March 2019 PULSE

MARCH 2019

IN THIS ISSUE

Clinician’s Corner by Ashley Tighe Subacromial Pain: Is Decompression Surgery Outdated?

LIFELONG RELATIONSHIPS It feels like a lifetime ago when I went to PT school at Quinnipiac College, home of the Braves! “Back in the day,” you could become a physical therapist in four years. Things change! Over the years, the profession has transitioned to a doctoral program, the “Brave” became a more politically accepted Bobcat, the college became a university, and the admission standards have evolved to the point where I would have never even been admitted…

Since I started with PTSMC there has always been a loose connectivity to QU. We have welcomed students, employed many aides who are in PT school, and can proudly point to great clinicians and partners who are alumni.

In the last several years the roots have grown stronger and deeper. PTSMC’s connectivity to the faculty has blended to the point where some of QU’s have become some of ours and visa-versa. Todd Cacopardo, Michelle Kijewski, Ken Kosior, Duane Scotti, and Russ Woodman have enjoyed being part of both organizations.

Recently more opportunities have begun to emerge. My colleague, Katherine Harris, who has been at QU for many years, earned the leadership role in QU’s PT program, and Ken Kosior accepted a full professorship.

They reached out to me based on our professional relationship and, more importantly, PTSMC’s reputation as the “go to” organization for outpatient care in Connecticut. I was humbled and proud when Mike Durand and I sat with Kathy Harris and Ken Kosior and they said, “We have so many students

with you as aides, affiliates, and ultimately employees who love to be part of your culture. We want to build a stronger and more formal relationship.”

That initiative is now in motion. As of a month ago, we are in discussions to create a defined student pathway to include one day I.C.E. – Integrated Clinical Experiences – with every QU PT student at a PTSMC location.

With Juliann Chacko’s help, we are also in the process of clearly defining a “student pipeline”, a plan and process in which PTSMC will accept a prearranged number of students from the PT school at set intervals over the next several years.

In return, PTSMC helps develop great talent and cultivates potential employees. We are also exploring “co-hosting” continuing education courses, combined leadership programs, and access to QU’s faculty and facilities. Ultimately, we envision a strong partnership we can all benefit from.

Thank you for making PTSMC one of the mostly highly respected private practices in Connecticut – one that attracts the very best PTs in the business. We earn our reputation every day based on what each of you deliver to those we serve and look forward to cultivating more young talent who can follow in your footsteps.

Great job!

Alan

Valentine’s Day Poem Winner - Wallingford!

Congratulations to Wallingford for winning the Valentine’s Day Poem contest! We love that their poems were about the benefits of PT as well as the life-long relationships formed at PTSMC! They won a special Valentine!

Techy Tips from Kristen Forster 5 Reasons It’s Important to Update Your Software Regularly PTSMC Wellness Program Join us for the March meet-up Learn how you can win a $100 prize Get answers to common questions in the HR Buzz!

Lauren Peladeau is this month’s employee spotlight! Learn more in a new video.

PTSMC is implementing a password expiration policy on March 6th. Keep an eye out for more information!

MAY 11, 2019

Get Together for the 6 pm Hartford Yard Goats Game! More info to follow.

StriveHub Fab 5

“From check in to check out it’s an easy process. The staff are professional, courteous, caring and very eager to help everyone feel better. I switched from a big corporate office to this office and what an incredible difference! Highly recommend.” - Groton “Outstanding physical therapists! The engaging and helpful PT Aides give patients assistance and attention. My PT explained everything in detail and made me feel comfortable and confident that I could push myself.” - Windsor “My therapist is an excellent listener. She takes the information, does a thorough assessment, and developes a dedicated therapy plan specifically for me. My program has been very successful. I highly recommend Ann (Hall) in Essex.” - Essex

Right (with Ashley Tighe): Roses are red, Violets are blue, If it wasn’t for physical therapy, I wouldn’t have met you!

“Mike (Lynch)’s positive attitude, encouragement, and professionalism inspire my son to work toward his goal of recovering from a sports-related injury.”

- Naugatuck

Thank you to everyone for sending us your poems! Check out all of the photos on our Facebook page.

“Mary Clark is excellent. I leave with better posture and alignment, plus confidence to work on the exercises at home.” - New Haven

Left: Roses are red, Violets are blue, Thanks to my PT, My back feels like new!

CLINICIAN’S CORNER Subacromial Pain: Is Decompression Surgery Outdated?

Subacromial pain and subacromial impingement is one of the most common disorders of the shoulder, being referenced to account up to 65% of all shoulder complaints.1 Subacromial Impingement (SAI) is an umbrella term for numerous pathologies including: partial rotator cuff tears, calcific tendinitis, subacromial bursitis, and tendinosis.1 Main signs and symptoms of SAI include: +Neers, +Cross Body Test, difficulty with overhead activity, and anterolateral acromion pain spreading to lateral humerus. Through cadaver studies, it has been identified that this impingement occurs due to the limited space between the head of the humerus and the undersurface of the acromion which typically lies within 7 and 14 mm in “healthy” asymptomatic shoulders.1,2 Specific extrinsic factors that can cause SAI include anatomical factors and biomechanical factors. The shape of the acromion itself is the main contributing extrinsic factor.2 There are three types of acromion shapes: Type I Flat, Type II Curved, or Type III Hooked.3 The coracoacromial ligament can also become thickened causing narrowing of the joint space. Biomechanically, if the humeral head has excessive superior translation with motion, or if abnormal scapular motions causes the acromion to move inferiorly, SAI will occur.2 Due to these extrinsic factors, exercise with emphasis on RTC strengthening is recommended as the first line of defense, followed by activity modification and cortisone injection.2 However, if treatment is unsuccessful within three months, there has been documented research showing a push towards subacromial decompression surgery (SAD). In fact, in the UK alone, over 21,000 subacromial decompression surgeries are completed each year, and the rate of this surgery has increased fivefold over the past two decades.2 What are we as therapists accomplishing within this three-month time span before surgeons are pushing patients towards surgery? Land, Gordon, and Watt conducted a randomized control trial published December 2018 in Physiotherapy Research International exploring the effect of manual therapy on SAI.3 They completed a double-blinded RTC of sixty participants aging between forty and sixty years old with at least three of five positive orthopedic signs: Hawkins and Kennedy, Neer, external rotation resistance test, rotator cuff tendon palpation, and cross body adduction.3 Participants were randomized into an: active control group who received ultrasound for six weeks, an intervention group complete upper thoracic mobilizations for six weeks with a daily HEP over a twelve week period, and an intervention group receiving soft tissue mobilization of posterior shoulder for six weeks with posterior shoulder home stretch program over a twelve week period.3 All therapy was performed by one of two therapists involved with the study, and outcomes were taken at three, six, nine, and twelve weeks with a six month follow up email.

Results revealed no differences in participants at baseline with both intervention groups significantly decreasing pain, improving functional outcome scores, and increasing posterior shoulder AROM compared to control at twelve weeks; however, neither treatment group showed a significantly greater benefit in comparison.3 Email follow up at six months revealed continued decrease in pain and increase in functional outcome scores within both

BY ASHLEY TIGHE, PT, DPT WALLINGFORD

treatment groups.3 This RTC provides evidence that manual therapy coupled with exercise has the power to address extrinsic causes of SAI and improve function and pain outcomes.

British Journal of Sports Medicine published a meta-analysis in December 2018 which analyzed numerous trials and studies comparing SAD surgery versus placebo surgery.2 This meta-analysis explored over a thousand patients between the ages of forty-three and fifty-nine years old.2 Lahdeoja, et al. explored pain, physical function, and quality of life as their main outcomes as prognosis of patient recovery.2 Their main eligibility criteria for selecting specific studies was RTC trials comparing SAD versus any other form of treatment including manual, exercise, and placebo.2 Eighteen publications with nine different trials were considered for this analysis, where two trials compared SAD to placebo and five trials compared SAD to exercise and manual therapy. Analysis results revealed with high certainty no clinical benefit with respect to pain, function, or quality of life outcomes at six months or a year following SAD surgery.2 Lahedoja, et al. also discovered that there was not significant evidence to suggest surgical participation benefiting patients’ participation in sport or work activities six months following surgical date.2 Of note, this meta-analysis also discovered that in Brox, JI trial research patients continue to report an average pain of 1.5-3/10 on the visual analogue scale five years follow up irrespective of treatment provided.2 Thus, even surgery isn’t able to get our patients completely pain and symptom free.

We must consider this updated research when working with our SAI patients.

Consider the risks associated with a subacromial decompression surgery: blood vessel damage, chronic shoulder pain, infection, nerve damage, hematoma, rupture of biceps tendon, and acromion fracture.4 Reflect on the psychological toll many patients undergo when they agree to “go under the knife.” Are we failing our patients by not stressing the importance of a conservative approach followed by specific compliance to their specific HEP? Is there more education we can provide our patients with regarding therapy and surgical outcomes and the risk of chronic pain associated with SAI? Is it more important to stress a patient’s progress in AROM, strength, and activity participation rather than focusing on their pain? Can we provide our patients with better self-management techniques, activity modifications, and coping mechanisms in order to provide them with a better overall quality of life? You decide.

1. Umer M, Qadir I, Axam M. Subacromial impingement syndrome. Orthopedic Reviews. 2012; 4 (2);18. doi:10.4081/or.2012.e18.

2. Lahdeoja T, Karjalainen T, et al. Subacrominal decompression surgery for adults with shoulder pain: a systematic review with meta-anlysis. Br J Sports Med. 2019; 0:1-10. doi:10.1136/bjsports-2018-100486.

3. Land H, Gordon S, Watt K. Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: a randomized controlled trial. Physiotherapy Research International. 2019; 2. doi:10.1002/pri.1768.

4. Ojedapo Ojeyemi, M. Shoulder decompression surgery: recovery, risks, and complications.

Sports-health. Available at: https://www.sports-health.com/treatment/shoulder-injury-treatment/shoulder-decompression-surgery-recovery-risks-and-complications. Accessed 19 Feb. 2019.

UPDATES

- OUT IN THE COMMUNITY THIS MONTH -

PTSMC Continued Education course reminder

STUDENT PROGRAM UPDATE

We’ve been pleased to host the following four students for their clinical affiliations in Wallingford, Orange, Waterbury and Watertown respectively. Each will complete their time with PTSMC by presenting an in-service or completing a final project.

We have recently finalized some of our internal courses for the Mentorship Program, which you will see below. As a reminder, these internal courses are required for clinicians in the Mentorship Program and are Kathleen Barry (Quinnipiac University) will present on “Cervical & Thoracic SNAGs” on March 7th from 12:00 open to all PTSMC clinicians.

– 1:00 pm at the Wallingford clinic.

To adjust your schedule for the day of a course, you have three options: 1. Work your regular shift 7 am - 3:30 pm and then attend the course.

2. Work 4 hours on the day of the course and use 4 hours of continued education time.

3. Work 4 hours on the day of the course and make up 4 hours during the week.

Jacob Ciolino (Washington University) presented on“Movement Based Methodologies - Developing a Systematic Plan for Patient Care” on February 20th at the Orange clinic.

Zachary Kaplan (Stonybrook University) will present on"Theory and Demonstration of Functional Range Conditioning” on March 3rd at the Waterbury office.

As her final project, Megan Manzo (Scranton University) is creating a PT Aide training program for Watertown new hires.

2019 Courses Email coned@ptsmc.com to attend

September 28-29 PTSMC Guilford Therapeutic Neuroscience Education: Teaching People About Pain Clinicians $475

March 27, 4pm - 8pm PTSMC Branford Lumbar 1 | Mike Gans Internal Email4coned@ptsmc.com April 30, pm - 8pmto register PTSMC West Hartford TNE | Therapist Tom Kassan Physical Internal Avon

October 12-14 Sacred Heart University Myopain TDN 3 Clinicians $1,095

Newington (part-time) May 17-19 Southington

Sacred Heart University Myopain TDN 2 Clinicians $995

* Cost is subject to number of participants, meals and any additional instructor expenses

Beginner Mat Pilates at PTSMC Southington!

Tuesdays at 7:30 am 45 min. classes | $15 for a single class 10 class package for $135 (10% savings)

Designed for those new to Pilates. Participants will learn fundamentals upon which to build. Classes will focus on basic movements of the Pilates method. The exercises are done on a mat using body weight as resistance, which makes it low impact and gentle on the joints. The class will focus on proper body alignment and movement, good posture, and core strength and stability.

Register online, by phone, or in person. Learn more at www.PTSMC.com/pilates-class

Taught by certified Pilates instructor Sara Miller, PT Aide in Southington

Saturday, March 2nd at 9 am Groton at Hare Hop 5K in Mystic Wednesday, March 13th at 1 pm Mike Lynch presenting “Is Your Back Out of Whack?” at Prospect Senior Center Wednesday, March 20th at 11 am Lauren Peladeau presenting “PT for Pain Management” at the Groton Senior Center Thursday, March 21st at 2 pm Mike Antunes presenting ”Oh My Aching Joints” at Middletown Senior Center Sunday, March 24th at 8 am Waters Region at Shamrock Shuffle

Techy Tips

By Kristen Forster 5 Reasons It’s Important to Update Your Software Regularly

Getting an alert to update operating systems and computer software always seems to happen at the worst times. Most likely, you’ll put off downloading the latest updates for your computer until the next day, week, or even month.

To help you gain a better understanding into the importance of updating your software, here are 5 vital things you may be overlooking.

Hackers are more active than ever The main reason anyone has for downloading and installing the latest update is to stay protected from security threats.

Older software will continue to have the same bugs and exploitable holes in the code that allow hackers and cyber criminals to cause trouble. This is made even more serious by the fact that all of these exploitable entry points have generally been made public after the release of updates!

Your documents are at risk without latest updates When you consider how nearly everything is stored digitally, your documents suddenly seem far more at risk than ever before. Certain malware can actually wipe your documents as well as transmit it from your computer to a remote server.

Your automatic updates may have been disabled Believe it or not, hackers do have the ability to turn off your antivirus software remotely. Additionally, you could face an inside attack and have your antivirus software turned off manually. This could end up being extremely serious as it would mean hackers have easier access to your computer while also having the ability to roam freely. This is a great motivational reason to check for the latest updates as you’ll always have peace of mind when it comes to this type of attack.

You could pass on malware to friends and colleagues if your computer is infected Installing the latest software update for your operating system and antivirus program will allow you to get real-time alerts when you receive dangerous files, emails, and attachments. Depending on the severity of the attack, you could save yourself some explaining as well as any costs for damages.

You’ll miss out on new and exciting features Thankfully, software updates don’t all revolve around doom and gloom as developers are always working to improve functionality on all kinds of apps. From the moment an app is released, developers are constantly adding new and improved features to make the end-user experience that much better!

HUMAN RESOURCES D4Ds and Goals and Objectives

Next Accrual Tier Change: Date you will move into the next vacation tier accruing additional hours Used: Hours you have used to date and does not include future hours requested and approved.

Balance: Hours balance as of current date Reset Date: Date your vacation hours reset to zero. You need to use all your vacation hours by this date or you lose them Remaining Accrual: Hours remaining that you will be accruing before your reset date

The 2018 D4Ds and 2019 Personal Goals and Objectives deadline of March 1st is here!

Employees D4Ds and Goals and Objectives will be scanned into Human Resources.

Questions and Answers

To view Login to Paychex Flex and click on

Q. How many vacation hours do I have left before I lose them?

A. Balance + Remaining Accrual Per the example: 21.23 + 50.77= 72

Common Vacation Questions

Q. What is my total accrual for the year?

A. Accrued Hours + Remaining Accrual Per the example: 69.23 + 50.77 = 120

Under Personal Information click onBelow are some common vacation questions and answers. To find the answers follow these steps: • In Time and Attendance Click on the Time Off icon

• The following will display

Q. When do I lose my vacation hours?

A. On your Reset Date.

Per the example: 7/24

Q. What days have I used vacation hours in my accrual year?

A. You have 2 options to view.

• View under Request Status • Click on View Calendar in the top right hand corner to view the calendar showing the days requested and hours used.

Definitions of Headers: Accrued: Hours you have accrued to date Granted: Hours you have been granted to date (0 will appear during probation period)

MARCH BIRTHDAYS Dan Delgado Donna Baribault Lindsey Scianna Renee Gallant Alison Pearce Maggie Oumov Bailey McPherson Joanna Fisher Sylvia Yanez-Carlson Tommy Kirsch Zack Currie Sara Miller Katie Newton Danielle Jaffer Nancy Chilson Mikayla Raffone Shelby Howe Leah Pfrommer Jenna Bouffard Mary Wojtowicz Heather Feiner

1 1 1 3 4 6 7 7 8 8 12 13 14 15 16 17 18 20 21 22 24

Windsor Admin Watertown New Haven Admin Branford Guilford Waterbury Watertown Avon Guilford Southington Newington Southington Avon New Haven Avon Westbrook Watertown Westbrook Admin

Max Erwin Brooke Uliano Dominique Riley Mary Coletti Stephanie Brilla Ted Raczka Gabby Didiano Janelle Berry Linda Easterling Bill Chapin Gabby Verrilli

25 26 26 26 26 26 27 27 29 30 31

Plainville Wallingford Orange Westbrook Southington Branford Wallingford Wallingford New London Branford Naugatuck

ANNIVERSARIES Admin

Patient Benefits Advisor

Bryan Baker Jillian Cristaldi Shelby Howe

Westbrook Newington Avon

Physical Therapist Physical Therapist Physical Therapy Aide

RY! We mistakenly forgot to include Emily Searle in the attendance reward for the 3rd and 4th quarters of 2018.

R E SO

’R

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Donna Baribault

EMPLOYEE NEWS

NEW EMPLOYEES Welcome to PTSMC. We’re so happy to have you!

Maggie Oumov PT Aide Branford

Shannon Judd PT Aide Branford From left to right:

Shannon Harrell - PT Aide Orange Madeline Lynch - PT Aide New Haven Josh Ogunmwonyi - PT Aide Southbury Nicole Perrin - PT Aide Southbury

CURRENT JOB OPPORTUNITIES AT PTSMC

Physical Therapy Aide Essex Naugatuck Southbury Auditor (20 Hours/Quarter) Southington Admin - this is open to current PTs Windsor Check PTSMC.com for our most up to date postings and feel free to share! We’re always interested in connecting with referrals of colleagues and friends.

Call Karen if you are interested in a position.

Physical Therapist Avon Newington Southington

Jenn Detlefsen (Admin) welcomed baby boy Kyle on February 5th.

Patient Services Coordinator West Hartford

Meagan Hoffman (Westbrook) welcomed baby girl Adalynn on February 15th.

Lauren Mariotti (Watertown) got engaged to Tony.

PTSMC Happenings

Naugatuck said goodbye to Kayla Thomas, who left to pursue her dreams in Texas!

Steven de Castro and Lauren Peladeau of Groton attended the Groton Senior Center’s “Souper Bowl.”

New Milford wore red to raise awareness for American Heart Month!

Groton celebrated Valentine’s Day by hosting a Patient Appreciation Day.

Social Media Sensation!

Channing Harwood of Plainville and Sara Miller of Southington attended Healthy Family FunFest.

New Haven met up with Ted Raczka, Branford Partner & Director, for happy hour.

Employee Spotlight This month’s employee spotlight is on Lauren Peladeau, PT, DPT of Groton! View the video at www.ptsmc.com/videos.

Rob Bass, PT in Southington

Rob Bass is our float PT, but he’s currently working out of Southington! Since working there, he’s shared a ton of photos! On the left is PT Aide Sara Miller teaching her Pilates class to Rob and Pete Cambi.

On the right is a picture of of the gifts Southington handed out to patients on Valentine’s Day!

MARCH WELLNESS MEET UP! Saturday, March 30th 10:30 - 11:30 am Join us for a walk or run at the West Hartford Reservoirs (1-5)!

Email Mal at wellness@ptsmc.com if you have any questions or would like to attend. The entrance is at 1420 Farmington Avenue in Farmington!

This counts as a #GetMoving workout!

g

in v o M Get

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challenge

Think you can be the most active PTSMC employee for 2 months?! Can your office be #1?!

Join the #GetMoving Challenge NOW! What is #GetMoving?

• Physical activity & social media based competition from March 18th – April 28th • Post or email proof of 3+ activities of at least 30 min each week (6 weeks = 18 total workouts!)

• One week = Monday -- Sunday • Examples of activities are: walking, shoveling, dancing, running, workout class, lifting, dancing etc!

• Anyone who completes 100% of the challenge will receive a prize pack

#GETMOVING

Life Beat

Cauliflower Parmesan Crisps Prep Time: 30 minutes Cook Time: 17 minutes Total Time: 47 minutes Servings: 4 (Makes 12-13 pieces)

Ingredients • 3 lb head of cauliflower (1 average head of cauliflower) • 3/4 cup fresh grated Parmesan cheese • 1 tsp garlic powder • 1 tbsp dry parsley Instructions 1. Preheat the oven to 425°, and line a large baking sheet with parchment paper.

2. Cut cauliflower florets off the stem.

3. Steam cauliflower florets until tender.

4. Place steamed cauliflower florets in a food processor and pulse a few times until it looks like fine crumbs and chunk free.

5. Allow to cool a bit then transfer cauliflower crumbs in a doubled cheese cloth, dishtowel, or colander, and squeeze out all the liquid.

6. Place cauliflower in a mixing bowl and add Parmesan cheese, dry parsley, and garlic powder. Mix until all evenly incorporated.

7. Use a cookie scoop to scoop out cauliflower "dough."

Roll into a ball with your hands and place it on the baking sheet.

8. Press down to flatten the "dough" into a thin disk, fixing the broken edges.

9. Bake for 15-17 minutes, until golden brown.

10. Let the cauliflower crisps cool before taking them off the baking sheet. Use a spatula to gently scoop them up, then enjoy!

Register by March 15th by emailing wellness@ptsmc.com!

How to Log Your Activity 1. Post on Facebook by “checking in” or tagging Physical Therapy & Sports Medicine Centers.

2. Post on Instgram using #GetMoving and tag @ptsmc. *Tags in Instagram stories WILL count this year. Be sure to tag us!

3. Tweet your workout using #GetMoving and tag @ptsmc.

4. E-mail your workouts to wellness@ptsmc.com. If you’re using e-mail to log your workouts, you must send at least one photo per week.

If you have any questions about the challenge, email wellness@ptsmc.com or contact Emily Fillion or Mallory Mason!

Office Challenge Any office whose participants all complete 100% of the challenge will receive a healthy reward!

Weekly Competition Choose someone in your office to perform/complete the weekly challenge for #GetMoving bragging rights. Example: Who can do the most pushups in 30 seconds! The weekly challenges will be coming from Mal. Send your video to getmoving@ptsmc.com.

Individual Winners Each winner will receive a $100 prize!

1. Most logged workouts 2. Most workouts posted to social media 3. Most creative social media posts