A Season for Disclosure

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Patients often ask if my work varies during certain times of the year. The truth is that I've been unable to observe consistent seasonal patterns in the number or type of injuries treated in my office.

January rarely brings an immediate influx of people suffering strains from skiing and snow shoveling. Knee pains born of a New Year's fitness resolution may not reach maturity until July. The spring and fall are quite similar in terms of shoulder pain related to activities like pitching (baseball) and cleaning windows.

These issues are my typical labor and may be rooted in seasonal interests. But many factors obscure the effects of latitude on the yield of injuries, such as individual pain tolerance, patience (or stubbornness), job status, insurance deductibles, and backlogs in the schedules of orthopedic surgeons.

Whatever the season, people with various aches and issues continue to trickle into the office, and I'm thankful for that.

[Wait. Did he just compare pain to a crop and say he's grateful for injuries?]

What I mean is that gratitude through all seasons is critical to my work. This certainly applies to other professions and may seem obvious given a physical therapists calling and place in the entire realm of health care. But in my experience, some models of outpatient rehabilitation serve patients and therapists better than others.

Of course it's rewarding for a physical therapist to help clients regain a portion of their lives, their ability to work, play, or simply care for themselves. But quite honestly, those rewards do have their limits, especially during busy seasons. While all health care providers want to be busy, the art of providing excellent care during busy seasons is not for rookies.

If you or someone you know is in need of outpatient rehabilitation, there are a few things you should know.

It is good when a physical therapists livelihood depends primarily upon the quality of work that they do, and not upon affiliations with health care networks, contractual obligations, or creative lease arrangements.

It is good when the natural checks and balances of free enterprise can quickly dry up the trickle of patients where a therapist fails to deliver outstanding care.

It is good when important business concerns like medical necessity, proficiency, scheduling, and balancing efficiency with quality of care have the chance to take care of themselves instead of being mandated by out of touch administrators.

To list these strengths of small, independent physical therapy practice is not to say that other models cannot provide high quality care. But I've worked in settings where a constant swell of patients presses against you whether or not you take the time to pay attention to the details. I know what it is like to be busy on a beautiful Thursday afternoon when someone needs a lot of reassurance and a little specific guidance beyond the general exercise protocol for their diagnosis.

While there are no substitutes for clinical competency, I’m sure that both patients and providers could stand to benefit from an honest appraisal and disclosure of the season they are in.

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training the "core" - an example

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Check the vid of Kyle. We did three rounds of this circuit after some traditional heavy lifts. Done.


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20 Rep Squats (are not for everyone)

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If your employment required you to load far more than your body weight onto your shoulders and repeatedly lift it, you would be moaning and griping, soliciting the services of Metzger Wickersham.

There would be a TV news hard-luck segment about what a person will go through to provide for their family. Those watching would feel both pity and admiration for your miserable lot in life. Some might even ask how they can help you evade all that weight in favor of something more sensible.

But once every week or so in my basement, a few lunatics line up to willingly experience a misery that defies sensibility. We don't get paid a cent, though the payoff per unit of time is enormous.

I can’t wait to dread it. Under the bar is a deep place of meditation, with "twenty” my mantra.

-------- -------- --------
Is everybody in? 

The ceremony is about to begin. 

     -The Doors

Wake up. Your head must be ready for this. 

Stand with your arms draped across the barbell set to chest level, loaded with a weight that's a struggle to handle for one good squat. You're going for twenty. Doing twenty. Just go.

[Disclaimer - barbell squats are an awesome exercise that make you awesome. Yet most individuals could use a few days, weeks, or even months of corrective exercise and work on precise form before challenging themselves. Squats don't hurt people. People hurt people.]

Injured? Heck no. You may fail, but you probably won't get injured. It's only 1 or 2 percent more resistance than what you attempted just 6 or 7 days ago.

So get in there. Step under the bar and lock it into the groove across your scapula. Breath deeply and brace your entire upper body for one punishing isometric. In the last moment before the first and possibly worst descent, you must see yourself hitting that first rep, feel the joints loaded, digging out of the bottom position.

It’s time. 

Descend smoothly, see white as you brake and accelerating the weight upward.


Damn, that’s heavy. You’re crazy for lifting it once, much less twenty times.


The sooner you move on, the sooner you’re finished. This will end.


A little winded, hearts racing. Nothing exists except the task at hand. Nice.


Somewhere in here, a rep or two actually feels pleasant. You’ve found the groove, firing on all cylinders.



You're in plenty deep enough to experience the misery. This is not joint pain, but the ache of every muscle ablaze from the mental effort required to maintain form.



Few hard-core gym-rats squat, and most that do have racked the weight by now. They're sitting on the leg extension machine drinking bottled water.


The whole idea of 20 reps squats is pointless stupidity made up by some idiot.


Yes, half way! Ugh, half way.


You embrace the sting and throbbing as evidence of pushing your limits. Yeah, you went there.


When everything tells you to quit, you decide not to. 


You’re an unfeeling machine executing pre-programmed instruction. There's no choice in the matter.


You will never look at a barbell again, much less lift one. 


It’s down to five. Right about now is why you don’t train on a full stomach.


The bar heaves, climbs upward so slowly. You thought you saw a splinter of light. Is that the end of the tunnel?


No. That thought helped you for one rep, but you’re heading into the valley now. The dark pit of hell, the physical and mental test that's the point of all this. [Whether you're fighting against 40 or 400 pounds is not the least bit important, as long as it drags you through the valley.]





Each and every time you make it through the valley, you really do come out as a different person.

No. Nobody. No one fails at 19.

You explode, throwing the weight through the roof. Did gravity lessen? No, the bar still sank and then barely ascended at all.


You stagger and lean forward to rack the beast. Unload. Unwind. Finally. Careful now. You should sit down or hold onto something for at least a minute or so. The world will return in a moment.

You did something…strange and extraordinary. Your potential is not unplumbed. You didn't need 26 miles to find a test. You didn't need a surfboard and a tsunami to get you adrenaline pumping. You didn't need to have your face turned inside out to get something you can feel.

Squats are easier on your face than Fight Club


Cholesterol, blood pressure, hormone regulation, blah blah blah. Yeah, I'm sure you can - next week, move the resistance up just 1 or 2 percent. That's not very much more. That's not for everyone.

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