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I recently underwent a similar change, having worked in outpatient orthopedics for 6-ish years (+lots of $$ spent on con-ed including manual therapy certification) and abruptly switching to acute care. My decision was spurred by increasingly high patient volumes (which seems to be a trend in Vegas OP) and an inability to provide what I would consider 1-on-1 patient care in a manner that fit my values. I've been in acute care for about 8 months now and haven't looked back. As a result of this, I do feel like a new graduate at times, but I've been excited to dig into new information and material, while enjoying the pace and exposure to a variety of conditions acute care offers.

Some things I've found useful thus far:

Don't be afraid to ask questions. Most of my fellow co-workers are younger than me, but have more experience in this area. Check your ego at the door.

I've found getting to know the nurses in each unit to be invaluable. Find them prior to seeing your patient, get any further information they may have regarding your patient (outside of your chart review) and discuss with them any pertinent findings of your evaluation.

Chart review! I want to know as much as I can regarding my patient's prior to seeing them. I mostly do evaluations and want to garner as much of a clinical picture as I can including lab values, vital trends, imaging findings / reports, physician notes, nursing notes, surgical reports, pending tests / labs, medications, etc. You can gain a lot of information from the electronic chart.

Vital signs on everyone. This is easier in the ICU where everyone is monitored, but on your ortho and med/surg floors I don't think I can under state this. I've run into countless asymptomatic people who upon assessment have systolic BP > 200, or more recently having a patient who's blood pressure dropped from 85 systolic to 50 systolic following 1 sit<>stand.

Collaboration with your fellow speech, occupational and respiratory therapists. I can be myopic at times, so getting input from findings from your other therapists can be helpful.

Having a good line of communication with your case managers. You are an advocate for your patients and need to have an open line of communication to discuss or challenge d/c recommendations.

Lines. Double check for any lines, tubes or catheters even if nothing stands out. Our electronic chart will tell me what lines are present upon chart review, but it doesn't hurt to double or triple check prior to mobilizing a patient.

Some resources I've found helpful as a new acute PT:

https://physicaltherapyreviewer.wordpress.com/
http://ptthinktank.com/2012/12/18/so-you-think-you-can-walk-acutept/
https://twitter.com/dr_ridge_dpt
https://twitter.com/DrDaleNeedham
www.medbridgeeducation.com ($200/yr with discount code, a number of courses focused on acute care)
http://www.amazon.com/Rapid-Interpretation-EKGs-Sixth-Dubin/dp/0912912065
http://c.ymcdn.com/sites/www.acutept.org/resource/resmgr/imported/labvalues.pdf

It's been a learning process with the transition, but I've been thoroughly enjoying it. Plus, I get the added benefit of seeing anatomy on a deeper level when it comes to wound care. Not to mention, the added benefit when you get your patients who are mechanically ventilated up and moving, while seeing their appreciation that they have for your services / help. Enjoy!

This is what I have in my library off the top of my head:

Magee - Orthopedic Assessment - Good for special tests, differential diagnosis, and general background knowledge. This is the first textbook many PT schools ask their students to purchase.



Joint Structure and Function - A good biomechanics textbook if you're interested. I remember it being assigned in both my undergrad kinesiology class as well as Biomechanics and Adv. Biomechanics in PT school.


Observational Gait Analysis - Good gait analysis text but super detailed. It is out of Ranchos Los Amigos, one of the foremost gait mechanic analysis institutions in the US.



Mulligan - Manual Therapy - A great resource, but Mulligan was kind of a strange fellow so keep that in mind.


Manual Therapy - Advanced - Great read, but honestly kind of pricey and probably not worth the cost for an OT. PT though? Definitely recommend.



American College of Sports Medicine - Super convenient to have. Great for medical exercise dosage and cardiopulmonary considerations.


Therapeutic Exercise Foundations - Good read, with some manual therapy thrown in.

If you're super intense, though, you'll want Sahrmann's Book.


To be honest, as a student of any discipline, I'd recommend just making a free account on hep2go.com and looking through their exercises to brush up. The above reads are great if you are interested, though, and I'd recommend for any PT library.



Hope this helps!

Hi Jeff,

We can't give specific medical advice, just more general information. So here goes.

The first thing I will say, and I can't over-emphasize this enough, is DON'T GET SURGERY RIGHT AWAY! For most people, low back pain is readily able to be rapidly reduced, eliminated, and managed. If you fall into the category of the few who do not recover as expected, then you might consider an injection (With PT to follow), THEN you might consider surgery. The typical outcomes for lumbar surgeries are not good, and it should usually be considered as a last resort. That being said, if you have any alterations in bowel and bladder control it would be something you would consider (with the help of your surgeon) early in the process.

I would also like to address your attitude about your prognosis. Do not let your diagnosis limit you from doing what you love. Your job right now is to manage this episode, reduce the underlying cause, and then return to your function. If done appropriately, you could very well be back to doing everything you enjoy without pain/numbness/tingling.

Let's talk about inversion therapy. Inversion therapy is really just a form of lumbar traction. As such, the reason it probably helps is that it allows you to reduce the compression load on your lumbar spine (low back), which will create more space between your vertebrae while you are on the device, which in turn allows your nerve root to calm down a little. However, when you get off of the table, the compression returns, reduced the room for the nerve root, and then it gets unhappy again. We used to believe that the traction force actually helped pull the inner disc material back into the disc, but what we have found is that is not the case. In the neck, traction is still thought to be useful, but it has been shown to have limited effect in the low back.

So, how do we typically treat these types of problems? There are multiple ways, and no one way is right for everybody. However, the successful methods have something in common. Whatever they do, they reduce the compression load intolerance in your back, which allows the nerve root to calm down and stay calm. I am particularly fond of a method called the McKenzie Method. It is a method that allows us to classify your disorder, then treat it based on how you respond to specific movements. So a PT who is trained in this system could evaluate you and treat you using these specific movements. The nice thing is that you can also use the system for yourself, and if you are successful then you can manage your condition without a medical professional. The creator of the system has written an extremely simple book that I find often helps people treat and manage their condition. The book is called Treat Your Own Back by Robin McKenzie. I recommend that you get a copy as soon as you can.

If you don't want to do that, then that is not the end of the world, but I do want to mention a few things about prognosis of this disorder. When you talk about symptoms in your leg, we call those peripheral symptoms. One of the single strongest predictors of a positive outcome is being able to take eliminate those symptoms in your leg, which is called centralization. So when you think about your symptoms, remember that even if your back symptoms are less, if your leg symptoms are worse then that is a negative thing. Conversely, if you reduce your leg symptoms, but you have more back symptoms, that is actually a positive thing. Central is better.

I know I wrote a lot, but I hate to see anyone with back pain that could potentially be pain free and isn't getting themselves the right help. I'm here to say that, in all likelihood, your back and leg symptoms are treatable without surgery, and you should be able to enjoy living your life the way that you hope to. Please try the book. It is just one method, but it can be very effective if performed properly.

All that being said, you should always seek professional medical attention if you find yourself in need. I apologize for the long response, and feel free to ask any follow-up questions that you have.

EDIT: Also, there are a few more activities that individuals with these conditions typically should avoid during their recovery.

1. repeated forward bending
   
2. prolonged sitting/standing over the sink/etc. (Anything that makes you bend your back forward)
   
3. lifting heavy items
   
   After recovery with this disorder we can return to plenty of forward bending activities, but often it helps to avoid them while reducing the condition.
   

If you are looking for something more educational I suggest "A Guide to Better Movement" by Todd Hargrove. It's an interesting read on how the nervous system modulates movement, and it is written intelligently but is still an easy read.

If you are looking for something more along the lines of a novel try "Run, Don't Walk" by Adele Levine. It a story about a PT who worked at Walter Reed Medical Center treating veterans coming back from Iraq and Afghanistan. The book is less about the science of physical therapy and more about her interactions with patients. It's also good in that the book is darkly funny and not depressing.

On a professional level, I would recommend something related to anatomy. This is one of the toughest courses in any curriculum and any advantage will be useful.

On a more personal note, I would recommend reading something that gives a patient's perspective -- something that helps us understand what it's like to be a patient or have a disability. Here are a few of my faves:

1. Don't Worry, He Won't Get Far on Foot by John Callahan
   
   
2. The Diving Bell and the Butterfly by Jean-Dominique Bauby
   
   
3. Moving Violations by John Hockenberry.
   
   and anything by Oliver Sacks (though The Man who Mistook His Wife for a Hat is my fave).
   
   Enjoy!
   

How are you with Anatomy? If not so great, first get this and learn as much in there as you can. Especially the neuro-musculo-skeletal stuff.

Now that you kind of know a little about anatomy, you'll need to learn how all those parts work. I recommend this kinesiology textbook.

Now that you know all the pieces and how they're supposed to work together, you'll need a text that talks about musculoskeletal dysfunctions and how to go about managing some of those conditions with exercise and other forms of treatment. I recommend this text for that.

Good luck!

Musculoskeletal Anatomy Flashcards https://www.amazon.com/dp/0323057225/ref=cm_sw_r_cp_apa_i_.HcZCbYTT1WCF

I used these physical flash cards but I'm sure most found on Amazon would work. More about the daily process of going through material so it gets pretty ingrained into your memory.

As long as you are not having other underlying serious issues ruled out by imaging/symptoms - like bowel/bladder/incontinence/bilateral leg or arm weakness/tingling/numbness - then PT is generally helpful. I would recommend finding a PT with some background with McKenzie background - just ask the front desk when you schedule.

This book is also a very good option - https://www.amazon.com/Treat-Your-Back-Robin-McKenzie/dp/0987650408/ref=sr_1_1?ie=UTF8&qid=1519450256&sr=8-1&keywords=treat+your+own+back.

If you can, get an aide position in a neuro rehab unit. This will give you incredible exposure to assessment/treatment/handling. There’s a lot of neuro patients who need more than one person to handle (e.g., two people and a hoist to move, three people to stand or walk). For this reason aides get a lot of hands on experience in neuro given the therapist will teach them how to safely assist with the transfers/assessment/treatments. It’s cheaper to have one therapist and one aide versus multiple therapists working on the one patient.

This is a very good pathology based textbook and this is very good for PT based intervention and assessment.

I would get in touch with your program and see what the book list is like, but we use this book for two classes and it's FANTASTIC.

Disclaimer: I'm not a PT, I'm just on these boards because I'm considering switching careers into it.

I am/was a chronic pain sufferer for many years, with the past 2 years being drastically worse and debilitating. However after making serious dedicated effort I am making huge progress and am at this point fully convinced that I will not only entirely beat chronic pain, but also be even better off than I was.

IMHO, by the time you reach chronic pain > 6mo-year things have become much more complicated than your average PT/MD is going to be looking. 'Climbing out of this hole' is very possible, 'very soon' is unrealistic. What is more realistic is something like 'I will crawl, and walk, and climb from the pit of this ravine until climbing is my friend and I won't even realize I've reached level ground until I look down from the mountain I have climbed.'

You are likely going to have to do a lot of learning, because an MD/PT/Ortho/Chiro whatever is not going to be able to change enough aspects of your life to 'cure' you. Additionally it would be unwise for them to try because the time it would take they could of prevent so many more people from entering chronic pain to begin with. That is not to say that they will be worthless by any means. They will always have the insight that their degree and years of experience have given them, and are in fact invaluable in this way.

While you may or may not have lower cross syndrome, this is not where I'd recommend starting. At this point it would be my guess that you're very tight in may places over your body, and have developed a plethora of compensation patterns. That's totally fine, they are very likely all reversible in time. One problem this presents though is the idea of 'of if I fix compensation X then I'll feel better' but they are all interacting with each other, so as you fix one another will change. But after you work over the entire body over significant periods of time it will start to come together. This is mainly because once you learn how a single compensation is happening you will eventually be able to get more and more corrections on 'auto-pilot' so that these corrections will be happening as you try to correct other patterns.

The first thing I suggest is learning about pain science. It's proven to actually reduce pain, and will help you make more informed decisions through the journey. I highly recommend http://www.amazon.com/Guide-Better-Movement-Science-Practice/dp/0991542304/ref=sr_1_1?s=books&ie=UTF8&qid=1427501143&sr=1-1&keywords=better+movement . It's a good starting point and requires almost no background. It also has some good exercises at the end of the book based on the Feldenkrais method. Feldenkrais is certainly not a cure all, but I find extremely helpful, as it helps address the motor patterns in a very learning friendly environment.

Finally, if you are depressed don't forget the possibility of seeing a psychological therapist. You are depressed because you hurt all the time. That is inevitable, but being depressed can also prevent you from fixing the pain int he first place. You have to fight the war on all fronts. You may also want to consider picking up meditation (or find a mindfulness based therapist). It's also backed by lots of research and from my experience the way you learn from meditation and the way you learn to be pain free have lots of overlap. By mindfully observing and learning from your moment to moment experience you have greater ability to direct your future moments.

Best of luck on your journey.

This book is good for that:

Kinesiology: The Mechanics and Pathomechanics of Human Movement

And here is another good book for learning muscle testing techniques:

Muscles: Testing and Function, with Posture and Pain

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Anatomy, Anatomy, Anatomy and this.

as /u/picklesandmustard said try to get in some PT aide hours and please empty your mind of what you think PT is before getting to PT school.

https://www.amazon.com/Stretching-30th-Anniversary-Bob-Anderson/dp/0936070463/ref=sr_1_1?s=books&ie=UTF8&qid=1527541680&sr=1-1&keywords=stretching+bob+anderson&dpID=51d16P6YQOL&preST=_SX218_BO1,204,203,200_QL40_&dpSrc=srch

You might find this book worth reading:
https://www.amazon.com/Explain-Pain-David-Butler/dp/0987342665

It's expensive, but you might be able to track down a copy at a library.

I asked the same question and many pointed me to this one:

http://www.amazon.com/Muscles-Testing-Function-Posture-Kendall/dp/0781747805

Hanging Weight Scale | 660lb Digital Electronic Weighing Scale https://www.amazon.com/dp/B07P7Y6XF1/ref=cm_sw_r_cp_api_i_rXE2DbCX41XZH

The McKenzie method for treating your low back!
Unbelievable results with our patients in-clinic, and many have been able to avoid surgery. Check out his book, he breaks down back problems in very simple terms and the book is less than $10.

http://www.amazon.com/Treat-Your-Back-Robin-McKenzie/dp/0987650408/ref=pd_sim_14_1?ie=UTF8&dpID=41hHXOtgAiL&dpSrc=sims&preST=_AC_UL160_SR104%2C160_&refRID=0WM09F7XR7XGQQ6JGMCT

Not to be snarky, but the cutting edge research says it's all placebo or neurophysiologic at best. Meaning nearly any novel stimulus could have resulted in the same response.

The alternative hypothesis that everyone hates can be found on www.painscience.com and in the book explain pain as well as aches and pains. If read those resources you will never go back to manual therapy as a mechanical means of alleviating pain and restoring function.

https://www.amazon.com/Louis-Gifford-Aches-Pains/dp/0953342352

https://www.amazon.com/Explain-David-Butler-Lorimer-Moseley/dp/0987342665/ref=pd_lpo_sbs_14_t_0?_encoding=UTF8&psc=1&refRID=T1P9ZAV0ATF9P88BFPHZ

It might just be me but describing the depth of an incline press made me think for a second (I assume from the BB?) I'm going to describe it a little differently... The in-congruent position of the shoulder is at ~60^0 Abduction and 30^0 Horizontal Adduction. (Start Arms at your sides, jumping jack motion out 60^0 then arms to the middle of the body 30^0) Which means it puts the most stress on the ligament structures of the joint. I think the most potential harm for injury can come from not having adequate back muscles to stabilize the scapula during the movement if you are doing a incline bench press forcing the rotator cuff muscles to be over strained in stabilizing the joint. The question by full ROM are you talking but full extension of the lift or Full ROM of the shoulder in Abduction like doing a Military Press.... I agree with /u/narf007 too the DB could be the way to go if worried about instability.

Source: Myself working currently on my CSCS, being a SPT, and Kinesiology of the Musculoskeletal System by Neumann