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Need In Service Topic - July 29, 2000 7:36:00 PM   
melissa y. gomez


Posts: 13
Joined: January 10, 2000
From: Uniondale(LI),NY,USA
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I am on my first affiliation(orthopedic). My CI wants a topic from me for an inservice by next week. Can anyone give me some ideas. thanks. Anything is apprciated. Maybe tell me what you P.T.'s out there did yours on.

Post #: 1
Re: Need In Service Topic - July 30, 2000 1:14:00 PM   
Dana D


Posts: 142
Joined: September 19, 1999
Status: offline
It's always hard to pick a topic..
Were there any really interesting surgeries/procedures that any of your patients had done while you were there? Any interesting diagnoses? something that you had to look up because you didn't know much about it? or something your CI didn't know too much about?
Was there something you learned about at school, but didn't have the chance to see it first hand, and want to share your info with the staff... incase they encounter it someday?

I did one of mine on scoliosis and some exercises used for it, how it is dianosed/how the cobb angle and pelvic obliquity are measured on an x-ray...and surgical correction of...when indicated... and so on...

The second one I did was on neural plasticity... and all the theories of it... such as how it's greater in young children... I found a great article using an analogy... of someone when the are post stroke...or other CNS insult.
It compared it to a corn field... how the farmer always had a nice direct path plowed from his house out to the field... but after a while of being sick and not plowing the field, it was overgrown. When the farmer began to feel better, he went out and plowed another path out in the field... but the plow he ususally used was in the shop so he had to use a different plow... so his path was a little off and a little crooked... but it still worked and got him out to the field...just a little slower

The article explains it MUCH better!!! but it made you go "wow... that's a neat way to put it!!!"
and the staff loved it... and used it for family/patient educational purposes and whatnot..

So, just some ideas for ya...
Good luck [IMG][/IMG]

(in reply to melissa y. gomez)
Post #: 2
Re: Need In Service Topic - July 30, 2000 3:11:00 PM   
Betty Smoot


Posts: 49
Joined: March 2, 2000
From: Sonoma CA
Status: offline

Good luck with your inservice.
Remembering some of our recent student inservices off the top of my head:
Strain/Counterstrain techniques
SI joint anatomy/treatment
Treatment of unrinary incontinence

You could also pick any joint and do an anatomy and biomechanics review. Or same with spine, for example cervical spine mechanics and its ligaments and what they do.

How bout a review of current treatments of chronic pain or neuropathic pain. Lotsa stuff in the pain literature. There's also the newish classification of RSD that might be useful (Complex regional pain syndrome and all it's subtypes) Check pain websites for info: search for pain, complex regional pain syndrome, etc.

Oh yeah...we had a PTA student do an inservice in the form of Jeopardy!! Very fun and interactive. He had an answer board and questions in categories, of varying values and difficulty. We got points and even a prize at the end. You amy want to limit it to one topic though so you can try to teach about a single subjuct.

Have fun, be prepared, have handouts if you do a lecture format, and use audiovisuals if you takes the spotlight off of you.


(in reply to melissa y. gomez)
Post #: 3
Re: Need In Service Topic - July 30, 2000 3:40:00 PM   


Posts: 967
Joined: July 29, 1999
From: Cuyahoga Falls, Ohio
Status: offline

Try engaging the staff in the controversy surrounding traditional care or the craziness that passes for theory in non-traditional treatments that have grown in popularity.

Get "A Big Mistake" off of my web site, or The piece about postmodern thought (What Went Wrong) and pass them around. They should generate some real debate.

Go to

Let me know how it goes.


(in reply to melissa y. gomez)
Post #: 4
Re: Need In Service Topic - July 30, 2000 6:17:00 PM   
Andrew M. Ball, MS, PT


Posts: 500
Joined: October 9, 1999
From: Chapel Hill, NC, USA
Status: offline
I agree with Barrett. And I'd take it a step further . . .

There is WAY too much continuing education and in-services that lack true science out there. Try a MEDLINE sweep on the effectiveness of Craniosacral Therapy, Strain-Counterstrain, etc. BEFORE you try to teach to techniques of ANY of those wack-job bogus approaches. Come to thing of it, maybe THAT would make a good topic . . .

?Experienced therapists who use silly unproven techniques, that were abducted by aliens, played poker with G-d, and were forced into weight loss programs . . . Next week on Jerry Springer.? Don?t laugh, at least the Springer guests know the facts of their topics . . . or at least the facts that they make up is more interesting than the techno-babble-bull of CST or human gamma-motor bias.

Okay, maybe that was mean, but there?s a point to all of this. Consider the following story:

Just this week, I met an OT with whom I?m sharing a pediatric client. Now keep in mind that the first time I saw this kid, she screamed for 2 full hours . . . no matter what I did. Second time I went out to see her, she was a normal kid. A bit fussy, but no screaming. I see kind of reaction all the time, but never such a high pitched shrill, from so little a child, for so long of a period, and without a half-time show.

Anyway, the treating OT works for a group that bills itself as "THEE" place to go for pediatric sensory processing, etc. kind of problems. They've recently gotten into a lot of craniosacral therapy. Before I told her about my experiences, she suggested that when she went out to see the child the first time, the kid screamed the entire session. The second time she tried a little Craniosacral therapy, and wouldn't you know, she calmed herself halfway through the session (couldn't have simply been that the kid got used to her . . . OH NO! HAD to be the CST.)

Having taught some of these techniques early in my career, and knowing that most clinicians ignore blatant fact, I let slide the fact that the evidence-based Rodgers and Whitt study must have been missed by this OT, or at least ignored . . . so I concentrated on asking her about her clinical evaluative technique. Afterall, an effective Craniosacral treatment depends upon an effective evaluation . . . Not even Upledger argues that point.

So, I asked about the clinical evaluation . . . the frequency, amplitude, and force of the child's pulse. Was it limited to one cranial bone? Did one bone appear to be "stuck"? Was the beat balanced and symmetrical from side to side?

Turns out that this wacko couldn't answer ANY of the above questions. It seems that a student did an in-service on Craniosacral therapy treatment without performing a MEDLINE search to tease out the Bull@#$ from not. This practitioner took away from the in-service (and her "clinical experiences", that a Craniosacral technique actually works because of this case . . . in lieu of Craniosacral evaluation, and despite the fact that this kid's M.O. is to scream through the entirety of the first session, only to become accustomed to the practitioner during the second or third session. Good G-d, I wish I had that kind of faith in organized religion . . . but that?s another story.

"I just use what works", she said
"Oh" I replied, biting my bottom lip to keep from laughing at her so hard that it began to BLEED.

The PT student working with me, knowing my thoughts on stories like this, thought I was going to blow an aneurysm.


The AMA doesn?t know why people blow an aneurysm, which is when a blood vessel bursts in the brain for no apparent reason. If you ask me, there?s a reason. A health care pracitoner says just about the dumbest thing you?ve ever heard in your life. It's about a whacko technique like Craniosacral Therapy, Strain/Counterstrain, or the effectiveness of PT on SI joint dysfunction (see the journal review club for the discussion on this issue). Then it goes in your ear . . . and the stupidity, is now IN YOUR HEAD. And it would be okay if you could just say something about what the facts according to MEDLINE to this idiot, but you can't, cause that would be mean and unprofessional, so you don't (You rather bite your lip until it bleeds). But those words of stupidity are still in your head. And you go to work, but your not REALLY going to work, cause all you can think about is STUPID, STUPID, STUPID . . . and you're eating dinner with your kids, but your not REALLY eating cause your brain is going HASN'T THIS IDIOT READ AT LEAST ONE RESEARCH ARTICLE IN THE PAST 20 YEARS SINCE GRADUATION?!?! . . . and at the end of the week the athorities find you DEAD in your bathtub.

I live down south where it's constantly about 100 or so each day . . . and it's true what they say . . .

It's not the heat, it's the stupidity.


Anyway, the OT is now charging for this crap as a cornerstone of her intervention. Students need to realize that due to dwindling time and $$$ for continuing education, allied health professional's are depending on them more and more to disseminate information on new techniques to them. Students therefore have a higher responsibility to differentiate the fact from fiction than they ever had before. Far more than they could ever imagine.

So, you as a student have a choice . . . help the profession by choosing a topic based in science and fact, well researched by a MEDLINE sweep, or play a sick game of professional PICA by smearing the BS of Craniosacral Therapy, Strain/CounterStrain, or SIJoint treatment effectiveness without a care in the world about what the current research says. The REALLY sad thing is that in all likelyhood, your "experienced" CI won't know the difference anyhow . . . or won't care. Most of my CI's just wanted a nice looking presentation and it didn't much matter what I talked about. I had slides, which they'd never seen a student do before. (Yeah, Wow'ed my by dragging 'em up to the TRAILING edge of technology). So sad, cause I did a few really good ones as a student, but one of the presentations was a HUGE piece of crap. Of course I didn't think so then, but they were so impressed by the Harvard Graphics effects (a precursor of PowerPoint . . . circa 8 track tapes), that they didn't really comment on what a festering pile of dog snot the presentation really was.

My students who choose to do the latter, usually don't pass my affiliation, and it always prompts a call to the ACCE. It says something about the professional philosophy of the student, the school, and the future physical therapy profession. The good therapists are trying to promote a profession of fact, not a technical dispenser of pseudo-scientific art.

Students must therefore recognize that they have a greater responsibility than to their grade alone. Inservices demonstrate what's great about this profession:

Your work as a student can change the way that a CI approaches clinical practice.

An inservice can also demonstrate what SUCKS about this profession:

Your work as a student can change the way that a CI approaches clinical practice.

[This message has been edited by Andrew M. Ball, MS, PT (edited July 30, 2000).]

(in reply to melissa y. gomez)
Post #: 5
Re: Need In Service Topic - July 30, 2000 7:37:00 PM   
melissa y. gomez


Posts: 13
Joined: January 10, 2000
From: Uniondale(LI),NY,USA
Status: offline
Thanks everyone. I am going to take everyone's ideas into consideration. I am curently thinking about looking into Fibromyalgia.(but that is not definite) I will keep everyone posted.
I just have to say to Mr. Ball that you seem to be a really tough CI. Although a very well read and good one I might add. You gave me this "umph" to want to put alot into my inservice. Your point was well taken.(Thanks) So, what are your thoughts on Fibromyalgia. We didn't go into great depths about it in school. Do you believe it is a real diagnosis or not? I am going to do a medline search right now. I have 4 more days to hand in a topic.
Please reply. Everyone is welcome to email me titles of research articles if they would like. - Thanks again everyon for replying.


(in reply to melissa y. gomez)
Post #: 6
Re: Need In Service Topic - July 30, 2000 9:34:00 PM   
Andrew M. Ball, MS, PT


Posts: 500
Joined: October 9, 1999
From: Chapel Hill, NC, USA
Status: offline

Fibromyalgia is an excellent topic. I?ve heard everything from Myofascial Release to proper aerobic exercise to more B6 or B12 in the diet as a treatment approach. Fibromyalgia is VERY misunderstood as a diagnostic condition. My experience with it is limited to pediatric rheumatology in which the feeling is that it?s caused by sleep disturbances. You may want to sweep MEDLINE for information on post-training paradoxical sleep also. If it is in fact a sleep disorder, then it will (according to recent studies) have an effect upon the learning of motor tasks, as motor tasks are processed during sleep during the 1st and 3rd night after being exposed to a new motor task.

I?m glad that I gave you an ?umph?! That was exactly the point of my post . . . but please don?t call me Mr. Ball (makes me think my father just walked in), Drew is just fine.

As far as your question is concerned, I?m not sure that I deal with this type of population enough to really form an opinion. That said, like many things in physical therapy, I think that the pain, discomfort, and daily struggles that some people and families experience is real. What it comes from (e.g. sleep problems, post-traumatic residual effect, etc) is up for debate, and as such, treatments based upon these etiologic theories must be called into question. Like Autism however, as we become better able to determine etiology (e.g. was this particular case of Autism the result of an environmental insult between 20 and 24 days gestation, or was it an issue of genetic strands?) I think that we?ll be better able to match appropriate treatment to specific etiologies of different disorders. Outcomes will improve as a result.

Your question prompted an interesting sweep of MEDLINE for me though. I read though the abstracts of about 50 studies and ordered a few choice ones. The ones most interesting to me in terms of etiology were:

Gedalia A, et al. Fibromyalgia syndrome: experience in a pediatric rheumatology clinic.
Clin Exp Rheumatol. 2000 May-Jun;18(3):415-9.

Green S. Sleep cycles, TMD, fibromyalgia, and their relationship to orofacial myofunctional disorders.
Int J Orofacial Myology. 1999 Nov;25:4-14. Review.

Arnold LM, et al. Antidepressant treatment of fibromyalgia. A meta-analysis and review.
Psychosomatics. 2000 Mar-Apr;41(2):104-13.

Drewes AM. Pain and sleep disturbances with special reference to fibromyalgia and rheumatoid arthritis.
Rheumatology (Oxford). 1999 Nov

White KP. Trauma and fibromyalgia: is there an association and what does it mean?
Semin Arthritis Rheum. 2000 Feb;29(4):200-16.

I also looked into a few studies examining treatment of fibromyalgia. There were a few flimsy opinion papers that talked about herbs, and alternative medicine, etc. The better the study though, the worse off we as PT?s seemed to look. The following was a Meta-Analyis of 7 relevant studies (e.g. the only relevant studies on the subject fit for statistical inclusion) that summated the statistical results of the studies (n=1050 patients). I thought I wrote in a passionate manner. Either this guy has a hidden agenda or his ex-wife is a fibromyalgia specialist.

Karjalainen K. Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults.
Cochrane Database Syst Rev. 2000.

He concludes that ?there appears to be little scientific evidence for the effectiveness of multidisciplinary rehabilitation for these musculoskeletal disorders. However, multidisciplinary rehabilitation is a commonly used intervention for chronic musculoskeletal disorders, which cause much personal suffering and substantial economic loss to the society. There is a need for high quality trials in this field.?

Gee, he sounds really pissed doesn?t he?

I also found this one:

Armstrong R. Fibromyalgia: is recovery impeded by the internet? Arch Intern Med. 2000 Apr 10;160(7):1039-40.

I couldn?t get to the article from my computer, but I?d love it if you?d send me an abstract if you pull one up.

Finally, I?m going to be presenting a series of free continuing education courses to RehabEdge members. More details are to follow, but my intent is to have members trade off on their knowledge. Please download the Distance Education / Meeting software from my website at [URL=][/URL]

That would be one hell of a thing to put on your resume don?t you think? Presented an inservice on Fibromyalgia to a national audience at [URL=][/URL] Think about it an e-mail me privately at

(in reply to melissa y. gomez)
Post #: 7
Re: Need In Service Topic - July 30, 2000 10:38:00 PM   
melissa y. gomez


Posts: 13
Joined: January 10, 2000
From: Uniondale(LI),NY,USA
Status: offline
Thanks again "Drew",
I am going to go to my shcool library tomorrow to try to find some or any of those articles you put down. I also did a medline search for articles. I just hope that my school library will have what I need. Oh when you order stuff from medline, how long does it usually take for you to recieve it?
Thanks again.

(in reply to melissa y. gomez)
Post #: 8
Re: Need In Service Topic - July 31, 2000 7:43:00 AM   
Andrew M. Ball, MS, PT


Posts: 500
Joined: October 9, 1999
From: Chapel Hill, NC, USA
Status: offline

SJ is correct about her assertion of seratonin. Several of the articles listed suggest that as a possible eitology. I don't know if it's THEE cause, or just one of many. Anyway, when you order from MEDLINE, you have to connect with a library in the area . . . it's quicker just to go there and do it yourself, but if you order online it takes 2-4 weeks or so.


(in reply to melissa y. gomez)
Post #: 9
Re: Need In Service Topic - August 1, 2000 1:26:00 AM   


Posts: 139
Joined: January 11, 2000
From: pullman,wa,usa
Status: offline
Go to the Fibromyalgia Network website. [URL=][/URL]

This is an excellent organization focused on helping patients and health providers alike.

(in reply to melissa y. gomez)
Post #: 10
Re: Need In Service Topic - January 10, 2001 8:46:00 PM   
melissa y. gomez


Posts: 13
Joined: January 10, 2000
From: Uniondale(LI),NY,USA
Status: offline
I just wanted to thank everyone who contributed to my question. My inservice turned out well. I got a lot of info from that website and I even mailed away for info. The Journal of PT acutally had a really good article in it also. I am sorry that I didn't reply to everyone sooner but sometimes it can get really busy, I am sure that all you PT's out there can understand.
Thanks again.

(in reply to melissa y. gomez)
Post #: 11
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