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Professional PT
Clinical Corner
Issue 5

May 2015

The Key Ingredients for an Exceptional Patient Experience


Inside this issue:
Key Ingredients

A Day in the life of..

2,3

Four Simple Reasons

4,5

Evidence of Team
work

Use of Lumbar Support Brace

Course Review

Etiology & Interven- 9


tion of Running Related Lower Extremity Stress Fractures
Article review

10

GEMS

11

Announcements:
MedBridge novice
Knowledge Track is due
May 15, 2015
Rehabilitation and Performance Enhancement
of the Athletic
Knee seminar is May 9,
2015
Maitland seminars sponsored course coming
soon!

David Skudin

We can transform an
ordinary moment into
an extraordinary one
for our patients and
deliver an exceptional
patient experience utilizing these 4 ingredients.
1. Calling
The way you perceive
your work has a major
impact on whether you
'bother' to exceed expectations or not. We
relate to our work as a
"job", a means to pay
the bills as a "career",
aspiring for promotions, job titles, etc., or
as a "calling", one's
personal mission and
life purpose. Calling is
the first key ingredient
for exceeding others'
expectations.

Empathy enables us to
take off our own eyeglasses and put on
those of the patients
and families we are
called to serve so as to
see through their eyes.
When we do so, changing I or You to
We, we can better

patient compassionately if we are to exceptionally serve all those


entrusted to us.
4. Emotional Connection
Patients rate an emotional connection
through personal and
proactive communication as "very important" for
healthcare providers,
more than any other
industry. Emotions
influence what we remember, how we
evaluate experiences
and our future decisions,"

Whether administrative, clinical, business


related departments
or corporate, we are
all part of the patient
understand and re2. Empathy
experience and can
spond to another pertransform the ordinary
Empathy is the ability
son's feelings.
into the extraordinary
to identify with and
by bringing together
3. Compassion
understand another's
the key ingredients for
feelings, situation and With the desire to see
creating an exceptional
motives. The key to
through the eyes of
patient experience:
delivering exceptional
patients and families
calling, empathy, comcare experiences to
that comes with empapassion and making an
everyone, all the time, thy, compassion comemotional connection.
requires caregivers
pels us to act; it's the
to view all care experi- outward expression of
ences through the eyes an inner desire.
David Skudin is the Direcof the patients and
tor of Customer Service
As physical therapy
for Professional PT
families.
industry leaders, it is
our job to treat every

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2014

YPage 2

Professional PT Clinical Corner

A DAY IN THE LIFE


Justin Harbst ATC at Manhasset High School/Great Neck Clinic
Monday April 13th 2015

attend school.

playing a sport they must see


the nurses. If they see a doc
6:30am: Arrive at Great Neck
-Justin grabs a quick bite to eat
who
then removes them from
clinic
(1 minute) then returns to floor
phys. Ed. class, they must also
to attend to Annas patients.
Manhasset athletes must arrive
be removed from participating in
to PT at 6:30 AM to allow enough 9:20am: Parent of Manhasset
after school activities. This
time for treatment and still get
athlete arrives for treatment.
means they are not even allowed
to class on time, which means
Justin is made aware that his son to warm up with the rest of their
Justin can see anywhere from 2team.
fractured his ankle while skiing
7 Manhasset athletes before
out west and quickly makes a
However, depending on the inju8:00am. The athletes can be
referral to Dr. Drakos. Justin is
ry, Justin is allowed to put them
lacrosse (lax) players in middle
able to get his son in ASAP.
through exercises on the sideschool or softball players in their
line.
last year of high school. Many of 10:00am: Justin emails Kevin,
-If an athlete sustains a concussion,
the athletes he sees are already the other ATC at Manhasset, to
update him on the athletes being they must follow the school protocol,
committed to college for lawhich Justin strictly adheres to and
crosse. They do PT before school seen
because they have to go to
practice after school, even if it is
just to watch. Boys and girls lax
players from Manhasset often
commit to DI colleges by their
sophomore year in high school
and some even have verbal commitments as early as freshman
year.

10:00am-1:30: Justin assists


Anna with the rest of her 39 patient case load.
1:30: Justin must leave for
school, but finishes up some

7:40am: Girls Manhasset lax


player arrives after seeing Dr.
Neri. Surgery is scheduled for
April 24th.

2:30-3:08: Justin eats lunch, gets


any last-minute notes in, and sets
up the fields/gym for practices or
games.
3:08: Bell rings signaling the end of
school

7:00am: Girls Manhasset lax


player seeing Dr. Neri to discuss
ACL reconstruction
Justin emailed Dr. Neri the night
before to give him a heads up
about his athlete

has helped to create. Sometimes


explaining the step by step process
to the parents can be the most difficult part.

*no athlete is allowed in the athletic


training room until then.

notes, confirms afternoon appointments for his athletes with


Michele, and grabs lunch.

1:45-2:15: Justin meets with


Kevin and the assistant AD at
Manhasset to discuss any sched-Justin discusses with mom what ule changes.
we will be doing pre-surgical as
2:15-2:30: Justin meets with
well as how the school
inthe school nurses to discuss any
surance works.
injuries that pertain to missing
8:00am: All athletes, except for physical education class.
pre-surgical lax player, leave to
-If an athlete is injured while
For internal use only. Not intended for external sharing or distribution.

3:08-3:40: Justin and Kevin will


treat and evaluate between 25-50
athletes, depending on the season.
Treatment can include taping,
stretching, icing.
-Evaluations are done on a first
come first serve basis, if an athlete
shows up right before practice it
does not matter if they are on a varsity sport or in middle school, they
will have to
wait.
-Very little physical therapy is done
in the athletic training room as there
is no time.
(continued on 3)
Professional Physical Therapy 2015

Page 3

Issue 4

A DAY IN THE LIFE (continued from page 2)

3:40-4:15: Kevin heads out to

office where Michele evaluates


her ankle. It is
decided
that she most likely has a high
grade lateral ankle sprain, but
-Justin will determine which
Michele would like her to
see
athletes can participate in pracan orthopedist. Justin texts Dr.
tice/games or if they need furAngel who returns his text and
ther
treatment. If an athlete
says she can come by the next
is going to sit out of practice for
day anytime she likes. Justin
more then a day, then either
follows-up with the mom and
physical therapy or a docs visit
the coach.
is warranted. He contacts the
parents to discuss his thoughts 6:30-9:00pm: Boys varsity lax
and assists, if needed, in
game, which Justin is covering.
making appts at docs offices or
-Justin tapes and stretches at
the Great Neck clinic.
least 15 athletes before the
4:15-6:30: Justin and Kevin
game and updates the parents
are out on the fields covering
who
are standing on the
practices and games. Justin
sideline about their injured chilmakes numerous phone calls
dren. Justin makes last minute
(5-8) to parents as injuries oc- decisions
based on precur. game testing, which athletes
can play. If they have seen a
During a girls lax game, an
doc and have a note clearing
athlete rolls her ankle. Justin
them to participate in all activievaluates and decides he would
ty, which has then be signed by
like a second opinion. As the
the nurses and school physidocs offices are closed, he decian. Justin has the final say as
cides he would like a second
to whether they can participate
opinion and sends her with
in the game or not.
her parent to the Great Neck
the fields while Justin says behind to call parents and docs.

Note from the editor:


Welcome to the May Clinical Corner. This is a busy time of year
in the clinic, please make sure to
take some time for yourself to reenergize. This months newsletter
is filled with some good information from all clinical departments of the company. Hope
you enjoy and as always feel free
to send in your articles.

9:30pm: NO INJURIES!!!!!
-Justin is almost done for the
day, he returns to the Athletic
Training Room to straighten up
from pre-game/practice treatment. Finally, he heads home
to eat a home cooked meal that
was prepared by his loving girlfriend (that is way out of his
league) and winds down to
some country music and Modern Family.

Justin Harbst is an ATC at Manhasset High School/Great Neck Clinic

Nine tenths of education is encouragement.


- Anatole France .

Robert Shapiro
For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015

YPage 4

Professional PT Clinical Corner

Four Simple Reasons Athletes Must Sprint


Robert A. Panariello MS, PT, ATC, CSCS
The athletes ability to sprint at
high velocities is an integral
component in the related fields
of Sports Rehabilitation and the
Performance Enhancement Training of athletes. A principal objective of the rehabilitation process
is to restore the athlete to their
previous level of athletic performance including the athletes
pre-injury running velocity. With
regard to the athletes performance enhancement training, a
necessary component of training,
when appropriate, would be to
enhance the athletes abilities in
linear velocity. The review of the
various rehabilitation and/or performance enhancement training
program designs often leads to
the inquiry, as well as reveals
the lack of an appropriate programmed sprinting volume as
often the focus of the running
volume prescription is tempo in
nature. The Rehabilitation and
Strength and Conditioning (S&C)
Professional must ensure that
the athlete incorporates an appropriate and proficient amount
of sprinting volume into their rehabilitation and performance enhancement training program designs. Based on the athletes
medical history, physical quality
levels, biological age, training
history, etc., these appropriately
prescribed sprinting volumes will
vary from athlete to athlete.
Nonetheless it is essential to include appropriate high velocity
sprinting volumes into the athletes rehabilitation and training
program design.

The following are some of the


simple explanations for prescribing suitable sprinting volumes for
the athlete:

from the agonist muscle group(s)


while the antagonist muscle
group(s) has a lower level of
contribution. This emphasized
contribution of the agonist musSpeed Enhancement The obcle group results in a shift in the
vious reason for the incorporaco-activation index in favor of
tion of appropriate sprinting volthe agonist. This emphasized
umes is for the athlete to incontribution of the agonists recrease their linear velocity.
sult in optimal high speed proSpeed is a dangerous weapon in
pulsion, as well as a fluid motion
the world of sport and the fastest
of the body in the desired direcathletes will have a distinct adtion of movement. Charlie Franvantage over their slower oppocis and Tudor Bompa have indinent in the arena of athletic
cated that the highest skilled
competition.
athletes are those with the abilImprove the co-activation in- ity to completely relax their andex of the lower extremity
tagonist muscle groups during
musculature - An additional
high velocity movement and that
benefit of performing high sprint- ridged and rough movements are
ing velocity training is the effect a result of poor coordination beupon the bodys co-activation
tween the agonists and antagoindex. A simple example of the
nists.
co-activation index occurs during
Speed Endurance Its one
slower velocity body weight (as
thing for the athlete to perform
well as applied weight intensity)
at top sprinting speed for a few
activities resulting in the stabilirepetitions, but a necessity of
zation of a joint via the agonist
many athletic contests is for the
and antagonist muscle groups
athlete to perform at top velocity
working together as these slower
frequently throughout the length
movement velocities result in an
of the competition. If the athlete
applied stress application over a
does not have the speed endurprolonged period of time. Thus
ance to perform at maximum
the co-activation index of the
velocity repeatedly over time,
agonist and antagonist muscle
excessive fatigue will occur regroups working together during a
sulting in a loss of force output,
prolonged slow activity perfortechnical proficiency, possible
mance is close to a 1:1 ratio.
risk of injury, and neuromuscular
High velocity sprinting moveinefficiency during the sprinting
ments are dependent upon a
performance. The athlete must
brief factor of ground contact
perform an adequate volume of
time. The performance of high
sprinting to establish an approvelocity sprinting activities repriate level of speed endurance.
quires a prominent contribution
(continued on page 5)

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015

YPage 5

Professional PT Clinical Corner

Four Simple Reasons Athletes Must Sprint


Neuromuscular timing The
literature has demonstrated that
hamstring muscle most often
injured during athletic competition is the biceps femoris (BF).
One possible mechanism that
may result in the injury of this
muscle is poor neuromuscular
timing. The BF muscle is comprised of a long head and a short
head with different nerve innervations. The tibial nerve innervates the long head of the BF
while the short head is innervated by the common peroneal
nerve (Figure 1). If the neuromuscular timing of the BF muscle innervation is poorly coordinated, this may result in a hamstring injury.
An analogy of neuromuscular
timing made occurs during the
rehabilitation of the rotator cuff
musculature of the shoulder in a
baseball pitcher. During this
shoulder rehabilitation a neuromuscular timing must be established between the musculature
of the gleno-humeral (GH) and

(continued from page

gression requires the shoulder/arm to travel at higher


throwing velocities during each
throwing phase of the athletes
rehabilitation. Thus the neuromuscular efficiency, or timing, of
the GH&ST musculature that is
required for optimal throwing
performance is enhanced via a
progression of higher throwing
velocities. Therefore wouldnt the
efficient timing of the dual innervation of the biceps femoris require the same high speed program design for optimal perforscapula-thoracic (ST) joints of
mance as well as the prevention
the shoulder for optimal throwing of injury?
Figure 1 The Biceps Femoris
Optimal running velocities are
Muscle
imperative for success in many
performance to occur. During the athletic endeavors. Appropriately
final stages of rehabilitation the
prescribed sprinting volumes at
initiation and progression of a
the applicable times will not only
post-operative rotator cuff repair enhance and athletes sprinting
tossing/throwing may be prevelocity, but maintain that linear
scribed as follows: Short Toss to velocity throughout the course of
Long Toss to Pitching on Flat
athletic competition while assistGround to Pitching from a Pitch- ing in the prevention of lower
ers Mound.
extremity injury as well.
This rehabilitation throwing pro-

MedBridge Facts:
Professional Physical Therapy clinicians earned 633 C.E.U's and completed 300 courses this
year to date thru MedBridge.
Top 5 clinics in completed courses are :
1. Columbus Circle (32),
2. Whitestone, (28)
3. West Side (19)
4. Roslyn (18)
5. White Plains (17)

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015

Page 6

Issue 4

Evidence of teamwork relevant to the quality and safety of patient care


Daniel Hirsch

Studies have focused extensive


research finding a relationship between factors contributing to adverse incidents and the role in
which teamwork plays on the
quality and safety of patient care.
This article by Manser, reviewed
the literature in order to conclude
a connection based on domains of
healthcare including operating
rooms, intensive care, emergency
medicine and trauma teams.

they found interesting results.


Members of different professional
groups all perceived themselves as
having little personal responsibility
for creating and ultimately resolving tension.

correlation between the quality of


teamwork and patient outcomes
exists in every clinic. Formal practice to improve communication
between staff and other healthcare
providers is an effective way to
improve clinician performance and
Comprehension of patient care
the patient experience in physical
goals were highly predicted among
therapy. As we continue to grow,
team members of an intensive
the role in which teamwork plays
care unit when clear open commuon the quality and safety of panication was perceived. Health
tient care should always remain a
care providers attitudes on releading priority.
Methods used to study staff attisearch toward strong teamwork
tudes and perceptions included
indicated that they do not fully apsurveys, interviews and focus
preciate the influence of psychoT. Manser. Teamwork and patient
groups to measure the perceived
logical factors on clinical perforsafety in dynamic domains of
quality of teamwork. Retrospective mance. Manser also concluded
healthcare: a review of the literaanalysis discovered communicathat improved teamwork may conture. Acta Anaesthesiologica
tion and teamwork issues to be
tribute to increased clinician health
Scandinavia. Volume 53, Issue 2,
the leading contributory factor in
as well as improved patient out(2009): pages 143-151.
incident and adverse event recomes.
ports. Observational analysis proAlthough this article did not invided similar findings indicating;
clude physical therapists in the list Daniel Hirsch is the Director of Incommunication breakdown directly
ternal Audit for Professional PT. He
of healthcare providers, we know
impacted an increased rate of surcan be reached at
that skilled physical therapy is a
gical errors.
critical part for our patients limited dhirsch@professionalpt.com or by
When the study investigated clini- by injury in reaching their highest phone (516) 321-2400 ext 2473
cians perceptions of teamwork,

level of function. I believe a strong

Clinician Spotlight: Jessica Paparella DPT


Congratulations to Jessica Paparella for presenting
at the Long Island District of the NYPTA on April
12, 2015 at NYIT in Old Westbury. Jessica presented a course entitled, Concussion: Manual
Therapy to Optimize an Environment for Healing .
Jessica Paparella DPT, PT is a physical therapist
and Clinical Director with Professional Orthopedic
and Sports Physical Therapy in our Garden City facility, Jessica graduated from Stony Brook Universitys Physical Therapy program in 2009. Jessica is a
former collegiate softball player and has a special
interest in manual therapy.
For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015

Professional PT Clinical Corner

Page 7

Use of a Lumbar Support Brace;


When to use a lumbar support

Robert Shapiro MA PT COMT

grade spondylolisthesis.

temporarily when nothing


else is working and another
route is being considered

post-surgical when ordered


by physician

hyper-acute pain as a tempo- What are the effects of a lunar support?


rary measure

unstable disc lesion where


exacerbations have a minor
or no apparent cause.

task specific, when a certain


avoidable activity consistently
causes an episode

advanced segmental degeneration

gross instability such as

the increase in abdominal


compression decreases intradiscal pressure by up to
30%.

limits ROM so as to prevent


unwanted movement

limits unwanted postures

prevents sudden pain provoking movements.

Selection of Techniques: Quick reference


PAIN/RESISTANCE

ACUTENESS

TECHNIQUE

Pain, no resistance

Empty (serious pathology)

None

Constant pain

Hyper-acute (chemical)

RICE

Pain before resistance

Acute (mainly chemical)

Grade 1,2 , traction

Pain w resistance

Sub-acute

Grade 1,2 Passive physiological, or


Passive accessory movements

Pain after resistance

Non-acute

Grade 3,4

Resistance no pain

Stiff (mechanical)

Prolonged stretch, Gr 4+++

Random quiz questions


1. what is the most common nerve injury after anterior shoulder dislocation?
2. How accurate is muscle testing in the diagnosis of cervical ? 0 %, 25% 50% or 75%??
3. What is the importance of the iliocapsularis muscle of the hip?
4. How much cervical ROM is required to tie your shoes?
5. What is the normal functional range in the TMJ for opening?
Answers can found on page 11
For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015

Professional PT Clinical Corner

Page 8

Shirley Sahrmann Seminar Review:


Last month I had the pleasure of
attending a shoulder and neck
seminar by physical therapist
Shirley Sahrmann. If you are
not familiar with her, she is most
known for her categorization of
the movement system, and diagnosing musculoskeletal problems
by their movement impairment
as opposed to the tissue pathology. A Sahrmann course is worth
taking to see her detailed examinations. She also loves to laugh
at her own jokes and has the
funniest cackle, which had the
audience cracking up.

Adrian Datu DPT, OCS, CSCS, Cert. MDT, USAW

ment into what exercises will be


the most effective in addressing
this presentation. This eliminates randomness in the treatment and justifies everything
you do. To correct this impair-

bility as well as proper mechanics. The quadruped position can


be used to treat nearly every
body part and is one of the most
effective positions to treat scapular dyskinesia. Although not a
believer in manual therapy she
does believe in doing stabilization with movement or guiding
the body part in order for it to
move properly. Finally, place the
majority of emphasis on addressing daily modifications.
Patients are more likely to
change a habit versus doing an
exercise.

Sahrmann's movement system


impairments is strictly based on
a thorough examination and
evaluation using anatomy and
kinesiology. She describes what
should be normal according to
research. Her treatment consists
of having the patient move in
these normal patterns. More so,
she spends time discussing what
they should be doing as activity
modification to promote this
movement pattern.

Her text book, Diagnosis and


Treatment of Movement Impairment Syndromes, goes
into more detail recognizing and
treating different movement patterns. I highly recommend it to
ment you need to strengthen the
further enhance your examinascapular external rotators, like
tion skills.
the serratus anterior, and the
posterior tilters like the lower
traps. Also, stretching the muscles that might be placing the
scapula into anterior tilt like the Adrian Datu DPT, OCS, CSCS,
Cert. MDT, USAW is a physical
pec minors.
therapist in our West Side faThe most common shoulder dysThe big takeaways I got from her cility.
function you will find is scapular
lecture are ideas that can be
internal rotation with anterior
In case you haven't figured it
used in the clinic right away.
tilt. This is a common presentaWhen in doubt address the ser- out, Adrian is the tall one.
tion of shoulder impingement but
ratus anterior. It plays a huge
is much more descriptive. The
role in the upper quarter for staexam easily guides your treat-

Quick reference: Grading Collateral Ligament injuries:


Grade 1 < 5 mm joint line opening with stress
Grade 2 5 to 10 mm joint-line opening with stress
Grade 3 10 mm joint-line opening with stress

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015

Page 9

Issue 4

Etiology & Intervention of Running Related Lower Extremity Stress Fractures


Benjamin Pringle MS ATC, CSCS
The annual incidence of injury
among runners have been estimated from 37%-56% where >
90% of running related injuries
occur in the lower extremity1.
Stress fractures are a common
lower extremity injury in runners/athletes with rates of 5%20%1. Regarding demographics
affected, Caucasian female long
distance runners are of highest
risk of stress fractures. Lower extremity overuse injuries in the
general competitive athletic population account for 13% of men
and 24% of women, some of
which can lead to bone stress related injury2. Stress fractures are
considered an overuse injury
caused by an accumulation of microtrauma due to high impact related activity. Bone is an adaptive substance like muscle and
responds to the stresses placed
upon it. Review Wolffs law
(Julius Wolff) and work by Harold
Frost and his mechanostat theory.
Microtrauma results in a bone pathology continuum of least severe
to most; periostitis or osteopenia,
stress reaction, stress fracture.
Levels of microtrauma can be correlated to mechanotransduction
and the term known as microdamage threshold3,4.

short, loading rates are measured


as the amount of force one produces in a given period of time
when striking the ground during
impact activity such as walking,
running and jumping. Other risk
factors that have been identified
are gender, bone density, sudden
changes in physical activity, high
volumes of high impact activity
without adequate rest, unforgiving or changes in training surfaces, improper or over worn footwear, abnormal foot postures (pes
cavus and pes planus) and high or
low body mass index.

Regarding prevention of this pathology, recognizing the early


signs and providing the proper
intervention is vital. As clinicians,
we must take thorough histories
during our clinical examinations
paying special attention to sudden
changes in physical activity and
watch for signs and symptoms
such as pain during and/or after
high impact activity, local bony
tenderness, pain with bony percussion and localized soft-tissue
swelling over bone5. Advanced
cases involve pain that persists
well after activity and at night.
The most comprehensive and definitive method of diagnosis beyond a clinical examination is an
Upon completion of my literature MRI. Attempts in reducing and
review and research proposal last preventing the incidence of these
fall at San Francisco State Univer- pathologies have been studied.
sity in finalizing a Masters Degree Current methods include orthotin Kinesiology, lower extremity
ics, gait analysis, gait retraining
stress fractures was the topic I
and anti-gravity treadmills with
chose to address. The main findno substantial findings. One ining from my literature review was teresting intervention that has not
that loading rates was the main
been further studied is gait refactor that was linked to injury
training. I recommend articles 6
risk but had not been further car- and 7 listed below as I believe
rier out in recent research and
there is promise in technology rewith the athletic population. In
For internal use only. Not intended for external sharing or distribution.

garding the prevention of


this pathology in addition to
devices such as the Alter G
Anti-Gravity Treadmill.
There is also a need for evidence based conditioning
programs involving cross
training for runners to enhance performance and
minimize overuse injury.
1. Nagel, A., Fernholz, F., Kibele, C., Rosenbaum, D. (2008). Long distance running
increases plantar pressures beneath the
metatarsal heads: a barefoot walking investigation of 200 marathon runners. Gait
and Posture, 27; 152-155.
2. Yang, J., Tibbetts, A.S., Covassin, T.,
Cheng, G., Nayar, S., Heiden, E. (2012).
Epidemiology of overuse and acute injuries
among competitive collegiate athletes.
Journal of Athletic Training, 47(2);198
204.
3. Morseth, B., Emaus, N., Jorgensen, L.
(2011). Physical activity and bone: the
importance of the various mechanical
stimuli for bone mineral density. A review.
Norsk Epidemiologi, 20(2); 173-178.
4.Nazer, R.A., Lanovaz, J., Kawalilak, C.,
Johnston, J.D., Kontulainen, S. (2012).
Direct in vivo strain measurements in human bone - a systematic literature review.
Journal of Biomechanics, 45; 27-40.
5.Beck, B.R., Bergman, A.G., Milner, A.,
Arendt, E.A., Klevansky, A.B., Matheson,
G.O., Norling, T.L., Marcus, R. (2012).
Tibial stress injury: relationship of radiographic, nuclear medicine bone scanning,
mr imaging, and ct severity grades to clinical severity and time to healing. Radiology, 263(3); 811-818.
6.Crowell, H. P., Milner, C. E., Hamill, J.,
Davis, I. S. (2010). Reducing impact loading during running with the use of realtime visual feedback. Journal of Orthopaedic & Sports Physical Therapy, 40 (4);
206-213.
7.Crowell, H.P., Davis, I.S. (2011). Gait
retraining to reduce lower extremity loading in runners. Clinical Biomechanics, 26;
78-83.

Professional Physical Therapy 2015

Page 10

Issue 4

Progressive Hip Rehabilitation: The Effects of Resistance Band Placement


on Gluteal Activation during Two Common Exercises
Reviewed by Robert Shapiro MA PT COMT
Purpose of the Study: to better
understand the influence of the
placement of resistance bands on
muscle activation during The
Monster Walk and The Sumo
Walk. The Monster Walk is primarily focusing on sagittal plane
movement and is performed with
the patient standing with a band
around their legs and while maintaining the legs in an abducted
position, the patient walks forward. The Sumo Walk is more
focused on the frontal plane and
the patient is standing with a
band around their LE and the patient performs a sidewalk while
maintaining the tension on the
band.

one around the forefoot.

No significant differences in activity were noted with change of


Each participant performed 3 conband from the foot to ankle.
secutive trials of each band placement as per the randomized or*Gluteus medius activation inder.
creased progressively during Monster Walks with further displaceSignificant Findings:
ment of the band on the leg but
*TFL activation increased with
only marginally increased with
further distal placement of the
movement of the band from the
band from the knee to the ankle
ankle to the foot.

Clinical Significance: Both the


Monster and Sumo Walks utilizing
resistance from mini bands are
useful in the rehabilitation of an
individual who suffer from pelvic/lower quarter dysfunction.
Placing the mini bands around the
foot has potential to increase gluteal activation due to the internal
rotation torque placed through
out the LE requiring the gluteal
muscle to activate to neutralize
this movement .

Study Methods:
9 healthy volunteers from a local
university were recruited.
The participants were instructed
in the correct technique to perform the Monster and Sumo
walks. They were also instructed
to maintain an abdominal brace
and to move in a slow controlled
fashion.
EMG electrodes were placed on
the rectus abdominis, external
obliques, internal obliques, upper
and lower erector spinae, latissimus dorsi, gluteus medium, gluteus maximus, TFL and biceps
femoris.
Three band placements were
used; one at the knee (at tibial
tuberosity), one at the ankle
(lateral malleolus) and the last

but no difference was noted when


the band was moved to the foot
during both the Monster and Sumo walks.
*During Sumo Walks, placement
of the band around the foot required a significant increase in
gluteus medius activation compared to placement at the knee
or ankle .
*Gluteus maximus activity increased significantly with the
placement of the band around the
forefoot during both types of
walks when compared to placement around the knee and ankle.

For internal use only. Not intended for external sharing or distribution.

Cambridge, Edward D.j., Natalie


Sidorkewicz, Dianne M. Ikeda,
and Stuart M. Mcgill. "Progressive
Hip Rehabilitation: The Effects of
Resistance Band Placement on
Gluteal Activation during Two
Common Exercises." Clinical Biomechanics 27.7 (2012): 719-24.

Professional Physical Therapy 2015

Professional PT Clinical Corner

Page 11

Clinical gems of the Month

Robert Shapiro MA PT COMT

Tying your shoes requires 110


degrees of hip flexion along with
33 degrees of ER.

During elbow extension the


olecranon of the humerus moves
laterally (with relative ulnar medial rotation). This movement
The role of the multifidus is not causes a pronation movement at
to produce rotation but to counter the elbow and therefore it is imthe flexion effect of the abportant to remember that in order
dominals.
to attain full elbow extension conjunct pronation must be attained
The pain pattern for a serratus
posterior trigger point is very
broad but best characterized by
a deep ache under the shoulder
blade with a sharp pain with inhalation.
Sit to stand requires 104 degrees of hip flexion.
Since articular cartilage is aneural what can cause pain in PF
joint? Subchondral bone (highly as well. *(Conjunct rotation is deinnervated), infrapatella fat pad,
fined as a small amount of rotamedial plica, bursa and distal ITB. tion that occurs at a joint during
flexion/extension which is caused
Capsular pattern of the AC joint by the ligament surrounding a
is pain at extremes of shoulder
joint and the shape of the joint
girdle range.
surfaces)

Prone knee bend test is positive


if it reproduces pain on the unilateral lumbar area, buttock, or posterior thigh may indicate lumbar
radiculopathy of L2-L3 nerve
roots.
Capsular pattern of the subtalar
joint is: Limitation of varus
range of movement
Passive Scapular Approximation Test: a test for irritation of
the 1st thoracic nerve root, performed by having the seated patient approximate their scapulae,
test is considered positive if this
movement causes scapular pain.

If you have any GEMS you want


to share please email me at :
rshapiro@professionalpt.com

Quiz answers:
1. axillary nerve, injured approx. 31% of the time with anterior GH dislocation
2. 75% accurate with confirmation during surgery.
3. Its function may be to tighten the anterior capsule of the hip to increase femoral stability, it a muscle that is
used as a landmark during hip surgery in order to expose the anteromedial hip capsule and the psoas tendon
interval
4. 66.7
5. 40-44 mm

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015