When I went on some of my first interviews as a new grad, one of the most common things to talk about in an interview was weather I took a “bottom up” or a  “top down” approach to treating lower extremity injuries. Bottom up refers to the theory that how the foot hits the ground determines the kinematics of the lower extremity and is the focal point to treating these injuries. The top town approach is very much the opposite and refers to the theory that stability and motor control of the lumbar spine and hip determine how the foot hits the ground making it the starting point for all lower extremity injuries.

In my graduate studies an emphasis was placed on foot/ankle mechanics and recommended treatment was posting and orthotics to control the lower extremity. In contrast ,my first job was at a clinic in Los Angeles, was hyper-focused on gluteal strength for correcting lower extremity mechanics . A major influence being that at USC Dr. Christopher Powers was publishing a ton of evidence linking lack of gluteal muscle strength and patellofemoral knee pain.

Writing this out is seems painfully obvious that depending on the patient either, and often  both of these approaches are used. I have had great success treating ankle, hip, knee and even radiating pain in the thigh and buttock by addressing foot and ankle mobility and/or stability issues. Just as often, hip, knee or foot pain is addressed by beginning to treat the lumbar spine and pelvis and addressing proximal stability issues and muscle imbalances.

It can be difficult to self diagnose what the root cause of your pain is and it may very well be that it is a combination of these. My approach begins with gait evaluation (watching you walk). This is where we decide where to begin investigating. I do not automatically focus on one end or the other and try to let your movements tell the story rather than dogma, theory or a new research report. It makes it hard to answer someone at a party who asks me,”why does my knee hurt?” In that moment I simply do not know enough to answer that. I do not have a cookie cutter approach and I will not know unless I examine them. The answer becomes less cut and dry but the end results are much better.

Posted by Andrew S. Eisen DPT

We are extremely lucky to have the opportunity to showcase art from two of Seattle’s best artists, Amber Anderson and Cait Willis in our clinic.  Collaborating with local artists has been a fun and unique experience. The artwork has added a great aesthetic to the space and we are getting a lot of questions about the pieces and the artist behind them. All of the work is for sale. If you have not seen it you should stop in and check out the art, you have to see these in person!

This is the artist’s statement from Amber

Using fire as a tool and symbol of transformation, I sculpt and manipulate encaustic bee’s wax on recycled wood supports. From my process I create multiple textured layers that utilize the natural wood grain as a landscape, influencing composition from the wood surface to the wax layers. I continue the transformation process by translating one medium to another- paintings become prints, prints are underpaintings, drawings are printed on the paintings. My artwork is not multimedia, but is instead multiple processes transcribed from the evolution of mediums.  Wax layers capture content like a moment in time captured in amber. Both the content and the process are rooted in evolution.

Conceptually, my art is based upon my being a humanitarian. I build images utilizing ideas about environmental, cultural, social and political issues, both in contemporary time and times past. My influences stem from language, history, humanities, and sciences, which are analogous to the evolutionary building process of my art. My background in chemistry has led me to combine universal truths from sciences of alchemy, chemistry, physics, and psychology to inform core ideologies in my artwork. Although I use concrete ideas to create visual imagery, I employ symbolism as a means for abstract representation of larger ideas. Physical qualities such as smooth or impasto texture, transparent or cloudy, and opaque depth of field, are used to represent subject matter. I draw further analogy between chemical reactions used in my creative process and concepts about human experience. Painting with bee’s wax is a figurative and literal metaphor, directly correlating to the transformative properties that humans undergo. Both humans and wax change mutably and result in distinct moments from a chemical reaction; phase state changes including initial state, entropy, and equilibrium. I firmly believe humankind -the body and the mind- are driven by chemical reactions. I strive to understand and convey these chemical reactions through my art

Amber R. Anderson; arrayartconservation@gmail.com

Posted by Andrew Eisen DPT

Side Planks

https://video.optimispt.com/categories/home_education/videos/2988104

Bird-Dog

https://video.optimispt.com/categories/home_education/videos/2988113

In good health,

-Andrew Eisen DPT

 Our friends at Herriott Sports Performance (HSP) have started a new stability class that would be a great compliment to traditional physical therapy core training. It is also a great way to gain stability for injury prevention and maintain stability in the spine, hips and shoulders.

Redcord is an exercise concept for building core stability and enhancing balance, flexibility and practical strength. It is suspension based exercise that uses your body weight as resistance and a mix of ropes, slings and straps to create an unstable base of support which increases demands on stability and muscular control. Redcord training is also a powerful stimulus for activating the body’s deep stabilizing musculature.

The simplicity and effectiveness of the Redcord exercises makes it an excellent compliment to conventional strength training and as a standalone training alternative for everyday wellness.

Record Active training is for EVERYBODY. Exercises can be easily adjusted to your strength level. Grandmas and gold medal athletes alike will benefit from the restoration and enhancement of optimal neuromuscular function and practical strength that protects the body and increases the quality of life and performance.

Recommended class attire is casual gym wear. NO bare feet are allowed in the training area.

Towel service is provided

For a class calendar of all HSP classes https://clients.mindbodyonline.com/ASP/home.asp?studioid=2930

I love running and am happy to see that this new/old trend has moved people who previously never liked or wanted to run to go out and move.  Barefoot or minimalist running can be a great tool and a useful way to improve your running form if used properly. As a physical therapist I have also seen that improper use can cause can lead to stress injuries. Here are a few tips to keep you running happy/efficiently and not injure yourself in the process.

Tips for using barefoot (minimalist) running:

1. Work on your body position! This is in my opinion the most important part of running period. Putting on a new shoe or sandal or taking it off will not automatically improve your stride if your body positioning is poor.
2. Gradual reduction – If you have ran in a shoe called the Beast for the last ten years then putting on a five finger and hoping that your arch will strengthen may not be the best idea. Like all training, gains are made when the body adapts to stress OVER TIME, too much too soon and you will be in the PT office or worse. Work your way towards a less stabilizing, more neutral shoe first, before taking away cushioning and going to a minimalist or barefoot shoe right away.
3. Start small – At first use your minimalist shoes for shorter runs or speed work, allow your body to get used to the feel of a new stride and less cushioning during shorter workouts.
4. Listen to your body – If something is not going well you need to address it. Not everything is for everybody and if you find your self getting stress injuries despite your best efforts back off. You are not a bad person because you run in shoes!
5. Surface matters – The evolutionary theory of running is fascinating and offers some pretty great insight into what we are designed to do but let’s remember that your ancestors were not running away from sabre tooth tigers on asphalt. Start on softer surfaces grass, dirt etc.

Enjoy the run

-Andrew Eisen DPT

I was fortunate enough to go to a public high school in NY that had a program for kids who interested in medical science. My junior year I took an elective class in sports medicine. I was so excited for this class and I can still remember the first assignment that I was given (which was a current events in sports medicine assignment).

Before I took this class I thought that for sure I was going to become a teacher. I grew up in a family of teachers, my parents, aunt, uncle etc all teachers. My high school lacrosse coach/mentor also a teacher. If you asked me what I was going to be when I was 16 my answer was probably a phys ed teacher/lacrosse coach. Everything changed when I stepped into that class. The class itself while interesting was not necessarily the most serious or challenging class ever but it was my teacher’s ability to recognize my interest and her caring to take the time to talk to me about it, to introduce me to a profession where I could continue to learn and teach and help people move and feel better. After my junior year in high school I was lucky enough to know exactly what I wanted to do and I have never looked back. I love my profession and it is because of one amazing person, an amazing teacher that I am lucky enough to be part of the only profession that I can imagine working in. I see it as my job to pay back the gift that was given to me by not only remaining a student but by teaching everything that I know and discover to my patients, colleagues and students. The teaching aspect of physical therapy is the most important part. All of the manual therapy and fancy techniques in the world do not matter if you can not teach someone how to manage their own condition. I owe Ms. Greenberg everything, I certainly owe her a long overdue thank you. I recently tracked her down and sent her a letter. Before I share a bit of that letter I will say that if you have someone that changed your life, a mentor, teacher etc track them down and thank them, and do them proud every day by passing along the knowledge that they imparted on you.

Dear Ms. Greenberg,

I hope this email finds you well. I was a student of yours in your sports medicine class at Midwood High School in 2000, when I was a junior. I owe you a long overdue thank you. I get asked all the time why/how I got into my profession and you are the answer every single time. Your class was the start but it was your teaching ability and your caring to talk to me about career paths and push me in the right direction that have allowed me to pursue the only career and profession that I have ever wanted.

After graduating from Midwood in 2001 I was accepted into a 5 year Masters in physical therapy program at Ithaca College. While I was there the profession was going through some major changes and making a shift towards a clinical Doctorate degree. I was luck enough to finish the 5 year Masters and go for a Doctorate immediately after.

After graduating and passing my boards I moved to California and began working at an outpatient orthopedic clinic with a strong sports medicine focus. I worked there for 2 years after deciding that I wanted to move to Seattle and become a better therapist. I knew that I was good at treating sports injuries and post surgical conditions but I also knew that I had a lot that I could learn about treating chronic and subacute conditions. I wanted to train as a manual therapist and found a clinic in Seattle that would mentor me in manual therapy while I studied and took additional continuing education courses from the North American Institute of Manual Therapy (NAIOMT). After three years and a much deeper understanding of biomechanics, neurophysiology and gaining skill as a manual therapist I left to open my own clinic. In January I started my own business and with two good friends and highly skilled therapists started Union Physical Therapy.

I still have more goals within the profession but after 5+ years as a PT I can say that I love being a PT. Even on hard, particularly trying days I still would not want to be in any other profession. And you are the only reason that I ever became interested in it.

I want you to know that I also teach graduate students and try my hardest to pay the gifts that I have received forward. Between the patients that I treat and the patients that my students go on to treat, you are responsible for literally thousands of people moving and feeling better.

Thank you. I hope that I can become as a good of a teacher as you were/are.

-Andrew

It is not an accident that we provide care in a particular style, for an amount of time and for a certain price.  The fundamental beliefs behind the decisions made at our clinic are to provide the best level of care in the most cost efficient manner for the patient. In the physical therapy world a therapist is often judged by how productive they are. A CEO or regional manager or clinic manager sets a “standard” for how many patients each therapist should see. Many levels of management place subtle or often not so subtle stress on the therapist to treat a high volume of patients. Often the therapist is told that this is what they need to do in order to gain the proper amount experience and that if they did not treat this many patients that the company would fail and that they would not get to help anyone. In order to “see” all of these patients one on one care with the therapist is kept to a minimum, often 15-30 min per patient and then “handed off” to an aide for the rest of their care. This type of therapy is cost effective (for the company) and productive (for the company). For the patient it can lead to increased number of visits, lack of progress and increased time and money spent at the physical therapy clinic. For the therapist it can lead to the frustration of not truly knowing what is being done with their patients, increased paperwork and paradigm shift from the focus on patient care to focus on statistics.

As a doctored profession we have a right to uphold the ideals that we learn in PT school. We have the right to treat our patients to the best of our ability. To teach and learn from our patients, to build relationships, to keep the cost down and quality high. Having worked for large companies in the past I am finally at a point in my career where I can control the duration and frequency of patient visits without corporate pressure. I can see a patient for a whole hour at time, I do not go home wondering what exercises/how they may or may not have been taught to my patients. I can spend less time worrying and more time helping, listening and refining my skills. Less time with paperwork and more time teaching patients how manage their own symptoms so that they do not need to spend time and money in the clinic. And, the dirty secret that no one wants to tell you is that it doesn’t cost you any more money. In fact our rates are on the low end of the national average. When you go to a clinic where the PT sees 2,3 or even 4 patients an hour they are billing as much or more for each patient as we do. But we are only seeing one per hour. Our focus is not to make the maximal amount of money but to make the maximal amount of change. To me, seeing four patients an hour versus one is like the difference between wonder bread and an artisanal bakery. The only weakness of this model is that we can not treat everyone in need of physical therapy. Once the dough is done that’s it, no more baking for today! Smaller batches of patients with higher quality care. Quantity or quality the choice is yours (and ours).

 Andrew S. Eisen DPT

Andrew is a cooperative partner at Union Physical Therapy

It is an honor to write our first official “Community Partner Spotlight” about an amazing organization/event. I have had the pleasure of participating in the AIDS/Lifecycle bike ride three times and can honestly say that it has been one of the most life changing experiences of my life. The first time I participated in this ride I had no idea what I was getting myself into. I knew that I got to ride my bike from San Francisco to Los Angeles and that I was going to raise money for a worthwhile cause. At the time I had little connection to the community and little/no understanding of the day-to-day struggles of those living with HIV/AIDS. Once I experienced this event, met the community ad it supports I realized that I was in some small way a part of the effort to help the lives of those living with HIV/AIDS. Four years later, I am in a position to give a little bit back by helping participants enjoy their ride a little more. We are offering a 50% discount of preventative bike fitting for this year’s participants. I know that preventing achy knees is not going to solve the world’s problems, but if it allows a few people to have a meaningful experience (and not spend a week in the med tent) then I am happy to help. Here is some information about this ride and the organizations and people it supports.

AIDS/LifeCycle is co-produced by the San Francisco AIDS Foundation and the L.A. Gay & Lesbian Center and is designed to advance their shared interests to end the pandemic and human suffering caused by AIDS.

The goals of AIDS/LifeCycle are to:

1. Raise funds to support the HIV/AIDS services of the L.A. Gay & Lesbian Center and the San Francisco AIDS Foundation;
2. Increase awareness and knowledge about the services and programs offered by the benefiting organizations;
3. Increase awareness and knowledge about HIV/AIDS among participants, their donors and the general public;
4. Increase AIDS activism and volunteerism among the participant and donor communities, inspiring them to become ambassadors in the fight against AIDS;
5. Provide a positive, life-affirming experience for people affected and infected by HIV;
6. Contribute to an increased understanding of the disproportionate impact HIV has had on the GLBT communities in SF and LA;
7. Encourage an environment of dignity and improved quality of life for those affected by HIV and AIDS.

To learn more about the ride please visit: http://www.aidslifecycle.org/

For information regarding our partnership visit: http://www.aidslifecycle.org/about/participant-discounts/outcal-discounts.html?participant_type=nutrition-holistic-health

Maximal respect,

Andrew Eisen DPT