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Raising the Bar in Rehab

60 Things Every PT Should Know

Published November 11, 2008 10:53 AM by Lisa Catenacci
A while back I emailed the faculty and staff in the Marquette PT Department and asked them to help me compile a list of things every PT should know. I got back a nice variety of responses--and here they are. 

Do you have anything to add? Leave a comment and I will gladly add it to the list!

  • 1. You have to know some Bob Dylan songs
  • 2. Articularis Genu?
  • 3. You won't know all of the anatomy all the time
  • 4. I'll know my song well before I start singing
  • 5. Don't have your patients do anything you wouldn't have your mom do
  • 6. Rodney Dangerfield muscles: Brachialis and Soleus
  • 7. Morale is to the physical as three is to one
  • 8. Know pain, no gain
  • 9. Know the 17 muscles that have attachments to the scapula
  • 10. Volunteer for something in your professional organization
  • 11. Come back annually to MU in July for the reunion weekend CE course
  • 12. Donate to the PT Faculty Student Scholarship Fund on an annual basis (even if it's only a little bit, as over time it can really add up)
  • 13. Take the time to recognize support staff, aides and others who help make your life easier
  • 14. Share updates of your e-mail address with the department so you are notified of upcoming conferences, or other department news
  • 15. Start saving for retirement right away!
  • 16. Know when to hold a patient's hand and when to kick a patient's behind
  • 17. Know how to use electrical stimulation for pain relief and muscle contraction
  • 18. Know the effect of a longer external moment arm on the internal torque necessary to hold an object in isometric static state
  • 19. Know that chiropractors are our friends (NOT)
  • 20. Gait is 60 percent stance, 40 percent swing...or is it the other way around?
  • 21. A muscle only knows how to shorten and to resist being pulled part
  • 22. You gotta love the quadriceps....
  • 23. Torque makes the world go 'round
  • 24. A muscle CANNOT produce a torque if it either pierces or parallels the axis of rotation
  • 25. The gluteus maximus is aptly named
  • 26. If at first you don't succeed, re-evaluate your hypothesis
  • 27. Look before you leap-observe the patient's attempts before you jump in with instructions
  • 28. Know thyself-and know that patients know themselves better than you do, so listen to them
  • 29. Patience is a virtue-be in control of yourself and your session
  • 30. Unto thine own self be true-despite what others may want you to do
  • 31. PT = people touching, not physical terrorism (despite what your patients might say)
  • 32. No evidence doesn't mean that nothing works
  • 33. "On Old Olympus Towering Top A Fine Vested German Viewed A Hop"
  • 34. Know that professional membership in the APTA is critical and benefits the entire profession
  • 35. Know your Practice Act and who to contact for questions
  • 36. Know your Code of Ethics and Guide for Professional Conduct
  • 37. Know how to legally and ethically supervise PTAs and support personnel
  • 38. Know what autonomous practice really means
  • 39. Know what direct access really means to us as licensed professionals
  • 40. Know how to use EBP appropriately
  • 41. Don't procrastinate and leave your documentation until the end of the day
  • 42. Regardless of your busy schedule, take the time to get to know your patient. They will lead you to the answers
  • 43. Make it a goal to learn something new about physical therapy, or try a different treatment technique once a week
  • 44. Passion for Vision 2020 is contagious. Educate your fellow co-workers on the goals and Vision of the APTA and how they can be involved
  • 45. Do not pre-judge your patient's level of function based on age (Sometimes the 80 year olds can run circles around the 40 year olds!)
  • 46. Take pride in knowing every day you go to work you will somehow make someone's life better!
  • 47. A cough is only effective as the deep breath that precedes it
  • 48. Perform five consecutive deep breaths with a 3 to 5 second end-inspiratory "hold" to magically raise a patient's desaturated SpO2 within 10 to 15 seconds after completion
  • 49. Controlled exhalation by your patient promotes mobility, especially when they are fearful and/or in pain ("whistle while you work")
  • 50. Utilize the "reverse action" principle for recruiting the inspiratory accessory muscles by stabilizing the head/neck and/or the upper extremities to provide some assistance/respite to the Diaphragm
  • 51. Perform the "Fuzzy Navel" test and check for "inspiratory paradox" among other things:
  • a. When the ribs move inward rather than outward on inspiration, it may herald the fatigue of the Diaphragm and/or length-tension inappropriateness of it (flattened out or loss of the Zone of Apposition)
  • b. Inspiratory Paradox may be the first change of fatigue to be seen and the first sign to indicate recovery when it is no longer observed
  • c. The abdominal muscles are relaxed (passive), not active, during a normal resting expiratory phase as elastic recoil of the lungs and ribcage take place
  • 52. Auscultate and pay attention to tubular vs. vesicular sounds with or without "crackles" to identify between fluid, atelectasis, fibrosis or normal, respectively
  • 53. Routinely remove your patient's shoes and socks during your PT initial evaluation:
  • 54. Inspect for condition/length of nails, pitting edema, ulcers, bunions, hammer toes, suppleness of the forefeet, etc.
  • 55. "Augmented abdominal breathing" can be used as a diaphragmatic inspiratory assist strategy to control for anxiety & panic
  • 56. Use of an oscillatory fan can help prevent/relieve anxiety or panic
  • 57. Routinely check your patient's pulse rate and rhythm at rest, with activity, and into recovery
  • 58. An irregularly - irregular pulse rhythm almost always will be atrial fibrillation
  • 59. Indicators for function ("red flags") to pay close attention to:
  • a. FEV1.0 (<1.25 liters)
  • b. 6MW (<300 meters)
  • c. Unable to rise to a standing from a 17" seat height without arms helping requires > or = to 3-5 in lb torque/lb body weight
  • d. +Trendelenburg (Wall Test) when lateral pelvic stabilizers< 3-5 in.lbs. torque/lb. body weight
  • e. An MEP > (+)100 cm H2O from TLC is needed for effective cough force.....the more positive the MEP the better up to a point
  • f. Check your patient for protective sensation of the feet of at least 4-5 grams of force
  • g. An MIP of <(-)50 cm H2O from near RV is likely to have a patient to require some ventilator assistance to avoid fatigue/failure......the more negative the MIP the better
  • h. And so many others!
  • 60. Work-to-rest ratios get smaller (i.e. more rest than work ) as a patient's functional tolerance deteriorates


...85% of medical school graduates fail to demonstrate competency on a musculoskeletal exam (Freeman) and only 1/3 of US medical schools require ANY coursework on musculoskeletal medicine...yet the AMA resists direct access because????

Christie, PT November 12, 2008 8:11 PM

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