2024: The Year I Didn't Blog

Happy New Year! 2024 has come and gone seemingly in the blink of an eye. Somehow I managed to read far more this year with audio books on faster speeds during my commutes and travels. I read so much – and wrote a little bit in other places – but I didn’t write any blog posts here! I’ve missed my blog and hope to return more in 2025, but I'm also planning on writing a book! Now that I'm sharing that with everyone, hopefully this will keep me committed to the goal. 

My first book will be "It depends." Anyone whose gone through PT School - or probably any professional medical education - will likely tell you stories of how they asked questions in school only to be repeatedly told, "it depends." Though frustrating, with the hindsight of a decade of clinical practice, it's now a lot easier to recognize that this is the best answer, and now I can come up with a whole host of considerations that the question would depend on. This is a chance to tell some clinical stories to shed light on why working in healthcare is so complex, and also highly entertaining. So hopefully I'll be able to write the book while keeping up with my blogging!

Early in 2024, I was invited to give some talks at different conferences, so I dedicated the early part of the year to a lot of reading and developing those presentations. The biggest talk was alongside colleagues Dr. Karen Litzy and Dr. Devra Sheldon at the American Physical Therapy Association Combined Sections Meeting in Boston about Complex Regional Pain Syndrome. I also spoke at the TRIA Orthopedic and Sports Medicine Conference in Minneapolis about Rehabilitation for the Adolescent Athlete thanks to an awesome colleague recommending me for the job. In 2025, I'm working on giving a talk at the Seattle Children's Hospital Rheumatology Conference where I'm partnering with a physician and we're talking about differentiating between rheumatological conditions and chronic sport-related pain in young athletes. 

My writing in 2024 was limited, but looking back it was all fun. I wrote three articles for The Next Hoops and some blog posts for Pain Geeks. The Next publishes everything you could ever want to read about women's basketball. They're fantastic. If you're a fan of the WNBA or any college team, I highly recommend you check them out and subscribe. My articles for them included coverage of last year's Apple Cup where University of Washington played Washington State University, something that will be more difficult to achieve as the college conferences were realigned heading into this current season. 

I also teamed up with fellow physical therapist and writer Lucas Seehafer where we reviewed the 2023 WNBA injury stats heading into the 2024 season.  I'm excited to continue to partner with Lucas in the future as more data is collected and hope that next year, the League manages to stay healthier! 

My final piece for The Next was an exploration of how the WNBA medical staffs have been expanding as the League has been growing. It included spotlights on several of the medical providers around the League.  It gave me a chance to meet new athletic trainers, physical therapists, and strength coaches working in the WNBA as well as to catch up with some of the providers I have known for more than 15 years. They're an awesome group of people and it was really fun giving them the spotlight, though most of them are pretty happy being behind the scenes. 

For Pain Geeks, I was invited to lead their fall book club discussion choosing the book, "When Breath Becomes Air" by Paul Kalanathi. For this I wrote two blog posts leading up to the meeting. Part 1 and Part 2. The book is gut wrenching and heart breaking while simultaneously beautiful and inspiring. I rarely read books twice, but I really felt that this one deserved discussion and it was fun chatting about it with the other Pain Geeks. PT pals - if you're working with patients experiencing chronic pain and want to really grow your community of medical providers, the Pain Geeks are all over the world and our group meetings continue to make me a better clinician. Check them out. 

I guess since I've mentioned a book I loved in 2024, I'll also write about what I read last year. Thanks to audio books, I broke personal records completing 76 books! Incorporating a bit more fiction seems to make me read faster, and I read more of those than usual because several people kept telling me to jump into Sarah J. Maas's books. Let me just get this out of the way: I liked the "A Court of Thorns and Roses" Series. I did not like the "Throne of Glass" series and didn’t finish it. I like other genres far more than these and don't know if I will read any romantasy in 2025... but if that's your jam, please do enjoy it! I can already feel the daggers coming from some of my friends who thought these books were  life changing. Sorry, friends!

What books did I like the best in 2024? 

I listened to several biographies or memoirs and also read a few. In a lot of cases, the narrator was also the author and I love when that happens. Incredible athletes like A’Ja Wilson who shared her relationship with her grandma alongside her basketball journey made me want to root for her even though she’s not on the team I cheer for. I felt like The Terminator was sitting in the car right next to me as Arnold Schwarzenneggar described his childhood and how he ended up in body building. It was so much better than hearing my own internal monologue. Dancer/actress Kelly Bishop’s tales of her life and career on stage as the main character in A Chorus Line before she became Emily Gilmore, matriarch in Gilmore Girls. I learned a lot and as a Gilmore Girls fan was so glad she read it herself. My heart broke learning about Britney Spears and how she was basically tortured by her parents and also hearing Matthew Perry describe his ongoing battles with drugs. And there were several others that were all really fantastic, but these were the most memorable from that genre.

I read several books about Israel, Gaza, antisemitism, Judaism, and Hamas. In the wake of the October 7, 2023 massacre at the Nova Music Festival, I found myself involved in numerous conversations about the Middle East, a place I have been, a place  I lived and worked as an Emergency Responder, and a place that is very important to me. "Israel" and "Uncomfortable Conversations with a Jew" both were filled with detailed history of the conflict, but I thought it was important to read from a different perspective. For that, I read “Son of Hamas” and “I Shall Not Hate” as well as some graphic novels about the Middle East.  

In the past, I primarily read non-fiction books, but I do love fiction and my temporary commitment to
flying faeries was fun for a while. I think my brain needed somewhere to chill out after all the journal articles and novels helped me recover. My favorite non-fictions this year came from Emily Henry and Taylor Jenkins Reid and I've been working my way through another Greg Iles book that's super long but I love his work. I also liked, "Everyone in my family has killed someone" by Benjamin Stevenson.

And my favorite non-fictions this year were "Rare Gems," by Howard Megdal - Minnesota Women's
Basketball History at its finest, "Unreasonable Hospitality," by Will Guidara - which aligns with my commitment to therapeutic alliance with my patients and going out of my way to make others feel special. Though it fits as a memoir, Kate Fagan's "All The Colors Came Out" where she talks about her basketball life along with the relationship it facilitated with her father was perhaps the best book I read all year. Tears and laughter. 

So there's 19 of my favorite books from last year... and it was even hard to choose those! 

What am I most excited to read in 2025? 

Biographies: Maya Moore's Love and Justice and Brittney Griner's Coming Home

Fiction: the new prequel for the Hunger Games that explores the back story of Haymitch - Sunrise on the Reaping - by Suzanne Collins and novels by Abby Jimenez

Non-Fiction: Jay Shetty's 8 Rules of Love and Louis Gifford's Aches and Pains series. 

I like to read a classic and/or banned book and this year I think it'll be Brave New World. 

Beyond that - here's to lots of fun 2025 travels and meet ups with friends with outings planned in Maui, San Francisco, and Austin already... but more for sure to come.  Who wants to get together?  Let's make some plans! I'm sure there will be plenty of basketball games to attend, hopefully some more Goo Goo Dolls concerts, and fun adventures around the PNW.  Happy New Year, all!

To Clam, or Not to Clam

As the battle to annihilate the coronavirus continues, everyone is faced with new realities. For me, those realities include chatting with my teenage patients on the phone, transitioning to Telehealth, and only seeing "high priority" kids while covered head to toe in PPE. The patients are still the most important part (and my favorite), but the volume is dramatically reduced so the majority of my time has been spent learning. I've also been working on the Seattle Children's Sports Physical Therapy Journal Club, summarizing papers to share with the department on a monthly basis.  The May topic, coming out tomorrow, is a collective look at these four gluteal muscle electromyography (EMG) papers:

1. DiStefano LJ et al, “Gluteal muscle activation during common therapeutic exercises.”  JOSPT 2009.
2. Boren K et al, “Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises.” IJSPT 2011.
3. Macadam P et al, “An Examination of the gluteal muscle activity associated with dynamic hip abduction and hip external rotation exercise: A systematic review.” IJSPT 2015.
4. Bishop BN et al, “Electromyographic Analysis of Gluteus Maximus, Gluteus Medius, and Tensor Fascia Latae during therapeutic exercises with and without elastic resistance.” IJSPT 2018.  

Why this topic? I believe it is imperative for clinicians to be lifelong learners and that reading research is one approach to improve your skills as a clinician.  I also think it's really hard to do this, which is why I stared writing this blog - a place where I could store things I've learned and write out my thought processes.  The impetus behind this particular topic of learning boils down to two key points.

Key point number one: The Clamshell Debate.

If you've ever gone to outpatient orthopedic physical therapy, you've likely done the clamshell exercise.  It's very common and frequently patients will say they've done them in the past.  Thanks to Seattle Storm Sports Performance Coach Emily Blurton for her video demonstration:

Early in my PT career, I frequently recommended this exercise.  I had pre-made exercise programs that I used repeatedly for multiple conditions.  Now I make every program for the patient in front of me, often updating them at every session, and this exercise rarely appears. To me, the clamshell doesn't look like anything a person does in daily life or in sports. Maybe it looks like you're lifting your leg to get into a car.  But that's standing up, so maybe not.  Even worse, a lot of patients do them incorrectly and find them boring and too easy.  I don't create exceptionally difficult exercise programs, but it's a lot easier to convince someone to work on something that's challenging than on something that's simple and mundane.  And most of the time I don't really harp on having proper form - but with this exercise, is there any benefit to doing it wrong?  Biomechanically speaking, an "incorrect" squat will still give you some strength gains, but potentially not where you may want to target them.  I don't think shooting for the moon, missing, and landing amongst the stars is actually meaningful in this scenario. 

The circumstances under which I will recommend the clamshell are very specific: the patient needs to 1) have a restricted weight bearing status from the physician due to a surgery or fracture and is therefore unable to do the exercises I prefer but would still benefit from strengthening or 2) have a significant deficit in their active hip external rotation movement with available passive mobility that I want them to purposefully control. (Translation - they're too weak to do any of the other exercises I like better, but I never actually tell patients they're weak!)

I share many of my patients with coworkers who like this exercise, so we've had conversations about clamshells for years.  The biggest discussion came when I had a student who I practically forbade from assigning clams without excessive clinical reasoning of why they were a good choice for that patient. Now that I have some extra time to dig into the research, I'm looking to prove myself wrong.  Does the evidence oppose my clinical bias? And how do you explore the efficacy of an exercise?  

Point Number Two:  What research should I be reading?  

Levels of Evidence - Creative Commons CC BY-NC 3.0

In case you're not familiar with the Levels of Evidence for scientific materials, here's a very basic overview.  Certain types of research can be "trusted" more than others, particularly when you're trying to generalize data to a larger population than was actually studied.  Here's an example: Let's say that tonight at dinner, you ask your child if they likes peas.  If they say no, can you now conclude that this single case of your own observation applies to all the kids of the same age in the USA?  Of course not. But it is your expert opinion that your own kid does not like peas and you understand how that data applies in your household.  Now what if you took a survey of your kid and your two next-door neighbors houses who happen to have seven more kids, asking all of them if they like peas.  You have more information about kids in your neighborhood and their feelings about peas, but still shouldn't make wide-spread assumptions about the whole country based on your small sample.  This would be closer to a small case study moving up the pyramid. If you surveyed your neighbors and then three other researchers did a similar study in different cities, asking fifty kids in second grade and then the same kids again in sixth grade and maybe one researcher also asks about carrots, the number of data points continues to increase and your ability to generalize information across a bigger group improves.  Now you've moved up into more of a cohort study.  

This is a very simplistic demonstration, but sometimes simple demonstrates a major point.  Right now with the Coronavirus Pandemic, small studies are being smeared all over the media without sufficient data and with incorrect descriptions.  It's a good time to point out that you need to be cautious about how you interpret what you read.  Notice at the top of the pyramid sits "systematic review." A systematic review takes multiple research papers into account to accumulate more data points to try to make conclusions.  It is based on a researcher compiling data from other researcher's published works.  Each individual study may not have done the same research, but their data overlaps and new conclusions are drawn from having more data points. I DID NOT USE SCIENTIFIC RIGOR in my collection of resources for this blog post and I have minimal experience in data analysis, so I'm certain there are flaws in what I've found by summarizing these four papers.  However, I basically (unintentionally) created a mini systematic review by reading four different papers (including one which was also a systematic review!). 

I collect articles to read in the future. This collection was one reason behind starting a journal club! I've previously written about the anti-library where you collect resources to learn about the things you know you don't know here. Along with my anti-library, I also have folders of papers I've previously read. I had already read Dr. Lindsay DiStefano's Glute EMG paper (the first in the list) which was probably the nail in the coffin for clamshells for me. Imagine assuming that all kids don't like peas because one kid said they didn't?  I've basically assumed that clamshells are a poor quality exercise based on the findings of one paper that studied 21 participants doing 12 exercises.  Dr. DiStefano was my research advisor in PT School so I almost always read her publications, or have them saved for the future. (Bias Alert!)  So I need more data points! I searched for more recent Glute EMG papers to compare to hers and found three more, intentionally choosing papers that included the clam shell exercise and ultimately including one with a somewhat contrary view.  Now the data I'm considering reflects over 500 participants and many more exercises including multiple variations of the clamshell.

EMG studies are used to understand muscle activity during movement.  Not only are these papers valuable, but they can also influence patient care by helping to better understand what exercises target which muscles.  I've previously hinted at reading EMG studies with regard to the shoulder here, and for sure that knowledge changed my PT practice for post-op shoulder patients. EMG studies aren't perfect, but by looking at a collection of them, you can assume similar risk of error for each study.  Participants in these papers were first assessed for their maximal volitional isometric contraction (MVIC) (aka how strong they were for a specific muscle).  Then, by placing sticky electrode sensors on the skin at certain locations, measurements of muscle activity were taken with each exercises and compared to the maximal strength possible for that person. For an exercise to improve strength, the exercise must elicit at least 40-60 % of maximal strength (MVIC) for gains to occur.  

Here's what the papers found:
DiStefano et al: The top exercises for glute medius based on % MVIC were side-lying hip abduction (81%), single limb squat (64%), lateral band walk (61%) and for the glute maximus were single limb squat (59 %) and single limb deadlift (59%). Clamshell exercises (depending on hip flexion position) were shown to have glute medius activation of: 38-40% MVIC and glute maximus activation of 34-39% MVIC.  (Clamshells don't pass the 40% minimum cut point which has been my rationale to discontinue using them in the clinic). Other exercises were examined in the study, but since they did not cross the 40% MVIC threshold, they are omitted here.

The Boren study used a cut-point of 70% MVIC as the minimum acceptable for strengthening and examined a larger variety of exercises. Glute med exercises with >70% (MVIC) were the side plank with hip abduction (103.11% bottom leg, 88.82% top leg), single leg squat (82.86%), clamshell variation #4 hold top leg in full hip extension while internally rotating (76.88%), and prone plank with hip extension (75.13%).  For the gluteus maximus, plank with hip extension (106.22%), glute squeeze (80.72%), side plank with hip abduction top leg (72.87%), bottom leg (70.96%) single leg squat (70.31%).  This paper suggested that the best exercises to target both glute med and glute max were the prone plank with hip extension, side-planks with hip abduction, and single limb squats.

The clamshell exercise had four variations in the Boren paper. Of these variations, #4 described above was the only option to reach their defined threshold of >70%.  If you use the criteria of 40-60% outlined in the DiStefano paper, all the clamshell variations would meet that target as sufficient for strenghtening for the glute med, but only the standard clamshell works for the glute max at 53.10% with other variations all below 30% MVIC.

The Systematic Review by Macadam et al reviews multiple papers and breaks down exercises by body position.  The cross-over step up and lateral step up had the highest average glute max and glute med % MVIC.  Pelvic drop, sidestepping with hip internally rotated and band at the ankle, standing hip abduction variations, rotational single leg squat and transverse lunges all had glute med % MVIC over 40%.  Standing hip abduction, rotational single leg squats and transverse lunges also had % MVIC over 40% for glute max. 

In sidelying, side planks with hip abduction had the highest average glute max and glute med % MVIC. (That exercise is really hard, though, and wouldn't actually be appropriate for the majority of my patients.)  The paper examined 13 clamshell variations including the standard hip external rotation and others.  In one study, three clam variations (not the standard hip external rotation) had average glute med % MVIC over 60% but other studies had clamshell averages in the 30% range.  From this paper, I can start to ease up on my thoughts that patients do the clamshell incorrectly - and more that they're just creating their own variation.

And finally, Bishop et al compared glute med and glute max EMG to tensor fascia latae (TFL) EMG creating a "Glute to TFL Index."  The TFL and gluteus maximus both insert on to the iliotibial band and contribute to hip abduction.  The TFL is sometimes considered to be a contributor to low back and lower extremity pains and/or injuries and may increase in tone or "tightness" to compensate for gluteal deficits.  Bishops "Glute to TFL Index" findings were that the clamshell with resistance was 99.54 and the clamshell without resistance was 87.89 meaning that the gluteal muscles were selectively used for these exercises much more than the TFL.  The clamshell exercises far surpassed all the other tested exercises in this study with the next best exercise being the bridge with resistance at 48.86 and prone hip extension with 48.57, both about half of the clamshell values.  Thus, this paper recommends use of the clamshell exercise as a glute-targeting exercise that does not incorporate the TFL.  To these findings, I'll add another dose of bias. Does this really matter?  Does the Glute to TFL Index have clinical meaning?  I'm not sure because I don't know if I really want to "turn off" the TFL. I'll let the clams have this one. 

Free photo 5470017 © Pavel Losevsky - Dreamstime.com

In the end, I haven't been convinced.  A healthy dose of confirmation bias potentially sprinkled with some self-serving bias may contribute to that decision, but to me, the evidence seems clear. Maybe I'll be nicer to those who know that the clamshell has the higher glute to TFL index, but without that rationale, these papers suggest many other glute strengthening exercises.  For sure, I'm open to hearing alternative opinions. Are you team clamshell?  Or team ANYTHING ELSE!  I use prone glute squeezes more often than I use clamshells.  And I'm incredibly grateful for my coworkers who challenge me to think about these topics. 

(Again - this is an abbreviated summary of the results sections of the papers.  More information looking at the discussions and limitations and other aspects of the research is available if you'd like more!  For the full written summary for Seattle Children's Journal Club, go ahead and email abby.gordon@seattlechildrens.org and I can send it any time). 

New WNBA Injury Data Published!

Alert! Hot off the Presses! Physical Therapists working in Sports... Athletic Trainers... Strength and Conditioning Coaches... High School Basketball Coaches... Female Athlete Parents... Orthopedic Surgeons... WNBA Colleagues... Basketball Fans... Any one else who is interested in learning something today... Check this one out.

Presenting at Seattle Children's Sports Symposium

A new paper was published (April 16, 2020) in Arthroscopy, Sports Medicine, and Rehabilitation entitled "Injury in the WNBA from 2015-2019."  You can find the paper here. I jumped for joy to see this new release when it was in my inbox this morning.  Gotta love alerts that know what I'm interested in.  In case you don't know, women's basketball player injuries was the topic of my PT School Thesis paper, "College and Professional Women's Basketball Players' Lower Extremity Injuries: A Survey of Career Incidence" which you can read here.  In November 2019, I
had the opportunity to present on this topic to the Sports Medicine Department at Seattle Children's Hospital, updating my findings and making it more applicable to our department's work in pediatric sports medicine.  This topic is on my mind constantly, and since WNBA Physicals were supposed to be this week, now postponed until the coronavirus battle is under control, I'm thrilled to have basketball on my mind.  A new publication five years after my own with some similar findings from an entirely different approach was both gratifying and validating and this paper could not have come at a better time.

The new paper, written by Orthopedic Surgeons at the University of Chicago summarized injuries in the WNBA between 2015 and 2019 which were compiled from publicly accessible websites.  Interestingly, the findings were similar to my research with regard to ankle sprains being the most common injury and both papers explore ACL Injuries.  My study only looked at lower body injuries so it did not examine concussions, but this recent paper did and I've previously written about the WNBA Concussion Protocol here.

Here's why this paper is important, in my opinion.

PubMed is a search engine for research papers, kind of like Google, only your search will bring scientific information. A PubMed Search conducted today, April 20th, for "WNBA AND Basketball" will give you EIGHT results.  In comparison, A PubMed Search for "NBA AND Basketball" will give you 120.  This new paper doesn't appear in that search.  Neither does mine.  I'm not sure what you need to do for PubMed to determine you're worthy, but it's apparent that the topic isn't a common one found in this search engine.  PubMed is where I go first when I want to find research on a specific topic that impacts my patients. 

So how about a different search engine like Google Scholar.  There "WNBA and Basketball" has 5,120 (94 results since 2020), including this new paper and my own, and "NBA and Basketball has 55,000 (1140 since 2020).  Obviously I did not screen every title to see if they actually refer to basketball and the NBA which is why I wrote the search this way, but it's SO EASY to see the discrepancy.  In my opinion, a new publication looking at the WNBA is a HUGE win for the WNBA. 

The papers that are found on the Google Scholar search are on all sorts of topics.  There are publications about injuries, like the ones I'm talking about and, as a physical therapist, which I find most interesting.  But there are papers about basketball, about female athletes, about gender differences from various perspectives including pay and spectator attitudes, differences between draft selection and playing times, sexuality, fan experiences, race, television time, and the list goes on. 

The battle to improve opportunities for women in sports continues.  The battle for pay equity, though improved with the new WNBA Players Association negotiations for their collective bargaining agreement, continues.  The battle for sports media to increase awareness of women's competitions and to increase support of elite female athletes continues.  And this week, the battle for increased awareness of injury data - which ultimately can help contribute to injury prevention strategies, continues, but with a step forward.  I tip my hat to you, University of Chicago Orthopedics. 

Beauty. Strength. Poise. Confidence.

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

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

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

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

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

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

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

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

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

2018 WNBA Season Update - A Race to Stay Healthy!

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

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

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

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

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

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

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

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

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

February Challenge: Read 28 papers in 28 days!

I decided to participate in a challenge to read 28 journal articles during the 28 days of February.  This challenge was organized by: Jacob Manley and Michael Fitzpatrick (a PT and PT Student, among several other areas of expertise - the Movement Doc), Samuel Spinelli (a PT - The Strength Therapist), and Jason LePage (Prime Physio Fitness - a PT Student at Quinnipiac University in CT so he automatically gets my support!). 

(P.S. Please don't tell Dave Ramsey I'm going off track of my current plan to get through a boat load of research articles - this was time sensitive and felt like a great opportunity!)

The idea that these guys have - to read more of the literature to improve their practice and knowledge - is commendable.  Way to go fellas!  Their goal is "to improve our ability to read research, improve our evidence appraisal skills, and read research studies that we may not have read before." They post the articles open access and they also write up a summary on the article to start conversation and get feedback.

I won't be posting about all the articles they've selected to discuss this month - but I wanted to share about the challenge in case others might want to participate - it's definitely not too late to jump on board.  Also, the first article they included deserves some attention as it fits into the chronic pain theme that I've already started posting and learning about.  I may do others moving forward - but since I haven't seen those topics at the time I'm writing this - it's too soon to tell.  Also- I should note that I'm writing this post as I read the article with all my thoughts on it and will read their posted review of the article afterwards so it won't bias my process. 

This particular article (and the entire challenge), can be found by going to the Movement Doc site and joining their members only section, is entitled, "Indviduals' Explanations for their persistent or recurrent low back pain: a cross sectional survey." It is from 2017 by Jenny Setchell et al.

Introduction: The study begins with a description of the biomedical model versus the biopsychosocial model.  I've previously mentioned pain with consideration for the biopsychosocial model and the need to consider non-anatomical contributors to pain here, here, and here.  If you're new here - it's the idea that psychological components such as stress, anxiety, depression, and even the word choice used to describe pathology can impact our patients and their pain.  In consideration of this model, the article states, "how people think about their pain is an important predictor of severity and chronicity." 

Purpose: This paper examines patients with low back pain to determine what caused their pain and where their understanding of their condition came from.

Methods: The study used a survey marketed via social media and postings in local health centers to recruit participants with low back pain.  The majority lived in Australia - locale of the primary investigator - and about 75% were female.  My thoughts: Whenever I see that a study was marketed in this manner, I immediately consider the fact that this means that participants had to have the time and the means to participate as well as a way to come across the study in the first place.  It automatically rules out those who don't have a computer or health club membership from participation which might mean an influence of socioeconomic status of participants.  I consider this important because, based on the biopsychosocial model, a person with less financial means has been excluded, but this financial status could be a significant impactor to their pain experience. 

Analysis: The authors used "discourse analysis"  - a statistics term I had never heard before.  "Discourse analysis is based on the premise that the language we use has a role in creating or constituting reality, rather than simply reflecting it thus discourses are seen as having a real world effect."  It is a way to assess how people think.  This is the basis of the fear-avoidance behavior model- where, for example, if someone was told they herniated a disc in their back, they may avoid certain motions that they think are associated with that pathology.  The study responses were analyzed to determine four discourses which all the participants were then categorized into. My thoughts: statistics is super hard and I'm so thankful that there are people who specialize in studying this.  This concept, discourse analysis, is really interesting because in my mind, no two people will respond the same way to the same input information so to categorize responses into groups for better understanding seems sensible.

Study results: The four categories (discourses) to the question "What is your understanding of why your low back pain is persisting or recurring" were: 1) the body is a machine that has a defective part - this is the biomedical model and was most common, 2) Low back pain is permanent, 3) LBP is complex.  Those who were unsure of the cause of their pain were ultimately included in this grouping. This is the biopsychosocial model.  4) LBP is negative, should be avoided, and has a poor impact on life.  The second question was "Where does this understanding come from?" and 89% of the responses identified a health care provider as the supplier of these discourses as well as about 25% from the internet!!! My thoughts: WE'RE HARMING OUR PATIENTS!  We need to do a better job communicating with patients as healthcare providers.  Hippocratic Oath People!

Discussion: The authors summarize that most of the surveyed participants responded with biomedical responses as to the cause of their low back pain and that they learned this information from their healthcare providers and/or the internet.  There was an expression of hope as some responses to where the pain came from included both an anatomical/biomedical response as well as a biopsychosocial model type response

My assessment: I thought this article was very interesting and that it aligned with the recent articles I've read on chronic back pain and the biopsychosocial model.  It is clinically applicable and relevant as it is a strong reminder of the importance of the language that clinicians use with patients.  Following my write up of the above information, I read the review document from the challengers and was able to recognize a few differences in how I interpreted the information versus how they did.  First, in the introductory portion, I had picked up on the interests of the authors looking at the biopsychosocial model as contributing to the patient's outcomes, but I had not picked up on the idea that the authors include here that how the patients perceive their pain and what they think their outcomes will be, are also contributors here.  For example, if a person thinks their back pain will never get better, this can impact their outcome.  Overall, the study limitations the group found were all similar to my understanding, which was pleasing to me, and this experience of literature appraisal with someone else to compare to was overwhelmingly beneficial.  I'm looking forward to the rest of the articles this month - and you should feel free to join in or check out the articles - or even the reviews being posted - because it's a fast way for you to get a lot of information!

Article referenced:
Setchell J, Costa N, Ferreira M, Makovey J, Nielsen M, Hodges PW. Individuals’ explanations for their persistent or recurrent low back pain: a cross-sectional survey. BMC Musculoskeletal Disorders. 2017;18(1). doi:10.1186/s12891-017-1831-7..

About Me - Professional Abby

I guess I just jumped into trying to be a blogger without actually introducing myself sufficiently.  My apologies.

Hey there.  I'm Abby Gordon - a Physical Therapist living in the Seattle area for the past 3 years.  Job-wise, I'm currently working at Seattle Children's Hospital in their outpatient sports medicine Mill Creek (soon to be Everett, WA/North) clinic.  On the side, I consult with the Seattle Storm and recently have added on consultation for the Spectrum Dance Theater.

How did I get here? The personal basics: My undergraduate education was a BS in Exercise Science from the University of Connecticut in 2007.  While in college, I was also a manager for the University of Connecticut Women's Basketball Team for four seasons along with a season each of Women's Soccer and Softball.  After graduating, I worked for the Connecticut Sun Women's National Basketball Association team as their Travel Coordinator and Equipment Manager for four seasons before returning to UConn for my DPT in Physical Therapy which I completed in 2014.

While in graduate school I wrote a research project focusing on women's basketball lower extremity injuries.  My paper, if you're so inclined, was published in 2014, and you can feel free to be the only person, maybe ever, to read it: here.  The research process was incredibly beneficial in helping me grow as a physical therapist.  I have much more appreciation when I read scholarly writing now, because I know that it took several years for those papers to get to publication - along with blood, sweat, and tears of a group of investigators.  I have, on several occasions, considered further participation in research - but then feel like there's so much information to read - I should start there and get to the research at a later point in time.  This blog is a way for me to keep some of the research I'm reading organized and share key ideas that may help others.

So there's the basics of how I came to be AIG DPT... You'll see the basketball theme permeating the physical therapy career.  Basketball, somehow, is my favorite thing of all things.

Happy Thanksgiving everyone!

Abby