Author Archives: Zachary Huff, PT, DPT, OCS

My Blueprint for Clinical Practice Development

Blue print

My physical therapy program was designed to prepare “generalists;” physical therapists who can work in nearly any setting/environment with the knowledge and skill to get the job done and prevent death/dismemberment  Coming out as a generalist is a double edged sword; you can work anywhere, but that doesn’t mean what you’re doing is of the highest calibre. One of the best options to quickly gain experience, mentorship, and training is via post-graduate residency. Obviously this isn’t an option for everyone, particularly those in the tribal setting…me included. With this in mind, I created my own blue-print/schematic for clinical development. This schematic was based on the general structure of my colleagues’ residencies, comprising of the following components. Continue reading

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5 Clinical Tips When Using MDT

MDT Logo

http://www.nsrpt.com/service2_page1.aspx

When I was in PT school, I was exposed to Mechanical Diagnosis and Therapy (MDT). MDT utilizes a movement-based classification system that categorizes patients into certain treatment categories. Depending upon where/when they experience symptoms and how they respond afterward performing certain test movements, you can make a relatively accurate diagnosis as to what type of pain they are experiencing (chemical vs mechanical) and prescribe a solid home exercise program. Of course, this is incredibly over-simplified. If you want further information, check out their official website. Some of my classmates dismissed it or were ambivalent towards it, some liked it and pursued further education in its use, and some embraced it’s methodologies to a fanatical extent. By no means do I fall into any particular “camp,” nor am an MDT purist/fanatic, but when something works you can be assured I’ll blend those principles into my practice. Over the past 5 years of practice, I’ve found a few clinical pearls that improved my efficacy when using the MDT method.

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What You Say and How You Say It

Megaphone Yelling

This January, I was given the privilege of assisting in an orthopedic lab for a local PT program. I was present for 8 of the labs and had the opportunity to work with a number of great up-and-coming students. At the end of the semester, one of the students asked me “How do you tell your patients what is wrong with them? Do you use medical jargon?” I told him that I use medical jargon on a daily basis, but not without explaining exactly what the terms mean, how it relates to their functional impairments, and how we can address those impairments. I don’t do it to sound smart, I do it because demonstrating that you’re knowledgable can go a long way to getting a patient to put their trust in you and their recovery in your hands. But how much does what we say matter and how much does how we say it?

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Pain Science and a Case of Chronic Knee Pain

Knee Pain

What we say to or patients, and how we say it, has a huge effect on their recovery. In fact, I’d propose that what we say, more so than what we do, ultimately determines how well a patient will react to physical therapy. Re-orienting patients’ beliefs about pain, its mechanisms, and its meaning has been discussed at length by numerous authors, clinicians, pain scientists, and researchers (cough, cough: David Butler, Lorimer Mosely, Adriaan Louw, or Todd Hargrove).  We can directly influence a patients’ perception of pain by the words we use and the picture we paint.  Continue reading

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Core Stability Training: Should we use it?

Low back pain

I can’t tell you the number of times I’ve had a patient tell me they needed to strengthen their core, have asked for some specific spinal strengthening exercises for their chronic low back pain, or have had a physician write a physical therapy prescription for spinal stability training. Conservatively, I’d say it happens on a weekly basis. There are numerous programs out there that teach you how to selectively activate your deep spinal stabilizers and how to encourage this in your patients. The theory behind this approach postulates the deep spinal stabilizers have delayed activation in people with chronic low back pain when compared to pain-free individuals. This begs the questions, “Is that really what I should be doing?” I have my own thoughts/views on its use and place in physical therapy, but we’ll save that discussion for later. Continue reading

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Evolve

When I graduated physical therapy school, I thought I had a firm grasp on all things PT. My patients had been improving during my clinical rotations, I received a stellar report from my final clinical instructor, and I had added few letters behind my name after passing the national boards. Plus, I was a Doctor of Physical Therapy! I soon realized, though, my grasp wasn’t as firm as I initially thought. My clinical rotations had done a wonderful job preparing me for the majority of what I could expect to see in an outpatient clinic, but hadn’t prepared me for the level of chronicity I would experience in the tribal system.  Continue reading

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Choice

First off, I love when patients ask questions. Not because I want to flex my metaphorical brain muscle and show them how smart I am, but because I want them to understand why they’re coming in, why their home program is important, and why they’re doing whatever it is I have them doing. I encourage everyone, from their initial evaluation to the day they walk out the door at discharge, to be open with me and ask whatever question pops into their heads. I even ask them to give me a call or shoot me an email if something comes up after they leave my care. Some of these questions have been thought-provoking, requiring me to reference whatever literature I had on hand before I could even hazard a guess, while others were off-the-wall and some left me silently shaking my head in bewilderment. Continue reading

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Introduction

I wanted to take a second to introduce the purpose of this blog…to discuss the life of a tribal physical therapist! It’s not a well-travelled career path, but has provided loads of learning opportunities that I’d like to share. I plan to cover quite a bit (thoughts, concepts, theories, current research, manual techniques, clinical pearls, musings, etc) and hope you enjoy the content. I plan to continue improving the site and the hope to have it up and running soon. If you have any questions or comments, feel free to utilize the provided comments section.