2012 APTA Combined Sectionals Meeting

Posted On: March 5, 2012

I am Dr. David A. Johnson and I am licensed as both a chiropractic physician and as a physical therapist in Illinois. I am the owner and Director of Clinics at North Shore Spinal & Sports Rehabilitation located in Highland Park and Lake Bluff.

I went back to graduate school to get my Doctor of Physical Therapy degree at Rosalind Franklin University, graduating with that degree in June of 2010.

In February I attended the American Physical Therapy Associations Annual Combined Sectionals meeting, which was held this year in Chicago. All I can say about this meeting is, �wow.�

There were thousands in attendance and there were lectures on variety of topics. There was no way to attend all of the lectures, but I did have the opportunity to attend some very interesting lectures.

The following is a summary of my notes in outline form of the courses I attended:

ACL injury update

• Valgus deformity in a step down or a jump off a box is bad
• Focus on training the hip musculature (g-max and g-med)
• Bridges, clams and hip abduction
• Plank with hip extension and hip abduction
• Progress into closed chain but when you have patients do squat work get them to load their gluteals by sinking back into their hip
• Retrain box jump downs getting them to land without valgus and sinking their but down farther (loading their gluteals)
• The above should be used as a screen and prevention procedure particularly in women
• Check out MRI for bone contusions
• Geographic bone contusion of the lateral tibial plateau and the lateral femoral condyle are seen in 33% of the cases
• The bone contusion is a microfracture of the subchondral bone
• 70% of the geographic bone contusions go on to have cartilage problems and early OA
• If a patient has a geographic lesion you should place them on a non-weight bearing status for 4 weeks (maybe even 6 weeks) with crutches to allow for the microfracture to heal preferably before ACL surgery but you could also do this after
• The accelerated rehab course for these ACL injuries probably is accelerating their OA, so slow down with these cases.

Rotator cuff repair update

• Know the size of the tear and understand what was done surgically
• Immobilizing in 45 degrees of scapular abduction helps the repair
• Patients will be in the sling for 4 weeks for a small tear and repair up to 8 weeks for a larger repair
• PROM can be done with limits on the ROM
• Passive ROM can create strain on the rot cuff repair
• Do not start external rotation with the arm at the side as it puts to much strain at the repair
• PROM guidelines: ER/IR at 30-45 degrees of scapular abduction limiting ROM, Progress to ER/IR at 90 degrees of scapular abduction and finally weeks later introduce ER/IR at 0 degrees of abduction
• Complex Regional Pain Syndrome (CRPS� formerly RSD)
• There is a new way to treat CRPS
• These patients loose engram of the limb on the sensory homunculus
• You have to make the patient aware of the involved extremity
• Send them home with a People magazine and have them circle with a pen all of the right hands in the magazine (if it�s their right hand)
• Have the patient simply pronate and supinate the limb as they look at it
• OPTP has hand cards we can get and you can play games getting them to recognize handedness
• We will have to get a mirror box to have them use the opposite limb to help form a new homunculus
• All of these should be addressed before moving into other rehab efforts

The Schroth Method for treating Scoliosis

• A method out of Germany which has been showing good results
• Bring the force of the air into the curve
• Mirrors are important
• In order to make changes the patient has to see how to move out of the posture.
• The homunculus needs to be created by making the patient change the posture.
• Overcorrect, intensive exercises all day.
• Objective: Reduce or decelerate scoliosis.
• Understand the 3-D pathology
• 3 blocks normally, divide scoliosis in triangular blocks.
• You must treat in 3D not in 2D.
• It is important to know which muscles are involved so you can correct the posture.
• You are trying to create an engram in the homunculus.
• The patient has to exercise 30 minutes per day.
• The patient needs to be in conscious posture.
• Breathe in and elongate the spine. Hold spine upright and hiss out. Improves vital capacity.
• Cheneau/Rigo Cheneau Brace
• A 3D brace used in Europe that has shown better results than traditional braces

Patella-femoral dysfunction update

• Quadricep dominance is a real problem
• Do not train the quads as it may worsen the problem
• Watch them go down a step and see if they load glutes
• Train glute max (bridges, clams) and gluteus medius
• Move into closed chain but make sure they load their gluteals
• Lunges with forward bending at the hip reaching forward

The American Physical Therapy Associations Annual Combined Sectionals meeting was quite informative and all of the speakers were first rate. The information that I gathered, I took back to the clinicians at North Shore Spinal & Sports Rehabilitation so they can better serve our patients.

All of my clinicians were happy to receive the information and we updated our protocols to include the most recent literature and evidence in our approaches. By attending lectures, reading journals and sharing the information we continue to practice the best evidence based medicine we can at North Shore Spinal & Sports Rehabilitation. We do this so we can better serve our patients and community.

Having attended my first Combined Sectionals meeting, I am now hooked and I look forward to attending more in the future.

To schedule an appointment, please call our�Lake Forest, Lake Bluff office�at�847.295.0920, or our�Highland Park office�at�847.432.4077.�You may also use our online�Request an Appointment�form.