It seems like people in this country are more fixated on what Tiger Wood's apology speech means instead of their medical coverage, the availability of direct access, and their overall health. I did a little research on this. In my clinic, I asked if anyone knew about the Medicare cap and what the current trends are in healthcare coverage. No one knew about any caps to Medicare or the details about our healthcare crisis. They just knew about the attempts to pass the reform. However, almost everyone talked about and had multiple opinions about Tiger's speech, what he should have said, and what sponsors should do. What the hell is going on??? To confirm this phenomenon, I did some searches on twitter. Using Twitter you can see how many people are talking about a specific topic and what they are saying. The number of discussions on Tiger was about 1200 x more popular.

It seems like the media has slowly melted the public%u219s brain into a gossip filled goo. As a physical therapist, what can you and I do? Well first we can provide our patients with information about their healthcare rights and concerns. I think physical therapists as a profession have done a poor job of PR. Only in the past few years as the APTA started the PR campaign of Try PT First. Where was this in the past 20 years? We need to do our part to inform the patients! I think as a profession, we should join forces with other professional in our area to promote our services, educated people about their coverage, spread the word about direct access, and collaborate on building the profession.

How can you start? Here are some simple ideas: post information in your clinic about any of the above issues, go on your social media outlet (facebook, twitter, MySpace, etc.) and spread the word, hold seminars on the topics. We can and need to put out information that will help our patients become more educated about these issues. Only informed patients and people in general can make a difference. So get out there and tell people about the horrible Medicare cap, the details of direct access, and the crisis on healthcare (in case you didn't know, the trend on healthcare costs, unless changed, will bankrupt America!!!). So please be informed and inform others.

On a daily basis, I discuss the health care reform details with my patients. My overall consensus is that most people have no clear understanding of what the reform really is. Most people equate it as "socialized medicine" and are not in favor of it. It's just a plain and clear example of how little most people know about the reform. They seem to forget about the people who currently DO NOT have insurance. Have we become a society of "what's in it for me" only mentality? Does the person captured in video at a townhall meeting saying, "keep you government hand off my medicare" represent the level of ignorance of the American people?

First, there is NO WAY the reform will be socialized medicine. Lets think about it. The hundreds of millions of dollars the insurance industry has spend in the past decade lobbying for their benefit would never "allow" such a bill to pass. It would shut down all of their businesses. Like most bills that pass, some of it will be good for the people and some of it will be good for corporations. We really won't know what exactly will be passed until it does. However, there are some good things currently in the bill regarding physical therapy. Just go to the APTA site for information. (i.e. 2 year extension on the medicare cap expemptions).

For now I think now is the time for every physical therapist, PT assistant, friends and family of PTs, and students to attend the townhall meetings. Ask your reps to support Medicare direct access, to repeal the Medicare physical therapy cap. for details about the meeting schedule in your state and what to say, click on http://vocusgr.vocus.com/grspace2/Newsroom/ViewAttachment.aspx?SiteName=APTA&Entity=PRAsset&AttachmentType=F&EntityID=6154&AttachmentID=3494c0dc-8c17-48bf-a50c-2bffab035769

http://vocusgr.vocus.com/grspace2/WebPublish/controller.aspx?SiteName=APTA&Definition=Resources&SV_Section=Resources

I encourage everyone to take action now because the oppotunity to make a large difference may not come again.

"Lets Do It!" Steve Young, DPT Body Solutions Voorhees NJ 08043

With the rise in swine flu cases in the US and the statement by the World Health Organization saying " at this point, it's impossible to contain it", we should all be on alert. Encourage your patients and staff members to wash their hands often. You can read an short article on what you can do to help reduce the symptoms and duration and possibly the risk for the swine flu. Also, while the information is specific to the flu, it also applys to any virus. In fact, the use of the recommended nutrient will be much more effect for a cold than any anti biotic. (anti biotics have no effect on colds).

This is a must read with now: Article on Swine flu

I just purchased a Deep Muscle Stimulator made by Dr Jake last week. The Deep Muscle Stimulator is a durable and "high tech" massage tool. You can read the actual description about it on the web. Here, I will describe the effects of the Deep Muscle Stimulator on myself and my patients.

I've been using it on my tight right hip for the past week. The hip has been tight for the past 2 years. I herniated a disc and pinched a nerve 2 years ago causing weakness in the left hip. Since then, I've popped the disc back in and relieve the nerve symptoms. However, I was stubborn and decided to continue my weight lifting during that process. Due to my stubbornness, I developed some imbalances and bad neuromuscular compensations. Anyway, the Deep Muscle Stimulator gave immediate relief of the feeling of tightness in the right hip after 10 minutes of use. After 4 days of treatment my IT band which originally feels like a roll of quarters now feels like a roll of dimes. So far, it has definitely helped with the tightness. With such good results, I decided to use it on my patients.

I used the Deep Muscle Stimulator on a patient with a frozen shoulder. I placed it on the insertion of the Pec Major and worked the long head of the biceps for 5 minutes. He was immediately able to perform the pulley abduction exercise with 20 degrees more motion. When he came back, he reports pain free use of that arm for the rest of the day.

I've also had many other patients with "knots" in their neck. They asked me to use the Deep Muscle Stimulator on them. So far, the response has been, "Where do I buy one of these"!

I am very happy with the results so far. I will spend the next few months writing about the results of this amazing device on my patients. It should have amazing clinical applications for frozen shoulders, neck and back pain, and tendonitis. If any of you have experience with it, please let me know. I wonder if other therapists or doctors have developed clinical protocols for specific diagnosis.

I can't be the only one using the deep muscle stimulator. If you are using it, please comment here!

I recently received emails about Total Motion Release and decided to buy the introductory ebook and video. The creator of the approach uses movements to correct dysfunction. Interestingly, the movements are done on the "good side" to fix the bad side.

I have applied the introductory information to a few patients with relatively good results. i.e. took hip pain away by correcting for trunk rotation deficit. The trunk rotation deficit was restored through seated rotation towards the side with MORE motion. No passive stretching was performed towards the direction of the ROM limitation.

I would like to hear experiences from people who are familiar with Total Motion Release techniques. If you have any, please post your resluts with this approach. If you need to contact me directly, visit our website at Body Solutions

I am often suprised when my patient tells me "how come my previous therapists never explained it like that before"? During the initial evaluation, I make a point to educate the patient thoroughly about his or her diagnosis, the phases of healing, and the outlined plan and expectations. I am often met with a look of amazement and gratitude. The patients all tell me they have never heard of the phases of healing in any previous therapy experience. I find it shocking that they were never given this important piece of information.

Having the patient totally understand the phases of healing helps in so many ways. First, it helps with adherence to your recommendations. If they understand why you want them to limit use initially and gradually increase funcational use (all based on phases of healing), they will adhere to your recommendations with much higher efforts. Second, it starts the and builds the foundation of trust. The patient needs your guidance and expects guidance from you, not just stated limitations or recommendations. Finally, for those of you who own your own clinics, it is a form of marketing. To me, anything you do that exceeds your patient's expectations is a powerful form of marketing.

I consistently think of ways to improve the quality of care of every patient in my clinic. From improved patient care to new web site Body Solutions.

My advice is to constantly think of new and better ways to get your patients better. If you have tips of your own, please share them with everyone. I would appreciate it if no one posts messages like " check out my new program for this...". If you try to post messages to simply market your own crap, I will hunt you down!

Every year I notice the decreasing payments from health insurance companies. Yet, their stock prices continue to rise. They are making more money and independently owned physical therapy practices make less.

I started a practice because I wanted to do things my way (the right way of course). I didn't want the super crowded and extremely packed schedule of a typical large chain PT company. I wanted more one on one care and more personal approach. In my clinic, we give each patient the needed care and work as hard as possible to make sure they recover as fast as possible. However, with the decreases in reimbursement, it's getting tougher to do. Since 2002, the national average reimbursement has dropped from $102 to $71. Yet, costs for policies have gone up an average of 68% during that time. To add salt to the wound, another clinic owner enlightened me about these insurance company's intentions. He spoke with the regional rep from one of the insurance companies. The clinic owner asked why a hospital based therapy clinic gets $130-$150 per visit while we get $50 a visit. Their answer was shocking. They pretty much said they want to put us out of business by 2010, and because we are all separate little companies, we have no power to stop them!!!

After restraining my self from choking the phone I was one, I took a deep breath and thought "how can we fight this". In New Jersey, the NJ society of independent physical therapists have been working hard to help us "little people" do big things. I hope any therapist reading this considers joining them. http://njsipt.com/index.php

In other states, I'm sure therapists are facing similar issues. Between this crap and STARK issues, we need to voice our opinions and DO SOMETHING. If you are reading this and thinking this does not affect you, you are very much mistaken.

In our physical therapy clinic in Voorhees NJ ( Body Solutions ) the clinicians meet on a monthly basis and review the current research. Hundreds and hundreds of papers later, we've realized that many of the typical physical therapy exercises are actually BAD!

How many of you have seen or done squats with your back against a wall or a theraball? I see it in gyms and other clinics all the time! If you look at the research on shearing forces, that exercise is horrible. It shuts the hamstrings down and creates an anterior shear in the Tibiofemoral joint. Yet, it is still prescribed as an exercise. My theory is that the prescriber is LAZY! Yes, they figure that the wall or ball will give the patient an easy way to do squats "correctly without their knees going over their toes".

I have plenty of BAD exercises to list and explain. I would REALLY like the readers to contribute to this. IT WILL HELP ALL THERAPISTS WHO READ IT!!!

So do you know of a bad exercise???

Well, this weekend, I went to Columbus Ohio to see the Arnold Classic fitness convention. It's been a while since I've lectured to personal trainers. However, this weekend reminded me how poorly educated the entire field of personal trainers are. Let me explain.

The profession of personal trainers is not regulated. Anyone with any kind of background and education (or lack there of), can call themselves a "personal trainer". You may be saying, "Well, the trainer I know is certified". Unfortunatley, there are over 130+ organizations that offer certifications and over 600+ certifications available. Even the good certifications have mistakes in their teachings. It is a dreadful situation for the consumers who are looking for expertise in fitness only to find, someone who looks fit but knows very little about fitness.

YES, most trainers know how to lift from "feeling" and from "books and magazines". In the thousands of trainers I've encountered over the years, only a handful have actually read research (the best source of info). Most trainers do not know that they are killing their client's joints through improper exercises and form. Even trainers who think and truely believe they have technique down to a science, are mistaken. They are simply teching perfect form of a mechanically bad exercise. Here are some typical BAD exercises: Wall squats, any type of sit ups, typical side laterals, and machine exercise for the "Core".

Back to my main point: This weekend, I had a trainer who was working for a company selling a piece of equipment that costs $5 to make for $50+ dollars. It was a adjustable strap that hooks onto a rail (i.e. top of a power rack) and allows you to hold onto to strap through either your hands for feet to do exercises. Well, this trainer decided to "teach" someone how to use the straps to workout even if you have back pain. I cautioned her that he has an acute back pain. She dismissed it and said "I'm a trainer and I know how to work around everything". At this moment I had to think to myself, "do I want to spend the next few minutes debating with the trainer about stuff she doesn't know".

She proceeded to have him hold onto the straps with his hands and lean back. He then was instructed to do squats while leaning back. She was very careful to tell him, "keep you knees over your toes and don't let them go forward" (this will be an important point later in this story). If you can't imagine this exercise, just picture someone leaning back against the wall and performing squats.

Once he got to the bottom position, I proceeded to palpate his hamstrings (I actually used by foot because I was too lasy to bend down). Upon impact of by toe onto his hamstring, the entire muscle belly started to swing (i.e. it was totally relaxed). This was an attempt to give the trainer a hint about what was happening at the knee (tibiofemoral joint). Unfortunately, her ONLY concern was that his knee did not go forward.

When she was done with the demo, I proceeded to ask her about any knowledge of sheering forces in the knee. She said, " as long as the knee doesn't go forward it's OK". I then proceeded to tell her about studies on anterior sheering forces in the knee with exercises that decrease hamstring activation during a squat (i.e. wall squats, hack squats, the exercise she is teaching). She became irritated and firmly stated, "I'm a trainer and I know what I am doing. I know when my clients are ready for this exercise. They don't have any pain doing it". At this point, I realized that she like most trainers, is not open to the idea that what they have been doing during their entire training experience may be wrong.

The point of the story is that the current mentality of trainers and the approach to their educated is flawed. They are honest, hard working, motivated, and they truely want to help people. Unfortunately, they have not been provided with the right guidance for where to look for scientific information. They don't realize what little they know! There is so much more to exercise than: 1. what muscles are working 2. what does / doesn't hurt 3. are the joints in the right position

Trainers need to realize that you can do harm to joints and muscles with no sign of pain. Yes, teaching improper movement mechanics and increasing joint sheering forces both damage the body without pain. You don't feel the pain until years later. By then it is too late.

I hope everyone reading this blog shares this story with anyone looking to get in shape using the services of a trainer. Be very careful about who you use. Typical red flags with a unqualified trainer are:

1. They don't perform a thorough physical screening to look at your back, knees, shoulders, etc... 2. They don't recommend further examination by a medical professional if you have a history of any orthopedic issues 3. They put you on low carb diets 4. They answer, "everybody is different" or "Lets just change it up a little" when you ask, "why does this exercise bother me (i.e. it doesn't feel right)". 5. They give you routines that look similar to routines seen in magazines. 6. They have never read any published research concerning exercise. YOU SHOULD DEFINITELY ASK IF THEY DO READ RESEARCH 7. They are fond of one author of a book and use his or her methods

Due to the demands of my personal training and physical therapy facility in Voorhees New Jersey Body Solutions, I have had little time to travel and lecture. Hopefully people reading this will have a better understanding of the current problem with the field of personal training in my area (Voorhees, Medford, Cherry Hil, Marlton) and nationwide.

It's been awhile since I posted something. It's been busy in the clinic and in life in general. I would like to start the new year with some thoughts on the current insurance crisis in America.

I've seen insurance premiums go up 20-30% every year. Since we actually pay 100% of the medical insurance for our full time employees, the increases are starting to hurt. I can see how other companies are starting to purchase cheaper policies. This problem is also evident in our patients. Many of our patients now have very poor coverage. Their deductibles are high, the co-pays are outrageous, and their limitations on visits are very low.

Our average reimbursement per patient has also dropped. Many of the insurance pay less for the same work.

With all of these factors affecting the industry, it's no wonder why many private facilities are switching to a cash only practice. I've considered the possibilities. However, we are not currently ready to make the switch. We have added more cash based services like pilates, massage, and personal training. All of the additional services are, in a way, necessary to offset the decreasing reimbursement numbers. At this rate, in 3-5 years, I believe many private practices will have to transition to a cash basis and avoid insurances all together.

The funny thing, is that the stocks of these insurance companies are going up and up!