Travel hacks make traveling easier. JetSet makes learning an adventure.Read More
by Chris Medina
I expected a great course from past experiences but this one exceeded them beyond imagination.
In the last year, I took two Con Ed courses with Jetset Rehab Education. When I saw that they were traveling to Cabo San Lucas with Marcie Hayes and Stephanie Di Stasi, I decided to register. I expected a great course from past experiences but this one exceeded them beyond imagination.
One could not ask for a better setting. First of all, the open air classroom was literally on the beach and had views of the famous arch of Cabo San Lucas. Instead of a white wall, the scene of the ocean, mountains, and occasional sail boat gliding by filled the space. The background sounds of waves, beach activity, and the occasional gust of warm wind were the only distractions to speak of. During the short mid lecture breaks, one could even take a quick swim and refresh in the Sea of Cortez. The course was instructed by what can only be called "Master Clinicians." Both Marcie Harris Hayes and Stephanie Di Stasi never failed (somehow) to keep the attention of the students. To be honest, as students, our attention never wavered. They were amazing. Their insight into the mind of the clinician made the material very relevant and the presentation of cutting edge evidence regarding hip dysplasia, femoral acetabular impingement and hip labral pathologies kept the course current.
"For me the best part about this trip was being able to network and meet new people."
Another point that I cannot forget to mention is the food! Breakfast and lunch was served complimentary for all the Jetset students at the beach club restaurant below the classroom. It was amazing. If this restaurant ( SUR Beach House ) was in my city, I would go to all the time!
"Another point that I cannot forget to mention is the food!"
All of this considered, my favorite part about this trip was being able to network and meet new people. I was fortunate enough to spend some time with Randal and Jay (Co founders of Jetset Rehab Education) who are two amazing people that I now consider my good friends. I love what they are doing with Con Ed in the Physical Therapy community by putting on courses with great topics and speakers as well as making it a great life experience. I will say this: I am a Jetsetter for life and I will be attending as many classes as I can.
Chris Medina is a Physical Therapist now practicing in the Orange County area of California
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I’ve always known that I wanted to work with the athletic patient population, and quickly learned that they can be among the most difficult patients to treat, because of the demands of needing to return to sport as soon as possible and not miss too much competition time. Further exacerbating this, every parent of a youth athlete thinks their son or daughter is the next LeBron James or Serena Williams, so they can add to the pressure to get their child back to playing. For some of these high level patients, there is even more external pressure from college recruiters or professional scouts.
After PT school, I realized I lacked the confidence working with these patients. The movement faults and impairments I knew to look for in the average patient were not obviously apparent in these patients, and some of their symptoms only came on with high level activities. I was fortunate to have done a 16 week clinical internship with a phenomenal therapist (shoutout to Jeff Wang at Glendale Adventist Therapy and Wellness Center!) at the end of PT school, who pushed me to improve every day of that clinical experience. After that, I knew I wouldn’t stop continuing to seek out learning opportunities to work in this field.
"The movement faults and impairments I knew to look for in the average patient were not obviously apparent in these patients, and some of their symptoms only came on with high level activities."
In addition to perhaps struggling with working with athletes in the clinic, new grads are not qualified to provide sideline coverage at athletic events. The SCS is a specialty certification that designates an expert in athletic injury management, including acute care, treatment, rehabilitation, prevention, and education. Read this article for more details on why the SCS is worth pursuing if you are interested in some day providing on field coverage.
Fast forward 5 years, and now I can say that I am confident in my ability to treat the athletic patient population. Here are some tips on how to pass the SCS exam:
"This may not be immediately obvious, but sports patients are really at the end of the day ortho patients, they just move faster."
1) Consider taking an orthopedic residency. This may not be immediately obvious, but sports patients are really at the end of the day ortho patients, they just move faster. Completing an orthopedic residency involves weekly mentoring from a clinical specialist, didactic learning, and honing in on clinical reasoning. Additionally, you can also consider a sports residency or fellowship. Here is the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) website.
2) Familiarize yourself with the SCS application process, exam format, and test materials. Here is the American Board of Physical Therapy Specialties (ABPTS) SCS candidate guide.
3) Study, study, study. Unlike the OCS exam, there is no Current Concepts (if you are preparing for the OCS, this is the definitive material to study to pass the exam. As such, you will need to study from several different sources in order to adequately cover the material covered in the SCS exam. I used the following sources:
Each source has material to study, with practice tests. You'll have to figure out what works best for you, but as for myself I knew I needed to set up a plan to keep myself accountable. My friend and colleague from fellowship, Shemaiah Holness, assigned ourselves 1-2 chapters each from the above study materials to go over each week, and had review sessions every Sunday in which we would go over the material and practice quizzes. This worked out well for us as we didn't want to let the other down by not preparing that week.
Of course, there are other study material sources, but these are what I used. Among the others I know of are Evidence in Motion and Praxis, however personally I chose not to pursue these opportunities simply because it was not financially feasible, as they are not cheap. Give yourself at least 3 months, preferably more to study and go over practice exams, and resist the temptation to procrastinate as the SCS exam is definitely not something that can be passed by cramming in the weeks leading up to it!
After taking the test, you will have to wait 3 agonizing months until learning if you've passed, but if you follow the above tips, you will have prepared adequately and set yourself up for success. The SCS is definitely a certification that is worth the effort to pursue, as less than 2% of all APTA members are recognized with the credentials. Good luck!
Robert Dulay, PT, DPT, OCS, SCS, FAAOMPT is currently practicing in Southern California with Kaiser Permanente
Robert Dulay, PT, DPT, OCS, SCS, FAAOMPT
Doctor of Physical Therapy
Board Certified Orthopaedic and Sports Clinical Specialist
In Sept of 2018 we are hosting a course in Portland, Oregon. Our instructors are two very accomplished clinicians: Jared Vagy & Stephen Morrison. They have been trained from different backgrounds with Kaiser Permanente. Using their training in both the Spine and Movement Science Fellowships, they discuss the benefits of using both the manual and movement approach. Here, you can get an eclectic viewpoint in treating the weekend warrior patient. This was a fun episode where both Dr. Morrison and Dr. Vagy take over as hosts.
please comment below and let us know what you think!
Dr. Jared Vagy received his Doctorate in Physical Therapy (DPT) from the University of Southern California (USC). As a Doctor of Physical Therapy in clinical practice, he completed a one-year residency program and became a Board Certified Orthopedic Specialist. He then completed an additional one-year fellowship program in Movement Science at Kaiser Permanente Hospital.
Dr. Jared Vagy has published three books and numerous articles on injury prevention. He delivers seminars internationally on the topic. He is an adjunct instructor of clinical physical therapy USC in the DPT Program. He is a mentor for both the USC Physical Therapy residency program and the USC DPT program. He is on Academy Faculty for the TheraBand Academy and is on the Editorial Board for ADVANCE Physical Therapy magazine.
In addition, Dr. Vagy served as a physical therapist in China for the Chinese National Track and Field Team, completed a rotation at the USA Olympic Training Center, worked with USA Track and Field at the Olympic Team Trials and covers international competitions such as the Weightlifting World Championships. He has rehabilitated several world champions, gold medalists and Olympic athletes. His assessments and treatments are rooted deeply in an understanding of the movement system. He is a firm believer in an active approach to rehabilitation and works with clients of all ability levels to achieve their maximal function.
Contact Dr. Jared Vagy:
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2 days to go! We are super excited to meet and see each one of you in Cabo. Just wanted to send along some updates about the class.
First, we did speak with the Hotel and they do offer a Shuttle service. If interested, please contact Cristina@bahiacabo.com and she'll give you the details on getting that set up for you.
Lastly, wanted to remind everyone - Don't forget your passport!!
The weather will be perfect for a Physical Therapy course, a sunny mid 80s day.
Dress: All of us, including the instructors are going to keep it very casual. Dress for a quick lunch break beach run. (You may never take a class like this again!)
Need some reading for the plane? Try our instructor's fantastic study published in JOSPT.
Need a good podcast for the flight? Look no further than the Jetset Rehab Education Podcast available on itunes and all podcast apps.
We wish each and every one of you a safe trip.
Below, is the course itinerary. We look forward to seeing you all there.
Handouts will be provided by Jetset at the start of the course.
Randal & Jay
May 5th, 2018
8:00-9:00 AM Breakfast / Registration
9:00-11:00 AM - Structural and muscular characteristics of the hip joint and variations in people with pre-arthritic hip disease
11:00-11:30 AM - Movement system diagnoses of the hip
10:30 AM - 11:45 AM - Break
11:45 AM -12:45 PM - Systematic examination of the hip. Tests for source and movement system impairments.
12:45 PM - 1:45 PM - Catered Lunch
1:45 PM - 2:45 PM - Treatment based on movement system diagnosis.
2:45 PM - 3:45 PM - Case Demonstration : Diagnosis & Treatment
3:45 PM - 4:15 PM - Discussion
6:00 PM - 8:00 PM - Networking Experience - Appetizers / Libations at Sur Beach House
May 6th, 2018
Post-operative Management and Return to Play Guidelines
8:00 AM - 9:00 AM - Breakfast
9:00 AM - 10:30 AM - Muscle performance and movement impairments following surgery
10:30 PM - 11:30 AM - Navigating the early post-operative period: using movement system treatment from day 1
11:30 AM - 11:45 AM - Break
11:45 AM - 12:45 PM - Pearls and pitfalls: post-operative rehabilitation for individuals with pre-arthritic hip disease
12:45 PM - 1:45 PM - Catered Lunch
1:45 PM - 2:45 PM - Late-phase rehabilitation guidelines and return to play preparation for athletes with hip pain
2:45 PM - 3:15 PM - Return to Performance testing
3:15 PM - 3:45 PM - Q & A.
** Handouts will be available to you at the course.
Randal & Jay.
disclaimer: We are not financial advisors. Correction: I mention that our guest is in his mid 30s, but at the time of the recording he is 29, he will be financially independent in his early 30s.
Every now and then something simple can change your life. Often it is an idea and this idea aligns with something inside you that makes it stick. It then grows into a thought process and evolves into a major change. In my case, reading the blog The Fifth Wheel PT by Dr. Jared Casazza enacted such a change. In particular this blog post and this guest blog post led me to begin a journey that led to early student loan repayment, increasing my index fund investing (roth ira) and tracking my finances. It further led to credit card hacking with Andy Bahn and traveling to Hawaii and Las Vegas for free!
Now, I know, financial independence can sound impossible for some of you. The debt can be overwhelming. Trust me, there is a way out. You just have to know down that FIRST DOMINO as they say. It is simpler that you think. It will take work, it will initially be time consuming but once you have your system in place it you don't have to think about it!
I am not in anyway a financial advisor but I see finance as one of the main downfalls of our profession. I see people who are not happy with their place of work staying in jobs they dislike because of financial reasons. Finance and Ethics are very closely intertwinned and can potentially lead to people doing a poor job at getting people better because they dislike their job. I see these as potential threats to the profession of PT, further exacerbated by high student loan debt, purchases of expensive cars, buying homes, buying unneeded items at target and not putting money in a retirement fund. All of this puts financial pressure on the PT and who knows? Perhaps we are losing some amazing PTs out there because they see a profession that is not financially healthy and thus choose to do something else. For this reason I have been using this blog to help people get to the resources that can change the way they handle their business. I hope you enjoy this podcast and read a few of the resources we linked to below.
Please comment with your thoughts!
The millionaire next door
The richest man in Babylon
Mr. Money Mustache
Bogel heads forum
go curry cracker
Eat the Financial Elephant
Let's ask the experts....
The holidays can be confusing for any Physical Therapist, Chiropractor, Masseuse, Occupational Therapist. The reason for this is because family members ask us for advice. Often they are the most difficult patients because they a) don't listen, b) want the quick fix, c) are intoxicated, d) they want a free massage e) don't respect you as a medical professional, (after all they knew you when you were in diapers, who can blame them?). Almost all practitioners have negative experiences that have led them to question the treatment of family members. If you think about it, this is smart. At a holiday get together we cannot chart review, there is not a treatment area, and if the word gets out, you will have a line of folks waiting to get " a freebe." There is also a chance that they will not seek treatment after the holidays thinking that your session was enough. This could prevent them from seeking the care they need. I can recall the Thanks Giving party of 2011 when I was treating a family member on someones bed and after I was done there was a line of 6 people waiting for their session! I have a big family and my day off turned into a work day. Some would call this a rookie mistake. As a Christmas morning blog post, I thought it would be a good idea to hear strategies from some seasoned Physical Therapists and how they navigate their holiday season requests. I hope the decision to treat or not treat is easier after reading this.
Randal Glaser PT, DPT, OCS, co-ofunder JetsetRehabEd.com
Mariam P. Butler DPT,OCS,SCS,FAAOMPT
I personally have no problem telling people "no." I've been known to say "this is my one day off, can we discuss this later?" then plan a date and time to do that. I'd rather have them see me first over someone else honestly. It depends on my mood because our job isn't a 5 minute conversation where we can give some advice and send people on their way. If I am going to help, then I know it'll be at least 30 minutes. Sometimes, if I'm feeling up to it, then I'll just do it knowing I'll have to help that relative eventually. It's easier at my own house where I have a table and stuff I need for treatment. If it's somewhere else, I'll say "tell me what's going on so that I know what to assess later when I have my table set up along with all the measurement tools I need to appropriately evaluate you." That's always a good way to listen to the person so they know you do care about them, but at least you don't have to "work" during a family function. I think overall, it's on us to be the ones to help our relatives because we know what we're doing. What are they going to do otherwise? Go see their MD that will likely just recommend meds? MOST PT's are PT's because they care about people, and want to genuinely help people get better. It's our responsibility to guide them the right way. If we feel they should go see an MD, a PT, or another health care professional, then we should be the ones to advise that, educate them on their body and give them realistic expectations on what to expect.
Andre Chavez PT, DPT, OCS, Movement Science Fellow
Treating your relatives over the holidays can be an interesting task but something that all clinician will face this holiday season. Careful consideration has to take place before doing this. You know your family members better than anyone so you know who is going to listen to what you say and who thinks you don’t know anything. You also have Aunt Mildred who just wants you to push on them because it feels good. Since this is relative, (please excuse the pun) I pick and choose who I treat based off what I know about them and the situation. For example, my dad is stoic so if he is asking me for advice or for a mini-evaluation I’ll give it to him because he wouldn’t ask if he didn’t want to get better. Then you have Aunt Susanne who has Fibromyalgia and spends half of every Thanksgiving and Christmas dinner talking about her new pains and ailment . . . I wouldn’t touch that with a ten-foot pole. And then you have your cousin Ryan who you still must talk out of dumb decisions every now and again and who thinks you just gives massages anyways, I’ll pass on that one too. For me it easy it depends on the relative and the situation.
Michael Curtis PT, DPT, OCS author of Why you have Bad Posture and Turn down your Pain.
I’ve found it helpful around the holidays to refer friends and family members to a trusted resource online – and I’d recommend the same for you…
Here’s your script: Memorize it, repeat it, sell it, and you’re golden.
“Wow! it sounds like you’re going through a lot right now. I have the perfect article with videos of exercises you can do that I think will give you some relief. Send me an email to remind me and I’ll give you the link.”
If they follow up with you, you can link them to a good article while also informing them to follow up with their PT or doctor should their symptoms continue.
This tactic has worked well for me because:
It offers them quality information and actionable exercises
It gets you off the hook for treating Aunt Marilyn on your grandparent’s couch
It puts the responsibility on them to email you
It funnels them into following up with someone else in-person
Where do you get these online resources? You can use any trusted resource you know of (if you have some, put them in the comments below for all to see). Also feel free to use what I’ve got on MichaelCurtisPT.com – patient education articles based on body regions with exercise videos for each diagnosis.
I hope this approach works as well for you as it has for me.
If it doesn’t work, I’d go with the “Home Alone” version:
“I’m going to give you to the count of ten to get your ugly, yella, no-good keister off my property… Merry Christmas ya filthy animal!”
It’s funny and bad enough when the just-met stranger at the office party or happy hour finds out I’m a Chiropractor and starts telling me about their neck and back pain and asks for a real quick free adjustment right then and there; it’s worse when it happens at the family party- because I can’t just laugh it off and walk away. These loved-ones deserve my attention and real answers. When I faced this fresh out of school, I would ask all kinds of questions and give them a ton of advice, and usually working on someone on the couch, floor, or someone’s spare bedroom. Looking back, I think I may have been eager to prove myself, or was just so happy to be able to give back to the family that I really tried to treat them as if they were in my office. The smells of a feast, screams of kids running around, and party sounds were definitely a distraction. I know better now. Nothing beats the focus, clarity of purpose, and single-mindedness of practicing in my office. Now I listen and happily give them some basic advice, (like, ice/heat/move/immobilize it) and then tell them they really need to get it taken care of. I don’t care if they see me or someone else. I offer to see family in my office for free, but tell them if they cancel or are chronically late, I will start charging them something. At least half of my family has insisted on paying anyway.
Gabrielle PT, DPT, OCS, Woman's Health Specialist
Surprisingly the holidays are pretty smooth sailing for me! Yes, I’ve made that rookie mistake of opening the can of worms, but for each family member I’ve treated:
1) usually they only need one treatment and if they follow my directions, they can usually prevent it from happening again, or know how to manage if symptoms return or
2) they don’t follow my directions, symptoms return , they come back to me, I ask them if they did what I told them to do, they say “no”, then I say “do what I told you to do”, then they never ask me again. I don’t know if the latter is a good thing or bad thing!
My husband is also a PT, so there is double the chance that one of us will get summoned BUT I can say that my family and my in-laws are very respectful of my personal time at family functions (thank goodness). Their respectfulness of our time makes me more inclined to help out if the situation does arise!
My advice is, just like life, find a healthy balance, and don’t end up opening Family Room PT, Inc during holiday dinner (unless you want to and you’re charging co-pays!)
Happy Holidays from the Jetset Rehab Team
Please check out our 2018 courses, hope to see you next year!!!!!
I am sorry to announce that our ACL Rehab course in Mammoth will be cancelled. The low snow levels among other factors have led to this decision. All who registered will receive a full refund or a credit for a future course. We are making plans to reschedule this amazing course later in 2018 so please follow us on social media to get updates on the new dates.
We wish all of you a happy holiday and we hope to see you in 2018.
The Jetset Team
ACL rehab with two leaders in the field.Read More
Part II - The detailed card information to start travel hacking today.Read More
An introduction on "Travel Hacking" - Optimizing your credit card miles to travel for free!
Jetset Rehab EducationRead More
NEW CLASSES UP for 2018!Read More
Part II of our How to start a PT blog Podcast series.
Check us out on itunes!Read More
How to Start a Physical Therapy Blog
Michael Curtis PT, DPT, OCS
How Michael Curtis PT started his Physical Therapy Blog and how you can do it too!Read More
How to blog. What you need to know if you have, or are considering starting a Physical Therapy blog. Networking in our continuing education courses. www.jetsetrehabed.comRead More
Alignment: Finding relief in every step
Melanie Carlone, DPT, RYT of http://customorthoticsolutions.com/is a longtime friend of Jetset Rehab Education. When she attended our class in Portland last year we recorded this during our networking hour. She is a Physical Therapist with over 30 years of experience. She is a fantastic Physical Therapist and I treasure the time I worked side by side with her in Atlanta, Georgia quite a few years ago.Read More
The Clinical Neurodynamics course taught by Michael Shacklock explores the relationship between abnormal mechanics of the nervous system and pain syndromes. The course covered the theory of neurodynamics, assessment of the nervous system through neurodynamic testing, and treatment strategies to reduce the sensitivity of the nervous system.
What is neurodynamics?
Clinical neurodynamics is the application of nervous system mechanics and physiology and how they interact with the musculoskeletal system. As the musculoskeletal system creates movement, the nervous system accommodates these movements through a variety of movements, such as elongating, sliding, or compressing. When the movement of the nervous system is restricted, the production of symptoms can occur.
The lower quarter course begins with learning how to palpate and evaluate the sciatic, tibial, peroneal, and surreal nerves. Palpating the nerves allows the practitioner to determine where a neurodynamic problem is and how sensitive the nervous system is.
After palpating the nerves of the lower extremity, assessment of the nervous system continues through the use of neurodynamic testing. While many of us are familiar with the standard neurotension tests such as the straight leg raise or the slump test, these neurodynamic tests can be further broken down to determine where a neurodynamic problem is. An important aspect of using neurodynamic testing is the use of structural differentiation to determine whether the symptoms are produced by the nervous system or the musculoskeletal system. If structural differentiation indicates neural involvement, then a neurodynamic approach to treatment can benefit the patient.
Neurodynamic dysfunctions can originate from three different causes. One possible cause of neurodyanmic dysfunction is an issue at the mechanical interface (intervertebral foramen). There can either be a closing dysfunction which is caused by an increase of pressure on the nerve in the mechanical interface (disc herniation, inflammation, etc…) or an opening dysfunction caused by hypomobility and stiffness.
Another possible cause of neurodynamic dysfunction is a neural tension dysfunction in either the peripheral nerve or nerve root. These occur due to a lack of movement (sliding) in the nervous system. The third cause is a pathology in the nervous system such as a tumor or diabetic/alcoholic neuropathy.
The treatment approach when treating a neurodynamic dysfunction depends on the sensitivity of the patient’s nervous system. The sensitivity of the nervous system is divided into three different levels.
A level 1 (limited) sensitivity would be a patient whose symptoms are easily provoked and takes a long time for the pain to subside. A patient in this category of sensitivity would perform either static openers or off-loaders (for an interface or peripheral nerve dysfunction, respectively) to decrease the sensitivity of the nervous system. An example of an off-loading movement for the sciatic nerve would be for the patient to be supine with the ipsilateral leg slightly bent in external rotation.
The level 2 (standard) sensitivity would be a patient with an abnormal neurodynamic test (ie. straight leg raise or slump test) and symptoms that do not last long after provocation. Treatment for patient’s with a level 2 sensitivity would include dynamic openers/closers and sliders/tensioners for interface and peripheral nerve dysfunctions, respectively. The treatment for the patient above with sciatica would involve progressing the straight leg raise or slump test with the patient side-lying while moving the ipsilateral leg more and more.
The level 3 (advanced) sensitivity is for patients with symptoms that are difficult to provoke or for patients that require a high level of physical performance. The treatment for a patient with a level 3 sensitivity would involve placing the nerve under more tension. An example of treatment for this patient could include laterally flexing the torso away from the symptomatic side to while performing a straight leg raise to increase tension of the nerves.
The importance of diagnosis was emphasized as it will allow the practitioner to use the right technique to help the patient. If a neurodynamic test is abnormal and clinically relevant, a neurodynamic approach should be attempted to help the patient. If the neurodynamic test does not reproduce the patient’s symptoms, a different approach should be pursued to help the patient. A neurodynamic approach is not a panacea, it has it’s time and place just like other techniques.
The goal of the treatments are to find a movement that the patient can perform without pain. The movements are then progressed in difficulty until the patient can perform the movement that was once painful. For example, many of the movements begin with moving a joint while side-lying and gradually incorporate more complex movements while progressing to a standing position. The treatment approaches are an excellent example of graded exposure to movement.
When moving a joint, there will be 20 percent more strain on the nerve in a localized sequence. By modifying the sequence of movement, the stress can be reduced on the nerve. For example, most straight leg raises start with the knee extended then moving the hip into flexion. This sequence will increase the strain on the sciatic nerve in the hip. If we change the sequence by starting with the knee bent then flexing the hip, we might be able to reduce the pain associated with hip flexion by reducing the stresses placed on the nerve.
Nerves are mechanosensitive. When nerves are placed under enough force, they will produce symptoms. When treating an abnormal neurodynamic problem, the symptoms need to correlate to the patient’s complaint. Symptoms (pain, numbness, tingling, etc…) can be provoked when enough force is applied, but that doesn’t mean that it is abnormal or relevant to the patient.
For practitioners treating neuromusculoskeletal conditions, the Clinical Neurodynamics course will provide the essential framework for helping patient’s with dysfunctional neurodynamics. After this course, practitioners will have the tools needed to thoroughly assess and treat abnormal mechanics in the nervous system.
A special thank you to Dr. Michael Li and the guys at Jetset Rehab for hosting the workshop!
(Special Thanks to Dr. Michael Braccio for sharing his blog with us! find more blogs on www.michaelbraccio.com )
*** We look forward to bringing back Dr Shacklock in the fall of 2017 and in 2018 for more neurodynamics courses! Stay tuned.....