All About Imaging in Tendinopathy with Sean Docking

Sean Docking tendinopathy

As a follow up to Rachael’s interview with Jill Cook, we have a chat to Sean Docking about imaging in Tendinopathy, in particular Ultrasound Tissue Characterisation (UTC) in relation to a tendon structure point of view and what is clinically relevant.

Sean Docking is a research fellow at La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. His PhD research involves the use of Ultrasound Tissue Characterisation (UTC), a new and novel technique that allows measurement of subtle changes in tendon structure that are not detectable using conventional imaging techniques. Over to Sean…


Vertiginous Symptoms and Objective Measures of Postural Balance in Elderly People with Benign Paroxysmal Positional Vertigo Submitted to the Epley Maneuver

Woman with vertigo symptom sitting down vector

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common and treatable causes of peripheral vestibular vertigo in adults. Its incidence increases with age, eventually leading to disability and a decreased quality of life. The research aims to assess short-term effects of Otolith Repositioning Maneuver (ORM) on dizziness symptoms, quality of life, and postural balance in elderly people with Benign Paroxysmal Positional Vertigo. A quasi-experimental study, which evaluated 14 elderly people that underwent the Otolith Repositioning Maneuver and reevaluation after one week. The authors performed statistical analysis by descriptive analysis of central tendency and dispersion; for pre- and post-treatment conditions, the authors used the Wilcoxon test. All aspects of the Dizziness Handicap Inventory (physical, functional, emotional, and total scores) as well as the Visual Analogue Scale (VAS) decreased after therapy (p < 0.05 and p = 0.001, respectively). However, more than half of the elderly participants did not achieve negative Dix-Hallpike. Regarding static and dynamic balance, there were significant differences in some parameters of the modified Clinical Test of Sensory Interaction and Balance, Limits of Stability and gait assessment measured by the Dizziness Gait Index (p < 0.05).

Results reveal clinical and functional benefits in elderly people with Benign Paroxysmal Positional Vertigo submitted to Otolith Repositioning Maneuver. However, most of the participants did not overcome Benign Paroxysmal Positional Vertigo and not all aspects of postural balance improved. Therefore, a longer follow-up period and a multidisciplinary team are required to establish comprehensive care for elderly patients with dizziness complaints.

Oncology E-Learning for Undergraduate. A Prospective Randomized Controlled Trial


The e-learning education is a promising method, but there are few prospective randomized publications in oncology. The purpose of this study was to assess the level of retention of information in oncology from undergraduate students of physiotherapy. A prospective, controlled, randomized, crossover study, 72 undergraduate students of physiotherapy, from the second to fourth years, were randomized to perform a course of physiotherapy in oncology (PHO) using traditional classroom or e-learning. Students were offered the same content of the subject. The teacher in the traditional classroom model and the e-learning students used the Articulate® software. The course tackled the main issues related to PHO, and it was divided into six modules, 18 lessons, evaluated by 126 questions. A diagnosis evaluation was performed previous to the course and after every module. The sample consisted of 67 students, allocated in groups A (n = 35) and B (n = 32), and the distribution was homogeneous between the groups. Evaluating the correct answers, we observed a limited score in the pre-test (average grade 44.6 %), which has significant (p < 0.001) improvement in post-test evaluation (average grade 73.9 %). The correct pre-test (p = 0.556) and post-test (p = 0.729) evaluation and the retention of information (p = 0.408) were not different between the two groups.

The course in PHO allowed significant acquisition of knowledge to undergraduate students, but the level of information retention was statistically similar between the traditional classroom form and the e-learning, a fact that encourages the use of e-learning in oncology.

Let’s Get Social in Glasgow at IFOMPT 2016!

IFOMPT 2016 Glasgow

We know all about the programming and the pre and post conference courses, but the most important thing, IFOMPT social programme, has now been confirmed. We hope that you join us for these exciting events and experience some of Glasgow’s most iconic venues!

 Glasgow Science Centre Sunday 3 July – Conference Welcome Reception at The Glasgow Science Centre
Cost per ticket: FREE
 Old Fruitmarket Glasgow
Tuesday 5 July  – 
Scottish Ceilidh at The Old Fruitmarket
Eat, drink and be merry and sample some Scottish Dancing at this relaxing informal soiree
Cost per ticket: £36.00
 Kelvingrove Art Gallery and Museum
Thursday 7 July – 
Conference Gala Dinner at The Kelvingrove Art Gallery and Museum
A 3 course dinner with wine, welcome drink on arrival and entertainment.
Cost per ticket:£78.00

The other thing that mustn’t be missed is the DH Lawrence & The Vaudeville Skiffle Show (+ support, Ciaran McGhee – Scottish singer). Conference speakers Roger Kerry a.ka. @RogerKerry1 and Alan Taylor a.k.a.@TaylorAlanJ swap lecterns for banjos, guitars and washboards! Come on Weds 6 July and experience the sound of Outlaw English Folk music & Americana at one of Glasgow’s most authentic gig venues.  For tickets, please click here.

Find out more about the IFOMPT social programme

Export Your Activity Reports From Physiopedia Plus



Have trouble keeping your learning portfolio up to date? Physiopedia Plus users now have it easy thanks to new printable activity reports and data exports…

If you are a UK physiotherapist it could be a stressful time of year with the UK registration body, the HCPC currently selecting 2.5% of registered professions to submit an individual CPD profile. Now is not a good time to wish that you had been keeping your portfolio up to date throughout 2015 / 2016!

We know that you are all very busy and committed professionals and so we want to make the process of maintaining an up to date and useful portfolio as easy as possible. We also want to help you with your CPD profile submission if you are selected for audit. For this reason we previously implemented activity logging on the Physiopedia Plus website so that all your learning activities on the site are automatically recorded. We have now made all this activity data easy to access in multiple forms so you can quickly select, view, download, print and/or upload this information however is most appropriate for you and your situation. This is perfect for regularly adding evidence of your learning activities, with any related reflections, to your paper portfolio or ePortfolio. Or could even be used for quickly producing an evidence document for submitting directly with your CPD profile.

The new My activity export / print page offers 3 options to PP+ users:

  1. Print or save a report – select a time period and download a PDF report that summarises all your PP+ activities during that period including courses completed, PP+ points awarded and a comprehensive list of your activities. Print this report or upload it to your ePortfolio (see below for a screenshot of an example PP+ activity report).pp-plus-activity-report-1024x880
  2. Analyse my activity – for those who wish to edit, apply custom formats or analyse their learning activity log, this option provides a CSV download for a selected time period. You can then open this standard file type in a spreadsheet or database where you have the freedom to reorder, filter and graph this data so you can create your own personalised activity report.
  3. Import into an ePortfolio – for the more advanced ePortfolio users out there we also offer a Leap2a file download option for your selected time period. Don’t worry what this means… this is a file format that is recognised by the main ePortfolio platforms (e.g. Mahara, Pebblepad) and allows for an easy to use import option to automatically add separate ePortfolio journal/blog entries for each of your PP+ learning activities. This then allows you to add reflections where appropriate alongside each of these activities for the richest and most detailed record of your learning activity (see below for a screenshot of a Mahara journal with imported PP+ activities).pp-plus-journal-entries-in-mahara-1-1024x811

You can choose how and when to use these PP+ report / export facilities to support your own learning and the recording of your activities. For example you may wish to export a report after you have completed a PP+ course, you may wish to export a report each month throughout the year, or you may just wish to use this facility once a year to publish an overall summary of your annual activities.

Access these new features via the Export/Print link in the My activity log block on your PP+ dashboard. Please do get in touch if you have any related questions or suggestions as this is very new and we know that it could be improved further to make your CPD experience even easier and more useful…

Do You Take My Insurance? – The Most Common #CastPT Question

“Do You Take My Insurance?”

Do you know what your own insurance benefits are? Do you know your in-network co-pay and deductible? How about your out-of-network co-pay/co-insurance and deductible? What are your physical therapy or rehabilitation benefits? This is a vital concept to grasp and understand so you can answer this question and help your patients make an informed choice, especially when they are looking for the best value.
Health Insurance coverage is drastically different than what it was just 10, even 5, years ago. More and more people are choosing high deductible health plans and “insurance” is becoming more of a catastrophic save your ass plan, rather than a “pay it all for me: plan similar. It is more similar to automobile insurance, which does not cover “wear and tear” items like new tires, an oil change, or even a new head gasket at 210,000 miles! When was the last time your automobile insurance paid you to get a 90,000 mile service?
Aaron LeBauer SAAB I once owned a 1993 Jeep Cherokee which got broken into in when I moved to San Francisco. I paid the $250 deductible to get the broken window repaired and received a check from my auto insurance company to cover the stolen items inside.
A dozen years later my 1993 SAAB 900, after 5 trips across country and countless miles driving to bike races, blew a head gasket at 214,000 miles and change. It needed major surgery, more than just a “routine” reverse total shoulder replacement and double it’s street value, so I called up my local NPR station and donated it.
That’s easy enough to understand. Right?

Health Insurance is Not Auto Insurance

When it comes to health insurance, it’s not so black & white or easy for most people to understand, even those of us who are in the “game.” When is the last time you had to get an authorization from Geico to get your 90,000 mile check up? or if you have a SAAB, to get your water pump replaced, again!
Most of the times when my patients report to me that their insurance “wouldn’t pay” or that their visits are “not covered.” What they mean is that they have not reached their deductible. Unfortunately even the insurance representative or the patients’ human resources insurance representative do not understand and tell or convey to patients that physical therapy in our clinic is “not covered” or that they “will not pay.” What they should do is educate the beneficiary about the meaning of their benefits. It is my guess that they just don’t know either.
A vast majority of my patients do not reach even their in-network deductible in my practice as my average patient is seen for 5-8 visits. That’s about $600 – $1000 for a patients care. I am out-of-network and so they usually do not even get close, however some do and when they file a claim, they do get reimbursed.
Just last week I went to see a Sports Medicine D.O. for a check-up and my co-pay was $80 since he is listed as a specialist (a visit to a family medicine physician is a $50 co-pay). For my co-pay and $1,247/month for my family of 4 premium I received about 20 minutes of his time, and that’s stretching it.
I get 30 PT or Rehab visits per year, and have an $80 co-pay in-network and a $5,000 deductible. So in essence, if I needed Physical Therapy, Occupational Therapy or Chiropractic treatment, I would pay for my therapy out of pocket anyway. Why wouldn’t I look for the best value?
I’ve been doing a soft survey of therapists during my presentations in the last few years. A majority of people have seen co-pays over $50 and a significant portion have seen co-pays of $80, $90 and even $100. Where is the physical therapy benefit in that?

$1,100 Physical Therapy Treatment!

Recently a client of mine reported that since January 1st about 10 of his patients have stopped their physical therapy treatment because the bills they have received so big, they can’t afford physical therapy. I’m not talking about people who can’t afford their $20 co-pay, I’m talking about a bill for $1,100, 1 unit of manual therapy and 1 unit of therapeutic exercise. With a co-pay of 20%, that’s $220 a visit for 2 units and about 30 minutes. He reported that almost all of these patients had high deductibles of $5,000 and some have to pay the whole $1,100 bill for just 1 visit!

In a cash-base practice, we usually compete on value and time, now in this case, and with rising deductibles, it is also easy to also compete on price!

Understanding Your Physical Therapy Benefits

insurance benefits worksheet cash based practice
Determine Your Insurance Benefits Worksheet
To help my patients understand their benefits I’ve created an Insurance Benefits Worksheet that I’ve made available on my clinical website. I can direct patients to use it when calling their insurance provider to inquire about and educate themselves about their insurance benefits.
Do you know your insurance benefits? Pull out your insurance card, pick up your phone and use this Insurance Benefits Worksheet to find out for yourself. This worksheet and 30 other documents, such as the receipt or superbill I provide to patients, are available for you to customize & use in your own practice in the CashPT Toolkit.

What Are Your Benefits?

After you make the call to your insurance company, post your deductible, co-pay and physical therapy or rehabilitation benefits in the comments section below. Let’s see who has the highest deductible!

Via Dr. Aaron LeBauer of

Photo by Stuart Miles and courtesy of
cash based physical therapy checklist
Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic…

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Microtrauma: no longer to be ignored in spondyloarthritis?

Spondylosis and Scoliosis ( film x-ray lumbar - sacrum spine show crooked spine ) ( old patient ) ( Spine Healthcare )
** Note: Soft Focus at 100%, best at smaller sizes

Novel clinical and animal model data support that biomechanical factors play a role in the onset and progression of spondyloarthritis. Bringing together these insights with the progress made in our understanding of the immunopathogenesis and genetic susceptibility of spondyloarthritis may provide new opportunities for better management. Tail suspension prevents arthritis in a tumor necrosis factor overexpression model. A similar approach also reduces new bone formation after acute arthritis in mice. Physical labor is associated with disease severity, including structural disease progression. Sentinel immune cells in the enthesis provide a link between local damage and the development of inflammation. Loss of stability likely triggers tissue remodeling, including the formation of syndesmophytes. Improving muscle strength and control while avoiding excessive strain or overuse should be considered in the approach toward patients. New regulators of tissue turnover and remodeling are emerging including microRNAs.

Local damage may provide a trigger for spondyloarthritis. For structural disease progression loss of stability may be an important factor. Control of inflammation will prevent stability issues and improve the long-term prognosis of disease. Physical therapy will continue to provide benefit for patients in the short and in long-term management of disease.