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Consumer’s Guide To Health – Episode 44: Can MDT Save Health Care?

ab@allanbesselink.com (Allan Besselink) — Fri, 25 May 2012 19:42:25 +0000

The podcast “Consumer’s Guide To Health” returned to the airwaves in January. This biweekly podcast and live stream airs on BlogTalkRadio every second Thursday at 11:00am central time. Join the discussion!

Episode 44 is entitled “Can MDT Save Health Care?”.

The health care system continues to rant about prevention, but little is truly being done to address the issue. The health care system continues to rant about making care patient-centered, yet puts them in a passive role from the moment they enter the medical system.

MDT, or Mechanical Diagnosis And Therapy, provides a framework not only for assessment and treatment, but also for patient-focused competent self care and prevention. Today we will explore MDT and examine how widespread adoption of its approach - from consumer to clinician - could effectively and simply solve many of health care's woes.

All previous episodes of CGH are currently available on my BlogTalkRadio channel. You can subscribe via RSS and the podcasts are also available on iTunes. The next episode will be on Thursday, June 7.

Episode 44 Notes: Can MDT Save Health Care?

Welcome to the Smart Life Project's "Consumer's Guide To Health" for May 24, 2012. I'm your host, Allan Besselink, coming to you live from Austin, Texas (as I do every other Thursday at 11:00 am central time). This show is brought to you by the Smart Life Project, a health initiative based in Austin, Texas committed to providing sports science solutions for training, rehab, and life. Life is a sport - play smart.

Becoming a consumer of your own health and health care is critical in this day and age. The health care and fitness worlds can be a challenge to negotiate. But we are also in an era of accessibility to information, and as I always say, knowledge is power - if only we'd use it. Let's face it though - the inability to challenge our belief systems in the face of good scientific evidence is the primary limiting factor in the advancement of both health care and coaching, as well as human performance and injury prevention. And as I always say - don't shoot the messenger.

The primary goal of this show is to increase awareness of these issues so that people can become better consumers of their own health - from the grass roots level.

With that in mind, our call in number is (347) 843-4753.

Today's episode 44 is entitled "Can MDT Save Health Care?".

Those of you who listen on a regular basis know that consumer awareness is an important aspect of the show. In the United States, there are some significant problems with the health care system as we know it. Chronic - and oftentimes preventable - medical conditions such as obesity, heart disease, and diabetes put a huge drain on the medical system. Beyond that, if we look in the orthopedic world as but an example, low back pain is one of the, if not the, most common ailment on the planet and costs us billions of dollars a year. If you live on planet earth, chances are good you are going to end up with an episode or 10 of low back pain over the course of your lifetime. But I also like to call low back pain the poster child for everything wrong in health care these days - over-utilization of imaging, clinician ignorance of clinical guidelines, non-evidence-based care, limited access to care, excessive costs of care, and, overall, a very passive approach to care. Yet if we look at the problem of low back pain, the clinical guidelines and solutions are straightforward.

For today's discussion, I welcome our guest Curt Rickert. Curt hails from the Motor City - Detroit, Michigan - and he completed his bachelor's degree at Michigan State University - go Spartans! After becoming a PT 21 years ago, he went on to complete the Diploma in MDT in 2006, thus becoming one of 350 or so clinicians globally to attain the highest level of training in the McKenzie Method. In the next few weeks will be making the foray into private practice, opening Curt Rickert Physical Therapy in Kerrville, TX.

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Photo credits: joehardy

Rhubarb Report: Episode 41

ab@allanbesselink.com (Allan Besselink) — Fri, 25 May 2012 05:53:11 +0000

I can say without hesitation that this week may go down on record as one of the most surreal weeks I have ever experienced. I can remember the feeling when I moved to Austin in 1990, getting off the train and stepping into a brave new world. That was surreal. But when you stand up and take the oath of allegiance to become the citizen of a new country? Now that is truly surreal.

It is hard for most to comprehend what that does to your psyche, your mindset, and your self perception. The best descriptor? It is just … different … now. Suffice it to say that it was a great experience that made for an interesting week that I will certainly never forget.

Besides, now I have an excuse to celebrate May 21 annually!

While that was going on, rumor has it that the world was still turning on its axis. Apparently, truth was still stranger than fiction, and the land of rhubarb was alive and well. I bring to you, hot off the presses, Episode 41.Enjoy!

1. Any triathlete who doubts Lance Armstrong’s return to triathlon is sadly mistaken. I have predicted since, oh, Tour de France victory 3 or 4 or so, that he would eventually make a stunning, dominating return to triathlons. The man himself kept telling the world it wouldn’t happen, but, I just had the feeling that it would.

His return to the sport came at Ironman 70.3 Panama earlier this season. Now, add a victory to the record books. Armstrong won Ironman 70.3 Florida with a time of (shuddering) … 3:45:38. He won the event by 10 minutes. As a coach, I would project that, on the right course, he has an 8:00:00 – 8:15:00 Ironman in him right now. Last time I looked, that would win most of them, including the World Championships.

Any triathlete who doubts his abilities, especially those who doubt his running – need to check those splits:

Swim 0:24:52

Bike 02:01:03

Run 01:15:56

It is only a matter of time before Mike Reilly announces Lance Armstrong as the Ironman Hawaii World Champion. Remember that you heard it here first.

2. I can understand, or at least comprehend, people having a bucket list of items that they want to do before they die. I get the concept at its most basic level. But when those bucket list items are simply to say “I did it”, without any relevance or context to their lives, then I am a little challenged to understand.

We’ve seen this happen with running a marathon. Sedentary people start training long enough to cross the finish line, collect their medal, and return to their sedentary lives. I don’t get it. Then, the Ironman triathlon started appearing on peoples’ bucket lists. When does a 140.6 mile ultra-endurance event just “pop up” on your bucket list? I don’t get that either.

Now, the latest in what appears to be a growing list of items finding their way onto the bucket lists: climbing Mount Everest.

The bad news is that four people died on Mount Everest last weekend. What makes it compelling, and what makes me wonder, is when the news item quotes a person as saying that

“There was a traffic jam on the mountain on Saturday. Climbers were still heading to the summit as late as 2:30 p.m. which is quite dangerous".

A traffic jam on Mount Everest? Are you crazy? There are that many people on the mountain that it constitutes a traffic jam?

It seems like people will go to great lengths to have a better bucket list accomplishment than the next person. Maybe that says volumes about the general self image of the populace nowadays. Maybe it says something about our adventurous spirit, the “I did it because it was there” mentality. Or maybe it is just plain stupid. You be the judge.

3. Here is one that definitely rates in the “are you serious?” category. According to reports, spectators for the Formula One race in Austin in November will be shuttled into and out of the event – expected to be an 80 minute round trip. If the ticket price wasn’t high enough, add that shuttle fare into the mix as well.

Montreal may have a similar scenario, but Montreal’s F1 circuit on Ile Notre Dame is within walking distance of the metro and downtown. Austin’s F1 circuit is within walking distance of … Elroy. Need I say more?

Oh, and while we’re at it, rumor is that they will only be selling three day passes for the event. If this country wants to get people interested in Formula One, making them commit to a three day ticket isn’t the best way to do so – but I digress.

Photo credits: Wikipedia

The APTA’s Vision 2020: My 12 Year Report Card

ab@allanbesselink.com (Allan Besselink) — Thu, 24 May 2012 05:13:52 +0000

We are now into year 12 of the APTA’s 20 year “Vision 2020” mission statement. With the APTA National Conference right around the corner, I think it is important to assess the accountability of the organization in meeting the goals of Vision 2020. I would like to believe that the association exists to serve the membership, and thus here is one member’s personal report card.

For those that need a refresher, here is what the APTA’s House Of Delegates put forth in 2000: “By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health.”

So with that said, let’s take a look at where we stand on all of this, 12 years down the road.

First, a quick history lesson of sorts. The entry-level physical therapy degree is that what is required to take the state licensure exam. Although you may have a physical therapy degree, you still have to pass a licensure exam in order to practice as a physical therapist.

A number of years ago, the entry-level PT degree in this country was a Bachelor’s degree. This is still currently the standard in most countries around the world. Also, it is important to note that foreign-trained physical therapists must still pass the licensure exam, regardless of their own entry-level degree, if they are to practice in the United States. Licensure is “the great equalizer” in terms of professional education.

Over time, the APTA forged ahead with a goal of having a Master’s degree as the entry-level to practice. With Vision 2020, the entry-level degree would become a Doctorate degree.

With that background information, here is my Vision 2020 report card. Each of the six primary elements of Vision 2020 are noted, along with their separate operational definitions per the APTA.

Autonomous Physical Therapist Practice. “Physical therapists accept the responsibility to practice autonomously and collaboratively in all practice environments to provide best practice to the patient/client. Autonomous physical therapist practice is characterized by independent, self-determined, professional judgment and action.”

If you are in a room of 10 physical therapists, you won’t get agreement on what professional autonomy looks like, yet in reality (and from a medico-legal perspective), all practice with “professional judgment and action”. For some reason, this has become more of a self image problem than anything else.

The defining issue of professional autonomy is the state licensure exams and practice acts.

Grade: F. A self-image extreme makeover would be beneficial.

Direct Access. “Every consumer has the legal right to directly access a physical therapist throughout his/her lifespan for the diagnosis of, interventions for, and prevention of, impairments, functional limitations, and disabilities related to movement, function and health.”

As of year 12 in the APTA’s 20 year “Vision 2020” mission, there are 17 states with real, gatekeeper-free direct access and professional autonomy. But interestingly enough, we had that same number (or thereabouts) at the start of this 20 year venture, doctorate degree or otherwise. Remember that 20 years ago, the entry-level degree was a Bachelor’s degree. A change in entry-level degree, yes, yet no change in access.

What makes this worse is that the APTA continues to talk about varying “shades” of direct access. As a consumer, you either have it or you don’t. And most don’t.

Grade: F. Ask the consumer about direct access. If they are even aware that the issue exists, let me know.

Doctor of Physical Therapy and Lifelong Education. “The Doctor of Physical Therapy (DPT) is a clinical doctoral degree (entry level degree) that reflects the growth in the body of knowledge and expected responsibilities that a professional physical therapist must master to provide best practice to the consumer. All physical therapists and physical therapist assistants are obligated to engage in the continual acquisition of knowledge, skills, and abilities to advance the science of physical therapy and its role in the delivery of health care.”

The operative terms here are that the Doctorate degree “reflects the growth in the body of knowledge and expected responsibilities”. If that is truly the case, then I am not sure how any foreign-trained physical therapists are surviving the licensure exam with their entry-level Bachelor’s degree. Just what does a 3 year doctorate – with fewer clinical hours than many of the old Bachelor’s degrees – actually provide in terms of “value-added benefit” for the graduate or, better yet, the consumer?

Graduates are now faced with a financial burden that is oftentimes in excess of $100,000 in student loans which, by the way, is on par with lawyers and with far lower return on investment over both the short- and long-term. An annual tuition of, get this, $43,000 is not uncommon. DPT programs have not provided any associated increase in the ability to earn greater income than when the entry-level degree was a Masters degree or, worse yet, a Bachelor’s degree. My $25,000 degree in 1988 would be worth $50,000 today given a 3% cost of living increase per year.

The profession was told, quite explicitly, that there would be a significant impact of the Doctorate degree on consumer awareness. The entry-level Doctorate degree was going to be the be-all-and-end-all to our professional autonomy. Sadly, the data has yet to reflect this claim. As it stands right now, I would call this a case of degree bloat – no more, no less. There is no increase in professional responsibility with a Doctorate degree, but there is a significant increase in financial investment.

Grade: F. Ask the new graduate about their return on investment.

Evidence-based Practice. “Evidence-based practice is access to, and application and integration of evidence to guide clinical decision making to provide best practice for the patient/client. Evidence-based practice includes the integration of best available research, clinical expertise, and patient/client values and circumstances related to patient/client management, practice management, and health care policy decision making. Aims of evidence-based practice include enhancing patient/client management and reducing unwarranted variation in the provision of physical therapy services.”

Educational programs continue to struggle with this. They continue to spend time and effort teaching students assessment and treatment interventions that have little to no scientific support. This is usually done under the premise not of clinical reasoning but that “you will need to be aware of this when you are practicing”. Educational programs could simply choose to not waste their time and efforts on these issues, and spend the time on important issues like clinical reasoning, thinking, and effective communication skills. Part of this is defined by accreditation standards which may or may not reflect evidence-based clinical guidelines.

Grade: F. Educational content has remained pretty similar over the years, but the entry-level degree has changed. Hello?

Practitioner of Choice. “Physical therapists personify the elements of Vision 2020 and are recognized as the preferred providers among consumers and other health care professionals for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.”

Patients will never see physical therapists as the practitioner of choice if they can’t freely access them. Patients don’t have the right to choose. They have to go to a gatekeeper first in 33 of the 50 states. Simply stated, our level of recognition as “practitioners of choice” will go hand-in-hand with direct access.

Grade: F. Ask a patient who their first choice is for back pain, and let me know what they tell you. Can you say “chiropractor”?

Professionalism. “Physical therapists and physical therapist assistants consistently demonstrate core values by aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication and accountability, and by working together with other professionals to achieve optimal health and wellness in individuals and communities.”

Fortunately, this has never seemed to be an issue with the profession. The APTA continues to be a strong advocate for professionalism. The profession, as a whole, seems pretty comfortable with this concept clinically.

Grade: A. Let’s all sing “Kumbaya”, we can celebrate our professionalism while we avoid the 800 pound gorilla(s) in the room!

Summary:

I have been a physical therapist for 24 years. I was trained in a different country, and practiced there as well. I have been a member of my professional association for the majority of the time that I have been a physical therapist.

I have the privilege of working alongside patients, other clinicians, and students – so I am not getting a limited perspective. I am practicing in a state (TX) that the APTA claims is a “direct access” state, but the practice act certainly does not reflect that whatsoever.

It is my professional opinion that the primary issue affecting physical therapists in this country – that of direct access and professional autonomy – has been mishandled and misguided over the past 12 years if not longer. The APTA's current stance on these issues is disheartening at best. While the academics are busy glorifying themselves with their advanced degrees, the profession as a whole is still in the dark ages in terms of licensure and autonomy.

With that said, and with accountability key, I would urge the APTA to use the next 8 years to revise their strategy. As they say, if you do what you’ve done, you will get what you’ve got. Sadly, what we’ve got isn’t much different than what we had 12 years ago.

Photo credits: amboo who?

Naturalization On Victoria Day

ab@allanbesselink.com (Allan Besselink) — Tue, 22 May 2012 05:17:37 +0000

The United States of America has a rich tapestry of cultures. The country’s heritage and history is firmly rooted in the influx of immigrants who have come to the United States and helped to make this country what it is today. Some have come here seeking solace from religious oppression. Some have come here seeking freedom. And some have come here with a simple desire to live a better life.

Today, May 21, is Victoria Day in Canada. It is the date on which Canadians celebrate the beginning of summer. Victoria Day has been celebrated since long before Confederation in 1867.

Today, May 21, is also Naturalization Day in the United States, or, perhaps more accurately, Allan’s Naturalization Day. Today, I officially became a naturalized US citizen. I don’t have a tale of religious persecution, nor am I running away from political oppression. My tale isn’t dramatic like that, but with that said, it is a tale of naturalization nonetheless.

Canada’s immigrant history is very similar to that of the United States’. All I have to do is look at my own family tree to see it. My grandparents on my father’s side moved to Canada from the Netherlands in 1952 after World War II. My father was born in the Netherlands and eventually became a naturalized citizen of Canada. My mother’s side of the family moved to Lunenburg, Nova Scotia from Germany in 1751. The United States wasn’t even a thought at that point in world history.

I came to this country on August 13, 1990 – a total of 7953 days ago, or 21 years, 9 months, and 9 days. I have called Austin “home” for all but two of those days – the two days I spent on an Amtrak train traveling to my final destination. I was 24 years old, a young man starting his career in earnest, a blank slate spread out in front of me. For me, it wasn’t a case of moving away from something, but rather it was a case of moving towards something – a quality of life that Austin would afford me.

Along the way, I developed a deeper appreciation for the US Constitution, the Bill of Rights, and the Declaration of Independence – and the values contained therein. These documents are the true fabric of this country. They also espouse values that I think many born and raised here have sadly forgotten or have taken for granted.

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

As strong as I feel about those words and values, I finally decided to begin the process of naturalization. It was an odd thought initially, having grown up within one mile – one mile – of the United States and being able to see it from my front window every day. I completed the paperwork, passed my interview, passed my civics test, reading and writing tests. I was approved and then waited for the day.

Lo and behold it finally arrived.

Today, almost 20 years to the day after becoming a permanent resident, I stood to take the oath of allegiance with 898 new immigrants from 84 different countries. I have to admit that it is a touch of dramatic irony that I would become a citizen on a Canadian holiday - Victoria Day. Life is funny that way.

You can never take your history away, and nobody will ever be able to take the Canadian spirit out of me. It is a part of my DNA, a part of my heritage, and perhaps even a part of my legacy. But today, I took an oath to be an American citizen, and I am proud to support and defend the US Constitution.

I was a first generation Canadian. And now, I have become a first generation American.

I think that it would only be appropriate to make note of some people that have been an important part of this story. Immigration attorney Paul Parsons has been involved with keeping all of my paperwork in order, from permanent residency to citizenship. Thanks to Paul, Norma, and Gina for all of their help. It goes without saying that friends and family have certainly been supportive in the process. I owe each and every one of them many thanks.

But there is one particular person that reminds me of the values of being an American citizen. Josh Kennedy is an ultra-runner, a father of three boys, and a West Point graduate and has served this country proudly. My interactions with Josh over the years have reminded me of the ideals of the American dream, the power of freedom of speech, and the true importance of “life, liberty, and the pursuit of happiness”. Josh defines the term “proud American” for me as a person who truly believes in the beauty of being an American for all of the rights, liberties, and responsibilities that this country avails us.

It is one thing to complain about the state of the union, but it is another thing to stand by those beliefs and put a vote down to change it. I can say that it is an honor to now contribute to the democratic process in this country.

Photo credits: cpence

A Journey On The Road Not Taken

ab@allanbesselink.com (Allan Besselink) — Fri, 18 May 2012 05:30:29 +0000

It started off as just a pristine black and white photocopy, but over time it has slowly become a faded yellow piece of paper. It isn’t very big, with just a few words printed on it. This piece of paper has occupied a place on my refrigerator for many years now. It has been with me on my journey from Brockville to Austin.

On it are the words to a wonderful piece of writing by none other than Robert Frost. It is entitled “The Road Not Taken”.

It is a constant reminder of what happens when we make that first step forward and dare to do so. It could be in life, in love, in the pursuit of happiness, in growth, in self discovery.

I remember reading it not long after graduating from university. For me, it was symbolic of the journey we all face.

Ah the journey.

That would be the journey that seems to be making an appearance in my writing lately. Being on the road, or standing at a crossroads. It could be Robert Frost, or Robert Johnson.

”Two roads diverged in a yellow wood,
And sorry I could not travel both … “

The crossroads. A decision must be made. Where do I go from here?

What happens when you stand there are the crossroads, and ponder and reflect on the two pathways, and choose to do nothing? Or what happens when you take the well-worn path, knowing exactly where it will lead?

”Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back … “

You can always re-visit the other path. But once you make that choice to move forward, it is hard to go back from whence you came. Oliver Wendell Holmes once said, “A mind once stretched by a new idea never regains its original dimension”. I couldn’t agree with him more.

The piece of Frost’s poem that really rings true for me is the ending …

”I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.”

I’ll be the first to admit that I have taken some rather uncommon paths – many roads not taken – on my journey. Some of them have lead to chasing rabbit holes, many have lead to amazing life experiences. But they have all contributed to an incredibly vivid journey of learning and growth of which I am forever grateful.

With risk, lies reward.

Venture forth on the road not taken. You might be surprised at what you find – and what you learn about yourself in the process.

Photo credits: Paul Badger

RunSmart Video 16 – The Reality Of Running Injuries

ab@allanbesselink.com (Allan Besselink) — Wed, 16 May 2012 17:12:38 +0000

This is the 16th in a series of RunSmart videos. The series is on-going, with a new video released on a biweekly basis. These videos complement the material presented in the book “RunSmart: A Comprehensive Approach To Injury-Free Running”. The full series of videos can be found here. A compilation of the first 10 videos will be available on Vimeo as well.

For those of you that are interested in a more interactive learning environment, consider attending a Level One (half day), Level Two (one day), or Level Three (two day) RunSmart program. The Level One program is 4 hours and focuses on basic training principles, running mechanics, and injury prevention. The Level Two program is 8.5 hours and focuses on performance optimization and training program development. The Level Three program is a two day, 15 hour program that includes a comprehensive approach to running injuries. The next Level One program will be offered in Austin on June 30, 2012. The next Level Three program will be offered in Austin, Texas on August 17 - 18, 2012.

In this video, I discuss the reality of running injuries. The statistics are abysmal. The scientific research indicates that injuries are not related to biomechanical mal-alignment or that sort of issue. The key element to running injuries? Training.

I hope you enjoy the video series. If you would like me to address any specific aspect of the RunSmart approach, drop me an email or add a comment to this article.

Photo credits: abesselink

Went Down To The Crossroads

ab@allanbesselink.com (Allan Besselink) — Tue, 15 May 2012 17:18:53 +0000

The 101st birthday of bluesman Robert Johnson last week got me thinking about the man and his music. It also got me thinking about how “the crossroads” is a recurring theme in life.

In a previous post, I mentioned my now-legendary discovery of “Crossroads Blues” at an early age while sitting in the back of our Toyota Celica. Then, many years later, my curiosity got the better of me. In death, as much as in life, Johnson was a man of epic proportions, yet of great mysticism and legend. I wanted to learn more about the legend.

So what did I do? There was one obvious choice: to travel to Mississippi in search of the legendary crossroads at the intersection of Highways 49 and 61.

Although it was the mid-‘90s, for a brief moment I could envision the era of Robert Johnson, the juke joints, and the musicians. The blues, one of the indigenous musical genres of this country, was born there in the Mississippi Delta. I found myself driving down some lonesome roads into the middle of what seemed like nowhere in search of his grave site. I eventually found Mount Zion Church, believed to be the resting place of one Robert Johnson, King of the Delta Blues Singers. I paid my respects to the great bluesman at Mount Zion Church.

Part of the mysticism revolves around the debate of where, exactly, Johnson was laid to rest – or if the date and cause of his death are even correct. There are now three locations that are believed to have Johnson’s grave: Little Zion Missionary Baptist Church (Greenwood, MS), Payne Chapel Memorial Baptist Church (Quito, MS), and Mt. Zion Baptist Church (Morgan City, MS).

Many years after this, I had a rather profound realization. There was a prominent link between Robert Johnson and a place that was right in my own backyard: San Antonio. His first recording session was on November 23, 1936 in room 414 of the Gunter Hotel. This was the session in which he recorded “Come On In My Kitchen”, “Kind Hearted Woman Blues”, I Believe I’ll Dust My Broom”, and, yes, “Cross Road Blues”. His second recording session was in Dallas.

I'd been to places like Quito, Clarksdale and Yazoo City – but his recordings were done right here in Texas.

So off I went to San Antonio on another adventure. There it was, at yet another crossroads, at the corner of Houston and St.Mary's: the Gunter Hotel. I am sure at one time it was a beautiful hotel with chandeliers and an upper mezzanine level that overlooks the lobby. It must have been a sight to behold for Johnson in the mid '30s. There is now a historical landmark inside the lobby. Images of Johnson adorn one window case as do his records, right next to the "Robert Johnson” conference room. What a place that would be for a meeting!

My reflections on these adventures reminded me that we are always finding ourselves at new crossroads in our daily journey. We are always faced with a crossroads, a new pathway to take, a fork in the road, a decision to be made. The crossroads may bring us anxiety, it may bring us sorrow, it may bring us pain. But, it also holds all the answers, at least the answers in the here and now. We manage to find our way forward as we stand at the crossroads, and we move down the next path, whatever that might be.

For those interested in the lore and legend of Robert Johnson, I would strongly urge you to watch “The Search for Robert Johnson” and to read “Searching for Robert Johnson: The Life and Legend of the "King of the Delta Blues Singers"” by Peter Guralnik.

Photo credits: Wikipedia

Is Physical Therapy In The United States Heading In The Right Direction?

ab@allanbesselink.com (Allan Besselink) — Mon, 14 May 2012 20:17:22 +0000

On April 24, physical therapists, physical therapist assistants, and students of physical therapy took part in a Federal Advocacy Forum on Capitol Hill. I for one applaud the efforts of this group in that they were able to present one small (yet at least united) voice to Congress. We certainly need a stronger voice in today’s health care world.

With that said, and with my annual APTA membership due for renewal, I am having my doubts about the direction that the profession is heading in this country these days, and the rate at which it is heading there.

I have now practiced in the United States for almost 22 years. The APTA’s Vision 2020 – the official vision statement for the profession – has now been in existence for 12 years. But when you look at the issues that are front and center with our Federal Advocacy Forum, you have to wonder where our priorities truly lie.

Here are the three primary issues that were being supported at the Federal Advocacy Forum:

1. Repeal of the Therapy Cap via the Medicare Access to Rehabilitation Services Act (HR1546 / S829). This legislation repeals a provision from the Balanced Budget Act (BBA) that set an arbitrary annual financial limitation on Medicare beneficiaries’ rehabilitation services.

2. Adding physical therapists to the National Health Service Corps Program via the The Physical Therapist Student Loan Repayment Eligibility (HR1426 / S975). This legislation would provide for physical therapists’ participation in the National Health Service Corp’s Loan Repayment Program. This would help to address the rising debt of physical therapists by encouraging them to serve in rural and urban underserved communities.

3. The Traumatic Brain Injury Act of 2012 (HR4238). This legislation would help individuals and families gain access to the most appropriate community-based services for traumatic brain injuries.

First of all, I am not saying that these aren’t important issues to the profession. But when it is almost impossible to get a group of physical therapists together, in one place, to lobby for anything, should the profession not be using that time and effort to focus on bigger issues? Should that time not be spent pushing our role in health care reform, direct access and autonomous practice, and the like?

Perhaps we should be looking at the mechanisms underlying these issues, and address those mechanisms first.

For example, health care reform, with physical therapy front-and-center, could have a huge impact on the services available to all patients, Medicare and otherwise. If patients had direct access to physical therapy, the initial costs would drop and patients could make better use of that “arbitrary financial limitation” regardless of where it is set. Having a free marketplace, and not one dominated by the gatekeeper model, would bring costs down even further. He who provides the best outcome at the best price wins in the insurance company’s eyes, no?

Our professional association should have given consideration to the debt load long before it moved to a doctorate program. When a degree in physical therapy now costs about the same as a law degree, you have to debate the return on investment. Of course, the educational programs are making their money either way …

That is a topic to be discussed further in an upcoming post.

Maybe I am missing something here. Maybe there is greater strategic political planning than that which I am aware. Sure, I will grant you that possibility. But now that we are 12 years into Vision 2020 – and with very disputable progress towards direct access to physical therapy nationwide – I have to wonder if the Federal Advocacy issues are really where our best efforts should be focused.

I think it may be time for an “Extreme Makeover” of sorts. Tune in over the next few weeks as I propose not only the big issues that need to be addressed in this makeover, but some solutions as well.

Photo credits: neuezukunft

Consumer’s Guide To Health – Episode 43: Is It Really An Injury?

ab@allanbesselink.com (Allan Besselink) — Sat, 12 May 2012 05:09:08 +0000

Episode 43 is entitled “Is It Really An Injury?”.

Most active people will resist the need to enter the health care system. Frankly, I wouldn't blame them at all! But this can take an acute problem and make it chronic, which then creates another set of issues. It would be very helpful to quickly assess "is this really an injury?" and then move on to the appropriate solution and pathway, be that self care strategies, further assessment, or both. How does a fitness participant know that this is something that they need to have assessed?

Episode 43 Notes: Is It Really An Injury?

Welcome to the Smart Life Project's "Consumer's Guide To Health" for May 10, 2012. I'm your host, Allan Besselink, coming to you live from Austin, Texas (as I do every other Thursday at 11:00 am central time). This show is brought to you by the Smart Life Project, a health initiative based in Austin, Texas committed to providing sports science solutions for training, rehab, and life. Life is a sport - play smart.

The primary goal of this show is to increase awareness of these issues so that people can become better consumers of their own health - from the grass roots level.

With that in mind, our call in number is (347) 843-4753.

Today's episode 43 is entitled "Is It Really An Injury?".

There is a significant problem faced in our country these days, and its name is obesity. With that said, many turn to walking and running as a means of exercising. That all sounds like a great concept, right? We are trying to promote health over obesity. But what happens when the pursuit of health creates more problems?

The statistics would indicate that running, as but one example, is displaying an increasing number of participants. There are now believed to be 38 to 40 million runners in this country. But those same statistics also indicate that a large % of runners - thought to be upwards of 60% - will become injured. Worse yet, up to 70% will have a recurrence of their injury, and 5% will actually lose time at work because of this activity-related injury.

In our good intentions to create a world of fitness, we may in fact be creating some significant health problems. Though they may pale in comparison to the long-term health ramifications of obesity, we must still acknowledge the presence of the problem and find some solutions.

Fortunately, we have solutions. Competent self care strategies can guide us. If you are, in fact, injured, competent self care strategies will be the best option for the vast majority of running- or fitness-related injuries. Most will be able to utilize exercise-based strategies to resolve their injury with some specific guidance and mentorship at most.

Most active people also resist the need to enter the health care system. Frankly, I wouldn't blame them at all! But this can take an acute problem and make it chronic, which then creates another set of issues. It would be very helpful to quickly assess "is this really an injury?" and then move on to the appropriate solution and pathway, be that self care strategies, further assessment, or both. Once a person has become motivated to be active, they definitely don't want whatever this problem is to limit their training or fitness activity. How does a fitness participant know that this is something that they need to have assessed?

[continued]

Photo credits: joehardy

Rhubarb Report: Episode 40

ab@allanbesselink.com (Allan Besselink) — Fri, 11 May 2012 05:01:48 +0000

It is amazing how time flies by so quickly and how easy it is to lose track of what is going on in the news. Over the past few weeks, I have been preparing a two day course, with the final product being presented in Reno this past weekend. Even with the barrage of digital data that pervades our existence these days, it is still pretty easy to lose sight of what is happening in the world when you are on the road.

During my travels I was able to explore Desolation Wilderness, just outside of South Lake Tahoe, and revisit that thing called peace and quiet – otherwise known as solitude. It is still possible to remove the digital leash in order to be one with the analog world.

And then, I came back to the real world – where rhubarb is plentiful once again. Here is Episode 40 of the Rhubarb Report – a smattering of rhubarb from the worlds of sport and politics.

1. It was a sad day when I heard that San Diego Chargers linebacker Junior Seau had passed away. Seau was, without question, a pro football legend. His passionate playing style made him bigger than life when he was on the field.

Seau was also dealing with life after professional football. As an athlete, you grow accustomed to the daily routine, the fan adulation, the roar of the crowd. Suddenly, you are left with your own thoughts and your own internal solitude. How do you handle life when your playing days are over? For many, it is the first time in their lives that they have been without football, the one thing that has provided stability for them over such a large part of their lives.

Sadly, this happens far too often in professional sport. The player’s unions, regardless of the sport, should actively promote counseling after retirement. It should almost be mandatory. Along with this, some form of community re-integration program would be beneficial. When you have experienced the pro sport version of post-traumatic stress disorder, doesn’t it seem appropriate to have the proper counseling to go with it?

2. It doesn’t happen often, but the Philadelphia 76ers, a number 8 seed, knocked off the number one seed, the Chicago Bulls, in the first round of the NBA playoffs. The Bulls looked like a solid bet for the Eastern final, if not to advance to the NBA Championships. This is another example of what happens to team dynamics when injury strikes. When your best player, Derrick Rose, goes down with an ACL tear, you get to witness how a team handles adversity. The Bulls didn’t handle it well at all. Exit, stage left.

3. The United States is becoming a more and more divided nation. Add another contentious issue – that of gay marriage – to the ever-growing list of issues to polarize this nation. The media and the political parties are doing a fine job of “divide and conquer” with propaganda and emotion. People are getting fired up and taking a stand emotionally, yet really don’t understand the issues at hand.

President Obama has taken a stand, supporting gay marriage. What say you, the voter? Should the government even be involved in personal choices made by individual citizens?

It would appear that this is a constitutional hot potato. When you use the word “equality” in this country these days, exactly what does it mean anymore? Does it really matter if you like it or not – or if it aligns with your perception, religion, and personal beliefs – if it is an issue of constitutionality? And what about “life, liberty, and the pursuit of happiness” – isn’t that a basic right for all in this country?

Tune in to the upcoming presidential debates. Sadly, they will probably serve as a microcosm of all things polarized in this country. As Rodney King once stated, “why can’t we all just get along?”.

Photo credits: Wikipedia

Allan Besselink | The Official Site of the Smart Life Project And Rhubarb Diaries - Home

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