Practice What You Preach: Modeling a Lifestyle of Movement

Name: Tara Dirocco, Class of 2021

Undergraduate: UC Berkeley

Hometown: Santa Barbara, CA

Do you find yourself needing PT from being in PT school?

Is this the most you’ve sat still in a long time?

These questions consumed me on my first week of PT school. I could not handle (or believe!) all of the sitting, after being a PT aide at an aquatic center where I spent the past year moving around all day in a pool.

Feeling the ironies of my situation, knowing that a sedentary lifestyle is the reason many patients will come to see me in the future, I decided to make my PT school experience a challenge.

How much could I move in a sedentary environment?

How could I remain physical?

How could I find my own therapy, all day long?

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Standing desk set up with computer/books at eye level

With some help from biomechanist and movement advocate Katy Bowman, I hit the drawing board.

Katy Bowman notoriously says, “Don’t just sit there, but don’t just stand there either.” Stagnancy is the problem— not sitting, not standing. A lack of movement is the root of many health ailments. We sit all day, move intensely for an hour, and expect our tissues to be compliant. Poor tissues.

Movement is linked with increased productivity and just about every health benefit…so as movement experts, why isn’t movement woven into the very fabric of our learning regimen? Why aren’t we innovating every day to find new ways to help those in stagnant jobs improve their situation? Why aren’t we modeling the way?

We have a duty as physical therapists to model the way out of stagnancy and into an embodied society. Can we practice as we preach? Can we create new movement positive environments together?

We can move all day long. I dare you.

Here are my tips to all the students and human beings out there.

In class:

  1. Sit in different ways.
  2. Take your shoes off.
  3. Roll out your ankles.
  4. Stand up and take notes while standing.
  5. Do calf raises. Do calf stretches.
  6. Do squats— mini ones if you’re embarrassed.
  7. Go on a walk or climb some stairs whenever you have a break.
  8. Roll out your wrists. Stretch your wrists against the wall.
  9. Switch how you are sitting again.
  10. Cross your ankles. Uncross your ankles.
  11. Sit in a figure 4 stretch.
  12. Sit on the edge of your seat.
  13. Sit on your feet.
  14. Practice diaphragmatic breathing.

When studying:

  1. Stand! Make a fun standing desk set up out of your many textbooks.
  2. Make your computer at eye level.
  3. Lay on your belly for a while.
  4. Lay on your back and study for a while.
  5. Lay with your legs up the wall and study for a while.
  6. Lay in a hip flexor stretch and study.
  7. Perform hamstring strengthening exercises while lying on your belly.
  8. Switch the position of your legs often.
  9. Switch the arm you’re leaning on… in fact maybe don’t lean on any arm!
  10. Take movement rewards every 30 minutes.

(Please note: if you have any recent injuries, conditions, or limitations, consult with your healthcare provider team before attempting these positions, especially for a prolonged period of time)

-Tara Dirocco, 1st year student

 

How I Lost the Most Valuable Ligament

Name: Erin Lemberger, Class of 2020

Undergrad: University of Northern Colorado

Hometown: Littleton, CO

Fun Fact: A one humped camel is called a Dromedary and a two humped camel is called a Bactrian.

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Let me just tell you about my first semester of PT school. I’ll start off by saying that PT school is a lot of work, so of course, the first semester was stressful. But regardless, there are 80 of your closest friends that make studying, adventuring, and everything that happens in between a whole lot easier. I started the semester by buying a season pass to ski all winter long and to use as a major de-stressor when school became difficult. I have been skiing since I was a little tike, so what could go wrong? I had never been hurt skiing nor seriously injured so it couldn’t possibly happen now. Here’s my advice, kids. When the mountain does not have enough snow to open up more than one run, there’s not enough snow. Just trust me.

 

So here’s how it went. I go to Arapahoe Basin (lovingly known as A Basin) with my now boyfriend, Preston, and we’re having a great time just enjoying the weather and the snow. We ski about three runs before the resort is flooded with people also trying to ski the one run that is open. We spend about 20 minutes waiting to get on the lift that will take us to the top, so the decision to get to the top, ski all the way down, and head on home is smart. I’m happily skiing along trying to keep up with Preston, but when I get to about 50 feet from the bottom, realize I’m going a little too fast. Preston is down at the bottom and I go to stop and my ski catches a patch of ice (remember the not enough snow comment?) that takes me out. I flip over backwards and roll hard, and although the details of that fall are fuzzy, I’m sure now it was a classic plant and twist. My skis don’t pop off and my right knee is screaming in pain; I can’t stand on it, so I get my first toboggan ride down the mountain to meet Preston.

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About 20 minutes before I fell. The view is pretty right?

I’m going to start this part of the story with the advice that I would not recommend getting hurt in PT school, but I want to brag about our professors for a little bit. I think I was in denial that I ruptured my ACL, so I went to Dr. Tom McPoil and asked him to check out the knee. Tom tapes me every morning for about 2 weeks while we are trying to get MRIs and doctors appointments scheduled; he was a saint. After a few days of taping, he decides Dr. Mark Reinking should check out my knee too, thus getting two amazing faculty giving me advice. You probably know what happens next: I have surgery to reconstruct my ACL with a semitendinosus/gracilis autograft (they took my hamstrings to make a new ACL). I was thankful I could do surgery over winter break. Over the month that we had off, I got time to recover and relax instead of worrying about school. I started PT off campus and then switched to seeing a PT in our faculty once the new semester got closer. Our faculty are incredible, understanding, kind, teaching, inspiring humans who are the reason I am fairly active for 5 months post-op. My PT, Nancy, is one of the many reasons I am certain that I want to go into this profession because she makes me laugh when PT for an ACL reconstruction is painful. Although I would not recommend tearing your ACL, I have gotten more perspective than I could have imagined from the process.

 

Okay, now go back. I tore my ACL. It was an absolute pain (in the knee) 90% of the time. It was hard watching my friends all ski while I was stuck at the lodge, it’s terrible that I still have pain running even though it’s normal, and I have a huge mental block doing most physical activity now, which is hard. Here’s my advice: Take care of yourself. Have fun, but within healthy limits for yourself. I recommend you also know that life simply happen. Having a positive outlook has made a huge difference for me. Sometimes you just have to see the brighter side. That all being said, I am here, I am passing, and I am chugging along just fine in PT school. So, if you do injure yourself while in school, remember that it is all doable. That’s a promise!

Here’s some other friends that are going through injuries in PT school and some advice they have for dealing with it:

Ryan Pineda, Class of 2020: Lisfranc fracture, surgery completed, in PT currently

“Find a good Netflix show to break up the studying and try not to think about

how much fun your friends are having. Also make sure to buy pass insurance for

your ski pass.”

 

Gabe Lawrence, Class of 2020: meniscal tear, surgery happening this week!

“Make sure to stay active and find something to take your mind off the injury

while you’re rehabbing. It’s easy to be lazy when you have an excuse. Just

because you‘re down a limb doesn’t mean you can’t use the other three.”

 

Jake Berndl, Class of 2020: bilateral inguinal hernia, surgery completed, progressing back to normal physical activity

“Don’t sustain a more serious injury like the above three. Put a positive spin

on your down time – catch up on studying while your classmates are out

having fun instead of studying. This way, when tests or finals roll up, you’re

prepared. Also, don’t forget to ask your surgeon the important questions…”

 

Managing Your Posture in PT School

Name: Joshua Holland

Undergrad: Idaho State University

Hometown: Centennial, Colorado

Fun fact: Before PT school, I worked at a BBQ restaurant in Missoula, MT called Notorious P.I.G.

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Last week, I was editing my Biomechanics skills video when I noticed a curly-haired DPT student in my video with fairly poor posture. I was far from excited when I realized that student was me. I knew my posture wasn’t the greatest after years of asymmetrical shoulder position from college pole vaulting and poor lifting mechanics, but I had no idea it was THAT bad! My shoulders were protracted with my head in a significantly forward position. My initial thought was, “man, I am about to be a PT soon…how am I going to teach posture when my own posture is so poor?!”

An average day for PT students involves a heavy dose of lectures, studying, and an even heavier dose of sitting. Often a PT student may be seated in lectures for 8 hours a day. By the end of the day, professors may start to notice students performing many combinations of wiggling, shifting, and slouching, with many students standing up in the back of the class.

The field of physical therapy involves movement for rehabilitation and we often hear, “exercise is good!” However, within school, sometimes we neglect our own movement in order to remain studious. The intention of this blog post is to initiate the thought of posture and provide some quick exercises that DPT students can use throughout their day. As future clinicians, we are role models to many of our patients, so it is important that we recognize our own posture and work to preserve good body mechanics within ourselves in order to have long-lasting careers and fully help our patients.

I couldn’t sleep after seeing my poor posture! So, I set out the next day to find ways to correct and maintain posture and decided to share them with you all. In this blog post, I interviewed Dr. Alice Davis, an expert on the spine, and fellow first year DPT student, Sarah Spivey, a certified pilates instructor since 2007, to provide some tricks on improving posture!

 

Question and Answer Interview with Dr. Alice Davis

Q: Often our posture is poor in class, we tend to slump over to write down our notes, what are some cues we can use in class to correct this?

A: Make sure your feet are flat on the floor and use the back of the chair to support you. You are becoming kinesthetically aware of your body in space as PT students, so try to be aware of the weight on your ischial tuberosities as you sit. Try to make each ischial tuberosity level. The overuse of repetitive poor posture is what creates problems over time, so start to realize your body position while you sit in class.

Q: While we sit in class it feels like we roll our shoulders forward and lean forward to pay closer attention or write on our devices, what are some cues to get those shoulders back with a neutral head?

A: Because you are sitting at computers for most of the days, you tend to have some upper cervical extension and increased flexion in the lower cervical spine. Imagine there is a rope going straight through your head and down to your seat, try to make that rope as straight as possible. A quick exercise you can do in class is move your shoulders up an inch, back an inch, and down an inch, then hold this for ten seconds, and relax. Try to do 10 reps for 10 seconds of this exercise.

Q: For the anatomy nerds out there, what are some of the muscles that are affected by this forward leaning posture/slumped position?

A: The upper cervical spine is extended in this forward posture position. Suboccipitals are a major component in this and often called the headache muscles because it can result in cervicogenic headache. A cervicogenic headache is when the pain begins in the back of the neck first before it goes up to the skull. This can be posture and stress related. Other muscles that play into extensor moment of the upper-cervical spine are the splenius and semispinalis muscles.

Q: Is there any other tips and tricks we can use in the classroom and out of the classroom to help with posture?

A:  

  • Foam rollers are great! You can put the foam roller vertically along your spine with the head and sacrum supported. Using your arms, do some snow angels for pectoralis major and minor.
  • If you are feeling uncomfortable and wiggly, your body is telling you to move – get up and move around.
  • Do something during lunch time. Eating is important, but try not to study if you don’t have to. Give 30 minutes during lunch for your body and mind.
  • Breathing is important. Moving the body and getting the diaphragm to move through breathing helps those muscles that support the thorax. Watch your breathing pattern, especially when you are stressed. Try to do some slow inhales and exhales.
  • Try a simple nodding of your head, as if you’re saying yes. This lengthens the longus colli and capitis muscles that can help with postural support. You can even do this when you’re driving! Rest your occiput on the headrest and perform a little nod. Try to hold the nod for 10 seconds with 10 repetitions.

 

Here are some techniques and exercises for managing posture in graduate school (or any career environment!) brought to you by our very own DPT first year, Sarah Spivey!

 

Sit on deflated Gertie ball.

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This will allow you to sit up on your ischial tuberosities (IT) to encourage a more natural lordotic curve while also eliminating the pressure on the ITs. By sitting on a relatively unstable surface you will also increase the use of your postural stabilizers. Try to incorporate five minutes per hour of sitting.

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Another technique is to use the Gertie ball between your lumbar spine and your chair. Find your ideal posture by allowing yourself to slump in your chair. Now, move into a full anterior tilt of your pelvis until you feel pressure in your lower back. Now, ease off until you feel the pressure disappear. Scoot back toward the back of your chair and place the ball at the level of the lumbar spine. The ball will help you maintain your neutral posture during sitting.

Head nods/nose circles on Gertie ball.

Lie in supine on a firm surface. Bend your knees and place your feet at the distance of your ASIS. Allow your sacrum to feel heavy and equally distributed on the floor/mat. Take a few breaths and notice if you have excessive space between your thoracic spine and the floor. If so, on an exhale, allow your t-spine to sink toward the floor. This should limit any rib flare. Place a 1/3 – ½ inflated Gertie ball (or folded towel) under your head. You should feel pressure evenly distributed near your occipital protuberance – this will insure you are lengthening your cervical extensors (especially for those of use with a forward head!). Take a few breaths and allow your head to feel heavy on the ball. Imagine a one-inch line on the ceiling and slowly trace this line down with your nose. Return to your starting position making sure to avoid moving into extension. Repeat this 8-10 times. Now draw slow circles with your nose around your one-inch line. Keep your circles small and controlled. Perform 6-8 in each direction.

Wall sit pelvic curls.

While sitting in class, if you start to feel your low back tighten up, try this stretch! Stand against a wall with your feet about 12 inches in front of the wall and hip distance apart. Try to feel contact of your sacrum, rib cage and the back of your head on the wall. You should have a very small space between your lumbar spine and the wall. As you exhale, draw your abdominals in and curl your pubic bone up toward your nose. You should feel your lumbar spine flatter against the wall. As you inhale, slowly allow your ischial tuberosities to widen until you are back in a neutral position. Repeat 10-12 times.

 Seated neck stretch – sitting on hand.

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Feeling tension in your neck during class? Scoot forward so your back is away from the chair and sit tall on your ischial tuberosities. Imagine lengthening your cervical spine and then gently tuck your chin toward your chest. Try not to flex your cervical spine! Now allow one ear to fall toward your shoulder. You should feel a stretch on the opposite side. If you would like to increase your stretch, you can sit on the hand of the side you are stretching. For example, if you are feeling the stretch on the right side, sit on your right hand. This will bring your shoulder down and away from your ear.

 

Overall, I hope  this post helped you become more aware of how important it is that we practice good posture while in school, or with any lifestyle! Do you have favorite exercises or tips to remind you to practice posture? Feel free to share with us in a comment below!

Dry Needling…Not a Type of Craft that Your Grandmother Does

Name: Katherine Koch

Undergrad: The Ohio State University

Hometown: Cleveland, OH

Fun Fact: Last summer, I climbed six 14ers

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Dry needlingnot a type of craft that your grandmother does. This type of treatment uses thin filiform needles inserted by a physical therapist into myofascial trigger points, or a tight band of muscle that might be causing pain (1). Dry needling is based on physiological evidence supported by research that is usually part of a broader treatment plan (2). If this needling sounds familiar to you, you’re not alone. Acupuncturists use the same type of needle to adjust the flow of energy, or chi, throughout meridians in the body. Acupuncture is an ancient Chinese medicine and operates based on the belief that these thin needles can relieve tension, stress, and pain when inserted by an acupuncturist (3). While you won’t be getting an itchy sweater from this treatment, it can lead to pain relief for many people. 

However, there is still confusion and debate among physical therapists and acupuncturists concerning the rights and responsibilities of physical therapists in performing dry needling on their patients. This debate of dry needling by physical therapists was recently taken to a Denver district court when the Acupuncture Association of Colorado (AAC) challenged the Colorado State Physical Therapy Board (Board). The AAC claimed that physical therapists had not undergone enough training to perform dry needling and requested the Board reverse the rule that allows physical therapists to practice this method of treatment. The AAC argued that physical therapists only perform 46 hours of training to be certified to practice dry needling, while acupuncturists train for almost 2,000 hours. The association claimed this made dry needling by physical therapists an “unsafe practice of acupuncture” (4). However, this statement is strongly misleading due to the additional 3,400 hours of doctorate level schooling that physical therapists already have behind them before they complete those 46 hours specific to dry needling training. Physical therapists spend three years in graduate school learning how the human body works, what can go wrong with it, and how to fix it within the realm of physical therapy. Additionally, doctors of physical therapy are required to take continuing education courses throughout their careers.

Additionally, the AAC made the claim that dry needling is just a misnomer for acupuncture, while the two are fundamentally different practices. They may look similar to the untrained recipient, but physical therapists and acupuncturists perform their respective treatments with fundamental ideological differences between the two. This is not to say that one is better than the other, and patients may make the informed autonomous decision to receive either or both treatments. However, as the Denver District Court decided, there is no need to prevent members of one profession from performing treatments all together. In December 2017, the court recognized that physical therapists are acting within the Colorado Physical Therapy Practice Act when they perform dry needling.

As the Colorado Chapter of the APTA President Cameron MacDonald put so eloquently,

“this legal debate was brought forth by those who wished to restrict the practice of another profession from their own. This debate could have been about any intervention utilized by physical therapists, and not just dry needling. It is imperative to consider this legal challenge and the lawsuits brought against the Colorado PT Board through the lens of the Colorado consumer of healthcare. Consumers in Colorado are provided access to health care providers which have a defined scope of practice under which to deliver patient care. Health care professionals are expected to provide the best care they can, and to practice under a scope flexible enough to both protect the consumer and not limit the development of practice by health care providers.”

When physical therapists perform dry needling, they are practicing within their professional scope. When acupuncturists perform acupuncture, they are practicing within their professional scope. Both professions can live harmoniously alongside each other while helping patients within their respective realms.

Why does any of this matter? First, any judicial ruling or legislative rule concerning a profession as a whole likely has implications that affect many of its members. In this case, physical therapists that perform dry needling in Colorado were in danger of losing their legal right to treat patients in this way. Further, patients were in danger of losing out on a treatment that can benefit them. To be effective health care providers, it is imperative that physical therapists are informed practitioners in order to best advocate for their profession and best treat their patients. Denying to inform themselves and take positive action does a disservice to future physical therapists and patients who will benefit from the work done to advance the profession today. In order to practice as autonomous providers, physical therapists must continue to advocate for their profession and understand the issues surrounding it. It also stands to reason that since the American Physical Therapy Association participated in this case as an amicus party and presented information that no doubt helped sway the case, physical therapists should support and be members of the organization that advocates for them on this broad level.

This debate is not in Colorado alone; lawsuits in three states have gone the opposite way and the state boards have been forced to remove dry needling provisions from their practice acts.4 Since each state has their own physical therapy act, it is important that the Colorado practice act, which will be revised next year, continues to maintain its inclusive language that provides “for new developments in physical therapy practice, which includes dry needling” (Caplan and Earnest, LLC, personal communication, January 9, 2018). For the good of physical therapists, patients, and the future of physical therapy as a profession, this particular case is closed.


If you are a student physical therapist, like myself, who hopes to perform dry needling as a professional one day or if you simply would like to learn more about its practice, please refer to the references below.

  1. Dry Needling by a Physical Therapist: What You Should Know. American Physical Therapy Association. http://www.moveforwardpt.com/Resources/Detail/dry-needling-by-physical-therapist-what-you-should. Published December 25, 2017. Accessed January 28, 2018.
  2. Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017;:1-41.
  3. Miller J. Physio Works – Physiotherapy Brisbane. Acupuncture and Dry Needling. https://physioworks.com.au/treatments-1/acupuncture-and-dry-needling. Accessed January 28, 2018.
  4. Migoya D. Acupuncturists sue Colorado’s physical therapy board over the very definition of their craft. The Denver Post. https://www.denverpost.com/2017/04/05/acupuncturists-sue-board/. Published April 7, 2017. Accessed January 28, 2018.