5 Things I Learned in 2009

image As 2009 comes to a close in the next few weeks, I would like to reflect back on a few things that I learned, or at least strengthened my understanding on, this year.  It is a practice that I try to perform each year and recommend you do as well.  I feel that it helps me focus my energy and prepare for the upcoming year.  Please comment on this and share with me what you learned this year.

1. Posture plays a significant role in upper extremity function.

Its been well documented that posture plays a role in function.  As an example, now that i have you sitting in front of your computer, slouch as much as you can (as if you weren’t already!) and try to elevate your arm.  How high do you go?  Now sit up straight and elevate your arm again, goes up all the way doesn’t it?  I get that, there is research to support changes in subacromial space, increased impingement etc.

image What I am talking about is function – how a simple thing like tightness of the pec can tilt the scapula, which inhibits the lower trap.  But let’s not stop there, try this one.  Sit in your chair and slouch again.  Now anteriorly tilt your pelvis.  Isn’t it amazing how you can not slouch when you pelvis is tilted?  Looking at the body as a whole is an amazing approach.  learn, understand, and apply the concepts of the upper and lower body cross syndromes into your patient care.   Read more about these concepts from Vladimir Janda in this nice article from Phil Page.

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 Figures from Chaitow: Muscle Energy Techniques, 3rd edition, with permission

image Another interesting note, I recently tried out this cushion that helps you sit more upright.  It’s called the Tush Cush, hilarious!  It helps you site with an anterior pelvic tilt.  It really works, you sit better and you back feels better.  A great product for those that drive or sit a lot that experience any spine or shoulder pain.  I am actually using it as I type this!

2. Trigger points are real and can be managed.

I am going to take some heat for this and I have already heard from people that disagree.  I have witnessed many soft tissue structural issues that occur from acute and chronic postural adaptations that respond well to trigger point therapy.  Haven’t you had a knot in your upper trapezius / levator that felt better and improved your neck and shoulder motion after you self-massaged the area?  I have.

There isn’t a lot of science behind the theories just yet, but there is more every year.  The Journal of Bodywork and Movement Therapies is working towards improving this as well.  I’ve mentioned it in my post on the Essential Reading List, but you really need to check out some of the work of Leon Chaitow.  He is not the only person with this thought process, there are many, many more.  But Leon does a great job putting the info together in a practical way in his books.  He also summarizes the available efficacy well.  Here is a good video of one of his technique:

3. There are a lot of great resources on the internet to learn new techniques and share ideas.

As I grew this website over the last year, I found many more great resources on the web.  The majority appear to be from strength and conditioning specialists, but there are a some by athletic trainers and physical therapists as well.  Some have a small cost (but are worth it) but most are free resources.

Take advantage of these resources, they are only getting better every day.

I try to share what I find each week in my Stuff You Should Read articles.  Be sure to fill out the form below to sign up for my newsletter.

4. Online continuing education is effective and a great way to further our skills.

image If you remember back to earlier posts here, I have been saying that I think online continuing education is the wave of the future.  Don’t get me wrong, the live seminar/lab structure will never be replaced, but more and more people will begin to explore online education.  There are many pros – study at your own pace, go back and forth as you see fit, combination of video, reading, and interaction, and the fact that you don’t loose a whole weekend!

I have started some webinars this (and will do more, I know it’s been awhile).  These are live presentations that I perform from a distance.  I have my past webinars recorded and available at AdvancedCEU.

I also just finished my first 7-week online continuing education program on the Recent Advances in Evidence-Based Evaluation and Treatment of the Shoulder.  I didn’t know what to expect but the response was huge.  This was a great experience and I will continue to grow this program, will likely start another one in either January or March (Let me know what you would prefer).  UPDATE: You can now start this program anytime at ShoulderSeminar.com.

See some of the responses from participants around the world:

  • “I’ve been a PT for 18 years and have grown confident in my treatment of all shoulder injuries. I have a strong reputation in the Cape Cod community as the shoulder PT. This course was humbling. I have never been as excited to treat shoulder patients then I have been during the past 6 weeks due to this course. Mike’s video presentations, assigned research reading, and knowledge on the discussion board made me think differently about how and why I treat shoulders the way I do. His knowledge has challenged me and opened my eyes to things I need to consider for evaluation and treatment and what I need to do better. He has fine tuned all my treatments. I’m a better PT now, and my patients will get better results. It’s amazing that I’m most excited about shoulder treatment now than at any other point in my 18 years experience. Thanks Mike.” – Jim Hawley, PT Hyannis, MA
  • “The course was FANTASTIC!!!!! I learned a lot and i hope there are more courses like this one! Great experience!” – Eduardo Corrêa – Salvador/Brazil
  • “Mike Reinold’s Online Shoulder Course is not one to miss. The information from this 7 week course is a great clinical foundation for all clinicians that see patient’s with various shoulder pathologies. You will definitely walk away a better clinician and provide better care for your patients after taking this course.” – Megan Eorio, DPT Danville, CA
  • “Mike’s course does a brilliant job of integrating the most recent evidence based practice with current surgical techniques and rehab of the surgical and non-surgical shoulder patient. He brings together a very organized learning experience that offers the participant the flexibility to move at their own pace and access to open discussion with a diverse, very knowledgeable cross-section of therapists. This course organized the approach I will take with my shoulder patients in the future.” –  Christine Panagos. Portland, Oregon.
  • “This online course was a great learning experience for me. It definitely expanded my knowledge on shoulder pathology and treatment techniques. I was able to interact with some of the best clinicians in the country without leaving my home. I highly recommend this course and look forward to future online courses taught by Mike Reinold.” – Christie Gaston, PT, DPT Homewood, IL
  • “This course provided an unbelievable amount of content, focused on recent research, regarding the shoulder joint. If you complete this course, with all presentations and readings, you will have a very thorough understanding of the shoulder joint. It was great to have the ability to review the material at any time, from anywhere, via the internet format. Also, the ability to interact with a leader in our field for over 6 weeks is incredible!!” – Carlyle Schomberg, Waynesville, NC

5. It is easy to get consumed by work, there are more important things in life.

You can thank my now 1 year old daughter for this one.  I am guilty of being consumed easily, not just in work but really anything I set myself to do.  My motto was always, “I’ll work hard now so that I can afford to slow down when I need to in the future.”  Well, that time is now.  My goal of 2010 is being consumed with the important things in life.  A friend of mine once told me, when our careers are all said and done, the only people that will truly remember you accomplishments are your family.

Have a great holiday season and an even better 2010!

Photos by bigpresh and thomasbrightbill

15 replies
  1. CritterJPT
    CritterJPT says:

    Mike,

    One other note. I really think the crossed postural syndromes are critical for healthcare practitioners to understand though we must always consider the fact that the dominant arm tends to be affected to a greater extent than the nondominant arm, especially in the context of the overhead athlete as well as when pathology affects the dominant arm. I originally presented data (Platform) at CSM in Boston discussing forward shoulder asymmetry and posterior shoulder tightness. WHat this data specifically showed was that as the degree of the forward shoulder asymmetry increased that there was a concominant decrease in GH IR ROM at 90 degrees of abduction as well as a more restricted Tyler Test. Todd Ellenbecker, John Borstad, and I have also been trying to add to the literature on this topic. I would enjoy hearing your perspective on forward shoulder posture and the asymmetries you encounter especially in overhead athletes and patients with shoulder pathology

    Christopher Johnson MPT MCMT ITCA

  2. Christopher
    Christopher says:

    Mike,

    It is good to know that you have taken the time to reflect on this past year and you have obviously arrived at some very important conclusions that are often overlooked. I think the first two conclusions are particularly important. Posture and trigger points are intimately linked from my clinical experience. It is relatively easy to predict where trigger points develop based on a sound postural observation. Practicing in NYC, one could sustain themselves treating just upper trapezii and levator scapulae trigger points. Though there is no solid research on this to date from my understanding, the optimal sequence of treating these trigger points from my clinical perspective is to use a progressive pressure release technique followed by a stretch of the involved muscle and most importantly to retrain the proper muscles which should be carrying out the desired action. I am in the process of developing a nice tutorial with Luke Bonjiorno (New York PT) and would love to share this stuff with you as well as the rest of the folks who are posting comments. One additional comment…I tell all of my patients that posture and the ability to fight gravity is the most important thing at the end of the day. In NYC this point is easy drive home because I tell my patients to look out the window and tell me what they see. Their obvious response is lots of buildings. I remind them that all of these buildings would have fallen to the ground if they did not have a stable foundation. This in my mind is the role of sound posture. So instead of trying to buy the ideal chair that balance your body from a postural standpoint and consider the support surface you are either sitting or standing on and life will treat your musculoskeletal system better.

    Chris Johnson, MPT MCMT ITCA

  3. Kory Zimney, PT
    Kory Zimney, PT says:

    Mike, thanks for the post. Great points all the way from #1-5 as you always do.

    And yes #5 is such a great point. Our life is like an hour-glass glued to a table, we don't get to turn it over and try again. We have to enjoy the precious present that we have everyday.

    The continual thing I learn every year is that there is always so much more to learn and my patients deserve my continual effort to learn to help them maximize their function through optimal movement. I have just started using blogging myself, from encouragement through reading yours and others, as another avenue to help educate and encourage patients and others to improve their health through exercise.

    http://koryzimney.blogspot.com

  4. Roderick Henderson, PT, OCS, MA, CSCS
    Roderick Henderson, PT, OCS, MA, CSCS says:

    Mike. Thanks very much for mentioning my blog. You've managed to create an excellent blog here and your passion definitely shines through in your material. I'm glad you keep learning too, I find learning and sharing informaiton often go hand in hand. I hope we can inspire other PTs to get more active and keep moving in the right direction.

    Merry Christmas to you and have a blessed 2010.

    Rod Henderson, PT, OCS,CSCS

  5. Harrison Vaughan, PT, DPT, Cert. SMT
    Harrison Vaughan, PT, DPT, Cert. SMT says:

    Mike,
    Great points giving an overall positive aspects over the past year. For anyone, not just professionals in healthcare, #5 point is ultimately the number one. I do not have a child but do realize that I do get carried away at times wanting to learn more in our field and working hard to do it but have to step back and consume arguably more important parts of life. It is great to hear this from a very successful clinician & academician as you are.

    Probably not a good thing for authors and book companies but I agree with online education as the future. My young career has been focused more on learning from other clinicians through sites as yours, rather than textbooks. Information may not be as evidenced but is more up to date and very much from a clinician view-point.

    Keep up the good work.
    Best,
    Harrison

  6. Christie Downing, PT, DPT, Dip. MDT
    Christie Downing, PT, DPT, Dip. MDT says:

    …yes, immediate relief is often needed…but a repeated end range motion is often just the trick to do this…

  7. Mike Reinold
    Mike Reinold says:

    Christie – really good point about trigger points. I definitely agree with you that they are a symptom, no doubt, and the solution is not found within the trigger point. I should have been more clear!

    In my current clinical setting, my patients need to feel immediate releif and restoration of function. I can't solve a problem in one day, but I can help the symptoms while I am working on the long term problem. I hadn't thought of it from this perspective, thanks for the comment, you helped me articulate this better!

    Good call on the sciatic pain as well, no doubt.

    As usualy, great addition to the discussion. Thanks

  8. Christie Downing, PT, DPT, Dip MDT
    Christie Downing, PT, DPT, Dip MDT says:

    Mike,
    Excellent example for posture ed in shoulder function…I've been using this one for years. It's also important in showing someone how they can usually mitigate sciatic type syptoms with this as well. They really need to be shown the cause/effect relationship.

    Regarding TPT/MME, I'm not going to give you heat, but I'll give you something to think about:
    Is a trigger point a symptom, or it's own separete entity?
    I won't say outright what my opinion is, but I'll give you an example. One of my current patients who is very "pro massage" who is very aware of her upper trap "trigger point" was shown how she can mitigate it with posture correction and self directed repeated end range exercises! Who do you think will be more likely to take an active approach in their rehab…the person who learns how posture correction and exercises mitigate their symptoms, or someone who has TPT release done "to" them? No heat meant to you…just something to think about.

  9. Mike Reinold
    Mike Reinold says:

    Link should be working now, sorry. Was trying to use Google Docs but that didnt work, back to Box. Anyone know how to embed a PDF into a webpage?

    Carl, you'll need to join me for an online course!

  10. Anonymous
    Anonymous says:

    You're a good man Mike. Well written.

    The only thing you might need to do is start offering some courses in Canada, then I will respect you more :( kidding

    Good job.
    Carl

  11. Anonymous
    Anonymous says:

    Hey, Mike. Great points, especially like the postural elevation example because in a matter of seconds it makes people realize what that slumped posture does to their function! As far as the shoulder course, I vote for January but please let us know before we plan out our CEU money for the year! Thanks for all the great guidance! Happy Holidays
    Nate Lee, DPT

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