Latissimus Tears: The Newest Injury for Throwing Athletes (Part II)

Just when you thought rehabbing pitchers was hard enough, a new injury has emerged in the throwing population

If you haven’t read Part I of our series, please check it out now. In part I we discussed anatomy, how the lats are in involved with pitching, reasons for the increase in lat injury frequency, and a brief surgical review.

For Part II, we are discussing common compensations we see in the “lat dominant” population and demonstrate a few examples of our favorite functional exercises to retrain this dominance with video demonstration by OSSPT patient and San Francisco Giants prospect, Caleb Simpson.

As previously mentioned, the lats have multiple attachment sites, spanning across several joints in the body, including the thoracic and lumbar spine, pelvis, ribs, scapula, and humerus. Because of all these various attachment sites, the lats have a major influence on posture, breathing, pelvic control, scapular mobility, and glenohumeral positioning. When the lats are working properly, they are crucial in power development with throwing; however, when the lats become too dominant, they are at risk of injury.

Although we are big believers of implementing deadlifting, horizontal/vertical pulling, and carrying into an athletes plan of care, we need to make sure the lats do not become the dominant muscle with all lifts for the throwing athlete.  When presented with a task that is too demanding for the throwing athlete, he/she will revert to over-utilizing the dominant muscles.  Our job as physical therapists is to, first identify these compensations, then educate and correct the athlete of proper movement patterning.  We must prescribe the athlete with exercises that are challenging, but also achievable.

To assist with better identifying when the lats may have become too dominant, we have listed some common compensation patterns to look for.

Common “Lat Dominant” Compensations

1. Excessive lumbar extension/anterior pelvic tilt: with attachments anterior pelvic tiltto the thoracolumbar fascia, spine, and pelvis, overly dominant lats will often lead to excessive lumbar extension and an anteriorly pelvic tilted position.  Overly-dominant muscles often lead to shortened muscles so we need to incorporate exercises that force the lats to work in an eccentric, lengthened position while maintaining a neutral spine.

2. Faulty breathing mechanics: most of our patients, particularly our athletes, have poor diaphragmatic breathing and often over recruit the accessory respiratory muscles, including the lats.  Many of the accessory respiratory muscles further pull the body into a lumbar extended, anteriorly pelvic tilted position. At rest, we breathe approx. 15,000-20,000x/day. If we are constantly breathing improperly, the lats are living in faulty, shortened positions.  We spend a lot of time teaching proper diaphragmatic breathing to our throwing athletes and incorporate diaphragmatic breathing into our exercises when possible.

3. Rib flaring: the first two compensations we discussed will often lead to rib flaring, so if we correct the excessive lumbar lordosis/anterior pelvic tilt and faulty breathing mechanics, the rib flare may resolve; however, a rib flarerib flare can also develop due to weakness of the anterior core.  With our throwing athletes, we must incorporate anterior core control exercises while in an overhead position. This will ensure our pitchers can successfully control the rib cage, which is vital to ensure proper scapular position as well.

4. Shoulders falling into IR and/or adducted positions: the most common technique used to identify this compensation pattern is the prone horizontal abduction exercise.  Instead of the shoulder remaining at 90 deg. during the arm raise, the overly dominant lat will pull the arm down toward the hip (as you can see in the picture below). In early stages of rehab, teaching and performing this exercise correctly can be an appropriate intervention to reduce the lat dominance and improve mid trap and rhomboid activation with this movement.

Lat dominant prone T5. Insufficient scapular elevation/upward rotation: due to the lats attachment to the inferior aspect of the scapula, “dominant lats” can lead to depressed scapula, or at the minimum, dominant lats can prevent proper scapular elevation/upward rotation with overhead movements. For the throwing athlete, a lack of proper scapular control and movement will lead to impaired glenohumeral joint congruency and contribute to rotator cuff/labral pathology.

Exercise Examples

1.Plank –> Downward Dogan excellent upper extremity closed chain movement that promotes proper scapular upward rotation and requires anterior core control, while putting the lat in a lengthened position. We cue the athlete to drive thru the palms, maintain a neutral spine, and bring the hips to the sky. We will use this exercise as a primer before introducing higher level overhead movements.

2. MedBall Lat Pullovers: this exercise forces the athlete to maintain a neutral spine, not allow rib flaring while controlling the medball overhead, and teaches proper eccentric lat control. We will often incorporate diaphragmatic breathing techniques while in the overhead position as well. Just like our previous exercise, this can be another primer movement.

3. Wall Angels: this exercise is an excellent choice for the general population to address common postural dysfunctions including excessive lumbar lordosis, anterior pelvic tilt, increased thoracic kyphosis, rounded shoulders, and forward head positioning. To perform correctly, the athlete cannot allow rib flaring either.

4. Half Kneeling S.A. 90-90 Row-ER-Press: as we progress through our exercise examples, we are gradually increasing loads as well. With this exercise, we continue to demand proper core control, emphasized by adding an unstable surface via the Dynadisc for the R knee. This exercise also demands proper posterior rotator cuff activation as we cue the athlete to drive his fist straight to the sky during the press movement. To better replicate the pitching demands and mimic a glove side pulling that many pitching coaches instruct with an isometric glove side row.

5. Unilateral Overhead KB Marches: this exercise is a great stability based exercise in multiple planes of movement, particularly when we add the band resistance as well. The big thing to watch for is excessive lumbar extension, rib flare, pelvic drop, or the athlete not keeping the KB shoulder in full flexion with slight shoulder ER. We cue them to drive the KB to the sky w/o allowing the shoulder to shrug. As we can see in the video below, Caleb is having some difficulty with maintaining extended elbow position and he is allowing the shoulder to rotate internally.

6. Tall Kneeling Halos: our last exercise may  look easy from the surface, but halos will reveal compensations really quickly. This exercise demands excellent core stability and a combination of excellent shoulder stability and mobility.

The lats are important muscles for the throwing athlete and it’s vital that we identify and correct common movement dysfunctions and implement appropriate exercises to re-train these faulty movement patterns.

I hope you enjoyed our 2 part blog post. I wanted to provide a quick shout out to Mike Reinold and Eric Cressey.  I was introduced to these two guys eight years ago while working with the Atlanta Braves and I have attempted to read everything they have produced since that time and they are two of the biggest influences in my professional career. Both guys put out great material on a daily basis and so much of how I treat our baseball players is either directly or indirectly influenced by them, including this blog post. I want to say a big thank you to Mike and Eric for how much they have helped, not only me, but the medical and performance profession as a whole.

 

Latissimus Tears: The Newest Injury for Throwing Athletes (Part I)

Just when you thought rehabbing pitchers was hard enough, a new injury has emerged in the throwing population

With Spring Training underway, baseball is officially back!  As a fan, I am more than excited.  As a medical professional and a PT who spends a lot of time treating the baseball population, I know my schedule is about to ramp up.  As Posner, et al (2011) found, April is the month with the highest injury rates for MLB players, with pitchers having a 34% higher injury than position players.  One of the injuries we are seeing more often than in years past in our professional pitchers are latissimus injuries.  For a lot of reasons, we will discuss below, it seems that latissimus injuries are being diagnosed more frequently than they were in decades past.  It was not until 2010 that the first lat repair surgery was performed on a professional baseball player, when Jake Peavy went under the knife.  Since then, many of the game’s biggest stars, including Stephen Strasburg, Fernando Rodriguez, Clayton Kershaw, Noah Syndergaard, and Cardinals top prospect Alex Reyes have sustained lat injuries.  In a systematic review of 30 professional baseball pitchers, Mehdi, Frangiamore, & Schickendantz (2016) found that the average time required to return to pitching was 99.8 days for the non-operative group and 140 days for the surgically treated group. As you can see, once you sustain a lat injury, the recovery is slow.

Because so few PT’s in the traditional clinic setting treat professional athletes on a regular basis, we created a massive two part blog for our audience to serve as an additional resource to develop a better understanding of the injury and implications for pitchers.  We hope you will enjoy!

In Part I, we will review latissimus anatomy and it’s involvement with pitching, theories for the increase in lat injuries for professional pitchers, and a brief review of the surgery.

In Part II, we will discuss common compensations for “lat dominant” athletes and demonstrate a few of our favorite functional exercises that specifically focus on addressing the common compensation patterns.

Anatomy

lat picture

The latissimus dorsi is the largest and most powerful muscle in our backs, originating from the T7-L5 vertebrae (basically our bra straps to our belt line), the thoracolumbar fascia, iliac crest, the bottom 3-4 ribs, and the inferior aspect of our scapula.  The lats then insert on the intertubercular groove of the humerus. THAT’S A LOT OF ATTACHMENTS, LEADING TO A LOT OF MOVEMENT INFLUENCES. To make matters more complicated, the lats have a lot of variability in respect to its specific attachment sites.

The general functions of the lats include extension, adduction, cross body adduction, and internal rotation of the shoulder.  For many recreational lifters, the lats become the dominant muscle with all vertical and horizontal pulling movements such as rows, pull ups, and pull downs.

How are the Lats involved with Throwing?

For baseball pitchers, the lats are one of the most important muscles in developing arm speed, and therefore, increasing throwing velocity.  As Eric Cressey (2016) has previously stated, the lat “connects the lower body to the upper body to allow for force transfer that ultimately leads to arm speed and ball velocity”. The lats have several very specific and important functions in the pitching motion, including the following:

throwing phases

  1. Initially, the lats work eccentrically during the cocking/lay back phase to control the shoulder external rotation occurring.
    1. When a muscle is working eccentrically, it is being lengthened under load. When a muscle is working concentrically, it is being shortened under load. For example, when you do a biceps curl, the curl portion of the movement is a concentric movement (shortening of biceps). As we slowly lower the weight, we are still using the biceps muscle eccentrically (lengthening of the biceps).
  2. Next the lats transition from eccentrically lengthening (storing elastic potential energy) during the cocking/lay back phase to concentrically shortening (utilizing that stored energy to generate high arm speeds) during the arm acceleration phase.
  3. Finally the lats continue working concentrically as the arm accelerates during throwing to release, acting as one of the major force generators during this phase. According to Fleisig, Andrews, Dillman, & Escamilla (1995), the throwing arm accelerates at over 7000 degrees per second, which is the fastest recorded human motion in sports (3).

The further the lay back phase, the mowagner.jpgre the elastic potential energy created by the lats, thereby providing more opportunities for increased velocity.  If you look at the picture below of Billy Wagner, one of the hardest throwing pitchers in the history of the game, you can appreciate the considerable amount of layback in his throwing shoulder, and it quickly makes sense how he became of the games hardest throwers. He generated vast amounts of elastic potential energy via the lats.

If the idea of elastic potential energy is still confusing, then check out this short video below which provides additional information.

What Does all that Energy Talk Mean Injury Wise?

Muscles and tendons, throughout the body, are most vulnerable to injury during the eccentric phase of movement (being lengthened).  When you add large loads to the eccentric phase, as seen when throwing a baseball, and then ask the muscle-tendon complex to transition from being maximally lengthened to concentrically contracted at high speeds , we are asking for trouble. As you can see, the demands on the lats are very high during the throwing phase.

To provide a better visualization of what happens when you overload a muscle/tendon during the eccentric phase, check out this video below (beware of language).  At the 30 second mark, you will see a lady (wearing the ironic “Today is the Day” shirt) take a quick step back with her left leg, leading to an eccentric stretch to the Achilles, followed by an attempt to quickly concentrically contract and shorten her Achilles. Unfortunately for her, she overloads the tissue, rupturing her Achilles (if you don’t mind the language, you can literally hear the pop happen).

Why the Increase in Lat Injuries?

Clearly, pitching places a lot of demands and stresses on the body, particularly the lats, but the question remains, why such sudden increases in lat specific injury risk?  The answer appears to be multi-factorial.  Below, I have listed some of the probable causes.

    1. Pitchers are throwing harder: From 2008-2017 the average 4-seam fastball increased from 90.9 mph to 93.2 mph. Additionally, in 2008, there were only 196 pitches thrown 100+ mph in the league for the entire season.  In 2017, there were over 1,000 pitches thrown 100+ mph for the league (Clair, 2018).  As throwing velocity increases, so do the stresses placed on the entire body as whole; furthermore, Gowan, et al (1987) showed that professional pitchers (harder throwers) have a much higher lat recruitment during the arm acceleration phase than amateurs.  Simply put, velocity is rising, and as velocity rises, so do the stresses placed on the lats.
    2. Pitching Year Around: Year around throwing is the root of all evil. At OSSPT, we tell our pitchers that the risks of year around throwing are analogous to the risks of smoking. Similar to how smoking is the top risk factor for many health conditions, year around throwing is the top risk factor for almost all throwing injuries.  As amateur pitchers constantly jump from school ball to travel ball, and then indoor lessons, they never allow their body to take a break, resulting in excessive cumulative stresses placed on the lats, and body as a whole.  Also, we know that as we throw throughout the year, our body undergoes some specific changes which further increase lat injury risk.  For example, we know that throughout the season, pitchers have a significant decrease in shoulder internal rotation, total motion, and elbow extension (Reinold, et al, 2008).  Also, Zeppieri et al (2015) showed that collegiate pitchers lose hip ROM and strength throughout the throwing season.  Besides simply reducing the amount of cumulative stresses placed on the body, we also must take time off from throwing to receive adequate rehab to regain strength and motion losses prior to the next season.
    3. The American Sports Medicine Institute has released throwing guidelines and recommends no overhead throwing of any kind for a minimum of 2-3 months per year(http://www.asmi.org)
      • Weighted Ball Programs: Because pitchers and performance coaches are constantly searching for ways to increase velocities, weighted balls have become the newest trend in baseball. Based on the literature from Reinold et al. (2018), a 6 week weighted ball throwing program led to a 3.3% increase in throwing velocity. A velocity jump like that could be the difference between AA ball or the majors.  All good news right? Not quite, Reinold et al. (2018) showed that the weighted ball group had a 4.3° degrees increase in external rotation, meaning more lay back, which may explain the velocity jump, but it also means increased eccentric loading for the lats as well. Not surprisingly, in the study, the weighted ball group also had a 24% injury rate, while the control group had no injuries during the 6 weeks period.  Although the usage of weighted balls appears to have some performance benefits, we are still uncertain of how to safely implement these throwing programs in regards to how often, how heavy should the weighted balls be, what ages are most appropriate, etc. Because of all the uncertainties surrounding weighted balls, we strongly recommend that you proceed cautiously when attempting a weighted ball program.
      • Lat Dominance/Faulty Training: We will discuss this in much more detail in Part II, along with providing some of the exercises we utilize to retrain our lat dominant throwing athletes.
Surgery

While most lat injuries are Grade I or II strains (partial tears), occasionally a throwing athlete will sustain a tear large enough that requires surgical intervention.  Dr. Anthony Romeo performed the first lat repair surgery on a MLB player and has become the pioneer of the lat repair surgery.  According to Dr. Romeo’s website,

“The latissimus dorsi repair is done by making an incision in the back of arm, near the armpit. The ruptured tendon is then located, and sutures are placed in the end of the torn tendon. Those sutures are then used to pull the tendon back up to the arm bone where the tendon ruptured. Small metallic anchors, called buttons, are then used to fix the tendon to the bone.” (https://www.romeoorthopaedics.com/surgeries/latissimus-dorsi-repair).

In the picture below, you can see OSSPT patient and San Francisco Giants prospect Caleb Simpson’s incision following his lat repair surgery.IMG_1797

To check out Part II, click here.

References

Clair, M. (2018, August 29). Are pitchers really throwing harder than ever? Retrieved from https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever/c-292153594

Cressey, E. (2016, May 4). Pitching injuries: should lat strains even be happening? Retrieved from https://ericcressey.com/pitching-injuries-lat-strains

Cressey, E. (2018, July 9). 5 reasons for the increase in lat strains in baseball pitchers. Retrieved from https://ericcressey.com/5-reasons-lat-strains-baseball-pitchers

Fleisig, G. S., Andrews, J. R., Dillman, C. J., & Escamilla, R. F. (1995). Kinetics of baseball pitching with implications about injury mechanisms. The American Journal of Sports Medicine, 23(2), 233–239. https://doi.org/10.1177/036354659502300218

Gowan, I. D., Jobe, F. W., Tibone, J. E., Perry, J., & Moynes D. R. (1987). A Comparative Electromyographic Analysis of the Shoulder During Pitching. Professionals versus Amateur Pitchers. The American Journal of Sports Medicine, 15(6), 586-590.

Mehdi, S.K., Frangiamore, S.J., & Schickendantz, M.S. (2016). Latissimus dorsi and teres major injuries in major league baseball pitchers: a systematic review. American journal of orthopedics, 45(3), 163-167 .

Posner, M., Cameron, K., Wolf, J., Belmont, P.,  & Owens, B. (2011). Epidemiology of major league baseball injuries. The American Journal of Sports Medicine, 39(8), 1676-1680.

Reinold, M.M., Macrina, L. C., Fleisig, G. S., Aune, K., & Andrews, J. R. (2018). Effect of a 6-week weighted baseball throwing program on pitch velocity, pitching arm biomechanics, passive range of motion, and injury rates. Sports Health, 10(4), 327-333.

Reinold, M.M., Wilk, K.E., Macrina, L.C., Sheheane, C., Dun, S., Fleisig, G.S., Crenshaw, K., & Andrews, J.R. (2008). Changes in shoulder elbow passive range of motion after pitching in professional baseball players. American Journal of Sports Medicine, 36(3), 523-527.

Zeppieri, G., Lentz, T., Moser, M., & Farmer, K. (2015). Changes in hip range of motion and strength in collegiate baseball pitchers over the course of a competitive season: A pilot study. International Journal of Sports Physical Therapy. 10, 505-513.

https://www.physio-pedia.com/Throwing_Biomechanics (picture)

Is My Post-Marathon Pain Normal & What Now?

Congratulations! For all those who completed the full marathon, you have accomplished a feat that less than half of 1% of people in the United States accomplishes in his/her lifetime (1). For those who completed the half marathon, less than 1% of people complete this feat yearly. Immediately after the race, the sense of accomplishment and pride quickly morph into some notable soreness (at least for us).

To help combat your post-run aches and pains, we have several tips:

  1. Re-hydrateduring the race, we sweat out fluid to keep our body temperature regulated and we must replenish those fluids after the race to reduce cramping, dehydration, and potential heat exhaustion. The average adult should consume approx. 3 liters of water daily (2); however, less than 25% of adults drink enough water on a daily basis. For the next few days after the race, re-hydrating is vital and we encourage people to at least intake the normal recommendations of 3 liters.
  2. Perform Light Exercise: exercising may seem counter-intuitive after a long run to reduce soreness, but the literature strongly recommends performing light low load exercise to reduce muscle soreness after a strenuous run. This can be as simple as a 15-20 minute walk, riding a bike, or a light swim. All of these activities will promote increased blood flow which can help expedite the inflammatory process and promote lymphatic drainage, which are all contributing factors to the muscle soreness/stiffness.
  3. Soft Tissue Work: After a marathon, blood flow and other fluids become stagnant in the muscles and other surrounding tissues. Through a variety of techniques, such as foam rolling, we can help “squeeze” out those stagnant fluids, which the body will then replace with new fluids/nutrients reducing soreness and aid in overall recovery of the soft tissues. Too often, patients believe foam rolling should be a “no pain, no gain” situation; however, we should avoid excruciating pain. We instruct patients to stay in an “it hurts so good” zone where you are experiencing only a little discomfort while foam rolling and no worse afterwards. Another excellent recovery strategy is receiving a soft tissue massage from a licensed and skilled massage therapist. This should be a lighter intensity massage, focusing more on “flushing” strategies. The muscles are already traumatized from the run. We do not want to add additional trauma to the tissues or this can slow recovery.
  4. Take Time Off Running: For all of our high level runners, do not freak out. We are only asking you to take a short break. For half marathoners, we recommend taking a week off. For our full marathoners, at least two weeks off of running is our recommended time off. Some people may choose to perform light runs as a recovery strategy, but we encourage utilizing cross training strategies mentioned above.

We know there are a lot of snake oil salesmen pushing all kinds of expensive recovery products on the market. Many of these are unnecessary and have not shown any evidence of being beneficial. Following these simple strategies, you should be back to pounding the pavement in no time.

For those runners who experienced specific pain during or after the race, such as hip pinching, knee grinding, low back pain, foot pain, etc, this may be a WARNING of an underlying issue that warrants more specific and skilled treatment from a physical therapist. Up to 68% of runners experience an annual injury (2). Many of these injuries go untreated and lead to a snowball of issues down the road, often resulting in runners shortening distances or eliminating running all together. In a previous blog post, The Straw That Broke the Camel’s Back, which details how repetitive, overuse injuries occur and are often due to underlying movement impairment syndromes. Running is no different. Running, in itself, is not a bad or harmful activity; however, running without the prerequisite movement patterns, flexibility, mobility, stability/motor control, etc. will lead to injury over time.

Do not stress, soreness is normal and expected after any high level workout, much less a 26.2 mile run; however, if you notice that one particular area is not recovering like the rest of the body, then we can help. No referral is needed. Call us at 405-735-8777.

sports injuries

References

  1. https://www.statisticbrain.com/marathon-running-statistics/
  2. http://www.marathontrainingschedule.com/blog/45-mind-numbing-facts-figures-statistics-running-2/

The Straw that Broke the Camel’s Back

We have all heard the common proverb “It’s the last straw that breaks the camel’s back“, referring to how something presumably minor can, overtime, cause a catastrophic and sudden reaction, due to the cumulative effects of the individual actions. Whether this refers to car tires wearing down overtime until the tire eventually blows a flat, a tree covered in ice during a snow storm that slowly bends more and more until it finally snaps, or continually “squeezing” into those tight jeans until finally one day you try squeezing into them and they rip at the seam, the overlying idea is that it was not one single event that led to the destruction; instead, it was gradual wear and tear over time. The same holds true for a large majority of injuries to the human body.

“It’s the little details that are vital. Little things make big things happen.”

– John Wooden

Many of the injuries we treat are not due to a single traumatic event, but are more often from chronic wear and tear, or as we describe it, repetitive microtrauma. Whether that be rotator cuff tears, carpal tunnel syndromes, lateral Epicondylagia/Tennis Elbow, Bulging/Herniated Discs, Arthritic related conditions, knee pain, tendonitis, etc., the underlying cause of the dysfunction is due to repetitive microtrauma leading to tissue breakdown and pain. 

What causes repetitive microtrauma?

The simple answer is an underlying movement dysfunction and/or sustained postures, which results in muscle imbalances, soft tissue restrictions, joint dysfunctions, adverse neural symptoms, impaired stability/motor control, and eventually structural adaptations. Our job as physical therapists MUST be to not only treat the site of pain, but to identity and treat the underlying movement dysfunctions which led to pain and limitation in the first place. In other words, we must identify and treat the cause of the cause.

If my pain goes away, why does it matter?

When a patient comes into OSSPT with a rotator cuff tear, whether it be post-surgical or for conservative treatment, our first priority is to provide a proper environment to allow adequate healing to the damage tissue. Then we must identify and treat the underlying movement dysfunctions which led the rotator cuff to tearing in the first place, to prevent future recurrences. Simply giving generic range of motion and strengthening exercises is not enough and will result in short term improvements, at best. If we don’t fix the underlying cause of the cause, the likelihood of future re-injury is high.

Physical therapists wonder why so many of their patients return to the clinic weeks/months/years later complaining of the same symptoms they were previously treated for, often, blaming the patient for being non-compliant, a failed surgery, age, etc., without ever looking internally. We, as a profession, need to spend more time educating and proving to patients that we are more than just a profession of people who give out “stretches and stuff” as some claim, and prove to patients we are an invaluable member of the medical team, because right now, we are heading in the wrong direction as a profession, having become a bunch of overqualified exercise supervisors. If we keep heading this direction, doctors will continue to disregard our abilities, insurance companies will continue to cut reimbursement, and patients will continue to devalue the services we provide, until eventually, it will be the straw that broke the camel’s back for our profession.

Here’s to the Crazy Ones…

“Here’s to the crazy ones, the misfits, the rebels, the troublemakers, the round pegs in the square holes… the ones who see things differently — they’re not fond of rules… You can quote them, disagree with them, glorify or vilify them, but the only thing you can’t do is ignore them because they change things… they push the human race forward, and while some may see them as the crazy ones, we see genius, because the ones who are crazy enough to think that they can change the world, are the ones who do.”

– Steve Jobs

What made Steve Jobs so special was not his genius. We are surrounded by “geniuses” everyday. What truly made Steve Jobs so special was his laser focused vision, his imagination, his optimism, and his determination. It was his unwillingness to accept the status quo. He wanted more from his employees and his company.

When Geoff and I opened OSSPT we committed ourselves to only hiring those same likeminded people who wanted more for themselves and for others. We searched for individuals who might be considered the crazy ones, the misfits, the rebels, the troublemakers, the round pegs in the square holes”. We didn’t want the typical physical therapist; we wanted the outlier. We wanted the physical therapist who voluntarily works full time, while simultaneously completing a very expensive and time consuming 2.5 year orthopedic residency program because he/she wanted to provide a better quality of care to his/her patients. We wanted the physical therapist who works 45 hour work weeks then spend his/her days off completing extensive manual therapy fellowship training. We wanted physical therapist who is not satisfied with being “average” or “typical”… and we luckily found just that.

Our physical therapists have the most advanced training possible and are the most highly qualified to treat your specific needs. You can quote them, disagree with them, glorify or vilify them, but the only thing you can’t do is ignore them because they change things… they push the human race forward.” We are challenging the traditional treatment model of chasing pain, treating symptoms and not causes, searching for short term relief in spite of long term improvements. We are striving to change the norm and in some small way, change the world. While some may see them as the crazy ones, we see genius, because the ones who are crazy enough to think they can change the world, are the ones who do.”

So what makes our staff so special? It’s our laser focused vision, our imagination, our optimism, and our determination to truly make a positive and lasting impact on our patients. We are not satisfied with being average. We are not satisfied with doing the norm and while we have a long way to go, we are tirelessly working every day to improve. The norm has been failing patients for years and they deserve better, and that is what we aim to provide. If all our individual contributions result in a tiny positive change to the world for the better, then we have succeeded. So… Here’s to the crazy ones!

Our Profession Owes You an Apology

When an individual has a heart related condition, they see a cardiologist… When an individual has a skin related condition, they see a dermatologist… When an individual has a cancer related condition, they see an oncologist.

In every area of our lives we search for the experts, why should physical therapy be any different?

The quality of care we have come to expect from the physical therapy profession has become so low that the assumption is that all physical therapy is the same; however, this could not be further from the truth. When a physical therapist graduates from school, in a sense, they become a “jack of all trades”. They have a very broad knowledge base making them novices in all aspects of physical therapy including orthopedics, pediatrics, acute care rehab, neurological, spine,  sports rehabilitation, etc; similar to how graduates of medical school have developed a foundation of cardiology, neurology, immunology, etc. The major difference between medical school and physical therapy school, is that for the majority of physical therapists, the structured training ends after PT school, unlike medical school graduates who then advance to a multiyear residency program focused on a singular specialty, often followed by fellowship training to further specialize.

As any orthopedic surgeon would agree, not until the residency and/or fellowship programs do they become confident in providing the quality of care necessary to make measurable improvements for their patients.

“I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times.”

– Bruce Lee

Why don’t more physical therapists undergo additional training?

The unfortunate, but honest answer is that it’s not required and patients aren’t demanding that their physicians refer them to the experts. Most patients do not search for the best physical therapy clinic to attend and often go wherever the doctor recommends. Unfortunately, many of these referral decisions are based on location, personal relationships, or financial ties with that clinic. Furthermore, Less than 10% of physical therapists have completed a post graduate residency program and less than 2% of physical therapists have completed a manual therapy fellowship program, so the public often does not even know these residency and fellowship programs exist.

Does this mean that you can not be a good quality PT without completing a residency or fellowship program? 

Definitely not. I know quite a few good PT’s who have not completed residency and fellowship training, but I know for a fact that  these same PT’s would love to  complete a residency program if the costs were not so high, the time demands were not so much,  if their employers were more supportive, and if insurance reimbursement was paid based on results.

How is OSSPT any different?

First, every one of our therapists has completed fully accredited advanced orthopedic and/or sports residency programs. Also, our physical therapists have completed or are actively completing a manual therapy fellowship program to further improve his/her skills. Additionally, our company is independently owned by the same physical therapists treating you in the clinic with no outside influence by any hospitals, medical groups, or corporations, so patients can take a lot of confidence in knowing that the only reason physicians recommend us is based on the quality of care we provide and our excellent results. Finally, we are such strong advocates of residency and fellowship training that we cover the entire cost to complete the programs for all new physical therapy employees.

Moving forward, I challenge you, the patients, to demand more from us. Do your homework and seek a higher level of physical therapy care. We spend hours debating the best restaurants to eat, searching the internet for the best shopping deals, and researching the best physicians and surgeons, then blindly go to the nearest physical therapy clinic to our home/work without thinking twice. Ask friends for recommendations, ask your physician if they have any financial ties to the clinic they are referring, drive the extra 5 minutes to receive a superior level of care, understand you have a right to choose where you want to attend physical therapy.

If you have the choice of a superior level of care, for the same price, with the same therapist each visit, why not choose OSSPT? If you have more questions or would like to specifically discuss your case please reach out to me personally at Jeff@OSSPT.com or call us at 405.735.8777 to schedule an evaluation.