Tag Archives: Rehab

Meet Brent Brookbush and Why Functional Anatomy Is Important

I’d love to take this opportunity to introduce the MMIM Community to Brent Brookbush, PT, DPT, MS, PES, CES, CSCS, ACSM H/FS.  Brent is a breath of fresh air in our industry and even though he is a new grad to the PT world, he brings a ton of knowledge into rehab from his strength/conditioning background.  Brent has a unique skill set of taking daunting Human Anatomy and making it simple, and most importantly, functional.  Enjoy this 1st of many guest blogs from Brent where he introduces himself and lays the framework of why Functional Anatomy is important and critical.  As usual, for more Info on MMIM visit Medical Minds In Motion, LLC

-Rick

“The Brookbush Institute of Human Movement Science was created to enhance the delivery of evidence-based, practical education in human movement science. Most of our content is concerned with exercise and technique selection, routine design, assessment, etc. – the very application of the science in our field. With that being said, the fastest growing section of our online education platform is the portion dedicated to “Functional Anatomy” (Introduction to Functional Anatomy & Integrated Muscular Anatomy). Despite the fact that I’m as drawn as you are to new and innovative techniques, I have come to realize that understanding when to apply those techniques, understanding the intent of those techniques, and comprehension of the concepts with which those techniques were developed, is dependent upon on a strong knowledge of anatomy. Just as anyone can swing around a scalpel, it takes a surgeon’s knowledge of anatomy to use that scalpel in a manner that is effective. It could be said that a repertoire of effective techniques and assessments lies just beyond a conceptual doorway, and that functional anatomy is the key to that door.

Why “Functional” anatomy over traditional “Anatomy & Physiology”: Functional Anatomy implies a bias toward the subcategories of anatomy that specifically apply to human motion. It’s one thing to know that the trapezius originates from the external occipital protuberance to T12 and inserts on the spine of the scapula, acromion and clavicle, but it is another to know that the upper and lower trapezius work synergistically with the serratus anterior to upwardly rotate the scapula and ensure optimal acromioclavicular joint arthrokinematics. Further, all 3 of these muscles have a propensity toward under-activity in those individuals who exhibit upper body dysfunction, and due to this propensity may be the target of activation, integration, neuromuscular re-education and taping techniques. Further, these muscles have an effect on other joints, nerves and fascial structures – knowing how these structures are affected by dysfunction that may have originated with a change in the length and behavior of the trapezius, may provide us with a list of additional techniques that improve carry-over, or may simply be necessary for the more “stubborn” patient complaint. And that’s just one long-winded example…

If I may say with the utmost humility and respect for what we do, most of the concepts we build our interventions upon are fairly simple. Reciprocal inhibition, synergistic dominance, movement impairment, altered activity, adaptive length change, relative flexibility, compensation patterns, recruitment, release, stretching, mobilization, activation, integration, neuromuscular re-education, taping, IASTM, dry-needling, etc… can all be explained in a paragraph or less and often can be summarized in a sentence or less. But again, the concepts are just the doors to learning a repertoire of effective techniques and assessments, and our knowledge of functional anatomy is the key.

Where does that leave us? Dedicating time to increasing our knowledge of functional anatomy should likely consume the same amount of time that we dedicate to reading and understanding research in the pursuit of evidence-based practice. In essence, research refines our practice of techniques, built upon a foundation of functional anatomy knowledge. As an educator, I am excited about the opportunities a partnership with MMIM will provide. I can continue to build upon our library of foundational material, providing Rick Daigle and his faculty with a resource they can refer workshops participants too – leaving more time for practical education and lab in live workshops. I also look forward to gaining insight from the ingenuity of his staff, as they provide the Brookbush Institute with more great techniques for our library of practical content.”

Sincerely,
Brent Brookbush, President and Founder
DPT, PT, MS, PES, CES, CSCS, ACSM H/FS

Brookbush Institute of Human Movement Science

BrentBrookbush.com

Brent@BrookbushInsitute.com

Why Developing a Niche is Critical to Private Practice Success

Medical doctors specialize all the time…  Orthopedic surgeons specialize is specific joints/body parts… Attorneys specialize… Real Estate agents specialize… Chefs specialize…

So why can’t Physical Therapists specialize?  Before I go any further, I want to clarify that while I will be discussing Niche practice and specialization, I fully understand and agree that you have to keep your doors open for business and taking a wide variety of patients is critical to that success.

I will outline here how I think developing a Niche practice will make your practice more successful.

In this day in age, there are almost as many PT clinics out there as Starbucks or Fast food joints.  How does a patient know the difference from one to the other? How does a patient know if Clinic A is better at something than Clinic B?  How does a patient truly know what place is right for them.  Personally I think these questions are difficult to answer, but with a few steps you can market your practice in a way that will give patients insight on what you are the best at what you do and why they should comes see you instead of Joe Therapist, DPT down the street.

There are many ways to do this, but one of the most successful ways is to develop a Niche program.  In other words, a specialty that sets you apart from the rest.  By developing a Niche specialty you will have the following opportunities:

1- Get patients in the door that might not have in the first place.

2- Once you have those patients in the door, they become a referral source for you.  They can refer others that are searching for what you are offering and they also become a referral source for any patient that might need Physical Therapy in general.

3- Direct Access.  Simply speaking, you get patients in the door before they enter into the system and before they have seen any other practitioner.  This way you can help expedite the process by either treating them or referring them to the right professional.

4- Strengthen your already developed MD relationships.  Now you have Direct Access patients who might need a PCP, or maybe you need to refer to an Orthopod for further testing.  This is a way to get patients to someone you trust and make sure they get excellent care.  This also will show your referral source that you trust them as well and value their opinion.  HUGE.

5- Strengthen your other referral networks.  Maybe the patient would benefit from seeing a Chiropractor, a Massage Therapist or maybe they need a Personal Trainer.  Now you can refer there patients to the appropriate professional, again that you trust and know will do a great job.

6- Your patients will thank you.  They will thank you for caring, they will thank you for helping them and they will thank you for taking them seriously.  They will also thank you for not wasting their time and helping them get to the bottom of their issues sooner rather than later.

I take this philosophy as very much the philosophy of “Good to Great”, By Jim Collins.  Don’t try to just be good at a lot of things, rather be great at one thing and then build it from there. Show the market place why you are the best at something and the rest will follow.

I hope this helps someone people think about some new marketing strategies and some new methods of how to get patients in the door.  The old school model was to visit MD after MD after MD and hope that you were able to convert a few patients from those cold calls.  The new school version is thinking outside the box and thinking like a professional.  Show value in your skill set and show how you can bring value to your referral sources.  In other words, work as a team.

-Rick

Rick Daigle, PT, DPT

Mobility vs. Stability: A guest blog from Mitch Hauschildt

I’d like to introduce you all to Mitch Hauschildt, MA, ATC, CSC. Mitch is a great friend but also one of the best clinicians I have ever met. Hands down. Mitch is the Rehab Coordinator for Missouri State University and is the Founder of Maximum Training Solutions. You can reach him at mitch@maximumtrainingsolutions.com. Here is Mitch’s take on Mobility vs. Stability!

Mobility.

Stability.

Both are needed for proper movement and function. Without both, authentic movement will never be achieved and injury risk will rise as a result.

Let’s break it down a little bit further…

Mobility has been defined as “the ability to produce a desired motion” (via Bill Hartman). The key word in that basic definition is “ability.” If someone doesn’t have the ability to produce or reproduce a specific movement pattern (due to lack of range), then they are inherently immobile.

Stability has been defined as “the ability to resist movement.” Without the ability to resist poor movement, one will never be able to create truly authentic movement and will always have compensatory patterns.

Be careful with this, however, because it can be very easy to confuse joint stiffness with joint stability. They are 2 very different things according to the nervous system. If someone only has joint stiffness, at some point they will be stretched to the end of their limited range and they will collapse and sustain and injury because they don’t have true stability.

So, how do we train mobility and stability? Gray Cook makes it very clear that you ALWAYS train mobility before stability. That is to make sure that you avoid the joint stiffness scenario that we just discussed.

I agree with Gray on this point almost all of the time when we are talking about relatively healthy individuals with relatively “normal” mobility (whatever that is). I have found that there are some occasions where it make sense neurologically to challenge the body via stability training within an available range of motion as you continue to improve their mobility. There are also some instances where it works well to improve both mobility and stability simultaneously. As with all situations, the rules are the rules, but they can be broken from time to time.

There is one area where this rule cannot and should NEVER be broken. That is the post surgical rehab patient. Mobility and joint range of motion MUST always be the first priority immediately following a surgical intervention. Without full range of motion, performing simple ADLs becomes problematic for patients.

Neurologically, activation patterns are significantly altered with poor range of motion. Because the nervous system controls every aspect of the body, the ripple effect that poor range of motion has on the body is immeasurable.

First, joint stability will never be realized with a limited range of motion. When muscles only work in a shortened position, they lose their mechanical advantage and can’t create the appropriate torque needed to keep a joint stabile in an unstable environment.

This leads to larger issues elsewhere. When the local stabilizers can’t keep a joint centrated, prime movers take over because they are typically larger muscles that are in a position to greatly improve joint position, even though that is not their intended role. This leads to decreased performance, especially if they are an athlete, because the prime movers are tied up performing stabilizing duties instead of moving the body. For the same reasons, this will also lead to overuse injuries.

These same poor activation patterns also impact other joints in the body. For example, the rotator cuff is specifically tied to grip strength. It is a protective mechanism that is used by the brain to protect a damaged shoulder. Thus, if the rotator cuff can’t work correctly due to a limited range, that person’s grip will be compromised.

Going further, that same patient with a poor functioning shoulder will have problems in the lower extremity. It is rather obvious that the Lats play an important role with the shoulder joint. Many people forget that the Lats are directly tied to the Gluts in a crossing pattern in the low back. Thus, if one Lat isn’t working well (because of a compromised shoulder), the opposite glut won’t function properly. This can lead to knee pain because the Gluts are a powerful external rotator of the femur, keeping it in an advantageous position for the patellofemoral joint.

Continuing on down the chain, when that glut doesn’t work, it will likely be correlated with an anterior pelvic tilt. An anterior pelvic tilt is associated with a number of issues, including an ankle dorsiflexion restriction. This can lead to ankle and foot problems. And, I can keep going…

Moving away from activation patterns, we also have to keep in mind that a poor functioning joint will have other effects on the joints around them. Looking at the joint-by-joint approach (Cook and Boyle), we understand that the human body is simply a series of stacked joints which alternate between needing joint mobility and joint stability. So, if you lose joint mobility in one joint, you are going to be asking another joint to make up for it. The body will find the motion somewhere. Unfortunately, the motion will have to come from a joint that is intended to provide stability.

As an example, if an ankle patient doesn’t regain full range of motion, they will develop knee or back pain. This is because the knee and low back are intended to be stable joints, but when presented with a lack of mobility below them, these joints become unstable and painful. It is consistent and predictable.

Honestly, these examples are just the tip of the iceberg. As you read this, you may be thinking to yourself, “I know Mitch, this is common sense.” And you are right. Unfortunately, I can’t tell you how many young athletes come into my practice from other therapists who are cleared to return to play missing 10, 20, sometimes 30 degrees of motion. Then, I get to tell the kid and their parents that they can’t play because they aren’t ready and then I get to spend the next few months fixing what should have been done early in the rehab process.

It’s honestly not about me though. None of us got into this profession for us. We love our patients and want the best for them. So, lets start doing just that. Give them the best treatment available. Today. Tomorrow. Next week. Next year.

Mobility precedes stability in the post surgical patient. ALWAYS!!