Programa de aquecimento para prevenir lesões no futebol FIFA 11+

Prevenção de Lesões: FIFA 11+ Manual from ComoTreinarFutebol

Assessing the Neuromuscular System

Autor :Chris Fox in http://www.thestudentphysicaltherapist.com/   Recently a patient with low back pain also had complaints of UE symptoms. She had awakened that morning with burning in her L lateral 3 finger tips. Even though I was seeing her for her back, I quickly looked at her UE symptoms in order to give the patient some information about the impairments. Since she had neural complaints in her lateral 3 fingers, I thought it would be wise to assess neural tension of the median nerve. Upon placing the limb in a partially tensioned position, the patient exhibited clonus of elbow flexion. Questioning myself, I took the patient out of the tensioning position and immediately did rapid elbow extension without any resistance. Placing the limb back into the median nerve tensioned position slowly resulted in clonus again. This lead me to do a slightly more thorough neuromuscular screening. The patient had a history of decreased sensation on the R side and had seen a neurologist 5 years ago, which resulted in negative EMG studies. The patient denied any constitutional symptoms and had negative gait ataxia, Hoffman's, slump test and Inverted Supinator Sign. On the R side, she did present with some odd neuromuscular signs. With Babinski, she reacted with involuntary hip flexion on the R while L side was negative. With tensioning of the R median nerve, the patient rolled out of the tensioned position involuntarily. She was hyperreflexive on the R side as well. Due to this atypical presentation, I referred the patient to a neurologist. Afterwards I consulted with several physical therapist, including my mentor, all of whom had never heard of clonus with a neural tension test. The reason I present this patient encounter is to review the essential components of a neuromuscular screening. Due to the fast pace of the clinic and the fact I was seeing her for her back, I was unable to do a thorough exam. Below I will include all things I should have looked at: -Dermatomes: looking for altered sensation along different spinal levels -Myotomes: looking for weakness along different spinal levels -Reflexes: looking for either hyporeflexia (Lower Motor Neuron lesion) or hyperreflexia (Upper Motor Neuron lesion) -Cluster for Cervical Myelopathy:     -Gait Ataxia     -Babinski     -Inverted Supinator Sign     -Hoffman's Sign     -Age >45 -Slump Test and SLR: tensioning of the neural system from the LE -ULNT's: tensioning of the neural system from the UE -Clonus: looking for potential Upper Motor Neuron lesion -S&S:     -NIght Pain     -S&S of Cauda Equina Syndrome     -Bowel &Bladder Changes     -Nausea & Vomiting     -Significant Changes in Weight in Last 6 Months     -Fever     -Hx of Cancer     -Unusual Fatigue     -Tolerance to Heat and Cold The above list is many of the aspects one needs to consider in your neuromuscular examination. Our normal exams will also look for spinal and peripheral joint mobility and the joint's response to repeated loading. However, when concerned about a potential neuromuscular disease, we should be aware of the accumulation of these S&S. For example, with this patient's young age (20), history of decreased sensation on one side, difficulties with heat/cold, and odd reactions with neural tensioning diagnoses such as multiple sclerosis come to mind. It is for this reason that it is essential we screen our patients thoroughly for systemic conditions of all types.

HOW TO TRAIN FOR SKI SEASON adequate physical training by TechnoGym

HOW TO TRAIN FOR SKI SEASON

http://www.technogym.com  21 November, 2014 by Giulia 

The winter sports season is coming up, and it’s important to be aware of the risks of skiing – a physically demanding sport – without adequate preparation in terms of strengthening the body, increasing flexibility and warming up to avoid potentially serious injuries.

Technogym’s Master Trainer team recommends that training can be divided into three steps: a home (or hotel) workout; a warm-up on the ski slopes; and a post-ski workout.

Check out an ideal training programme in the infographic below, and share with your fellow ski aficionados. Have a great 2014/2015 ski season!

Tensor Fascia Latae and Iliotibial Band

Functional Evaluation

By Jeffrey Tucker, DC, DACRB  in http://www.dynamicchiropractic.com/

The tensor fascia latae (TFL) acts through the iliotibial tract by pulling it superiorly and anteriorly. It assists in flexing, medial rotation and abduction of the hip and extension of the knee joint.

The TFL arises from the anterior part of the outer lip of the iliac crest, the lateral aspect of the anterior superior iliac spine and the upper part of the anterior border of the iliac wing. Keep in mind that in addition to arising from the iliac crest, the iliotibial band (ITB) attaches into the posterior gluteus maximus muscle in the back. When the TFL and gluteal muscles contract, they increase tension on the band. Often, one muscle dominates the movement pattern causing an imbalance to occur, which may lead to injury. When a muscle imbalance exists, some muscles are short (overactive) and others are long (underactive).^1-7

Muscle length imbalance (or muscle weakness) is a common occurrence that occurs in the synergistic muscles in the hip:

Flexors: The TFL becomes short and the iliopsoas becomes a long and/or weak muscle.

Hip abductors: The TFL becomes short; the posterior gluteus medius becomes long (and/or weak).

The difference in the length of two synergistic muscles contributes to compensatory joint motion and the development of movement impairment. The weak muscle (iliopsoas or posterior gluteus medius) usually is associated with pain in the muscle belly, which is noted upon contraction or with palpation. The long muscle (iliopsoas or posterior gluteus medius) synergist will cause the pain to usually occur during hip-joint motion because the pain generator is the faulty control of the head of the femur in the acetabulum. The gluteus medius is the primary frontal-plane stabilizer of the hip. When it's underactive, the TFL, adductor and the opposite quadratus lumborum (QL) become overactive.¹

Shortened muscles over time can become structurally short and mechanically incapable of lengthening to an appropriate level.^1-7 Long muscles can become structurally long and incapable of shortening to an appropriate level.^5,6 When muscles are incapable of firing correctly, compensation occurs, and this will alter joint motion from its normal path.

If you have been performing the overhead squat maneuver (described in previous articles), you will notice that the knees can drift inward or outward on the descent. The TFL is implicated as being overactive in both the knee moving inward and outward, which may seem to be a contradicting statement. The movement at the knee depends if the foot is in the open or closed chain. In the open chain, the TFL is a major abductor of the femur and is noted as being overactive when the gluteus medius and/or maximus are underactive.^1,13,14 The gluteus medius and/or maximus have been shown to be prone to underactivity when the lack of activity leads to synergistic dominance or overactivity of other muscles.^1,9,14 Overactivity (synergistic dominance) of the TFL, piriformis and biceps femoris can all stem from or lead to underactivity of the gluteus medius/maximus because they are each a functional synergists to the gluteal complex.^1,9,14

In the closed chain, the knee could move inward if the TFL is overactive doing the squat evaluation. The TFL (and the soleus, lateral gastrocnemius, biceps femoris) attaches to the lower leg and has the ability to produce external rotation of the lower leg.^13,14 The TFL (and the adductor complex, biceps femoris [short head], and lateral gastrocnemius) affects either the femur and/or the lower leg. When overactive, these muscles can cause altered knee position.¹⁴ In conjunction, the medial hamstrings (particularly at the knee), gracilis, popliteus, medial gastrocnemius, and the gluteus medius and/or maximus are muscles which, when underactive, will allow the femur to adduct (internally rotate) and/or the lower leg to abduct (externally rotate).¹⁴

The TFL (and biceps femoris [short head] and lateral gastrocnemius) crosses the knee joint (tibiofemoral joint) laterally. When overactive, as compared to the medial structures, it laterally pulls the femur and lower leg closer together in the frontal and transverse planes.¹⁴ Without adequate medial support, the knee is virtually pushed inward, resulting in the "knee-inward" compensation during the squat assessment.

The TFL, bicep femoris (long head), piriformis, gluteus minimus and medius all have an effect on the femur and when overactive can cause the knees to move outward during the overhead squat assessment.¹⁴

Common Stresses

Intrinsic Factors/Causes of TFL-ITBS

1. Tightness in the TFL-ITBS. This is detected by performing the modified Ober's test. The client is positioned in side-lying, with the unaffected side down. The pelvis and spine in neutral alignment and the bottom leg flexed for support. The uppermost leg is extended (although the leg may be flexed as much as 10 to 15 degrees, and the test still will be valid) and needs to be above the horizontal. The hip is laterally rotated and extended, as far as no lumbar extension occurs. Tell the client to actively flatten the waist towards the floor and actively hold the leg in slight abduction and lateral rotation. The knee is not locked and the foot is relaxed. The client is then instructed to slowly lower the leg towards the floor until the iliotibial band hangs on the greater trochanter and cannot lower any further. The key to an accurate test is not letting the pelvis move, either into lateral tilt, anterior tilt or rotation. As the leg lowers, the hip should not flex or medially rotate. It's essential to maintain the laterally rotated position of the hip. Ideally, the leg should lower into at least 10 to 15 degrees adduction (approximately two to three inches above the floor for females and one to two inches above the floor for males) without loss of proximal control of the pelvis or hip. The iliotibial band lacks extensibility if the leg does not adduct sufficiently.
2. Myofascial restrictions in the hip and thigh musculature, which will increase tension on the band. The iliotibial band is not sensitive to mechanical stretch. The iliotibial band only becomes sensitive to mechanical stretch in the presence of inflammatory pathology. The client will describe fascial inflammation as "burning outer-thigh pain." Manual palpation can detect tension in the band. Visual postural analysis reveals a deep groove along the iliotibial band when it's tight. With the client in the Modified Thomas test position, the tensor fascia latae is tested by adducting the horizontal thigh until the pelvis moves. This should be 15 to 20 degrees. Iliotibial band tightness is confirmed by restricted passive extension/adduction of the thigh with the knee flexed to 90 degrees.
3. Weakness in hip abductors (common in distance runners).
4. Weakness or poor control of knee muscles.
5. Dominance of anterior hip muscles, (TFL) over posterior hip muscles (gluts). Tight hip flexors cause the pelvis to rotate while walking. This leads to one side of the abdominals and one side of the gluteus medius shutting down.
6. Excessively flat feet or high arches. Poor instep strength is a cause of Achilles tendon inflammation and chronic knee pain from the iliotibial band attachment at the knee.
7. Bow legs or knock-knees.
8. Leg-length inequality.
9. Limited ankle ROM. During the overhead squat if the feet/toes externally rotate, this is usually associated with decreased ankle dorsiflexion and lateral gastrocnemius muscle tightness. During the overhead squat, when you observe the feet turn out, you likely may observe knee valgus (inward knee movement) due to increased hip adduction muscle activity. This must be resolved through mobilization, inhibition and muscle-lengthening procedures before moving up the kinetic chain. The biceps femoris (short head) and TFL also can cause the lower leg to abduct which can perpetuate eversion of the foot/ankle.¹⁴

Extrinsic Factors/Causes of TFL-ITBS

1. Training errors (e.g. excessive mileage, sudden increase in mileage, sudden increase in intensity of training, too much hill work, running on crowned roads).
2. Worn-out running shoes. Top runners replace their running shoes every 250 to 300 miles. I'll see clients who wear shoes up to 500-plus miles.
3. Overstriding.
4. Failing to warm up or cool down.

Functional Testing of the TFL

Have the client stand two to three inches from a wall with their feet together, with the sacrum and thoracic spine on the wall. The client should be able to contract the abdominal and gluteal muscles to flatten the lumbar spine onto the wall and hold it there. This test reveals the ability to self-correct a lumbar lordosis. If the client can't posterior tilt the pelvis to flatten back on the wall, then the tensor fascia latae (TFL) and iliotibial band could be the cause. Have the client repeat the test with their feet shoulder-width apart. This unloads the TFL and IT band and enables the client to posterior tilt the pelvis to flatten back on to the wall. To correct this dysfunction, have the client repeat the test procedure with their feet shoulder-width apart, actively posterior tilting the pelvis and holding this position for 20 to 30 seconds and repeat the stretch three to five times. Over time, gradually bring the feet closer together. When the client can do it with their feet together have them rotate the hips out while actively posterior tilting the pelvis. A unilateral shortness of the TFL muscle can contribute to sacroiliac joint problems and restrict external hip rotation and extension. In terms of performance, it affects the swing phase of the leg during sprinting, because it causes the foot to swing out at toe-off and the foot to go medial and pronate at touchdown. This can be the cause of shin splints because of the rapid deceleration.

Treatment and Rehabilitation of TFL-ITB Syndrome:

Acute Phase

1. Ice.
2. Anti-inflammatory diet and supplements to reduce inflammation.
3. Activity modification. Stop the perpetuating factors that caused the irritation.
4. Sleep with a pillow between the knees to decrease tension on the ITB.

Subacute Phase

1. Massage, myofascial release techniques.
2. Address tight areas and trigger points. A foam roll is best for this.
3. Stretch the TFL-ITBS. The Modified Thomas maneuver is one way to manually stretch the TFL-ITBS. I prefer teaching clients the "standing self-stretch" method. For the right TFL-ITBS, stand in a split-leg stance with the right leg behind the left in a full stride stance. Externally rotate the right foot, leg and hip and maintain weight on the right foot. Raise the right arm straight overhead with the palm facing forward. Place the left hand on the left iliac crest and push with enough pressure from left to right to feel the stretch. Stand with a "tall spine" and slightly rotate the left shoulder anterior. You may need to slightly extend your torso to gain a greater stretch sensation. Hold this pose for 20-30 seconds and repeat this maneuver two to three times. Performing a gluteal bridge with the toes raised with adduction gets a stretch to the TFL as well.

Strength and Stability Phase

1. Bridging with single-leg raise. Repeat the movement up and down. Build up to one to two minutes of slow continuous movement.
2. Clam shell. The aim is to strengthen the gluteus medius. Lie on your side with your hips stacked one on top of the other and your legs together with the heels connected. Extend your lower arm, palm up, so that you can rest your head. Now angle your stacked thighs forward 30 to 45 degrees, without changing the position of your spine, which must be still in a straight line from your head to your tail. From this position, pre-contract the gluteus medius and lift the top leg. In the beginning, allow the heels to stay in contact. Do not let the pelvis rotate forward or backward. Lift the thigh up from the hip to its maximum height. Hold it up for 10 seconds and slowly bring it back down. Repeat this 10 times.
3. Standing with an elastic band around the knees, perform a single-leg/thigh abduction (one at a time) in a semi-squat position. Keep the big toe down on the ground. Build up to one to two minutes of continuous movement.
4. Step downs. Step down from a 2" to 6" stable step very slowly.

References

1. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby, Inc., 2002.
2. Liebenson C. Integrated rehabilitation into chiropractic practice (blending active and passive care). In: Liebenson C, Ed. Rehabilitation of the Spine. Baltimore: Williams & Wilkins, 1996:13-43.
3. Comerford MJ, Mottram SL. Movement and stability dysfunction - contemporary developments. Man Ther, 2001;6(1):15-20.
4. Panjabi MM. The stabilizing system of the spine. Part I: Function, dysfunction, adaptation, and enhancement. J Spinal Disord, 1992;5(4):383-9.
5. Kendall FP, McCreary EK, Provance PG, et al. Muscles: Testing and Function, with Posture and Pain. 5^th ed. Baltimore: Lippincott Williams & Wilkins, 2005.
6. Janda V. Evaluation of muscle imbalances. In: Liebenson C, Ed. Rehabilitation of the Spine. Baltimore: Williams & Wilkins, 1996:97-112.
7. Sahrmann SA. Posture and muscle imbalance. Faulty lumbar pelvic alignments. Phys Ther, 1987;67:1840-4.
8. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: A theoretical perspective. J Orthop Sports Phys Ther,2003;33(11):639-46.
9. Janda V. Muscles and motor control in low back pain: assessment and management. In: Twomey LT, Ed. Physical Therapy of the Low Back. Edinburgh: Churchill Livingstone, 1987:253-78.
10. Janda V. Muscle strength in relation to muscle length, pain, and muscle imbalance. In:International Perspectives in Physical Therapy VIII. Edinburgh: Churchill Livingstone, 1993:83-91.
11. Edgerton VR, Wolf SL, Levendowski DJ, Roy RR. Theoretical basis for patterning EMG amplitudes to assess muscle dysfunction. Med Sci Sports Exerc, 1996;28(6):744-51.
12. Richardson C, Hides J. Closed chain segmental control. In: Richardson C, Hodges P, Hides J, Eds. Therapeutic Exercise for Lumbopelvic Stabilization. A Motor-Control Approach for the Treatment and Prevention of Low Back Pain. Edinburgh: Churchill Livingstone, 2004:221-32.
13. Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Physical Rehabilitation. St. Louis: Mosby, 2002.
14. Vasilyeva LF, Lewit K. Diagnosis of muscular dysfunction by inspection. In: Liebenson C, Ed. Rehabilitation of the Spine. Baltimore: Williams &Wilkins, 1996:113-42.
15. Fry AC, Smith JC, Schilling BK. Effect of knee position on hip and knee torques during the barbell squat. J Strength Cond Res, 2003;17(4):629-33. Exercise Specialist

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Dr. Jeffrey Tucker is a rehabilitation specialist, lecturer and healer best known for his holistic approach in supporting the body's inherent healing mechanisms and integrating the art and science of chiropractic, exercise, nutrition and attitudinal health. He practices in West Los Angeles and lectures for the National Academy of Sports Medicine and theAmerican Chiropractic Rehabilitation Board. For more information, please visitwww.drjeffreytucker.com. 

PEDro is the Physiotherapy Evidence Database multiple languages Português,Español, Italiano, 简体中文,한국어

Welcome to PEDro

PEDro is the Physiotherapy Evidence Database. PEDro is a free database of over 28,000 randomised trials, systematic reviews and clinical practice guidelines in physiotherapy. For each trial, review or guideline, PEDro provides the citation details, the abstract and a link to the full text, where possible. All trials on PEDro are independently assessed for quality. These quality ratings are used to quickly guide users to trials that are more likely to be valid and to contain sufficient information to guide clinical practice. PEDro is produced by the Centre for Evidence-Based Physiotherapy at The George Institute for Global Health.

http://www.pedro.org.au/

Search Physiotherapy Choices

http://search.pedro.org.au/physiotherapy-choices

http://www.pedro.org.au/portuguese/

Physical Therapy Home Exercise Program Software

http://www.clinicient.com/

Save Time and Increase Patient Compliance with Integrated, Video-based Home Exercise Program

When it comes to physical therapy home exercise programs both therapists and patients can struggle. Therapists struggle finding the time to create effective home exercise programs for patients. Patients struggle to remember how to perform the exercises correctly at home without their therapist by their side. With the new Clinicient home exercise program these struggles are a thing of the past.

Clinicient’s web-based physical therapy home exercise program makes it fast and efficient to create professional home exercise programs your patients can easily understand and comply with successfully at home. It integrates the market’s most comprehensive home exercise program into a patient’s medical chart, enabling therapists to quickly create, reference, update and share personalized exercise programs patients can more easily comply with at home. Patients can receive the home exercise program via email while they’re still in the office and can access their individual home exercise program via the web or from your patient portal anytime—so they have the videos, photos and detailed instructions they need to correctly follow their home exercises when on the go.

https://www.youtube.com/watch?v=BBDL5VdHr7o

• Benefits
• Features
• Screenshots
• Demo

The Clinicient Home Exercise Program solution is a practical, efficient and safe way to continue the momentum of in-office treatments with home exercise programs patients can replicate on the go with trust and confidence.

CREATE PERSONALIZED HOME EXERCISE PROGRAMS QUICKLY AND EFFICIENTLY

• Start with thousands of pre-loaded, professionally tested exercises
• No wasteful or costly paper print outs or hard to understand drawings
• Create and reuse standard exercise templates and protocols
• Set up preferences
• Upload videos/pictures of your patient performing the exercise correctly
• Maintain a record within the patient notes for easy reference, updating and follow up
• Save time explaining exercises over and over in the clinic

INCREASE HOME EXERCISE COMPLIANCE

• Enable patients to securely access their home exercise program anytime and anywhere
• Fit your patient’s learning style with videos, photos, line drawings, and detailed instructions
• Help patients stay on track with compliance grids
• Personalize the program with videos and photos of the patient performing exercises correctly

HOME EXERCISE PATIENT PORTAL AND EMAIL INTEGRATION MAKE COMMUNICATION EASY

• Email HEPs to patients in real-time before they leave your office
• Let patients easily access their HEP from your patient portal
• Enhance your service offering with access to exercises on web-enabled devices
• Express your professional image with branded email and patient web portals
• Provide secure and private environment
• Free two-month trial – try before you buy
• Free customer service
• Less than an hour to set up
• Web-based no software to buy or maintain
• Save money on paper, toner and other printing costs

SAVE TIME AND MONEY

• Free two-month trial – try before you buy
• Free customer service
• Less than an hour to set up
• Web-based no software to buy or maintain
• Save money on paper, toner and other printing costs

 Clinicient’s web-based physical therapy home exercise program software offers the most comprehensive tools around to make it fast and easy to create professional home exercise programs patients can easily understand and comply with at home.

PHYSICAL THERAPY EXERCISE PROGRAM CREATION

• Integrates Physiotec™ physical therapy exercise program into therapist’s note taking
• An expanding library of more than 5,000 pre-loaded home physical therapy exercises
• Variety of specialty areas
• Create, customize and re-use standard exercise protocols
• Reference, update and change home exercise programs  in notes
• Date stamped home exercise programs  automatically attached in chart
• Upload your own videos, pictures or line drawings
• Five different video formats optimized for common devices
• Easy search

PHYSICAL THERAPY EXERCISE COMPLIANCE

• Patient home exercise web portal
• Email PDF of initial and updated home exercise programs  to patient
• Computer, tablet or smartphone access
• Home physical therapy exercise videos, pictures, drawings and detailed instructions
• Patients can view video/pictures of themselves performing exercises
• Compliance grid for easy exercise tracking
• English, Spanish or French language options

PRACTICE IMAGE AND BRANDING

• Branded web portal option
• Branded email
• Professional quality videos
• Leading-edge home exercise tools

PHYSICAL THERAPY EXERCISE PROGRAM SET-UP AND SERVICE

• No risk, free two-month trial
• One-click set-up
• Free live-person customer service
• Free set up support for patient portal
• Secure and HIPAA compliant

By Jim Plymale

 | FEBRUARY 15, 2013 http://www.clinicient.com/

How Well Are You Selling Your Therapist’s Time in Your Physical Therapy Practice?

i

Don’t Be Afraid of the “S” Word:  We’re all in Sales 

I was talking with@Jerry_DurhamPT at the APTA Combined Sections meeting in San Diego, CA in January and we were discussing the fact that most physical therapists wouldn’t see themselves as salespeople. Jerry recommended a book to me by Daniel Pink called To Sell is Human, which I just started reading. The basic premise of the book is (pretty evident from the title) that we all spend a significant amount of our time “moving or persuading” people. In other words, we are all in sales. In fact, the studies in the book indicate that we spend as much as 60% of our time “selling” even if we aren’t in sales.

I think the word “selling” gets a bum rap, especially in physical therapy businesses. When we think about sales we often think of the pushy, annoying salesperson who forces their way into our lives offering a product or service of no apparent benefit to us, just to benefit themselves. However, if we change our viewpoint slightly, we might recognize the need and the value of selling as an essential part of what we do to improve our patients’ lives and to improve our businesses.

In what way is a physical therapy practice in sales? We are selling the benefits of the services we provide. We are selling referring physicians on the value of sending their patients our way to help them achieve their goals. We are selling therapist’s time. We are selling patients on the necessity of coming in, often multiple times a week—and we all know how much harder this has become with the increasing shift of costs to the patient. We are selling patients on complying with their home exercise programs.

It’s important to think about the importance of having a “selling” or “persuading” mindset as you approach your relationship with your staff, your patients and your referral sources. Think about how much you believe in the value of the services you provide. The value of every therapist’s time. The value of your patient’s time. The value of a referring physician’s time and the confidence they place in you when they send you a referral.

How Well Are You Selling Your Therapist’s Time?

With that in mind, what are you doing to make the most of time? I’d like to suggest two metrics that we’d like every practice owner, therapist and front desk person to track as key performance indicators (KPIs) of how we’re managing therapist’s time and your referrals.

• Vacancy Rate – this measures the amount of “unsold” time on a therapist’s schedule as a percentage of the total time available. Both the therapist and the front desk need to be thinking about “selling” this available time.
• Average Scheduled Frequency – this measures the average number of days per week an active referral is scheduled for appointments. Each referral has a “capacity” for visits each week that is documented in your plan of care. Are you getting your patients scheduled and attending? This is key not only to your patient’s improvement and achievement of goals, but also to your relationship with the physician who refers patients to you. They are looking to you to keep the patients compliant with the plan of care.

Why are these important? What gets measured, gets managed. Once you start tracking these metrics, make  a plan to improve these key metrics. As you can see, they are linked. If you have empty space in your schedule, you can fill it with patients who aren’t at full capacity. You’ll also notice patients that have gone “missing in action.” Once you’re doing that and your patients are enjoying the benefits of faster achievement of their goals, you’ll want to communicate the results you’re seeing to your referring physicians. As a result, you’ll start to notice more referrals coming your way, which will further increase your capacity to fill your therapist’s schedules. When a patient cancels, your front desk will have the mindset of “filling the vacancy”.  When you get a referral, you’ll be focused on scheduling the patient in advance and making sure they’re tracking to the frequency dictated by the plan of care.

A good friend of mine once told me “the culture lives in the conversations”.  Try consciously talking to your staff about selling the most valuable asset you have: your therapist’s time. These subtle shifts can go a long way in improving not only your clinical results, but the bottom line for your physical therapy business.

http://strivehub.wordpress.com/          PHYSICAL THERAPY BLOGS

21 Physical Therapy Blogs You Should Be Reading

Over the past two years, physical therapy bloggers have come, and physical therapy bloggers have gone. As such, I felt that it was about time to update my original post (The Top 13 PT Blogs You Should Be Reading). If you’re looking to learn from the people who are pushing this profession forward, then look no further.  Of note, I made sure to only include blogs that post high quality content consistently (minimum 1 post/month).

As a reminder, these blogs are in no particular order! They are, however, categorized based on my whims.

Without further ado, here are the top 21 physical therapy blogs you should be reading!

1. Clinically Focused

MikeReinold.com

Winner of Therapydia’s coveted Best Overall Blog for 2013, which should be enough to make you click on the link and check it out.  Seriously, stop reading this description and just click the link.

The Manual Therapist

Winner of Therapydia’s coveted Best Overall Blog for 2014, which should be enough to make you click on the link and check it out.  Seriously, stop reading this description and just click the link!

Allan Besselink

A blog that is forward thinking, with a nice mix of serious & lighthearted topics, and written by someone with extensive clinical experience and an obvious passion for the profession.  Here is one of my favorite posts of his.

Julie Wiebe PT

Had to pick one person to represent the Pelvic Mafia on this list.  If you have an interest in pelvic health, check out this blog.  Also, check out the hashtag #pelvicmafia on Twitter for access to a ton of other useful content.

In Touch Physical Therapy

Penned by Harrison Vaughan, DPT out of Virginia.  This blog is rich with content, and its tagline explains it much better than I ever could: “Physical Therapy Blog on Evidenced-Informed Orthopedics, Manual Therapy and Knowledge Translation from Academia to Clinical Practice”.

Forward Thinking PT

Another blog focused on EBP and advocacy   They do a great job incorporating video into their posts, which I love.  After you’ve gone through their blog, be sure to check out the rest of the site; they have really valuable resources including a list of clinical prediction rules and analysis of commonly utilized orthopedic special tests (including sensitivity and specificity of each test!)

2. Business Focused

Ben Fung’s Blog

 A rare blend of a clinician who is also grabbing an MBA… so you know his opinion on business/marketing holds more weight than other clinicians who like to pretend they know what they’re talking about when it comes to business (read: me).

Clinicient Blog

Tips on improving your clinic’s Revenue Cycle Management (RCM), patient retention, and daily operations.  They’ve got a nice mix of text-based posts and webinars.

WebPT Blog

WebPT provides great content.  If you are struggling to figure out what the heck PQRS is, or what Medicare is going to do next, this is a great place to start.

DrJarodCarter.com

Here’s a great blog for the private practice owners out there, specifically those operating or considering operating a cash-based clinic.  The blog is both a ‘How To’ for starting a PT clinic as well as a place for general musings and industry analysis.

3. The Enigmas

Both of these blogs are penned by a (wo)man writing under a pseudonym (CynicalPT and CinemaAir, respectively).  All I know is they’re both smart PT’s who have opinions worth listening to.  Of note, both blogs feature pretty awesome interviews with some pretty awesome PTs.

The Cynical Physical Therapist

It’s got PT-themed memes, people… MEMES!! This blog’s got a mix of serious topics and jokes- all with a hefty dose of cynicism.

Cinema Says

Kills it with the interviews, and also provides some high quality analysis on where the PT industry should be heading.

4. The Skeptics

Every blog in this grouping is heavily science-based… all gold standards for developing critical thinking & reasoning.

SomaSimple

True, SomaSimple is not a blog… but I don’t care. It needs to be on this list.  Mostly because if I included all the bloggers/contributors on Soma that should be featured in this category, it would be the 65 PT Blogs you Should be Reading.  If you head over to SomaSimple & dive in, you’ll find a ton of great content by great writers like the ones listed below (stuff like this).  If you’re looking for a community of experienced clinicians, ongoing dialogue, and a healthy dose of skepticism, you’ll find it here. Despite the fact that I don’t often contribute to the discussion boards, I am a Grade A lurker, and find myself especially drawn to the Neuro? Logical! forum.

BodyinMind

Body in Mind is a group of Australian clinician/scientists exploring pain as it relates to the body and mind (duh).  Based out of Australia, Body In Mind focuses on providing evidence-based research & analysis on the issues encountered in every orthopedic clinic.

Physiological

This is a brand new blog “where physiotherapy gets logical” written by two of our friends Kenny Venere and Chris Joyce.  Both of these guys are ahead of the curve, think critically (and force you to do the same), and are  the type of people we need pushing our profession forward.  Check them out and thank me later!

Keith’s Korner

Science-based medicine, research and (above all else) critical thinking are highlighted in this blog.  It really is difficult to take on heavy concepts while maintaining a conversational tone, but Keith manages to do both with ease.

The Sports Physio

Cheerio, mate!  Our first blogger from across the pond, so put another shrimp on the barbie (that’s what British people say, right?).  The blog, written by Adam Meakins, takes the phrase “there are no sacred cows” to heart, which is really what our profession needs in my humble opinion.

Better Movement

Includes almost two hundred free articles that discuss the science of movement and pain. You can find a lot of this information elsewhere by slogging through textbooks, internet articles or Pubmed. But on this blog it is presented in a format that is condensed, readable, accurate and practical.

HealthSkills Blog

Well, if you’ve read this far… you’ve reached our first Easter Egg.  There are actually 22 blogs in this list, because I somehow missed  this great one!  If you want to learn about the nuances of chronic pain & patient care, then check this out!

5. Somewhere in Between

Some business, some advocacy, a little clinical talk, with some technology peppered in.  These are your catch-alls… where you can get a bit of everything

PT Think Tank

If I’m being honest, this is the only blog on the list that isn’t in my “PT Blog Bookmark Folder”.  The reason it’s not in the folder is because it has its own place on my bookmark toolbar.  It was one of the first places I stumbled upon when I first found the online PT community, and their messages immediately resonated with me. Plus, us Quinnipiac grads need to stick together.  If you are just entering the social media scene, their PT Hashtag Project is required reading.

PT Talker

A podcast-based blog that’s focused on advocating for both the profession as a whole, as well as for the individual experts within our field.  All of the podcasts are downloadable MP3s, which is handy when you’re on the go.

Evidence In Motion Blog

EIM is well known throughout rehabilitation for its focus on education and advocacy, and their blog doesn’t disappoint.  I hope that over time I can find a way to convey my passion for the profession with only half the force, clarity, and effectiveness of these guys.  If you want to know where the profession is going, what you should be doing, or just want to get pumped up reading about physical therapy (which I wasn’t sure was possible a year ago), head over and dive in.

Learn Muscle Anatomy: Bursae

Posted by Courtney Smith on Wed, Jul 30, 2014 @ 08:27 AM

http://info.visiblebody.com/

The other day, I let my ten-year old niece play with Muscle Premium on my phone (while I watched cartoons). She kept making the model spin—around and around and around, like a ballerina, until she abandoned it for the muscle actions.

"Auntie," she said, and then didn't follow up with anything, completely engrossed in Elbow Flexion. When I prompted her, she looked up at me and whispered, as if confessing a secret, "Is it supposed to hurt?"

I asked her what she meant. She pointed to the moving model.

"Do bones rub against each other like that all the time? Because I feel like it should hurt."

I watched the animation for a bit—the olecranon of the ulna slid against the humerus's olecranon fossa, back and forth, flexed in a continuous loop. It did look a bit like they were rubbing together. Actually, if there wasn't something there acting as a cushion, moving the joints would be incredibly painful. Luckily, we're not that bad off.

"It doesn't hurt," I began, settling back to finish The Legend of Korra, "Because you have little pillows called bursae inside you that stop your bones from rubbing like that."

She turned her attention back to the TV and waited until the end of the episode to ask more. (My niece is polite like that.)

That was an actual exchange between me and my niece Em, who has an affinity for all things science and interesting. She's awesome.

Anyway, what I told her was the truth: bursae prevent our bones and muscles, particularly in the joints, from rubbing together and creating painful friction. Imagine trying to bend your knee without something to cushion the movement. Talk about ouch, right?

 

See those purple lumps in the picture? Those are bursae. They live between bones and bones, or bones and muscles, or muscles and skin, serving to prevent friction at points of stress throughout the body. In the picture, you can see the bursae are either prominently displayed (on top of the patella) or partially hidden between bone and muscle. Think of how often you move and bend your knees—I'm doing it right now, and I'm just sitting! It would be a much more painful action without the bursae there to cushion things.

Bursae come in three packages: synovial, subcutaneous, and adventitious. 

THREE TYPES OF BURSAE

Most of the bursae in the body are synovial: thin-walled sacs interposed between bones, muscles, and tendons. The lining of a bursa contains a capillary layer of synovial fluid, which provides two lubricated surfaces that enable freedom of movement. Synovial bursae tend to be located in your joints, like your knees, feet, and shoulders.

 

There are also adventitious, or accidental, bursae. These occur in soft tissue over bony prominences, usually because of repeated pressure or shearing.

An example of an adventitious bursae is a bunion, which is a deformity of the big toe. Wearing ill-fitting shoes can sometimes force the big toe inward towards the other toes. The bursa at the metatarsophalangeal joint becomes swollen, but the biggest issue is the normal part of the head of the first metatarsal bone is tilting sideways and sticks out at its top. This creates a large bump or prominence.

 

Subcutaneous bursae lie between the skin and a bony process, like the aforementioned olecranon of the elbow.

  

BURSITIS

You've probably spent enough time on this blog to know what the suffix –itis means, so you won't be surprised when I say that bursitis is the inflammation of a bursa. When the bursae become inflamed, their gliding ability is lost, which can be painful. An inflamed bursa is usually the result of trauma, overuse, or infection. Even something as simple as lifting something heavy can bring it on.

The joints of the hips, elbows, and shoulders are normally the areas affected by bursitis, but it can occur anywhere (inflammation of the bursae in the knee is known as Washmaid's Knee).

WANT TO LEARN MORE?