November 2022 PULSE

FALL MANAGEMENT MEETING

October 20th kicked o PTSMC’s Annual Fall Management Meeting. The event is an opportunity for PTSMC’s leadership to gather and collaborate for an extended period of time to focus on making our organization a better place for our people and those we serve.

I always get to the meeting early because I enjoy watching our people reconnect with each other. The energy, the laughter and the joy are palpable!

Highlights of the meeting included time spent with administrative leaders. Our most impressive guest presenters were our very own! Juliann Chacko on the student program, Danielle Dunn on clinical excellence and Melissa Boutagy on clinical compliance.

We also did a “Cracker Barrel” activity where partners and directors spent time with administrative leadership from di erent departments. The activity is designed to focus twenty minutes on one topic in a small group and move on.

• Sandra Boccialetti (Human Resources) discussed retention strategies.

• Kristen Forster (Operations) concentrated on remote services.

• David Lawrence (Information Technologies) discussed security and devices.

• Sara Gareiss (Practice Liaisons) facilitated conversation around the expanded role of practice liaisons.

• Marilex Santiago (Diversity, Equity, Inclusion) helped everyone to understand the nature of bias.

• Ryan Balavender (Facilities) explored the best practices to maximize clinical space.

We also spent an hour viewing a technology-based presentation with an outside vendor. The basic premise is that technologies exist and are rapidly expanding in the healthcare space with the goal of “leveraging” human talent. Companies that are willing to embrace some of these changes will be more e ective and e cient in the future.

We also spent time discussing and revising our incentive programs. Incentive programs impact almost everyone at PTSMC and are challenging to design and administer. We are taking steps to make our measures easier to understand, pay with more frequency and are achievable. Our goal is to provide a system that is fair and transparent.

A large block of time was spent taking a look back and a look forward. Leadership was reminded of and reviewed our ve-year plan created at year end 2017. At that time, we challenged ourselves as an organization to “double in ve years.”

The measures that most easily translate to a successful and growing physical therapy company are new patients and visits. They are the drivers of virtually everything else. At year-end in 2017, PTSMC cared for 15,204 new patients and provided 174,480 visits. At the time, it was our best year ever!

In order to achieve our goal of doubling by the end of 2022, PTSMC needed to grow an average of 14%, year over year, for ve straight years. We had never set a ve-year plan and I remember thinking about all the people, processes and small victories this plan required to have any chance at being real. This was a bold plan for us.

How did we do?

In the past ve years PTSMC has added eight new locations via start up and an additional four clinics through acquisition. Our continued growth allows us to “improve the quality” of more lives in all the communities we serve. In addition, a healthy PTSMC creates greater opportunities for our people to learn, grow and take on new responsibilities and positions.

Despite going through an unplanned pandemic, when we project forward to the end of 2022, it looks like we will be very close to our 2017 goals. We are projected to end the year 0.6% short of our new patient goal and 0.1% shy of our visit goal! Come December 31st, we expect to serve 30,408 new patients (-197 from double 2017) and provide 348,960 visits (585 short of double 2017).

After absorbing this success story, we spent time visioning the next ve years: What does PTSMC look like in 5 years? What three things must PTSMC start doing to be successful? What three things must PTSMC stop doing to achieve our goals?

I have often said the COVID pandemic was my rst, we had no playbook and COVID is still creating a more challenging business environment than I could have imagined.

Spending time with the partners and directors working on PTSMC was exhilarating and fun. I am humbled and astonished by what this group has accomplished. I also, know that it takes more than leadership to be successful. I thank you for your dedication and commitment to PTSMC and those we serve. As I consider the “next ve” I am con dent that our people will continue to be the key to our success!

Thanks, Alan

IN THIS ISSUE

Clinician’s Corner by Bernie Lapaan, Avon & Wethers eld Physical Therapist Prevention Program and Throwing Injuries in Youth Baseball Players

2023 PTSMC Sponsored Courses Survey Results

HR Buzz

D4D & Goals and Objectives

Preferred or Chosen Name in ADP Connecticut Paid Leave

Employee Spotlight

Harrison Picard, Fair eld Physical Therapist Assistant

Money Beat: Student Loan Forgiveness Site Opens Application of Forgiveness

By Jim Hungerford

DEI: Resources for Education on DEI By Marilex Santiago

StriveHub Fab 5

“Each time I have visited for my issue it has been a valuable experience. We have done a variety of exercises and treatments to help me with my issue, and I was also given a printout of exercises to do at home between visits. I feel it is making a di erence in my level of discomfort - at times there is even no pain at all. All of the sta are all welcoming, encouraging and very knowledgeable.” - Guilford

“Liz (Veilleux) was very knowledgeable regarding my son's pain in the leg. She was able to diagnose it accurately and taught the right exercises. We saw improvement in a week. The pain is gone now! She is also personable and so we feel comfortable sharing our concerns.” - West Hartford

“Tom (Kirsch) actually listens before he imparts his deep knowledge by communicating clearly. I also like the friendliness, which is not only welcoming but encouraging.” - Avon

“Camille (Mogelnicki) at the front desk is the best. She is kind, happy, patient, a real gem!! And Michael (Popolizio) made a great connection with my son, helping him with his exercises while talking to him about his day, his interests, etc and making him feel very comfortable. He was kind and patient as well! Would recommend this facility to anyone!” - Glastonbury

”They are very thorough and very caring. Everyone knows therapy, and especially intense therapy, can be very painful and uncomfortable. They are very considerate of this. I am 73 years old and my pain level is not what it use to be. They take all of this into consideration and work according to how you are feeling that day” - Danielson

CLINICIAN’S CORNER

Prevention Program and Throwing Injuries in Youth Baseball Players

By: Bernardine Lapaan, PT, DPT Physical Therapist at PTSMC Avon & Wethers eld

Warm-ups increase blood ow and temperature in the muscles as well as mentally prepare you for physical activity.1 They are an important part of an exercise program and a corner stone for injury prevention in sport. Despite the bene ts, athletes may skip the warm-up all together to jump into practice or game, which puts them at risk for preventable muscular injuries. Some barriers to compliance are time constraints and lack of knowledge by the coach and/or athlete, especially with younger athletes. For example, Sakata et al reported an increase in cases of serious shoulder or elbow injuries in professional baseball players who specialized in the sport before high school.2 Educating children as soon as they start participating in competitive sports on the importance of warming up before practice and games as part of their natural routine may be paramount in creating good habits to prevent sports injuries now and later down the road.

In 2019, Sakata et al aimed to evaluate the e ectiveness of a shortened prevention program on the incidence of injuries to the shoulder and elbow in youth baseball players (n= 237 players, mean age of 10 years old) over 12 months. Secondary outcomes of interest included elbow extension, shoulder IR and ER, total shoulder rotation (ER + IR), shoulder horizontal adduction, and hip IR ROM; thoracic kyphosis angle; and modi ed Star Excursion Balance Test. The 10-minute prevention program, named the modi ed Yokohama Baseball-9, consisted of ve stretches, two thoracic mobility and two lower extremity balance exercises. Exercises were chosen based on identi ed risk factors for throwing injuries, including decreased elbow extension, hip and elbow rotational ROM, posterior shoulder tightness, rotator cu weakness, scapular dysfunction, poor posture and impaired SLS balance.2 The stretches were held for 10 seconds for one set while all other exercises were done for 1x10 repetitions. These exercises were performed as part of the players’ warm-up and were recommended to be performed at least 1x/week for 12 months.

Based on their results, this program may help with protecting the elbow/shoulder for baseball players while improving their ball speed. At the end of the study, researchers reported fewer players reported shoulder and elbow injuries in the intervention group vs control group (24 players vs 42 players, respectively), leading to a lower incidence of shoulder and/or elbow injuries in the intervention group (1.7 per 1000 athlete-exposure vs 3.1 per 1000 athlete-exposure). In addition, athletes in the intervention group had an improved shoulder horizontal adduction ROM (indirect measure of posterior shoulder tightness), improved hip IR ROM, decreased thoracic kyphosis, and faster ball speed as measured by a radar gun.

When educating our younger athletes on the importance of warm-ups, we need to consider sports speci c movements to prescribe as part of their routine as well as the length of that routine to improve patient adherence. This program may be a good tool to put in our bag for our baseball athletes as well as their coaches as part of an injury prevention program.

Reference

1.) Park HK, Jung MK, Park E, et al. The e ect of warm-ups with stretching on the isokinetic moments of collegiate men. J Exerc Rehabil. 2018;14(1):78-82. doi:10.12965/jer.1835210.605

2.) Sakata J, Nakamura E, Suzuki T, et al. Throwing injuries in youth baseball players: can a prevention program help? a randomized controlled trial. Am J Sports Med. 2019;47(11):2709-2716. doi:10.1177/0363546519861378.

CE181: Owens Recovery Science: Personalized Blood Flow Restriction Rehabilitation

We know that BFR is a highly requested continued ed topic and SHU is hosting a one-day course this year. Please note this is an “external course” not a liated with PTSMC.

Date & Time: December 3, 2022, 8 a.m. - 5:30 p.m.

Location: 4000 Park Avenue, Bridgeport, CT- Center for Healthcare Education at SHU

CEH: 8.5

Cost: $600 Course details & registration here: https://www.sacredheart.edu/academics/colleges--schools/col lege-of-health-professions/departments/physical-therapy/continuin g-education-opportunities/ce181-owens-recovery-science-personali zed-blood- ow-restriction-rehabilitation/

All

completed the survey! The results are in. Below you will see the percentage of clinicians that ranked a course in the TOP 5 (really 6 due to ties). Next, you will see a short list of courses with the greatest amount of #1, #2 and #3 rankings. Now, with these results, the Clinical Excellence Team will work to schedule the top ranking courses for 2023.

DIALOGUE FOR DEVELOPMENT (D4D) & GOALS AND OBJECTIVES TIME IS AROUND THE CORNER

Employees who participate in the Dialogue for Development & Goals and Objective process will be contacted by their supervisor to schedule their meeting time. D4D’s are completed during December, January, and February.

Fillable D4D forms and Goals and Objective SMART format samples are now located in ADP:

• Home Page

• Company Documents & Links

• Forms Library

• Performance Feedback Forms

Note: PTSMC employees who work less than 20 hours may or may not participate in this process. Check with your supervisor.

Supervisors will be emailing completed D4D’s to D4D.GO@ptsmc.com

To review prior D4D’s & Goals and Objectives in ADP go to

• Myself > My Documents

PREFERRED OR CHOSEN NAME IN ADP

Employees can now edit their preferred or chosen name in ADP. Employees legal name is still required for payroll and compliance purposes. Employees can enter their preferred or chosen name by selecting:

• Myself> My Information> Pro le

• Click on pencil next to name

• Check box “I use a name that’s di erent from my legal name” and ll out the required elds

Under the CT Family Violence Leave Act, victims of family violence (also called domestic violence) may receive up to 12 days of job protected leave in a calendar year and may apply for up to 12 days of CT Paid Leave income replacement bene ts for the following reasons:

• Seeking services from a victim services organization

• Seeking medical or psychological care or counseling

• Relocating

• Attending civil or criminal court proceedings arising from the family violence

Victims of family violence may need to take longer leaves to address serious mental or physical health conditions arising from the family violence. In the case of a serious health condition, the victim may apply for up to 12 weeks of job protection and 12 weeks of CT Paid Leave bene ts in a 12-month period. The serious health condition would need to be substantiated by a healthcare provider in a medical certi cation form.

Do you have a coworker that goes above and beyond? Who is 110% engaged in PT for Life?

Each year PTSMC asks you to take a moment and think about your fellow sta members who ARE the answer to those two questions. To BRAG about him or her on how their PT for Life actions are making a di erence in someone’s life.

Please take an opportunity to “boast” about a coworker of yours that goes ABOVE & BEYOND their job for patients and fellow sta members.

Employees will receive a written recognition and gift card! As the “bragger” you can choose to have your name stated or remain anonymous.

Recognitions will be displayed in a special addition of the December PULSE!

Click HERE to submit by November 18th ��

Reminder that supervisors cannot be a bragger for the employees they supervise.

Email mallory.mason@ptsmc.com with any questions.

DOMESTIC PARTNER BENEFIT

E ective August 1, 2022, PTSMC began providing employees the option to enroll domestic partners to our health insurance, vision, and dental insurance plans through UnitedHealthcare. This new policy allows employees to enroll same-sex and opposite-sex domestic partners. In addition, a domestic partner’s children (tax dependents) are also eligible for coverage.

Click the link below for a video session from One-Digital for the full details: https://www.brainshark.com/onedigital/vu?pi=zGYzCxnQHzf20Dz0

NOVEMBER IS A THREE PAYROLL MONTH

The November 30th payroll will not have medical, dental or Colonial deductions. 401(k) will be deducted.

CONGRATULATIONS!

Congratulations to the following PT Aides who have completed the SIPTA (Skills Introduction for PT Aides) Program:

Ashley Cato, Windsor Shae Eucalitto, Simsbury Amy Jespersen, Lock Street Raymond Seward, Guilford Kayla Wong, Shelton

Spot light

Harrison’s History

Harrison Picard found his way to PTSMC just over 4 years ago. He has a great PTSMC story, and before we get there, it’s important to know what Harrison was up to before...

Harrison grew up in Watertown, CT. He never had a true de ning moment like a personal injury that drew him toward PT; he just naturally gravitated toward and enjoyed anatomy and sports medicine. He also had a great connection to the PT world because his aunt is a physical therapist. He shadowed her in high school on holiday breaks and in the summers, which continued to foster his interest.

He attended Sacred Heart University and, as you’d guess, majored in exercise science. Even though Harrison’s rst applications to PT school did not work out, he only has positive thoughts about his journey because of where he is now! He took a “gap year” and stuck with the industry because it is what he loved. In college, he worked as an Aide for another company in Fair eld. When he was trying to gure out his next move, he knew he wanted to be a little closer to home, so he applied for a PT Aide position in the PT For Life o ce in Southbury!

Becoming a PTA

That year working in Southbury taught Harrison a lot and piqued his interested in the Physical Therapy Assistant route. It truly came down to what was best for him, and after crunching the numbers, understanding the timelines, and re ecting on his experiences working with and seeing PTAs in action, he shifted his focus.

While working in Southbury, he ended up meeting Rebecca Petrosino (current Fair eld Partner). He remembers she was bouncing around working in multiple o ces at the time while working toward opening her own clinic in Fair eld. This intrigued Harrison, because he loved the Fair eld area and built great relationships with the people and his classmates at Sacred Heart. Once Rebecca opened the Fair eld clinic, Harrison followed.

After about a year of being a PT Aide in Fair eld, Harrison started the PTA school application process! He enrolled in and attended Naugatuck Valley Community College to obtain his Physical Therapist Assistant degree. He continued to work as much as possible, not only for some money, but to learn from the clinicians and implement the things he was learning in school. Once he graduated, there was no question, he wanted to be in the PTSMC Fair eld clinic. The transition was super smooth and couldn’t have worked out more perfectly.

Harrison has loved the diverse patient population at the Fair eld clinic, which consist of athletes from all the surrounding schools, a large geriatric population, and city weekend warriors! The variety of patients he gets to work with is a big reason he loves being in Fair eld.

Harrison’s Happenings

Working as a PTA, Harrison is also a part of the PTSMC Development of Clinical Success Program (DOCS) Program. He is one of the rst PTAs on track to complete this program! He has really enjoyed it a lot, especially the mentorship. Kristina Lipeika’s (Watertown PT) knowledge and experience has been helpful, and she’s worked with him on his thought process for treatment in conjunction with compliance.

Currently, Harrison lives in Stratford, CT. His girlfriend and he have some big life changes coming, because she is graduating PT school at Stony Brook University! They are at the stage in life where all of their friends are getting married �� So their time and travels currently revolve around bachelor parties and wedding events. They even have a friend’s wedding coming up in Ireland this summer they are really looking forward to! Their ultimate goal is to one day travel to New Zealand. Once weddings calm down, this is the trip they will nally make happen together.

Outside of work, Harrison plays rugby on the weekends with his friends. He used to play when he was at SHU and loves that he can keep playing. He also does a lot of seasonal-based activities. In the summer, he loves shing and hiking, and in the winter, he does a lot of snowboarding. Usually, he stays in New England to snowboard, venturing mostly to Vermont or occasionally New Hampshire or upstate New York. Also at the top of Harrison’s travel bucket list is a trip out west to snowboard. He is super happy that now working full time (no schoolwork anymore) he has more time for all his hobbies and activities!

NOVEMBER BIRTHDAYS

Pauline White 2 East Hampton

Nicole Skirkanich 3 Admin

Sharon Hallahan 3 Essex

Emily Hansen 3 Simsbury

Ken Caselnova 5 Glastonbury Matt San Angelo 6 Southbury

Shauna Vasilo 7 Westbrook

Cara McEvoy 10 Guilford

Avery Owen 10 New London

Emily Fillion 11 Admin

Hailey Boulanger 11 Watertown

Amanda Cabush 11 Windsor

Sandy Wickman Mason 13 Admin Susan DeCarli 13 Glastonbury

Emma Topper 13 Southington

Laewa Forrest 14 Admin

Mia Martinez 14 Middletown

Ryan Balavender 16 Admin Cindy Hales 16 Admin

Liza Peressini 16 Danbury

Todd Cacopardo 16 East Hampton Brian Vo 16 Windsor Payton Anastasio 17 Branford

Dave Domkowski 17 Orange Mike Antunes 18 Middletown

Amber Manville 18 Southbury

Jules Pera 19 Guilford

Quinn McAnaney 19 Guilford

Hannah Jenkins 23 Middletown Kelly Hoisl 23 Windsor Steven Genna 25 Orange Debra Desmarais 25 Putnam

Reilly Merrill 25 Wallingford

Vladimir Smolgovskiy 25 West Hartford Linda Mullin 26 Lock Street Christine Rasile 28 Admin

NOVEMBER ANNIVERSARIES

Danielle Casey Executive Coordinator Admin Liz Veilleux Physical Therapist West Hartford

Ryan McGowan

Rebecca Infosino

Tyler Carmen

New London

Wallingford

Wallingford

Fair eld Adam Duren

Melissa Fierro

Lock Street

Amanda Leiss Patient Services Wallingford Coordinator

Jenna Hancock Patient Services New London Coordinator

Ryan Balavender Director of Facilities Admin

Harrison Picard, Fair eld Physical Therapist Assistant

CONGRATULATIONS

ON HER

SARA

Congratulations to Sara Gareiss on her promotion to Business Development Coordinator. In her new role, Sara will supervise our Practice Liaisons, continue to increase referrals and pursue new business development opportunities for increased revenue. In addition, Sara will be managing the credentialing process of new and current clinicians.

Sara received her Bachelor of Science in Movement Science with an academic emphasis in Athletic Training and her Master’s degree in Motor Control from Texas Christian University in Texas. She currently is working toward a Master’s in Business – Health Care Administration.

Sara arrived at PTSMC after working as an Athletic Trainer at a high school, a Bone & Joint clinic, and a couple of Division 1 universities. She most recently was an Athletic Trainer and Mental Health Coordinator at Quinnipiac University where she also held teaching responsibilities. She began at PTSMC in December 2019 as a Practice Liaison.

Sara is truly excited about this new role, as it furthers her opportunity to make connections and build relationships both within PTSMC and with those entities that support us in bringing our mission to fruition. Sara commented, “Already, I have had the chance to learn new skills, hear new perspectives and collaborate with even more of my PTSMC family than I might have typically had the chance to interact with regularly, and that might be my very favorite part of growing into this job.”

Sara seeks opportunity for collaboration and relationship growth and believes that serving in this capacity will allow her to continue to bring a positive impact to our collective goals.

Mike Durand, Vice President of Business Development stated, “Sara made an immediate impact at PTSMC, seamlessly working with the partners and directors in her PL region and stepping up into a leadership role within the Practice Liaison team. As PTSMC seeks new business development opportunities, Sara’s energy, enthusiasm and networking skills will be strong assets for success.”

On a personal note, Sara is “super proud to be a horned frog, always, but especially this year as it marks the 50th anniversary of the Athletic Training program at my alma mater!” GO FROGS!

UPCOMING END OF MONTH DEADLINES

OCTOBER END OF MONTH

Timeframe Documentation FD Balancing

10/1 - 10/31 11/7 at 6:00am 11/8 at 7:00pm

NOVEMBER MID MONTH

Timeframe Documentation FD Balancing

11/1 - 10/15 11/21 at 6:00am 11/21 at 3:00pm

NOVEMBER END OF MONTH

Timeframe Documentation FD Balancing

11/1 - 11/30 12/6 at 6:00am 12/7 at 7:00pm

Student loan forgiveness site opens application of forgiveness

By Jim Hungerford, CPA, Director of Accounting and Finance

The Department of Education (DOE) has o cially opened its online application site for the new federal student loan forgiveness program.

Students with Pell Grants, which are available to outstanding students with exceptional hardship, will be able to get up to $20,000 in federal student loans forgiven.

Those without Pell grants can get up to $10,000 in federal student loan debt wiped away.

Debt forgiveness is limited to individuals with less than $125,000 in annual income and couples with less than $250,000 in income. This applies to subsidized and unsubsidized loans, as well as PLUS Loans.

Private loans are not eligible to be forgiven. Only loans through the federal government are eligible. Federal Family Education Loans and Perkins Loans that were not consolidated into federal Direct Loans before Sept. 29, 2022, won’t qualify, either.

What you need to apply for student loan debt relief

The DOE website, which o cially opened Oct. 17, is the only place where you can apply for the debt relief. There are a lot of scams already out there of websites o ering to help you apply. Only go to studentaid.gov. The form, which takes two minutes to complete, asks for the borrower’s name, Social Security number, date of birth, phone number and e-mail. No documents are required, but borrowers must certify under penalty of perjury that all of the information is correct. The application form is available in English and Spanish.

Once you apply, you will get a con rmation e-mail or a request from the DOE for more information, if needed. Whatever loan servicer is administering your loan will then contact you to let you know what your new payment is once the amount of the loan forgiveness is applied, assuming a balance remains.

You have until Dec. 31, 2023, to apply for loan forgiveness, but the sooner you can get your application in, the better, since payments that have been paused because of the pandemic will have to start making loan payments again in January.

The DOE recommends that borrowers apply for forgiveness by Nov. 15, so you won’t have to pay after the student loan payment pause ends, or you will have a new lower payment after the forgiveness hits your account prior to January.

PUMPKIN DECORATING CONTEST

Check out some of the amazing photos from this year’s Annual Pumpkin Decorating Contest! You can see all of the pumpkins on our Facebook page or using this Survey Monkey link: https://www.surveymonkey.com/r/PTSMC-22-Pumpkins

Voting closes on October 31st at 11:59pm. Happy Halloween!

Holiday Food Drive

For 2022, PTSMC is setting the bar high and has a goal to donate: 2,700 items!

How to get started: Designate a Food Drive Leader and ll out this form with information needed for yers: https://www.surveymonkey.com/r/2022FoodDrive

- The local group your clinic will be donating to.

- The time frame for collection.

- This can be any time from now through the rst week of January. It is best to contact your donation site to see when items are most needed and base your collection on their delivery dates.

- Consider hosting a ra e for those who donate.

Colored yers will be made speci c to each clinic’s collection dates and donation sites. They will be mailed to clinics as soon as possible once the details have been submitted. Post yers in the Welcome Center and around the clinic.

Once it’s time to start collecting set up a collections box. Lots of clinics like to decorate around their box with the theme of the holiday they are collection for.

Before delivering your donations be sure to count your total number of items and let Mallory Mason know the nal total.

First time hearing about this initiative? Here’s what you need to know: The annual Holiday Food Drive is a cherished tradition at PTSMC. President Alan Balavender began this initiative many years ago to give back and serve our local communities in need. Through the generosity of our people and patients, in 2021 alone, PTSMC collected and donated 2,574 items across the stated.

These donations come from patients, employees, friends and family- anyone and everyone who are fortunate enough to be able to share and contribute.

uglyisweatericontest

Choose any date between December 1st- 23rd for your clinic to dress in festive holiday attire and ugly sweaters. Snap a group photo and submit it to Emily Fillion.

All photos will go on the PTSMC Facebook page December 21st – 28th. Make sure to like PTSMC's page so you can see when the photos go live!

The PTSMC extended community will vote for which clinic had the "best" holiday fashion by reacting, commenting, or sharing that clinic's photo on Facebook.

Last year the Guilford clinic was back at the top of the podium with a VERY creative collaboration. Let’s see which clinic can top this for 2022 and win a sta lunch!

Flu and Bivalent Booster

Vaccinations:

• Getting vaccinated protects you and the people around you and those more vulnerable to serious illness, like babies’ older adults, and those with chronic health conditions.

The Flu

• Flu spreads annually typically between October and May.

• Recommended to start receiving the u vaccines as early as September prior to Flu Season.

Covid -19 Vaccines

What is the Third Dose?

Third dose is an additional COVID-19 vaccine for those who are moderately or severely immune compromised. This population can receive a third shot 28 days after their second shot to provide adequate immune protection.

COVID-19 Booster

• Bivalent Booster is now available for those ages 12+ (P zer) and 18+ (Moderna)

o Bivalent” means the vaccine is e ective against two di erent antigens. BA4 and Omicron BA.5 variants that are most prevalent today. The booster is an additional dose after the primary vaccines series weakens over time.

• Monovalent Booster: available for those 5-11 years of age.

• All Covid-19 Boosters are recommended to those more than 2 months from their last vaccine.

**It does not matter how many boosters a person has received – only the length of time between boosters. **

Talk to your provider if:

• You have had an allergic reaction to prior vaccines (all)

• Ever had Guillain-Barré syndrome( u)

• If you have an allergy to polyethylene glycol or polysorbate (COVID Vaccines)

Locations Near You:

COVID Vaccines & Booster

• https://www.vaccines.gov/search/

Flu Vaccine

• https://www.vaccines.gov/ nd-vaccines/

November

#GetMoving

Oct. 17 - Nov. 28

Pumpkin Winner Announced Nov. 1

PTSMC Food Drives Dates vary Nov. - Dec.

Flu Shots & COVID-19 Vaccine Initiative Nov. 1 - Feb. 10

BRAGS Submit by Nov. 18 Shared Nov. 30

December

Ugly Sweater Contest

DEI

Diversity, Equity, & Inclusion

Dec. 1 - 23

Take Action Today: Resources for education on DEI

By Marilex Santiago, Administrative Coordinator

A lot of work in DEI is about education. The more we educate ourselves, the more actionable steps we can take as individuals and as a company. Here are some great resources for a range of learners and time commitments.

Belonging At Work: Belonging At Work is a guide to creating inclusive workplaces. The book suggests simple actions to make employees feel comfortable and capable on the job. A sense of belonging is both a universal human need and a major motivator. Employees perform to their full potential when they feel accepted and celebrated for their authentic selves.

If you enjoy listening to podcasts, here is one to check out: reWorked: This podcast focuses on best practices and well-being tips that help organizations rework their workplace cultures to become more inclusive. In discussions with CEOs, activists, D&I practitioners, and HR leaders, the show outlines di erent diversity and inclusion journeys and lessons learned along the way.

Finally, for visual learners, here are two great videos that o er a quick insight on the importance of diversity in the workplace:

Purl by Pixar: https://youtu.be/B6uuIHpFkuo Pixar’s short lm featuring Purl, a ball of yarn who doesn’t t the mold at B.R.O. Capital teaches a great lesson in diversity. This short lm has its laughable moments but its end message is powerful, which is welcoming people who are di erent allows for a more inclusive and diverse workforce.

That Little Voice by RBC: https://youtu.be/Ll56imVATLk RBC’s diversity video depicts uncomfortable situations that happen in the workplace. This video uses the phrase “that little voice” as a way to show how people from di erent cultures and backgrounds often feel like an outsider.

PTSMC Happenings!

PTSMC clinicians and administrative sta attended the CTAPTA conference. The Orthopaedic Residents did a poster presentation during the conference.

Pictured in top photo from left to right: Danielle Dunn: Director of Clinical Excellence & Residency Program & Wallingford PT

Liza Peressini: Danbury PT

Conner Gavin: Orange PT

Channing Harwood: Clinical Excellence Coordinator & Plainville PT (pictured in all 3) Picture in the top right photo: Sandra Boccialetti (left): Director of Human Resources

Pictured in the bottom right photo: Tom Kassan (right): West Hartford Partner & CTAPTA Chair Public Policy Committee & Co-Chair DEI Committee

Simsbury attended the Friends of Simsbury Farms Golf Tournament. Pictured from left to right: Partner Emily Hansen, PT Eric Horne, Health Fitness Specialist Shelby Howe, and PT Jen Ashman. The foursome did some pre-golf stretching!

PTSMC clinicians attended the Myopain Dry Needling 1 course.

Two patients helped Alex Gauthier, Essex PT (right), celebrate his birthday by bringing in a cake.

PTSMC Shelton celebrated a successful rst year in business with a Grand Opening and Ribbon Cutting with patients, PTSMC coworkers and the Greater Valley Chamber of Commerce.

Congratulations to recent Leadership & Management Development Program gradutes! Finally! This LMDP group had four original members that started the program in December 2019. After the pandemic, we had a restart in September of 2021 and added participants for a group of nine. Through a series of needed meeting reschedules this awesome group nished in September 2022! During this time, all participants have taken on a leadership position at PTSMC.

Pictured from left to right:

Front Row: Alyssa Gri o (East Hampton PT), Kelley Cahill (Essex PTA - part of December 2021 group)

Second Row: Christina Mogelnicki (Newington Director), Katy Sullivan (Orange Assistant Director), Sandy Wickman Mason (VP of Operations), Mike Durand (VP of Business Development)

Third Row: Alan Balavender (President), Erik Schmitt (Westbrook Assistant Director), Erik Olsen (Southbury Assistant Director), and Brian Greer (Glastonbury Partner)

Back Row: Matt Baronowski (Avon Director), Mike McGowan (Windsor Assistant Director) Not pictured: Channing Harwood

Eric Horne, Simsbury PT, married his wife Moira. He’s pictured here with some of the PTSMC Simsbury crew.

Elena Masiello, Wallingford PT, got engaged to her boyfriend Aaron.

Roslin Wilhelm, Naugatuck & Watertown PTA, married John DellaVecchia.

2022 Top Workplace Survey Comments

Thank you to all employees who completed the Energage survey back in May! We value your feedback & wanted to share the most common themes from over 500 comments.

I LOVE MY JOB BECAUSE...

At the clinic I work at, I feel comfortable, appreciated, and there is always something to do.

I am a orded the autonomy over my day to day schedule to maintain an appropriate work / life balance.

I enjoy coming into work everyday. It doesn’t feel like a job I HAVE to go to, but more like a place I WANT to be everyday with a great team.

I feel like I am contributing to the care of patients in a meaningful way.

I get to do something I love and the people around me enjoy helping others as well.

I get to help people return to doing what they love to do while working alongside great people.

I get to make a di erence in peoples lives everyday.

I love my job because I get to be a part of a team that continues to day in and day out take care of each and every person that walks through our doors. I feel appreciated, respected, and needed. PTSMC has also helped me to push myself in learning new information, strengthening my con dence, and guiding me on the career path I have a newfound passion for.

I work with people that are dedicated and make me enjoy coming into work.

It is a team e ort from all employees which all help the outcomes of our patients and the company is patient centered, not volume centered.

PTSMC is committed to excellence.

PTSMC is a Fun place to work. There are many opportunities to make a di erence in patient and employee lives. People who work at PTSMC genuinely care about patients, each other, clinical excellence and having work ow operations that make sense and are helpful to do great work.

WHY WOULD YOU RECOMMEND WORKING AT PTSMC?

Excellent clinicians and know how to treat people with respect. A fun environment to be apart of.

The people are amazing and the culture of the company has a good balance of supporting the people and driving the business.

PT owned company, not corporate, fun atmosphere, team oriented.

BESIDES HIGHER PAY, WHAT WOULD MAKE YOU LESS LIKELY TO LEAVE PTSMC?

Better bene ts

More documentation time built in More vacation and work hours that are non-clinical.

WHAT CONTRIBUTES MOST TO YOU WANTING TO STAY WITH PTSMC?

The people and community I work with

Flexible schedule and amazing coworkers.

The kind work environment and career help.

I am surrounded by people who make a di erence in our peoples well being and health.

All the people I work with every day!

The level and delivery of care.

WHAT TOOLS AND RESOURCES ARE THE MOST HELPFUL IN YOUR JOB?

Having well trained PT aides and front o ce sta support are the most helpful tools.

SHARE AN EXAMPLE OF PTSMC OPERATING BY STRONG VALUES:

Patient centricity & safety

Brags and tness challenges are good. They connect us and are positive.

Staying open during covid and continuing to keep sta safe.

Participating in community events, assisting patients both outside and inside our clinic.

Our patients are number one from the rst phone call to their last day when they leave with pride and a tshirt.

WHAT IMPROVEMENTS TO WORK/ LIFE FLEXIBILITY WOULD YOU VALUE MOST?

Documention time within the day/the 40 hr week

HOW DOES PTSMC HELP YOU BALANCE WORK AND LIFE?

Flexible with my work schedule when needed.

2022 Top Workplace Survey Comments

Thank you to all employees who completed the Energage survey back in May! We value your feedback & wanted to share the most common themes from over 500 comments.

WHAT MAKES YOU FEEL APPRECIATED AT PTSMC?

I feel included and get along with my co-workers and that makes the biggest di erence for me. I feel that I can be open and honest with my manager and we have a mutual respect and trust.

I have a very good relationship with every single person that works at PTSMC. A team atmosphere is promoted.

WHAT GETS IN THE WAY OF YOU FEELING GENUINELY APPRECIATED AT PTSMC?

I feel sometimes I should be compensated a little more for my work at PTSMC as I try to put a lot of e ort into the clinic and provide quality care regardless of how long it takes / patient schedules, etc.

High case loads, excessive time doing paperwork, don't even get 30 minutes of lunch because patients run over into the time slot.

WHAT CHANGE IN YOUR BENEFITS PACKAGE

WOULD BE MOST VALUABLE TO YOU?

Better medical- lower deductibles

WHAT ASPECTS OF YOUR BENEFITS PACKAGE

DO YOU FIND MOST VALUABLE?

Health insurance . So many doctors in network.

Vacation Time.

Retirement.

WHAT COULD PTSMC DO TO PREVENT BURNOUT FOR ITS EMPLOYEES?

Time for documentation within the work day.

O er gym membership discounts, provide fun classes to sta like yoga, pound, Pilates, ice cream social, more events after work that involve multiple clinics, more team building opportunities

Partners and directors ask sta about how they are feeling, are they experiencing burn out?

WHAT DOES PTSMC DO TO SHOW YOU IT CARES ABOUT PREVENTING BURNOUT?

Flexible work schedules to address family, life events and help decrease personal stress.

I'm encouraged to use my time o .

Constant check-ins and communication!

WHAT FORMAL TRAINING HAVE YOU FOUND MOST VALUABLE?

Outside courses brought in, Mentorship as a entry-level PT, CEU opportunities.

WHY DO YOU FEEL PATIENTS RECEIVE LESS THAN EXCELLENT CARE?

Too many double bookings with no where to put patients on the schedule due to understa ng- not enough one on one care and individualized attention.

WHAT DO PRESIDENT, VICE PRESIDENTS, PARTNERS AND CLINIC DIRECTORS DO TO SHOW THEY KNOW WHAT'S REALLY GOING ON?

Update us and keep us informed on major decisions.

Frequent emails including Mid Month video, the PULSE, always keeping us in the loop with communication, look for feedback

WHAT ARE YOUR CONCERNS ABOUT THE DIRECTION PTSMC IS GOING?

I fear the more we grow, the more we lose sight of how well all clinics are involved with one another and the in uence we could have working together.

I feel that in just my clinic alone there has been alot of turnover for multiple reasons… if you want to keep your workers and patients happy then we should do things to make them want to stay.

HOW DOES PTSMC HELP ENSURE PATIENTS RECEIVE EXCELLENT CARE?

Everyone works well together and listens to the patients to ensure their care. We address any concerns patients may have and come up with solutions tomake sure they are comfortable.

Helping PTs take appropriate continuing education classes.

First-rate customer service, follow-up on pt. concerns whether rst or 50th visit, and patient buy-in.

WHAT DOES PTSMC DO INEFFICIENTLYOR POORLY?

Lack of sta coverage for sta bene ts time-sick and vacation, the whole o ce su ers

WHAT DOES PTSMC DO EFFICIENTLY AND WELL?

They are very attentive to the needs and care of each patient Family/team environment and respectful of personal lives

HOW HAS THIS JOB NOT MET YOUR EXPECTATIONS?

Pay & bonus system Double booking without commuication

WHAT MAKES THIS JOB BETTER THAN YOU EXPECTED WHEN YOU STARTED?

The people! The sta , the culture, instantly part of a team Environment- we work hard and are also shown appreciation for working hard.

WHAT DO YOU MOST VALUE BEING WELL INFORMED ABOUT AT PTSMC?

Future plans for the organization.

Management decisions, Policy changes, Performance.

The happenings behind the scenes

I feel like all individuals at the company are kept up to date and have the opportunity to o er feedback and that is essential to me in my workplace.

2022 Top Workplace Survey Comments

Thank you to all employees who completed the Energage survey back in May! We value your feedback & wanted to share the most common themes from over 500 comments.

WHAT HELPS YOU FEEL INCLUDED AT PTSMC? Outings.

The open communication and friendly environment among myself and my co-workers.

The Pulse newsletter helps me feel included in the happenings at PTSMC.

Regular communication from leadership. Regular group activity available at the facility level as well as company wide.

HOW DOES YOUR SUPERVISOR SHOW THEY CARE ABOUT YOUR CONCERNS?

Listening, open & understanding, one on one & group check ins

WHAT DO YOU LIKE ABOUT THE DIRECTION PTSMC IS GOING?

I like that the company is growing, without sacri cing any patient care.

HOW DOES YOUR SUPERVISOR HELP YOU LEARN AND GROW?

My supervisor encourages me to grow and learn, and they keep a positive and productive relationship with me and the rest of my coworkers.

WHAT DO YOU FIND MOST MEANINGFUL ABOUT WORKING AT PTSMC?

Patients! Helping patients feel better & improve.

WHAT DO YOU DISLIKE ABOUT MEETINGS AT PTSMC?

Don't have then or they don’t happen often enough

WHAT DO YOU LIKE ABOUT MEETINGS AT PTSMC?

Informative

Good opportunity to voice opinions

Time to talk to each other about whatever concerns are happening, and time to socialize!

HOW DO PEOPLE SHOW YOU THEY ARE COMMITTED TO THE MISSION AT PTSMC?

Through exibility with family and professional commitments with employees. It helps us stay fresh and prevents burnout when working with patients. We are able to show up excited and ready to work.

They show they are committed by showing up to work with a positive, hardworking attitude. And providing care for our patients that show and make the patient feel as they are apart of the PTSMC family and that we care about them.

Hard work, dedication to craft, willing to help when needed.

HOW ARE DIFFERENT POINTS OF VIEW ENCOURAGED AT PTSMC?

Open door policy, open to feedback.

WHAT ARE SOME OF THE WAYS MANAGEMENT SHOWS THAT PATIENT SAFETY IS A TOP PRIORITY?

COVID has been a big priority over the last few years and making sure all patients and sta feel comfortable within the clinic.

Quarterly compliance training

WHAT MAKES IT DIFFICULT FOR PATIENTS TO COME FIRST IN DECISIONS AT PTSMC?

Packed schedule

Insurance requirements and reimbursement

HOW DOES PTSMC MAKE IT EASY FOR PATIENTS TO COME FIRST IN DECISIONS?

Always thinking about what is best for them when it comes to care and scheduling.

We work around their schedules to make sure people are getting the care they need.

I think the patient is given thorough and personalized one-on-one time with the PT. Part of that success is due to our clinic director and PTs style of practice. Even when aides are utilized to guide the patients through exercises, the PT is still either actively involved or close-by. The patient usually does not have more than 10 minutes without the head PT checking in on them. Patients and PTs work collaboratively, and their needs are always considered rst.

HOW DOES PTSMC EMPOWER YOU TO USE YOUR FULL POTENTIAL?

I feel that my work is important, which makes me want to do the best job possible.

Learning opportunities. Allows me to treat how I like to treat. By always changing.

WHAT MAKES YOU HESITATE TO RECOMMEND WORKING AT PTSMC?

Pay

WHAT ABOUT PTSMC IS MOTIVATING TO YOU?

PTSMC has motivated me to go back to school for physical therapy. It has reinspired the passion for this career.

My co-workers and helping patients.

The di erent leaders in the clinic that we meet at courses and meetings.

SPINE PICO

By: Conner Gavin, Orange, PT and Liza Peressini, Danbury PT

P: patients with sciatica

I: lower extremity neural tension exercises

C: lumbar manual therapy techniques

O: functional and pain outcome measures

Question:

In patients with sciatica, do lower extremity neural tension exercises or lumbar manual therapy techniques report better scores for ROM, symptom distribution, pain and functional performance on outcome measures?

Intro:

Alshami et al, performed a prospective controlled trial to investigate the short-term e ect of slider and tensioner exercises on pain and range of motion of straight leg raise and slump tests in patients with low back-related leg pain with peripheral nerve sensitization. A total of 51 patients with low back-related leg pain with peripheral nerve sensitization were divided into 3 treatment groups: slider (slider neural mobilization exercises + transcutaneous electric nerve stimulation [TENS]), tensioner (tensioner neural mobilization exercise + TENS), and control (only TENS). All patients received six sessions over two weeks. Measures taken at baseline, after the 1st, 3rd, and 6th session. Measures taken were VAS for pain and ROM of SLR and slump tests were performed for the symptomatic side. Patients had to have peripheral nerve sensitization lasting less than three months. Eligibility was determined by the S-LANSS assessment, examination of SLR and slump test. TENS intervention was applied to the low back paraspinals. All tensioners and sliders were performed in the slump position, both tensioners and sliders were performed for two sets of 10 with a two-minute break in between sets.

Results of the study showed a VAS (MCID 1.8-1.9) change from baseline to visit 6 of 3.0 in the tensioner group, 2.5 in the slider group, and 1.1 in the control group. SLR (MDC 5.7 degrees) measurements in hip exion from baseline to visit 6 showed a 23° increase in the tensioner group, 16° increase in the slider group, and 5° increase in the control. Slump (MDC 1.94°) measurements in knee extension from baseline to visit 6 showed an increase of 21° in the tensioner group, 19° in the slider groups, and 5° in the control group.

In conclusion, the results showed signi cant improvements in all outcomes in favor of the slider and tensioner groups but not the control group. There was no signi cant di erence between the slider and tensioner groups. Participants in the tensioner groups showed a more immediate reduction in pain and slightly elevated improvements over the slider group. The study shows that nerve tensioner and slider exercises can help reduce pain and improve nerve mobility in patients with low back pain with radiating pain. Limitations of this study are that there was no measurement of nerve centralization or patient reports on function. These measures would help increase the signi cance for use of these interventions in clinical practice.

Kaur et al looked at the e ectiveness of neural mobilization and conventional therapy in patients with neurogenic low back pain. The study used a sample of 27 patients aged 18-45 with sub-acute neurogenic LBP. The experimental group underwent passive straight leg raise mobilization in supine position for three sets of 10. The conventional group included patient education on exercises and proper posture, ergonomic advice, and how to lift heavy objects for the two weeks ahead.

10 sessions were held over the course of two weeks with advice to stay as active as possible. Exercises performed in the conventional group were pelvic tilt exercises, back extension exercises in the form of press ups, and cat camel. Outcomes investigated were VAS, hip exion ROM, symptom distribution using the Werneke’s Overlay Template, and disability measured by the Modi ed Oswestry Disability Index.

Results after two weeks of intervention showed signi cant di erences from pretest to post-test in all categories in both groups. However, median values of the variables demonstrated greater improvement in the nerve mobilization group compared to the conventional group. Signi cant changes include: VAS scores decreasing from ve to two, hip exion ROM increasing by 22°, MODI decreasing by 9. The conventional group with decreased on the VAS by 1, 3° increase in hip exion ROM, and a 1-point decrease in the MODI. Statistically signi cance was achieved in reducing symptoms in the reported areas of discomfort after the study completed in the neural mobilization group, but not the conventional group.

The conclusion of the study shows that passive SLR neural mobilization has been shown to have short-term bene ts on patient reports of pain, hip exion ROM, symptom distribution and disability associated with neurogenic LBP. It is important to note the signi cance of postural education and exercise that should not be ignored and used in conjunction with neural mobilization to achieve the best outcomes. Further studies should examine this form of treatment beyond the completion of the study in order to de ne long-term bene ts of these techniques.

Mahmoud wanted to investigate and compare the e ectiveness between neural mobilization and lumbar manipulation techniques on leg pain, functional disability, and the amount of nerve root compression for patients with chronic low back pain (CLBP) with sciatica as a result from a herniated L5-S1 disc. Spinal manipulation has been used in several di erent professions with the aim to reduce pain and improve mobility by causing a transient stretch of the joint capsule to restore the position of the nerves for improvements in function. Neurodynamic (ND) mobilization has less research behind the bene ts, however, these techniques allow for a non-aggressive movement of the nerve within the sheath and result in physiological e ects including but not limited to edema reduction, decreased sensitivity, and enhanced excursion of the nerve. Nerve compression can result in disruption of nerve function, and overtime lead to intraneural events and poor gliding. In this study, two groups were formed, Group A and Group B, each derived from 30 participants. Inclusion criteria required the patients to have an MRI con rming a disc herniation at L5-S1 (posterolateral) and su er from unilateral radiculopathy for >three months. Patients were excluded if they had a hip, knee, or ankle pathology, in ammatory disease, or severe spondylotic osteophytes, recent spinal surgery, diabetes, or claudication resulting in radiculopathy. Group A received neural mobilization techniques while group B underwent lumbar manipulation 3x/week for six weeks.

MRI was used to determine the degree of nerve root compression and graded on a scale from 0 to 3, with 0 being described as normal, 1 as contact, 2 as deviation, and 3 as compression. Along with imaging, the patients also lled out the VAS and Oswestry Disability Index (ODI). Group A intervention techniques included the SLR and the slump technique, with the passive motion of the foot into dorsi exion/plantar exion from the investigating therapist. Each technique was performed until pain was relieved or until maximum pain-free range of motion was met. Group B underwent lumbar grade V manipulation in three di erent positions, each repeated three to four times with a time interval of 30 to 60 seconds between each. The three techniques include posterior anterior central vertebral pressure, lumbar rotation, and rotation with straight leg raise.

The results from the 60 participants who underwent the six weeks of treatment found a signi cant decrease in pain (VAS), functional disability (ODI), and compression (MRI) (P<0.05) in both groups. When comparing between group results on pain levels, functional disability, and degree of nerve root compression, Group B reported greater improvements than Group A. The authors of the article speculate this could be due to the e ect caused by providing a large thrust to the bulged disc, potentially reducing the size. Research on lumbar manipulation technique have suggested that it may a ect the blood perfusion of the segment and surrounding tissues, reduce the disc on nerve root, and create a hypoalgesia e ect. Future research should further investigate the e ects of neurodynamic mobilization and proper dosage for clinical use to reduce sciatica related symptoms (Mahmoud 2015).

In this study, Vijayaraj compared the e ectiveness of the McKenzie method and neurodynamic mobilization on CLBP with radiculopathy. To determine who was eligible, patients were screened using the slump test, Faber’s, SLR, and prone lumbar instability test as well as the VAS and Modi ed Oswestry Disability Questionnaire (MODQ). The inclusion criteria were chronic LBP >three months, between 25-60 years old, centralization phenomenon, and radicular symptoms. Patients with precautions or contraindications for manipulation were excluded from the study.

There was a total of 30 participants: 15 in Group A and 15 in Group B with each session carried out for four weeks. Group A included the McKenzie group, where they received 15 minutes of TENS and 20 minutes of traction. After they began, they were in the following positions for ve minutes each: prone, prone on elbows, prone on hands, and nally with pillows under until the patient can tolerate 10 minutes in the most extended position, ve days per week. Group B underwent the neurodynamic mobilization, however, also began the same as Group A in terms of answering all outcome measures and assessing AROM. The patient leg was lifted to 70° of exion with additional adduction for full tension of the sciatic nerve. Mild discomfort was allowed until the symptoms reduced. Three minutes of on/o mobilization were performed for three repetitions ve days per week.

The results compared the VAS, MODQ, and spinal AROM prior to treatment and at week four. Group A, the McKenzie group, proved to be more e ective on treating symptoms of CLBP than Group B. In all measurements, within group changes were signi cant, however, Group A had greater improvements than Group B. With mobility testing, Group A had greater gains in exion, extension, and side exion than Group B, as well as VAS and MODQ scores. The study further supports the use of the McKenzie technique to reduce lumbar radicular symptoms over the use of neural mobilization techniques. Further investigation should look at the use of neurodynamic mobilization and the use of accurate positions, proper identi cation of distal nerve branch involvement, and precision on technique (Vijayaraj 2018).

Conclusion: The information obtained from the rst two articles found that neurodynamic mobilization compared with an exercise or manual therapy group demonstrated greater improvements in pain and function. These results can be used in a clinical setting for patients with sciatica-related symptoms to perform gentle nerve glides and tensioners to reduce the symptoms before using other forms of treatment, such as conventional exercises. The latter two studies found di ering results when compared to manual therapy techniques, with a more speci c use of the Mckenzie method. These studies found that manual therapy techniques, speci cally lumbar manipulation, improve pain, mobility, and function greater than neurodynamic techniques. The conclusions drawn from all four studies suggests that manual therapy techniques of Mckenzie based interventions and lumbar manipulation provide a greater impact on outcome measures when compared to neurodynamic mobilization alone. Although Neurodynamic mobilizations were not as e ective as manual interventions, the bene t should not be ignored when treating individuals with sciatic and radicular symptoms. Bene t may be found in performing both interventions on a patient-to-patient basis who are experiencing these symptoms before introducing therapeutic exercise. Further research should be done on varying combinations of manual techniques and neurodynamic mobilization as well as the addition of exercises for the best treatment for sciatica.

Resources:

1. Alshami, Ali M., et al. “E ect of Neural Mobilization Exercises in Patients with Low Back-Related Leg Pain with Peripheral Nerve Sensitization: A Prospective, Controlled Trial.” Journal of Chiropractic Medicine, vol. 20, no. 2, 2021, pp. 59–69., https://doi.org/10.1016/j.jcm.2021.07.001.

2. Kaur, Gurpreet, and Shallu Sharma. “E ect of Passive Straight Leg Raise Sciatic Nerve Mobilization on Low Back Pain of Neurogenic Origin.” Indian Journal of Physiotherapy and Occupational Therapy, vol. 5, no. 3, July 2011, pp. 179–184.

3. Mahmoud, W.S.E. (2015). E ect of Neural Mobilization Versus Spinal Manipulation in Patients with Radicular Chronic Low Back Pain. European Journal of Scienti c Research, 131(1), 122-132. http://www.europeanjournalofscienti cresearch.com

4. Vijayaraj, V. (2018). A comparative study between McKenzie technique and neural mobilization in chronic low back pain patients with radiculopathy. International Journal of Orthopaedics Sciences, 4(2l), 802–806. https://doi.org/10.22271/ortho.2018.v4.i2l.115

5. Manchikanti, Laxmaiah, et al. “Epidemiology of Low Back Pain in Adults.”

Neuromodulation: Technology at the Neural Interface, vol. 17, 2014, pp. 3–10., https://doi.org/10.1111/ner.12018.

6. Delitto, Anthony, et al. “Low Back Pain.” Journal of Orthopaedic & Sports Physical Therapy, vol. 42, no. 4, 2012, https://doi.org/10.2519/jospt.2012.42.4.a1.