PT as Part of the Physical

This post is not on-topic for this blog. Well, not obviously on topic. But I want to write about this topic anyways because it's a big part of what I want from my schooling and how I think I can improve the healthcare system. Big stuff.

I have this hypothesis. The hypothesis is that if a consult with a physical therapist was a part of the regular physical then we could improve health outcomes over the long-term.

Right now, almost all PT is treatment. There is almost no component of screening or prevention. The stuff I write about strength training and physical activity for wellness are more prevention work than most PT's can do. 

Our national profession organization, the APTA, my professors and others in the field are all well aware of this limitation. And their is a desire to improve the situation. That's part of why the switch to doctorates and self-referral are important to the future of the profession.

This Canadian physical therapist elaborates nicely on the topic.

If, as a part of every physical, you had an expert who checked out your posture and your gait (the way you walk) then hopefully we can spot problems while they can still be prevented. This consult could also include talking about workplace ergonomics since that will have a huge impact on a person's body over time.

Preventing even a small percentage of low back pain cases would be huge. Low back pain is the most common cause of missed work and represents a huge drain on people's lives and the economy.

Physicals weren't called annual check-ups where I worked, when I worked for a PCP. How often you needed a full health review was based on age and specific health conditions - health 20-somethings were only expected to get a physical every five years. Part of the experiment and study needed to validate my hypothesis would be figuring out how often makes sense, both from a health standpoint and an economic standpoint.

I'm not certain that this kind of screening and prevention will pan out to work well. But it seems likely. So I want to find out.

Class at Iron Gate Exhibition

Recently, I ran a class at Iron Gate Exhibition (IGX) on the topic of Speed & Agility. I co-taught the class with Dakao Do of Schwert am Schwert of Houston, Texas. Below is the class description and the outline of the class. 

I'm going to flesh out the outline a bit, but I actually ran the class with just a sketch. Not only that but the first time that Dakao and I got to talk in-person about the material was just Thursday night, for a Saturday morning class. And in-between we were both very busy with running IGX. We had talked on the phone about a month before, but this is all movement related stuff, so there's a limit to what you can make clear over the phone.

Additionally, there was some stuff that I'd planned to discuss but did not get to (there's never enough time).

Suffice it to say it was a bit of an adventure. But the whole weekend was, so that's par for the course.

Structure and Motion

Fast, maneuverable footwork is an essential component of historical fencing and martial arts. Correct skeletal alignment is the structural foundation on which safe, strong, fast fencing and fighting are based. Structure is present in all guard stances, movements, and strikes. This class will teach some fundamental principles of leverage for control, power, and safety in the fight. Building on that foundation, we will cover a variety of drills designed to improve footwork through the principles of overload, permutational analysis, and body awareness (proprioception). Simple (and cheap) tools such as ladders and cones will be demonstrated to provide drills to bring home to your club. High-intensity interval training for speed and cardio conditioning will also be covered.

Class Outline

Key Principles

• Overload
• Specificity
• Progression
• Intensity
• Task complexity

• Training Power - appropriate reps and rest are required to train power
• Permutational Analysis - underlying theory for highly varied footwork training
• Proprioception - many training tools and methods described here are intended to provide proprioceptive feedback

Tools

• Space - sometimes that's all you need
• Ladders
• Rings
• Dots/Cones - I prefer dots over cones for many drills since you can step on dots, and thereby use them to require precise footwork and this is a mechanism of proprioceptive feedback

The class was organized like an extended training session.

1. Warm-up
1. Lateral lunge
2. T-spine spiderman
3. Lateral shuffle
4. Grapevine
2. Ladder - Ladder drills should include 5-6 activities
   

   More on ladder drills will be included in later posts
3. Lateral & Diagonal
1. Explosive
1. The hip, knee and ankle should be in a straight line for efficient transmission plus joint safety
2. Dinosaur Walk
3. Lateral Bound
2. Agility Rings
1. 1-2 Stick
2. 1-2 Bound
1. Increase distance
2. Assisted/Resisted
3. Diagonal
3. Change of Direction (cones/dots)
1. Forward W
2. Lateral W
3. Lateral W and Sprint
4. L and +
4. longsword circle drill, with 10 variables
5. Z-ball
4. Speed & Acceleration
1. 30-yard shuttle
1. Simple
2. Varied
3. Alternatives
2. Split-squat start
3. Lean-fall-run
4. 60m suicide sprint
5. Conditioning
1. Metabolic power
2. Recovery
   
   This is just a taste of what was in the full-class and many of these topics will be filled out later.