THE AMERICAN ACADEMY OF SPORTS PHYSICAL THERAPY
DECEMBER 5-7, 2019 | WESTGATE LAS VEGAS The American Academy of Sports Physical Therapy will once again present Team Concept Conference, December 5-7, 2019 at the Westgate Las Vegas Resort and Casino. The theme for 2019 is “Hot Topics,” reflecting the emergent nature of the subjects on the agenda. Registration and room reservations are NOW OPEN! THE COURSE The course begins at 1 pm on Thursday, December 5 with an SCS Hot Topics course. These topics are not only necessary for those preparing to sit for the SCS exam, but for all practitioners!
in this article!) and ending with a spine rehabilitation specialty program in the afternoon. Wrap up takes place around 5:15 pm. Be sure to visit with all of our exhibitors and sponsors...these generous organizations help us to keep registration fees reasonable, and represent the most current trends in sports physical therapy. Spend time with them! We will also have an appbased competition to share, so don’t forget your smartphone or tablet!
Rounding out Thursday's sessions is the annual welcome reception in the expo hall for all attendees. Great food, good drinks and great networking! Friday kicks off the first full day of the conference. Our optional (and popular!) TeamMates event will take place over the lunch hour for the “Rookies” and “Captains” participating. Meet, network and find the perfect mentor. Friday evening is our first ever Poster Presentation and Reception at Team Concept Conference. Join your colleagues from 6-8 pm in the conference foyer for refreshments and information. Saturday is another full day of education, featuring the first AOSSM Exchange Lecture (more information
AOSSM EXCHANGE LECTURE Our first annual AOSSM exchange lecture will be presented Saturday, December 7 at noon. Our speaker will be Brian Busconi, MD. His topic will be Functional Rehabilitation After Anterior Shoulder Stability Repair.
Dr. Busconi is the Chief of Sports Medicine and Arthroscopy, UMass Memorial Medical Center; an Associate Professor of Orthopedics and Physical Rehabilitation, Pediatrics, and Family Medicine and Community Health at the University of Massachusetts Medical School, as well as the Director, Sports Medicine Center, UMass Memorial Medical Center. Dr. Busconi graduated from the Tufts University School of Medicine, Boston, MA. He served his Residency at the UMass Memorial Medical Center - UMass Graduate Medical Education, and his Fellowship in Sports Medicine and Arthroscopy at UMass Memorial Medical Center - UMass Graduate Medical Education.
SPEAKERS Brian Busconi, MD (AOSSM Exchange Lecture) J. W. Thomas Byrd, MD Jeff Dugas, MD Stephen Nicholas, MD Ashley Campbell, PT, DPT, SCS Zachary Christopherson, PT, DPT Chad Condidorio, PT Barb Hoogenboom, PT, ATC, EdD Jason Hugentobler, PT, DPT Airelle O. Hunter-Giordano PT, DPT, OCS, SCS, CSCS Walter L. Jenkins, PT, DHS, LATC, ATC Dan Lorenz, DPT, PT, LAT, CSCS Rob Manske, PT, DPT, MEd Erik Meira, PT, DPT Russ Paine, PT
He is a Board Certified Sports Medicine, Orthopedic Surgery.
Rob Panariello, PT, MS, ATC, CSCS
Dr. Busconi's clinical interests include arthroscopic surgery of sports and nonsports-related injuries, adult and pediatric orthopedic reconstructive surgery.
FACSM
EXHIBITING AT TCC Reservations for the exhibit hall are now open. Cost is $750 for a single booth; double booths (if available) are $1400. Exhibitors receive marketing benefits through booth purchase at Team Concept Conference. More information is available on the website or through the Director of Marketing, Mary Wilkinson, at mwilkinson@aaspt.org.
Mitch Rauh, PT, PhD, MPH, Tim Tyler, PT, MS, ATC Mike Voight, PT, PhD, FAPTA Kevin Wilk, PT, DPT, FAPTA Blaise Williams, PT, PhD
Make your plans now to join us in Las Vegas for this exceptional event! DETAILS Up to 23.5 BOC-approved CEUs, Category A. Pricing: AASPT Member: $465 AASPT Member/Bring A Friend: $410 APTA Member: $555 APTA/Bring A Friend: $500 IFSPT Member: $540 IFSPT/Bring A Friend: $500 Non APTA/IFSPT: $590 Students and Residents: $275 (will be verified) Exhibitor Attendee for CEU: $185 HOUSING NOW OPEN: LIMITED SPACE! FOLLOW US ON OUR WEBSITE OR ON SOCIAL MEDIA TO LEARN MORE ABOUT OUR STELLAR SPEAKERS! Facebook: @AASPTAPTA Twitter: @AASPTAPTA
MEMBER OF INTEREST: CIARA BURGI, PT, DPT, SCS, OCS, FAAOMPT, CSCS
A familiar name around the sports physical therapy world is Ciara Burgi. Rightfully so, as she has impacted many through her mentorship and advice for those who seek her insight on sports physical therapy and career development. Originally from the small town of Baraboo, Wisconsin, she now resides in North Carolina working as a sports physical therapist for Duke University’s Olympic sports; a prestigious role that she did not take any shortcuts toward. Her educational path includes completing her undergraduate
Ciara Burgi, shown center in gray dress, at Duke Sports Medicine Research Day.
degree at University of Wisconsin–Milwaukee in 2009, a doctorate in physical therapy at Duke University in 2014, a sports residency at Houston Methodist Sugar Land in 2015, a fellowship in manual therapy through the Institute for Athlete Regeneration (IAR) in 2016, and most recently the completion of the Division I sports fellowship at Duke University in 2018. Not surprisingly, she is an advocate of post-professional training. According to her, post-profes-
sional programs allow individuals to expand their network, challenge their ideas, and force people out of their comfort zone for the sake of improvement. Although she is a proponent of additional training, she admits that it is not the only route to success and notes that completion of a program does not guarantee a highly skilled therapist. Instead, it is up to the residents and fellows themselves to build lasting relationships, humbly immerse themselves in a challenging envi-
Duke Sports Medicine staff at the Quick Lane Bowl.
ronment, and capitalize on each opportunity. Although physical therapy wasn’t on Ciara’s radar when she finished undergrad, she has been geared toward working in sports from the start. For two years, she was a performance/strength coach in a sports medicine clinic. One of her main roles was training athletes who had completed their rehabilitation but had not yet competed in sport. Noticing a gap between “rehabbed athletes” and high performing athletes is what sparked her interest in physical therapy. Finally coming full circle, her current role in Duke Athletics has allowed her to merge her strength and conditioning background with physical therapy. One of her responsibilities is to collaborate with Duke’s Sports Performance staff to assist all injured athletes in the weight
room, allowing them to continue training with their team. Her favorite part about working in the Division I athletics setting is the opportunity to collaborate with many different professions to enhance the student athlete experience. Research is another area where she’s been able to collaborate with many different people. Ciara recently published a scoping review on ACL return to sport testing criteria in the British Journal of Sports Medicine. Not only is the article a permanent contribution to sports medicine but earned the top prize at Duke Sports Medicine Research Day. While in physical therapy school, she also published a three-year surveillance of injuries at a summer dance clinic. This interest stemmed from her background as a contemporary dancer, which
continues to be an influence. Dance being both athletic and aesthetic, taught her how to observe subtleties in movement, cue efficiently, and be systematic in her approach. Additionally, Ciara leads the Pro Bono Incubator which is a program under the umbrella of Move Together, a non-profit founded by Josh D’Angelo and Efosa Guobadia, whom Ciara met in physical therapy school. The mission of Move Together is to “increase access to quality rehabilitation medicine around the corner and around the world.” The Pro Bono Incubator helps to fulfill the organization’s mission through an application-based grant program, mentorship, and resources to help actuate pro bono rehabilitation innovations. In just four years, Move Together has granted over $30,000 in fund-
completely unfamiliar state, transitioning from a resident to a faculty member at Houston Methodist Sugar Land, or transitioning from fellowship to a staff member at Duke, her greatest challenges and largest periods of growth have always occurred during transitions. She has learned through trial and error that it’s better to start smaller and do a great job, rather than taking on too much and not being able to devote full effort. Her positive mindset pushes her forward as she considers these challenges an opportunity to evolve.
Ciara and her Move Together “family.”
ing to pro bono clinics in the US, built three clinics in Guatemala, and started Global PT Day of Service. The 2019 Impact Report boasts treatment of 12,529 patients by 3,297 volunteers with a total impact on 15,826 lives. Her drive, grit, and ability to succeed may be a familial trait since her parents are a success stories as well. She spoke admiringly about her mother and father who started and run the Save Cows Network. She calls her father the “Lebron James of cow feet.” Although it sounds funny to those not familiar, the process and consequences of trimming cow hooves is an integral piece of dairy cow care. In 1989, the Burgis started a small operation which escalated into a full-blown manufacturing, consulting, and education company that hosts courses and sells equipment and products worldwide. Although it is far outside the realm of physi-
cal therapy, her parents’ work ethic certainly influences her own standards of success. She has taken her parents’ work ethic into her own career. Although seemingly invincible, she has encountered challenges in her career. She admits having trouble with one common theme: transitioning between roles. Whether it’s moving to a
Ciara at work with her father.
Finally, when asked for her closing thoughts and advice for aspiring sports physical therapists, she quickly recalled a memorable quote by Coach K after his 1000th win. “Get on the right bus be with great people and it will take you places you can never get on your own.” Of course, she also wanted to unbiasedly remind everyone that “Duke is the greatest place in the nation!”.
COMBINED SECTIONS MEETING 2020 MORNING SPORTS ROUNDS SUBMISSIONS NOW OPEN: DEADLINE SEPTEMBER 15!
CSM: DENVER 2020
Every year, the American Academy of Sports Physical Therapy sponsors private sessions for our members running simultaneously each morning of CSM. These sessions are called Morning Sports Rounds. Would you like to present a Morning Sports Round at CSM 2020? Submissions are now being accepted through September 15! Here are the details: • Sessions are one hour and 15 minutes starting at 6:15am
• Sessions are case-based, meaning that the material is presented in the narrative of patient cases (one or many)
To submit, please provide:
• Keep number of speakers low due to time constraints - having only one speaker is fine
• Three learning objectives
• Try to have personal interactions with participants (small class size)
Submit your proposal in MS Word format (.docx) to Academy Programming Chair Michael Mullaney at mullaneypt@gmail.com by September 15, 2019.
There is no reimbursement for speakers - not even CSM registration discount, since this is outside of formal CSM programming.
• Short title • Brief description
• Speaker name(s) and bio(s)
IN MEMORY: D. KEITH KLEVEN sion of Sports Physical Therapy in many extraordinary ways: from working with the traditional patient to many celebrities over the years. Keith always contributed to the Section and profession when he was asked to serve and help. I remember spending many hours with Keith and Larry Holmes; when Keith was his "corner man". We attended several of Larry's sparring workout sessions and Keith was always the consummate professional. He is a great loss to our profession and we pray for and wish his family well.”
The American Academy of Sports Physical Therapy is sad to announce the passing of D. Keith Kleven. Keith was a long-time pioneer of sports physical therapy and a founding member of the Academy. He passed away at home in Las Vegas, Nevada on May 30 after a long illness. Working with star athletes such as Tiger Woods and Larry Holmes, Keith was also known as a man who would treat a youth athlete or weekend warrior with the same care and concern. He was also known as a mentor to many young sports physical therapists. With the news of his passing, many Academy members and friends of the Academy have stepped forward to comment on the legacy he leaves behind in sports physical therapy. Sue Heins, PTA, who worked for Keith for many years and who is counted him as a close friend said simply, “It is a hard day. I know he is in a better place, but it is hard to believe I will never see him again.” According to Walt Jenkins, AASPT President, “Keith Kleven was one of the founders and early leaders of the American Academy of Sports Physical Therapy. He was a visionary who was not confined by the limits others established for sports physical therapists. To this end he broke new ground by working with high profile athletes in a variety of sports including professional boxing, golf, Olympic
athletes and dancers. Keith was the ultimate clinician who was constantly refining and growing his clinical skills to meet the needs of his patients. Our academy is indebted to him for his ability to inspire us and lead us to become a true specialty practice area. Our thoughts and prayers go out to Keith's family and those who were close to him.” George Davies, another founder of the AASPT, remembers, “Keith Kleven was an outstanding professional and represented the profes-
“Keith was always bigger than life to me. He was legendary as the physical therapist for the stars when I came into the sports physical therapy world. However, when I met him in person his genuine smile and personality put me at ease and I learned so much from him over the years,” states Barb Sanders, Texas State University. “What a treasure and what a legacy!” Steve McGee, LightForce Therapy Lasers and owner of CDM Sport, was a close friend of Keith’s, says, “Thank you for your thoughts to honor Keith, as he has always been such a special friend to me for over 30 years, and an even a better Friend to the AASPT! The high standards that he and Sue Heins always had for his patients was a given, and it came with brutally honest feedback all the time! He hated how treatment formulas were from the big chains –which
to come see me make a presentation, when it should have been I going to check on him. Rest in peace my friend, and thanks for allowing me to be one of the countless people you have made a better clinician and person.”
always made offers to buy his clinic. Keith always said no because he would never change his quality of care to his patients! I have a very heavy heart right now, but peace that Keith is able to move on now after suffering for so long.” Terry Malone, University of Kentucky, stated “Keith was one of the originals. He was a Private Practice “creator” (there was no roadmap for the originals). He was a sports physical therapist before such a designation existed! Keith cared about his patients as if they were all the same – even though some fought for the world championship and others were average folks. He assisted the Academy whenever possible and he will be missed.” “He was one of the first physical therapists to establish the relationship of fitness, training and physical therapy in one site and provided care to some of the most elite athletes in his time,” according to Bob Mangine, University of Cincinnati. “ It is a sad day for our profession that an individual with the vision to introduce the concept of sports physical therapy as a specialty area of practice is no longer with us. Keith will be missed by all of us, whom he influenced the way that we practice.” “When I was going through physical therapy school at the University of Miami, I heard about this physical therapist in Las Vegas who developed a clinical practice around treating and training athletes, entertainers and performers,” says Pete Draovitch. “It was such a novel concept at the time
where one clinician would oversee care for someone from an operating room table and returning them to an even higher level of performance. When I began working with golfers in the early 90’s, I made sure one of the events I would attend would be the tournament in Vegas so I could meet this Keith Kleven guy. When I walked into the office there were athletes and performers of all types. Little did I know that day I would meet someone who I would share countless hours walking around PGA Tour golf events following the players we were lucky enough to treat. We would share our thoughts on treatments, trends, training, travel, etc. It was a give and take relationship. He gave and I took. I never saw him raise his voice, never saw him negative and he always said the right thing at the right time to make people feel good about themselves. What he viewed as sharing experiences with a younger clinician, I viewed as parables being shared by the wise elder. There isn’t a time that I pick up some boxing gloves to work with a patients movement or fitness that I don't think of Keith. Above all else he was a humble and gentle soul who made this world a better place. The last time I saw him he was already ill and was being escorted around by his wife. He made time
Similarly, Mike Voight, former AASPT president, editor in chief of the IJSPT and professor at Belmont University, says, “I first met Keith over 50 years ago when he took the time to talk to me as a young boy. He told me about his “dream job” of being a physical therapist and why I should pursue this profession. Years later, I saw first hand his special touch of molding physical therapy students into young colleagues.” “I'm saddened to hear of the passing of Keith Kleven. He was a wonderful, kind and considerate man. He always had a smile, a kind word, and willing to help/assist you in whatever you needed or asked,” says Kevin Wilk, former AASPT president. “He was a pioneer and leader of our Academy. I never heard Keith say an unkind word about anyone or anything. When I think of Keith, I think of the way we should all conduct ourselves; he was like the "Bart Starr" of physical therapy. Bart passed this week too. RIP & God Bless them both!” Turner A. “Tab” Blackburn sums up Keith’s nature: “I’ll never forget when Keith worked with us on the fun runs. Despite his celebrity, he never minded getting his hands dirty assisting with all the behind the scenes activities to make the runs fun and competitive! He represented us on the world stage and in our backyard!”
MEMBER SPOTLIGHT: AMY ARUNDALE, PT, PhD, DPT, SCS By Shefali Christopher Did you always know you wanted to be a PT? What inspired you to be a PT? I had some very good PTs for injuries as I was growing up. As I was going through college I was deciding between coaching soccer, PT, and orthopedic surgery. I decided I wanted something a bit more stable than coaching (Ironic now since I work in pro sports!). Ortho was intriguing, but the patient interactions were so short and so much of the patient contact time was in the OR, that I decided I wanted to treat conscious not unconscious people! It came to my junior year in college, and I'd had pressure from my undergrad professors to pursue medicine, but after studying abroad and a bit of time away I realized I loved the relationships that were built through PT. I loved the impact you could have on someone's life and the amalgamation of coaching, teaching, science, and people. Who are the biggest mentors you had that helped you along the way? There are a ton of people I have to thank for supporting me to where I am now! In college my athletic director, Greg Kannerstein, encouraged me to keep dreaming about what I my ideal job and encouraged me to keep coaching. Joe Black has been a major mentor to me personally and professionally ever since I
first met him at the AASPT booth at CSM my second year in PT school. Chuck Thigpen, Rob Schneider, and Lynn SnyderMackler have all been major influences and mentors clinically and research-wise. I'm also thankful for mentors I have aboard who have a support clinically and professionally, like Martin Hagglund, Joanna Kvist, Clare Ardern, Stefano Della Villa, and Mike Davison.
What would you tell new PTs / AASPT members who want to get more involved? Go introduce yourself! That handshake or email can have a major impact on your career! Our profession is amazing, and it's definitely people-centric. The sports world especially is small and connect, so don't be afraid to reach out! If you want to get more involved, just ask. Whether its wanting to get more involved
“Playing coed soccer on terrible fields with guys twice my size and no brakes, I found I was getting really beat up and not having as much fun.” in the AASPT or trying to find a job in sports ask how you can volunteer. The AASPT can always use volunteers, and at sports teams in lower leagues there is always a need for extra hands! What are the biggest challenges that you see facing the profession / the sports world? I think maintaining high quality evidence informed care in the social media age is a major challenge. I think more than ever education is key, both keeping up-to-date as a therapist and athlete education. Social media makes it so easy to get information. At the same time it's incredibly easy to get misinformation. As therapist we have to hold ourselves accountable to evaluate the evidence thoroughly, rather than taking information for granted. It's tough as we all have a lot of demands on our time and reimbursement is getting smaller, but we have to take the time to look at the evidence itself, not just social media. It's also on us then to take what we learn and help our athletes. Having conversations with our athletes and making sure that they understand their bodies, their injuries, and whats going on, is on us. We can't leave it to YouTube and Twitter. Congrats on your role with the Brooklyn Nets! Can you tell us more about how you got there
and what your job responsibilities currently are? Thank you! My path to Brooklyn was a bit circuitous. I finished my PhD in 2017, and did a short post-doc in Linköping, Sweden. I was connected with the Nets by a friend/mentor in London after my visa to work in the UK was rejected. I actually didn't get the role that I interviewed for because the other candidate had more clinical experience. But they liked me and my skill sets so created a role for me. I'm incredibly thankful for the opportunity! My role is primarily clinical. As part of the Nets performance team I treat, rehab, and care for players. I travel with the team most of the time, although will sometimes stay back if we have a player(s) who aren't traveling due to an injury/rehab. In addition, I am working with the team to pursue research examining injuries, prevention, monitoring, and rehab. Honestly, it's my dream role in terms getting to combine practice and research, while working with an amazing team of experienced practitioners! We know you are a pretty prolific Aussie rules football player. How does your PT world mesh with your Aussie rules world? Thanks! Well, footy has become an outlet for me and helped me keep my life in balance. It's also a community. I started playing in the second year of my PhD (having played soccer my entire
life up to that point). Playing coed soccer on terrible fields with guys twice my size and no brakes, I found I was getting really beat up and not having as much fun. My best friend's husband studied abroad in Australia and had played for years, so when they started a women's team he recruited me to play. I loved the sport as soon as I started and I also felt like I'd found “my people.” Outside of the physical therapy community, it was a group of people who supported me, pushed me, and married competition, athleticism, passion, and family. So footy quickly became part of my work life balance. I'm a busy bee so it helped me keep my work in perspective, and gave me personal goals to work towards. In 2017, I made the developmental US national team, and am working towards making the top US squad for the 2020 International Cup (the world cup of Australian Rules Football). So while the NBA schedule is crazy, the Nets have been incredibly supportive of my goal. When I interviewed my boss told me that they wanted to support both my professional and personal goals, and they have been absolutely true to that word! And now footy has infiltrated my PT career as well. I've started doing research with the United States Australian Rules Football League helping them develop injury prevention strategies.
Treatment and Rehabilitation of the Hip One-Day Course
Lecture, Clinical and Arthroscopic Surgery Lab Demonstrations Open to PTs, PTAs and ATCs Provides 8.0 Contact Hours BOC Approved This one-day course will provide participants with an in-depth, didactic review of clinical evaluation, surgical treatment options, and rehabilitation techniques for select intra-articular and extra-articular hip conditions, including femoroacetabular impingement, acetabular labral tears, and articular cartilage pathology, as well as snapping hip syndrome, greater trochanteric bursitis, and hip flexor pathologies. Arthroscopic surgery lab sessions for the hip will be conducted via live streaming from the Medical Academic Center (MAC) Bio-Skills
Demonstration Lab to the MAC auditorium, allowing participant interaction with the surgeons. In addition, hands-on clinical lab sessions, including examination and advanced rehabilitation techniques will be presented.
Presented by
In partnership with
Informational flyer available on AASPT website. Presenters G. Peter Maiers II, MD Brian E. Camilleri, DO Erik Meira, PT, DPT John Anderson, PT, DPT, LAT, ATC Mark DeCarlo, PT, DPT, MHA, MS, SCS, AT-Ret For more information, contact Mark DeCarlo, PT, DPT, MHA, MS, SCS, AT-Ret at mark.decarlo@teamrehab.com
Saturday, January 25, 2020 Medical Academic Center 13225 N. Meridian Street Carmel, IN 46032 REGISTER ONLINE BY JANUARY 17, 2020 REGISTER HERE COURSE FEE: $200 (includes lunch) $50 discount for AASPT Members! Use code "MEMBER."
THIRD WORLD CONGRESS OF SPORTS PHYSICAL THERAPY COMING TO VANCOUVER, BC IN OCTOBER!
The International Federation of Sports Physical Therapy (IFSPT) Third World Congress of Sports Physical Therapy will be held October 4-5, 2019 in Vancouver, British Columbia, Canada in conjunction with Sports Physiotherapy Canada. Join us at the Vancouver Convention Centre to gain new tools for your toolbox with this year’s conference theme - High Performance to Clinical Practice! Programming Programming for this year’s Congress will cover a variety of topics, including but not limited to, injury screening and return to play, neuroplasticity in athlete rehabilitation, concussion updates, surgical vs. non-surgical management of the athlete, rehabilitation of the upper and lower extremities, pain science in athlete rehab and performance, the use of technology in sport, women’s health, and leadership in sport. CEUs will be available for U.S. physical therapists and physical therapist assistants.
The IFSPT General Meeting will be held on October 3, 2019 in conjunction with the Congress. Pre-Congress Courses will also be held on October 3, 2019. For a full program overview, visit https://www.sportphysio.ca/calendar-of-upcomingevents/spc2019/meet-the-speake rs/ Confirmed Speakers Dr. Clare Ardern PT, PhD, Editor of JOSPT Professor Roald Bahr, MD, PhD Dr. Christian Barton PT, PhD Dr. Keith Baar, PhD Dr. Lara Boyd PT, PhD Dr. Johann Windt, PhD Dr. Maria Constantinou PT, PhD Dr. Ann Cools PT, PhD Professor Kay Crossley PT, PhD Sarah Haag PT, DPT, Women’s Health Certified Specialist Dr. Alex Hutchinson Journalist, PhD Dr. Greg Lehman PT, MSc, DC Karen Litzy PT, DPT Dr. Kerry MacDonald Dr. Bob McCormack MD
Dr. Luciana De Michelis Mendonca, PT, PhD Dr. Ebonie Rio PT, PhD Professor Ewa Roos, PT, PhD Dr. Emma K Stokes PT, PhD, MSc Mgmt. Dr. Anthony Schneiders PT, PhD Sarah Smith, PT Dr. Kristian Thorborg PT, PhD Dr. Jane Thornton, MD, PhD Dr. Rod Whiteley PT, PhD Registration is open! Don’t miss this miss this opportunity. Take advantage of the Early Bird Registration rate now through August 1, 2019. Please note prices are listed in Canadian Dollars. AASPT members will also receive the discounted IFSPT membership rates. Registration link and more information: https://www.sportphysio.ca/ calendar-of-upcomingevents/spc2019-2/registration-for2019-world-congress-of-sport-phys ical-therapy/ See you in Vancouver!
LASERS VS. SHOCKWAVE: WHAT IS THE BEST CHOICE FOR SOFT TISSUE INJURIES? Mark Callanen, PT, DPT, OCS Modalities are generally devised to help promote healing and/or decrease pain. Two advanced devices that focus on treating soft tissue injuries include Class IV laser and shockwave technology. While both can be effective, how they work and what conditions they are best suited for can be confusing. Mechanism of Action While laser imparts photonic energy into tissue to create photochemical changes at the mitochondrial level in a process referred to as photobiomodulation (PBM), therapeutic shockwave (ESWT) devices deliver radial or dispersive sound waves into tissue. The uni-phasic waveform of a shockwave provides peak pressures that are 1000 times greater than a biphasic ultrasound wave, followed by a second phase of negative peak pressure that creates a cavitation effect. This is believed to create microscopic damage to tissue which spurs on the inflammatory responses.1,2 Clinical Effects While shockwaves’ MOA is not completely understood,2 established treatment effects include the following, some of which are shared with PBM: • Mechanical stimulation • Increased local blood flow*
• Increase in cellular activity* – release of substance P*, prostaglandin E2*, NO*, TGF β*, VEGF, and almost certainly other inflammatory cytokines* • Transient analgesic effect on afferent nerves* • Breakdown of calcific deposits (primarily, but not exclusively in tendon) *Indicates shared treatment effects with PBM. It should be noted that laser generally downregulates inflammatory mediators and associated pain factors like Substance P, as opposed to the increase Shockwave creates. This is an important differentiator. Target Tissues Since laser impacts mitochondrial activity, it can influence most eukaryotic cells. This means it can be used on nerves, tendons, muscle, ligaments, joint capsules, bone, and wounds. This provides significant flexibility when treating both acute and chronic condi-
tions in different areas of the body. Shockwave is best applied to recalcitrant problems, such as chronic insertional tendinopathy (lateral epicondylitis, plantar fasciitis, patellar tendonitis) and calcific tendonitis of the shoulder.1,2 There is also research that supports treatment of nonunion fractures of long bones3,4,5 and avascular necrosis of the femoral head.6,7,8,9 Similarities/Differences The two modalities are similar in that they both can help improve blood flow and promote growth factors to damaged tissue. They differ in that while they both influence inflammation, laser generally helps reduce it, while shockwave increases it. Think of the laser as cellular concierge helping guide cells through the stages of healing in a faster and more efficient manner. Shockwave is a professional wrestler
that is body slamming tissue; restarting the inflammatory process in order to promote blood flow to areas that need it. Recent Research Despite their differences, a 2019 study endorsed the use of both devices together to treat plantar fasciitis. Laser was applied after shockwave, which had better outcomes than using either modality independently.10 A separate 2017 plantar fasciitis study concluded that laser and shockwave were equally effective for improving pain and functional scores, and that both were more effective than treating with standard ultrasound.11 Contraindications Regarding contraindications, laser can be used over total joints, hardware, and lung fields, whereas shockwave should not be used over lung tissue and can cause cemented implants to loosen. Other contraindications are fairly similar between the two. You would not want to use these devices over an active infection, the lower trunk of pregnant women, epiphyseal lines, or active cancer sites. Knowing the tissue type, pathology, and the acuity level of an injury should help define whether one or both of these modalities should be used to stimulate healing and maximize outcomes.
References 1. Watson, T. Electrotherapy on the Web. School of Health & Social Work, University of Hertfordshire UK. http://www.electrotherapy.org/ modality/shockwave-therapies#Return%20to%20Top 2. Wang, CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. Journal of Orthopaedic Surgery and Research 2012, 7:11. 3. Haupt G, Haupt A, Ekkernkamp A, Gerety B, Chvapil M: Influence of shockwave on fracture healing. J Urol 1992, 39:529-32. 4. Schaden W, Fischer A, Sailer A: Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Orthop 2001, 387:90-4. 5. Valchanou VD, Michailow P: High-energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 1991, 151:181-4. 6. Ludwig J, Lauber S, Lauber HJ, Dreisilker U, Raedel R, Hotzinger H: Highenergy shock wave treatment of femoral head necrosis in adults. Clin Orthop 2001, 387:119-26. 7. Lin PC, Wang CJ, Yang KD, Wang FS, Ko JY, Huang CC: Extracorporeal shockwave treatment of osteonecrosis of the femoral head in systemic lupus erythematosis. J Arthroplasty 2006, 21(6):911-5. 8. Wang CJ, Ko JY, Chan YS, Lee MS, Chen JM, Wang FS, Yang KD, Huang CC: Extracorporeal shockwave for hip necrosis in systemic lupus erythematosus. Lupus 2009, 18(12):1082-6.
9. Wang CJ, Wang FS, Yang KD, Huang CC, Lee MS, Chan YS, Wang JW, Ko JY: Treatment of osteonecrosis of the hip: comparison of extracorporeal shockwave with shockwave and alendronate. Arch Orthop Trauma Surg 2008, 128(9):901-8. 10. Takla M, Rezk S. Clinical effectiveness of multi-wavelength photobiomodulation therapy as an adjunct to extracorporeal shock wave therapy in the management of plantar fasciitis: a randomized controlled trial. Lasers Med Sci. 2019 Apr;34(3):583-593. 11. Ulusoy A, Cerrahoglu L, Orguc S .Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy, Ultrasound Therapy, and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial. J Foot Ankle Surg. 2017 Jul - Aug;56(4):762767. Presented by
Co-Titling Sponsor of rhe Kevin Wilk AASPT Traveling Fellowship
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DECEMBER 5-7, 2019 | WESTGATE LAS VEGAS REGISTER ONLINE AT WWW.AASPT.ORG/TCC
REGISTER SOON | HOUSING OPEN AT WWW.APTA.ORG/CSM
COURSES SEPTEMBER Injury Management of the Dancer: Treating the Recreational, Pre-Professional and Professional Dancer. September 14, 2019 Location: Cincinnati Children's Hospital Medical Center Cincinnati Children's Hospital Medical Center Sabin Auditorium (Location D) 3333 Burnet Avenue Cincinnati, OH 45229-3039 or from the comfort of your home via our Livestream feed! This one-day interactive course will feature a consortium of regional expert speakers in the field of dance medicine. The course will provide attendees with specific, evidence-based evaluation and treatment strategies to provide physical therapists and athletic trainers with a comprehensive approach to evaluating and treating dancers backstage and in the clinic. General Registration Onsite and Livestream (before August 9th, 2019): $175 Late Registration Onsite (after August 10th, 2019): $225 Late Registration Livestream (after August 10th, 2019): $200 Registration Link>
with practical skills that will enable them to fully evaluate the injured runner and design a comprehensive training approach to maximize outcomes. Register here: bit.ly/Willy2019 Download flyer: bit.ly/WillyFlyer Certified Running Gait Analyst – Level 1 Sept 21-22, Tucson, AZ We provide the knowledge, skills, and tools to simplify running and turn rehab and fitness professionals into heroes for runners. Running injuries are complex and runners want results fast! Learn how to simplify running to get runners back to enjoying the sport they love. The five most common running gait impairments will be covered, and participants will have the chance to use the latest in 3D technology to analyze form and learn advanced methods for gait re-training. Register Here
Open ERA Course (capacity 30) from 8am to 5pm on Saturday, Sep 21 and Sunday, Sep 22, 2019, at: MOTION Sports Medicine - Midtown East 160 E 56th Street
ADVANCED DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE SEPT 13 - 15 MCKINNEY, TX FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE SEPT 20 - 22 GLENDALE, AZ
New York, NY 10022 FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE SEPT 27 - 29 DENVER, CO
Open ERA Course (capacity 30) from 8am until 6:30pm on Saturday, September 14, 2019 and 8am until 4:30pm on Sunday, September 15, 2019 at: Los Gatos Orthopedic Sports Therapy 16615 Lark Avenue, Ste 101 Los Gatos, CA 95032 Presented by CogentSteps
Open ERA Course from 8am to 5pm on Saturday, September 28 through Sunday, September 29, 2019 at: BodyCentral Physical Therapy 1991 E Ajo Way, Suite 149 Tucson, AZ 85712 Presented by CogentSteps
Restoring Load Capacity in the Injured Runner with Rich Willy, PT, PhD Location: The Lab, Santa Barbara, California Date: September 14-15, 2019
All CogentSteps LLC courses register at www.cogentsteps.net.
Rehabbing INJURED RUNNERS is hard! This course will enable you to put the latest evidence into practice. Through a mix of didactic and laboratory sessions attendees will leave
All Structure and Function Courses register at https://structureandfunction.net/courses/
OCTOBER The IFSPT Third World Congress of Sports Physical Therapy will be held October 4-5, 2019 in Vancouver, British Columbia, Canada, in conjunction with Sports Physiotherapy Canada. The IFSPT General Meeting will be held on October 3, 2019 in conjunction with the Congress. More information and registration
ADVANCED DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE OCT 4 - 6 SCOTTSDALE, AZ FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE OCT 11 - 13 MENTOR, OH
Open EMR Recertification Course from 8am until 5pm on Saturday, October 19 2019 at: USF Health School of Physical Therapy and Rehabilitation Sciences University of South Florida 3515 E. Fletcher Avenue (MDT Building, Room 1006) Tampa, FL 33612-4766 Open ERA Course from 8am until 6pm on Saturday, October 19 and 8am until 5pm on Sunday, October 20, 2019 at: USF Health School of Physical Therapy and Rehabilitation Sciences University of South Florida 3515 E. Fletcher Avenue (MDT Building, Room 1010) Tampa, FL 33612-4766
Certified Running Gait Analyst – Level 1 October 19-20, Chicago, IL We provide the knowledge, skills, and tools to simplify running and turn rehab and fitness professionals into heroes for runners. Running injuries are complex and runners want results fast! Learn how to simplify running to get runners back to enjoying the sport they love. The five most common running gait impairments will be covered, and participants will have the chance to use the latest in 3D technology to analyze form and learn advanced methods for gait re-training. Register Here Keeping Them in the Game: Managing Sports Injuries in Young Athletes will be held on October 25-26, 2019 in Bloomington, MN. This conference is intended for physical therapists and athletic trainers working in an outpatient therapy setting with intermediate to advanced experience. Continuing medical education credit will be available. Course details are available here: https://reg.abcsignup.com/reg/event_page.asp x?ek=0037-0016826da75e60f4431d8ccc0bca3ba85470 To register today, click here! https://reg.abcsignup.com/reg/reg_login.aspx Contact us at institute@tria.com or (952) 8065603 with any questions.
10/25/19-10/26/19 ERA Washington DC Medstar Lafayette Centre 1120 20th St NW, Building 1 South - A Level Washington DC, 20036 Presented by CogentSteps 10/26/19 EMR Recertification Washington DC Medstar Lafayette Centre 1120 20th St NW, Building 1 South - A Level Washington DC, 20036 Presented by CogentSteps
NOVEMBER
FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE NOV 1 - 3 JEFFERSON, LA FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE NOV 22 - 24 PASADENA, TX
Open ERA Course From 8am until 6:30pm on Saturday, November 9 and from 8am until 4:30pm on Sunday, November 10, 2019 at: Evolution Physical Therapy, Inc. 12703 Cerise Ave Hawthorne, CA 90250 11/13/19-11/14/19 ERA Anaheim CA Disneyland Anaheim CA TBD 11/14/19 EMR Recertification Anaheim CA Disneyland Anaheim CA TBD Open ERA Course 8am to 5pm on Friday, Nov 15 through Saturday, Nov 16, 2019 at: Farmington Health Center - University of Utah 165 North University Avenue Farmington, UT 84025 DECEMBER
Open ERA from 8am until 5pm Tuesday Dec 3 and Wednesday Dec 4 2019 at: Room 208A, Student Union University of Nevada, Las Vegas 4505 S Maryland Pkwy Las Vegas, NV 89154, USA Presented by CogentSteps
All CogentSteps LLC courses register at www.cogentsteps.net. All Structure and Function Courses register at https://structureandfunction.net/courses/
Open EMR Recertification from 8am until 5pm Wednesday Dec 4 2019 at: Room 208B, Student Union University of Nevada, Las Vegas 4505 S Maryland Pkwy Las Vegas, NV 89154, USA Presented by CogentSteps REGISTER NOW!
THE DETAILS December 5-7, 2019 Westgate Las Vegas Resort and Casino Room Reservations now open! THE COURSE Course begins at 1 pm on Thursday, December 5 with an SCS Hot Topics course. These topics are not only necessary for those preparing to sit for the SCS exam, but for all practitioners! Rounding out Thursday's sessions is the annual welcome reception in the expo hall for all attendees. Great food, good drinks and great networking! Friday kicks off the first full day of the conference, ending with the optional TeamMates event. We'll be featuring a special speaker, a delicious dinner and drinks, and more time to network and find the perfect mentor. Saturday is another full day of education, ending with a spine rehabilitation specialty program in the afternoon. Wrap up takes place around 5:15 pm.
Open ERA Course 8am to 7pm on Saturday, Dec 14 and 8am until 4:30pm on Sunday, Dec 15, 2019 at: Brooks Rehabilitation Hospital 3955 University Blvd S Jacksonville, FL 32216
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Treatment and Rehabilitation of the Hip Saturday, January 25, 2020 Medical Academic Center 13225 N. Meridian Street Carmel, IN 46032 Lecture, Clinical and Arthroscopic Surgery Lab Demonstrations Open to PTs, PTAs and ATCs Provides 8.0 Contact Hours BOC Approved This one-day course will provide participants with an in-depth, didactic review of clinical evaluation, surgical treatment options, and rehabilitation techniques for select intra-articular and extra-articular hip conditions, including femoroacetabular impingement, acetabular labral tears, and articular cartilage pathology, as well as snapping hip syndrome, greater trochanteric bursitis, and hip flexor pathologies. Arthroscopic surgery lab sessions for the hip will be conducted via live streaming from the Medical Academic Center (MAC) Bio-Skills Demonstration Lab to the MAC auditorium, allowing participant interaction with the surgeons. In addition, hands-on clinical lab sessions, including examination and advanced rehabilitation techniques will be presented. Presenters G. Peter Maiers II, MD Brian E. Camilleri, DO Erik Meira, PT, DPT John Anderson, PT, DPT, LAT, ATC Mark DeCarlo, PT, DPT, MHA, MS, SCS, AT-Ret
ActivForce empowers professionals to quickly measure muscle force and symmetry, providing immediate and precise data for evaluation and goal tracking from first session to successful recovery.
REGISTER ONLINE BY JANUARY 17, 2020
Take the subjectivity out of manual muscle testing. ActivForce is a strength assessment system that allows you to objectively gauge strength and quantify improvement.
REGISTER HERE COURSE FEE: $200 (includes lunch) AASPT MEMBERS RECEIVE A $50 DISCOUNT: USE CODE "MEMBER" For more information, contact Mark DeCarlo, PT, DPT, MHA, MS, SCS, AT-Ret All CogentSteps LLC courses register at www.cogentsteps.net. All Structure and Function Courses register at https://structureandfunction.net/courses/
Digital Dynamometer ActivForce includes a digital dynamometer that enables you to measure strength objectively, and evaluate right/ left symmetry. The free app provides testing protocols for all major muscle groups. Dashboard The ActivForce dashboard lets you view and track your patients’ data over time. A single account may support multiple logins, and each login may track an unlimited number of patients.
Flexibility ActivForce can be used to test any muscle group and up to 200 pounds of force. Its small size and durable design allows for maximum flexibility. Evaluation ActivForce enables physical therapists and clinicians to perform muscle assessments that identify potential strength deficiencies that could lead to injury. The system allows coaches and trainers to perform baseline evaluations and track progress throughout the season to develop the most effective strengthening programs. Rehabilitation ActivForce may be used post injury or surgery to assess muscle weakness and provide the data necessary to develop and track the most effective rehab protocols based on the patient or athlete’s current strength. www.activbody.com