoresis (now that I have - I can tell you I don't really like it as a treatment... but at least I know how to do it and can explain why I don't like it or why I would use it), I had never worked with a transgender person (at least who was openly discussing it with me), I knew NOTHING about pain science, and my total number of post-op ACL patients treated was in the single digits.  These are BIG topics that I felt inadequately prepared to deal with and dove into reading and learning as much as possible to better help my patients.  It also shows me how much more there is to learn, how impossible it is to know everything, how important it is to be a lifelong learner, and how critical it is to have a network of colleagues who specialize so that you know who to ask for help.  I know that I can treat a baseball player - and probably help them get better - but that one of my coworkers would be better at breaking down their throwing form than I am.  So I keep learning about how to do it better by sharing patients and learning from coworkers and reading... a lot.  And it makes me proud that my coworkers know that a teenage basketball player who comes into the clinic might connect well with me because of my background, and would recommend sharing that patient with me.

5) I can't believe I started my blog the year the Seattle Storm won the WNBA Championship.  Since I moved to Seattle specifically to volunteer with the team, it was amazing to watch them work and have the chance to blog about some of that experience.  I'm so grateful that I've been able to work with the Storm, the Connecticut Sun, and the UConn Women's Basketball teams because women's sports are on the rise, the WNBA is up and coming, there is more and more coverage for women's sports, and because it has been so awesome learning about women working in sports and trying to promote them.  I wrote a little about that here.  But writing my own posts about the Storm and women's sports showed me how little there even is about injury writing in sports from a healthcare provider perspective, and there's even less when it comes to women's sports.  It's challenging because of athlete privacy - but I thought I had a unique perspective on some of the injuries or risk factors that were being discussed around the WNBA and was glad to write about them.  I can do more.  I will do more.

6) The opportunities for women in sports are still severely limited.  Writing a blog requires a considerable amount of reading and research.  I found a few more women to look up to and learn from during this process... but they were few and far between.  Many of these women are clinicians treating athletes and patients - they're not writing about their experiences or regularly presenting at conferences, so it's hard to learn from them.  They're doing all the right things - but they're not on the social media boards the way so many males are in our profession.  Something I never publicized were my efforts to try to change opportunities for women working in sports medicine.  I wish I could say I'd had more success on my efforts in the past several months, but I've hit several road blocks.  I will not stop this battle... and I hope the upcoming year will result in continued growth and more opportunities.

7)  The world is changing.  Politics are affecting healthcare and women and I didn't really express my opinions of this on the blog very much, but all my increased reading made it very apparent.  I'm sure some of my opinions came across in the blog, but overall I've tried to remain apolitical in this space.  I can't promise it will remain that way because I care about so many of the things that are happening in the world.  I'm interested in global warming - but have not read anything about the topic.  I'm interested in healthcare reform... I spent several days reading the Obamacare (Affordable Care Act) legislation during PT School so I could present it to a clinical rotation as well as to my classmates.  I care about special needs children, people with mental health issues, those who are experiencing chronic illness or chronic pain, and anyone with a pre-existing condition who may be impacted by healthcare change.  I have considerable interest in mental health and know that there will definitely be posts about it in the future.  By and large - I've kept the political opinions out of here, with the exception of gender equality issues - and I expect it will probably stay that way.  Maybe.

So that's a year of blogging!  Thanks for joining me on the ride... it's been fun!  Please comment, even if to just say hi.  I'd really appreciate it.  Here's to another year of learning and helping people get back to their favorite activities.