Monthly Archives

November 2016

Unraveling the Complexity of Low Back Pain

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Viewpoint from the Journal of Orthopedic and Sports Physical Therapy

The “Viewpoint” section in the November 2016 JOSPT written by O’Sullivan, et al, offers an overview of the current research on treatment for low back pain. The authors begin by pointing out that “exponential increases in magnetic resonance imaging (MRI) scanning to identify these damaged structures have led to escalating rates of spinal fusion and disc replacements”. Surgery, along with spinal injections and pharmacological management, have limited long-term efficacy and carry significant risks.

The Physical Therapy profession has come up with a wide variety of manual techniques, taping, and exercise to help offer pain reduction and increased function to patients dealing with low back pain. The manual techniques are utilized to correct positional faults, decrease tone and guarding of the muscles, or improve flexibility. These have had good short term effects but there is limited research on the long term effects. Taping, dry needling, and electrotherapy are also shown to have short term effects. Exercise has long been touted as the best long term cure for low back pain but research does not support WHICH form of exercise works for low back pain.

So, how does a patient choose between this confusing list of options? There is “growing evidence that low back pain is a multidimensional disorder” which demonstrates the “need for a multidimensional clinic-reasoning approach to patient examination and management in order to identify the various and relevant underlying drivers of pain and disability for each individual”. Or, to put it more plainly, the evidence shows us that each person is unique. The causes of their low back pain and how it affects each individual is unique to that person. Each person has a desired level of activity to maintain or achieve which needs to drive decisions made about their care. Some people struggle with fear and anxiety that they will never have the life they want due to their pain. This needs to be addressed in some form during treatment. Patients need to be empowered with tools to utilize in their management of low back pain. These tools may include exercises, use of pain relievers, self-massage techniques, ergonomic changes, and modifying movement patterns. Support is required to grade an appropriate return to activity level for each person.

What is all comes down to is this – every BODY is different, unique, and special. Every BODY needs to be treated based on their history and on their future. Every BODY needs personalized care to make the most out of this life. Because every BODY CAN!

What are all those letters after your name?

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Dr. Amy Konvalin, MSPT, DMT, PhD, OCS, FAAOMPT – WHAT?!? I am often asked what all those letters stand for that are listed behind my name. And, what are the letters that are listed behind other therapists’ names? To start, let me begin by explaining the entry level Physical Therapy degree.

In the early 1950’s, a Baccalaureate Degrees (BS) was the entry level degree for Physical Therapists. In 1979, the American Physical Therapy Association (APTA) House of Delegates adopted the resolution that the entry level degree for Physical Therapy would be a post-baccalaureate degree and schools starting shifting to the Master of Science (MS) as the entry level degree. In 2000, the APTA released the Vision 2020 which stated that physical therapy services would be delivered by doctors of physical therapy (DPT). So, the entry level degree that each Physical therapist holds is largely dependent on the time frame in which they graduated. The curriculum has changed significantly over the years to meet the rigors of a DPT program and due to the advancements in medical research that have occurred over the years.

Since I graduated in 2000, the same year that Vision 2020 was released, I received a Master of Science in Physical Therapy. As I grew in my practice, the demands of Vision 2020 weighed heavily on my mind. Would I do a transitional program to earn my Doctor of Physical Therapy? Would I get advanced training through a fellowship program? After moving to Washington State in 2006, my plan slowly unfolded.

The American Board of Physical Therapy Specialties offers an Orthopedic Certified Specialist (OCS). This involves passing a rigorous 8 hour exam that is written each year by Physical Therapists who are experts in outpatient orthopedic physical therapy. It is grueling and I am grateful to have passed the exam in 2011.

I earned my Doctor of Manual Therapy (DMT) in 2011 by completing a year of classes and advanced clinical instruction followed by research to support my dissertation topic. When I completed this degree, I felt comfortable that I had met the APTA’s desire of Vision 2020. But, I wasn’t done yet!

Back to school I went for another year of intense study and clinical instruction followed by a written and practical examination. When I had successfully completed these, I earned Fellow status in the American Academy of Orthopedic Manual Physical Therapist (FAAOMPT). This is akin to the fellowships doctors go through during their training. Although not required in the physical therapy profession, it is highly recommended to continue learning and advancing skills in the clinical setting.
Well, after all this it was only one more year of school and a dissertation to earn my Doctor of Philosophy in Orthopedic Manual Physical Therapy (PhD). ONLY!

I hope this helps to explain the “alphabet soup” behind my name a little better and give you some knowledge as a consumer when you see these letters behind the names of other Physical Therapists. And, if they have different letters behind their names, please feel free to ask them about it! I guarantee you, if they took the time and energy to earn those letters they are more than happy to share that information with you!

What does a Physical Therapist do?

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“I have been referred to see a Physical Therapist but I don’t actually know what they do.”

“Wait, you treat THAT too?”

I have heard these comments from patients, friends, and family for the past 16 years so I figured it was time to explain why physical therapy is so hard to define.

1. There are lots of different things that we do based on the treatment settings where we work. In PT school, we have the opportunity to learn about the diverse environments that make up the profession. There are Pediatric Physical Therapists who work in schools to provide help with children who have difficulty with gross motor skills (walking, sitting, stairs, etc). While hospital based Physical Therapists treat a range of patients from those who have just had surgery to people who have suffered from debilitating diseases. Some Physical Therapists work in Rehabilitation Centers with people who have recovered from their life threatening disease but are not strong enough to return to their home. Physical Therapists work in burn units, debriding tissue and helping to restore normal healthy skin for burn victims – they are the true heroes of our profession. The list goes on and on but I hope this gives you an idea of why our profession is so hard to define!

2. If you have been referred by your doctor/friend/trainer to go to see a Physical Therapist, you will go to an outpatient Physical Therapy Clinic. These can be stand -alone clinics (such as Physical Therapy for EveryBODY) or may be embedded within a medical clinic or even hospital. Each of these facilities treats patients who are able to come into the clinic and receive services. But, the treatment you receive at each facility is based on their focus.

3. Orthopedic or outpatient physical therapy clinics are usually focused around one of the following themes. 1) The research based clinics follow the research that states teaching patients to exercise leads to the best long term outcomes. Physical therapy research has rapidly expanded in the 16 years I have been in practice and the one fact that remains a constant is that getting people moving will limit their pain and dysfunction as they age. 2) The manual therapy clinics focus on improving how the muscles, joints, ligaments, fascia, and other tissues move in order to improve each patient’s quality of life. The definition of manual therapy is muscle manipulation, joint mobilization, and joint manipulation.

4. Physical Therapists with different experiences and training treat in different ways. Over 16 years of practice, I have seen and performed a wide variety of treatments as my knowledge and skills have grown. So, if you have tried physical therapy before and it didn’t work for you, I encourage you to research a physical therapist in your area who has the skill set you are looking for. If I can help in any way, please feel free to contact me!