Monday, December 16, 2013

Building a Successful Therapeutic Relationship!

The patient-therapist relationship is vital to the success of the patients' plan of care. Although that theory may seem obvious, the value of a functional relationship between a PT and their patient is sometimes neglected whether consciously or unconsciously. Good service is invaluable!

So how do we develop this relationship?

Open Dialogue: From the initial evaluation all the way to discharge, therapists and their respective patients should be continuously discussing the progression of their therapeutic program. Therapists should be assessing what's giving positive results, no results, or negative results.

Education: Therapists should be consistently keeping their patients aware and engaged by educating them on what may be causing any symptoms, the plan to treat it, why they're doing what they're doing, and what to expect from it all. Being that a therapeutic program has time limitations, it's also quite essential and beneficial for the patient to be given lasting information to take from their care in order to be responsible for their health in the forthcoming days after they have been discharged.

Accountability: On the other hand, therapists are not the only takers to responsibility. Patients MUST be willing to trust in the therapist's creative plan, follow the therapist's guidance, and take the initiative to perform their Home Exercise Program (HEP) regularly. Patients should be open enough to tell therapists how they feel about their current treatment program. I ask my patients how they feel about their treatment at almost every subsequent appointment.

When there's a good communicative relationship between the two parties, it creates a larger potential for a successful therapeutic experience even if physical therapy is determined to not be the cure to their specific disorder. As a Physical Therapist, I think I can speak for a grand number of other therapists when I say we find gratification in gratifying. Personally, it serves as a humbling reward for a patient to express gratitude for how they were treated throughout the patients' tailored program. It is the fuel that keeps my wheels turning (or my hands mobilizing to keep things in perspective).


Clifford Civil, PT, DPT, ACSM-HFS

Monday, December 2, 2013

Ski Season: A Guide to Preparing for the Slopes!!

I am so excited for ski season this year but before I hit the slopes I want to give some friendly advice to all of our patients on how to avoid an injury!

Here are some very scary statistics for you type 'A' personalities:

Half of all ski injuries involve the lower extremity (hip/knees/calf/ankle/foot) and about 1/3 are upper extremity (shoulder/elbow/hand/wrist) - the rest are back/trunk injuries and head injuries. Head injuries are almost twice as common as back injuries so wear your helmet!

With snowboarding, 2/3 of all injuries are upper extremity. Usually from falling on our stretched hands – wrist guards can significantly decreases the chance of a wrist fracture. Also if you plan on doing tricks, snowboarders are 3x more likely to be injured while jumping than skiers.

Now that everyone is properly scared here are some tips to prevent you from becoming one of the above statistics:
  • Stay active! It takes a lot of endurance to ski down a hill and once you are at the top there are only two ways down – ski/snowboard or being sled down by ski patrol (yes I have had to do this – meniscus re-injury!) Start small – if you can keep a conversation while you perform your cardiovascular exercises then you are working at a good level.
  • Stay flexible! While you do not need to be like Gumby, snow sports take a lot of movement.
  1. Quadriceps – hold your ankle to your hip and push your pelvis forward
  2. Hamstrings – sitting in a chair, put your leg straight out in front of you, heel on the ground, and lean toward your toes 
  3. Iliotibial band – cross one leg in front of the other and push your hip out to one side
  4. Hip rotators/low back – Lie on your back with your knees bent. Let your knees fall to one side. Hold for 30 seconds and repeat on the other side 

  • Stay strong! I don’t want to hear any whining about being sore after skiing! 
  1. Quadriceps – Squats 3 sets of 10. To add more strength, I add 5 seconds holds when my patients are ¼ their normal depth. This is to reproduce the stance posture you have when skiing or snowboarding. This can also be done on a BOSU ball (black platform side up) to make it harder and to insure that both legs are working equally 
  2. Hamstrings and glutes – Lunges 3 sets of 10 to make things harder use a BOSU ball to lunge onto the blue dome side 
  3. Core – Planks, hold 1 minute, repeat 3 times. On your toes and hands, push your body up. Do not let your back/hips dip down toward the floor.
  • Improve your balance! It is always helpful to be upright while you ski! Stand on one leg (near something you can hold on to) for 30 seconds at a time - repeat 4x on each side. To make it harder you can stand on a pillow/BOSU ball or even close your eyes. 
  • Be able to jump (a lot)! You will need to be able to jump and land at times on the slopes to turn or to impress your friends in the “trick park”. 45 degree stair jump – Start on the bottom of the stairs with your feet at a 45 degree angle from the stair then jump up one stair and land with your feet at the opposite 45 degree angle. 
Remember to warm up before you start on those black diamonds and no, this does not mean drinking cups of hot chocolate at the lodge. Now if you feel that you have been a couch potato since last season, may I suggest one of our Gravity Training System (GTS) classes. Each class has a three person maximum with a trained, experienced, wonderful instructor. A couple of classes before ski season will insure that you look fabulous on the slopes!

Let it Snow!!

Julie Garner, PT, DPT, COMT, CCI