You can find the Post Rehab Blog now at www.postrehabblog.com. Please visit us there for information to help you build a profitable post rehab practice and effectively manage a wide range of medical exercise clients. Happy Holidays!!
Showing posts with label post rehab conditioning specialist. Show all posts
Showing posts with label post rehab conditioning specialist. Show all posts
Friday, November 28, 2008
Sunday, August 24, 2008
Post Rehab Tip #13 - What documents do I need for insurance reimbursement?
When seeking insurance reimbursement for post rehab services contact the client’s insurance claims adjuster. You will need the following documents when you make the contact:
a. Signed post rehab referral for the client's physician
b. Post Rehab Program Goals (functionally-based)
c. Post Rehab Program Design (include duration, frequency & number of sessions)
d. Post Rehab Assessment
Securing insurance reimbursement for post rehab services requires more than having these documents on hand. How to negotiate the insurance reimbursement maze is reviewed in detail in our "Insurance Reimbursement for Post Rehab Professionals" workshop. Dealing with insurance carriers is becoming part of the daily life for post rehab professionals. This and other streams of post rehab income are reviewed in our podcast titled "Multiple Streams of Post Rehab Income". Follow this link to listen in our how to develop multiple streams of income in your post rehab practice - Multiple Streams.
Dr Mike
a. Signed post rehab referral for the client's physician
b. Post Rehab Program Goals (functionally-based)
c. Post Rehab Program Design (include duration, frequency & number of sessions)
d. Post Rehab Assessment
Securing insurance reimbursement for post rehab services requires more than having these documents on hand. How to negotiate the insurance reimbursement maze is reviewed in detail in our "Insurance Reimbursement for Post Rehab Professionals" workshop. Dealing with insurance carriers is becoming part of the daily life for post rehab professionals. This and other streams of post rehab income are reviewed in our podcast titled "Multiple Streams of Post Rehab Income". Follow this link to listen in our how to develop multiple streams of income in your post rehab practice - Multiple Streams.
Dr Mike
Tuesday, August 19, 2008
Post Rehabilitation Red Flags.........when should you refer or proceed with caution?
When should you refer your client to a medical professionals? Do you know the signs your client needs an evaluation by a licensed medical professional? If you are not 100% sure, then using our post rehab red flags might be helpful. These red flags are reviewed in each of our post rehab workshops and these are a vitally important concept all post rehab and corrective exercise professionals must embrace and understand. The red flags are listed above. When you see these red flags, as a post rehab professional, you must refer the client to a medical professional or modify the client's exercise program. It's up to you, the post rehab professional, to determine is a referral or program modification is necessary. For more information on the post rehab red flags go to www.postrehabfoundations.com.
Dr Mike
Monday, August 18, 2008
Corrective Exercise.....when to correct or when to refer?
As post rehab courses and guidelines proliferate, knowing when to appropriately use corrective exercise techniques and post rehab training programs seems to get lost in the discussion. Simply the presentation of a client with a postural fault, muscular imbalance or pain is sometimes not enough of a reason to begin corrective exercise. A thorough medical history and assessment on the client must be completed first. Also, discussion with the client's physician or physical therapist is required to ensure you have the full picture before proceeding with exercise. Its interesting that few corrective exercise or post rehab courses really focus on the pathology and assessment of these postural faults, pain and/or imbalances but they do readily encourage exercise. Remember, posture and pain may be the result of a long-term condition or fault and what we see is not what is really going on with the client. The introduction of corrective exercise can exacerbate a dormant condition. Sometimes pulling the string of a postural fault may cause the breakdown of other faults and result in the client having more pain. Now it is important to get to the underlying problem but if you can't anticipate the possible complications, then you shouldn't begin corrective exercise without a thorough history, assessment and discussion with the client's physician. Remember, what is you see is not what you get in posture or with pain. Though a thorough assessment, medical history, x-rays, CAT Scans and MRI's are not 100% accurate, these allow us to eliminate possible conditions. Then we can start to correct faults with a better understanding of possible causes. I am not saying corrective exercise is not great for clear cut postural faults which are easily corrected. But in the back of your mind you should always think, what other complications might be causing the pain or fault and have I given enough consideration to these complications. What you see with human posture and pain is seldom what you get. If you see red flags, talk to the client's physician or therapist. We will discuss the post rehab red flags in our next blog post.
Dr Mike
Dr Mike
Sunday, August 17, 2008
Post Rehab Tip #11 - The step-by-step medical history interview
A thorough medical history must be completed on each post rehab client. Verbally ask the client each question on the med history form. Direct interaction with the client allows for a much more accurate medical history appraisal and avoids the possibility of a medical condition slipping through the cracks. The medical condition missed in the medical history may result in the client exacerbating an old condition or causing a new injury. The most important aspect of the medical history is to listen. Your client will tell you every medical concern they have but you must listen closely for the subtle meanings within the medical history interview. The importance and approach to taking a medical history is reviewed in our Medical Exercise Specialist and Essentials of Post Rehab Fitness workshops.
Dr Mike
Dr Mike
3 Keys to Managing Post Rehab MCL Sprain
Another common injury we see with athletes is the MCL sprain in the knee. The MCL is a stabilizer of the knee and often damaged. Though MCL ruptures are seldom surgically repaired, the occurrence of 1st and 2nd degree sprains is common. The 3 keys to managing this client in a post rehab setting are as follows:
1) Avoid full knee extension until authorized by physician or physical therapist.
2) Strengthen the quad and accentuate vastus medialis recruitment.
3) Avoid activities that increase swelling.
These 3 keys are the foundation of the post rehab program for the MCL client. Also remember, PFS is always lurking with the effused knee. Effuse is common with MCL involvement. Please click the link below to listen to the discussion of these 3 keys.
Dr Mike
Post Rehab Challenge
Your client is a 24 year-old cyclist. She sustained a 2nd degree of the left MCL. She has completed physical therapy and now she has full ROM but an atrohied quadriceps. She has some swelling and point tenderness at the MCL after cycling. How would you adjust the seat for this client and what motion would you limit until the swelling and point tenderness are gone? What complications are associated with knee swelling or effusion?
1) Avoid full knee extension until authorized by physician or physical therapist.
2) Strengthen the quad and accentuate vastus medialis recruitment.
3) Avoid activities that increase swelling.
These 3 keys are the foundation of the post rehab program for the MCL client. Also remember, PFS is always lurking with the effused knee. Effuse is common with MCL involvement. Please click the link below to listen to the discussion of these 3 keys.
Dr Mike
Post Rehab Challenge
Your client is a 24 year-old cyclist. She sustained a 2nd degree of the left MCL. She has completed physical therapy and now she has full ROM but an atrohied quadriceps. She has some swelling and point tenderness at the MCL after cycling. How would you adjust the seat for this client and what motion would you limit until the swelling and point tenderness are gone? What complications are associated with knee swelling or effusion?
Friday, August 15, 2008
3 Keys to Managing the Post Rehab Meniscal Tear Client
Meniscal tears are common in runners and other athletes. If you can manage the post rehab meniscal tear client, you will have great success as a post rehab professional. Arthroscopic surgery sometimes diminishes the importance of the rehab process afterward. This sometimes leads the client to neglect rehabilitation and start running before the meniscus has fulled healed and the quadriceps has regained its strength. The 3 keys to managing PFS are noted below:
1) Control swelling
2) Strengthen the quadriceps and recruit the vastus medialis
3) Avoid high impact activities
Dr Mike
Post Rehab Challenge
Your client is the same 46 year-old female noted in the previous 'post rehab challenge". Please explain the importance of the meniscus and why the menisci are the most important structures ih the knee and not the cruciates.
1) Control swelling
2) Strengthen the quadriceps and recruit the vastus medialis
3) Avoid high impact activities
Dr Mike
Post Rehab Challenge
Your client is the same 46 year-old female noted in the previous 'post rehab challenge". Please explain the importance of the meniscus and why the menisci are the most important structures ih the knee and not the cruciates.
Thursday, August 14, 2008
3 Keys to Managing the Post Rehab Patello-Femoral Syndrome Client
Patello-Femoral Syndrome (PFS) is another common condition seen in athletes. PFS is associated with weakness of the quadriceps and chronic effusion (swelling). PFS can curtail a post rehab training program. There are 3 keys to managing the post rehab PFS client. The 3 keys are listed below.
1) Recruit the vastus medialis.
2) Stretch the IT band.
3) Strengthen the quadriceps.
4) Control swelling - this is the bonus key.
Click the link below to listen to my discussion of these 3 keys.
Dr Mike
Post Rehab Challenge
Your client is a 46 year-old runner training for a 10K run. She reports low grade anterior knee pain after prolonged sitting. She also has mild swelling after running greater than 2K. Please develop the exercise program for this client and explain how the swelling might assist in the development of PFS.
1) Recruit the vastus medialis.
2) Stretch the IT band.
3) Strengthen the quadriceps.
4) Control swelling - this is the bonus key.
Click the link below to listen to my discussion of these 3 keys.
Dr Mike
Post Rehab Challenge
Your client is a 46 year-old runner training for a 10K run. She reports low grade anterior knee pain after prolonged sitting. She also has mild swelling after running greater than 2K. Please develop the exercise program for this client and explain how the swelling might assist in the development of PFS.
Wednesday, August 13, 2008
3 Keys to Managing the Post Rehab Spondylolethesis Client
Spondylolethesis is another condiion commonly seen in athletes. Managing the spondylolethesis is challenging. Spondylolethesis are graded using a 1-4 or 1-3 scale. Severe spondylos (grade 3-4) are sometimes treated surgically. Those spondylos that are non-surgically managed (1-3) should be referred for post rehab conditioning after discharge from physical therapy. There are 3 keys to managing the post rehab spondylolethesis client. The 3 keys are:
1) Determine the grade of the spondylolethesis. This information will come from the physician, physical therapist or chiropractor.
2) Avoid lumbar extension 10 degrees beyond neutral.
3) Strengthen the abdominals and position the client is slight lumbar flexion for normal activities. Slight flexion protects the spinal cord from damage.
Follow these 3 keys to develop a safe and effective post rehab program for the spondylolethesis client. Click the link below to listen to my discussion of these 3 keys.
Dr Mike
1) Determine the grade of the spondylolethesis. This information will come from the physician, physical therapist or chiropractor.
2) Avoid lumbar extension 10 degrees beyond neutral.
3) Strengthen the abdominals and position the client is slight lumbar flexion for normal activities. Slight flexion protects the spinal cord from damage.
Follow these 3 keys to develop a safe and effective post rehab program for the spondylolethesis client. Click the link below to listen to my discussion of these 3 keys.
Dr Mike
Post Rehab Tip #10 - Overall Leg Strength in Post Rehab Fitness
"Overall Leg Strength" is a concept to be considered when working with clients referred with lower extremity disorders such as total knee or hip replacement and ACL rupture. Overall leg strengthening simply means strengthening the muscles of the lower extremity to lift 2-3 x bodyweight. This is important for climbing stairs, stepping off curbs and getting out of a chair. The lower extremity must be able to control and support the client's bodyweight. Closed chain exercises such as the lateral step up, leg press (both bilateral and unilateral) and wall squats improve overall leg strength. Overall leg strength is vitally important to the clients functional capacity and level of independence.
Dr Mike
Dr Mike
Sunday, August 10, 2008
3 Keys to Managing the Post Rehab Shoulder Dislocation
One of the few conditions that requires immobilization for a significant period after injury is the shoulder dislocation. Dislocations are common injuries suffered by athletes. Once physical therapy care is over, the shoulder dislocation client should be referred to a post rehab program to continued strengthening. Let's outline the 3 keys to managing the post rehab shoulder dislocation client.
1) Improve joint stability
2) Strengthen the pectoralis
3) Avoid extreme shoulder horizontal abduction, external rotation and extension
These 3 keys are a foundation for the post rehab shoulder dislocation program. Developing the post rehab program based on this foundation will produce positive functional results.
Dr Mike
Post Rehab Challenge
Your client is a 48 year old female who fell on an outstretched hand resulting in a shoulder dislocation. She completed a 7 week program of physical therapy. She presents at your facility with a post rehab referral signed by her physician. She has 160 degrees of shoulder flexion and abduction. Both movements are pain free. She does have weakness when reaching overhead but no pain. Her rotator cuff muscles are weak. Which muscle(s) are important to strengthen to improve her joint stability? Which ligament structures are damaged with shoulder dislocation?
1) Improve joint stability
2) Strengthen the pectoralis
3) Avoid extreme shoulder horizontal abduction, external rotation and extension
These 3 keys are a foundation for the post rehab shoulder dislocation program. Developing the post rehab program based on this foundation will produce positive functional results.
Dr Mike
Post Rehab Challenge
Your client is a 48 year old female who fell on an outstretched hand resulting in a shoulder dislocation. She completed a 7 week program of physical therapy. She presents at your facility with a post rehab referral signed by her physician. She has 160 degrees of shoulder flexion and abduction. Both movements are pain free. She does have weakness when reaching overhead but no pain. Her rotator cuff muscles are weak. Which muscle(s) are important to strengthen to improve her joint stability? Which ligament structures are damaged with shoulder dislocation?
Post Rehab Tip #9 - Understanding Bone Spurs or Osteophytes
Bone spurs are known as osteophytes. Osteophytes occur as a result of osteoarthritic changes. Rheumatoid arthritis (RA) does not cause osteophytes. RA usually polishes the end of long bones. When the physician looks at an x-ray, an indicator of osteoarthritis is the presence of bone spurs along the margins of the joint. Osteophytes are a normal occurrence with osteoarthritis.
Dr Mike
Dr Mike
Sunday, August 3, 2008
My Post Rehab Story - Here's how the Medical Exercise Specialist certification started!
Hi, I am Dr Mike and in 1994 we offered the first post rehab certification for fitness professionals, the Medical Exercise Specialist workshop and certification. I am asked frequently how it started. So I would like to share this story. Please click the video link below to learn how the MES and our other post rehab certifications began more than 14 years ago. For more information on our certifications visit us at www.postrehab.com.
Post Rehab Tip 7 - The Components of Function
Medical Exercise Specialists and Post Rehab Conditioning Specialist are bombarded with information on "functional training" programs. It's important to understand the components of function and how exercise will impact on the overall functional capacity of the post rehab client. Functional improvement is the most important aspect of rehabilitation. The components to function include:
Dr Mike
Friday, August 1, 2008
The post rehab fitnesss/medical exercise approach....do you have a system?
Managing the post rehab client requires a systematic approach to assessment and exercise program design. The first step is understanding the related clinical anatomy and pathology of the client's condition. The next step is understanding what NOT to do with regard to exercise for the client. Once you understand what not to do now you must determine the key areas that must be assessed to determine the client's exercise capacity and function. After you have completed the client assessment now you may proceed with establishing an exercise program. Each post rehab client must be approached using this step-by-step systematic approach.
Dr Mike
- Understand the related clinical anatomy and pathology.
- Based on the client's condition what exercises and/or activities are contraindicated.
- Determine the key assessment techniques, based on the client's condition, you must utilize to assess the client.
- Develop a safe and effective post rehab exercise program based on your assessment findings.
Dr Mike
Sunday, July 27, 2008
Should I use soap?
SOAP notes are used in clinical settings to document the treatment, progress and recommendations for future management of the patient. Utilization of the SOAP format is usually thought of in a clinical setting. I don't recommend the soap format for the post rehab professional. I do recommend the use of narrative and/or form-based progress reporting format. We developed a session log to document the activities and the outcome of a post rehab session . Our post rehab progress report form allows PRP's to report client progress on a one-page sheet while noting changes in strength, rom/flexibilty, endurance, balance and function. Look for our upcoming podcast on writing post rehab assessment and progress reports.
Dr Mike
Dr Mike
Friday, July 25, 2008
Congratulations to our New Medical Exercise Specialists and Post Rehab Conditioning Specialists
We would like to congratulate our new Medical Exercise Specialists (MES) and Post Rehab Conditioning Specialists (PRCS). These individuals recently passed either the MES or PRCS exam. Again, congratulations and best wishes building your post rehab practices.- Lisha Perini, MES - San Luis Obispo, CA
- J.R. Smith, MES - Somerset, KY
- John Johnson, PTA, PRCS - Petaluma, CA
- Alana Yates, MES - Tulsa, OK
- Marsha B. Pogue, MES - Tulsa, OK
- Michon Wynn, MES - Tulsa, OK
- Neil Hodgson, MES - Tulsa, OK
- Eric G. Nieusma, MES - Fort Lauderdale, FL
- Michael Marasigan, MES - New York, NY
- Angel Perez, MES - Westwood, NJ
- Albert R. Ferrara, MES - New Providence, NJ
- Jill Foster, MES - Burke, VA
- Steve S. Page, MES - Corona Del Mar, CA
- Julia Derek, MES - New York, NY
- Steve Beattie, MES - Toronto, ON
- Jeanne M. Douthit, MES - Tulsa, OK
- Vinisha V. Shah, MES - Toronto, ON
- Adele Tevlin, MES - Toronto, ON
- Stewart Knorr, PRCS - Riverside, CA
- Ronald Holley, PRCS - Washington, DC
- Kristin Fisher, MES - Washington, DC
- Leslie Lawrence, MES - Edmonton, AB
- Lesley Bates, PRCS - Comox, BC
- Sally Whibley, PRCS - Errington, BC
- Jeffrey F. Collingwood, MES - Salisbury, CT
- Joan Collingwood, RN, MES - Salisbury, CT
- Karen Church, MES - Salisbury, CT
- Juliana DeFriese, PRCS - Concord, CA
- Sheryl Oeftering, PRCS - Keyport, NNY
- Michael Fitch, MES - Miami Beach, FL
- Hayley Ridgway, PRCS - Cheshire, England
- Jim Keizer, MES Miami Beach, FL
- Elizabeth Blanton, RN, MES - Valdese, NC
- L. Reine Vilim, MES - New York, NY
- Paul McKinney, MES - Victoria, BC
- Jacquelyn M. Campbell, PRCS - Fort Washington, MD
- Nicholas Luciano, MES - Bel Air, MD
- Jon Rainey, PRCS - Victoria, BC
- Kaly William Robinson, PRCS - Victoria, BC
- Thomas Acheson, PRCS - Victoria, BC
- Aisha Ellis, MES - Toronto, ON
- Derrick Whelan, MES - Toronto, ON
- Michelle Hosty, MES - Toronto, ON
- Levi Sampson, PRCS - Victoria, BC
- Kari Putnam, PRCS - Austin, TX
- Austin Barbisch, PRCS - Austin, TX
- Kimberly Lawrence, PRCS - Dublin, CA
- McAllister Dodds, PRCS - Lafayette, CA
- Lori Anne Thompson, MES - Belleville, ON
- Courtney Gregory, PRCS - Arnold, MD
Wednesday, July 23, 2008
How does a Medical Exercise Specialist Build Credibility?
Credibility seems the one thing post rehab professionals are consistantly searching for but in all the wrong places. I think our Medical Exercise Specialist workshop and certification is the best on the planet. The MES workshop is thorough and gives you all the tools and knowledge you need to succeed. But just having the MES won't give you instant credibility. Credibility is built from the ground up by working with a large number of medically-based clients with wide range of conditions over a long period. During that period you demonstrate the ability to manage and progress these clients effectively and you communicate this information to medical professionals and insurance carriers in a clear and concise manner. Again, this is over a long period.
I built credibility as a physical therapist not because I had a PT degree or a license. It was built over a long period treating a wide range of patients and working closely with their physicians and other medical professionals. If you think credibility comes in a certification, weekend workshop, an exercise technique or website, you are sorely mistaken. If you can look back at a large number of your clients and unequivocally say you have managed them well and 80% reached their goals.....YOU HAVE CREDIBILITY!!! The MES certification will give you more knowledge and skills to reach more medical professionals and clients. The MES certification can not make your credible if you have no foundation.
Please let us hear your comments on building credibility by recording your thoughts at 214-615-6505 x9985. We appreciate hearing from you. Click the link below to listen to my comments on building credibility.
Dr Mike
I built credibility as a physical therapist not because I had a PT degree or a license. It was built over a long period treating a wide range of patients and working closely with their physicians and other medical professionals. If you think credibility comes in a certification, weekend workshop, an exercise technique or website, you are sorely mistaken. If you can look back at a large number of your clients and unequivocally say you have managed them well and 80% reached their goals.....YOU HAVE CREDIBILITY!!! The MES certification will give you more knowledge and skills to reach more medical professionals and clients. The MES certification can not make your credible if you have no foundation.
Please let us hear your comments on building credibility by recording your thoughts at 214-615-6505 x9985. We appreciate hearing from you. Click the link below to listen to my comments on building credibility.
Dr Mike
Monday, July 7, 2008
Post Rehab Tip #5 - Wolfe's Law
Wolfe’s Law is the very basis of post rehab and strength training. Wolfe postulated that if we stress connective tissue it will become stronger. Strengthen training actually makes bone, muscle, tendons, ligaments, muscle and even cartilage stronger. Even connective tissue has limits. This limit is known as the "physiologic threshold". The physiologic limit or threshold is the amount of force the tissue may absorb before damage occurs. Tissue damage occurs when the force exceeds the limit. Sprains, strains and ruptures are examples of exceeding the physiologic limit or threshold. Wolfe's Law is fundamental in understanding the injury process and post rehab program progression guidelines. Click the link below to listen to this post rehab tip.
Dr Mike
Dr Mike
Monday, June 16, 2008
Post Rehab Tip #4 - Post Rehab Red Flags
When we implemented our Medical Exercise Specialist workshop and certification program, we realized it was important the post rehab professional be able to identify the inappropriate client. We established the "Post Rehab Red Flags" to give post rehab professionals hard fast signs they could easily see to identify that inappropriate client. The post rehab red flags are noted below:
a. Numbness/tingling
b. Radiating pain
c. Swelling
d. Nite pain
e. Loss of range of motion
f. Loss of function
g. Chest pain/shortness of breath
h. Open Wounds
i. Abnormal vital signs
Clients demonstrating any red flags should be referred to a medical professional. The client's exercise program may require modification based on your discussion with the medical professional. Recognizing these red flags will help you avoid exacerbating existing conditions or possibly injurying an apparently healthy client. Follow the link below to listen to this post rehab tip.
Dr Mike
a. Numbness/tingling
b. Radiating pain
c. Swelling
d. Nite pain
e. Loss of range of motion
f. Loss of function
g. Chest pain/shortness of breath
h. Open Wounds
i. Abnormal vital signs
Clients demonstrating any red flags should be referred to a medical professional. The client's exercise program may require modification based on your discussion with the medical professional. Recognizing these red flags will help you avoid exacerbating existing conditions or possibly injurying an apparently healthy client. Follow the link below to listen to this post rehab tip.
Dr Mike
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