In our latest video, Dr. Thomason demonstrates how different the size of vertebrae are on an actual patient when compared to the typical plastic models we see in the clinic. Our subject for this demonstration is a younger male that is about 5’6″ in height.
As part of this video, a lumbar vertebra and thoracic vertebra are shown. Also, methods to confirm which transverse and spinous processes correspond to one another are demonstrated. All of this is to illustrate how to confirm where you are palpating when assessing position/motion, or setting up for a treatment technique.
Welcome back to our interview series! For this one, we speak with Bill O’Grady, a veteran (in more ways than one) within the world of physical therapy and manual therapy.
Bill earned his Bachelor of Science in physical therapy from California State University, Long Beach during 1972; his master’s from the University of Southern California during 1977; and his doctorate at the University of St. Augustine for Health Sciences in Florida during 2001. He completed three-year fellowship in manual therapy with the North American Institute of Orthopaedic Manual Therapy during 1995.
Bill has served on the board of directors of the orthopedic section for the American Physical Therapy Association, chaired the orthopedic specialty council and was an original item writer for the specialty exam. He was chairman of the board of examiners for the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT).
Dr. O’Grady has received many honors for his contributions to the profession including the John McMennell Service Award from AAOMPT, the Paris Distinguished Service Award from the Orthopedic Section, the Lucy Blair Service award, and the Catherine Worthingham Fellow of the American Physical Therapy Association. Dr. O’Grady retired from the U.S. Army in 2002 as a full colonel after 38 years of service. He was the first “Life Fellow” of the AAOMPT, and is a diplomat of the American Academy of Pain Management.
Currently, Bill teaches as adjunct faculty with the University of Nevada – Las Vegas (UNLV) DPT program. In recent years, he also teaches occasionally with Professor Laurie Hartman DO, PhD.
As you can read, Bill is well versed within the world of manual therapy and has much wisdom to share. Take a listen to our interview with him and comment below!
The weekend of June 9 – 11, I had the pleasure of teaching a continuing education course in Chico, CA to a talented group of physical therapists. The course is called “Foundations of Manual Therapy: Clinical Reasoning for Direct Access” and is offered through Crunkeyser (Comprehensive Manual Therapy Seminars). To add to this honor, six Japanese physical therapists flew all the way to California just to take this course! Talk about pressure! In the end, we all had a lot of fun and really enjoyed our time together. Below are some pictures from a dinner out and our last day together. Hope to see everyone again at another course!
In our latest video, Dr. Thomason explains biomechanics of the hip joint for sagittal plane motions (i.e. a pure spin). Then he demonstrates a highly effective mobilization to regain loss of hip extension using this biomechanical knowledge. Watch and add your comments below to tell us what you think!
Have you ever taken a continuing education course and wondered… now what? Learning different or new assessment/treatment techniques and seeing the benefits of them during a weekend course can be simply life-changing to some. But let’s face it, your partner over the weekend isn’t normally like the patients you are going to be seeing on Monday when you return back to work. So, for some of us, doubt starts creeping into our minds of “can I really do this with the type of patients I see?”
The answer is of course, YES! Some of the instructors I get to teach with always end the course with suggestions of how to retain the titanic amount of information that was taught over the weekend, and how to continue practicing and refining your skills with new concepts that were learned. The following are suggestions that have been helpful for many over the years.
First, when it comes to assessment techniques (i.e. PIVMs, position/motion assessment, joint glides, functional tests, neural tension, etc.) choose something… anything. Dedicate just a few minutes of your appointment time with EVERY patient for the next day or two and perform that assessment on all of them. You don’t have to treat anything, just see what you find. That way, you get a ‘forced practice’ time on many different people in a short amount of time. After that day or two, pick another technique and do the same thing. Write down your findings somewhere for each patient. If you repeat this habit pattern, pretty soon, you will have gone through the entire weekend course material and have re-practiced it all! In case you are wondering whether a patient will say anything as to why you are assessing a part of their body that seemingly has nothing to do with the reason they have been attending your treatment… explain how important the ‘kinetic chain’ concept is for their diagnosis (which is not a lie and is in all likelihood a true statement), and you want to see how it could be effecting their dysfunctions.
Second, during your coursework, if you were also taught how to use different forms of mobilization (or even manipulation), educate your patient as to what you found in your brief assessment. If it is appropriate, and they agree, perform the technique to correct the dysfunction you previously identified. You already explained to them how important this is in helping improve their function, so hopefully they will be on board. After treating a dysfunction, see how many different things it effected for that patient. For example, see how treating their ankle effects their gait, how treating their pelvis can change their shoulder range of motion, or how treating their coccyx can change their neck range of motion (yes, this can happen). Again, over days and weeks, you will have practiced virtually everything you learned during your continuing education course.
Third, one thing that really helps advanced clinicians is pattern recognition. The ability to recognize common patient presentations and relate them to past experiences can really speed up your clinical decision making. Create (and write out) typical patterns of presentation, whether you have seen these patients or not. If you haven’t seen a particular diagnosis, look up in textbooks or online resources those typical patterns. That way you can develop a bank of clinical scenarios that you can play mental gymnastics with (or perhaps ‘clinical calisthenics’ would be a more appropriate term?) [Pettman]. As you review these cases and their usual presentations, pattern recognition will be much easier for you in the clinic (again… even if you have not actually seen the condition yourself).
Fourth, think back on previous patients you have had (i.e. reflection). Do more ‘clinical calisthenics’ with those patients and what you may have done differently with them, with your new knowledge. It’s always a good idea to look back on your successes (and failures) in the clinic to see what your clinical reasoning was, why you made the decisions you did, was your technique performed correctly… and what could you have done differently that may have given your patient a better outcome.
Lastly, if the clinic you work at has inservices, present some of the material you learned at an inservice. If you don’t have inservices, take charge and start organizing some! Choose topics that you are more comfortable with presenting and do that once every week, or every other week. That way, you are able to practice, but you also will have to review it enough to present the topic to your colleagues. Again, over time you will have reviewed the whole weekend course. And, it really makes you learn and practice your topic. Because, in order to teach something effectively, you have to be somewhat skillful at it!
In summary: yes, you can incoporate new material you learned over a continuing education course into your every day practice; yes, it will take time to get comfortable with it (and good at it); and yes, you will actually have to practice these things to get good at them. Think of it this way, if you are willing to spend your time and money (whether you pay for it, or your employer does) away from home for a few days to learn something new/different… I hope you would devote further time in or outside the clinic to develop the skills that were taught to you. Otherwise, why go in the first place?