FREE SECTION

This section is actually one of 8 Archives on the site, showing the Daily Update format.  Just a small portion of what is 
available on PTupdate.com.  This material is intended only for physical therapists, physicians, PT assistants, and athletic trainers,
practicing within the scope of their education and their own state practice acts.  All the data is 
for information only, and should not be implemented without professional advice.
*Most Instructional photo and video links will not work on this page (except ACL material) due to its availability to the general public.

ACL reconstruction using semitendinosis and Endobutton

The first photo shows the incision over the pes anserine, and the surgeon using his finger to separate the tendons, including the fibrous bands attaching it to the
gastroc.  The second shows a whip stitch tied around the tendon of the semitendinosis.  Once detached from the bone, a tendon harvester,
as seen in pic 3, is used.  This runs up the length of the tendon and cuts it off at the musculotendinous junction


The next series of pictures shows the tendon on the measurement board.  This tendon was long enough that one third was cut off,
the remaining two thirds doubled over, and the first third laid on top and wrapped.  Picture 3 shows the graft ready for insertion.  One
end has loose sutures for the tibial attachment, and the other has the endobutton, seen by itself in picture 4



The Endobutton is pulled through the femoral tunnel, and once out, is pulled so that it cannot fall back in, and lies
flush against the side of the femur.  The graft is then tensioned and the sutures anchored around the tibial screw.  In a
few days, I should have photos here for the Bone Mulch Screw and WasherLoc technique by Arthrotek, and perhaps an .avi 
video of their procedure.

JUNE 2003

June 30
Article Review: Current Information Regarding the Biochemical and Genetic Events That Occur During Disc Degeneration

June 27:  Sorry no update yesterday, but the article for today was huge, and had lots of material.  Also, for some reason, this page is extending out sideways and now not filling in the screen.  If anybody has computer savvy and knows why this is happening and how to fix, email me!  I did not change margins or word-wrap.  Perhaps this page has just become too large top-to-bottom and the software is now adding width, I don't know.
Article Review: Biceps Tendon Disorders in Athletes This article is from the Journal of the American Academy of Orthopaedic Surgeons, and at $75 per year, a very good investment!

Vacumed is a site that can link you to products based on categories.

NEWS:  With the previous Medicare cap, less than 2% actually reached either cap.   82% of therapy episodes required no additional therapy, and even with the caps, 14% of treatment was still medically not necessary.  Goals were placed based on the cap instead of the patients needs, many providers provided "free" therapy by not billing for all services provided, and most admit they changed their treatments because of the cap, and then re-changed once the caps were removed.

NEWS:  JCAHO has announced that beginning in January 2006, they will start testing surprise inspections!  Those 2 months of preparations that all the hospitals scramble to achieve won't be possible, and think of all the fun and stress this will create!

June 25
Article Review: Determination of Time of Biologic Fixation after Anterior Cruciate Ligament Reconstruction with Hamstring Tendons

LINK:  I have had many ATC's call over the years inquiring about shoulder braces to prevent recurrent dislocations.  I always keep catalogs in the office, and recently found this brace, called the Cadlow Shoulder Stabilizer.

June 24
Today's update was sent by Todd B., and contains a link to a site covering the SI joint by Richard L DonTigny PT.  The link is for a .pdf file, which my computer steadfastly refuses to acknowledge.  However, there is also an HTML version that can be accessed.I am not familiar with this, but it looks quite interesting.  Thank you Todd!

TERM:  The Torg ratio is the distance from the midpoint of the posterior aspect of the vertebral body to the nearest point on the corresponding spinolaminar line, divided by the saggital diameter of the vertebral body.  The ratio of 1 is considered normal, and a ratio of less than 0.8 is indicative of congenital stenosis.  The sensitivity of this value approaches 100%, but the predictive value is less than 12%.  This is because some very large athletes have proportionately larger vertebral bodies, and as many as 33%of pro football players have a ratio of less than 0.8

June 23
Article Review:  Return-to-Play Criteria in Athletes With Traumatic Injuries to the Cervical Spine

LINK:  A site sent to me by a patient:
The RealAge Tip of the Day is a quick daily e-mail designed to help promote health and longevity. Each tip is backed by the latest scientific research. To learn more about the RealAge Tip of the Day, or to sign up, copy and paste the following URL into your browser: http://www.realage.com/news_features/tip.aspx?cid=14421

June 22
I decided to put up a link to a message board, which I have not done before.  This discussion hinges on the very controversial T4 syndrome, which basically suggests that the area around T4, including a possible ganglion, may be implicated in many different maladies.  Often, mobilizing T4 or performing trigger point therapy just lateral to it will cause reproduction of upper limb or cervical symptoms.  Some in the discussion suggest that this may be from pressure to the thorax during the maneuver, etc.  A good read nonetheless, and a topic often covered on Chiro sites.  Click Here

TIP:  While I often advocate obtaining full ROM around a joint, there are times that it should not be attempted.  Meniscal injuries and post-meniscectomy patients are one of those times.  Don't worry about that last 5-10 degrees of flexion, it will come on its own.  Remember, the lateral meniscus can move up to 11mm during full flexion from extension, and the medial one would love to if it wasn't tied down to so many other tissues.  Forcing flexion only puts strain on the healing or torn tissue and agitates it.  If you are trying to stretch the quad, flex the knee as far as comfortable and then just extend the hip.  Tell the patient to avoid squatting and other full flexion positions.

June 21
Member submission:  Check out www.merckmedicus.com, register for free access to JBJS and current opinions in ortho and a bunch of other journals  (Thanks Eric!)

TIP:  The scapular slide test is a semidynamic test that assesses how loads applied to the scapula affect the musculature.  The first position, as in picture 1, has the person with their arms at their side.  Measure from the inferior medial angle of the scapula and the nearest spinous process.  This is done on both sides.  Next have the person place their hands on the hips with fingers anterior and thumb posterior and around 10 degrees of shoulder extension, and remeasure both sides (not pictured).  Last, have them fully IR the humerus with the arm at or just below 90 degrees abduction.  The threshold for asymmetry, usually seen in position 3, is 1.5 cm.  This test is more sensitive for dyskinesis patterns that involve excessive protraction of the scapula or other scapular movements away from the central spine. (photo 2 is wrong, but the IR position caused him pain)  Click on thumbnail for full size view.
     

June 19
Today's Update is information sent to me from Langer, regarding AFO use, their Total Control brace, and billing issues.  I have ordered the kit myself, and just need to make one for a patient, see how it works, and see how we are reimbursed by Medicare for it.

LINKS:  Here are some newsletters that are worth subscribing to for various useful bits of info.
Wellness Letter
Tufts Health & Nutrition Letter
Harvard's Women's Health Watch
Mayo Clinic Health Letter
Johns Hopkins Health After 50
Berkely Wellness Letter

NEWS:  A physician, Richard Martin of the National Jewish Medical and Research Center, has found that biopsies of lung tissue of asthma sufferers has mycoplasma pneumoniae bacteria along with a 6-fold increase in the number of mast cells, and those treated with long term antibiotic therapy noticed a reduction in their symptoms.

June 18
Today's update:  Go to the elbow/wrist/hand tips section, and at the end is a description of the Mill's manipulation for lateral epicondylitis, along with photos.

June 17
Today's update:  Go to the Tips section, thoracic spine, and scan down to the last set of pictures for an alternate method of thoracic manipulation, sometimes known as the "dog" manipulation.  Hand placement and body position, along with an explanation are shown.  Click the thumbnail for a full size picture.

NEWS:  The drug Mamantine blocks glutamate, which has been implicated in nerve cell death in Alzheimer's patients.  While not approved in the US, patients are permitted to order it via mail from Europe and use it if a physician supervises the treatment.  The drug may be an option to those patients who have failed all other treatments, and only have a nursing home as their next option.  Unfortunately, patients that have reached this stage cannot even make the conscious decision if they want to take the risk on a non-FDA approved drug, and the onus of the responsibility is placed on the primary caregiver.

June 16
Article Review:  Ibuprofen and Acetaminophen:  Effect on Muscle Inflammation after Eccentric Exercise

June 15  Happy Fathers Day-my first!
TIP:  Tone abs by periodically “sucking in your gut” throughout the day and holding for a 5-10 count.  Make sure your pelvis does not move, and you do
not contract your obliques or rectus, and you will have success at strengthening your transverse abdominis.

TIP:  Deadlifting always has a degree of risk to it, but is still one of the best ways to tone the buttocks and hamstrings, something we guys start to lose in our 30’s.  I have started this myself, and make sure I retain my lordosis, keep my back strong using the Nautilus, and keep my hamstrings flexible to reduce strain and pull.  Here is a link to a site with pictures of different styles of deadlifts.

TIP:  For those who hate to go out in the cold and run:  put your clothes in the dryer at night and turn on when you get up.  Take out the hot clothes, put them on and go straight out and begin your run.  You will warm up just as they are cooling down.

June 14
Article Review:  Dynamic Stabilizing Function of the Deltoid Muscle in Shoulders With Anterior Instability

NEWS:  A study in a Scandanavian Orthopaedic journal reports that tissue samples of those with Achilles ruptures reveals collagen degeneration, tenocyte necrosis and neutrophil infiltration not only at the rupture site, but on all parts of the tendon.  The opposite non-ruptured side also had these findings, but the side with the rupture also revealed inflammation, which parallelled the severity of the degeneration and necrosis.  The inflammatory process created collagenases and elastases, which may have added to collagen breakdown, thus leading to the ultimate rupture.

LINK:  Eric Wheeler submitted a great link for a site with an enormous list of forms/indexes/questionnaires that can be used in the clinic.  See the main index under "Forms".  Thank you Eric! 

NEWS:  CNN reports that 1 in 3 children born in the year 2000 will develop diabetes if eating habits are not changed.

NEWS:  The University of New Mexico found that slower punches during kickboxing classes were just as effective at burning calories and improving fitness, without the shoulder trauma that fast punches create.

NEWS:  Women are 2.8 times more likely to develop post-traumatic stress disorder, according to the University of California at San Diego.  All three of these signs with some degree of severity are clues there is a problem:  flashbacks, a disabling fear of being hurt again, and avoiding human contact for up to 3 months after the trauma.

June 12
Article Review:  Comparison of Surgical Outcomes Between Bursal and Articular Partial Thickness Rotator Cuff Tears

NEWS:  Today's issue of New England Journal of Medicine reports that blood pressure should be taken over a period of 24 hours, instead of one time in an office (where "white coat hypertension" may occur) to better diagnose HTN.

LINKS:  On Balance has a huge list of resources for those PT's interested in balance and vestibular rehabilitation, along with demonstrations and explanations of all kinds of tests one can easily administer in the clinic.  Balance and Mobility is another site with information for medical professionals and families of those afflicted with a balance disorder.

June 11
Today's update is a brief but conclusive overview of the accessory navicular and treatment options.

TIP:  Perhaps I am just clueless with regards to this stuff, but I was just introduced to Spenda, a sweetener made from sugar, but without the calories.  I have to admit, I like it.  I don't like using product with NutraSweet or saccharin, so this may be a healthy alternative for your patients who are trying to lose weight.

TIP:  Some think that most cases of lateral epicondylitis is radial nerve dysfunction, others feel it is tendinosis, and others feel it is a malposition of the radial head.  It may be all 3, with one causing the others, I don't know.  But here is a manipulation worth trying.  Take the radial head and mobilize in an AP direction to loosen it up.  Then have the patient flex their elbow to 90 degrees and then maximall flex their bicep while supinating to your unyielding resistance.  I "crunch" will be heard and felt at the radial head, along with relief.  Those that do not sublux may not have been incorrectly positioned in that patient.  

LINKS:  The American Academy of Orthopaedic Physical Therapists can be joined for only $95 US per year (less for students), and one will recieve the Journal of Manual and Manipulative therapy, the Articulations Newsletter, networking, and course discounts.  Podiatry Today is a newsletter that can be subscribed to for $40 year.  When checking out this site, they will give you options to become involved in other newsletters, some free.

NEWS:  Today's issue of JAMA reports that the drug ticlopidine, used by blacks to control recurring strokes, may be no more effective than aspirin, yet it costs 10 times more.

June 10
Go to the Book and Course Review section again to review a manipulation course I attended today through Cross Country University.  I realized that half the techniques taught are already on this website, but others are not, and there were some good ideas.  I will photograph these and post in the near future.

June 9
Go to the Book and Course Review section for a review of the David Poulter course I attended this past weekend.

June 8
Article Review:  Shoulder Impingement Presenting as Neck Pain

TERM:  Sourcil Sign is sclerosis of the undersurface of the acromion when viewed on an xray, and is indicative of impingement.

June 7
Click Here for a Word version of the Roland-Morris Disability Index.

TIP:  I just got done with half of a weekend course by David Poulter, the guy that came up with all the McKenzie courses.  He showed us a neat trick:  Stand and bend over as far as you can to assess your hamstring flexibility, and note where your fingertips come on your legs.  Then, sit with knees extended and feet flat against the wall.  Rotate through your full ROM right and left, then sidebend right and left, each 20x.  Stand and reassess (or test supine, as some do).  Notice a significant difference?  Perhaps the "hamstring tightness" you felt was actually reduced neural mobility.  The sitting position is not much different than slumping, and the rotation provides the extra dural stretch.  I tried having my wife perform 20 slump stretches on each leg, and she also showed significant gains in the ROM.  This information is another reason why we should all probably read David Butler's "The Sensitive Nervous System"

LINK:  Patients can go to the American Podiatric Medication Association website to learn foot care tips, including shoe purchasing.

TIP:  The Mayo clinic reports that most chlorine products lose their effectiveness at 84 degF, meaning that most hot tubs can be breeding grounds for bacteria, which can be inhaled in the steam.  Also, another report noted that 10% of the nations pools are unfit for human use due to bacteria levels, and many are close to being dangerous.  This is due to lack of education of pool maintenance persons and no watchdog groups to monitor pool cleanliness.

LINK:  Citizen.org is a site that allows you to check on a physician who may have been disciplined in their state.  This could save your PT reputation before you cause damage by referring to a potentially dangerous physician.

TIP:  Prior to working out, try a meal with 150-250 calories from both carbs and protein.  A half an apple with a tablespoon of peanut butter, or crackers with low fat cheese 2 hours prior to the workout will give you more energy for a better work out.

June 5
Click Here for a link from a Saudi journal detailing results of a study regarding arthroscopic shoulder surgery, but more importantly, a version of the UCLA Shoulder Scale with ranges for the scores that are obtained, and what they mean.  Thanks Joe T. for the link.

NEWS:  I recently read a study that detailed what most of us probably already knew:  skipping a meal when dieting, especially breakfast, is very counter productive.  Those who do it do not lose the weight compared to others who eat a healthy breakfast and do not skip meals.

NEWS:  A study in Spine journal details how claims from auto accidents drops significantly when Canada switched from a tort system to a no-fault system (thus eliminating monetary awards for pain and suffering).  Also, claim closure time was halved under the new system.  

June 4
Click Here for The Million Visual Analog Scale (as a Word document for printing).  High scores are associated with a lower rehab completion rate, higher levels of depression, and a higher rate of post-rehab health care utilization.  The score may assist in determining which patients may be at risk for poor outcomes

June 3
Article Review:  Trunk Muscle Strength in Flexion, Extension, and Axial Rotation in Patients Managed With Lumbar Disc Herniation Surgery and in Healthy Control  Subjects

TIP:  A recent study supports what many others have also indicated, those trying to lose weight who skip breakfast are just shooting themselves in the foot.

LINKS:  Here are a couple of new journals that offer a free issue:  
Clinical Aspects of Sport Medicine
Journal of Orthopaedic Trauma
Journal of Spinal Disorders and Techniques

TIP:  If looking for a great massage and soft tissue product, try Abolene.  It is a petroleum and paraffin based lubricant that is the closest thing to greased lightening I have ever used.  Sometimes hard to find, usually in plastic tubs in a pharmacy with the womens products, as it is labeled a facial cleanser.  I have used it for years, as my first hospital job used it all the time.

June 2
Article Review:  Lumbar Repositioning Deficit in a Specific Low Back Pain Population

TIP:  Make sure your total hip patients have sock aids, a dressing stick, long-handled reacher and shoehorn, elastic shoelaces, a raised toilet seat, long handled sponge, and a shower bench.  OT may not always perform this, and it only takes two seconds to review with patient when reviewing the other hip contraindications.

May 31/June 1
Article Review:  The Natural History of Spondylolysis and Spondylolisthesis:  45-Year Follow-up Evaluation.

NEWS:  A survey, releaved by the Health Coalition of Liability and Access, reveals that most Americans believe that more litigation means less care, that Congress should enact some reforms, and that a high number of lawsuits are not justified.  Click Here for the HCLA website and more info.

NEWS:  An article in the New England Journal of Medicine indicates that most medical release/consent forms have the language level of a 10th grade reader, which is too high for the aveage American, which is at the 8th grade level.  They suggest that forms should be modified for lower reading comprehension.  Great, lets just keep dumbing everything down instead of trying to coax people into a little improvement.  Maybe we can just continue until we are at the first grade level, with backwards letters and misspelling.

TIP:  Cross-over toe, a common problem in elderly patients, is usually due to failure or tearing of the plantar plate and joint capsule, allowing the second toe to fall out of alignment.  Usually, these patients will complain of pain on the plantar aspect of that metatarsal before the damage progresses, and those doing so should be treated accordingly to prevent progression.

LINK:  Advance for Directors is better than regular Advance, has news, generic articles that occasionally provide some clinically beneficial tips, and also a patient handout section.

MAY 2003

May 30
Treatment Tip:  This method of thoracic mobilization is quite effective, but very tiring and hard on the arms.  I can imagine it being real difficult for smaller therapists.  I began experimenting with having the patient push back into my hands as I apply the mobilizing force.  It helps quite a bit, and I have seen no change in results, and feel the same degree of joint play.  The extensor contraction does not appear to tighten the joint and act as a counter productive force.
Click on thumbnail for full size view of this technique


NEWS:  Preliminary studies have shown that Vitamin B products may be beneficial for pain relief with neurological injury, at least on rats.  Also, smoking increases bone loss in post-menopausal women.  More and more studies are revealing that smoking hampers bone formation via osteopenia, demineralization, high rates of non-union in fusion cases, and slower fracture healing times.

TIP:  Regarding yesterday's tip on videotaping throwing athletes:  If using either an 8mm or VHS-C camera, transfer the video onto the VHS tape, and then play on a 4-head machine that has single frame advance on the remote.  You can get one for less than $100 now, and then can play back frame by frame and show the patient what he/she is doing wrong.  This can also be used to market yourself, by having a coaching clinic where players, parents, coaches and trainers can attend and learn these skills.  We used to have an expensive 8mm player that did all kinds of great things, but a patient stole it!  Looked up one day and it was gone.

TIP:  Looking for a good method to say "Thanks" to a good referring source, or one that is new and sent you a patient?  Send a massage therapist to their office and provide 15 minute massages to all the staff members.  For 2-3 hours at $25-45/hour, you can't go wrong and the staff will love you.

May 29
Click Here for a member submission with links to sites that teach throwing mechanics, etc.  Read the commentary included to understand why I feel this type of information is very important.  Thanks Toby

TIP:  Often, the malpractice insurance you have through your employer covers you only while you are employed by them.  If you quit, go on your own, and a claim is filed regarding an incident that occurred while at your previous employer, you may not be covered!.  Your current coverage may not cover you for previous events!  Know your coverage to save your butt, and purchase umbrella policies (not that expensive) and make sure they will cover the gaps.  HPSO is endorsed by the APTA and is a common option.  Can you personally afford to defend yourself in a lawsuit?

LINK:  I am not a fan of the cheesy "The Fine Art of Healing" slogan the APTA is using, or even any of the others.  However, if you do like it, MedART provides all kinds of PT posters with this theme to spruce up your clinic.  Another option is Art Wall, where I have bought some unique posters that patients enjoy viewing.

May 28
Article Review:  Coccygodynia:  Treatment

TERM:  Orthorexia Nervosa is a term that describes a pathological fixation on eating only a perfect diet.  Persons may have this affliction if they focus on healthy food more than 3 hours per day, plan the following days menus, skip types of food they used to enjoy in order to substitute something healthy, show improved self-esteem when they eat something good, and quality of life reduction (Source: Advance for Directors)

NEWS:  A recent study by the NIH, published in JAMA, reports that women taking Prempro for HRT suffer an additional 23 cases of dementia for every 10,000 taking the hormone.  With increased reports of adverse effects, Prempro use has dropped from 3.4 million users last summer to 1.2 million users currently.

NEWS:  Lithium, currently used to treat manic depression, may show promise in preventing plaque formation that afflicts Alzheimer's patients by blocking the action of the protein GSK-1.

May 27
Article Review:  Toward a Better Understanding of Gait Changes With Age and Disablement:  Neuromuscular Adaptation.

May 21
Article Review:  Physical Therapy After Partial Meniscectomy:  Is It Effective?

NEWS:  Click Here for a page with some different news stories.

May 20
Today's update includes some news stories, a link to a new Orthopaedic journal, where a free trial copy can be obtained, a method to manipulate the biceps tendon, and the foot terminology set forth by the Terminology and Meaurement Committee of the Orthopaedic Foot and Ankle Society.  I read two articles in Spine today, and both were lousy, poorly written, had no significant clinical relevance, and therefore not abstracted.

May 19
Today's update includes a definition and description of the Lapidus procedure to the first MTP, the description of the Boyd and Pirogoff amputation, and the structural abnormalities that increase the likelihood of great toe ulceration in diabetic patients.

May 17/18
Article Review:  Scapular Dyskinesis and Its Relation to Shoulder Pain

May 16
Article Review:  Instability of the Proximal Tibiofibular Joint

NEWS:  A study done at the WVU School of Medicine found that in retired NFL football players, there is a 3x risk of future depression of they had 5 or more concussions during their career, and a 2x risk if three were 3-4 concussions.

NEWS:  JAMA reports that for every 2 hours a day spent watching TV, there is a 14% increased risk of type II diabetes!

May 15
Article Review:  Orthotic Correction Focuses on Tarsometatarsal Position

NEWS:  The National Heart, Lung and Blood Institute has announced that the blood pressure value of 120/80, once considered normal, is now slightly high and indicates risk for future hypertension.  The new government guidelines call this "prehypertension".

NEWS:  A recent JAMA indicates that over 60% of Americans are considered obese, that low carbo diets cannot yet be given either a thumbs up or a thumbs down, and that watching TV increases the risk of obesity more than other sedentary activities such as sewing, writing, or driving.

LINKS:
Informed Medical Decision Making
Collaborative Care
American Medical Assocation
National Institute of Health
American Cancer Society
Centers for Disease Control

May 14
Article Review:  The Clinical Importance of Meniscal Tears Demonstrated by Magnetic Resonance Imaging in OA of the Knee

TIP:  For those with tricep weakness from either HNP, neurological deficit, or another orthopaedic problem, encourage them to strengthen throughout the day by leaning on a flexed elbow, and even exaggerating the amount of weight they put on the limb.  As they gain strength, they can flex the elbow further, getting more into the "weak zone".  This could be done while standing at their kitchen counter, their desk at work, etc.

LINK:  This site has unique healthcare products mixed in with other gadgets.  Spine-Worx is available here for $39.95 (item 6X-2167), as is an inexpensive home JOBST type unit (item 6X-3083).  You can view these items and others on the site. 

NOTE:  I will be on vacation in Mexico until 5/13.  Will resume daily updates at that time.

May 5
Click Here for an update page that has information on the Simple Elbow Test, the Simple Shoulder Test, the WOMAC index for OA, the Carter/Wilkinson hypermobility test, and more stuff grabbed off the web.

May 3/4
Article Review:  Clinical Features of the Different Types of SLAP Lesions.

TIP:  Muscle testing the triceps looking for a C7 problem is often improperly performed when the PT has the subject sit, fully extend their arms out in front of them, and then resist having the PT try to break the locked-out position.  A sigificant weakness can occur and not be found if the patient is strong the the PT weak.  Instead, have the patient bend their elbows to 90-110 degrees, and then try to push you away while you keep the elbow bent in that position.  You will easily find the weakness here.  The long head of the triceps is usually the first to go, and performing this while the arms are raised to 180 degrees will isolate this grouping even more.

LINKS:  
Discount drugs out of the country:
Discount Drugs of Canada
Prescription Drugs Canada
Canada RX Shop
Buy online guide from the FDA 
The Pathology Guy:  Very interesting yet a little odd.
Animal Chiropractic
MassageWarehouse.com  Lots of products a PT clinic or training room could use
Serola Biomechanics makes Sacrotrac pillows, SI belts, and tennis elbow splints

TIP:  Posture, a multi-discipline magazine dedicated to postural correction, is published 4 times a year and can be ordered by emailing office@spinal-tech.com  Plus, it's free!

NEWS:  The South Beach Diet is a new book that uses many points in the Atkin's Diet, but does not eschew all carbohydrates.  Instead, it tries to balance with plenty of fruit, veggies, whole grains, nuts, and healthy oils.  Hardback version is now available by Rodale, for US$25.95


May 2
Click Here for a page with a whole bunch of tips, links, and news that would take up too much room on this page.

APRIL 2003

My Dad passed away last night at 11:55pm.  Thank you for all being patient during this time.

April 30
Book Review:  Good Orthoses and Other Forms of Conservative Foot Care in Book Review Section

What Happened With My Dad (For Members only)

April 15
Click Here for the Advanced Physical Therapy Education Institute, where you can subscribe to their free newsletter.

NEWS:  Not using wrist guards during in-line skating multiplies the risk for wrist injury by 10.4 times, and of elbow 9.5 times.  Lack of wrist guards accounts for 87% of all wrist injuries, and lack of elbow pads accounts for 82% of all elbow injuries.

TIP:  Here is a method to try and mobilize or tension the suprascapular nerve:  Components are horizontal shoulder flexion, shoulder girdle depression, cervical lateral flexion away and then rotation of the scapula all of which must slide the nerve though the notch. 

April 14
Article Review:  Anterior Drawer Test for Acute Anterior Talofibular Ligament Injuries of the Ankle:  How Much Load Should Be Applied During the Test?

NEWS:  Type II, or adult onset diabetes, was once rare in children.  However, lifestyle changes and obesity explosions in young children has resulted in signficant increases in the condition.  Some children as young as 6 are developing the disease, and excess weight is usually the culprit, with being black or hispanic also increasing the risk.  Here are 2 sites with more information on diabetes:  The Diabetes Association and the CDC

April 12/13
Member Tips from Kyle:  For patients with Morton's Neuroma, they should report that their symptoms are relieved when they remove their shoe and rub the foot.  If this is not reported, they probably are not suffering from a neuroma.  Also, male patients with sciatica and buttock pain often suffer from SI dysfunction, piriformis irritation, and sciatic compression from wearing a wallet in that particular pocket.  I suggest to move the wallet to the other side to relieve symptoms.   Thanks Kyle.  You are right on both counts.  Neuroma patients will almost always report symptom abatement when they take off their shoe.  You can also test for neuroma by squeezing their forefoot and then kind of grinding the metatarsal heads against one another to see if symptoms are reproduced.  Also, measure the width of their forefoot when standing and see if it is wider than the toe box of their shoe.  If so, they are compressing the met heads.  I have seen people squeeze their forefoot into a shoe that is one inch more narrow!  As far as the wallet idea, I usually have at least one or two men, usually 50-65, who have this problem and also wear a wallet that is ridiculously thick.  Their symptoms will give away the cause-pain sitting in the car, and localized to that buttock.  They are usually too old for SI problems, and the typical derangement complaint usually does not fit in this age group.  These people feel dumb yet consider you a miracle worker when they quit the wallet and their pain goes away!

NEWS:  A recent study found that wearing a FastSkin suit while swimming submaximally did not provide any physical or physiological benefits during free style swimming

TIP:  Do you have patients with knee OA, patellar problems, or meniscus injuries that have difficulty squatting for home gardening or their job?  If so, pads are made for baseball and softball catchers that fasten to the calf and provide a nice support for the posterior thigh when squatting.  Plus, they limit the amount of knee flexion and thus reduced knee compression!   

April 11
Article Review:  Jump Landing Strategies in Male and Female college Athletes and the Implications of Such Strategies for ACL Injury

April 10
Article Review:  Functional Biomechanical Deficits in Running Athletes with Plantar Fasciitis 

Answers to the DVT quiz from the other day:  Probabilities for scenarios 1-7 as follows:  Moderate, high, low, high, moderate, low.  All should have been sent to their physician for check-up.  How did you do?

April 9
Member Allan sent in this link, which is a 13 page article on the placebo effect and PT.  I saw this article posted at another site also.

NEWS:  Weightlifting in the US has increased 12% over the past year, while aerobic exercise decreased 2%.  Concerns are being raised as to how much blood vessel damage occurs with weight lifting, and how many persons suffer stroke and aneurysm rupture.  One study found that in one repetition max lifting contests, the blood pressure spiked as high as 370/360!

NEWS:  A physican at the University of Rochester is the one who invented Cox-2 inhibitors, but pharmaceutical company GD Searle & Co. are the ones who took the data and developed the product Celebrex.  Now the university is suing to recoup much of the profits, in a move that may change how many universities perform their research.  Traditionally, they did development and someone took the idea and ran with it.  Now, schools want to cash in on the profits their research has produced.


April 8
Article Review:  The Soleus Muscle Acts as an Agonist for the Anterior Cruciate Ligament

NEWS:  A new blood test being developed by Oxford University scientists for TB will look for T-cells as opposed to antibodies, and is going to be more accurate.  2 billion persons world wide are affected with the bacteria causing TB, and the disease kills 2 million persons per year.

NEWS:  Stents coated with the drug sirolimus, by Johnson&Johnson, prevents fresh muscle and scar tissue from growing into the artery causing reblockage as seen so often with typical stents.  However, the stent will now cost 3 times as much due to the change.

TERM:  Hot tub lung is a term to describe bacterial infection of the lungs that is caused by inspiration of mist, usually in an indoor hot tub, that has the mycobacterium avium present.

April 7
Test:  Does this patient have a DVT?  This was part of a study that I was involved in through  Virginia 'Commonwealth University PT program.  It basically presents case scenarios for patients , and you need to ask what is their risk for proximal DVT, and would you have sent these patients to their physician.  Review the questions, and I will put up the answers tomorrow.

NEWS:  Here are the adverse reactions to ephedra, which we should be aware of with athletes and dieting patients:  Death, heart attack, stroke, seizure, headaches, irregular HR, rapid HR, increased BP, nausea, vomiting, abdominal pain, heartburn, gastroesophageal reflux, tremors, twitching, jitteriness, insomnia, sweating, euphoria, neurotic behavior, agitation, depressed mood, giddiness, irritability and anxiety.

April 5/6
Article Review:  Risk Factors for Injury in Middle School Football Players.

LINK:  Click Here for the Cancer website, where one can learn the ABCD's of mole assessment (Asymmetry, Borders, Color, Diameter change).  We often see more of a persons back than even their own family members, and should alert them to anything that is suspicious.  I have a friend who is a dermatologist, and he has taught me some things to keep an eye out for.  Take a moment to speak with a local skin MD in your area and learn the same, as it may help save a life.

NEWS:  It now appears that HealthSouth fudged their earnings by some $2.5 billion, or almost twice as was previously alleged.  

NEWS:  C-section childbirth is on the rise, often voluntarily.  Now 1 in 4 births is done this way, often in cases of older mothers, or those who have had previous C-section and do not want the risk of a natural childbirth.  Also, increased reported of incontinence and pelvic disorders has prompted some women to choose an alternate birth method.



April 3

Question:  See a posting in the Forum section by site member Dr. S.C. Sood regarding Dowager's Humps, and please take a moment to comment.

Article Review:  Associations Between Back Pain History and Lumbar MRI Findings

NEWS:  A recent study in the New England Journal of Medicine indicates there is a relationship between the incidence of "silent strokes" and the risk of Alzheimer's.  Those with clinical evidence of brain damage from these strokes showed a greater incidence of dementia and Alzheimer's.

NEWS:  Medicare premiums are expected to rise by 12.3% next year, which amounts to an extra $86.40 elderly persons would have to pay.

NEWS:  A University of Pittsburgh is now the first to show, via a PET scan, the cellular damage seen in the brains of persons suffering from Parkinson's.  Previously, the damage could not be viewed until autopsy.

NEWS:  A drug being used in Europe, called memantine, has shown promise of slowing down memory loss and physical decline in persons with Alzheimer's.  The drug may be able to be used in addition to the current medicines taken by these patients, and the US government is now reviewing the evidence for use in this country.

April 2
Article Review:  Iontophoretic Administration of Dexamethasone Sodium Phosphate for Acute Epicondylitis.

Evaluation Tip:  The Posterior Load and Shift Test is used to detect posterior shoulder instability.  Pain or grinding are the common positive findings.  Have the patient either site or lie supine, stabilize their scapula, flex the arm to 90 degrees, internally rotate, and apply a posterior force along the shaft of the humerus.

April 1
TIP:  Another epicondyle taping tactic:

MARCH 2003

March 31
Article Review:  Acute Compartment Syndrome of the Foot Following An Inversion Injury of the Ankle with Disruption of the Anterior Tibial Artery: A Case Report

PRODUCT:  Visit Midwest-PT to see a handheld portable US machine that delivers constant US at approximately 1.0 w/cm2, running only US$139.95.
March 29/30
Article Review:  Microcirculation Associated with Degenerative Rotator Cuff Tears

March 28
Article Review:  Manual Therapy and Exercise Therapy in Patients with Chronic Low Back Pain.  Also includes the description of Schober's test.

March 26

Click Here for a link to an article abstract that deals with claudication and medication, including pentoxifylline, which my father took for PAD.

NEWS:  Due to the accounting scandal perpetrated by the CEO and upper officers, shares of HealthSouth, the country’s leading rehabilitation provider, have dropped to $0.11 and have been taken off the NYSE.  Odds are the company will be forced into bankrupsy, and most likely will sell off assets and clinics to cover debt.

The American Neurological Institute has reported that patients with MS show the presence of myelin olgodentrocyte glycoprotein (anti-MOG) antibodies in their system.  Those with progressive MS almost always had elevated levels, while one-third of those with relapsing/remitting MS displayed their presence.  This may be either a cause or an effect, but the presence of the anti_MOG in persons may be a diagnostic tool for detecting the more severe forms of MS and issuing a prognosis.

A new 3 year study is underway to discover if reaming out the tibial canal when placing an intermedulary nail benefits the fracture healing process or impedes it, as some surgeons have suggested.

CRIS, or Composite Reinforcement Instead of Sidebars, a new bracing idea for knee OA and ACL patients.  The bracing is based on the theory that fit, location of straps and stiffness are the most important aspects in reducing tibial translation as opposed to large sidebars.  The products for a custom made brace can be purchased for approximately US$140, and fabrication takes 4-6 hours.  The streamlined and less bulky brace can be seen in the April 1 2003 issue of O&P Buisness News

Click Here for the French Qolid website, where one can pay to have access to hundreds of questionnaires used in medicine.

March 25
Article Review:  PoleStriding Exercise and Vitamin E for Management of Peripheral Vascular Disease

LINK:  Click Here for a VA webpage with abstracts that also provides links to other sections of their site.

March 24
Today's update is 4 more movies on the movie page.

March 22/23

I have added a FORMS section and a MOVIE section to the Member Index.

This Stuff would have been good for me when I was a kid, I certainly would have eaten better.

Click Here for a newsletter in the Stretching Handbook

March 21

OK, I am back.  Here are 4 movies showing manual techniques.  Unfortunately, I cannot view them on my computer, so I need you members to tell me which movie shows what, so I can provide a detailed explanation of the technique provided.  Also, I would like feedback as to the quality, size of the files (too long to download?), etc.  Also, will take requests for any other techniques!

Movie 1                Movie 2                    Movie 3                Movie 4

 
March 15/16
Article Review: The Effect of Eccentric Strength Training at Various Speeds on Concentric Strength of the Quadriceps and Hamstring Muscles

NEWS:  According to a new issue of The Journal of Foot and Ankle Surgery, surgical treatment of bunionettes, or bunions at the fifth metatarsal, can be very successful.  In the study, the bunion surgery was done on 25 feet from 16 people who had unsuccessfully tried other treatments. Overall, 96% rated the surgery as either good or excellent and said they would do it again. Complications from surgery occurred in four feet, including infection and nerve compression. But for the most part there were no limitations on daily activities. After surgery, 28% of the people still required comfortable shoes and could not wear fashionable shoes. But no one required modified shoes or braces. Other surgeries to correct bunionettes include shaving excess bone to remove the bunionette or realigning the joint behind the little toe to correct the deformities.

March 14

NOTE:  Instead of reading an article for an update today, I met with someone who used a digital movie cam to make some .mpeg movies of some manual techniques.  He is due to refine these and email me by tomorrow night, and I will post.  Hopefully it works well and I can create a whole list of these.  If any special requests, let me know!

TIP:  I have noted many times how controlling excessive and/or delayed pronation can reduce PF pain, as it can diminish the amount of tibial internal rotation during gait.  Remember that the torque motion can also exacerbate an injured meniscus as well, so make sure that your patients with meniscus tears have this problem, if present, under control.

TIP:  If you treat a patient that has a torn plantaris or gastrocnemius and has pain during ambulation or when standing, do this:  Have them stand in your clinic barefoot, and keep adding magazines under their heel until they no longer feel pain or strain.  If under 1/2 inch, you can go with an in-the-shoe lift.  If over 1/2 inch, have the bottom of their shoe temporarily built up by a shoe maker, or have them wear heels/cowboy boots until healing has occurred.

NEWS:  Columbia University has found that those individuals who consume large amounts of saturated fats (from animal based products) have significant higher risks for developing Alzheimer's than those who consume lower amounts.  Also, those persons who ate large concentrations of polyunsaturated fats (14.5 grams daily from vegetables/nuts) had a 70% reduced rate of Alzheimer's than those who ate small amounts of these fats.



March 13
Article Review: Adult Degenerative Lumbar Scoliosis

March 12
Here is a nice list of bicycling tips to provide to your patients as we enter the spring exercise season

Click Here to go to the Slack website for a new interactive CD-ROM called "Orthotics:  A Comprehensive Interactive Tutorial".  A good purchase for those who want to expand their clinical practice and include some orthotic service.

Click Here to go to a site that offers free medical journals online, older issues of course.  Or Here for another site

Click Here to quickly complete a survey that a fellow PT is completing

March 10
Article Review: Pelvic Seat Designs and Their Effect on Pelvic Angle, Trunk Angle, and Comfort.

To view prices, pictures, and styles of the saddles mentioned in the above article, go to either BikeNashbar  (Go to "Shop By" categories and choose "saddles")or Performance Bike

March 9

Member Tip:  Remember to strengthen the sartorius in athletes who have had their semitendinosis and gracilis removed for an ACL autograft.  While standing, (an ankle weight or sport cord can be used), have the patient simulate the motion used when crossing the legs.  Strengthening (or "super strengthening") this muscle can facilitate knee flexion strength along with posterior-medial dynamic stability.

TIP:  Patients with C7 dysfunction and/or damage may not have any symptoms into the arm, but rather scapular and upper trapezius pain.  The standard muscle test used by most PT's, where the patient locks their arm in front of them and the PT attempts to "break" the lock is quite ineffective.  The patient can have 4/5 strength and still be able to lock out the arm.  Instead, have the patient flex their elbow to 90 degrees, and then have them push out into you.  Once you have matched their contraction, you can apply extra force to break the contraction in order to grade more efficiently.  Having the patient sit in a chair and perform this overhead will really reveal the weakness, as the long head usually goes first.

TIP:  An article in the Dallas Morning News reports on a few companies that have sprung up to help persons with hard disk crashes that really had no warning signs, and need to recover disk function.  Sometimes, excessive clicking and other noise will warn of an impending hardware failure, other times this may not happen.  Those drives manufactured in the 1990’s that are still operating may be on borrowed time.  Computer users should perform back-ups and defragment routinely.  Companies such as Seagate, Maxtor, and Western  Digital make drives that last, while IBM’s Desk Star (called “Death Star” by one computer tech) and Fujitsu MPG have been problematic.  Two companies that can help recover data are CBL Data Recover Technologies and Data Recovery Services.

March 8


Added to the Protocol Section are 4 new protocols:  Rotator Cuff Repair, Acromioplasty, Posterior Tibialis Tendon Insufficiency, and a Trunk Stability Protocol

NEWS:  Sarcopenia, or muscle loss due to  disuse, can be somewhat reversed with exercise.  The National Institute on Agine as a video and booklet called "Exercise", that can be found online here, or by sending US$7 for S&H to NIAIC, Dept. W, PO Box 8057, Gaithersburg, MD, 20898-8057.  You can call and order at 800-222-2223

NEWS:  Harvard researchers found that the intensity of physical activity needed to reduce the risk of heart disease depends on individual fitness levels. Their findings are published in Monday's rapid access issue of Circulation: Journal of the American Heart Association. "The harder one exercises, based on his or her perception, the lower the risk of heart disease, even if the activity does not meet current recommendations for physical activity,"

NEWS:    The National Cancer Institute has reported that two studies using aspirin can reduce pre-cancerous growths of polyps by as much as 35% in those who are considered high risk.  COX-2 NSAID’s may also prove to be effective after more study.  However, another issued report notes that those who take aspirin daily for CAD using either baby aspirin or coated aspirin may end up with far less beneficial results compared to standard aspirin.  Persons who took these products and followed had higher incidences of cardiac events, and now further study is needed.  Click Here for full story.

March 6
Article Review: Eccentric Muscle Strength in Functional Ankle Instability

March 5
Click Here for a Word version of the Swiss Spinal Stenosis Score (SSS).  The treatment portion of this score indicates post-surgical treatment, but could be changed to post-therapy treatment.

NEWS:  Medicare beneficiaries with 4 or more chronic conditions like asthma, arthritis, DM or HTN are 99 times more likely to experience a preventable hospitalization than those without a chronic condition, as reported in the Archives of Internal Medicine.  82% of those on Medicare have at least 1 chronic condition, 65% have multiple and these people account for 95% of all Medicare costs.  The average cost per capita of a person with no chronic condition was $211, rises to $2394 with 2 conditions, and up to $4701 with 4 conditions.  Current treatment focuses on providing acute care instead of managing these chronic conditions in the first place, according to the co-author.

Becker Orthopedic provides various extension orthosis for those with kyphosis.  The new L35, which is not featured on this link, is a 3 point system with easy waist adjustment straps.  I have a patient that insists I find him a brace such as this to help with his posture, and like the features of these models.

March 4
Click Here for a Word version of the Oxford Claudication Score that can be edited and printed on your own letter head for clinic use.  Tomorrow will print the SSS score.  These are both valuable tools, as indicated in 2/28 article review, especially when treating Medicare and other payers who look for proof of functional improvement with therapy, not just ROM and strength.  Your physicians and referral sources may also appreciate the information and your ability to support your treatment with outcomes.


March 3
Article Review: NSAID's and Musculoskeletal Injuries:  What is the Evidence?

March 1/2
Article Review: Spine Loading Characteristics of Patients with LBP Compared to Asymptomatic Individuals.

NEWS:  "Only One Man Died" is an exhibit going on through Feb. 2006 at the College of Physicians in Philadelphia.  It details the medical treatments used during the Lewis and Clark expedition.

NEWS:  Risedronate (Actonel) is a drug that has been shown to significantly reduce moderate and severe vertebral fracture risk by 70% within one year.  A study with 1994 post-menopausal women revealed that an overall reduction of 63.9% could be expected in risedronate treated patients.

FEBRUARY 2003


All articles prior to this date in the Archives Section