Tuesday, May 20, 2008
Post Rehab Tip #2 - Pain Levels
Avoid exercise when the client reports pain levels above 5 on a 1-10 scale. Pain levels above 5 indicate possible tissue damage. Follow the link below to listen to this post rehab tip.
Tuesday, May 13, 2008
How many streams of income do you have coming into your post rehab practice?
There are 15 primary post rehab income streams for post rehab professionals trying to build a profitable practice. Join us May 14, 2008 for a FREE 90-minute teleseminar titled "Multiple Streams of Post Rehab Income". As our economy slows the importance of the post rehab professional of developing additional streams of income beyond one-on-one training is clear. In this teleseminar Dr Mike will discuss the primary streams of income a post rehab professional may establish to increase the profits in his or her practice. We will discuss these streams:
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Medical Referrals
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Insurance Billing
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Dynamic Back School
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Women’s Fitness 101
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Balance Assessment/Senior Fitness Classes
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Hypertension/Diabetes Training
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Ergonomics and Job Site Analysis
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Pilates Training
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Massage Therapy
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Sports Conditioning
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Volunteer in Sportsmed/Chiropractic Clinic
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Body Fat Assessments
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Presentations to Local Support and Civic Groups
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Phone and/or Online Fitness Coaching
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Development of DVD’s, Fitness Products or Publishing
Monday, May 12, 2008
Multiple Streams of Post Rehab Income
Can you use your post rehab assessment to sell personal training sessions? Listen as I (Dr Mike) interview David Gilks, MES, MEPD owner of Core Essetials Personal Training and Rehab Studio discuss how he uses his fitness assessment to sell personal training sessions? David will be one of our co-hosts for the "Post Rehab Profits & Protocols" program which starts on May 14th. Our introductory call will identify "Multiple Streams of Post Rehab Income" post rehab professionals may establish to make their practices more profitable. Click on the link below to listen as Dr Mike interviews David on how he uses a comprehensive assessment to sell personal training. David reports a 100% closure rate on sales of personal training packages using this strategy.
First Hand Information Gives Clarity
I had an interesting conversation with a kinesiologist working in a physical therapy clinic about the role of the rhomboids and lower trap in shoulder and mid-thoracic dysfunction. During the conversation she quoted the work of Dr. Shirley Sahrmann, PhD, PT of Washington University in St Louis, MO. Dr Sahrmann's work on identification and treatment of postural and muscular imbalances is standard learning for physical therapists. During the conversation I noted this young lady either misunderstood or left out key components regarding Dr. Sahrmann's guidelines for the management of the mid-thoracic region. When I asked questions to clarify her understanding (not to embarrass or ridicule her, but to make sure she was following the appropriate exercise guidelines for her client) she noted she never attended a seminar or read Dr. Sahrmann's book “Diagnosis and Treatment of Movement Impairment Syndromes”. She obtained her information from a colleague that attended a Sahrmann seminar.
For fitness professionals’ credibility is a key in establishing relationships with medical professionals. Attending workshops taught by medical professionals and reading textbooks for medical professionals will significantly improve your understanding of medical conditions and your ability to develop safe and effective post rehab program for clients. This will go a long way toward your credibility. The point I am trying to make is educate yourself and understand all aspects of a rehab philosophy if you plan on incorporating it into an exercise program. The subtle nuisances are lost when you use second-hand information rather than authentic information from the author. Important points are lost when the concept travels by word of mouth. I recommend reading articles and/or texts from these authors as well as attending workshops that focus on the concepts they developed.
• Vladmir Janda, MD (start with Janda's compendium which you may purchase at www.optp.com)
• Shirley Sahrmann, PT, PhD (we mentioned Sahrmann's book earlier)
• Robin McKenzie, RPT (McKenzie's technique for managing discogenic back pain produced lumbar extension as a means of treating radiating pain.)
• Greg Johnson, RPT (founder Institute for Physical Art - the institute offers a great course titled “Functional Orthopedics”. I don't think non-therapists are eligible to take the course but it is a fantastic workshop.)
• Frank Noyes, MD & Bob Mangine, RPT (Cincinnati Sports Medicine Center - their spring sports med symposium at Hilton Head, SC is the best and most comprehensive out there.)
• Philip Greenman, DO (Dean of the Michigan State University College of Osteopathic Medicine - his textbook “Principles of Manual Medicine” is a must read for massage therapists, physical therapists and chiropractors.)
• James Andrews, MD & Kevin Wilk, RPT (Alabama Institute of Sports Medicine – Andrews and Wilk have developed rehabilitation guidelines for a wide range of orthopedic surgical procedures.)
• Stuart McGill, PhD (Waterloo University - his research in spinal function is fantastic. Dr McGill's book is titled "Low Back Disorders".)
• James Cyriax, MD (the father of orthopedic medicine. His book the “Textbook of Orthopedic Medicine” is a classic text for physical therapists and chiropractors)
For fitness professionals’ credibility is a key in establishing relationships with medical professionals. Attending workshops taught by medical professionals and reading textbooks for medical professionals will significantly improve your understanding of medical conditions and your ability to develop safe and effective post rehab program for clients. This will go a long way toward your credibility. The point I am trying to make is educate yourself and understand all aspects of a rehab philosophy if you plan on incorporating it into an exercise program. The subtle nuisances are lost when you use second-hand information rather than authentic information from the author. Important points are lost when the concept travels by word of mouth. I recommend reading articles and/or texts from these authors as well as attending workshops that focus on the concepts they developed.
• Vladmir Janda, MD (start with Janda's compendium which you may purchase at www.optp.com)
• Shirley Sahrmann, PT, PhD (we mentioned Sahrmann's book earlier)
• Robin McKenzie, RPT (McKenzie's technique for managing discogenic back pain produced lumbar extension as a means of treating radiating pain.)
• Greg Johnson, RPT (founder Institute for Physical Art - the institute offers a great course titled “Functional Orthopedics”. I don't think non-therapists are eligible to take the course but it is a fantastic workshop.)
• Frank Noyes, MD & Bob Mangine, RPT (Cincinnati Sports Medicine Center - their spring sports med symposium at Hilton Head, SC is the best and most comprehensive out there.)
• Philip Greenman, DO (Dean of the Michigan State University College of Osteopathic Medicine - his textbook “Principles of Manual Medicine” is a must read for massage therapists, physical therapists and chiropractors.)
• James Andrews, MD & Kevin Wilk, RPT (Alabama Institute of Sports Medicine – Andrews and Wilk have developed rehabilitation guidelines for a wide range of orthopedic surgical procedures.)
• Stuart McGill, PhD (Waterloo University - his research in spinal function is fantastic. Dr McGill's book is titled "Low Back Disorders".)
• James Cyriax, MD (the father of orthopedic medicine. His book the “Textbook of Orthopedic Medicine” is a classic text for physical therapists and chiropractors)
Sunday, May 11, 2008
Post Rehab Tip #1
When developing the post rehab program for the spondylolethesis client avoid excessive lumbar extension (beyond neutral) and strengthening of back extensors with movement beyond spinal neutral or past zero degrees. Emphasize strengthening of the abdominals and maintaining slight trunk flexion. Any extensor strengthening must be done while positioned in slight trunk flexion and should not allow the client movement past neutral spine into excessive extension. Follow the link below to listen to Dr Mike's discussion of this post rehab tip. Visit us again in 3-4 days for another post rehab tip.Tuesday, May 6, 2008
How to Utilize Post Rehab Professionals?
How should the medical community utilize the post rehab professional and post rehab programs?
First and foremost, the post rehab professional (PRP) is not trained to nor has the ability to replace the physical therapist, chiropractor or any other medical professional. The PRP should limit his or her practice to the development of functional conditioning programs for clients after their discharge from physical therapy and/or chiropractic care. The post rehab program should be developed based on feedback from the client's physician and physical therapist. This maximizes the possibility of a positive functional outcome.
With the aging of North America, or the "silver tsunami", the number of babyboomers being discharged from rehab in the next 10 years will become staggering. Research studies estimate more than 800,000 total knee and hip replacements were performed in 2004. That number is expected to increase 22% by 2010 for total hip replacements and 63% by 2010 for total knee replacements. Babyboomers between ages 50 and 75 will need the bulk of these total joint replacements. Each patient will need a regimen of physical therapy but the bigger issue is the maintenance of the functional gains made in rehab and the use of exercise to manage the residual functional deficits that remain after rehab. These deficits include lack of strength and endurance; balance dysfunction, joint instability, minimal muscle fiber recruitment, limited proprioception and power and restricted flexibility. Each of these deficits is treated by the physical therapist or chiropractor using various treatment modalities but at some point, due to insurance restrictions or the patient's plateau of progress, the patient must be discharged. This is the point where the licensed rehabilitation professional should refer the client to a certified post rehab professional or program (the term aftercare fitness is also used).
Physical therapists, occupational therapists and chiropractors over the next decade will be overwhelmed by a steady stream of boomers seeking treatment for a wide range of musculoskeletal, cardiovascular, neurological and metabolic disorders. The smart therapist or chiropractor will establish a network of trained and certified medical exercise specialists and post rehab conditioning specialists to refer his or her patients to at the time of their discharge. The MES' and PRCS' should be well trained in post rehab program design as well as being adept at identifying post rehab "red flags" that indicate the need to refer the client back to the physical therapist, physician or chiropractor. As you can see, the post rehab professional can augment the physical therapist's treatment plan and ensure the highest possible functional outcome for the client.
There are a few important basics that make the "post rehab model" work. They are 1) the client when discharged and referred to the PRP must be "medically stable". Medically stable means no radiating pain or significant swelling; no night pain or significant functional loss; normal vital signs, no open wounds and the client must have fair+ strength in the effected region. It is the medical professionals responsibility to ensure the client is medically stable before referring the client to a post rehab program. If the client demonstrates these "red flags" the possibility of a positive outcome is significantly decreased. The "red flag" client needs further medical treatment and is not a good candidate for referral to post rehab. The medical professional should not refer this client until the client is medically stable. 2) The post rehab professional must understand his or her role is to develop the post rehab exercise program and progress the client through the exercise sessions. The PRP must assess the client's progress at 30-day intervals and report that progress to the referring medical professional. Not reporting the client's progress to the referral source impairs the overall medical management of the client's condition. This is also unprofessional and should warrant the elimination of any future referrals to the PRP. 3) The client must be compliant with the program and attend as well as participate in the post rehab exercise sessions. 4) the PRP must have skills and knowledge to design of post rehab programs for a wide range of medical conditions. The PRP should hold a certification to design programs for post rehab clients. 5) All the members of the rehab spectrum; physician, physical therapist, occupational therapist, nurse, chiropractor and post rehab professional; must understand the post rehab program is not part of the treatment process but it is a means of improving on or maintaining the functional gains made during rehabilitation program provided by the licensed medical professional. The treatment is performed by the medical professionals, once the client is stable, the PRP steps in and provides safe and effective functional conditioning programs. If the PRP fully understands and accepts his or her role, the utilization of PRP's will become an essential part of the rehab spectrum as well as positively affecting the functional outcome of rehab programs. I predict, over the next decade, the PRP will become a more integral part and accepted member of the rehab network.
First and foremost, the post rehab professional (PRP) is not trained to nor has the ability to replace the physical therapist, chiropractor or any other medical professional. The PRP should limit his or her practice to the development of functional conditioning programs for clients after their discharge from physical therapy and/or chiropractic care. The post rehab program should be developed based on feedback from the client's physician and physical therapist. This maximizes the possibility of a positive functional outcome.
With the aging of North America, or the "silver tsunami", the number of babyboomers being discharged from rehab in the next 10 years will become staggering. Research studies estimate more than 800,000 total knee and hip replacements were performed in 2004. That number is expected to increase 22% by 2010 for total hip replacements and 63% by 2010 for total knee replacements. Babyboomers between ages 50 and 75 will need the bulk of these total joint replacements. Each patient will need a regimen of physical therapy but the bigger issue is the maintenance of the functional gains made in rehab and the use of exercise to manage the residual functional deficits that remain after rehab. These deficits include lack of strength and endurance; balance dysfunction, joint instability, minimal muscle fiber recruitment, limited proprioception and power and restricted flexibility. Each of these deficits is treated by the physical therapist or chiropractor using various treatment modalities but at some point, due to insurance restrictions or the patient's plateau of progress, the patient must be discharged. This is the point where the licensed rehabilitation professional should refer the client to a certified post rehab professional or program (the term aftercare fitness is also used).
Physical therapists, occupational therapists and chiropractors over the next decade will be overwhelmed by a steady stream of boomers seeking treatment for a wide range of musculoskeletal, cardiovascular, neurological and metabolic disorders. The smart therapist or chiropractor will establish a network of trained and certified medical exercise specialists and post rehab conditioning specialists to refer his or her patients to at the time of their discharge. The MES' and PRCS' should be well trained in post rehab program design as well as being adept at identifying post rehab "red flags" that indicate the need to refer the client back to the physical therapist, physician or chiropractor. As you can see, the post rehab professional can augment the physical therapist's treatment plan and ensure the highest possible functional outcome for the client.
There are a few important basics that make the "post rehab model" work. They are 1) the client when discharged and referred to the PRP must be "medically stable". Medically stable means no radiating pain or significant swelling; no night pain or significant functional loss; normal vital signs, no open wounds and the client must have fair+ strength in the effected region. It is the medical professionals responsibility to ensure the client is medically stable before referring the client to a post rehab program. If the client demonstrates these "red flags" the possibility of a positive outcome is significantly decreased. The "red flag" client needs further medical treatment and is not a good candidate for referral to post rehab. The medical professional should not refer this client until the client is medically stable. 2) The post rehab professional must understand his or her role is to develop the post rehab exercise program and progress the client through the exercise sessions. The PRP must assess the client's progress at 30-day intervals and report that progress to the referring medical professional. Not reporting the client's progress to the referral source impairs the overall medical management of the client's condition. This is also unprofessional and should warrant the elimination of any future referrals to the PRP. 3) The client must be compliant with the program and attend as well as participate in the post rehab exercise sessions. 4) the PRP must have skills and knowledge to design of post rehab programs for a wide range of medical conditions. The PRP should hold a certification to design programs for post rehab clients. 5) All the members of the rehab spectrum; physician, physical therapist, occupational therapist, nurse, chiropractor and post rehab professional; must understand the post rehab program is not part of the treatment process but it is a means of improving on or maintaining the functional gains made during rehabilitation program provided by the licensed medical professional. The treatment is performed by the medical professionals, once the client is stable, the PRP steps in and provides safe and effective functional conditioning programs. If the PRP fully understands and accepts his or her role, the utilization of PRP's will become an essential part of the rehab spectrum as well as positively affecting the functional outcome of rehab programs. I predict, over the next decade, the PRP will become a more integral part and accepted member of the rehab network.
Thursday, May 1, 2008
What do you have in your post rehab library?
Do you have the essential post rehab resources and references in your library? There are a few essentials texts every post rehab professional must have in his or her library. There are so many fitness and rehab textbooks available but I will narrow the list to six essential textbooks and a couple of periodicals. Take a look at the list of PR library essentials and/or click on the link below to listen to my descriptions of these resources and the reasons I consider them the Post Rehab Library Essentials.
1. Gray's Anatomy - this is the gold standard in anatomy. This text is used to train physical therapy, chiropractic, nursing, medical and other allied health professional students around the world. I know many of you have other anatomy books but as I stated earlier, Gray's is the gold standard. Having a copy of Gray's in your library is a good purchase.
2. Merck Manual - the Merck Manual lists and reviews every medical condition known to mankind. Each condition is reviewed in detail with discussion covering etiology, signs and symptoms as well as treatment guidelines. This is a must when dealing with complicated post rehab clients.
3. Examination of the Spine and Extremities - this is another classic that every post rehab professional should have. This text is used in the orthopedic training of physical therapy, occupational therapy, chiropractic and medical students. This is an easy to use text with great illustrations and diagrams. If you don't understand all the tests the physician or therapist performs on your client, get a copy of Hoppenfeld so you can understand. This text is a must for massage therapists, Pilates instructors, aquatic therapists as well as fitness professionals.
4. Physician's Desk Reference (PDR) - Though sometimes difficult to understand, the PDR lists all the medications known to man and their indications for usage. The biochemical action of the medication is outlined in the PDR but more importantly; the PDR lists side effects of these medications. The effect of these medications on exercise is your chief concern as a post rehab professional. This text should be updated no less than every two years.
5. PostRehabWorks - this is an interactive post rehab reference/resource with the 60 most common medical conditions encountered in a fitness setting reviewed. We provide post rehab exercise protocols, exercise flowcharts, post rehab assessment guidelines and more than 220 video clips of exercises, muscle and range of motion testing procedures as well as post rehab administrative forms. This is the most comprehensive post rehab resource available. If you are digging through physical therapy or chiropracitc textbooks trying to figure out what to do with your post rehab client, try PostRehabWorks. It takes the guesswork out of post rehab program design.
6. Post Rehab Exercise Protocols (PREPS) - PREPS is a simple use manual containing 62 post rehab exercise protocols for the most common medical conditions found in a fitness setting. These protocols are based on clinical observation with 1989 patients in a physical therapy/sportsmedicine clinical setting over a three-year period. These protocols are used by Medical Exercise Specialists, Post Rehab Conditioning Specialists, physical therapy and chiropractic clinics and fitness facilities around the world. These protocols provide step-by-step post rehab guidelines.
7. Journals/Periodicals - I highly recommend the "Journal of Orthopedic and Sports Physical Therapy" (JOSPT) for post rehab professionals and sports conditioning specialists. This journal is geared toward physical therapist but you will find some of the articles useful in post rehab program design. The other journal I would recommend for those "hard core" fitness professionals with an interest in human performance research, the European Journal of Applied Physiology (EJAP). I have found research topics in this journal I could not find everywhere else. Such topics as advanced muscle physiology and muscle function are regularly reviewed inn EJAP.
Click on the link below to download the MP3 file and listen to my discussion of each of these resources and my reasoning as to why they are on our "Post Rehab Library Essentials" list. Go to www.postrehablibrary.com for information on where to buy these resources.
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