I don't really follow a lot of political news. I found myself reading a few more political news pieces and articles recently, partly because this is an election year. I came across this article about the John Edwards trial and his defensive strategy relying on the definition of the word "the." This brings back vague memories for me of the Bill Clinton case and his definition of the word "is." It is hard to imagine how such seemingly complicated cases of financial law violations and an impeachment both include scrutinizing definitions of the most basic vocabulary.

I often ask my patients to describe their exercise regimen, or I will ask them how their current injury interferes with their exercise program. I hear varying responses. Some of my more active patients have a hard time cutting back on their 10-mile runs to allow their knees time to heal. Other patients need encouragement to walk around the block, but adamantly believe those walks count as exercise. When I ask these patients if they exercise, their response often sounds something like this, "Yes, I exercise. I do my leg lifts in the morning and I walk to get the mail in the afternoon." My marathon-running patients would argue that leg lifts and getting the mail hardly qualifies as exercise. It's all in how you define that word -- exercise.

I once heard a 375-pound individual tell me that he was healthy. According to his doctor, his blood pressure readings were within an acceptable range and he didn't have diabetes. The definition of "healthy" for that patient was the difference between having diabetes or not. Others may argue that anyone weighing 375 pounds is not healthy, but again, it all comes down to how you define the word. 

Wikipedia defines exercise as a bodily activity that enhances or maintains physical fitness and overall health/wellness. I would probably add some connection to heart rate and muscle contraction to that definition. It is important not to confuse exercise with capabilities - although my patient with hemiplegia is not running five miles, he is still able to complete exercises within his capable range. Exercise isn't defined by a certain distance or resistance, but instead by the impact a certain movement or activity has on that individual. 

Physical therapists need to be on the same page in how we define aspects of our care. How I define and prescribe exercise should be fairly consistent with the methods of my colleagues. In order for our profession to progress toward direct access, further specializations and autonomous practice, we need to define our role to other practitioners and our patients. 

What do you think? How do you define exercise? How do you define health? And while we are talking about it, how do you define "is" and "the?"

The discussion and use of dry needling in physical therapy practice has increased substantially within the last year. I graduated from PT school three years ago, and we rarely, if ever, heard or discussed dry needling as a treatment option. Reading through my JOSPT issue this morning, I came across two ads for dry needling certification within the first three pages. So what is dry needling? And what do our patients need to know about dry needling?

Dry needling is a technique including a dry needle, without medications, that is inserted into a trigger point to release the trigger point and relieve pain. It is minimally invasive, cheap and carries a relatively low risk of complications.¹ Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system, which differs from the Chinese medicine channel-based acupuncture practice model.

Evidence supporting dry needling as an effective intervention is quite overwhelming. Searching for "trigger point dry needling" or "dry needling physical therapy" yields pages of results, most of which support the use of dry needling for a variety of conditions.

Contraindications to dry needling include patients with needle phobia, unwilling patients or those unable to give consent, into a limb with lymphedema, patients on anticoagulant therapy or patients with a compromised immune system. The APTA lists pages of other relative considerations in addition to the list of absolute contraindications.²

Each state's regulatory board determines the performance of dry needling by a physical therapist. I searched through a few websites to find the training requirements to practice dry needling. Certification for dry needling includes a minimum of one introductory course (30 hours) through multiple education sponsors. After completion of the introductory course, therapists can begin utilizing the treatment immediately. Some states require a level II course to be completed within six months of the first course. Level I courses (from the Kinetacore website) start at $1,250.

What do you think? Do you practice dry needling or are you interested in becoming trained? Do you think dry needling is simply a "fad" that will eventually fade away?

References

1. Kalichman, L., & Vulfsons, S. Dry Needling in the Management of Musculoskeletal Pain. (http://www.jabfm.org/content/23/5/640.long). Journal of the American Board of Family Medicine.

2. http://www.apta.org/

Usually about once or twice a year, I break down and make an appointment for a massage. As all the hours add up of providing manual therapy for my patients, as well as my moderately rigorous exercise routine, I feel like I need some relief to start fresh again. It's one of the best gifts I give myself. I am a new person after those massages. My body feels more relaxed and my mind appreciates the hour of total silence. Actually, as I write this, I realize it's about time for my semi-annual massage. I should make an appointment soon.

A good friend of mine used to see a personal trainer. Two or three times a week, she would set up an appointment to increase her weight training, cardio and balance skills and was really happy with the results. After a month of seeing the trainer, she could not believe the results. She dropped a few pounds, fit into her clothes better and her self-esteem was the best I had seen in years.

My father-in-law occasionally sees a chiropractor. Every once in a while he will "tweak" his back and need an "adjustment" to relieve the pain. After a handful of sessions, he feels normal again and no longer needs the services of the chiropractor. (As a side note, I have offered many times to educate my dad-in-law about exercises and stretches he could do to maintain a healthy back, but so far no luck in persuading him to change his routine!).

I have friend who has been trying to conceive a child for many years. This year, she started trying other methods to reproduce, including seeing an acupuncturist to improve her fertility. After a few treatments (as well as other treatments and medications), she is now the happy (and tired) mom to a beautiful baby girl.

So, what do a massage therapist, personal trainer, chiropractor and acupuncturist all have in common? They all have direct access. Anyone can make an appointment and walk right into the offices of these practitioners without a note from their doctor. Why doesn't physical therapy fall under those same standards? PTs have more education than most massage therapists. PTs work alongside chiropractors, often treating the same patients. What needs to change so that if patients need physical therapy, they can make an appointment with their therapist directly and bypass the step (and extra time required) of seeing their physician?

I know not all PTs are on the direct-access boat. Some PTs like the way things are. I can understand that side of the argument. But given that so many other clinicians in the health care field practice without physician referrals, it makes sense that physical therapists should be included in that group.

What do you think? Why are the rules so different between PTs and the professions I listed above? Is there less risk to see a personal trainer than a PT?

I'm sure many of you have read articles or attended work meetings focused on the topic of communication. Regardless of your work setting, communication is one of the most important pieces of being successful. Knowing information that will help your patient or client is useless if you cannot convey that knowledge to the patient. Obviously, I'm telling you something here you have likely already learned.

There are times when my husband and I are in public and we default to non-verbal communication because of the people we are with at the time. This is commonly referred to as "the look." My husband will give me "the look" to mean countless different things, such as: "Don't even think about talking about that in front of our friends," or "Let's step away from the salesman so we can discuss this furniture purchase in private." Over the course of the last few years, I've learned to interpret my husband's many looks quickly. And, it's a two-way street. I've given my husband many "looks" as well, and he has learned how to read them and what they mean. (Mine are much less subtle than his, by the way).

I don't need to rely very heavily on non-verbal communication with my patients, as I sometimes need to with my husband. My patients and I are in an open gym, a safe environment for both of us to exchange our thoughts and information. I default to verbal communication in this setting for many reasons. I often use other communication techniques (demonstration or tactile, for example), not because verbal communication isn't accepted, but because the other techniques are more effective for certain types of teaching.

I've started to notice, slowly, more of my patients incorporating more "looks" into their treatment sessions, and I am learning to pick up on them. After I demonstrate an exercise, one patient may look at me in a way that says, "You have got to be kidding me! There's no way I can do that exercise!" Other times a patient will glance my way with a look that says, "I am finally starting to feel better." After some of my family teaching sessions, the group will look at each other and at me with faces of understanding and relief that they are no longer under the umbrella of ignorance.

Sometimes seeing a patient's face light up is better than any verbal thank-you or acknowledgement. When I see my patient's face, and that he understands his own body better and has the tools to maintain his own health and function, it's the best job satisfaction I could ask for.

But, you have to watch for those looks. You have to be aware of those non-verbal communication styles any time you are interacting with a patient. Because if you miss "a look," you may be missing a big part of what your patient needs and wants you to know.

For the past eight months, I met with a group of acute-care therapists to develop an early mobility presentation a PT conference. With four hours of allotted time, we met one to two times a month to organize the presentation. We divided up tasks such as typing the handout, finding photos and researching current trends. I think I have over 50 hours of time dedicated to developing this presentation. I spent hours making the margins of the handout exactly right. Many times we thought of new ideas and emailed the group with our thoughts, and happily saw pieces of the presentation come together more cohesively. We masterfully prepared a beautiful CE course, titled "Addressing Challenges to Early Mobility."

By the title of this blog, you know what is about to happen. We received an email last week saying the registration numbers for our course were low, likely due to other programming we were concurrently scheduled against. We were asked if we would like to withdraw from the conference, as the time we spent preparing for the course might not be justified if only a handful of attendees would hear the material. We may be able to instead present the course as a stand-alone CE offering, giving us time to market the course and not compete with other courses.

Oh, the heartbreak! I was devastated. I didn't see this coming. I was so excited to be involved in this project relatively soon after graduating. Imagine, having "Presented at a PT conference" on your resume! I was thrilled to be a part of something like this. While there is potential we will still be able to present our course, part of me is just sad to know we didn't complete what we had worked for.

I know we will (hopefully) have another opportunity to present the material, so I am thankful for that. And even though our course was cancelled, it was still a good learning experience to prepare a presentation to teach to other therapists.

What do you think? Have you ever worked toward something professionally and not been able to complete your goal? Have you ever presented a CE course?

As you well know by now, I am officially an outpatient physical therapist. I previously worked in acute care, and wrote a blog a while back about how much I walked on a daily basis. It was almost five miles on a typical acute day. As I mentioned in that blog, walking around the hospital, to various patient's rooms, to the therapy department for lunch... it all added up. I never stopped moving. Additionally, I was lifting patients throughout the day with transfers, gait training and bed mobility. It was a physically demanding job.

Fast-forward to today. Outpatient physical therapy is a different world. The clinic I work at is about 50 feet long by 20 feet wide, a fairly small space compared to other facilities I've seen. There are three private treatment rooms and plenty of equipment for patients to use, including a treadmill, traditional bike and an arm/leg combo bike. I don't do nearly as much walking as I had been, nor as much heavy lifting.

Now, I am tired in different ways. The first few weeks, my hands were exhausted from all the manual work I do throughout the day. I find myself squatting a lot more to get better alignment with the treatment table. When I instruct a patient to complete a forearm plank for abdominal/core strengthening, I usually do the exercise alongside him. But, I am nowhere close to walking five miles a day.

And - get this! To top it off, I receive emails alerting me to when other staff members bring treats and snacks to the back conference room. The trend seems to be two to three emails per week, from what I can tell. It is a nice, friendly email usually celebrating a birthday or leftover snacks from a weekend party. Nothing like a little message reminding me where I can find more calories in the day!

Obviously, this change in activity has manifested itself in unpleasant ways. My clothes fit, um, differently than they used to. I should explain. I'm a fairly thin-framed lady. I wear size "small" clothes. I haven't ever had to diet like many of my friends. But, I can normally notice even the smallest fluctuations in my weight, and this combination of changes in my life is no different.

So, I've had to make some other changes. My workouts aren't optional anymore. I'm much more conscious of portion sizes for my meals. If I know there are snacks in the conference room, I substitute it as part of my meal instead of simply adding more calories. I put a few inspirational quotes at my desk to remind myself to maintain a healthy lifestyle. I want to be a role model for my patients.

What do you think? Do you find yourself struggling with a sedentary job? How do you stay active throughout the day?

As I've been working in an outpatient orthopedic setting for the first time in almost three years, I'm beginning to remember some of the perks of working with these patients. It's been fun to educate my patients in a different way than when I worked in acute care. I have really enjoyed the one-on-one time with my patients without the constant interruptions (unintentional, I know) from doctors, nurses or other hospital staff. I'm slowly adjusting to the different focus of an outpatient evaluation (pain, loss of function) versus an inpatient acute evaluation (mobility, overall independence to care for self).

One question I ask my patients in the evaluation, or even in treatment sessions to mark our progress, is "How long have you been living with this pain?" Or, "When did the pain start?" I am very surprised that my patients will tell me they have had pain for months or years. Over that time they convinced themselves into a pattern of thinking: that the pain will eventually subside, that the pain isn't great enough to warrant attention, that any descriptions of pain will only illustrate the weaknesses of the patient, or due to lack of time the patient could not address his area of pain.

I may be channeling some of my subconscious Oprah as I write this, but I really feel badly when I hear that my patients have lived with pain for as long as they say. I cannot imagine losing any of that time due to pain. I have been lucky in that I haven't had to experience such a loss. Life is too short. Maybe that is why I am such an advocate for early intervention - both in an ICU and an outpatient setting. Life is too short to let pain "win" our time.

Physical therapists can make big impacts this way, by improving the quality of our patients' lives. And when we have the honor to help our patients this way, their lives are never the same. It's a very powerful relationship and clearly one of the most satisfying reasons to be a physical therapist.

What do you think? Do you remember a particular situation where you made a difference? Can you recall certain patients whose quality of life was improved because of your work?

P.S. I became an APTA member this week. More to come on that topic soon.

When I was finishing up my bachelor's degree in Spanish, I seriously considered withdrawing from PT school and instead getting my teaching certificate to teach Spanish. Many times I taught other students how to remember different verbs, or had volunteered at English-as-a-second-language facilities and really enjoyed teaching people new things. I think that's why I like being a physical therapist - because I can teach my patients a lot of things about their bodies, how to recover from injury and how to prevent future injuries. I'm constantly educating my patients throughout the day.

I had a wonderful opportunity to guest lecture at a physical therapy school last week. Last summer I had a student who was not familiar with respiratory equipment or treatment ideas/plan of care for critically ill patients. After discussing her clinical with the school, we realized that the curriculum would benefit from a lecture containing more detail about ICU-related equipment and treatment plans for those patients. And, coincidentally, this paired well with the presentation at the Wisconsin PT Association conference I will be giving later this spring with three other clinicians about the barriers of early mobility. So, as we developed the outline for the WPTA conference, I took some of that material and adapted it for the students to understand.

While I was preparing for the lecture in the months ahead of time (hello, over-organized Lisa!), I didn't really get nervous. I wanted to be thorough. I know in my own PT school experience, every minute of every course was crammed with information. There is so much to learn and so little time to present all of the material. I knew I needed to be detailed and concise at the same time. I also knew I didn't want to use PowerPoint. As a student, I hated PowerPoint. It's hard to sit in a lecture hall in a dark room for hours. I used a few photos but otherwise didn't rely on the PowerPoint.

Overall, I had a very fun time teaching. I think I did a good job. The students were attentive and didn't give any body language to indicate that I was boring or confusing them. They asked good questions. And, they laughed at my stories. Other than the seven hours in the car (three-and-a-half hours each way) and the jaw-dropping gas prices associated with such a long trip, it was a wonderful day.

Who knows? Maybe this will develop a craving in my career path to do more teaching. Hard to say. I love working with patients and nothing else can really compare to that, but helping a student develop that same love could be very inspiring as well. What do you think? Do you teach PT students? Do you enjoy teaching?

Well, I finally bought an iPad this week. I worked some overtime last week and this week (to help offset the costs) and nudged my husband that a gift to celebrate my new job was in order. The second-generation iPads were on sale, so we went and bought one.

So far, I love it. I've been using my iPhone for months and had accommodated my eyes to that small screen. The iPad now feels like such an upgrade - the screen is so much bigger than what I'm used to and obviously the touch screen makes surfing the Internet and playing games incredibly easy. I downloaded a few of my favorite PT apps and have been using those pretty often.

As I was sitting on my couch using the iPad, I noticed that I started changing positions more frequently. I would flex my hips and knees and rest the iPad against my quads as I reclined in the chair. A few minutes later, I would turn to sidelying on the couch with the iPad next to my head. After reading a few news articles, I would get off the couch and lay on my stomach on the floor and put the iPad under my face. I just couldn't get comfortable. A few times while I was trying to prop up the iPad to read, I could feel myself almost straining my muscles to hold the position for long enough.

We didn't buy a case with the iPad and I therefore had to hold the device up with my arms to be able to read from it. My arms fatigued. I then started flexing my neck forward and rounding my back to get closer to the screen. Hello improper posture! Although I hadn't given it much thought before I purchased the iPad, it was certainly affecting my posture negatively. I'm now searching the Internet for a holding case for the iPad - something I can stand up the iPad and read from comfortably.

When the Blackberry phone hit the market a few years ago, there was an upswing of finger and thumb tendonitis resulting from overuse injuries. I'm sure we could see a similar pattern with the iPad. As our patients come with complaints of back and neck pain, it's important to discuss their posture in all settings - during sleep, at work, during exercise and while reading. Do they watch TV with a pillow propping their neck forward? Do they cook and read the recipe by hunching over the countertop?

What do you think? Have you noticed postural changes as a result of tablet devices? Do you use a tablet personally and feel differences in the way you position your neck to read? Do you have any ergonomic advice for patients who frequently use electronic devices?

My husband and I are starting to consider getting a dog. I'm not really sure how serious we are about it. We both work full-time and neither one of us wants to buy a dog only to have it be alone for the majority of the week. It's a big responsibility. So, of course, in true Lisa-planning style, I ordered a book about dogs to do some research and see if we are really committed to taking care of a pet.

As I was reading through the chapters this weekend, there was a little blurb on the side of one page about how physical therapy for pets may be beneficial if your dog would ever need surgery or sustain an injury. Wow! I had a few lectures about pet physical therapy in school and I've heard about it through some coworkers, but I never expected to see physical therapy services promoted in a dog book!

Obviously the concepts are the same - dogs (or cats) have bones, muscles, nerves, ligaments and tendons just like humans do. Pets run, jump, walk and exercise too. It makes sense that they would be prone to injuries similar to what human beings experience. And, as physical therapists, this is another niche practice to expand our clinical expertise.

I searched online and found a few educational institutes aimed at teaching PTs how to adapt their skills to apply to animals. The Canine Rehabilitation Institute offers certifications to PTs (and assistants as well) through three courses and a 40-hours internship. They also have a link to veterinary rehabilitation jobs across the country. My little search online also found many rehabilitation centers for canines and pets, similar to rehab facilities for humans. Actually, as I was clicking on different sites I was led to a few pages describing animal amputations, braces, dog wheelchairs and other adaptive equipment made specifically for pets. It's amazing how much information is out there.

The pets I had growing up never had surgery or needed physical therapy, from what I could tell. I know if we end up getting a dog, I'll be more sensitive to look for signs of pain or weakness in my pet. What about you? Have you ever had a pet that needed therapy? Or, do you ever perform physical therapy on animals?

A comment was recently left on one of the blogs I wrote last summer regarding the DPT reputation and the obligation of the APTA to reduce the costs of the DPT degree.

#Icompletelyagree

I left Marquette University with a beautiful DPT degree and a lot of debt. If I compare the amount of money I owe to homes for sale in the Milwaukee area and I could be sitting on a one-acre, three-bedroom home in a lovely suburb, it is a lot of money. Those amounts of money have more weight now that I am a working professional. Given the economy on top of the debt position I am in, it's hard to get ahead. I wish someone had talked with me before I entered the PT program to explain the gravity of the debt I was about to take on. I'm not sure it would have changed my mind about my career path, or if it would have changed anything about my education, but it would have given me more knowledge. And, knowledge is power. Going into a doctorate degree ignorant of the financial consequences is something I regret, and I hope students today understand what they are taking on by enrolling in a PT program.

I met many other recent graduates at the CE course I attended last weekend, and we discussed the differences in our DPT programs. Two of the other students who graduated from different Wisconsin DPT programs had computer-based anatomy courses. The schools, for whatever reason, did not offer a gross anatomy dissection course and instead relied on computer software programs for students to learn human anatomy. Physical therapy students who will later graduate and become the musculoskeletal experts are learning from a computer.

In my opinion, to learn the human body, you have to get your hands in a body and see it firsthand. Chefs don't learn to cook by looking at pictures of food - they learn it by getting their hands on ingredients. Physical therapy education should be the same. If you expect students to leave school with the equivalent of a mortgage, the very least expectation should be a gross anatomy course - filled with cadavers, dissection and seeing the differences in body types. What happens when computer software anatomy courses are substitutes for a gross cadaver-based lab?

Students need to know the quality of education they will receive from a given DPT program. They need to talk to recent graduates, compare different universities and the courses they offer. Ask the average passing rate of the board exam. Ask how many PTs are employed full-time within three months of graduation. Apply to schools who offer the best quality of education, because you could be paying for that education for the next 30 years of your life.

What do you think? Are computer-based anatomy courses acceptable? Where do you draw the line? What happens when one computer-based course becomes two or three computer-based courses? Do you think the APTA should be responsible for the student debt crises of physical therapists?

This new job feels like a breath of fresh air. The environment is completely different from the hospital I came from, and the change is welcomed. I am thinking differently and approaching patients differently, using skills I haven't used in a while. I'm finding ways to incorporate my acute-care treatment strategies into the outpatient setting.

I have a lot to learn, obviously. I took a CE course this weekend hosted by the Institute of Physical Art with a focus on functional mobilization, soft-tissue mobilization etc. I've also been reviewing my notes from school almost every night -- ortho and modalities seem to be the areas I need the most right now. I can't believe how quickly I've forgotten all of this stuff. It seems like it was literally yesterday when I was sweating in front of my board exam, recalling the smallest detail of information to get the questions right. Funny to think it was actually almost three years ago. Time flies.

Transitioning from acute care to outpatient orthopedics will definitely take some time before I am up and running on my own, but it was the right move for me to make in my career. Had I waited any longer, it would have been that much harder to remember all the treatment strategies, special tests and other skills that this different setting requires. I'm really looking forward to becoming better at treating orthopedic patients, improving my manual skills and my differential diagnoses with new patient scenarios.

Of course, there are things I miss. Acute care was busy with a fairly demanding pace. Although our outpatient schedule has a few overlapping patients every day, when one of them cancels it can be pretty slow - at least for now during my orientation time, when I don't have any other projects or things to get done. I'm adjusting to those differences. The thing I miss most from my old job? My coworkers. They were, and are, an incredible group of people. I'm also looking forward to getting to know my new coworkers, too.

Have you ever made a career switch to a different setting? How did you adjust?

For the past six months, I have been interviewing for a new job. It took me a while to decide if I was actually thinking about leaving my current job. I don't have one major reason to leave my new job. I like my coworkers a lot. The hours are fairly flexible. The hospital is huge and there are many opportunities to work with different diagnoses. Within any given day, I can see a patient with a stroke, a patient with a knee replacement, a patient with respiratory failure and a patient with an amputation all before lunch. I was able to do some research and have it published while at my current job, something I never thought I would be able to do so quickly out of school. But, something was missing. There are many reasons why I decided to start looking for another job, and those reasons will be kept away from the publicity of this blog.

So in the past six months, I interviewed at five different facilities. I was so nervous going to my first one, which was at a hospital-based sports medicine facility. Same with the second one at a private practice orthopedic setting. The third I don't really count because it was not a valid option, as it started with only part-time hours. The fourth was a director position of a SNF, and the fifth was an outpatient orthopedic clinic. I didn't intend to interview at so many places (five feels like a lot to me, since I only interviewed at one place when I graduated PT school), but I wanted to find the right place for me.

I was so nervous at first. I couldn't eat. I would get to the facilities 20 or 30 minutes ahead of time and review all my notes in the car before I walked inside. By the third, fourth and fifth interviews, I was much more confident and felt more comfortable balancing the interviews with "selling myself" and asking the right questions to learn more about the job. I started learning how to answer the questions better. I was more prepared for what to expect. I was more confident in the later interviews than the earlier ones, and I was able to communicate more concisely too. I learned how to highlight my strengths without losing the interest of the other person.

During this interviewing process I spent many nights lying in bed, wide awake, wondering if I was doing the right thing. Should I really quit my job? What do I really want from my job, and from my life? What do I want to accomplish, and how I am going to get there? When is the right time to make a career move? Where can I make the most difference in the lives of my patients? What do I need now and what will my family and I need in the next five years? No one has the answers to those questions, I know, but it was an experience for me to ponder the possibilities during this time in my life.

All in all, I did accept a new position, and will also be staying at my previous job as a pool staff therapist... for those details you will have to tune in next week! Keep reading!

Two weeks ago I wrote a blog about my busy life, and how much I have to get done in the next few weeks. It is getting a little out of hand. I don't want to traumatize you all with the innumerable tasks I have on my to-do list, but for the sake of understanding this blog, just imagine a remarkable pile of multicolored post-it notes overtaking my work area. I have more icons on my desktop of unfinished projects than I care to admit.

I have a very hard time asking for help. Somewhere along my journey of becoming who I am, I learned to associate asking for help with admitting my own weaknesses, and acknowledging those weaknesses makes me extremely uncomfortable. I like having control and I like knowing all the plans. I hate surprises. Group projects were pure torture for me in school because I hated that the fate of my grade could rest in someone else's hands. But, I understood the point of those projects - to learn to work with others, because that's what happens in the real world.

Hello, real world. In the past few years I've learned to let go of some things. My husband, for example, pays all the bills, does our laundry and takes care of many other things around the house that I previously was used to doing. It was a tough transition but because I trust him and am able to give him feedback on my preferences (as irrational as they may be), we've come to a good give-and-take relationship with getting things done.

Now, in my professional life I haven't really been forced to ask for help in any major way. I'll occasionally ask for input on treatment ideas from other therapists, or ask someone for a copy of her lab-values reference sheet, but otherwise I am in control of many projects at work. But it's gotten to the point where I do not have the time to get everything done. I cannot prepare for a lecture at a local university and still complete numerous chart reviews as part of the documentation committee - there just are not enough hours in the day.

So, I've had to relinquish some of my duties and hand over the responsibilities to some of my colleagues. It has been hard. At this point of my life, my work is my life and vice versa. I work overtime. I do a lot of reading in my personal time. I've put a lot of myself into those silly projects and it has been hard to see other people take over. Don't get me wrong - I trust that everything will be handled just fine, but it just feels weird.

I need to learn not to take all these things with such weight. It really isn't that big of a deal. Medicare doesn't care if I am the head of the documentation committee or anyone else, just as long as the work gets done. It's just part of who I am and what I have learned to believe - that asking for help, or giving projects away, makes me feel like I'm not meeting the expectations I was hired to meet.

What about you? Do you like to take control over all your professional duties, or do you ask for help?

I met a friend for coffee this week, and we started talking about the Combined Sections Meeting in Chicago and our plans to participate in some of the APTA and WPTA events this spring. Eventually the conversation shifted to the APTA in general and the pros and cons of being a member. My friend pointed out that for chiropractors and medical doctors, membership to their respective professional associations is a requirement of their license. Some companies (in any profession) require their employees to be members of their professional association so the corporation can market itself as having 100-percent involvement in those areas. I didn't know that.

When I was in physical therapy school, it was "strongly encouraged" to be an APTA member, and we were required to have a copy of the APTA's Guide to Physical Therapy Practice book. The Guide was integrated into many projects and assignments throughout the three years in school. The APTA website was extremely helpful in finding research articles or news related to physical therapy and was a good resource throughout the years in school. The year after I graduated, my alma mater made APTA membership a requirement of the physical therapy program. I'm not sure if it is still a requirement.

There's a difference between mandating students and mandating professionals to be members of their professional association. Students are finishing school with a nice DPT degree and a student loan debt higher than many American mortgages. Adding additional costs for APTA membership (although discounted) only adds to the mounting debt crisis and at some point educators need to decide if those requirements are justified. Professionals, on the other hand, have an income and are better able to provide the out-of-pocket costs to become a member.

If APTA memberships were required of all professional physical therapists, membership would increase from around 30 percent (currently) to 100 percent. That means the funding for lobbyists who fight for our rights as practitioners and research funds would be substantially more than what they are accustomed to working with. Can you imagine how much the physical therapy profession could achieve with that amount of resources? As cliché as it sounds, if everyone would contribute, we could accomplish more together.

So, is it fair to ask everyone to be a member? Currently the APTA adjusts its services, including its website, to draw more professionals to join. The organization is constantly measuring the needs of the professionals and working to support all physical therapists. If everyone were a member, would APTA have the same drive? If increasing membership is a motivating factor for the APTA, how would its work change if membership was maxed out?

What do you think? Regardless of your views of the APTA, how would any business change if its sales were at the maximal levels? Would the quality of the company remain at its highest standard?