Category Archives: Uncategorized

Carry on my wayward son…

“Carry on my wayward son For there’ll be peace when you are done Lay your weary head to rest Don’t you cry no more…”                                                                                                                                              Kansas

As I wade through the current literature regarding the use of patient outcome measures in the practice of Physical Therapy, the above lyrics to a classic rock hit by Kansas come to mind.  I feel quite wayward about my use of outcome measures in the clinic when I read articles or presentations by researchers in our profession.  They do not believe outcome measures are worth my patient’s time, much less worth my time as a clinician.  I disagree. A simple solution I have found to avoid taking up valuable appointment time and/or overlapping patients is telling the patients as they are being scheduled to arrive 20minutes prior to their appointment.  Is it 100% fool proof?  Absolutely not.  However, the great majority of our patients comply with our request and rarely is it an issue.  Also, minimizing my time as a clinician in scoring the outcome measures also has a simple solution…practice.  I score the outcome measures we use in less than 30seconds now. You become very quick and efficient with enough practice. Continue reading


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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The Tribal Transition


It looks like we’ve had our second contributor, Dr. James Bailey, DPT, PT, come through to offer his transition into the tribal system. As I’ve mentioned before, the tribal sector is not a road well travelled and making the transition from an outpatient facility to a tribal facility isn’t an easy task. Thanks for taking the time to post, James.

My name is James Bailey and I obtained my doctorate in physical therapy from the University of Oklahoma in 2011. I was excited to graduate and start my career in an outpatient facility where I believed I was ready to take on any and all patients. Just like any new grad I was excited but also a little petrified about taking on a patient-load while knowing I was solely responsible for patient outcomes. This unease melted away quickly as I became more efficient with my techniques and my ability to communicate to address patient questions. My rotations while in school helped tremendously with these skills, but it is not the same when you are set loose with a clinical license and become the one making the ultimate decisions with patient care. Continue reading

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Full Circle

Since starting this blog, I’ve been hoping to receive contributions from others in the tribal setting. And fortunately, we’ve had a taker. Our first guest blog comes from Steven Lee, DPT, PT, a recent graduate, experienced tribal health consumer, and new employee of a tribal health center. Steven has seen tribal health from a variety of aspects and has chosen to share his story. Thank you for the contribution, Steven.

Growing up, I frequented Native healthcare clinics within my own tribe. Everything from a simple cold, to a grade III ankle sprain (basketball, it will get you) drew me to the free and available healthcare provided at such facilities. Sometimes it meant waiting 4 hours to see the provider for 5 minutes; other times, I found myself waiting 5 minutes to spend 4 hours in the emergency room. Simply put, it varied. Similar to any healthcare facility or corporation, so did the care. Continue reading

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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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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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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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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.