June 2023 PULSE

AWARD-WINNING PT FOR LIFE CULTURE

In 2022, for the 12th consecutive year in a row our employees placed PTSMC as one of the best places to work in Connecticuta “Top Workplace.” Additionally, the feedback that led to this award, also resulted in a 3rd consecutive Top Workplace USA award! This is an incredible honor and an amazing run for our company.

On April 26, 2023, the “Top Workplaces National Culture Excellence Winners,” which is based on the May 2022 employee survey, were announced... and I am proud to share that PTSMC again was distinguished in 4 of 5 categories! These awards, “highlight organizations that listen to employee feedback and drive people- rst cultures.”

• Innovation – recognizes organizations that have created a culture where new ideas are encouraged, which helps employees to reach their full potential and bene ts performance.

• Leadership- celebrates organizational leaders who inspire con dence in employees and the company direction. They listen to what matters most to employees and use that insight in decision-making.

• Purpose & Values- celebrates organizations that have successfully communicated the company mission and integrated those aspirations into the culture.

• Work-Life Flexibility- recognizes organizations that have built a culture that enables employees to meet the demands of their personal lives while maintaining high performance.

SAVE THE DATES!

PTSMC being recognized by our employees as a national leader in these categories is something we can all be proud of. As an organization, we are committed to nding and growing the best people possible. It is great people that embody and improve our PT For Life culture. Our people and our culture are the most critical factors behind the world-class level of care and service we are able to provide for our communities.

PTSMC is a Top Workplace because our people are passionate about what they do. We will continue to strive for improvement and create a workplace where everyone has an opportunity to learn and grow.

Thank you for what you bring to this organization. You allow PTSMC to do what we do and be who we are.

IN THIS ISSUE

Clinician’s Corner by Bri Boulerice, Waterbury Physical Therapist Recap of Dr. Chris Judson’s Doc Talk: Distal Radial Fractures

HR Buzz - Now on ADP Homepage!

Employee Spotlight: Zack Currie Guilford Physical Therapist & Assistant Director

The Extra Mile: Navigating Uncharted Territories

By Jack Pearce

DEI: Becoming a True Ally

By Marilex Santiago

PTSMC Orthopaedic Residency PICO

Congratulations Graduates and New DPT Students

StriveHub Fab 5

“

Keely (Yarish), my therapist, was extremely knowledgeable and made my shoulder feel great. I observed the other therapists and they were all focused on their patients and the whole group worked together well. Very pleasant atmosphere.” - Avon

Thanks,

Alan

Mark your calendar to get together for a great time with your PTSMC family across CT! We will be hosting two Social Hours for all PTSMC employees - both casual tailgate style gatherings with a side of food trucks and cornhole tournaments.

Finally, back by popular demand, a companywide event: Casino Night! This will be an a air for PTSMC employees 21 years of age and up, and a plus one.

August 24th – Social Hour #1

August 25th – Social Hour #2

September 30th – Casino Night

All events, beverages and food are free. Look for more details and invitations via email coming soon.

“From Day 1, Bernie (Lapaan) has been excellent. She explains ever assignment she gives. And her attention is so reassuring that she is dedicated for you to meet your recovery.” - Wethers eld

“My physical therapist, Sean (Doenias) is amazing and teaches me new ways to alleviate some of my pain and strengthen my muscles in the area where I was injured.” - Newington

“Dr. Kathryn Flodquist is simply the best. I know I can always rely on her to gure out the source and resolution of my issues. So grateful for her knowledge and the way that she educates.” - Waterbury

“I really liked the physical therapist, Danielle Butsch. She listened to me carefully, and the exercises she recommended seem to be helping. She was able to explain clearly what she thought the problem was and how to x it. Danielle was attentive in making sure I was doing the exercises correctly, unlike other PT places. I really feel like she got to the bottom of things quickly and that the exercises are going to help me a lot. I'm very happy with the help I received from her.” - Lock Street

CLINICIAN’S CORNER

Doc Talk Recap: Dr. Chris Judson on Distal Radial Fractures

By: Bri Boulerice, PT, DPT Physical Therapist at PTSMC Waterbury

Dr. Chris Judson, an orthopedic surgeon of the Orthopedic Associates of Hartford, recently presented at PTSMC Avon. Dr Judson specializes in the treatment of hand, wrist and elbow injuries with a particular interest in fractures. His recent talk focus speci cally on the management of distal radius fractures. Dr. Judson practices in the Plainville, Rocky Hill, Farmington and En eld areas and is happy to collaborate with therapists via email or text message regarding mutual patients.

Distal radius fractures are the most common orthopedic fracture, making up 18% of fractures in adults. These fractures occur more frequently in females, which is related to the higher rates of osteopenia and osteoporosis in this population. The most common mechanism of injury for a distal radius fracture is a fall onto an outstretched hand, more commonly referred to as a “FOOSH” injury, resulting in a Colles fracture. A Colles fracture, which may present as a “dinner fork” deformity involves dorsal displacement of the radius. Associated injuries in addition to a Colles fracture include distal ulnar styloid fracture, scaphoid fracture, and ligamentous injuries to the distal radial ulnar joint (DRUJ), triangular brocartilage complex (TFCC), and scapholunate ligament. TFCC injuries are often not diagnosed as they can only be detected with MRI and may be suspected in cases where a patient has ongoing ulnar sided wrist pain beyond the expected healing time frame.

Some common ways to categorize fractures include displaced vs. non-displaced, intra-articular vs. extra articular, comminution, and any associated dislocation. Many factors drive the decision-making process to opt for surgical or conservative treatment including radiograph alignment, fracture characteristics and stability, medical comorbidities, and the patient’s activity level. Dr. Judson emphasized the importance of the patient’s activity levels and functional goals in his decision-making process. If opting for non-operative treatment, this can include with or without reduction. In the case of a Colles fracture for example, this is often initially treated non-operatively with reduction in the rst two days after the fracture, which can be done in the orthopedic o ce.

If a patient is treated non-operatively, this involves a period of about 5-6 weeks of immobilization. For children, sometimes this can be as short as 3-4 weeks. Initially, the patient is often splinted using a sugar tong splint rst prior to tting them for a cast as this can accommodate for the initial increase in swelling. If patients have been reduced non-operatively, they will receive weekly or bi-weekly radiographs to ensure the reduction has not displaced. In the initial treatment of these patients while they are immobilized in a cast, it is important to assess cast t. Dr. Judson recommends about 1 nger of space on the cast for good t. If you are able to t 2-3 ngers in the cast, this indicates it is too loose and the patient needs to be referred back to the orthopedic o ce for a cast change. Goals during this initial time frame include full elbow and nger range of motion. The cast is removed at approximately 6 weeks, with initiation of active range of motion and gentle passive range of motion. At 8 weeks, passive range of motion can become more aggressive. Strengthening can also be initiated at this time, however with range of motion should be the primary focus until full range is achieved. At around 10 weeks patients are usually cleared to resume full activity if imaging demonstrates full healing. Full strength can take 6 to 9 months to return, and Dr. Judson emphasized the importance of patient education around this timeline.

Operative treatment may be selected for active patients with malalignment of the fracture, unstable fractures, or patients who require quick return to full activity, such as someone with an occupation that requires use of the wrist and hand. The current most common operative treatment is volar plating, which Dr. Judson uses in about 80% of his procedures. Volar plating has been found to be better tolerated than alternative surgeries, such as dorsal plating. The volar plate can be hidden under the pronator muscle, reducing likelihood of future irritation in this area from the plate.

Dr. Judson reports removing approximately 1% of these types of plates. Plates placed on the dorsal side are much more likely to irritate the tendons and require removal approximately 20% of the time, but occasionally are used when the fragments are only present on the dorsal side of the radius and do not extend to the volar aspect. Volar plating requires an incision along the exor carpi radialis tendon, which can be a common site of sensitivity after surgery. Dr. Judson recommends scar massage here to prevent adherence.

Another common method used in surgery is a fragment speci c method, in which a screw is used to stabilize the fracture that may not require plating. This method often requires a smaller incision. Finally, external xation is very uncommon today and has been largely replaced by a technique called bridge plating. With bridge plating, a stabilizing plate is placed under the skin from the radius into the hand to stabilize the fracture, similar to external xation, however this is not visible to the patient and decreases the risk of infection. This may be used in cases of combined fracture and dislocation or ligamentous injury, or comminuted fractures. The bridge plate is then removed after healing has occurred.

Post-operative timelines have signi cant variability depending on the patient. In general, after volar and dorsal plating, initial goals from 0-10 days post-op include full nger range of motion, edema management, and establishing a home exercise program. From 1-5 weeks post-op, patients begin to wean out of the brace and begin working on range of motion. This time frame is the most variable between patients as this depends on many factors including bone quality, complexity of fracture, and comminution. During this phase, the patient may begin “co ee cup weight bearing” where they are only lifting about the weight of a co ee cup. Pending early signs of healing, around 5-10 weeks, the brace will be discontinued and more aggressive stretching can begin. Strength can be initiated around week 8 as well, but there is some variability here too. At 10 weeks and beyond, nal rehabilitation goals include maximizing range of motion and strength, in addition to return to sport and impact activities.

Rehabilitation following bridge plating involves aggressive passive and active range of motion once the plate is removed at about 10 weeks as healing is complete at this time. The patient will likely have signi cant sti ness due to motion restrictions from the length of time the plating was present. One advantage of the bridge plating is the ability to WBAT immediately, which may be necessary in some patients that must use an assistive device.

Common complications include cosmetic deformity where the ulnar styloid is more prominent due to a shortened radius after non-operative management. Additional complications include sti ness, ulnar sided pain, tendon rupture of the extensor pollicis longus and exor pollicis longus, carpal tunnel syndrome, and complex regional pain syndrome. Dr. Judson emphasized the importance of contacting the surgeon if complications arise.

Overall, in the management of distal radius fractures, there are good functional outcomes with both operative and non-operative management. It is important to educate patients and set expectations early to provide successful care. Operative management can often have many variables that impact rehabilitation and patients bene t from open communication between the surgeon and therapist. Lastly, it is important to identify complications early to maximize outcomes for patients.

Click here to watch Dr. Judson’s Doc Talk

CLINICAL EXCELLENCE

Upcoming Courses

SPONSORED COURSES INTERNAL COURSES

Evaluation & Management of Headaches: Lab Intensive

June 24- 25, 2023

Instructed by Partner 4 Rehab: Jason Myerson & Jason Grimes

Modern Management of the Older Adult

September 16-17, 2023

Instructed by ICE

Introduction to the Assessment & Treatment of the Concussed Patient

June 10, 2023

Instructed by PTSMC expert: Rick Purdy

Click HERE for full descriptions of the upcoming courses: https://ptsmc.egnyte.com/dl/KxtTDaeeIf

Email Mallory Mason at ConEd@ptsmc.com for all sign ups or questions. All course attendance must be approved by Partner/Director.

CONTINUING EDUCATION OPPORTUNITIES LIST

Click HERE for full list of Internal, Sponsored and External con-ed opportunities. https://ptsmc.egnyte.com/dl/RCnzB8GqVU/Clinical_Excellence_List_of_Courses.xlsx_

PTSMC Clinicians Complete Myopain Seminars’

TDN3: Advanced Course

Modern Management of the Older Adult

September 16-17, 2023

Instructed by ICE

On May 19-21, 17 PTSMC clinicians attended Myopain Seminars Dry Needling 3: Advanced course, hosted by PTSMC at Quinnipiac University. Congratulations to the following clinicians for completing the the three courses!

Andrew Kalach, Fair eld

Elizabeth Rubbo, Guilford

Emily Searle, Branford/Lock Street

Je rey Hoerst, Glastonbury

Jennifer Powers, Fair eld

Kaitlyn Murray, Windsor

Kelly Hoisl, Windsor

Liza Peressini, Danbury

Meghan Blanusa, Naugatuck

APPLY FOR PTSMC’s

ORTHOPAEDIC RESIDENCY

Deadline to apply is July 30, 2023!

Acceptance decisions will be made in September 2023 for start date in December 2023.

***Applicants must have a valid PT license prior to the start of the residency program***

Learn more and apply online at: www.ptsmc.com/residency

Please email Danielle at Danielle.Dunn@ptsmc.com with any questions.

STUDENT PROGRAM UPDATE

2023 Student Program Incentive

BIG NEWS! After great conversations at the management meeting last fall, PTSMC has enhanced the Student Program Incentive structure to best show our appreciation for our clinical sta that go above and beyond by hosting students. Details on the new structure are outlined below and will be implemented this June! Please reach out to Juliann Chacko with any questions.

Timing

Natalie Peterson, Plainville

Pat Kinsella, Guilford

Paul Dinwoodie, Danielson

Quinn McAnaney, Guilford

Rebecca Sauve, Naugatuck

Roy Colter, Newington

Sam McMullen, Southington

Tom Harney, Putnam

UPCOMING JOURNAL CLUB AND CASE DICUSSION DATES

All meeting are 12:00- 1:00 pm on TEAMS.

Upcoming CD dates: 06/06, 07/11, 08/08

Upcoming JC dates: 06/20, 07/25, 08/22

Click HERE for the full 2023 schedule.

Email Meghan.Blanusa@ptsmc.com to be added to the meeting invites.

New incentives begin with the June 2023’s Superstar CI awards.

Full time students:

Clinical instructor receives $250 per student

Repeat CI Incentives:

1st student: PTSMC CI swag - 1/4 zip

5th student: $250 & PTSMC CI swag - jacket

10th student: $500 & PTSMC CI swag - vest

15th student: $750

Students Starting:

Brian Ranger from FPU will begin with Meghan Blanusa in Naugatuck.

Mary Karlberg from UScranton will begin with Liza Peressini in Danbury.

Carless Swanson from SHU will begin with Rebecca Petrosino in Fair eld.

Zara Ahmend New Haven PT Aide

Ryan Alexander New Haven PT Aide

John Allen Newington PT Aide

Ethan Barker Windsor PT Aide

Sarah L. Born Putnam PT Aide

Rosangie Burgos Naugatuck PT Aide

Erin Corbett Plainville PT Aide

Daniel Delgado Windsor Physical Therapist

Catherine Dow New Haven PT Aide

Paige Duquette Shelton PT Aide

Jonathan Farnham Shelton PT Aide

Greta Fowler Lock Street PT Aide

Welcome Back!

NOT PICTURED:

Emily Gamper Wallingford PT Aide

Xavier Gibson Naugatuck Physical Therapist

Kelly Goddard Wallingford PT Aide

Robert Harkin Danbury PT Aide

Evelyn Layne Groton PT Aide

Walker Lenz New London PT Aide

Isabella Matarazzo Wallingford PT Aide

Taylor McDermott Lock Street PT Aide

Alison Michaud Shelton PT Aide

Sarah Nguyen Southington PT Aide

Ameen Parks Westbrook PT Aide

Tyus Phengkaen Southbury PT Aide

Carly Rabinovich Avon PT Aide

Julia Marie Ricardo Wallingford PT Aide

Lauren Roy Wethers eld PT Aide

Madelyn Twitchell Soutbury PT Aide

Audrey Decker, West Hartford PT Aide

Adam Douich, Branford PT Aide

Christian Fillion, Guilford PT Aide

Ethan Lachnicht, Wethers eld PT Aide

Catherine Patrick, Guilford PT Aide

Mason Aaron Sarra, Plainville PT Aide

Tara Sbordone, Southington PT Aide

Samantha Sylvester, Southbury PT Aide

Employee Spot light

Zack Currie, Guilford Physical Therapist & Assistant Director

Zack’s story began over 3,000 miles away where he grew up in Victoria, British Columbia. Growing up as a multisport athlete, Zack had several injuries. Those injuries and subsequent recoveries are what originally sparked his interest in the athletic training profession. His love and talent for ice hockey led him to the East Coast, where he was recruited to play at the Division I collegiate level. Quinnipiac University o ered successful programs in both his academic and athletic pursuits. While at QU, he credits his athletic trainer with helping to con rm his attraction to the orthopedic and healthcare realm, especially the ability to help people get back to doing what they love to do. Zack looked at opportunities within athletic training and physical therapy and ultimately saw value in where physical therapy could lead him in the future.

In 2013, a clinical rotation brought him to PTSMC Guilford where he met Partner & Director, Steve Platt. After graduating with a degree in athletic training, Zack took the opportunity to play hockey professionally at the minor league level for the South Carolina Stingrays and later for the Evansville IceMen in Indiana. When it was time to move on from professional hockey, Zack decided to return to Connecticut and entered the DPT program at QU.

Upon graduation in 2018, his relationship with Steve and desire to stay in the area brought him back to PTSMC, this time as a clinician. He loved Guilford because of its larger size and the number of other clinicians he’d be able to learn from as a new physical therapist. His desire to focus on fundamentals, growth, and continuing to educate himself made PTSMC the perfect t.

Zack was a part of the Leadership and Management Development Program (LMDP) in 2021-2022 and was able to learn more about the administrative and business side of PTSMC. The skills he learned during LMDP prepared him for the opportunity to step into the Assistant Director role at Guilford in October 2022. In his role as Assistant Director, Zack says he’s been able to put the skills he learned to real-world use and act as an extension of the director when he and his colleagues need it. He’s enjoying this opportunity and is looking forward to continuing to improve himself as a leader and a clinician. Steve commented that, “Zack is the epitome of what we want a PTSMC employee to be. His leadership, work ethic and professionalism have a positive e ect on everyone that he works with.”

Of course, we cannot put the spotlight on Zack without also talking about his alma mater’s recent NCAA Ice Hockey National Championship win! Zack was excited to watch the game on April 8th and described the experience as “surreal and nerve-wracking.” This was QU’s third National Championship appearance, and they nally clenched the title! Zack played in QU’s rst National Championship appearance in 2013 where they lost to local rival, Yale. Triple clap for Zack and his teammates for their role in the success of the QU program. The big win was a great chance for Zack to reconnect and catch up with his former teammates. He says hockey can be tough because your teammates come from all over the world, so he doesn’t get to see them a lot. When they do have the chance to get together, it’s like no time has passed.

JUNE BIRTHDAYS

Emma Morales 1 Orange

Betsy Holt 1 Simsbury

Xantiana Sanchez 3 Southington

Josh McAdams 4 Danbury

Sarah Born 6 Putnam

Karolina Ozga 8 Fair eld

Nicholas Lopez 8 New Milford

Kelli Kaliszewski 9 Putnam

Alex Rostenberg 9 Avon

Lauralee Pelletier 9 Southbury

Julia Ricardo 10 Wallingford

Steven deCastro 11 Groton

Jacob Wall 11 West Hartford

Ben Romann 12 Plainville

Jill Cristaldi 13 Wethers eld

Nicole Carter 13 Southington

Randi Gallagher 14 Admin

Alexa Medor 14 Naugatuck

Dan Sha er 17 Avon

Rachel Slater 17 West Hartford

Daniel Blais 17 Middletown

Ethan Lachnicht 18 Wethers eld

Michael Babcock 19 Groton

Avital Liberzon 20 Guilford

Amiyah Peters 20 Southbury

Nicholas Sharp 20 Danielson

Liz Rubbo 20 Guilford

Spencer LeBel 22 West Hartford

Savannah Vartabedian 23 Windsor

Jake Minor 24 Simsbury

Carley Murphy 25 New Milford

Dan Pagliuca 25 New Milford

Nicole Stellato 26 Southbury

Harrison Picard 26 Fair eld

Sara Gareiss 26 Admin

Natalie Swanson 27 Lock Street

Kate Carlson 27 Admin

Jason Smutnick 27 Windsor

Aileen Carla Pingol 28 Orange

Emma Berger 28 Westbrook

Xavier Gibson 29 Naugatuck

Kasey Adinol 29 Wethers eld

JoJo Lusanga 29 Waterbury

Jocelyn Lucero 30 Branford

JUNE ANNIVERSARIES

Shawn Nash Physical Therapist Avon

Anita George O ce Assistant Admin

Anna Donato Patient Care Essex Coordinator

JoAnna Moomjian Patient Services Fair eld Coordinator

Jade Flanagan PT Aide Orange

Bri Boulerice Physical Therapist Waterbury

Ashley Cato PT Aide Windsor

Joyce Mak PT Aide New London

Micaela Nowacki Physical Therapist Putnam

Elena Masiello Physical Therapist Wallingford

Emily Pelz Physical Therapist Waterbury

Gabi Wise Physical Therapist Groton

Alyssa Tracey PT Aide Middletown

Dana Colonese Physical Therapist Orange

These days, Zack has found himself busy with the home he and his wife, Kathryn, purchased in 2022. They are spending their spare time getting to know their new town, spending their time outdoors and hiking. They plan small trips throughout Connecticut, New Hampshire and Boston to visit friends, and enjoy traveling to the Cape and Mexico for warmer weather. Whenever he can, Zack makes the 3,000-mile trip back to visit with friends and family in the Paci c Northwest.

Tom Kassan Partner & Director West Hartford

Juliann Chacko Assistant Director Orange & Student Program & Admin Coordinator

Navigating Uncharted Territories

By Jack Pearce, Senior Virtual Operations Coordinator

Change is hard. When a patient, either new or returning, walks in the door the rst thing they see is an empty front desk and a computer monitor with the PTSMC logo and the question above it: “Do you have an appointment today?” The patient may think, “Hmmm...I am not so sure about this...” Then the magic happens. A Virtual PSC pops up on the screen and says, “Hi, Mrs. Jones! It’s great to see you today!” In this moment we can dispel all those uncertainties and deliver that PTSMC welcome our patients have grown to expect.

There are absolutely skeptics. Think of an example of what people were skeptical about and now can’t live without...texting? Facetime? Cell phones? Online ordering? UBER – who would get into a stranger’s car?!

Setting the Course for Smooth Sailing

When a patient calls, the VPSC describes what the patient should expect for their rst appointment: “When you come for your rst appointment, you will see a computer screen where we will get to meet for the rst time. If you tap the screen to call me, I will be able to see you and you can see me. It’s super easy and we can even help you scan in documents and take your copay. We are part of the PTSMC team. It’s pretty cool!” This allows us to give the patient a heads up about the new technology, introduce ourselves, and describe the services we provide.

It's All About the Voyage

Some patients are already nervous about going to a medical o ce, whether it is from insurance worries or just general anxiety about coming in; we want to make sure we help them no matter what it is! As Steven de Castro, Groton Partner, always says, “There is nothing special about the four walls our clinics are in. What is special is what happens within them.” One of the greatest values we can add at PTSMC and what sets us apart is the unmatched experience we deliver to our patients. With the VPSC, we deliver the same level of service our patients have come to expect at PTSMC. The VPSC team is putting the patient rst and making sure that this kiosk is another tool to help us achieve that.

CONGRATULATIONS TO AMANDA LEISS!

Jack Pearce has been promoted to Senior Virtual Operations Coordinator, a new position at PTSMC. The primary responsibility of this role currently is the rollout of our Virtual PSC program. Jack has been with PTSMC since 2013, starting in Groton when he was 16! In 2015 Jack was trained on some front desk tasks and would always jump to where the clinic needed him. Jack took a couple of breaks from PTSMC, returning in 2021 to join the Remote Authorization Team and then left and returned in 2022. When asked what keeps bringing Jack back, he quickly replied, “It’s PTSMC itself. I have never seen another medical o ce that cares about their patients and employees like the people at PTSMC. We have created an environment where everyone who’s a part of PTSMC wants to see patients get the best care they can, and it feels amazing being a part of it.”

Kristen Forster, Director of Operations commented; "Jack's enthusiasm for customer service is downright contagious! He genuinely cares about making sure every patient, sta member, and colleague has the best experience possible. When it comes to embracing new technology, Jack's approach is all about putting the customers rst. Working with Jack has been an absolute blast, and I can't wait to see where this exciting adventure takes us at PTSMC!"

Personally, Jack is super excited and is looking forward to his wedding in June 2024! Jack has set a goal to hike all 48 New Hampshire mountains that are over 4000 feet in elevation. He likes to go to New Hampshire a few times a year. He has currently hiked 15 of the 48.

Jack is most enthusiastic about two things for his new role. First, he is excited about piloting something new for PTSMC. It is uncharted territory, using technology for e ciency while ensuring that the patients still get the amazing level of care and customer service that PTSMC believes in. Second, Jack is excited for what new challenges lie ahead with this role and what it means to lead a team. Jack feels there is a lot of growth at PTSMC and has always felt pushed to be his best self and feels it’s nice knowing that everyone here has each other’s back and will help push you be the best you can be!

Congratulations to Amanda Leiss on her promotion to Patient Services Administrator. Amanda joined PTSMC Wallingford in November 2021. Amanda brought with her varied experience in service and healthcare industries; in all positions she held leadership roles.

In her new role Amanda looks forward to taking on more administrative responsibilities and assisting Director Michelle Kijewski in anything that is needed to help the clinic succeed. In addition, she hopes to get more involved in community events with PTSMC. She had so much fun at the women’s self-defense class and 5k that PTSMC Windsor recently hosted and would love to get more involved in similar future events. Amanda’s favorite thing about working in the Wallingford clinic is how well everyone works together. No matter what arises everyone works as a team and is always helping each other with a positive attitude. Amanda says, “You can almost always guarantee to see smiles and tons of laughter amongst sta and patients when you step into the gym at Wallingford. It makes for a great place to work.”

Director Michelle Kijewski is grateful for Amanda and praised her: “Amanda is incredible! She single-handedly manages the Wallingford front desk operations seamlessly. We have six clinicians, which is a lot of volume for Amanda to handle. Amanda always has a ‘great day’ at the o ce, and it is contagious to our patients and sta . I know she will de nitely continue to grow in her role as a Patient Services Administrator and help to continue our success in Wallingford.”

In the April PULSE, Amanda was the Employee Spotlight. Notably in that article, Amanda shared the story of her pet piggies! Outside of work, you can nd her running or taking a class at Orange Theory Fitness. Over Memorial Day Weekend, she participated in the Vermont City Marathon and is doing Run to Home Base in July, which she is currently raising money for. Home Base provides clinical care for veterans and their families who were impacted by the invisible wounds of war all at no out of pocket cost to them. And now that the weather is getting nicer, Amanda enjoys taking her piggies out to local breweries and seeing all the surprised looks on people’s faces when they see a pig walk!

EMPLOYEE ENGAGEMENT

DEI

Diversity, Equity, & Inclusion

Becoming a true ally

By Marilex Santiago, DEI Leader & Administrative Coordinator

What does it mean to be an ally? The Wright Foundation explains, “A true ally wants what’s best for you. They hold a vision for you. They see your potential and push you to become the hero they know you are.” What a phenomenal way to support another person, especially when we live in a world where marginalized groups have big battles to face.

PRIDE Month, dedicated to celebration and commemoration of lesbian, gay, bisexual, transgender, and queer pride, serves as a reminder of the importance of allyship. Some of the struggles the LGBTQ+ community face includes being nine times more likely to be victims of a violent crime access to gender-a rming care, homelessness for LGBTQ+ youth, and higher rates of depression for LGBTQ+ veterans. Luckily, anyone can be an ally; it’s a choice. Here are examples of how YOU can be an ally or be a better one:

• Start by learning about various marginalized communities, their histories, and challenges they face. Read books, articles, and personal accounts. Engage with documentaries and movies to gain insight and empathy. Listen and be open to feedback and growth.

• Lift and promote marginalized voices. Share their stories, achievements, and concerns. Use your platform to elevate their voices and advocate for their rights.

• Speak up against discriminatory language and biases. Engage in conversations that challenge harmful beliefs and center the experiences and voices of marginalized communities.

• Show up for community events, donate to organizations promoting equality, and advocate for inclusive policies. Create safe spaces and celebrate the diversity within marginalized communities.

• To be an ally for another person, you must really align yourself with what matters to them. What are their ideals? Do you understand who they really want to become? Not who you’d like them to become for yourself, but who you hope they become for themselves.

Allies are compassionate, empathetic, and understanding. It’s about putting yourself in someone else’s shoes and taking regular action to support your fellow human being.

“Think about the allies in the historic and contemporary myths –Odysseus had Athena and Luke Skywalker had Obi-Wan Kenobi. They didn’t face their quests alone.”-The Heart of the Fight

Engagement & Wellness Calendar

JUNE

Monthly Awareness: PRIDE Month & Men’s Health Awareness Month

Women’s Self Defense Class: June 8, PT For Life Southbury

PTSMC Gear Order: June 16- 28

JULY

Monthly Awareness: Disability Awareness Month

Happy Fourth of July: Tuesday, July 4

Men’s Health Event: Date TBD

AUGUST

Monthly Awareness: Immunization Month

PTSMC Social Hours: August 24 and 25

Life Beat: Men’s Health Month

Men’s Health Awareness Month brings attention to preventable health problems, early detection and treatment of diseases and improving overall well-being among men and boys. Here are four action steps to make health a priority for men.

Step 1: Choose a Primary Care Provider

Many people think of the doctor as someone to see when they are sick. Be sure to visit the doctor for regular check-ups even if you feel ne. Some diseases don’t have symptoms at rst. Seeing a doctor will give you a chance to catch diseases early and learn more about your health. Don’t be embarrassed to talk about your health. Start by talking to family members to learn which diseases run in your family. Share this information with your doctor to help them determine what health risks to watch for.

Step 2: Schedule Screening Tests

Screenings help nd problems early when they may be easier to treat. If you are in a high-risk group or have a family history of disease, talk to your doctor about the bene ts of earlier screenings. Much like a vehicle maintenance schedule, check-ups and screenings need to take place as you age. Your PCP will determine the right frequency for you. Most people don’t enjoy going to the doctor or being prodded for medical tests, but making this a part of your routine could extend your life. Here are a few important screening examples for men:

• Check your blood pressure at least once every two years.

• Have an electrocardiogram or EKG starting at age 30.

• Complete routine lab work checking for high cholesterol, heart health, diabetes, kidney, or thyroid problems.

• If you feel stressed, anxious, or sad, ask your doctor to screen you for depression.

• If you are at risk of heart attack or colorectal cancer, talk to your doctor about taking aspirin every day to lower your risk.

• Have exams and screenings done for the most common kinds of cancer among men: Skin Cancer, Prostate Cancer, Lung Cancer, Colorectal (Colon) Cancer

Step 3: Good Nutrition

Food doesn’t just fuel the body; it can help ght o and prevent disease. To prevent all of the top disease killers of men, you need to avoid meals high in fat, sodium, and sugar. A healthy diet and regular physical activity can help lower blood pressure, blood sugar, cholesterol, and weight.

Step 4: Get Moving

It’s recommended adults participate in at least 150 minutes of moderate-intensity physical activity a week; 30 minutes of moderate activity per day. Physical activity helps you feel better, function better, and sleep better. It also reduces anxiety. Physical activity is a game changer for both physical and mental health!

Interested in more ways to improve your health? Join PTSMC in July for a Men’s Health event! Details coming soon.

(Reference: https://www.uspm.com/celebrate-mens-health-month/ )

PTSMC Happenings!

Putnam & Danielson celebrated PTA Cameron Walton’s engagement, PT Ashlee Peloquin’s birthday, and Administrative Professional’s Day for Melani Hayes (Danielson PSC) and Micaela Horne (Putnam PSA). Right photo: Putnam and Danielson stretched runners out at the Jog with Judy 5k.

Newington stretched runners out at the Newington Library 5k. Pictured: Janet Tarasuk (Practice Liaison) and Sean Doenias (PT).

JUNE

June 8 Newington

Cruising Newington

June 17 Watertown Watertown Block Party

JULY

July 12 Simsbury Open House!

July 16 Plainville Petit Foundation Road Race

July 19 Fair eld Fair eld Sunset 5k

for a sta

PTSMC clinicians attended the Orthopaedic Society Meeting, while PTSMC also had an exhibitor table for physicians. Pictured from left to right: Brian Greer (Glastonbury Partner), Janet Tarasuk, and Drew Gallagher (Southbury Partner).

Are you participating in an event?

Reach out to Emily.Fillion@ptsmc.com

Branford threw a baby shower for Partner Ted Razcka

Wallingford organized a Habitat for Humanity Volunteer Day. Pictured from left to right: Caroline Kregling, Kenny Kregling, Amanda Leiss, Andrew Perazella (New Haven), Elena Masiello, Michelle Kijewski, and Sam Zhu (Groton).

RACE TO THE WEEKEND WHEELS 5K

On April 29th, the Windsor clinic and Weekend Wheels teamed up for the inaugural Race to the Weekend Wheels 5k Run & Walk. Over $11,000 was donated to Weekend Wheels, a supplemental food program that helps feed children in need over the weekend! Assistant Director Mike McGowan spearheaded the race organization, and Windsor sta was there to assist and stretch runners out on race day. PTSMC sta also ran the race. Shout out to Amanda Leiss, Wallingford PSA for coming in 2nd for women! Congrats to the Windsor team on an amazing event!

LMDP met with guest speakers (from left to right in front row) Kristen Forster (Director of Operations), Karen Havlicek (Senior Human Resources Coordinator), and Steve Platt (Guilford Partner).

Back row pictured from left to right: Kenny Kregling, Shawn Nash, Je Lo, Natalie Swanson, Mike Durand, Colleen Menard, Pat Kinsella, and Sandy Wickman Mason

Did you miss the May monthly video?

President Alan Balavender discusses PTSMC’s new Advisory Board. He introduces the members and explains why he’s excited for this step.

Left photo:

Left photo: New Haven had a blast making pasta together

get-together. Right photo: New Haven stretched runners out at the Julia’s Run for Children race.

PTSMC HIGHLIGHTS

Social Media CATCH UP

BLOG POSTS

REEL

Shelby Pocius, Employer Services Specialist, was awarded a Kamatics DOERS Award! The DOERS award program is an internal program that Kamatics uses to recognize employees for Operational Excellence and in following their Core Values of Respect, Excellence, Accountability, Creativity, and Honor. Shelby was nominated by her peers at Kamatics. The award recognized her for taking great care of their employees, and speci cally for helping an employee with hand pain.

SoCIAl Media Sensation

PTSMC New Milford worked together to create the the baseball and softball performance and injury prevention blog post. They wrote information and recorded videos of exercises. Pictured: PT Colleen Menard demonstrating a stretch. Follow PTSMC on social!

Middletown celebrated their 5th anniversary! The team recreated a photo that Partner Mike Antunes originally took ve years ago. Congrats on ve years!

Congratulations to Jared Lynch, Data Analyst for achieving his MS in Public Policy and Christine Rasile, Senior Accountant, for achieving her MS in Accounting.

PTSMC Newington lmed a golf series on mobility and strengthening for golf performance. The videos feature Christina Mogelnicki, Director, and Noah Tedeschi, PCC.

PTSMC New Milford

Cameron Walton, Danielson PTA, married Michael Flanagan.

Congratulations PTSMC Graduates and New DPT Students!

Brianna Annunziato

Branford PT Aide

Graduated from the University of Hartford (UHART) with a BS in Health Science. She will be attending UHART’s DPT Program.

Maddie Archangelo

Fair eld PT Aide

Graduated from Sacred Heart University (SHU) with a BS in Exercise Science. She will be attending SHU’s DPT program.

West Hartford PCC

Graduated from Central Connecticut State University (CCSU) with a BS in Exercise Science.

Caidan Galovich

East Hampton PT Aide

Graduated from East Hampton High School. She will be attending the University of Delaware for Nursing.

Lauren Granato

Glastonbury PT Aide

Graduated from the University of Connecticut (UCONN) with a BS in Allied Health Sciences and a minor in Spanish. She will be attending Boston University’s DPT program.

Graduated from UCONN with an MS in Public Policy.

Isabella Matarazzo

Wallingford PT Aide

Graduated from CCSU with an BS in Exercise Science.

Nikki Matarazzo Wallingford PSC

Graduated from SHU with an AS in Radiography.

Graduated from CCSU with an MS in Accounting.

Ashley Cato, PT Aide Windsor, UHART

Anna Donato, PSC Essex, Belmont University

Aarohi Patel, PSC Avon, UHART

Alex Rostenberg, PT Aide Avon, UCONN

Amanda Warner, PT Aide Plainville, UHART

Christine Rasile Senior Accountant

Jared Lynch Data Analyst

Chrystina Dziala

Congaratulations to the following employees who are starting DPT programs!

Bri Boulerice, PT, DPT - Waterbury PT

Brittany Kearney, PT, DPT - Westbrook PT

Elena Masiello, PT, DPT - Wallingford PT

PICO Question: In adults ages 18-65 with hypermobility spectrum disorder (HSD) or Ehlers Danlos hypermobility subtype, what is the e ectiveness and safety of high intensity exercise compared to low or moderate intensity exercise on stability and self-perceived function?

Population: Adults age 18-65 with Ehlers Danlos syndrome (hypermobility subtype) or Hypermobility Spectrum Disorder (HSD). There are multiple subtypes of Ehlers Danlos syndromes (EDS) with di erent genetic presentations. EDS hypermobility is the most common. Common symptoms include increased joint range of motion, unstable joints, joint pain, and fatigue. This can often lead to joint subluxations and dislocations. See below for a list of EDS subtypes.4

Intervention:

Databases: CINAHL, PubMed, PEDro, Cochrane Database of Systematic Reviews, MEDLINE Complete, SPORTDiscus with Full Text Medline search strategy: [“Physical Therapy” or “exercise” or “high intensity”] AND ["Ehlers Danlos" or "EDS" or "Hypermobility Spectrum Disorder" or "HSD"]

Filters: past 10 years, all text, English Abstract Available

In order to ensure the most up to date research, we limited our search to only the past 10 years. In addition, due to the relatively limited number of studies available addressing this question, we used general search terms and all-text elds in order to capture as many relevant studies as possible.

Comparison: See conclusion below.

Outcome: A meta-analysis of randomized controlled trials, a systematic review or a single randomized control trial (RCT) would best address this question. The RCT study design allows for control of extraneous variables through the use of an experimental and a control group that are statistically homogeneous prior to the application of an intervention in order to conclude that any changes observed between the two groups is due to the independent variable. When analyzing a report of original research, it is important to analyze threats to internal validity including randomization, blinding, heterogeneity at baseline, adequate follow up, intention to treat with reason given for drop-outs, instrument calibration techniques, and standardized data collection protocols. Additionally, it is important to analyze external validity to determine if your patient case is represented in the study population.

Sub-types of Ehlers Danlos: classical EDS, classical-like EDS, cardiac-valvular EDS, vascular EDS, arthrochalasia EDS, dermatosparaxis EDS, kyphoscoliotic EDS, brittle cornea syndrome spondylodysplastic EDS, musculocontractural EDS, myopathic EDS, periodontal EDS.4

Liaghat B, Skou ST, Søndergaard J, Boyle E, Søgaard K, Juul-Kristensen B. Short-term e ectiveness of high-load compared with low-load strengthening exercise on self-reported function in patients with hypermobile shoulders: a randomised controlled trial. Br J Sports Med. 2022 Jun 1;56(22):1269–76. doi: 10.1136/bjsports-2021-105223. Epub ahead of print. PMID: 35649707; PMCID: PMC9626913.

A randomized controlled trial performed in 2022 by Liaghat, et al. investigated the short-term e ectiveness of high- versus low-load strengthening exercises on self-reported function in 100 patients ages 18-65 with hypermobility spectrum disorder (HSD), particularly involving the shoulder joint. There is currently no clinical practice guideline for advising loading patterns for this population and thus clinicians tend to be wary of prescribing higher load exercise programs for fear that this may result in safety concerns for the patient. Liaghat, et al. (2022) found that patients with HSD (Beighton score ≥ 4 for men of all ages and women ≥ 50 years, and≥ 5 for women < 50) could tolerate a 16-week high-load shoulder strengthening program, and this resulted in higher self-reports of shoulder functionality. Groups were randomized using a computer-generated system with block randomization set up by an external data manager, thus blinding the assessors, however it was di cult to blind the subjects or therapists due to the nature of this study. Visit the original study above for links to speci c intervention outlines provided to therapists.

The HEAVY intervention group received one-on-one treatment twice per week and were encouraged to train once per week at home. Patients were brought through a ve minute warm-up involving unloaded exercises. Five exercises were then used for scapular and RTC training: side-lying external rotation in neutral, prone horizontal abduction, prone external rotation at 90° shoulder abduction, supine scapular protraction and seated scaption. Loads were based on patients’ ve-repetition maximum to replicate a similar load for each participant. The rst three weeks of the study served to familiarize patients with the program and consisted of the following: 3 sets of 10, week 1 at 50% of 10 RM, week 2 at 70% of 10 RM, week 3 at 90% of 10 RM. Weeks 4-9 included 3 sets of 10 RM, weeks 10-15 included 4 sets of 8 RM, and week 16 was used as a taper period to allow anabolic response to occur prior to retesting.

The LIGHT intervention group (comparator) was designed to be a “typical” course of PT treatment for this condition in Denmark, including primarily self-training exercises performed 3x/week. Patients received individual training initially to orient to the exercise program and then again at weeks 5 and 11 when new exercises were introduced. Exercises included nine shoulder exercises: “phase 1 (isometric), posture correction; phase 2 (isometric), shoulder abduction, shoulder internal and external rotation with 90° exion at the elbow joint against a wall, and standing weight-bearing in the shoulders against a table; and phase 3 (dynamic with a yellow Theraband), shoulder abduction, shoulder internal and external rotation at 90° exion at the elbow joint and four-point kneeling with single-arm raising.”

Self-reported function was assessed using the following outcome measures / questionnaires: WOSI, COOP/WONCA, Tampa Scale of Kinesiophobia, European Quality of Life Scale, EQ-VAS, GPE, etc.. A statistically signi cant relationship (8/3% greater) was found between higher intensity exercise and self-reported function versus the light intensity group at 16-week follow-up. Patients in HEAVY were also found to have a less positive shoulder rotation, indicating improved stability of the shoulder joint.

This RCT yielded a PEDro score of 8/10, indicating good validity. [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been con rmed*.

Daman, M., Shiravani, F., Hemmati, L., & Taghizadeh, S. (2019). The e ect of combined exercise therapy on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome: A randomized clinical trial. Journal of Bodywork and Movement Therapies, 23(1), 202–205. https://doi.org/10.1016/j.jbmt.2017.12.012

A randomized clinical trial was performed in 2019 by Daman, et al. examining the e ect of combined exercise therapy on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome. This single blind study placed 24 participants into two groups, intervention (exercise therapy) or control group (no intervention). The exercise therapy group included closed kinetic chain exercises and proprioception exercises. Exercise sessions were completed three days a week for four weeks. Measurements of knee proprioception, pain intensity and quality of life were taken before and after the intervention. The study concluded that combined exercise therapy led to a signi cant improvement in all three categories when compared to the control group. The study included 24 women 18-30 years old diagnosed with hypermobility syndrome and who all attended associated physical therapy clinics. A computer randomly placed the patients into the two groups. Exclusion criteria included: women who already exercised three times a week or more, history of knee trauma, history or RA or knee OA, knee ligament injury, knee arthroplasty, neuromuscular or musculoskeletal disorder. Data was not recorded when any of the patients were at the beginning of their menstrual cycle due to increased hormone release which can increase joint laxity. Pain intensity, quality of life and proprioception were measured using the VAS, SF-36 and a goniometer. One physical therapist supervised all the patients and another blinded therapist evaluated them.

Exercise therapy was completed three times a week for four weeks. The rst week included squatting, bridging and plie one set of ve each, 30 seconds each of walking backwards, heel walking, walking on toes, walking with eyes closed, standing on one leg, and bending back and forth on one leg with eyes closed and then with eyes open. The second week included squatting, bridging, plie one set of ten, front and side lunges one set of ve, ten sit to stands and all of the walking and standing exercises from week one for 30 seconds each. Week three included everything from week two in addition to slow eight exercises (slow walk broad circle, fast walk broad circle, slow walk narrow circle, fast walk narrow circle) ve times each. The last week included squats, bridges, and plies two sets of 15, front and side lunges two sets of ten, ten sit to stands, ve sets of the fast eight exercises and 30 seconds each of backwards walking, heel walking, toe walking, walking with eyes closed, standing on one leg, bending back and forth on one leg with eyes closed and eyes opened.

Power analyses were performed to determine sample size for each group which was 12 women based on an 0.05 alpha value, 80% power and 0.2 beta value. The Shapiro-Wilk test was used to assess data normality and found data was normally distributed other than joint angle repositioning in weight bearing so this was assessed using nonparametric tests. The Mann- Whitney was used to compare angle error and paired t-tests and independent sample t-tests were used for within group and between group di erences of pain intensity, quality of life and joint angle repositioning in non weight bearing. This article scored a 5/10 PEDro score due to not including concealed allocation, blind subjects, blind therapists, an adequate follow up or intention to treat analysis.

Previous studies have looked at exercise over eight weeks and had similar results. This study showed that combined exercise in four weeks leads to improvement in proprioception which has a crucial role in joint stability, decreased pain intensity, and increased quality of life.

Luder, G., Aeberli, D., Mebes, C.M. et al. E ect of resistance training on muscle properties and function in women with generalized joint hypermobility: a single-blind pragmatic randomized controlled trial. BMC Sports Sci Med Rehabil 13, 10 (2021).

https://doi.org/10.1186/s13102-021-00238-8

This randomized control trial included 51 women between the ages of 20 and 40 with generalized joint hypermobility. This was operationally de ned by the authors as a Beighton score of at least 6/9. The subjects were randomly allocated to a 12-week resistance training group or a no lifestyle change group. The resistance training group program was mainly self-guided and completed two times per week. Inclusion criteria included: score of at least 6/9 points on the Beighton score (with right knee hyperextension being mandatory), body mass index between 18 and 30 kg/m2, and ability to understand German questionnaires. Exclusion criteria included: women who had surgery of the lower extremities or spine in the last two years, women with acute back pain or lower extremity pain, women who regularly undertook more than four hours per week of exercise, pregnant women, women less than one year postpartum, and women with known inherited diseases of the connective tissues (except Ehlers-Danlos hypermobility type). Participants were randomized using a computer-generated list. The assessor and statistician were blinded to the randomization list.

The intervention group engaged in two training sessions lasting approximately 50 minutes each for 12 weeks focusing on the lower extremities and the trunk. Resistance was mainly set at 80% one repetition maximum and three sets of 12 repetitions for each side were performed. One repetition maximums were determined at the start of the study and reassessed and adjusted at week 3 and 6. Participants were encouraged to increase the resistance whenever more than 12 repetitions was possible. Performance of more than 80% of the training sessions was considered acceptable adherence. Four participants stopped their training early and this was well documented. Two women dropped out due to lack of time. One person stopped after a knee injury not associated with the training and once due to an exacerbation of low back pain. This was classi ed as an adverse event. The patient was diagnosed with a lumbar disc hernia and underwent surgery. It was unclear if this exacerbation of pre-existing back problems was impacted by resistance training.

A power estimation was completed to establish the needed sample size. An intention-to treat analysis was performed for all participants who did not complete the study. Normal data distribution was assessed using the Shapiro-Wilk test and Q-Q plotting prior to selecting parametric or nonparametric tests. Independent t-tests were used to assess homogeneity at baseline. Any variables with signi cant t-test at baseline were handled with use of the ANCOVA and subsequent post hoc analysis using the Bonferroni correction. The primary outcomes of the two groups were analyzed using ANOVA.

Outcomes included muscle strength, muscle mass, muscle density, functional activity, pain and disability. No signi cant di erences between the groups due to the intervention was found for any of the outcomes measured. The authors hypothesized low resistance levels in addition to choice of outcome measures as possible reasons. The mean resistance during training in the single leg press at the end of 12 weeks was only 83.5% of body mass. Additionally, the authors discuss 2 training sessions per week may have been inadequate volume to produce strength and function changes. Lastly, the authors concluded the groups in the study may have been too heterogenous at baseline.

This article yielded a PEDro score of 8/10, indicating good validity. [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes.]

Conclusion

Overall, our literature search suggests that, although the research on this topic is very limited, it seems as though higher intensity exercise is safe and e ective in promoting improved function and decreased hypermobility in the short-term than lower intensity exercise. Limitations for our search included: two of the studies only included female patients and thus cannot be generalized to the whole population of patients with EDS/HSD, it was di cult to blind patients or therapists to treatment allocation, one study did not have adequate follow up or intention to treat analysis, and one study had heterogeneity between groups at baseline. Additionally, one study reports an adverse e ect, but it is unclear if this was due to resistance training. Moreover, this occurred in the study where authors hypothesized the exercise intensity was too low resulting in non-signi cant outcomes between the experimental and control group, so it is unlikely the exercise intensity contributed to this adverse e ect. All three of the studies chosen were randomized controlled trials, which is characterized as type I or type II evidence.

References

1. Liaghat B, Skou ST, Søndergaard J, Boyle E, Søgaard K, Juul-Kristensen B. Short-term e ectiveness of high-load compared with low-load strengthening exercise on self-reported function in patients with hypermobile shoulders: a randomised controlled trial. Br J Sports Med. 2022 Jun 1;56(22):1269–76. doi: 10.1136/bjsports-2021-105223. Epub ahead of print. PMID: 35649707; PMCID: PMC9626913.

2. Daman, M., Shiravani, F., Hemmati, L., & Taghizadeh, S. (2019). The e ect of combined exercise therapy on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome: A randomized clinical trial. Journal of Bodywork and Movement Therapies, 23(1), 202–205. https://doi.org/10.1016/j.jbmt.2017.12.012

3. Luder, G., Aeberli, D., Mebes, C.M. et al. E ect of resistance training on muscle properties and function in women with generalized joint hypermobility: a single-blind pragmatic randomized controlled trial. BMC Sports Sci Med Rehabil 13, 10 (2021). https://doi.org/10.1186/s13102-021-00238-8

4. EDS Types. The Ehlers-Danlos Society. Copyright 2023. Accessed February 11, 2023. https://www.ehlers-danlos.com/eds-types/