Monthly Archives: September 2013

The Top 11 Mistakes Physical Therapists Make

So this is a blog I wrote last year that got a lot of play- I’ve updated it a little and wanted to re-post it. Enjoy and please let me know if you do not agree!!!

I will probably ruffle some feathers with this blog- but that is my exact intent… You may agree with some and you may disagree with some. Please feel free to open up a discussion with me, that’s the point.

I have been cruising around the web reading blogs, articles, websites, face book pages and everything else possible and I have noticed one common trend. I am seeing the Fitness world really pushing hard to “better themselves” and learn from each other. By learning from each others mistakes (and our own) we will only become better at what we do. I came up with the idea to list what I think the 11 most common mistakes Physical Therapist’s make on a daily basis and how to resolve them. Here we go from 11 to 1!

But FIRST- Let me say that I have made EVERY one of these mistakes, but it’s learning from them that makes us better.

11. Inconsistent Re-Evaluations…Re-evaluations every 30 days or 10-12 visits is essential to developing proper Physical Therapy routines for patients. If we are doing a good job, the patient should be progressing consistently and we need to see where their “new baselines are. In all actuality, we should be reassessing every visit the person comes in for. Everything manual technique, every movement should be used as a way to evaluate and determine progress.

10. No reasoning for developing certain exercises in a patients program…When I have students I tell them one simple thing: I do not care what exactly you do with your patient (to a certain extent) but have a REASON for what you are doing. Physical Therapy is NOT cookbook so create a program for the patient sitting in front of you! There is no such thing as a bad exercise but there DEFINTELY is a wrong exercise for the wrong person! Regress to Progress…

9. Have the blinders on to other professions…I believe in chiropractic care, I believe in acupuncture, I believe in strength and conditioning, I believe in anything that works. PT’s have a tendency sometimes to only believe in what they do. If you do not have a Strength and Conditioning background, don’t pretend to be a strength coach. Working together with other professions will only make you better as a practitioner and it will only help your patients get better faster and more effectively!

8. PT’s tend to call themselves “Mulligan” Therapists, “Mckenzie” Therapists, “Maitland”, etc… Using tools and not the Tool box…This bothers me a a lot. Be your OWN therapist. Yes we must learn from others but there are pros and cons to each tool we use. A GREAT therapist knows how to use the tools to work with each specific patient. A GREAT therapist also never stops learning and never stops putting another tool into their box.

7. Utilization of Modalities for time killers or because it can be billed for…Do I even need to explain this one. If you know me; you know I hate utilizing modalities such as E-Stim and Ultrasound. If I need to explain this one to you then you probably fall into a lot of these categories I’m discussing. There is a time and place for Electrical Stim but US; I’ll battle anyone on this. Steel cage death match anyone?

6. A lack of understanding on how to market and build relationships…
This baffles me? PT’s build relationships with patients everyday but for some reason have a hard time talking to physicians or other health care providers. Have confidence in your knowledge and your skills. Chances are they will respect you more if you have confidence and can be clear and concise.

5. Not having the “cojones” to either question a possible improper diagnosis or make their own diagnosis…If you think something wasn’t diagnosed wrong- make sure you approach the appropriate person. Be ready to back your belief with solid data, but if you feel strongly, do not hold back. But make sure you are respectful. PT’s (in most states) are allowed direct access and that means we are an entry point into the healthcare system. Making a proper diagnosis from the start, needless to say, is fairly important. Now the fun part begins- you have made the diagnosis, but now you get to figure out WHY!

4. Are just content with being “good” and not “great”… Do something great, be something great and don’t settle for just good. Constantly learn, absorb, be mentored, mentor and teach others. This will set you apart from the pack. If you want to “just be good”, you will never get ahead and you are not doing right by your patients. Strive to be the best and nothing less.

3. Not listening to the Patient sitting right in front of you…The history is the single most important part of patient care. Take a proper history, listen to patient and you will gather more information than you could ever imagine. The history will lead your evaluation and will set you up for success. Patients also crave this. So give them what they want!

2. Not educating patients on the “why”…This really can be 1B. Just giving someone an exercise is not good enough… Just doing a mobilization is not good enough… Just doing post-op rehab is not good enough… You need to give the why component to the patient. Explaining why someone is not allowed to do X after a Cuff Repair or why open chain knee extension is the Single. Worst. Exercise. Ever. Just telling someone is not enough; you must educate them on the why. If you do this simple task, they will trust you more, listen to you more and get better faster. Isn’t that what we want?

And #1…. Drum Roll please……….

1. Go straight to the site of pain…
To take a phrase from a friend and colleague, Perry Nickelston: “Stop Chasing Pain”!…
Man has he this nailed on the head. Simply speaking just because someone has knee pain, doesn’t mean the problem is coming from the knee. By understanding human movement and how the body functions you can pick out and find the Non-Painful Movement Dysfunction that’s causing the Painful Dysfunction. It’s as simple as that. Systematically assess human movement and assess the patient- I promise you will find things that will blow you away and will blow your patient away. In other words: Treat the Problem and not the symptoms. You also must be able to explain to the patient why a sprained ankle 3 months ago is the reason for their neck pain. You have to get it first before the patient gets it. If you can answer this question, then you are on the right path. ”Why would a rigid great toe with decreased extension on the lead leg of a pitcher lead to medial elbow pain in the throwing arm?”

Chapter #1 of the Education System Series- Guest Blog: Kyle Balzer on “The New Grad Experience”

I think you all might enjoy this blog from a good friend of mine and colleague- Kyle Balzer. Kyle is a recent new grad and has a pretty cool perspective on things. Consider this the first chapter of a series of blogs that are based around the educational system. Kyle’s story is a good one and a positive one that I hope you all enjoy. Thank you Kyle for putting this together!

As a recent graduate of a Doctorate of Physical Therapy program, my life has been flipped upside down and I have experienced over the past few months not only what many have already experienced, but also what many so anxiously and nervously await.
When Rick Daigle, PT, DPT and co-owner of Medical Minds in Motion asked me to write an article on my experiences as a new graduate I was honored, but at the same time thought, “Now, what the heck could I have to say/write that people want to hear?” So here is my best attempt while not putting y’all (Rick lives in Texas now, so he’ll appreciate that) to sleep…
I’ll start with my final semester of school…
My wife had recently taken a position at the Morgan Stanley Children’s Hospital in New York City, so I had the luxury/challenge of looking for a job in the NYC/NJ (I hate to put a slash between those two because they are by no means similar) area. All the while, I was getting sick of school, getting sick of my Capstone project, and studying to take the NPTE in April, a week before graduation. Yes, you can take it early, and anyone who tells you otherwise is a liar. I signed up through Ohio, took it in Albany, then had scores transferred when I found out which state I would be working in. I passed, finished my Capstone, and graduated…and had my one year anniversary all in a matter of a few days.
I wondered though, how I would go about finding a job in the NYC/NJ area. Because I was taking the NPTE early, I started looking for a job earlier than most of the other students in my class. I had made many connections over the previous year or two on Facebook, as well as going to the 7 or 8 courses I had attended. Also, working with Laree Draper of On Target Publications and Movement Lectures has been one of the most helpful and exciting things I’ve been a part of (Laree, if you read this, I apologize for all of the dangling prepositions).
Due to the fact that I had already done so much learning and networking on my own, I had a very distinct vision as to how I wanted to practice physical therapy. I had interned in two outpatient clinics and a primarily school-based pediatric clinic, each of which I took positive and negative experiences from. I interviewed with three different places, all of which went well, but the one I ended up going with I chose for the following reasons:
1. I found out about it by searching through a couple hundred names listed on the FMS website when the map was honed in on the NYC/NJ area.
2. Some of the clinicians utilize the FMS/SFMA and I was welcome to do the same having already taken each introductory course.
3. The owner clearly valued learning and continuing education.
4. Patients were scheduled every half an hour with initial evaluations/assessments getting a full hour. (Eventually, I look to completely work for myself working in an environment where every visit is one hour long, but this is an ideal starting position)
5. “This is our Ultrasound machine…which probably hasn’t been touched in 5 years.”
6. The day I “interviewed” with the owner, (Sunday night I emailed him saying I was an interested student looking for a job, he emailed me back and told me to come in the next day at lunchtime to talk. This was one of the biggest selling points. He did not set up a “formal interview,” whatever that is, and just wanted me to come in to see the place and share views.) He recommended it because the current student was doing an in-service on Charlie Weingroff’s Training=Rehab DVD set and he had seen on my resume that I went to one of his courses and helped edit his paper for Nike. I was welcomed by everyone and was even looked to for confirmation of some of the content the student was presenting.
7. There was a major emphasis on manual therapy and really felt like I could be the therapist I wanted to be, right out of the gate.
…the list could go on forever, baby. (If you get that reference, you’ve spent your time wisely.)

So, I’ve now been working 30 hours per week for three months, lived in NYC after living in Upstate NY for 24 of my 25 years alive, and for the first time, have been able to help support my wife after she supported my way through graduate school; something I will forever be thankful for.
What have I experienced while working?
I have seen success, I have seen failure.
I have made mistakes and asked for help.
I have made friends with a patient’s 6 year old son who enjoys games, numbers, and talking sports.
I have co-treated if my patient or I feel stuck in a rut.
I have thought about how I talk to patients about their pain and movement based on my own experiences and observing other clinicians.
I have learned to hate “paperwork” (it’s really “digitalwork” at this point), but at the same time become more efficient with it.
I ALWAYS try to make people feel relaxed, smile, and laugh.
I have thought about patients long after I have left work and should be home “relaxing.”
I have referred to other professionals.
I have shown up early to accommodate a patient’s schedule.
I have intelligently debated on many occasions with the other clinicians in my clinic and look forward to the next debate.
I have learned Dry Needling from James Dunning and A Holistic Approach to Training from Patrick Ward.

And now that I’ve experienced all those things, I look forward to experiencing more. I look forward to learning as much as I can, which ultimately leads me to learn even more, because courses and books usually just make me realize how much more I need to learn. I look forward to co-treating more patients. I look forward to spending time with other professionals that have been generous enough to share their time with me. I look forward to working in a gym setting where I can see one client for an hour at a time with the comfort of knowing that I’ve been able to make significant changes (p < 0.005; that’s a research joke) in 20-30 minutes. I look forward to spending thousands of dollars on courses that will support my philosophy as much they will challenge it. But most of all, I look forward to not knowing what tomorrow will bring, but doing everything I can to prepare myself for it.