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What’s Next?

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If you’ve read this blog over any sort of extended time, you should notice a pattern: May to November, really good at writing frequently; December to April, really infrequent writing. I came into the winter this year with a head full of steam and several partially-written blogs. I had desires to reach out to more Occupational and Speech Therapists, and I also had the intention of voicing my strong opinions of PT-specific topics. But, as usually happens in December and January, I’ve had too much damn fun in Aspen and haven’t written a damn thing.

The mountains of Aspen have kept me aptly distracted from writing this blog.

The mountains of Aspen have kept me aptly distracted from writing this blog.

So, it hasn’t snowed a meaningful amount in several weeks, I got a quick ski session in this morning that was reminiscent of my days back skiing on the blue ice of the Northeast, and I’m left with a full afternoon to produce something meaningful for you. After procrastinating a couple hours by clearing a couple items out of my Netflix queue, I’ve sat down at the computer to write. In my mind, I’ve abandoned the two possible topics I had intended to write about and have forgotten what my partially-written blogs from November are even about. This will be stream of thought entry, proof-reading may be marginal, and I’d like to just get some of my current thoughts out to you. In these ramblings, I hope there’s something useful about being a traveling therapist that can be a take-away for you. If not, I’m sorry – at least my blogs are short.

The football playoffs started out with a lot of different potential outcomes for me. As a Native New Englandah and now as a Colorado Resident, the prospect of a strong Broncos’ team scares the heck out of me. It seems that in most of recent history, the Pats inevitably meet the Broncos in the playoffs – rivalries are fun, until it pits you against everyone around you. This year, we snuck by, the Broncos were eliminated early and my friends and co-workers (sorry, guys) were silenced. Crisis avoided. Then, two weeks ago, I realized my Pats were up against the Indianapolis Colts – Indy is also the home of this year’s CSM conference which is to be held 3 days after the Superbowl. If the Colts got past the Pats and went on to win the Superbowl, I would be in Indy for the victory parade…. Not a pleasant thought. Luckily, the Pats have prevailed beyond the Broncos, beyond the Colts, and are on to play in the Superbowl against the defending champions, the Seattle Seahawks. The NFL has once again stirred up controversy to make a good-guy/bad-guy scenario: Last year, the terrible Richard Sherman was portrayed as an out of control brute who can’t control his emotions, this year he is the intelligent tough-guy who will be playing through injury to take on the New England cheaters. I imagine by the time most of you read this, the NFL will have cleared the Pats of any wrong doing – it was trumped up controversy, folks, the NFL choreographed the whole thing to make you care about the Superbowl, just saying.

::segue coming::

The current center piece for our living room. A Hawaiian coconut painted with the Patriots logo. Below that, a series of books from Colorado, Hawaii, and Alaska.

The current center piece for our living room. A Hawaiian coconut painted with the Patriots logo. Below that, a series of books from Colorado, Hawaii, and Alaska.

Anyhow, let’s move along to the topic of therapy and travel. Did I mention I would be in Indianapolis for a conference next week? For those of you who may not be in Physical Therapy and may not know, CSM is our biggest conference each year, it moves from city-to-city each February, and over 10,000 PTs, PTAs, and students attend. Everytime I attend a conference, I come away incredibly motivated and excited for the future of our profession. I’ve written in the past about the need to gain knowledge and continuing ed while traveling (Traveling Doesn’t Have to Mean Professional Sacrifice – 4/11/11). Attending this conference accomplishes learning at a very high level and so much more – hanging out with old friends, meeting new colleagues/friends, discussing the future of our profession, meeting other travelers, and having a good time.

In the past, I have felt like the opportunity of being a traveling Physical Therapist may be some sort of compromise. Traveling frequently from place-to-place has limited me in creating real traction to move forward to the next stage of life (whatever the hell that is)! The approaching of CSM and some recent conversations with friends has brought this thought of the balance between travel-life and being established to the front of my mind again. This thought apparently comes to mind frequently around this time of year (Community Chest – 3/1/14). I was speaking with a co-worker, who is also a travel PT, and she was wondering what is “next” for herself. For me, “next” usually comes in the form of a 3-month plan that my wife and I spontaneously put together over a couple beers in mid-February. (Perhaps back home to New England for a few months? (and maybe catch some Red Sox games?)) (Who uses parentheses within parentheses? (Weird.)) But, this traveler I speaking with was asking the bigger question, “What’s next in her CAREER?”

Oh man, the “C”-word for travelers: “CAREER”. This word is only surpassed by the “S”-word: “Settledown”.

The life chosen as a traveler is unconventional. Kate and I, my wife, have chosen to roam fancy-free and mostly without any agenda other than to see as many different, awesome things as we can. We’ve been at this for 8 years and aren’t done yet, but it seems that through our meanderings, some sort of career-traction is being established. 1. I have had several requests for meetings at CSM this year, mostly about and due to travel (the total of all requests for meetings in previous years is zero). 2. I’ve inserted myself into conversations legislatively about licensure issues which has opened some big doors in the last couple of months. 3. Traveling just feels good to keep doing – after all, it’s what everybody does once they are retired and no longer hindered by their work schedule. Could it be possible that a career could be made traveling? Just writing down the words makes me feel uneasy, you’d think there would be some stop to this crazy travel-life. Who knows. For now, I’m excited for the Superbowl, CSM, and the next three months – but I should come up with a solid plan for the following three months soon. The three months after that? Not important, I’m doing jobs that I like, where like, with people I like.

Whoa, well I certainly got on a roll there. Hope it wasn’t too manic for you and sorry for blabbering about the Superbowl, be thankful I didn’t go on-and-on about the Rob Gronkowski dream I had this week. I’m just glad I finally got around to the topic of travel therapy. Have a wonderful winter and I promise I have more poignant topics soon.

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Why I AM a Manual Therapist

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A few weeks ago I read a blog that really caught my attention. The author explained why, as a sports and ortho Physical Therapist, he chooses not to use manual therapy. I’ve been thinking about his blog ever since I read it – it has frequently been the last thing I think of at night, the first thing I think of in the morning, and I think of it many times throughout the day as I work manually with the vast majority of my patients. My curiosity about this author and his stance against manual therapy has lead me on a bizarre journey finding other blog posts claiming manual physical therapy is a “sham,” “quackery,” and “pseudoscience”. Many of these manual therapy nay-sayers claim it doesn’t do anything meaningful. They say manual therapy is only a way for a clinician to act compassionately and/or cause indirect effects through being attentive to their patients. Essentially, they claim manual therapy’s benefits are an elaborate placebo.

When I came upon the first internet post that introduced me to the world of manual therapy nay-sayers, the post had already been out there on the web for 8 months. I came across it when someone in the online PT circles reposted it on Twitter. This reposting is one of over a dozen, and many more people comment on Twitter sharing their support and agreement. Apparently, there is an international network of physical (and physio) therapists who go from blog to blog verbally patting each other on the back about their distaste for manual therapy. They frequently refer to themselves as “recovering manual therapists,” they reassure each other with confident words about how novel each of them is to have stepped out of the populist belief that manual therapy is a good thing. The worst part about it is, many of these people are involved in professional leadership, research, blogging, and teaching – these people consider themselves leaders.

In this, my first introduction to the world of manual therapy nay-sayers, I was worried and confused and shot a quick email to a colleague. He is a leader, researcher, educator, and blogger – I knew he would know more than I did. In the first day I sent him the email, I heard nothing and nervously began to think, “Oh no, he’s one of them!” I woke the next morning and was comforted by his reply. He’d had experiences in talking directly with the manual therapy nay-sayers about their ideas – he described it plainly as, “a disturbing growing trend.” He is not a fan of these folks and their ideas. Frankly, neither am I.

If you’re like me, this is the first you are hearing of Physical Therapist researchers speaking out against manual therapy. Manual therapy is a corner stone of orthopaedic rehab… right? One of the articles I read over the past few weeks is a blog that has a robust comment chain following the article. The blog is a summary of a research article that claimed to be the end-all of spinal manipulative therapy research,

“Prof Menke concludes that more research is clearly NOT needed… That which is already known about SMT [spinal manipulative therapy] for back pain is quantifiably all that is worth knowing.”

Did you catch that? Th, th, th ,th, that’s all folks! Nothing more to see here. What an asinine statement: This guy summarized spinal manipulation in his research article and has it all handled for us! Here’s the link to the blog: (Spinal manipulative therapy: a slow death by data?) If you are an orthopaedic PT, I recommend you read the comments, they are scary – I, however, do not recommend you dig deeper to further posts and links, it gets downright frightening. One commenter on A Slow Death by Data states,

“My favorite ‘hands on’ technique is what most people call a ‘handshake’.”

He goes on to explain how his superior attentiveness and compassion to his patients are the secrets to his success without manual therapy – to his credit, he admits using his hands for “seeking more serious pathology.”  He then is repeatedly praised for his comments from the world of anti-manual therapy. How can these obviously intelligent and seemingly forward thinking people who are strongly rooted in Evidence Based Practice (EBP) believe that manual therapy is unimportant and, further more, that their treatments performed without manual therapy are superior!? This goes against everything I have ever learned and experienced as Physical Therapist working with orthopaedic patients.

I keep asking myself what could possibly be motivating the manual therapy nay-sayers. From what they write in their posts and comments, I believe many of them have had bad experiences with manual therapy in their careers, and I do not mean that as a slam. Some of these internet authors openly write about past experiences interacting with colleagues who claim manual therapy as a way to keep clients dependent on their services. If this is why they have grown so cynical of manual therapy, I am so sorry for the experiences they have had in the past that soured them to manual therapy. I have experienced similar misconceptions in my own PT career. I started out working in only high-volume sports and orthopaedic clinics through many of my student experiences and many of my jobs early in my career as a traveler. I once saw a clinic owner treat 8 workman’s comp patients in one hour. In the last 5 years, I have worked almost exclusively for clinics that book one hour treatments for their patients. I don’t think I could ever go back to the rat race of 2, 3, and 4 patients per hour, no way! I broke out of my bubble by seeing other models for delivering PT. I would suggest that a therapist who believes that manual therapy is no more than a pacifier go out and gain new experiences in manual therapy. There is a vast, vast majority of us manual therapists out there who use our hands because our patients get better faster and stay away longer – not to feed patients’ dependence on us.

Maybe these nay-sayers have only been exposed to manual therapy styles that they don’t see the value in. I have to admit, there’s a group of manual therapists that I don’t see eye-to-eye with either. I once worked for a private practice that had a manual therapy fellowship program built on a chronic pain background. The treatments were based on the smallest minutia I have ever seen in my life – for instance, a “pelvic ring instability” causing shoulder pain. Yikes! Way too many of the patients the other clinicians treated were getting SI belts to “stabilize their pelvic ring.” The therapists at that clinic – all brilliant, motivated, and extremely well intentioned people – were looking at the smallest details in human kinematics as their manual therapy targets. I am very much different. I consider myself much better with concepts than with the tiny specifics. If something is abnormally stiff, I want to move it. If something is hypomobile in the spine, it’s going to be a whole section of the spine, not a single level that I move. I do not believe in improving extension of one side of one segment of the spine – you just can’t do it, and our hands are not that specific – the research supports me in this belief. As clinicians, we are bad at determining joint mobility beyond three categories: hypomobile, normal, and hypermobile. If you find yourself frequently describing subrankings of these 3 categories (mildly, moderate, etc), research does not support our ability to be that discerning. Our hands may not be as specific as some will claim, but they are beneficial to a patient far beyond a handshake. My point is, I could get on board with a faction of PTs saying, “Hey gang, all this specific mumbo-jumbo is a bit much, lets get back to basics – move what’s stuck, stabilize what isn’t, and manipulate a group of spinal segments when indicated.” ….this is not the message I’m getting from the nay-sayers. Do not lump manual therapy together as one intervention. Manual therapy is many different, specific interventions. Some are more effective than others and the experience of the person providing those interventions matters very much.

OK, it is time to get back to the title of this blog.

So, why am I a manual therapist? Because it works. Not, “In my experience it works,” but because the research shows it works. It does!!! Patients get better faster for longer with manual therapy than without. What could be more mechanical and tangible than putting your hands on a restricted knee and straightening it, then performing a joint mobilization and straightening it further. If someone’s neck hurts, I’m going to see if manual traction helps – because it’s what the research indicates I should do, and because by using my hands, I am less likely to cause an increase in symptoms than traction performed mechanically. Then, if indicated, I’m going to manipulate the patient’s thoracic spine, because the research shows it will probably decrease their pain immediately. The use of hands-on techniques to decrease adhesions in skin or tendons through something as simple as transverse friction is undeniable (and well supported by research). These techniques are all specific things that require skill to apply and have very direct and mechanical effects. If you think the examples I’ve just given are too passive for your liking, and you want a patient more involved in their own rehab, let’s do some mobilizations with movement (Mulligan Concept) – how about some manually resisted PNF patterns? And, I really hope even the most radical of the manual therapy nay-sayers are putting their hands on patients to cue them with exercises and to improve harmful mechanics.

This is truly a case of throwing out the baby with the bathwater. Manual therapy is not one thing, it is a collection of many different techniques. If there are certain manual therapy techniques that don’t work, let’s address those specifically. I’ll gladly accept an argument for specific techniques over others. I’ll also gladly hear arguments that particular manual techniques are working differently than we currently believe they are. But don’t lump all manual therapy together and say it doesn’t work, it’s very well documented that much of it does. Let’s change this manual therapy versus no manual therapy conversation into a what manual therapy works best and when conversation. Those of us having this conversation already, should stop tolerating those that are absolute manual therapy nay-sayers, they make all of us look really bad and inhibit any productive conversation from happening.

As a Physical Therapist, if you’re not using manual therapy with your sports and orthopaedic patients, what the hell are you doing!? You’re not doing physical therapy. Physical Therapists are restoring function, motion, and abilities to hundreds of thousands of people every day – the ones doing it best are using their hands, a lot.

Let’s hug it out, the comments section is below. Please share your thoughts.

-By James Spencer, PT, DPT, OCS, CSCS,

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The THE Series

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The THE series. Of all our travel assignments this one has been the toughest to find THE housing, most unique in finding THE jobs, and longest of THE roadtrips. We left our apartment in Aspen 4 weeks ago today, we have put 4,500 miles on the car, racked up 8,000 frequent flier miles, and will finally move into our new place in one more week in Anchorage.

As I’ve mentioned in previous blogs, I feel like one role of this site is to develop a knowledge-base of travel healthcare experiences in an environment not influenced by recruiting companies. Everything Kate and I have been through over the past 6 weeks needs to be shared with other travelers, and can be used as a template for how-to and how-to-not.

Expect in the coming weeks the THE series: THE housing, THE job search, and THE first few weeks (a working title). Thanks for tuning in, travel safe.

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Back to Travel

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As I frequently do, I’ll begin this blog with an apology. The last couple writings from me have been exactly what I hate in a blog, whiny. However, don’t mistake me, I meant what I said.

I need to explain my over-arching intent for a short moment. I like talking about travel, but also want to write about physical therapy (another passion of mine) and about the logistics of this travel PT business. I think I have a lot to offer in these realms, and I always hope that others will participate and add to the conversation and body of travel PT knowledge!

So, while I’ve strayed from the path in the last few posts I intend for this blog to be concise, amusing to a chuckle-worthy level, and mostly about my travels as a Traveling Physical Therapist. I will now complete this blog in the form I feel most at peace with:

This is the 4th winter Kate and I have spent in Aspen. I have posted some of my favorite photos over those four years below. I hope you’ll take the time to click through the thumbnails to the full size pictures and enjoy some of the memories with us.

In addition, I plan to have my nice camera with me over the next few weeks to hopefully catch some other nice photos that I may share here before the up coming road trip in exactly 4 weeks!

Enjoy!

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Travel Healthcare Websites

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I had something I wanted to blog about, I have totally forgotten what that was. I got on a tear tonight. I’m excited, I’m on fire.

It all started when a friend wrote to see if Kate and I would be at the traveling healthcare conference that’s coming up in October in Vegas. I love the idea of it, I’d love to be a contributing part of it, and I know that no matter what, it’d be a great time.   …in fact, maybe we’ll go.

However, it led me on a little exploration of its organizers and the sites that are similar to HoboHealth. There are more sites than you would think and as best I can tell, HoboHealth is the smallest of these site that will turn up on a few basic google searches. What got me so fired up is that everyone else is fricken SPONSORED! Isn’t the purpose of our sites to help fellow travelers, to advise them in the ways to get the most out of their employment and travel experiences!? Let face it, staffing agencies are financed by us working in whatever job is available and willing to pay for us, not by us waiting around for our perfect assignment. While there are VERY GOOD staffing agencies, there is a direct conflict of interest in them paying us to give good advice!!! A site promising to aide travelers in their decisions cannot be funded by the very entities travelers are doing business with.

I have my own recruiters that I trust greatly, and I have plenty of companies that have failed at the task of holding their travelers’ needs at the center of their business. If you are one of the very few recruiters that works with me, know that Kate and I consider you within our personal circle and have the greatest trust in you. I wish I could plug my friends here, but it undermines the whole point of this website: To help travelers navigate the complicated business of travel PT and to help travelers have positive, well supported assignments in their own paradise.

I’ve spoken with some of my recruiters before about partnering, but never followed through, I never really knew why. I’ve visited sites identical to HoboHealth with 5 times the visitors and wondered how they got all that traffic. Tonight, when I realized those sites are advertising some of the very staffing agencies I despise, I figured out why this site has remained both independent and less visited. Our participants are real travelers just looking for tips from other travelers with no bias. Staffing agencies make their money on the work we do. They should be pleased to have us work for them and should work hard to keep us happy and protected. I love the opportunity here to help other travelers find the same joy in travel physical therapy that my wife and I have.

If you’re a site like HoboHealth without corporate backing, get in touch, let’s help each other help others. If you’re a traveler, ask questions and learn how to travel happily with companies that will support you, not companies only looking to earn their profit off your skilled work. I have found the companies that are willing to support me in my extravagant travels to awesome places with awesome people, I want you to find yours.

Oh man, I’m fired up…. and I finally feel like there’s a purpose to this very time consuming hobby.    🙂    Thanks for reading, I promise more light-hearted travel pictures soon.

 

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Transitions

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Snow fell last week all across New England, and the throngs of facebook updaters shouted the end of the world in full CAPSLOCK. Not me. Not I. Not us. I ran outside at 1 in the morning in suburban Boston wearing my full Beetlejuice Halloween garb and started pelting my friends in their heads with snowballs.

It’s go time. Time to move again. Time to pack up and get myself to a ski town. Snow is falling and time’s-a-wastin’.

I love/despise moving all at the same time (Is that lespise? Sounds French). Road tripping half way across the country and catching some sights along the way is spectacular. Weeding out the old clothes for the thrift-store pile and trying to jam everything in the back of my Accord is not spectacular. Do we move every several months because we get excited about our next destination or is it because we get tired of where we are? I don’t know, but I know I like it. We are getting better at moving. I now own a home brew set-up in Maine and I have one in a storage area in Colorado. Not having to lug all that along really lightens the load.

Next week Kate and I move back to Aspen where we’ve spent three of the last four winters. It’s kind of like going home now, and I’m fired up. We also get to take some pretty cool trips along the way. We’ll shoot to Mexico for a week, fly on over to Florida for Thanksgiving, and then return to Maine for the long drive. Looks like we’ll have a few extra days to make the drive, so hopefully we’ll get a chance to try out our new L.L. Bean ultra-light tent in a National Park somewhere. Bottom line: I should have some fun stuff to write about soon.

Just wanted to offer a preview of coming attractions, express my excitement for the coming ski season, and share my discontent for living out of a sedan. I think I’ve accomplished these goals, so I’ll sign off now and get back to packing.

Next time I write, I should be on the open road. Hey! Put down that chalupa and drive safe.

James

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I Am Spent.

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It’s been a crazy few weeks. Wedding, after wedding, after bachelor party, after wedding… I should be clear, I’ve had a freakin’ blast.

Did they know we were coming? - Oceanview Inn, Gloucester, MA

Each weekend has been so much fun. Friends that I sometimes see once in a year, I’ve seen 5 times this summer.  It has been so cool going to weddings on boats, to weddings at summer camps, and to parties in foreign countries, but come on. I’m tired.

I’m headed into the first weekend I’ll actually spend at the apartment I’ve been living in for 6 weeks. I am so excited for all the sleeping in I’ll do and the French Toast on the horizon. There’s an autumn festival up the street and a couple craft beer festivals going on around the state if we get restless around the studio apartment.

Anyways, Hobohealth has suffered from my social indulgence. Spammers, or more accurately spam bots (computer programs that register for websites and create general electronic-anarchy), have over-run the discussion boards and this blog has gone untended for far too long.

I’ve started working on a new forum for discussion, hopefully it’ll be up in the next couple weeks. While Hobohealth has headed in the direction of a blog, I’ve always thought the strength of it was natural, uninfluenced discussion between travelers and wanna-be-travelers. So, hang with us while we fix up our discussion board and continue to slowly, but steadily grow.

Other than Eric Gosselin, perpetual Traveler of the Month, there are few people I would drive with to Montreal for a 3-day bachelor party.

As we move forward, think of what you want to ask other travelers on our new forum, think of your best experiences as a traveler you’d like to share, be our Traveler of the Month, or even consider being a guest writer on this blog. Also, if you like to have input, the blog comments are up and running for your pleasure.

Well, gang, happy autumn. “They” say our foliage here will peak in 2-3 weeks. I’ll try to share some photos at that time and keep you entertained with witticisms until that point.

 

James

 

Boothbay Harbor, Maine