C&M OrthoSports Inc is a New York State accredited organization dedicated to providing the highest quality physical therapy continuing education possible. Feel free to contact us with any and all questions.  Ask about our group rates and holding a class in your facility! We know pain in the absence of trauma is usually associated with faulty, inefficient, repetitive motion.
This is why we need to educate our patients and the public that rolling, smashing, and poking at something that hurts is not nearly enough to get rid of (or diagnose) musculoskeletal problems. A number of big shots in the world of physical therapy (Mike Reinold and Chad Cook to name a couple) are producing webinars. The problem is that not all states have regulations on how many hours of continuing education have to be done in person each year.
There are only 5 seats left for the course as I’m writing this post…register today while you still can!
While everyone knows “Tommy John”, less people know about the man behind the surgery’s conception: Dr. Its efficacy was quickly apparent, as John returned to baseball after missing one season.  After John pitched well (miraculously, it was said at the time) in his first season back, Dr.
In our last blog post, I spoke about an assessment tool known as the Foot Posture Index (FPI). The topic of prescribing an orthotic came up as well.  Does a certain score indicate utilizing a corrective insert? I believe the proper way to use the FPI is to get a sense of the relationship of the midfoot and rearfoot.
The FPI can be a great part of an evidence-based examination.  Visit us at one of our physical therapy continuing education courses in Brooklyn and Staten Island and learn more about perfecting your skills in motion assessment, differential diagnosis, and applying your data to a highly effective treatment plan. Static evaluation of foot posture in weight-bearing is an essential component of an evaluation of the patient with any lower extremity injury.  A number of methods used to assess foot posture and type have been described in the literature, each one offering different advantages and varying rating in reliability. A manual and datasheet are available for free HERE.  You can also find a link to the study describing the validation process HERE.
The challenges presented by the complexity of the foot and ankle joint are surmountable with a thorough examination and assessment, comprehensive therapeutic exercise program incorporating strength, mobility, dynamic balance, proprioception, and functional activities, and manual therapy to enhance tri-planar mobility throughout the forefoot, midfoot, rearfoot, and ankle.  In our physical therapy continuing education course on the foot and ankle, we provide the tools needed to accomplish those tasks. Discussion of relevant nuances of clinical anatomy and biomechanics of the tri-planar motion of the foot and ankle. Discussion of patho-mechanics for the foot and ankle and the entire lower kinetic chain, with focus on inefficient transfer of energy from the forefoot proximally to the lower extremity.
Identification of red flags, including deep venous thrombosis, neurological disorders, and vascular disorders. Current treatment guidelines, clinical prediction rules, diagnostic criteria, epidemiological statistics, and evidence regarding foot and ankle pathologies. Review of surgical techniques and their pertinence to rehabilitation, protocols for tendon repairs, talocrural joint arthroscopy, ORIF, ligamentous stabilization, and related surgical procedures with attention to tissue healing processes. Practice of advanced manual techniques including joint mobilization, soft tissue mobilization, and precise range of motion for the foot and ankle complex. Application of therapeutic exercises, including neuromuscular re-education, strength training, flexibility training, dynamic stabilization, balance training, plyometrics, and functional exercise. Creative implementation of interventions with progression for all patient populations and skill levels. Considering the location of your patient’s pain is the first step in finding the true source of symptoms.  Use this cheat sheet to help peel away the first layer of ambiguity and discover what’s truly causing symptoms. Recognition of yellow flags is paramount in developing a plan of care that will be beneficial to your patient.  In the following few posts, we will discuss how to accomplish this and guide your patients accordingly. This evidence clearly shows the need for awareness of the presence of yellow flags in our patients.  In our physical therapy continuing education courses, we expand on this topic when speaking on low back and neck pain.
You’d be surprised how many patients are not imaged when they should be prior to coming to you, not to mention if you are seeing the patient through direct access.
Sudden onset is a medical emergency and the patient needs to be referred out immediately if this is suspected.  In all cases, this is a serious neurological condition and should always be investigated thoroughly when on the differential diagnosis list.
This inflammatory condition is typically first characterized by bilateral chronic sacroiliitis, gradually spreading cephalically and possibly into the coxafemoral joints. Next time, we will talk about “yellow flags” and their importance in treating patients with low back pain. Hard X-rays can penetrate solid objects, and their largest use is to take images of the inside of objects in diagnostic radiography and crystallography. The roentgen (R) is an obsolete traditional unit of exposure, which represented the amount of radiation required to create one electrostatic unit of charge of each polarity in one cubic centimeter of dry air.
The rad is the (obsolete) corresponding traditional unit, equal to 10 millijoules of energy deposited per kilogram.
The sievert (Sv) is the SI unit of equivalent dose, which for X-rays is numerically equal to the gray (Gy). X-rays are generated by an X-ray tube, a vacuum tube that uses a high voltage to accelerate the electrons released by a hot cathode to a high velocity.


In crystallography, a copper target is most common, with cobalt often being used when fluorescence from iron content in the sample might otherwise present a problem.
X-ray fluorescence: If the electron has enough energy it can knock an orbital electron out of the inner electron shell of a metal atom, and as a result electrons from higher energy levels then fill up the vacancy and X-ray photons are emitted.
So the resulting output of a tube consists of a continuous bremsstrahlung spectrum falling off to zero at the tube voltage, plus several spikes at the characteristic lines. In medical diagnostic applications, the low energy (soft) X-rays are unwanted, since they are totally absorbed by the body, increasing the dose. To generate an image of the cardiovascular system, including the arteries and veins (angiography) an initial image is taken of the anatomical region of interest. A specialized source of X-rays which is becoming widely used in research is synchrotron radiation, which is generated by particle accelerators. The most commonly known methods are photographic plates, photographic film in cassettes, and rare earth screens.
Before the advent of the digital computer and before invention of digital imaging, photographic plates were used to produce most radiographic images. Since photographic plates are sensitive to X-rays, they provide a means of recording the image, but they also required much X-ray exposure (to the patient), hence intensifying screens were devised. Areas where the X-rays strike darken when developed, causing bones to appear lighter than the surrounding soft tissue. Contrast compounds containing barium or iodine, which are radiopaque, can be ingested in the gastrointestinal tract (barium) or injected in the artery or veins to highlight these vessels. An increasingly common method is the use of photostimulated luminescence (PSL), pioneered by Fuji in the 1980s.
The PSP plate can be reused, and existing X-ray equipment requires no modification to use them. For many applications, counters are not sealed but are constantly fed with purified gas, thus reducing problems of contamination or gas aging.
Some materials such as sodium iodide (NaI) can "convert" an X-ray photon to a visible photon; an electronic detector can be built by adding a photomultiplier.
Our courses are based on the principles of evidence based medicine, expert clinical reasoning, and precise implementation of manual therapy and therapeutic exercise. There’s even some evidence to support their use for short term ROM increases and blood flow. Such motion creates a poor distribution of force, excessively loading certain tissues and leading to pain. If you have a crappy squat that leads to poor force-bearing, imbalance, and asymmetry, you’re going nowhere unless you fix it or stop doing it.
While both are important, foam rolling in the absence of movement modification is going to leave you with a less-than-optimal result. They’ve got some good information, and it’s clearly enriching to hear insights from the brightest in the business.
Sure, we have an established baseline of knowledge of anatomy and any manual techniques or exercises that would be in a typical PT webinar. We would be seeing two completely different feet and no one would know without investigation. The items of the FPI are not brand new to most PTs, and doing them in succession and assigning each a value is a good way to gain a comprehensive view of foot posture.
I’ve seen a patient sent to me after falling 15 feet from a boat deck, hitting the stairs, and crashing into the water who was NEVER X-RAYED after being brought to the ER. This process produces an emission spectrum of X-ray frequencies, sometimes referred to as the spectral lines. The intensity of the X-rays increases linearly with decreasing frequency, from zero at the energy of the incident electrons, the voltage on the X-ray tube. A second image is then taken of the same region after iodinated contrast material has been injected into the blood vessels within this area.
The contrast compounds have high atomic numbered elements in them that (like bone) essentially block the X-rays and hence the once hollow organ or vessel can be more readily seen. In modern hospitals a photostimulable phosphor plate (PSP plate) is used in place of the photographic plate. Our instructors have had extensive experience in orthopedic and sports physical therapy, athletics, training, and coaching. I recommend their use often.   However, they MUST be coupled with motion and neuromuscular re-education. If one does not address the motor patterns leading to pain, how can we ever expect the pain to permanently cease? Attacking the end and not the means will give you the same effect as rubbing your shin after you smack it into one of those pipes sticking out of the side of a building.
They’re practically everywhere right now, certainly in fields other than physical therapy, and it’s easy to understand why. But if precision is to be desired when treating our patients doesn’t it make sense to have utmost precision in our learning?


Jobe also pioneered a modification of the capsular shift (often combined with a Bankart repair) that allowed a higher percentage of overhead athletes to return to their sport effectively.
Jobe’s patients displayed an 81% rate of return to previous activity and an equally low rate of dislocation (3%). Jobe planned to use a tendon in place of a ligament, knowing that the architecture of type I collagen within the tendon leads it to have more tensile strength. Jobe originally thought was a less than 5% chance of recovery is now said to be around 85%.  Countless baseball players have had their careers extended significantly because of the innovation of Dr. It is up to the clinician to use discretion when using data from any test or measure and decide on whether its pros outweigh its cons for their patient and environment.  With statistical backing and tried and true assessment items, the FPI is certainly useful to many clinicians.
He wound up having a fracture on all 5 of his right transverse processes of his lumbar spine. The spectral lines generated depend on the target (anode) element used and thus are called characteristic lines.
These two images are then digitally subtracted, leaving an image of only the iodinated contrast outlining the blood vessels. Photographic film largely replaced these plates, and it was used in X-ray laboratories to produce medical images. In the pursuit of a non-toxic contrast material, many types of high atomic number elements were evaluated. After the plate is X-rayed, excited electrons in the phosphor material remain "trapped" in "colour centres" in the crystal lattice until stimulated by a laser beam passed over the plate surface. Electrons accelerate toward the anode, in the process causing further ionization along their trajectory. The broad knowledge readily available through C&M OrthoSports courses will equip you with a comprehensive framework on which to build proficient critical thinking and psychomotor skills.
As physical therapists, we are the preeminent movement specialists and use that expertise to improve motion and restore function.   This is the foundation of what we do, and all other interventions are (or should be) used to enhance and supplement this concept. All I am saying is that we need to have balance and be selective when deciding how to spend our precious continuing education hours and money.
There is a possibility of a clinician making a clinical decision to use an orthotic or not based on the score of the FPI. The radiologist or surgeon then compares the image obtained to normal anatomical images to determine if there is any damage or blockage of the vessel. In more recent years, computerized and digital radiography has been replacing photographic film in medical and dental applications, though film technology remains in widespread use in industrial radiography processes (e.g.
For example, the first time the forefathers used contrast it was chalk, and was used on a cadaver's vessels. This process, known as a Townsend avalanche, is detected as a sudden current, called a "count" or "event". From the comfort of your couch, you can hear live lectures from a presenter and interact with him or her as well. We need to touch, be touched, and get real-time correction if we are to learn psychomotor skills.
If you are an orthopedic PT, you put your hands on people all day whether for manual therapy or showing someone how to move. When the film is developed, the parts of the image corresponding to higher X-ray exposure are dark, leaving a white shadow of bones on the film. It’s a great way to disseminate information, being on a large scale but exhibiting a bit of a personal touch. It takes a special setting to enhance those skills, and it cannot be done with the internets.
Photographic plates are mostly things of history, and their replacement, the "intensifying screen", is also fading into history. The metal silver (formerly necessary to the radiographic & photographic industries) is a non-renewable resource. But if you’re learning something that requires you to put your hands on someone, there’s no substitute for face-to-face interaction. Thus it is beneficial that this is now being replaced by digital (DR) and computed (CR) technology. Where photographic films required wet processing facilities, these new technologies do not.
While it sometimes feels like an uphill battle, a well-placed tactile cue and some tailored verbal feedback often gets the job done.



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