Career Advice Article Archives

Check out all my career advice articles. There’s something for everyone, from students, to new grads, to the more experienced.  Explore the archives below or click the button to subscribe and never miss another post.

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5 Tips for Landing a Sports Medicine Job in Professional Sports

Four Leaf Clover There are a lot of students that I have worked with and that read this website that ask me one recurring questions – “My dream is to work for [insert your favorite sports team here]. How do I get a job in professional sports?”

I like your dream!  I too had the dream of being the PT/ATC of the professional team in the town I grew up in, Boston.  I was also a big fan of baseball, and obviously the Red Sox.  I was lucky enough to achieve my dream, here is what I would say to help you:

“Luck is when preparation meets opportunity” – Seneca, Roman Philosopher, 5 BC – 65 AD

1.  Determine what exactly you would call a “dream job.”.  I know when I started college, I really had no idea what my career would be like or what exactly I wanted to focus on.  I applied to some colleges as an athletic training major and others as a physical therapy major.  I often reflect and think that it is so difficult for a 16-17 year old to make a decision as to what they want to do for the rest of their lives.  I had so many classmates drop out or switch majors because they realized that physical therapy was not for them.  To be successful, you need to love what you do.

I would recommend you spend some time in your potential field in high school or early in college to see what a day-in-the-life is for people in the field you want to go into.  Many people don’t realize how challenging sports medicine is as a profession.  You need to be energetic, compassionate, patient, and love to interact with people.  People also don’t often realize what a normal work day is like.  I work 12-hour days, 7-days a week, for 9 straight months.  I am not kidding or exaggerating, check out a baseball schedule, there are no days off.  Even on our off-days we have treatments and have to prepare for upcoming games.  It is amazing that I have a supportive family.  As a physical therapist in a clinic, you are performing a service and your fate is determined by your patients.  If they come late, you miss lunch.

2.  Associate yourself with the best.  My next tip may be one of the most important.  You need to seek out the best people in your field and learn, work, and grow with them.  With hard work, time, and a lot of effort you will become one of them.  That is what I did, I searched out the best sports medicine people in baseball and discovered Dr. Andrews and ASMI in Birmingham, AL.  Over the course of almost 8 years, I progressed from a student research position, then did a year long sports medicine fellowship, 5 years later I was the Director of Rehabilitation.  I put myself in a position where I was desirable to baseball teams.

This also goes for networking.  Unfortunately, it is all about politics and who you know.  The more you can network and join associations or attend conferences with people that are in a position that you want to be in one day, the better.  Look for mentors, look for friends, and look for opportunities.

Out of the tunnel3.  Work your way up.  It is near impossible to reach the level of professional sports without spending time in the trenches.  High school and collegiate athletics is a step in the right direction.  Internships are very popular in professional sports and essential to getting your foot in the door.  Seek out the professional sports medicine association of the sport you are interested in (we are PBATS in baseball, not sure about other sports) and look into doing an internship or volunteering, even if it is just for training camp.  Nothing beats experience, so the more specific your experience can be the better.

4. Set yourself apart from your peers.  This one is important and difficult.  I was lucky and figured out what I wanted to do with my career early on in college.  When I was taking my neurological and pediatrics classes, I would spend my book money on buying new orthopedic and sports medicine books and just obtain my neuro and pedi required reading from the library.  OK, so this may not be good advice, but it shows and example of how I used my time and energy to set myself apart.  I read everything I could on my topic of interest, baseball sports medicine.

The easiest way to set yourself apart from your peers early on is to show an extreme desire to learn and achieve.  I really do feel that hard work will beat out intelligence every time when the race is close.  As your career advances, try to set yourself apart.  How can you do this?  Maybe conduct some research, submit manuscripts to journals and newsletters, take charge and organize journal club, work extra hours, take on extra projects, and volunteer your time.  Remember, this isn’t going to be easy, if you want a top level job, there will be sacrifices.

5.  Be patient.  I don’t think there are many new grads working in professional sports, probably wont be any time soon either.  Use the above thoughts to make yourself standout from the crowd.  Using baseball as an example, you are trying to get a job with only 30 positions in the entire world.   For my dream job, there was only one position.  I am lucky to say that I obtained my dream job and I am grateful for this. Realize that it will take a little luck and timing, make sure you do everything you can do to be sure you are ready when an opportunity presents itself.

Good luck and best wishes!

Photos by Kaibara87 and exquisitur

Using the QUADAS Tool to Assess the Quality of Research

Have you been feeling lately that the quality of research reports are not always the same across journals?  Or that some articles you read do not appear to have the best methodology?  With all the emphasis on evidence based medicine, it is more valuable now than ever to assure that research reports are of superior quality to assure that we are conveying accurate information to our colleagues.  Harrison Vaughan

Today’s guest post is written by Harrison Vaughan, PT, DPT.  Harrison is a physical  therapy practicing in South Hill, VA at In Touch Therapy.  His professional interests include clinical diagnostic tests and treatment consisting of orthopedic manual therapy, predominantly spinal manipulation.

Using the QUADAS Tool to Assess the Quality of Diagnostic Accuracy Research Studies

The research community has fortunately developed a tool to critique studies and aid in clinician’s decisions to choose the correct physical examination tests, called QUADAS.  QUADAS stands for:

  • Q – Quality
  • A – Assessment of
  • D – Diagnostic
  • A – Accuracy
  • S – Studies

Many of you may have never heard of it and from speaking with others, this appears to be the norm.

What is QUADAS?

QUADAS is an evidence based tool to be used for the quality assessment of diagnostic accuracy studies.  It consists of 14 items phrased as questions, each of which should be scored a “yes”, “no” or “unclear” that examine bias in the study.

How do clinicians determine which study is most appropriate based on QUADAS score?

Past studies have shown a score of 7 of 14 or greater of “yes’s” to be of high-quality and scores below 7 to be of low-quality.  However, some authors have recommend articles with 10 or higher “yes’s” as cut-off for a high-quality diagnostic accuracy study.

How do I use this tool in my clinical assessment?

Below is an example of comparing two studies using the QUADAS score to clinically diagnose SLAP lesion.  These studies were mentioned in a previous post on the clinical examination of SLAP lesions.

O’Brien’s test: Sensitivity: 100, Specificity: 99, LR+: NA, LR-:NA, QUADAS Score: 3

Biceps Load Test II: Sensitivity: 90, Specificity: 97, LR+: 26.38, LR-: .11, QUADAS Score (0-14): 10

clinical examination of SLAP lesions

From the data above, it appears from first glance that the O’Brien’s test is superior showing great statistical numbers compared to the latter test (even though both show promising figures). However, if you look at the QUADAS score, you can see the significant differences between the two showing O’Brien’s test has much more bias. The Biceps Load Test II is on the lower end of a high quality score (10/14) but much greater study that O’Brien’s (3/14). I am not specifically picking on O’Brien but this makes a good example of similar diagnostic values but very different QUADAS score. In other words, if you obtained a (+) O’Brien’s test, you shouldn’t be so optimistic of a positive SLAP lesion due to poor study design.

I recommend the book Orthopedic Physical Examination Tests-An Evidence Based Approach by Cook & Hegedus to obtain recent QUADAS scores (as well as sensitivity, specificity, etc) for most, if not all clinical diagnostic tests; both new and old. It will surprise you that most of the “classic” special tests that many have been using for years have poor diagnostic value.

Download the QUADAS tool.

It may be difficult for many to change their evaluation regimen, but I do hope this data changes your outlook on the best special test to choose and strengthen your examination.  I hope this information adds to your realm of knowledge and help you become more objective in clinical diagnostics.  Have you used the QUADAS tool before?  What popular study do you know of that everyone references but has a very low QUADAS score?  Thanks Harrison, great post.

Penny Whiting, Anne WS Rutjes, Johannes B Reitsma, Patrick MM Bossuyt, Jos Kleijnen (2003). The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews BMC Medical Research Methodology, 3 (1) DOI: 10.1186/1471-2288-3-25

Predicting Which Patients Will Not Respond to Physical Therapy


We are lucky to feature a guest post from Christie Downing, PT, DPT, cert MDT, ICLM.  Christie works at Alexian Brothers Rehabilitation Hospital in Elk Grove Village,  IL.  She specialize in musculoskeletal care as well as lymphedema management.  She is a MDT credentialed provider and student in the Diploma level of MDT, focusing primarily in MDT in both spine and extremity problems.

Predicting Which Patients Will Not Respond to Physical Therapy

Now, I love my profession as much as the next PT, but I think I am realistic when I say that PT cannot fix everyone’s problems. I’ve come to realize that predicting positive outcomes of intervention is only one side of the coin, and that we must also be able to predict who will not respond to physical therapy. Often times, the medical community is not privy to such predictors and focus their attention simply on an imaging study or other medical test.

If you have been followed this blog, you will find my previous post about Mechanical Diagnosis and Therapy (MDT) and its ability to predict annular competence in the lumbar intervertebral disc. In MDT, we often focus on the predictive abilities of centralization in those with a derangement syndrome to indicate GOOD outcomes.  This has been shown in several articles, include some of my favorites listed in the below references.1,2,3,4,5

However, a truly great therapist must also recognize when improvement by physical therapy just “isn’t in the cards.”

For those who practice MDT, this includes those with “irreducible derangement” which has specific diagnostic criteria for inclusion in this category. The predictive ability of failure to centralize in the irreducible derangement has exceptionally high predictors of chronic disability.3,6

Werneke and Hart showed this well in a study of 223 subjects with acute low back pain.  The authors assessed 23 different psychosocial, clinical, and demographic factors in an attempt to determine predictive values of chronic disability.  Of the 23 different variables, the strongest predictive variable to chronic low back pain and disability was noncentralization of pain.  This has been shown by Skytte et al as well.

Rapidly Reversible Low Back Pain

I’d like to pause for a moment and briefly discuss Rapidly Reversible Low Back Pain by Ronald Donelson, MD, MS. This was also Mike’s Book of the Week in the past.  In this book, Dr. Donelson critically examines our current state of diagnostic triage of those with low back pain. He takes a painfully realistic look at current practices and investigations among both the medical and allied health professions and highlights their shortcomings. Dr. Donelson has invested much time in investigating conservative care of low back pain and has taken a particular interest in MDT. So why does an orthopedic spine surgeon want anything to do with conservative care of low back pain? Well, you’ll have to read his book to understand the story about how he became acquainted with Greg Silva, PT, Dip. MDT. In my opinion, Dr. Donelson, in both his book and research,7 eludes to the notion that MDT clinicians have been able to help HIM better select patients for surgical intervention.

Imagine that, WE, as PTs, having valuable input as to the need for further intervention!

Very little frustrates me more than when I feel that a patient will not benefit from further PT only to have the physician continually refer a patient back to physical therapy for the same pointless interventions. Surely, not everyone can be a Dr. Donelson. However, how ready is the medical community to hear our messages?

Does this happen to you and what resistance have you faced when you predict a poor outcome?  Furthermore, what other pieces of evidence do we have that demonstrate strong predictive abilities for poor outcomes?  If anyone has predictors for poor outcomes of meniscal derangement and any other pathology, I would be particularly interested.

Note from Mike Reinold: Rapidly Reversible Low Back Pain is a great book that is highly recommended for those interested treating low back pain.  I was amazed at how simple, yet highly effective, the concepts are that are outlined in the book.  Definitely one of the best reads for treating low back pain for under $20!  Click here for more information or to purchase from  Thanks Christie, great post!  If you are interested in guest writing for this website, please contact me.


  1. Aina A, May S, Clare H; The centralization phenomenon of spinal symptoms – a systematic review Man Ther; Aug;9(3):134-143, 2004.
  2. Donelson R, Silva G, Murphy K.; Centralization phenomenon. Its usefulness in evaluating and treating referred pain. Spine; Mar;15(3):211-3, 1990.
  3. Skytte L, May S, Petersen P; Centralization: Its prognostic value in patients with referred symptoms and sciatica Spine; 30:E293-E299, 2005.
  4. Werneke M, Hart DL, Cook D; A descriptive study of the centralization phenomenon. A prospective analysis. Spine; Apr 1;24(7):676-83, 1999.
  5. Werneke M, Hart DL, Resnik L, Stratford PW, Reyes A; Centralization: prevalence and effect on treatment outcomes using a standardized operational definition and measurement method. J Orthop Sports Phys Ther; 38:116-125, 2008.
  6. Werneke M, Hart DL.; Centralization phenomenon as a prognostic factor for chronic low back pain and disability. Spine; Apr 1;26(7):758-65 , 2001.
  7. Wetzel T, Donelson R, : The role of repeated end-range/pain response assessment in the management of symptomatic lumbar discs. The Spine Journal; (3): 146-54, 2003.

Werneke M, Hart DL (2001). Centralization Phenomenon as a Prognostic Factor for Chronic Low Back Pain and Disability Spine, 26 (7), 758-764