In Touch Therapy is hiring


Not my usual type of post, but want to send out to my readers and pass on to others about a physical therapy job position opening at In Touch Therapy in Virginia.

This is a unique position in a small town seeing a mix of neuro, pediatrics, sports, chronic pain and other outpatient cases in a 1:1 environment under a remarkable team and fantastic mentorship in manual therapy (manipulation, dry needling, cupping, soft tissue mobilization, “Girdle” approach), therapeutic exercise, and how to gain therapeutic alliance and business mindset that has helped the clinic grow to 8 clinicians from just word of mouth—no ads.  It is NOT a run of the mill “get your patient in and out” type of clinic that you will see a bunch of theraband lying around and physio balls for all back pain.

I have been fortunate to be part of this team for 8 yrs and find it a fantastic opportunity for either new graduates or a clinician wishing to make a change from the hustle/bustle.  If you have enjoyed my posts over the years and thought-processes — this is exactly what you will get at the clinic.

If you or you know someone interested, feel free to pass on my email address –

Thanks everyone!



STAND: The Haiti Project

I want to share this video that was just released by the STAND Haiti Project, an organization in which I have written about in the past and fortunate enough in my short period to meet and get to know the organization’s prime move, physical therapist—Dr. Justin Dunaway.  This video WILL move you, no matter who you are and where/how you practice within the field of physical therapy or medicine.

It is a collection of fantastic footage of the organization’s trips to Haiti and I am proud—-no honored—to know several of the Fellows that you will see in the 14 minute film.  If you have the drive and opportunity in your life that matches your beliefs, capabilities and heart to volunteer—-that is allowed by your financial and family conditions—I strongly recommend this group.  I have not had the chance to attend due to aforementioned conditions but if interested in seeking out opportunities outside of the states—please do contact this group.

Best to all,


Why are muscles called liters / leaders?

Since writing last night, I’ve had some welcoming comments and more understanding of my mis-interpretation.


For me to hear “liters” is most likely “leaders“.  T’s and D’s are drawn out together around here 🙂  Too bad I didn’t get corrected by my patients or colleagues !  But either way, that was the reason I posted it.


So the more likely answer, thanks to Eric, Andrew and Travis; is that the old slang refers to leaders instead of liters.  This relates to a fishing term (you can tell I don’t fish…) when the line gets taut and pulls, like a muscle or tendon.  Either way you interpret it, enjoy the original post below 🙂



Growing up and now working professionally in southern Virginia for almost 8 years has taught me a lot …particularly that this region has its own language!  I have come across many phrases and jargon…most resulting in a giggle then a shake of my head as I’m from these parts.  We tend to leave off the “g” in our words, such as “sitting” turns to “sittin”  or “all of you all” turns to “all y’all”.  The almanac is King, hearing thunder in winter and seeing cardinals means it will snow.

There is one that continues to arise, seemingly day in and day out, from my older population in regards to what we all deal with in the PT profession….Liters.

Liters as a description of muscles/tendons from my patients…but according to the online slang dictionary…it can be used for one’s tendons, joints or ligaments of any location in the body.

A conversation from patient may go something like this,

“My liter is tight & pulling down back of my leg”

“What do you think is wrong with my liter

I will ask patients, tactfully, how they came up with liters as meaning of muscles & tendons.  I get answers ranging from my doctor told me that to simply having no idea as it was passed down from their parents/grandparents.  I have also heard someone say, “no one has ever told me I had a liter problem”.

So I wanted to find the origin of this puzzle.

Just like any sound human being, I went to google to search but really found nothing.

So here are my thoughts.   With an emphasis on maybe

  • Maybe the origin came from the heart (although not skeletal muscle) pumping out 5 liters of blood each minute.
  • Maybe the Latin root “liter” meaning “letters” translating in English to “literacy, illiterate, literature” somehow links to muscles/tendons…?
  • Maybe that skeletal muscle is 70% water…and a metric unit of water is a liter…whereas one liter of water is equal to 1 kilogram of mass.  Mass of the body can be measured in kilograms and ~55-65% of mass in body is from the muscles.
  • Maybe liter could have been mis-pronounced from litter…and there could be differences in skeletal muscle in a litter of cats (but found will catch up later in life) and skeletal muscle in litters of rats have been studied…
  • Liter can also be defined as objects strewn or scattered about.  Maybe its relation to fascia?
  • Dialect and accent from the south…phonetically… litter from a doctor sounds like muscle or tendon.

None of my patients know (even ones that use the verbage), I don’t know, so you tell me/us…what is the origin of liter as it relates to muscles/tendons?


AAOMPT Conference 2015 summary: Technique doesn’t matter, or does it?

The title to my blog is, “Physical Therapy Blog on Evidenced-Informed Orthopedics, Manual Therapy and Knowledge Translation from Academia to Clinical Practice” with a primary emphasis on the bolded phrase.  With the blog and intern teaching, I try to mingle all 3 aspects of EBP but especially giving a fairness to the two that most of us fight over presently, and more than likely until the end of time…which are “current literature and expertise“.

The separation of research and clinical practice was quite evident this past weekend at AAOMPT conference 2015.  If you haven’t been to a conference before (this was my first), this is the general set-up:

  • There are several presenters (researchers) who give lectures on their topic based on a common theme to the entire audience in one room.  Then, there is a roundtable discussion with hot questions aimed at them on their opinions of clinical practice, manual techniques, etc. with regards to current research.
  • The other aspect includes break-out sessions presented by clinicians based on a topic of choice.  These usually include some type of clinical reasoning, technique, and/or differential diagnosis on a topic related to OMT and orthopaedic practice.

To summarize briefly, the main lectures presented by researchers examined information on big data and how whole health services research will help in managing low back pain. Two main points came out of it:

1. Outcomes improve the earlier someone sees a PT.

2. The OMT technique doesn’t matter.

To summarize briefly, my experience listening to lectures in break-out sessions presented by clinicians:

1. Case studies / series showing results & outcomes of specific techniques / approaches when other general PT failed.

2. The OMT technique does matter.

But now this can’t be right.  Big data research shows technique doesn’t matter—get patients in, move them, and move on.  But clinicians presenting show specific techniques/approaches and wail that technique does matter…

If the national conference in OMT doesn’t agree, then how can I, in rural Virginia, extrapolate the information given to me by experts in the field?

How do I know what to turn to, research or expertise?  Which mainly drives my practice? In 2013, I asked readers of this blog a very similar question.  Here are the results.

Now granted the big data research topic involved low back pain, which we all know may not the most suitable subject for this talk….

We all want to balance being a clinician and researcher (clinical researcher), just like a collegian balances being a student and athlete (student athlete).

To paraphrase an expression from a good colleague of mine, Dr. Eric Jorde:

…just like student is first in a student-athlete, should clinician (expertise, gut feeling) be first in clinical-researcher?

Interesting reads from some of our own on this topic:

Should we move beyond the technique?

Should we move away from the product?


What are your thoughts?


AAOMPT Conference Louisville, KY

Colleagues / Readers,

My family and I will be attending this year’s AAOMPT Conference in Louisville, KY from Friday, Oct 23rd to Sunday, Oct 25th.  If any of you’ll are going to be attending, I would love to catch up and talk shop.

Shoot me an email at if you plan to attend and hopefully we can meet in person!


APTA Advocacy App for Android and iOS

The following post comes from Brandon Whittington (twitter / google plus), a soon to be graduate from Lynchburg College DPT program.  He has interned under me for the past 16 weeks, a real tech geek and wants to share the following information to the physical therapy world.

As a student physical therapist I like to stay involved with advocacy in the profession of physical therapy, however, sometimes (often) I find that things like emailing legislatures and keeping up with relevant topics and upcoming meetings gets overlooked.  Recently I came across this gem of an app below called the APTA Action app.  The application is featured on the APTA website and is available for Android and iOS devices for download.  This app really has made my ability to quickly keep up to date and take legislative action quickly and easily. I particularly like the Action Center feature, where you can take action as an APTA member or patient. The app does all the work, fills out the whole form and sends the email on your behalf with minimal work required for the user. I’m hoping for push notifications when new actions become available but for the time being, there is nothing like it to stay involved easily and quickly. Check it out, show your patients and spread the word!







Note from Harrison: Thanks for the post Brandon and great job! The limitations in getting involved with legislative action and advocacy within our field is barriers with time and access.  I am guilty as most of us are! I do think this application is concise and considering we all have phones, a quick and easy way to stay up to date.

Shout Out Time

There has been quite a bit going on in the field of Physical Therapy and great news from some of my personal colleagues that deserve recognition.

Dr. Justin Dunaway, a fellow fellow-in-training, recently started his own non-profit organization, STAND: the Haiti Project, to provide the citizens of Haiti with musculoskeletal healthcare and to eventually establish a permanent orthopedic rehabilitation through education of its residents.  His previous non-profit organization has already treated over 5500 patients and custom fabricated over 80 limbs!  Hopefully for a personal interview on my blog soon, but in the meantime, check out “Awesome PT’s” interview with Dr. Dunaway and follow STAND on twitter.

Dr. Ron Pavkovich, another fellow fellow-in-training, has his first publication out this month: The use of dry needling for a subject with acute onset of neck pain: a case report in the International Journal of Sports Physical Therapy.  Great job Dr. Pavkovich!  And, if you don’t know him and you think you have excuses, try having 5 children under the age of 2 with 3 twins born as soon as he started his Fellowship in Orthopaedic Manual Therapy!  I thought one was tough! This man is a rockstar while continuing to get great results as he has his own private practice!

I always promote the “6th vital sign” of gait speed as coined by Dr. Fritz as being an important factor in overall health, but now the ‘Sitting Rising Test’ can determine risk of mortality over the next 5 years.  Could this be the start of more research showing the importance of movement in overall healthcare?  Could this boast physical therapist’s ability to perform yearly screens?

2 of the 5 inaugural funds through Patient-Centered Outcomes Institute will be given to projects led by physical therapists.  This is huge news given that these two projects will receive almost $28 million in a high profile $64 million program.  BAM, get it Dr. Delitto and Dr. Duncan!

Dr. Andrew S. Rothschild, PT, DPT, OCS, FAAOMPT has recently started a new blog entitled, “Real PT Talk”.  He is a great guy and in the field to advance, including offering his mentorship services to 2 of my fellow fellows-in-training. He has two posts that have jived with some of my recent blogs.  This comes from a great clinician who has been through residency and fellowship trained programs….I recommend reading, “Selling of Physical Therapy” and “Separating from the pack”.

Any other great news? Send it my way and I’ll forward it!

How do I minimize confirmation bias?

“How do I minimize confirmation bias?” was a question directed to me by my current doctoral intern.

The terminology was brought to his attention after I told him that a patient being seen for initial evaluation did not achieve the best treatment due to his preconceived confirmation bias.   What led to this conversation?

-He told me prior to seeing a patient, by just reading medical history report (specifically activities that are deemed difficult to the individual), that considering the individual had difficulty in sustained positions (such as sitting, standing and walking); that the patient would fit the bill for a stabilization program.  He just “knew” this would help her.

– Now, I am all about having an initial hypothesis just from medical history and body diagram, but the subjective history and objective findings should refute or confirm your hypothesis.

– Confirmation bias, even if findings refute your hypothesis, will deter the clinician from applying appropriate interventions based on preconceptions.

– Now granted, he was able to “back it up” per Delitto et al’s Clinical Practice Guidelines for Low Back Pain; but what does latest meta analysis say with strong concluding statement?  Plus, we need to be aware of all 3 pillars of EBP and don’t jump to conclusions too quickly.

In his case, his mind was on a railroad track to just stabilizing the patient without having options.  You know how much I am not on board with this anyway 🙂  Therefore, he did not perform the appropriate history taking and objective findings to refute his findings, just found what he wanted to confirm what he already thought.  Therefore, he fit the bill of a saying, “you will always find what you are looking for”.

So his question to me was, “how do I minimize confirmation bias”

My answers:

1. Firstly, you need to be aware of your confirmation bias.  You can’t change what you are not currently aware of.

2. You can’t avoid it, but you can minimize it.

3. You have to be exposed to multiple intervention disciplines and approaches.   My current intern was preached stabilization in school, past CIs did not teach him anything else but to “use what he knew”, so he is unaware of manipulation, dry needling, and directional preference.

4. Not only being exposed to different paradigms, you need to practice and create patterns within these paradigms.  In theory, this would create more confirmation biases, but then again, it will allow you build a strong foundation that holds up the 3 pillars of EBP.

This is a start.  What are your thoughts?  How do you minimize confirmation bias?



What is in your goodie bag?


I recently sought dental work from a new dentist.  Great service, low waiting time and yeh…I got this goodie bag for my first visit.

I felt like a kid again.  No lollipop, but it was full of items branded towards the dental industry; such as tooth paste, tooth brush, floss, and mouth wash.

I would imagine if you polled 100 people on what products would identify dentistry, I guarantee 95% of them would say one of the above items.  These can be considered the core, or brand of self-treatment and identify the profession’s vision.

Over the past several months, I’ve performed an informal poll on during subjective history on new evaluations basically asking them what they thought PT did? The answers varied tremendously but for the most part were these 3 responses:

– I don’t know at all, my doctor just sent me here.

– Y’all show people exercises.

– I heard great things of y’all through friends and family.  They said you could help me with my pain.

Notice the y’all contraction? Come to Virginia 🙂


Basically what I received from their responses is that our profession really doesn’t have much of a brand at all.  Is it because we are so broad as a field in what we treat?  Is it that we do not have quality sub-specializations?  I do think it is definitely improving in regards to our perception to the public, but we have a long ways to go.

Therefore my question to you, what items would be in a goodie bag for you to dispense to your first time patients?

%d bloggers like this: