April 2019 News

A P R IL 2 01 9 h THE A M ER IC A N ACADEMY OF SPORTS PHYSI C AL TH E RA PY

WELCOME TO OUR NEW EXECUTIVE AND NOMINATING COMMITTEE MEMBERS! Congratulations to the newly elected Executive Committee and Nominating Committee members!

Treasurer Jill Thein-Nissenbaum, PT, DSc, SCS, ATC Assistant Professor Doctor of Physical Therapy Program University of Wisconsin Madison, WI

Thank you to all those who agreed to serve as candidates. It is essential for the continuation and growth of the AASPT that members step forward to accept the challenge of serving in leadership.

Representative at Large Erik Meira, PT, DPT, SCS, CSCS Black Diamond Physical Therapy Clinic Director Portland, OR The Science PT

Tim Vidale, PT, DPT, MBA, CSOMT Physical Therapist and Assistant Rehabilitation Coordinator Minnesota Twins Washington, DC

Nominating Committee And a very special thank you!

Also, thank you to outgoing executive committee members, Bryan Heiderscheit, Treasurer, and Stacey Pagorek, Representative at Large, for their years of service to the Academy.

Lenny Macrina, MSPT, SCS, CSCS Co-Founder, Director of Physical Therapy Champion PT & Performance Waltham, MA

Newly elected leaders will take over their positions after the APTA NEXT event in June.

PIONEERING TACTICAL ATHLETE SUPPORT BAILEY VAIL, PT, DPT In 2016, Bailey Vail attended her first APTA Combined Sections Meeting as a second year DPT student from Idaho State University. Just two short years later, Bailey has established herself as a leader in the rehabilitation, wellness, and injury prevention of law enforcement officers and was invited to share her expertise both at AASPT Team Concept Conference and CSM in 2018.

how to proceed, and they agreed that the best opportunity to influence change would be to catch LEOs at the start of their careers and to try to change their mindset early, thereby influencing the future culture of the department.

Like many in the profession, Bailey’s initial interest in physical therapy stemmed from participation in high school sports and her own sports injury rehabilitation. She entered PT school at the same time her husband started his law enforcement training.

However, it wasn’t until after hearing Kyle Sela, PT, DPT speak on the tactical athlete at CSM 2016 that she became more invested in this population. Realizing there was a huge problem related to the management of health and wellness of law enforcement officers (LEOs), she returned to her second year of PT school eager to act. She consulted with ISU Professor Emeritus Alex Urfer, PT, PhD about

A Police Officer Standards and Training (POST) academy was already located on the ISU Campus in Pocatello, Idaho. With her husband Brandon having just completed training and starting field work, Bailey knew that the law enforcement community is a close knit group and that she would likely meet resistance to “outsider” interference. Bailey and Dr. Urfer met with Cal Edwards, who was in charge of the ISU Law Enforcement Program at the time, and provided him basic statistics on the health and wellness of LEOs. Dr. Urfer helped craft a proposal for PT intervention and fortunately, Cal was on board. They quickly began working with

Yoga class for cadets.

Bailey Vail and her husband Brandon.

By Sylvia Czuppon

Lieutenant Whitney, who was in charge of the physical training of Academy cadets. Lt. Whitney had been teaching cadets about exercises based on his personal experience and training from the Cooper Institute.

Through persistence coupled with evidence, Bailey was able to demonstrate to Lt Whitney the value and benefit of a formal CTAP program. Lt. Whitney is now a strong proponent of the program and attempts to incorporate any feedback he receives to continuously improve the cadet experience.

The Idaho POST’s classroom PowerPoint lectures do not emphasize the importance of physical health and wellness. Therefore, Bailey’s first priority was to make supplemental lectures to enhance these powerpoints by including information about disease processes that LEOs are at higher risk for, as well as injury prevention strategies. The second priority was to bring all cadets into the anatomy cadaver lab to allow them to see the physical effects of disease processes; this enhanced the cadets’ understanding of

cadets are reporting injuries earlier so that overall time lost due to injury has been significantly lower.

Bailey with cadets in cadaver lab. how “real” these conditions were and how these conditions could affect them. This cadaver lab experience is unique to CTAP, and not traditionally offered as part of their POST training at any other academies in the country.

Third, hands-on training was revised to include activities more relevant to job-specific tasks. As an example, Bailey says the cadets used to run five miles consecutively for conditioning – “Which is great,” she notes, “Except as a police officer, when you’re working, you’re never going to run 5 miles.”

There are multiple goals to this program. The first goal is to ensure all cadets pass the physical readiness test.

Prior to program implementation, one to three cadets in each class would not pass; for the past seven semesters since the program started, no one has failed the test. The second goal is to introduce the cadets to multiple ways to exercise, regardless of access, and help them find methods they enjoyed to improve compliance during POST training as well as throughout their careers. A third goal was to prepare them for their job demands. Bailey joined her husband for several ride-a-longs to gain an appreciation for what LEOs do on a day-to-day basis. Unfortunately, unlike what is depicted in most TV and movie dramas, police officers sit

for over 50 percent of their shift. However, they have to be able to go from 0100 mph suddenly. How do you prepare them for this? Finally, a major goal of the program is to reduce injuries by improving muscle strength, endurance, movement patterns, and teaching gradual progressions of exercise activity. While they have not tracked injuries specifically pre- and post- program implementation, anecdotally Lt. Whitney has reported that

Cadets on conditioning run.

Bailey graduated in 2017 and was immediately hired as Adjunct faculty at ISU and as the Director of the Center for Tactical Athletic Performance (CTAP). She continues to be heavily involved with the health and wellness portion of the ISU cadet academy. DPT students at ISU have the opportunity to be involved with the CTAP program as a practicum experience, developing exercises and activities for the cadets, which serves to enhance the diversity of the students’ clinical experience. Currently, the CTAP program is only working with the POST academy in Pocatello.

But Bailey notes that the ISU DPT program just expanded to Meridian, Idaho where coincidentally, just across the street, the state’s largest police academy is located; she has hopes to expand the CTAP program here, too.

Additionally, after presenting at CSM and TCC, Bailey has been approached by many physical therapists interested in setting up similar programs in their areas, so she is working on “packaging” the program so that it may be more easily implemented. One challenge, however, is that health and wellness issues related to LEOs are universal,

but every state has different standards and teaching requirements for their cadets. Thus, while one state may require greater emphasis on one topic, another state may require a completely different emphasis based on their current standards.

Looking back, Bailey wishes she would have had a stronger research background and been able to collect more baseline data to examine the effectiveness of their intervention. While feedback for the CTAP program is positive, it is frustrating to not be able to say with full certainty that it is helping.

She is concerned that Cadets participating in an obstacle class. when trying to expand the program, without the data of allowing the program to develop. At to back up the program’s effectiveness, the POST academy, Matt Bloodgood she may meet greater resistance in the helped Bailey become a POST-certified future. instructor and has been a strong advocate at the state level to expand the To other PTs interested in starting CTAP program. Kyle Sela, PT, DPT not similar programs with tactical athletes only piqued her interest in the tactical in their communities, Bailey encourathlete, but while spending a clinical ages you to get to know the population. rotation with him in Boise, he menSpecifically, she says you need to “truly tioned the CTAP presentation at CSM understand where they’re coming from and what their challenges are. The more you know about that population, the better your interventions will be.”

With respect to those interested in working with LEOs, she recommends asking to go on a ride-along – provided you have a clean background check, most police departments will allow you to join them if you just ask.

Finally, Bailey emphasizes that a strong support system is critical to success.

She was fortunate to be supported by a number of people in addition to Dr. Urfer. Derek Gerber, PT, DPT, was responsible for running the ISU clinic and practicums and remained very supportive of the idea of dedicating DPT students to the Program. Just after the CTAP program started, Deanna Dye, PT, PhD became the Program Director at ISU and remained supportive Cadet graduating class.

2017, which led her to an APTA PT in Motion feature (http://www.apta.org/ PTinMotion/2017/5/Feature/ProtectingProtectors/) as well as an invitation from AASPT Tactical Athlete Special Interest Group Chair Rich Westrick PT, DPT, DSc, OCS, SCS to speak at both CSM and TCC in 2018.

Last, but certainly not least, Bailey’s husband Brandon has helped her come up with unique workouts and exercise ideas specific to this population’s job demands.

While interestingly, Brandon didn’t immediately buy into the project, he is now one of its biggest supporters!

To find out more about the Tactical Athlete SIG, visit www.aaspt.org!

MEMBER SPOTLIGHT: JENNIFER ALLEN, PT, DPT, OCS, SCS, CHT

By Shanon Fronek Dr. Jennifer Allen, PT, DPT, OCS, SCS, CHT, is not your average clinician. She is the CEO and cofounder of Bodycentral Physical Therapy and Sports Medicine in Tucson, Arizona. Her passion for teaching is exemplified in being an instructor for many courses, including the Emergency Medical Response for the Athlete by Cogent Steps, LLC; Structure and Function Dry Needling; and Hawk Grips. Dr. Allen is the primary mentor for the sports physical therapy residency program at Bodycentral Physical Therapy, and also works as adjunct faculty member at A.T. Still University in their Doctor of Athletic Training program. As a previous college softball player, she continues to share her love for sports and injury prevention by being involved in a multitude of community activities and outreach programs outside of the clinic.

A CogentSteps ERA course in progress at Bodycentral Physical Therapy.

Top: the “gym” at Bodycentral PT; bottom left: some of the Bodycentral PT staff; Bottom right: Jen Allen demonstrates dry needling techniques during a course.

Originally from West Virginia, Dr. Allen attended college at West Virginia University School of Medicine for Physical Therapy, and received her Doctorate in Physical Therapy at A.T. Still University. In 2001, Dr. Allen and Dr. Tonya Bunner set out on a mission to elevate care and opened up their practice, Bodycentral Physical Therapy in Arizona. Over the years their practice has exponentially grown from one 1,500 square foot facility into eight facilities across the Tuscon area that are equipped

and staffed to cover the spectrum of sports medicine and orthopedics. “It’s unbelievable to me that we have done this well. It’s all about the people that we bring in,” she adds.

Dr. Allen and her team at Bodycentral Physical Therapy have established two physical therapy residency programs in sports and women’s health.

“Education has always been at the root of what we do and who we are,” states Dr. Allen. “We find out what it is that makes [the

resident] tick. What gets them excited. And we try to build their residency around what they’re most excited about. We’re small enough that we can customize that residency experience.” From professional contacts in Major League Baseball, to local community connections in dance, softball, women’s rugby, and soccer, Dr. Allen thrives on the challenge to run a strong residency program and practice without affiliations, hospitals, or big medical centers in the area.

“We’ll partner with anyone to get our residents experience.”

“I’m not afraid to ask anybody for anything. And I think that’s what has gotten us here.”

The future of Bodycentral Physical Therapy looks bright with big plans on the horizon, including the addition of an orthopaedic residency program and another large sports center with focus on tactical athletes. Dr. Allen acknowledges Dr. Tonya Bunner, co-founder of Bodycentral Physical Therapy, and their exceptional team as being instrumental in their success and continued growth. “Tonya and I are a really strong team together. My

A CogentSteps ERA course in progress at Bodycentral Physical Therapy.

Bodycentrral Physical Therapy sports mentors.

strengths are her weaknesses and vice versa. But the other thing is the managerial group we have in line, our residency directors, and our residency coordinator. Without those guys, these things wouldn't happen. I can dream up a lot of stuff, but if there's not somebody there to help make it happen, it's never going to happen.”

Dr. Allen also mentions several individuals who have played an influential role throughout her career. For various reasons, whether via direct professional relationships, mentorship, or inspiration from research, she credits Bob Donatelli, Chris Powers, Irene Davis, Glenn Fleisig, Sherry Werner, Sue Falsone, Tonya Bunner, Richard ”Dick” Hillyer, and Lynn Snyder-Mackler with shaping her career.

Dr. Allen leaves student physical therapists and early career members with this advice: “Follow your passion number one, definitely, but don’t pigeonhole yourself so much that you don’t

learn from our other disciplines out there.” As a clinician with a diverse clinical background, Dr. Allen challenges us to broaden the horizons when it comes to building your education. Be a sports physical therapist. Know how to treat the rotator cuff repair of an athlete, but know how to look for related pathology throughout the entire kinetic chain.”Putting that in a nutshell, treat people as a whole.”

Follow Bodycentral PT on Facebook at bodycentral physical therapy sports and wellness center!

A Bodycentral Physical Therapy staff member works on a cyclist.

KEEPING THE MARINE CORPS MARATHON’S MEDICAL TEAM READY REQUIRES YEAR-ROUND PLANNING This article is reprinted courtesy of the author, and WTOP, Washington DC. The article is reprinted from September 25, 2018.

WASHINGTON — It may be more than a month until the Marine Corps Marathon, but the preparations are nearly complete for the medical staff that supports the October race.

There are about a thousand volunteers who help with the medical needs for the race, including the hundreds who work in the 14 medical tents that support runners along the 26.2-mile course through D.C. and Arlington.

By Sarah Beth Hensley @SarahBethHens Getting that many strangers from around the county on the same page for a massive one-day event can be tough, said Shelly Weinstein Bessenger, who oversees medical operations for the race.

“Trying to get 1,000 volunteers together to support an event is a lot of people,” said Weinstein, who is also a physical therapist. “They are an incredible, professional group of people who come from all over, who are all here for the same reason, and that’s to support the participants and the marathon.”

Michele “Shelly” Weinstein Bessenger.

It takes a nearly year-round effort to get the medical team and resources ready for the race.

Organizers determine medical supplies and equipment needed for the aid stations, decide where along the race course to put the tents, recruit volunteers and train them for their roles.

A YouTube video sent to all volunteers helps train them for their roles. But overall, most volunteers won’t see anything they aren’t able to handle.

Some of the medical team for the Marine Corps Marathon with Dr. Charles Stubin (Photo courtesy of Dr. Charles Stubin).

“Even though different systems may have different protocols, the way you take care of people doesn’t change. You’re empathetic, you stop and you do vital signs and then you assess. Those rules of practice are the same no matter where you’re from and what your role is. So from that standpoint, we can actually assimilate very well and work

very, very well together,” Weinstein said.

Kaiser Permanente in Silver Spring.

All the prep work leads up to marathon weekend, which includes a kid’s fun run, a 10K race and marathon — all of which bring thousands of participants and spectators to the D.C. area.

“It gives me an opportunity to combine an interest in medicine and a love of medicine. Also, it’s a love of sports and running and being in a different medical setting than my day-to-day, week-toweek office life,” said Stubin, who will work at a medical tent for his 10th year during this fall’s marathon.

“First aid plus” Most of the medical tents can do what Weinstein calls “first aid plus”: offer oxygen, automated external defibrillators, Vaseline, first aid supplies, basic medications and ice. Anything more serious may require transporting a runner to the hospital, she said.

Musculoskeletal issues — such as strains, sprains and blisters — most frequently sideline runners and cause them to stop at medical tents, Weinstein said. Most of the cases are minor, and medical teams stretch them, give them ice, tape them or bandage them before sending them on their way.

“Being on the marathon course allows me to reconnect with the primary care and just taking care of more general medical problems,” added Stubin, who trained in family medicine.

Dr. Nailah Coleman, a pediatrician and pediatrics and sports medicine specialist at Children’s National Health System, has volunteered with the event for about five years. She said the event is a way to assist during one of racing’s biggest days.

Of the fourteen aid stations along the course, five of them are “enhanced,” meaning they have the ability to do additional lab work, cardiac care and treatment for heat stroke. Those stations are located “where we historically have seen people have problems. So we use our data to look back and try to make things a little bit better every year,” Weinstein said.

‘The runners are happy to know that we are there.”

Teams at each medical tent are equipped to help anyone who needs medical attention. While the medical teams are happy to assist runners, they are just as fine to go unnoticed.

Look back at more than 40 years of photos from the Marine Corps Marathon, including winners, volunteers, Marines, spectators and thousands of runners.

“I think the runners know we are there. I think most of them want to go past the aid station and never have to stop, but I think there’s a reassurance for them that if they need to seek care, we have great care that we provide to these athletes … with a smile on our face,” Weinstein said.

“We know we are in the background. We don’t ever want to be in the forefront of an event. We recognize that, but I think that the runners are happy to know that we are there.”

The goal is always to get runners back on the course — and the medical teams do it well: More than 98 percent of the runners finish the race, Weinstein said.

The marathon’s smallest aid stations have nine people; its largest ones have more than 100 people.

The race is a time for volunteers like Dr. Charles Stubin to flex some medical muscles they may not regularly use. Stubin, for example, works as an OB-GYN at

“It’s a big event for the racing community. A lot of people come from far away to run in the race, so it’s great to participate and help them out and be a part of that day,” she said.

Dr. Nailah Coleman and another volunteer at a medical tent. Dr. Coleman has volunteered for the race for several years. (Photo courtesy of Dr. Nailah Coleman)

“Most of our runners, if they start, they are going to finish, and we will do everything we can to safely let them continue to finish the race,” she said.

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Volunteers set up a medical tent. “We all have the same goal of helping this injured or ill runner get better, so that hopefully they will be able to come back and race the next year.” (Photo courtesy of Dr. Nailah Coleman)

The medical team’s loyal band of volunteers help make the event a success, Weinstein said. They come back year after year “for the love of the sport and taking care of these athletes to make sure everyone is OK at the end of the day,” she said.

“I don’t think any participant really thinks they are going to end up at an aid station, let alone sick or going to the hospital that night. So I think this group of volunteers that we have is just very proud to take care of them, and they take their job incredibly serious, but they have fun. People have made friendships out of this,” she added.

For Stubin, he’s just happy contributing to a bigger mission.

“I feel like I’m a very small fish in a very big pond of talent associated with the Marine Corps,” he said.

To read the online article and review the photo galleries associated with this coverage, please go to https://wtop.com/marine-corpsmarathon/2018/09/keeping-themarine-corps-marathons-medical-te am-ready-requires-year-round-planning/slide/1/ Interested in being a volunteer for the 2019 Marine Corps Marathon?

Your help is needed!

You may email Michele Weinstein Bessenger at michele.weinstein@usmc-mccs.org.

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BENEFITS OF HIGH-POWER LASER THERAPY IN TREATING KNEE OA

By Mark Callanen, PT, DPT, OCS This article is provided by our Traveling Fellowship Co-Titling Sponsor, LightForce Therapy Lasers.

Most clinicians are familiar with knee osteoarthritis (OA), but when pressed on its exact mechanisms regarding pain and inflammation, there can be some confusion. Often, clinicians incorrectly jump to the “bone on bone” causal assumption regarding the source of pain for OA diagnoses. Prior to the advanced stages where this may be the case, there are numerous tissues in the knee that are innervated and can become pain generators during both the initial and late stages of OA. These include the joint’s intra-articular and periarticular structures, including menisci, adipose tissue, synovium, and periosteum.1 While cartilage is a-neural, as the cartilage’s extra cellular matrix breaks down and collagen and proteoglycans are lost, this degradation can lead to inflammatory responses in the joint that can promote pain.

Cartilage’s pathological process will eventually enter fibrillation, where the articular cartilage surface begins to roughen and progress towards fissuring, at which point cartilage begins to break off from the subchondral bone. This will expose areas of the periosteum which are highly

innervated. When pressure is applied on this tissue, pain ensues. This is accompanied by additional pain and inflammation as the body tries to “clean up” the joint space.

In the late phases of OA, fissuring leads to eburnation of the joint surface and is often accompanied by bone spur formation as the body tries to repair the damaged boney surface. At this point, compression of the joint surface often becomes acutely painful and more invasive treatments are introduced that may include injections, arthroscopy, and potentially joint replacement surgery.1

When managing knee OA, it is important to promote early intervention to slow and/ or avoid the late stage sequalae. Often, the health care system fails to educate individuals that OA is a process, not simply a diagnosis that results in joint replacement surgery. This can lead to patients feeling unempowered when it comes to managing their condition. Psychological counseling is recommended in chronic OA cases to help address depression and other related considerations.2 It has been shown that when joint inflammation and pain are addressed early, it can have a significant impact on the health and

longevity of the joint. This can have dramatic implications on joint mechanics, ROM, strength around the joint, and ultimately improved weight bearing and functional status. When ineffectively managed, knee OA can significantly impact quality of life and is associated with increased morbidity and mortality risk.3 This is significant given that knee OA impacts over 27 million Americans annually.1 Early treatment for knee OA centers around decreasing pain and improving function. While physical therapy that consists of stretching and strengthening exercises has been shown to significantly benefit this patient population,4,5 the initial focus of most plans of care center around reducing pain and inflammation at the knee. This is accomplished via oral medications that include steroidal and non-steroidal anti-inflammatory medications (NSAIDS), opioid agonists (e.g., Tramadol), acetaminophen (paracetamol), and interleukin-1 inhibitors.1 If these are not successful, intra-articular injection of corticosteroids or hyaluronic acid may be introduced to further improve pain and function.1 Given the unwanted side-effects of many pharmaceuticals, clinicians should be aware of modalities that are supported in the literature that help reduce synovial pain and inflammation.

High-power laser therapy can help by eliciting photobiomodulation in areas where damaged tissue and inflammation reside.

Due to the cost associated with Class 4 equipment, it is often overlooked.

While there is mounting evidence to support these mechanisms and the benefits of using laser on arthritic pathology,6,7 endorsements from different professional groups have been mixed. The European League Against Rheumatism (EULAR) suggested in 2003 that low level laser therapy (LLLT) in addition to other non-pharmacological approaches should be considered when planning optimal treatment for osteoarthritis.3 Recommendations from other groups have been less clear. The 2013 knee OA recommendations from the American Association of Orthopedic Surgeons (AAOS) were neither for nor against modalities (including electrotherapeutic modalities), based on conflicting research. However; no mention of low-level laser therapy (LLLT) was made in their review. As an aside, they found manual therapy results to be inconclusive as well, while they found strong evidence against the use of acupuncture for treating knee OA.5 The Journal of Orthopedic and Sports Physical Therapy (JOSPT) recently updated their guidelines on Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018. Again, no mention of laser was in the update, but they did support use of “biofeedback and muscle stimulation to patients following meniscus procedures to increase quadriceps strength, functional performance, and knee function.”4 It should be noted that JOSPT has supported use of LLLT in its 2017 Clinical Guidelines for Treating Cervical Dysfunction and

2014 Clinical Practice Guidelines for Treating Heel Pain/Plantar Fasciitis.

Why would laser be effective in helping these patients? When looking at the pain-generating components of early OA, it becomes clear. The most common symptoms of OA are inflammation and swelling of the synovia.7 High-power laser has the ability to quickly reduce peripheral pain via its impact on peripheral nerves and the endocrine system, while providing lasting relief due to its ability to reduce inflammation in arthritic joints via its impact on cytokines.3,6,7 High-power lasers’ impact on peripheral nerve tissue is not well known by many clinicians.

Its ability to reduce the conduction velocity and compound action potentials (CAP) of sensory nerves (C and A delta pain fibers), can reduce the pain signal produced from a peripheral joint once threshold levels of irradiance are reached during a treatment.8,9 This can lead to analgesic effects lasting up to 24 hours after a treatment.8 By reducing pain and inflammation at the knee, patients can often progress their weight bearing status and increase their activity levels, which can help prevent a host of co-morbidities which often exacerbate their condition: increased weight gain, Type 2 Diabetes, and central sensitization in the most severe cases.1 Due to the prevalence of knee OA, clinicians should consider adding laser to their arsenal in the fight against this disease.

This non-invasive modality has the ability to address pain in unique ways that other treatment options cannot. While it is not currently the standard of care, as high-power laser continues to gain recognition in the fight against pain and inflammation, it has the potential to become the modality of choice when treating this challenging patient population.

4. Logerstedt D, Scalzitti DA, Bennell KL, et al. Knee pain and mobility impairments: meniscal and articular cartilage lesions revision 2018. Clinical practice guidelines linked to the international classification of functioning, disability and health. J Ortho Sports Phys Ther. 2018; Volume 48 Issue 2: A1–A50.

References:

5. American Academy of Orthopedic Surgeons.

Treatment of osteoarthritis of the knee. Evidence-based guideline second edition. https://www.aaos.org/ cc_files/aaosorg/research/ guidelines/treatmentofosteoarthritisofthekneeguideline.pdf

1. International Association of Pain (IASP) 2010 Recommendations: Osteoarthritis Related Pain. https://s3.amazonaws.com/ rdcms-iasp/files/production/ public/Content/Content Folders/GlobalYearAgainst Pain2/MusculoskeletalPain FactSheets/ Osteoarthritis_Final.pdf 2. Keefe FJ, Caldwell DS, Williams DA, et al. Pain coping skills training in the management of osteoarthritic knee pain: II. Follow-up results. Behav Ther. 1990;21: 435-447.

3. Jordan KM, Arden NK, Bannwarth B, et al. EULAR Recommendations 2003: an evidence-based approach to the management of knee osteoarthritis: report of a task force of the standing committee for international clinical studies including therapeutic trials (ESCISIT).

Ann Rheum Dis. 2003;62: 1145–1155.

6. Alfredo PP, Bjordal JM, Dreyer SH, et al. Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study. Clin Rehab. 2012: 26523–26533.

7. Justyna Wyszyńska J, Bal-Bocheńska M. Efficacy of high-intensity laser therapy in treating knee osteoarthritis: a first systematic review.

Photomed Laser Surg. Vol. 36, No. 7. Published online: 1 Jul 2018. https://doi.org/10.1089/ pho.2017.4425.

8. Chow et al. Inhibitory effects of laser irradiation on peripheral mammalian nerves and relevance to analgesic effects: a systematic review. Photomed Laser Surg. Volume X, Number X. 2011; Mary Ann Liebert, Inc.: 1-17.

9. Holanda VM, et al. The mechanistic basis for photobiomodulation therapy of neuropathic pain by near infrared laser light. Laser Surg Med. 2017;49:516-524.

For questions or information about this article, please contact Bailey Brickley at baileyb@litecure.com.

UNIVERSITY OF VIRGINIA RUNNING MEDICINE CONFERENCE: A SUMMARY This year’s Annual Running Medicine Conference hosted at UVA was an incredible opportunity for healthcare professionals of all professions to improve their understanding of a running athlete as they present with injury, receive rehabilitation, and improve their performance. Shefali M Christopher PT, DPT, LAT, ATC of Elon University spoke as Keynote Speaker alongside many healthcare leaders offering their perspective on running medicine.

Dr. Christopher is a long-time member of the American Academy of Sports Physical Therapy (AASPT) and is a member of the AASPT’s communication committee.

Through lecture and lab, she led the discussion of pelvic pain, and the importance of including the pelvic floor as a component of care for our runners and endurance athletes. Pelvic pain and urinary incontinence affect both females and males, and they are very common in endurance athletes and postpartum runners.

Urinary stress incontinence occurs due to an increase in abdominal pressure when absorbing load during running. The pelvic floor makes up the bottom of the “canister” of the core muscles, and are active during hip, glute, and abdominal activation. The pelvic floor has a strong association with the diaphragm and the other core muscles; conse-

By Eric Magrum, DPT, OCS FAAOMPT Dr. Eric Magrum is a physical therapist at UVA/Encompass Outpatient Sports Medicine in Charlottesville, VA. His current residents contributed to this summary of UVA’s annual event.

quently, a dysfunction in breath control, flexibility, or strength of the core muscles can disrupt the activation of the pelvic floor.

With runners, it is imperative to assess running gait mechanics to determine if faulty mechanics may be contributing to pelvic floor pain or stress incontinence. Some important factors include but are not limited to changing ground react forces (GRF) with foot-strike patterns (forefoot strike typically results in reduced GRF), changing cadence (usually increasing), and working on breath control. It is important to understand how changes in gait mechanics affects the rest of the kinematic chain, and to ensure these are being appropriately accounted for.

Robert Wilder, MD, F. Winston Gwathmey, MD, and Eric Magrum, DPT hit the ground running discussing runners with anterior hip pain from their unique professional perspectives. Dr. Wilder is a professor and Chair of the UVA Department of Physical Medicine & Rehabilitation. He introduced differential diagnoses for runners,

their diagnostic criteria, and subsequent rehabilitative return to run expectations. With the addition of outlining potential surgical considerations, Dr. Wilder laid a detailed foundation for the more to come and introduction for Dr. Winston Gwathmey.

Dr. Gwathmey is an orthopedic sports medicine surgeon at UVA. Through a review of the relevant anatomy, he described the spectrum of hip morphology that may present a joint socket that is inherently too loose or too tight. Some morphology results in subsequent pathology, requiring surgery. A demonstration of videos displayed his surgical techniques and approaches. Collaboration with a rehabilitative professional is paramount for post-operative care and to determine who is appropriate for conservative management.

Dr. Eric Magrum is a physical therapist at UVA/Encompass Outpatient Sports Medicine in Charlottesville, VA. He is also a member of the AASPT. His case study presented a runner with anterior hip micro instability. Dr. Magrum described an arsenal of objective tests he may use for runners, specifically to those with this presentation. Example education and research-based manual therapy techniques and exercise prescriptions were provided to get us thinking about how we might help a patient with similar presentation.

Dr. Magrum appreciates this pres-

entation at the hip for its inherent similarity to other areas of the body, such as the shoulder, who’s treatment plan and approach can be analogous.

Dr. Siobhan M. Statuta, MD is the Director of Primary Care Sports Medicine Fellowship. She enthusiastically aimed to help improve recognition of hip and pelvic stress fractures and their management. Medical practitioners should be eager to rule these out, as the prevalence was recently found to be around 5.70 per 100,000 athlete exposures and as high as 20 percent incidence in sports medicine clinic visits. Understanding who your patient is in front of you (associated risk factors), their sport, and the likelihood based on location can already help you move the needle of your hypothesis before the physical exam begins. Sometimes the process of diagnosis can be more accurate by ruling out competing hypotheses, so an adequate understanding of the involved anatomy and allowing your subjective inquiry to guide your exam will best aide recognition. Physical exam should consider the involved bone, what stresses could be applied to create an accurate finding, and if this is right for your patient. Treatment often revolves around load management, though specifics will vary depending on the site.

Dr. Jay Dicharry, MPT, SCS addressed the deficit in today’s literature by discussing the impact of the upper quarter on running gait with a case study approach and data from his own lab. When we watch a runner’s gait, we look for individual components that

play roles in mechanical damping, steering parts, and providing a degree of bounce. Our immediate focus is often to determine which aspects of the lower quarter are most significantly impacting a runner’s performance, which can contribute to biomechanical expression of impact peak and loading rate. This could be an exaggeration in swing or stance phase, cadence, foot strike, or even footwear. With this goal in mind, can we add to our toolbox by considering the impact of components up the kinetic chain?

Dr. Dicharry uses the example of a twelve year old girl who recorded the highest loading rate ever observed in his lab. The patient weighs 67 lbs and has a one year history of patellofemoral pain. In recognizing that running is a combination of sagittal and transverse plane motion, we can more effectively manage ground reaction forces by addressing posture. Contemplate the effect of a runner’s center of gravity with an excessive backwards lean, neutral lean, or excessive forward lean of a runner’s trunk. By considering the entire kinetic chain, from 1st rib to forefoot, we as movement experts can provide more optimal rehabilitation and improve performance.

John Post, MD provided Running Medicine attendees a great overview of the growth of the total joint replacement and current evidence regarding return to athletics following a total joint arthroplasty (TJA), specifically total knee arthroplasty (TKA), total hip arthroplasty (THA), hip resurfacing arthroplasty (HRA),

and unicondylar knee arthroplasty (UKA). Does the difference between a THA vs TKA affect return to sport? How long does a replaced joint typically last? Does running on an artificial joint shorten its lifespan? Well, it depends on the patient in front of us. We need to consider pre-surgical levels of activity, joint being replaced, and replacement type utilized. The most accurate predictive factor for a favorable return to sport is the athlete’s participation in sport the year prior to the joint replacement, with data slightly favoring THA compared to TKA. With TJAs lasting approximately fifteen years, traditional recommendations advise waiting until later in life or until the pain becomes overwhelming. Exercising, specifically running, is not suggested as it is thought that this may reduce its lifespan. These recommendations, however, do not consider the person, and there are more benefits than previously considered to exercising and running after a TJA, including psychological, neuromuscular, strength, and proprioception.

In fact, current literature suggests participation in many athletic activities following THR and HRA may be advisable.

David Hryvniak, D.O. CAQSM RMSK guided us through common nerve entrapment presentations as they pertain to the hip and pelvis, discussed diagnosis strategies, and possible treatment options.

Dr. Hryvniak’s main point when considering the differential diagnosis of nerve entrapments is to

understand the working anatomy of the surrounding structures and other possible referrals to said area. For example, pain around the gluteal fold is often diagnosed as hamstring tendinopathy (or another orthopedic condition) because of the commonality, however we also have to consider all of the central and peripheral nerves that innervate this area, not just the common ones.

Diagnosis of nerve entrapment can be performed with both a clinical exam and other techniques (EMG, clinical ultrasound, and MRI). Oftentimes, EMG or NCV tests can be helpful in ruling out other causes of radicular symptoms (i.e. radiculopathy). Ultrasound and MRI have an equal specificity (86%) for diagnosing peripheral nerve entrapment; however, ultrasound had higher sensitivity (93% vs. 67%). Despite the positive psychometrics reported, it was clear that ultrasound should be an extension of the clinical exam, not the entire exam. Dr. Hryvniak alluded to the fact that it is common to misdiagnose these conditions if a complete clinical exam is not in place.

Identifying important aspects of patient history (e.g. past surgery, recent pregnancy), clearly identifying symptoms and location, and current course of symptoms are necessary for appropriate diagnosis.

Treatment of nerve entrapments can only be effective if the correct diagnosis is in place. Dr. Hryvniak states that a good rehab plan is still crucial to the correction of nerve entrapments. He also reports positive responses with use of oral medications, like NSAIDS,

steroids, and neuropathic agents.

Nerve blocks and peri-neural steroid injections can be helpful in treating/diagnosing acute radicular symptoms but not so much for chronic conditions.

Dr. Hryvniak described hydrodissection as a method for treating chronic nerve entrapment. This method is done by injecting saline or anesthetic to mechanically dissect layers of tissue away from a nerve. This essentially will relieve any pressure on a nerve that is causing radicular symptoms. Dr. Hryvniak alludes to the fact that when this procedure is done, he expects the reduction in symptoms to last “for a very long time” because of the reduction in pressure at the site of entrapment. Other treatment options include surgical decompression or PRP/prolotherapy, which needs more supporting literature.

Overtraining Syndrome (OTS) is multifactorial in nature and is often thought to be caused primarily by the imbalance of training and recovery. Dr. Kent Diduch reiterates this and challenges its commonality through his take home message, “It’s not just about the training”. The symptoms associated with overtraining syndrome can present in various forms and often mimic depression or REDs (relative energy deficiency syndrome); therefore recognizing, preventing and diagnosing overtraining syndrome can be difficult.

Overtraining syndrome is often associated with physiological, immunological, and biochemical alterations. Early warning signs may present as decline in performance, increase in infections

or an overuse injury. Dr Diduch used the Venn Diagram illustrated above to relay this concept of the “sweet spot”. This sweet spot describes the balance between training, nutrition, stress, sleep and recovery through which our athletes are going to be most successful. If any single circle/s are overloaded or are reduced in size, the sweet spot no longer exists and OTS may occur. All systems, not just physical recovery, should be considered for an underperforming athlete. Understanding who our athletes are can therefore be more important than simple objective data, such as exercise repetitions and rest counts.

Adequate subjective questioning is key, as the evidence shows it is far more sensitive than objective data for signs of overtraining. “Are we missing something here?,” Dr. Diduch asks the crowd. We should be asking about their sleep habits, stressors, nutritional changes. Not all athletes respond to changes in stressors equally, so it’s important to consider the athlete as an individual and collaborate with other health professionals as needed. “Sniff those you suspect are suffering and investigate because prevention should be our goal!”

It was incredible to see such valuable information presented from perspectives along a comprehensive healthcare spectrum. Each practitioner fits as a piece to the puzzle, and through collaboration we can provide the best service to our patients.

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.

This year’s event will have a different flavor, according to Tim Tyler, Team Concept Conference Chair. “The committee has listened to the desire of our attendees to hear new topics from new speakers.

We’ve answered the call with a fresh look.”

The committee won’t divulge the theme and speakers as yet, but indicates that there will be contributions from those authors involved in the updated Sports Certified Specialist exam home study preparatory course currently being finalized by the Education Committee.

“The breadth of subject matter is even more extensive in this year’s conference, and attendees will see new faces and hear new evidence-based practices they can use in their own clinics.”

This year’s conference will also feature the first AOSSM Exchange Lecture.

The welcome reception will be held, as always, on Thursday evening, with TeamMates held on Friday evening. Both will have special features this year, so plan on attending both events to network with your friends and make new ones!

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 Super Early Bird Registration rate now through March 31, 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!

DON’T FORGET TO REGISTER!

REGISTER ONLINE AT WWW.APTA.ORG/NEXT

REGISTER ONLINE AT WWW.APTA.ORG/NSC

REGISTRATION NOW OPEN AT https://www.sportsmed.org/aossmimis/annualmeeting

COURSES MAY

5/4/19 EMR Recertification New York NY MOTION Sports Medicine 160 E 56th St, New York, NY 10022, USA Presented by CogentSteps 5/4/19-5/5/19 ERA New York NY MOTION Sports Medicine 160 E 56th St, New York, NY 10022 Presented by CogentSteps 5/11/19-5/12/19 ERA Corvallis OR The SAM (The Samaritan Athletic Medicine Building) 845 SW 30th Street Corvallis, OR 97331 Presented by CogentSteps 5/18/19-5/19/19 ERA Lincoln NE Lincoln Physical Therapy & Sports Rehab, LLC 1501 Pine Lake Rd, Ste 20 Lincoln, NE 68512 Presented by CogentSteps FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE MAY 17 - 19 DENTON, TX Certified Running Gait Analyst – Level 1 May 18-19, Houston TX 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 MedSport Courses: Mind, Body, Spirit: Treating the Entire Athlete May 30-31, 2019 An evidence-based approach to sports medicine Sponsored by MedSport, UM Athletics, UM Kinesiology, UM Injury Prevention Center, Michigan Medicine Register or find more information here

Emergency Medical Responder Course: Sidelines Care May 31-June 2, 2019 Instructor: Matthew Owens, PT, DPT, SCS, ATC, CSCS Location: Children’s Healthcare of Atlanta Office Park, 1680 Tullie Circle, Atlanta, GA 30329 Target Audience: Physical Therapists seeking a Specialist Certification in Sports (SCS) or requiring certification for on-field coverage of sporting events Sponsor: Children's Healthcare of Atlanta For more information, follow this link> Contact: michelle.moore@choa.org FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE MAY 31 - JUN 2 KALAMAZOO, MI JUNE

6/1/19-6/2/19 ERA Garfield Heights OH Cleveland Clinic, Sports Health Center Sports Health Center 5555 Transportation Blvd.

Garfield Heights, OH 44125 Presented by CogentSteps 6/1/19 EMR Recertification Garfield Heights OH Cleveland Clinic, Sports Health Center Sports Health Center 5555 Transportation Blvd.

Garfield Heights, OH 44125 Presented by CogentSteps 6/1/19-6/2/19 ERA San Diego CA San Diego State University DPT Lab Peterson Gym – Room 1520 San Diego, CA 92182 Presented by CogentSteps 6/1/19 EMR Recertification San Diego CA San Diego State University DPT Lab Peterson Gym – Room 1520 San Diego, CA 92182 Presented by CogentSteps

6/8/19-6/9/19 ERA Durham NC Duke Sports Sciences Institute Stedman Auditorium 3475 Erwin Road Durham NC 27705 Presented by CogentSteps Certified Running Gait Analyst – Level 1 June 8-9, Wilmington, DE 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

6/10/19 EMR Recertification North Chicago IL Rosalind Franklin University of Medicine and Science, Physical Therapy Department Health Sciences Bldg Rm G.716 3333 Green Bay Road North Chicago, IL 60064-3095 Presented by CogentSteps 6/10/19-6/11/19 ERA North Chicago IL Rosalind Franklin University of Medicine and Science, Physical Therapy Department Health Sciences Bldg Rm G.718 3333 Green Bay Road North Chicago, IL 60064-3095 Presented by CogentSteps ANATOMICAL DISSECTION & DRY NEEDLING special discount. promo code: SF200 JUNE 13 - 16 BOULDER, CO Registration FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE JUN 14 - 16 RALEIGH, NC

All CogentSteps LLC courses register at www.cogentsteps.net.

All Structure and Function Courses register at https://structureandfunction.net/courses/

Register at www.apta.org/next

AUGUST

JULY

ACL Study Day is a one-day conference focusing on rehabilitation after ACL surgery. It will provide 6 contact hours and is geared toward the rehabilitation professional. Topics covered will range from surgical technique to return to play and beyond. Come join us on the beautiful UCLA campus for a day of learning. The information provided will be the most recent up-todate research, clinically relevant, and enable you to take action right away in the clinic/training room.

AOSSM Annual Meeting Return to Play Course July 11, 2019 Meeting July 11-14, 2019 Register at https://www.sportsmed.org/aossmimis/annualmeeting FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE JUL 12 - 14 FAYETTEVILLE, AR FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE JUL 19 - 21 CINCINNATI, OH FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE JULY 26 - 28 ANNAPOLIS, MD ADVANCED DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE JULY 26 - 28 HOPKINTON, MA

Open ERA Course from 8am until 5:30pm on Saturday, July 20, 2019 and 8am until 4:30pm on Sunday, July 21, 2019 at: Carew Education Center Trine University’s Rinker-Ross School of Health Sciences 1819 Carew Street Fort Wayne, Indiana 46805 Presented by CogentSteps

All CogentSteps LLC courses register at www.cogentsteps.net.

All Structure and Function Courses register at https://structureandfunction.net/courses/

Faculty: Kristofer J Jones, MD Susan Sigward, PhD, PT, ATC Dustin Grooms, PhD, ATC, CSCS Matt Ithurburn, PT, PhD, DPT, OCS Mark Paterno, PT, PhD, MBA, SCS, ATC Elizabeth Wellsandt, PT, DPT, PhD, OCS Registration: https://southcoastseminars.com/upcomingworkshops/acl2019 FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE AUG 9 - 11 FRISCO, TX Between the Seams: Baseball Rehabilitation for the Elite Professional Location: Austin, TX Date: August 10, 2019 Instructors: Matt Holland, PT; Brett Holland, PT; Corbin Hedt, PT CEU: TPTA Approved for 9 contact hours, 0.9 CEU/CCU Course Description: This 9-hour course will empower clinicians and field-specialists with the tools necessary to evaluate and treat overhead athletes of all ages, genders, and skill levels. The course will cover special considerations for rehabilitation of throwing athletes including sport-specific exercise prescription, an in-depth primer on throwing/hitting analysis, return-to-sport criteria, and the implementation of high-quality interval training programs.

Guest speakers from different disciplines will provide a truly all-encompassing perspective of the baseball/overhead athlete.

For more information, visit 5toolsport.com.

Registration

8/16/19 EMR Recertification Saco ME SMHC Sports Performance Center 12 Thornton Ave Suite 101 Saco, ME 04072 Presented by CogentSteps 8/17/19-8/18/19 ERA Boise ID St. Luke’s Rehabilitation 1109 W. Myrtle Plaza 1, Suite 200 Boise, ID 83702 Presented by CogentSteps SEPTEMBER 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

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 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 FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE SEPT 27 - 29 DENVER, CO

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

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 MAKE YOUR PLANS NOW! THE DETAILS December 5-7, 2019 Westgate Las Vegas Resort and Casino Room Reservations now open!

OCTOBER

NOVEMBER FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE NOV 1 - 3 JEFFERSON, LA 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.

FOUNDATIONS IN DRY NEEDLING FOR ORTHOPEDIC REHAB & SPORT PERFORMANCE NOV 22 - 24 PASADENA, TX

The IFSPT General Meeting will be held on October 3, 2019 in conjunction with the Congress.

Take advantage of the Early Bird Pricing now through August 1, 2019!

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 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

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

11/13/19-11/14/19 ERA Anaheim CA Disneyland Anaheim CA TBD 11/14/19 EMR Recertification Anaheim CA Disneyland Anaheim CA TBD DECEMBER

12/3/19-12/4/19 ERA In conjunction with TCC Las Vegas NV Location TBD 12/4/19 EMR Recertification In conjunction with TCC Las Vegas NV Location TBD

All CogentSteps LLC courses register at www.cogentsteps.net.

All Structure and Function Courses register at https://structureandfunction.net/courses/

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 4:45 pm.