🦀 PT Crab #60 - Hello Fellow. How are you now?

This week’s PT Crab features three traditional studies to fit our format and one new feature that I may be dropping in from time to time in the future. I don’t have too much to say other than that, except for thanking you once again for sharing PT Crab with colleagues and friends. It has really helped us grow and continues to do so. Thanks!

Ever considered running your own clinic? Here’s some data.

The Gist - This isn’t a lot of data since it doesn’t come from a scientific study or anything like that. It’s actually from the Twitter account of a PT I follow and respect. His name is Ryan Shelton and he hails from Kansas City, calling himself a Philanthro PT. #PhilanthroPT is one he uses regularly. A couple years back, he got tired of the way his clinic was run and wondered if he could do something on his own and it he could use it to give back to the community. PhilanthroPT was born. They’re a standard, small outpatient PT clinic that gives away 25% of their visits to people in need, for free. How do they pull that off financially? I’ve always wondered until Ryan posted some data about that earlier this week.

Tell Me More - He’s quick to say that he’s not “the world’s best business man” nor is he squeezing out as much money as possible from the business. In fact, he only sees 6-7 per day. He pulls in about $100 per visit and his monthly overhead is about $1500. Even after giving back $2,000 to his community per month, he takes home about $5,000 after taxes. That’s about $7,000-$7,500 per month pre-tax. $85,000ish. In other words, it’s totally doable for you and you can make plenty back to run a small clinic. He even has a small spreadsheet to help you estimate all these variables for yourself. You just have to provide 2 hours of community service in your community and tweet @RyanSheltonPT to get it.

Lastly - This isn’t an advertisement or anything. Ryan’s just doing a cool thing and helping make it available to others. Hopefully this inspires some people to start planning their own places so they can give back to their communities too. Good luck!

Rise up! Sit to Stand Workstations for Pain Prevention? Maybe…

The Gist - Many people have moved their offices home over the last year and it’s been long enough for poor ergonomics to catch up to them. Fortunately, this systematic review may have some guidance in how to adapt their workstations to improve LBP and neck pain. Unfortunately, there weren’t too many studies to pull from, but the authors were still able to gather a bit of data.

Three studies showed improved neck, lower back, and upper back pain with moderate clinical effect sizes when participants switched from traditional to standing desks. Another found that participants experienced more upper back and neck pain with a standing desk, but less low back pain. In general, the studies showed a positive effect of transitioning from sit to stand throughout the day.

Tell Me More - How can this help your patients? There are a few on-desk attachments that allow the transition from sit to stand (like the Varidesk) and a few desks that adjust in height (including cheapish ones from Ikea) that could be recommended. Some people have been known to put chairs or cardboard boxes on their current desks to lift them up higher, but it’s important to ensure that their keyboards stay low, otherwise they’re at risk for upper trap and levator scap pain due to prolonged shrugging to type.

Lastly, the studies available to this review weren’t perfect. Many results were clouded by other factors: one study only pulled from overweight and obese populations and another used workers at a call-center who habitually cradle phones between their ears and shoulders, possibly leading to neck pain that the study captured. The overall, cloudy conclusion from the research is put best by the authors:

Overall, findings suggest SSW may not absolutely relieve chronic neck or LBP but should not be excluded from pain management recommendations due to potential of positive impact.

That’s all we can definitively say on the matter today.

Paper? - If you insist.

What hits harder, the ground or a treadmill?

The Gist - If you’re seeing more runners with foot and knee pain since the gyms closed, this study could tell us why. Researchers from Harvard and the Henry Ford Health System compared tibial shock between treadmill running and outdoor running and found that the outdoors pounds quite a bit harder. Outdoor running pushed up the force by 4g (as in gravity, not grams or cell phone networks), from 11.44 indoors to 15.52 outside, a 35% increase! These runners were going similar speeds between indoors and out, but ran farther outside, so they may have been a bit more tired too.

Tell Me More - The researchers grabbed 192 runners about to compete in the Boston marathon, put them on treadmills with an inertial measurement unit strapped on their ankles, warmed them up, then ran them at 90% of planned marathon pace and grabbed 30 seconds of data, about 35 strides per person. After getting this initial stuff, they asked the participants to wear the IMUs in the marathon, then took data at kilometers 12, 23, and 40 to compare. At each data point, the shock from the ground was less than the previous, but still quite a bit higher than the treadmill. The researchers speculate that this is due to them slowing down as the race went on.

Why is the shock higher outdoors? They have speculation here as well. They believe this could be due to higher perceptual demands outside (AKA more distractions) that reduce running form, the asphalt could be harder than the treadmill belt, and/or that speed variances outdoors could be causing the increased shock. Treadmill speed is much more consistent than outdoor speed.

One last note for foot lovers, they controlled for foot strike and it was 75% similar indoors and out, so most runners were consistent. 74% were rear foot, 16% mid, and 10% forefoot.

Paper? Here.

How an Orthopedic Manual Fellowship Changes Your Career

The Gist - Researchers sent a survey out to 9 years of fellowship graduates, seeking information about how the fellowship changed their careers paths, income, and more. After getting the 75 responses back, they dug into the data. Here’s what they found:

The biggest changes were in cofidence in mentoring and views of oneself as a professional. Clinical reasoning skills were highly rated and so was the fellowship’s impact on technical skills. The mean salary increase was $9560 per year, while the median was $2500. 20% of fellows received raises in salary immediately upon completion of the fellowship.

These are all self-reported, and there’s not a lot of provable information here, but the survey shows that the fellowships made participants more confident, more skilled, and more money overall.

Tell Me More - In addition to the above, 76% of fellows became involved in research after their experience and 28% had published in peer-reviewed journals. 43% became instructors in post-graduate PT education, and 40% developed content for continuing education courses. On the other hand, “Life balance, family commitments, and marital strain were difficulties experienced during FT.” Overall though, “Graduates were overwhelmingly positive about the impact of FT on their professional and personal lives.”

There are clear limitations here, as I pointed out above. Not only was this a self-assessment, but people tend to value things that they have more highly than things that they don’t. All of these graduates put in a significant amount of work to become Fellows, and thus would value the experience quite highly by default. Lastly, this may not be true across the board for fellowships, since this one was a hybrid, multisite fellowship, different from many others that are available.

One last note actually, this was all based on Bellin College's Orthopaedic and Manual Physical Therapy Fellowship program, jsyk.

Do you have this paper? As always, I do.