Mobile Muscle

I am enjoying mobile blogging. The main problem is I cannot link to other sites or add pictures with any ease.... ah well

Today's muscle is the subclavius. You have one of these under each clavicle (L/R). It lies underneath the pectoralis major in your chest. In some patients/clients this muscle being tight can cause restrictions in shoulder mobility. When this happens we (the PT or the patient) can mobilize the muscle (aka move it around) to loosen it up and get rid of that restriction.

The muscle originates on the 1st rib and costal cartilage.
It inserts on the inferior middle 1/3 of the clavicle.
It is innervated by a very well named nerve: 'the nerve to the subclavius'
It's actions are to:
1) Aid in respiration
2) Anchor and depress the clavicle
3) Prevent lateral displacement of the clavicle

Runnin' Late

I am sitting on a delayed train that is going to make me a little late to clinic. Always a strange feeling to know I will be late... I really don't like being late, but it is kind of out of my control here...

So even though I have approximately 282 days left until I graduate many people are asking me what area I would like to work in when I get there.
I still have two 11-week clinicals to experience and five classes to help guide my decision. My ideal job would be to work with the Jets or Yankees as they are my favorite sports teams and I enjoy working with athletes. I would also enjoy being able to treat the kids I coach in high school football.
Another option is working in a hospital setting (probably acute care) because there seems to be more stability and a very nurturing nature inherently.
Anyway, the train is getting goin, I'll keep thinkin as the time takes me closer to graduation... off to learn!

Train Post

On my way to clinic, thought I'd check in...

Muscle(s) of the week:
I Love Spinach

This is the mnemonic we used to remember the divisions of the erector spinae (ES). The ES is the main group of back muscles that extends from the base of the skull to all the way to the sacrum. The main action of the muscles workin together is extension of the back (moving backwards). I wish I could include pics but I'm just on my treo but I will try to find some when I get full internet access.

Iliocostalis (lateral)
Longissimus (middle)
Spinalis (medial)

Reviewing anatomy 2 yrs after first learning it is very useful... I go now... happy Wednesday!

Yay CityTri

Last Saturday I had a great time (despite how early it was) being a medical volunteer for the CityTri event: Coney Island Adult & Kids Aquathlon. As a med. volunteer I was looking out for anyone with any musculoskeletal complaints and was ready to handle most other medical emergencies with my EMT background (or to refer them to the ambulance down the street :) Fortunately, there was not a single need for me, thus making me a little upset I did not participate in the quarter mile swim and two mile run...
I am still trying to enter any athletic competition in the tri/bi-athlon sphere... one of these days... for now I will keep training and volunteering while I continue to learn all about what I am doing in PT school.

Just wanted to say thanks to CityTri for having me and I look forward to participating in future events in any capacity...
I Tri / I Du / I Did

So go do it!

Yay Advance :-D

On May 11 of this year I erred and wrote a relatively negative response to what I thought was a snub of my quotes that were given for an article about the The Physical Therapist Student Loan Repayment Eligibility Act (H.R. 1134). The text of the article can be seen here as the last article on the web page. The confusion on my end is that there are multiple ADVANCE magazines. While I subscribe to ADVANCE for PT's & PTA's and was upset when I saw an article on the same topic without my quote there, I failed to realize the reason for this was that the article was published in ADVANCE for directors in rehab... so I apologize to ADVANCE for my confusion and would like to thank them again for their giving me an opportunity of being able to speak out on a very important issue in the world of PT. Furthermore, I highly encourage anyone who is a director in rehab or a PT/PTA (or students) to pick up either version of ADVANCE as their content is always excellent.

In other news, I had a day off today and have a lot more to talk about than usual.

Today I finished reading Reversal: When a Therapist Becomes a Patient by Eric Anthony Galvez, DPT, CSCS and friends. The book was excellent and I highly recommend it to anyone. It is useful for preparing you for dealing with a medical condition in which you lose a lot of your former everyday function and dealing with a very staggering diagnosis such as having a golf ball sized brain tumor. The book is also very useful for giving a patient's account to health care professionals. I certainly wish that this was assigned or even recommended reading for the "Psychological Issues" class that I took my first year in PT school.

I feel the book has made me better suited at dealing with patients who have gone through numerous medical procedures that threaten their livelihood and have lost the ability to perform many daily tasks and even have trouble walking. Best of all it was an easy read and filled with delightful candor and very emotionally warming stories. I have more to say about it but I am tired and have to be up real early in the AM.

I worked out today, which is part of the reason for my current state of being tired... I need to go make some PB&J and get my clothes ready for tomorrow... and maybe even make sure I plan my treatments for the patients I have a responsibility to... :-D

Hope everyone is smiling...

Physical Therapy vs. Therapist Assistants

I recently had a discussion with a PTA about this particular topic: why do some sources refer to the position as a "physical therapy assistant" vs. a "physical therapist assistant"? My general understanding is that the latter is the preferred and accurate term, especially since the APTA says so :) but also because in speaking with a number of PTA's the "therapist" title was preferred and more accurate in nature.

This led me of course to google (the ultimate research tool - don't tell that to my EBP professor's). I typed in "physical" and "assistant" to see what came up more. While the first result was for "therapy" the other 6 of the top 7 displayed were for "therapist". I visited the one site that was for a "therapy" assistant and ended up sending them the following message to the "contact us" section of their website:

I recently came across your page about the "Physical Therapy Assistant".

I would just like to point out that according to the American Physical Therapist Association (APTA) and numerous "PTA" programs and PTA's that I have spoken with, the correct phrase for their position is the "Physical Therapist Assistant". The emphasis of course on changing the "therapy" to "therapist".
Please take this change into consideration as it is more reflective of the true nature of the position and more accurate with industry standards.
Thank you.

Keep in mind that this is from allalliedhealthschools.com and I would imagine is a fairly popular website as it was the first result in my google search (this could just mean google found it to match my search phrase - not 100% up on google search results). For further informal research, I googled the terms "physical therapy assistant" and "physical therapist assistant" with the following number of results:

"...therapy..." - 889,000
"...therapist..." - 1,260,000

So this was fairly close. Looking through some of the results, the "therapy" group had some results due to some kind of error because (for instance) I searched through the APTA linked result for "therapy" thinking this was interesting but there was no mention of "physical therapy assistant" on the page just a mixture of those three words, which I thought was not supposed to pop up on google if you put the phrase in quotation marks... Also, I discovered that if you hit the "search" button more than once, you actually get a very different number of results. From my random number of clicks, it fluctuates between only two numbers, but I am not sure why or even how this can happen with such a wide range.

At the same time, I feel like two or three insignificant letters shouldn't be a big deal... but alas they can be very significant and when taken to meaning can mean very different things. In the end I support the APTA's stance and believe in consistency throughout the medical field to help alleviate some confusion and to avoid upsetting people such as the wonderful PTA's in this case who may be offended by a false characterization.

That was that, this is now... sleep...

"Day off"

NYC had some amazing weather today... the kind of weather cities like San Diego probably have 80% of the year... but I took advantage by riding my bike 12 miles to school (and back). Since I had a day off I took my time at school to work out, did some weights, ran on the treadmill, stretched out, and swam 72 laps (1800 m). I finished up just in time to go to a continuing education course.

Now why would a student go to a continuing ed. course? To learn! Even though this is considered a fairly advanced course, in my 3 hours there today I learned a good deal. Greg Johnson was kind enough to let me audit - so I take this forum to thank him again. The name of the course is Functional Mobilization [of the] Upper Quadrant (check out the link for course description and some reading for the course). There was a good deal of lab that I could only observe but the lecture was very informative. Greg Johnson spoke about dural restrictions and axial elongation to un-inhibit a central inhibition that is causing a peripheral weakness... ya dig? They were going to begin talking about vestibular issues when they returned from supper, but I had to take my 12 mile ride back home before it got dark and to prepare for clinic Friday... the course will go strong until Sunday so hopefully I will have a chance to stop by more of it. As a student there are many chances to "audit" these kinds of courses and I strongly encourage you all to take advantage, because once you are a "professional" it costs a lot of money to get this kind of info (especially at the high level that Greg Johnson offers).

Off to sleep, bye kids :-D

My Day

Prelude: "we" refers to either me and my CI or me and the patient/client... and generally we call everyone "we" work with a client...

I was in from 10:15 AM-6 PM

Started at 10:15 with a client who has MS and some hypertonicity mainly in her right hip. We worked on some manual resistance for upkeep with some patient education and she came to use our UBE which she can't access in too many other locations as they are rare and she also gets around with a scooter.

10:45 I had a client s/p a RC repair. We have been working on increasing his ROM through loosening up the restrictions around his shoulder from the injury (including the surgery). He had adhesions and tender points that we have been able to almost eliminate. He is still very tight in the periscapular area probably because of the muscle guarding he tends to have in the right shoulder to minimize the movement of that shoulder which we try to get at with some PNF scapular patterns. We warmed him up with some moist heat before we started treatment. He had some real tender points in the teres minor and supraspinatus on the side of the repair that were worked out with SCS.
Then we went and did a lot of shoulder exercises... I won't go into details here...

My CI was treating the next patient so I caught up on my paperwork, then had lunch, ran to the registrar to get some loan stuff done... I don't complain about loans enough but BOO LOANS!!! (another entry, another day)

Got back at 1:15 for a client who sprained her L ankle and had some RSD symptoms but nowhere near a true RSD, she was just sensitive to deep pressure on the area of the injury. She mainly had some remnants from the ankle injury, some tight peroneals (or fibularis muscles as some "official" tried to change it to --> check out this site that I just found - pretty cool). We are working to get her ankle stronger, increase proprioception, all for a better gait and future prevention of further injury. The ankle was also starting to go up the kinetic chain and affecting her knee, hip and back, so we are making sure we minimize that and prevent it the best we can.

As I finished up that client I took over the exercises for another client who had cervical, lumbar, and knee pain. We did plenty of work on the reformer including squats, heel cord stretching, bridging, etc; worked on the recumbent bike; to finish up we put IFC e-stim on her cervical and lumbar spine, moist heat over the back, and ice on the left knee.

My CI was treating pt's that I observed in between some paperwork.

At 4 my hopeful tri-athlete client came in who recently had arthroscopy on her right knee to repair her meniscus. She is a little more aggressive than she should be, but we keep preaching to her to ease up. Her patellar joint mobility was a little less in the R than the L today so I did a few patellar glides to free that up before we worked out. We then went over to the reformer for similar exercises to that last pt. with more focus on the VMO with External Rotation squats. One of the important ideas we stress with this client is to avoid how deep she squats in any aspect of life, even tying her shoes as deep squatting puts a great deal of weight on that just repaired meniscus and could reverse the positives. The benefit of the reformer is it places the individual in a gravity minimized position thus lessening the forces on the joints and allowing for movement that is less stressful on the body. We then moved over to the cable column to do some resistive walking which is very functional and helps build strength and proprioception. We then got on the treadmill which was pseudo-emotional for the client as it was her first time back on one since before the surgery. We only did 3 minutes fwd, and 3 bwd at 2 mph and 1.5 mph respectively. She jumped on the bike for 10 minutes and then we put some ice on that knee to help the healing process along.

The rest of the time I met with my CI to talk about the day and the overall progress I am (or am not:) making. Good day. I know it is a lot slower than a few of my classmates are used to, but I am learning a great deal every day. 'Till the morrow...

On a side note kudos to espn, and mike and mike in the morning for their support of the V foundation... cancer is an ugly word and in order to erase it we need more research which needs more money... keep fighting.

My favorite muscles

First to the trivia...

Longest muscle in the body... Sartorius
Strongest muscle in the body... read the wikipedia explanation...
# of muscles in human body... 639 (some sources say 640)
# of bones in human body... 206

Smallest muscle in the body... The stapedius...

The Stapedius is located deep in the ear. It is only 5mm long and thinner than cotton thread. It is involved in hearing.

Nate's original question was what is the muscle with the most amusing name..

While I enjoy reciting some of the names out loud... especially with unique accents...

the zygomaticus, politeus, sartorius, anconeus, buccinator (teres minor - you know you are a PT geek when muscles have sentimental value to you)...

Staying away from the "immature" ones, I think the funniest is the (extensor) digiti minimi, but not by much... also what's funny is the variation in how people say the muscles, that takes the comedy to a whole new level

Off to treat some sway-back posture, peace

Back in Brooklyn

Denver was energetically exhausting. The conference had so many great PT ideas flying around, so many 'celebrities of PT' that sleep becomes secondary. So all that energy I gained is slightly counteracted by the sleep debt I have to my body. But well worth it... See you in valley forge, PA...

Anatomy review:

Teres mInoR
-O: superior lateral border of scapula
-Ins.: inf. Facet of greater tubercle
-Inn.: Axillary n., C5-6 (5 is primary)
-Action: ER

Teres Major
-Origin: inferior angle of scapula
-Insertion: medial lip of interteburcular groove
-Innervation: lower subscapular n., C 6-7 primary and C8
-Action: IR, Sh. Add.

I list minor before Major b.c minor is superior to Major in the body... Not that it is better than, simply that it lies closer to the head... Also I generally try to capitalize Major and keep minor lower cased to help distinguish TM from Tm when abbreviating in my notes... Lastly and most importantly mInoR does External Rotation-ER despite having an I and R in it, so the opposite letters help me remember... With a lot of things in the body one needs some silly mnemonics to help remember...

Next time I will respond to Nate's comment and list the funnest named muscles...
This entry written on the Treo

Retroactive Taxi Post

Just ran out of clinic and am on my way to denver in the cab (to the airport...not a cab to denver)... thought I would blog some thoughts into my treo 650 to get to you-the reader.

I've been following two interesting debates over the past few days:

1) The advertisement of PT. On blog.evidenceinmotion.com, there was a good discussion that was sparked by a display in rockerfeller center in NY that promotes PT's role in diabetes prevention/management. A major issue with PT is how wide our scope is. It can be confusing to not have a specific area associated with us (as it should be 'bones and muscles'). But the nature of PT makes us not want to pigeon hole ourselves since there are so many 'niche' parts of the profession. We have 18 specialty interest sections that combined have around 43 special interest groups which get more specific into 'niche' areas... Bottom line is it is still difficult to define PT because we can do so much... But I will elaborate further when I'm not in a taxi

2) This is one I have been exposed to through my current clinical experience. As I have previously mentioned there is a large focus on myofascial work and positional release therapy (these both have many names from what I can tell). Today, my clinical instructor was explaining to me her rationale for using fascial work to correct an anteriorly rotated left hip. The main manual therapy technique we had received at this point of my education for such a condition was a muscle energy technique. My CI explained her thinking that the MET would not 'cure' the problem and it would likely return whereas with the myofascial work it would be a much more lengthy release thus being a longer term fix... Anyway it got me thinking about the timeliness and effectiveness of various PT interventions which I would love to get more into but I just got to the airport and have to catch my flight...

I do not currently have the ability to hyperlink you to some of the phrases in this entry so if you want elaboration on any of the phrases I mention always feel free to shoot me a comment or e-mail and I would be glad to field each question as best I can.