Continuing Education Bits for PTs & PTAs

Archive for May, 2013

How would you help this runner?

Introduction by Marilyn Pink: from time to time EDUCATA has the privilege of hosting guest bloggers on this platform. This series is written and moderated by Susan Banberger, a PT since 1999. Susan is a Diplomate in Mechanical Diagnosis and Therapy and works at Advance Sports and Spine Therapy in Wilsonville, OR. She has contributed to several publications, including the International Journal for Mechanical Diagnosis and Therapy. 

The case study examines the experience of a runner who has recently dared long distances and comes to the PT with severe hip pain.Please feel free to participate and comment at the end of the article, as much is learned by all in the process of exchanging ideas.

A runner with hip pain – getting him back in the race

By guest blogger Susan Bamberger

When a runner comes to physical therapy with debilitating hip pain, there are a multitude of treatment options. The accessibility of information from the internet leaves patients confused as to which shoes they should wear, if they should wear shoes at all, if they should stretch, and if so, should they stretch before or after their run, or both? They come to us to help sort out this information and to determine what is best suited for them.

Physical Therapists have the responsibility to create an effective plan for each patient in a reasonable amount of time. Not every treatment works for every patient. Anyone can research stretches, strengthening and shoes on the internet. Our challenge is in proving that we hold unique knowledge and skills to deal with individual problems in this information age. This case study is an example of how skilled physical therapy provided excellent results and gave this runner the knowledge and treatment he needed to return to running, pain free.

physical therapy runner with hip pain

The patient is a 38 year old male plant manager and new long distance runner presenting with complaints of left anterolateral hip and thigh pain. He was referred to physical therapy from his orthopedist, who diagnosed him with greater trochanteric bursitis.

His onset of symptoms was 6 weeks prior to the initial evaluation, after running a marathon (26.2 miles). By the end of the race, he was in intense, constant pain, rated at a 5/10 that remained constant for 3 days after. His symptoms became intermittent, and have not changed much since that time. His plan was to run 4 marathons in the next year, but he has stopped running completely, as every time he runs the pain comes back to the same intensity it was immediately after the race.

Since becoming symptomatic he has tried many stretches and strengthening exercises he researched on the internet. He has also received advice from his massage therapist. However, the same pain comes back when he runs. He has good shoes, and changes them every 250-300 miles, per industry recommendations. Because of all of his research, he is concerned that this is an issue that is going to keep him from running altogether.

When asked if the patient had any imaging, he replied “only an xray”. Then he said, “Why, do you think I need an MRI?” Sensing fear of life-altering structural damage, the patient was assured that one of the goals of physical therapy is to determine the right place for them. With a careful assessment over 2-3 visits, we should know if further testing is necessary.

Given the history, which structures are you going to examine?

How can we establish functional baselines and how vigorous can we be in our examination?

What examination tests would you use, and why would you use them?

We look forward to your comments!

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With our appreciation…

McKenzie obit

Robin McKenzie, world renowned physiotherapist, died peacefully on 13 May 2013 after a courageous battle with cancer.

Known and acknowledged around the world, he was the creator of the McKenzie Method of Mechanical Diagnosis and Therapy (MDT), a therapeutic approach now widely viewed as part of normal management for low back pain. His vision was that all patients with musculo-skeletal pain be taught how to manage their own pain. The two books he wrote specifically for patients: Treat Your Own Back and Treat Your Own Neck have sold over 6 million copies and are available in 17 languages.

photo3Robin McKenzie demonstrating MDT techniques

McKenzie treatment 2

His work will live on in the world of physical therapy, forwarded by the educational infrastructure of The McKenzie Institute International, which he created in 1982 and which has educated physiotherapists, doctors, chiropractors and other allied health professionals in 37 different countries.

Robin McKenzie led a rich professional life, that included:

  • Honorary Life Member of the American Physical Therapy Association “in recognition of distinguished and meritorious service to the art and science of physical therapy and to the welfare of mankind.”
  • Member of the International Society for the study of the Lumbar Spine
  • Fellow of the American Back Society, an Honorary Fellow of the New Zealand Society of Physiotherapists
  • Honorary Life member of the New Zealand Manipulative Therapists Association and an Honorary Fellow of the Chartered Society of Physiotherapists in the United Kingdom
  • Officer of the Most Excellent Order of the British Empire (1990)
  • Honorary Doctorate from the Russian Academy of Medical Science (1993)
  • New Year’s Honour’s List — in 2000 Her Majesty the Queen appointed Robin McKenzie as a Companion of the New Zealand Order of Merit

We will remember him for his accomplishments but above all for the deep caring for the well-being of all his patients. Thank you, Robin McKenzie, for your legacy to our profession.

For a complete biography, click here

To see a photo gallery of Dr. McKenzie, click here

In celebration of my friend and mentor, Dr. Jacquelin Perry

March brought several notable events to the Physical Therapy world. On Monday, March 11, my friend and mentor Dr. Jacquelin Perry passed away in her home at age 94.

Dr. Perry 001 tweaked-4

Dr. Perry had been diagnosed with Parkinson’s disease for quite some time, but that didn’t stop her. She kept traveling, wrote the second edition of her gait book with Judith Blumfield Ph.D., P.T, did some speaking engagements and continued to solve problems. So, herein I’d like to share a few of the life rules I learned from Dr. Perry:

Dr. Perry Rule #1 – Only bring issues forward that you truly want to solve, understand and improve

If you don’t want your personal or professional problem solved (i.e. if you just need to grovel in it for a bit) don’t bring it to Dr. Perry. She was a problem solver extraordinaire. The world was logical to Dr. Perry and she was always ready to figure it out.

One time I made the mistake of asking her for her opinion on a personal/professional issue. I rummaged around with it for a while. Finally she said “Marilyn, you just don’t WANT to solve it!” Then she got up and left my office!

Dr. Perry Rule #2 – There is no reason to ever stop

Dr. Perry flew around the world in her last years – there was no reason for her to stop. Many of you probably heard/saw her in those years. She didn’t miss many conferences that I know about!

As a minuscule example I’ll offer a memory of a dinner party: we were talking about an 8-year-old friend of mine who liked lizards – and lizards were cold blooded. I asked what was ‘cold blooded’. Without saying anything, she got up from the table with her walker, went to the library, brought back a physiology book and proceed to look it up and figure out what cold blooded meant.

Dr. Perry Rule #3 – The only roadblocks are those that you choose to see

I’d asked Dr. Perry once about what it was like when she graduated from UCSF in 1955 (which, I believe, is ten years BEFORE Rose Bird graduated from UC Berkley School of Law (Rose Bird was a former Chief Justice of California and the first female justice). I’d read a piece on how Ms. Bird, in her early years as an attorney, had to pretend she had a clerical rather than a legal mind. I asked Dr. Perry if she had similar experiences. She responded with “Oh no, not at all. I didn’t see any roadblocks, thus there weren’t any.”

Dr. Perry Rule #4 – Know the background, the science — and don’t fall asleep on the job

Dr. Perry was VERY approachable. You just had to know your stuff – know the literature from all sides and stand tall when you made your pitch.

Dr. Perry Rule #5 – Doing the hard work is only ½ of it. Clearly communicating the outcome is the other half.

Boy, did I learn a lot from Dr. Perry about being critical and concise with my communications! For some examples, please see the videos regarding how Scaption and Push-up+ came to be. She also coined VMO. We’d even talked about how the subscap should really be called 2 different muscles: the function and the innervations of the upper and lower subscap are different, so they should be communicated differently.

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I’m sure you can add to some of Dr. Perry’s rules to live by — and I would like to see your input on those rules. But, before I close, I want to address a couple of other characteristics of my friend:

Dr. Perry was the only child of a seamstress. She grew up in a one room apartment in downtown Los Angeles. She MADE her way – it wasn’t handed to her. And she never begrudged that. She was humble and believed in charity. She gave much to others with lesser abilities. As a matter of fact, EDUCATA and some of our partners,The Australian Physiotherapy Association, McKenzie, etc, are donating to one of Dr. Perry’s charities in her name.

Dr. Perry loved the outdoors. We’d go kayaking (and forget to take her Parkinson’s medicine with us, thus making it impossible to get out of the kayak at the end! Boy we had a lot of laughs about that one!). She loved analyzing movement — going to see Cirque de Soleil with her was a real experience.

Perhaps one of the things she loved best was bringing friends together. She did that superbly. Without Dr. Perry, I wouldn’t know her friends Jo or Judy or many others that I grew to respect and care about.

Thank you Dr. Perry for your gifts of intellect, friendship, acceptance, humility and encouragement!

Marilyn Pink, PT, Ph.D.

DID YOU HAVE THE CHANCE TO MEET OR INTERACT WITH DR. PERRY? I’d love to hear your experiences!

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