The foam roller was created by Moshé Feldenkrais, the inventor of the Feldenkrais Method—a method that shows how to use self-awareness to improve physical movement and flexibility. Originally used as a balance tool during standing exercises, people started using the foam roller as a tool for self-massage in the 1980s. Since then, foam rolling has become mainstream and foam rollers can now be found in fitness centers, Pilates and yoga studios, physical therapy offices, and in countless homes all over the world.

OPTP offers a wide array of durable, high-quality foam rollers in various sizes and densities—from super soft to firm. Whether you’re new to foam rolling or an experienced pro, the following videos show a wide variety of ways to incorporate foam rolling into your wellness routine with myofascial release techniques, warmup exercises, and full body workouts. So grab your foam roller and try a new technique, or two, or three, or four…

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If you are interested in somatic education, or if you are a practitioner seeking ways to help your patients and clients, you won’t want to miss the following videos that feature Stacy Barrows, PT, DPT, GCFP, NCPT, demonstrating how small, simple movements can be used to deepen motor learning and body awareness. 
 
Stacy is a Guild Certified Feldenkrais® Practitioner, a nationally certified Pilates teacher, and a registered physical therapist. She developed the SMARTROLLER® line of products to help clients at her Los Angeles-based physical therapy clinic to explore movement in a way that’s fun and meaningful, encouraging them to connect awareness with movement. 
 
Find out how you, too, can integrate mindfulness and movement using SMARTROLLER® products in the following videos. 

OPTP exhibiting at PMA 2022 
 
The Pilates Method Alliance International Conference is just around the corner and OPTP is excited to be exhibiting at the event! We hope to see you October 19-22 in Las Vegas. If you’re attending, visit us at booth #306 where you can experience and shop our wide selection of Pilates, fitness and therapy tools. 
 
Dr. Kristine Bragg workshop 
While at PMA, don’t miss Dr. Kristine Bragg’s workshop: Building a Better Balance Training Program. A postdoctoral scholar specializing in program evaluation, research and teaching, Dr. Bragg will help you revolutionize how you approach balance programming. Learn more about Dr. Bragg by following her on Instagram @mat.pilates and learn more about her must-see PMA workshop in the video below. 
 

 
We look forward to seeing those of you attending PMA. Whether you plan to attend or not, check out OPTP’s wide selection of Pilates products for studio or home use. 
 
Shop Pilates products 

Sitting and standing with a healthy, upright posture not only looks good, but can also help you avoid common neck and back problems. The following 30-second posture tips demonstrated by Dr. Yoav Suprun, DPT, OCS, Dip. MDT, CSCS, will help you practice healthy posture while completing common, everyday tasks.
 
Healthy posture while standing at a mirror to shave or apply makeup



 
Healthy posture while using your phone



 
Healthy posture while emptying the garbage and cleaning the trash can



 
Healthy posture while using a computer



 
Mid-back extension exercise for healthy posture
 



 
More posture tips from Dr. Yoav 
Find more posture tips in Dr. Yoav’s new book Aging Without Aching: Relieve pain, improve your posture, move better and stop kvetching. Written for people who want to age better, with less pain and more vitality, this book includes functional fitness exercises, body mechanics strategies, and secrets to aging with perfect posture.

 
If you’re a healthcare practitioner who wants to be part of the solution to this growing problem, it’s likely that your next question is, “how do I get started?” The answer is simple. Pain neuroscience expert Adriaan Louw, PT, PhD, has created a comprehensive resource for all things PNE. It’s called WhyYouHurt.com.
 
WHY PNE? 
It is currently reported that 25.3 million adults in the United States are suffering from daily chronic pain and one in six children and adolescents experience persistent pain. Find more statistics and learn why PNE is a viable addition to your clinical practice on the WHY page. 
 

Adriaan Louw explains why PNE is essential to helping patients in pain.

LEARN ABOUT PNE
PNE is based around the 3-3-1 principle, a simple foundation for understanding and tackling the complexity of the human pain experience. Learn about the 3-3-1 principle and get guidance on books, courses, fellowships and more on the LEARN page. The more you understand PNE, the easier it will be to teach to your patients.  
 
TEACH PNE 
“You think my pain is in my head,” is a common statement made by frustrated patients. Visit the TEACH page to view sample sessions showing how to respond to this statement and how to deal with other common patient questions and concerns. While you’re there, access downloadable patient homework, educational anecdotes, and simple ways you can teach your patients about pain.
 

Adriaan Louw explains how stories can be used to teach patients about pain.

ASK ADRIAAN 
Have a question related to PNE? Submit it on the ASK ADRIAAN page. Select questions will be answered in a video blog and posted to the page. 
 
Adriaan Louw has been at the heart of the chronic pain crisis for decades—researching, studying, and finding solutions. The knowledge and resources he’s gathered are now at your fingertips. Visit WhyYouHurt.com and find out how you can be a part of the solution to the chronic pain crisis and the opioid epidemic. For more information on PNE, books and resources are available at OPTP.com.

Toe Taps: 5 Variations to Try Today 



In honor of Pilates month, we’ve got 5 ways to spice up your toe taps, as demonstrated in the video above by Nicole Gregory, AFAA Certified Fitness Professional and STOTT Pilates Instructor at Pilates Detroit.
 
1.     Lie supine on the OPTP® PRO-ROLLER® with your head positioned on the PRO-ROLLER® Arch™ for a neutral position. Bring legs to a tabletop and, with arms spread wide at your sides for more stability or closer to you for more challenge, alternate from your left to right leg as you perform toe taps, activating your core.
 
2.      Lie on your back and with the OPTP® PRO-ROLLER® Super Soft on your knees, lift your legs into tabletop position, hip-distance apart. Push both hands into the foam roller as you alternate from your left to right leg, performing toe taps while keeping the foam roller stable against your legs.
 
3.     Lie on your back, lift your legs into tabletop position, and place the OPTP® PRO Soft Release Ball under one knee. Squeeze into the ball, using it as a tactile point as you engage your hamstring, while you perform toe taps for 10-20 seconds on one side before switching to the other side.
 
4.     Lie on your back, placing the Franklin Smooth Ball™ Set under your sit bones. Lift your legs up to tabletop, arms at your sides. Keeping legs parallel to one another, perform toe taps for 20-30 seconds as you challenge deep core engagement.
 
5.      Sit on the Pelvic Rocker™ Core Trainer with your arms on the ground at your sides. Pull your legs up to tabletop and alternating from your left to right leg, perform toe taps. To intensify the exercise, reach the leg forward, as if you’re riding a bicycle.
 
Celebrate Pilates month and strengthen your core with these 5 variations to spice up your Pilates Toe Taps.

Fun, Balance-Boosting Exercises

Balance is a key aspect of fitness and can help improve coordination, joint stability and body awareness. Improving balance can help with day-to-day functioning, as well as sports performance. Plus, it’s an important part of long-term health, as it can help prevent falls that could lead to injury. In the videos below, Derek Mikulski, BS, CSCS, CPT, and Alexa @lowimpactfit demonstrate fun, balance-boosting exercises that can help you improve coordination, joint stability and body awareness. 

Build lower body strength and core strength while improving balance with pistol squats. 

Strengthen the glutes and hamstrings while improving balance with single leg hip extensions. 

Strengthen the upper body and the core while improving balance with these simple exercises you can do anywhere. 

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Strengthen the upper body and lower body with this full balance-boosting workout. 

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Start moving toward better balance with these fun, balance-boosting exercises that you can do anytime, anywhere.

Featured balance products

‘Aha’ moments lead to a life of helping people heal

As a high school student with an interest in health care, Donna Gambino was invited to tag along for a series of physical therapy appointments with a family friend who was recovering from a knee replacement. “That was probably the first time in my life that I had an ‘aha’ moment, says Donna. “I walked into the physical therapy gym and immediately felt like, ‘Okay, this is where I belong,’” she adds.

During the following weeks and months, Donna observed as her mother’s friend gained strength, and other patients at the clinic continued to improve, as well. “I think it was the fact that these people were coming in so broken, and the therapists were able to develop a close working relationship with them, to even become friends with them. The therapists would get to meet with these patients frequently, to see their progress, and then to witness them walk out of the clinic stronger than when they came in,” she says. The experience solidified the fact that Donna wanted to become a physical therapist herself.

Finding what she really loves to do

After earning a Bachelor of Applied Science in Physical Therapy from Wayne State University in Detroit, Michigan, Donna married her husband, Chris, and they moved to Cleveland, Ohio. She landed a job as a PT at an acute care hospital, an experience she describes as the utopia of her career. “My managers were open to trying out new ideas and any crazy idea I had, they would give me a chance to try it for six weeks and see how it went.” At the clinic, Donna worked in cardiac rehab and orthopedic rehab, providing both in-patient and out-patient care. “I got my feet wet in many different areas until I could find what I really, really loved to do and what I excelled at,” Donna says.

Donna working with a client.

Discovering a love for teaching

While working in cardiac rehab, Donna worked on a team with a nurse and a doctor, providing rehabilitation care for individuals recovering from heart attacks and bypass surgery. The role required educating patients on fitness and lifestyle changes. “This was another pivotal moment,” says Donna. “I realized that it can’t just be about the body. I’m not just treating a shoulder or a knee,” she says. “It’s the whole thing. I realized that the mind plays a really big part in a person’s wellness, and that’s been a huge part of my journey,” she adds. The role also helped her to discover that she loves teaching. “It’s not my job to do anything for people. It’s my job to show people how to do it themselves,” she says.

In 1993 Donna and her husband moved to Michigan where she started a job at a local clinic providing outpatient therapy services. With 80% of orthopedic patients struggling with back pain, Donna began reading more and more research on the positive effects Pilates had on back pain patients. She realized that her PT knowledge and experience made her the perfect candidate to teach Pilates. “I thought, this is a tool I need to have,” she says.

In 2000 she enrolled in a Pilates certification program at the Professional Health and Fitness Institute—a Pilates school specifically for PTs. She embraced Pilates as a way to teach people how to safely start exercising after injury or illness, without re-injuring themselves. The results? “It benefits everyone who does it,” says Donna. “I have not had one person that I’ve ever trained in Pilates who hasn’t learned something new about their bodies or how to make it work more efficiently.”

Donna educates viewers on her YouTube channel: Infinity Health Pilates.

Taking Pilates to the next level

While seeing the positive results Pilates had on clients, Donna began taking notes for the book she hoped to write, someday when she had more time. That opportunity came sooner than she expected when a company came in and bought the clinic where she was working—requiring all the employees to sign a contract that included stipulations Donna was not in agreement with. “It was another ‘aha’ moment for me,” says Donna. “I knew I wasn’t going to sign the contract. I realized this is my time to go now and I quit that day—it was really freeing. I got in the car and called my husband and said, ‘I just quit my job. I’m going to take this Pilates thing to the next level and I’m going to write a book.’”

Donna’s first book, On a Roll @ Home: Home Exercises for Core Strength and Massage on the Foam Roller was published in 2006. She purchased Pilates equipment, built a studio in her home, and started getting referrals from therapy friends, massage therapists and chiropractors in the area. Her business, which is now called Infinity Health Therapeutic Pilates, began to grow. All of her business has been word of mouth and Donna believes her success has been her ability to help people heal and start doing activities they never thought they could do. “My tagline is Fitness Solutions for Postural Improvement. I truly believe that if your body is aligned properly, then movement is free and effortless. I can help people do that using the combination of my rehabilitation and fitness knowledge,” says Donna.

Donna helping Pilates clients master the magic circle.

Helping people through difficult challenges

In 2007, she published her second book, Age Perfected Pilates: Mat Exercises Designed to Improve Posture, Strength & Movement and in 2014 she published On a Roll @ Home: Home Exercises for Stretch and Massage on the Foam Roller. Donna and her husband recently moved to Cincinnati, Ohio, where she continues to educate through her books, private Pilates sessions, and her YouTube channel: Infinity Health Pilates. She says she is continually motivated by the opportunity to help people heal. “People can persevere and rise above even the most difficult challenges you can imagine,” she says.

Donna then relays the story of a PT client who she started working with when the girl was only 16. She had been born with a significant leg length discrepancy which caused her to walk with a limp. After a surgical procedure that involved cutting the bone and adding external scaffolding and screws, Donna worked with the girl during her difficult high school years as she worked to recover—including when she finally had the external device removed and was able to walk without it. “We’re still friends today,” says Donna, her voice cracking. “I was there when she walked down the aisle at her wedding—I cried the whole time. That’s why I decided to do this work in the first place.”

Reinventing Pain Care

As a physical therapist and the founder of the Integrative Pain Science Institute, Joe Tatta, PT, DPT, CNS, is on a mission to help individuals experiencing pain by treating the body, mind and spirit. A New York native who describes himself as “someone who values innovation and change, and is always asking how we can improve the delivery of healthcare,” Dr. Tatta knows there’s a better way to treat pain. His approach has been informed and inspired by a variety of people and experiences, but a defining example was the one set by his mom, a retired nurse who worked at an adolescent cancer care center for many years.

As a young boy, Dr. Tatta witnessed his mom take control of her health, and her life, by changing her eating habits, taking up an exercise program, learning to manage stress and anxiety, and making a career change. Without the use of medication, she took control of her health, and her life, and it made a deep and lasting impression.

Moving toward a medical profession with a health and wellness component

As a young boy, Dr. Tatta read the medical journals that were sent to their home. He was fascinated by the information, yet fully aware that wearing a white lab coat and writing prescriptions was not going to be his path. He had always had in interest in the physical body, how it performs, and how to optimize it. A natural athlete, he started gymnastics at the age of three, and although he played other sports through the years, gymnastics was his mainstay. “Gymnastics was a big influence on me as far as pursuing physical therapy, and there’s actually a little bit of mindfulness built into the sport, too,” he says. It eventually became clear that physical therapy was ideal—a medical profession with a health and wellness component.

After graduating from the physical therapy program at the State University of New York, Health Science Center in Brooklyn, Dr. Tatta worked for two years in an inpatient adult rehabilitation clinic where he saw patients with a variety of conditions including spinal cord injuries, traumatic brain injuries, neurological conditions and amputations. He then accepted a position at a physical therapy clinic in New York City that specialized in the performing arts, where he worked with dancers.

Seeking a new model of care

His early work experiences provided Dr. Tatta with a vision for a model of care that he wanted to deliver, which inspired him to collaborate with two other physical therapists and open their own clinic, Premier Physical Therapy and Wellness. “There was an older kind of physical therapy model out there, and we were interested in pursuing newer, more modern models of treatment and interventions for care,” says Dr. Tatta. With an interest in systems and a desire to affect change, he and his business partners opened over a dozen locations in 15 years.

Moving toward integrative pain care

During this time, Dr. Tatta was recognizing the high number of patients who were struggling with chronic pain, while learning how to run a group of successful clinics, but some of the most formative lessons were ones taught outside the clinic doors. After getting hooked on yoga classes, Dr. Tatta became a self-described yogi, learning meditation in the process. This led to mindfulness classes, and eventually he was introduced to Acceptance and Commitment Therapy (ACT), a science-backed approach to treating physical and psychological pain through mindfulness, meditation and other non-pharmaceutical practices.

He also studied nutrition and other alternative and complementary forms of care, as well as Pilates. “The thing about Pilates that interested me was how you can use the equipment to help facilitate movement and to help people who have challenges moving,” he says. “In fact, some of Joseph Pilates’ early work was on people who were in hospital beds. It’s really an ideal method for rehabilitation,” Joe says.

Sharing a new approach to treating pain

When he and his colleagues decided to exit the business and move on to other endeavors, Dr. Tatta decided to focus on writing a book that he had been contemplating. The result was the publication of Heal Your Pain Now, a book that shows how to take an integrative approach to treating pain using exercise, nutrition and the mind. He received a great deal of positive feedback from readers, including other practitioners who wanted to know more about implementing an integrative approach to pain.

These conversations set off a strong desire to address some of the major challenges in the physical therapy world, including how to train professionals about psychologically informed care and how to integrate pain care and other aspects of care like nutrition, supplements and mindfulness and acceptance-based interventions into physical therapy treatment. The result was the Integrative Pain Science Institute, which Dr. Tatta founded in 2016 in order to teach new biopsychosocial pain treatment methods to other practitioners.

Helping people take meaningful, purposeful action

In 2020 Dr. Tatta published his second book, Radical Relief: A Guide to Overcome Chronic Pain. The book introduces readers to ACT and mindfulness, and includes more than 40 cognitive exercises, along with metaphors and colorful imagery to help readers take purposeful action toward a more meaningful life—providing a safe and effective alternative to common pain treatments.

In addition to his books, Dr. Tatta has a podcast that focuses on many healthcare topics, including pain care. “We’re reading the research, but practices aren’t changing as rapidly as we need,” says Dr. Tatta. “So, I look at my platform, including the Integrative Pain Science Institute and my podcast, as a public service announcement for people with pain, as well as practitioners. I’m saying, ‘here’s what we know. Let’s share the information and then let’s start to take action on it so we reinvent how we deliver pain care.’”

Functional Balance Training: Uneven and Unstable Surfaces

Whether you are a physical therapist, chiropractor, athletic trainer, Pilates instructor, or other type of fitness professional, it is likely that you work with clients and/or patients who need to improve their balance.

The evolution of balance training

Over the last three decades, balance training has evolved dramatically. Through the 90s and into the early 2000s, health and fitness professionals began to look more closely at the “functionality” of the exercises they were prescribing; that is, how exercises translate to movement outside of the clinic, studio or gym.

It was realized that balance training in a predictable, static environment would yield sub-par results. Because most individuals need to have sound balance while moving, people need to combine traditional static balance exercises with mobile, multiplanar and unpredictable dynamic exercises across variable surfaces.

This realization caused health and fitness professionals to do two things differently:

1.) They began incorporating more dynamic, functional movement into their programming.
2.) They began utilizing functional new forms of equipment to help their patients and clients achieve their goals.

Balance tools for functional training

Since the shift towards more functional forms of balance training, innovators have created an abundance of balance training tools. Most of these tools offer some sort of variable surface to conduct exercises on and/or across. The basic logic behind these products is simple: exercising on a variable surface will introduce unpredictable balance demands to the patient or client, helping them build a stronger neurological connection between the brain, feet, and everything in between.

Most balance training tools fall into one of two main categories: unstable surfaces and uneven surfaces.

Unstable surface balance tools

Unstable surfaces can be thought of as any surface that moves as the patient or client is standing on top of it. With this variability in movement, the body’s main sensory systems that govern balance (the vestibular and proprioceptive systems) are turned on to a greater degree. Over time, this enhanced sensory and muscle activation can build better balance, helping the individual develop a better intuitive understanding of their body’s position in space.

While a vast number of exercises can be conducted on top of a balance tool that offers an unstable surface, mobile exercises (such as walking or lunging) can be challenging since the surface area of these tools can be quite small.

Examples of balance tools that offer an unstable surface include wobble boards, balance pads, balance discs, and instability platforms. These tools each offer their own unique form of instability.

Wobble Boards

Wobble boards come in many shapes and sizes, but the concept is similar across all variations. The tools feature a solid surface on top of a curved base that moves in either one plane of motion (easier) or in all directions (harder). Wobble boards are great for all patient and client types. If you are in the market for a wobble board, the Wobblesmart by OPTP is a great option. It can be adjusted across 6 degrees of difficulty to accommodate a range of balance abilities, making it very versatile.

Balance Pads

Balance pads also come in many shapes and sizes. These balance tools are commonly made from pliable air-filled foam, which collapses as a user stands on top. Balance pads are most commonly used with older adults, since they offer a lesser degree of instability and are low to the ground, minimizing the risk of a fall. For a great balance pad option, check out the OPTP Pro Balance Pad.

Balance Discs

Balance discs are similar to both wobble boards and balance pads in that they can be made of collapsible foam or offer a solid platform on top of a curved base. They can also be completely air-filled. These tools are circular in shape and are commonly used in unilateral (single leg) exercises. For an exciting and unique balance disc option, check out the OPTP Dynamic Duo™ Balance & Stability Trainers.

Instability Platforms

Instability platforms include a broad range of dome-shaped balance tools. These products are most commonly made from a durable rubber material that is balloon-like, being filled with air. This rubber air filled “balloon” can serve as the balance tool itself or can be affixed to a solid platform that the user stands on top of. For one of the newest innovations in instability platforms, check out the OPTP PRO-PODS™.

Uneven surface balance tools

As mentioned, one major consideration in today’s balance training program development is the functionality of exercises. That is, how does, “balance exercise x” help prepare the patient or client for doing, “activity x” in their day-to-day life?

Because most people spend a fair amount of time standing, walking, hiking, jogging, or running on surfaces that are not unstable, innovators recently began creating products that offer uneven surfaces. Balance tools with an uneven surface offer variability that is more similar to what people might encounter in their daily lives including hills, uneven grass or playing fields, rocky walkways, old sidewalks, and hiking trails.

These surfaces have fixed and unfixed obstacles that people must navigate on, over and across safely. Moving on and across an uneven surface offers the same benefits that unstable surfaces offer, with the added benefit of increased functionality. To train on any uneven surface, people would normally have to venture outside to the nearest park, trail, hill, field, or mountain; until now.

CobbleFoam: A highly effective approach to improving balance

OPTP recently released an innovative new balance training product called CobbleFoam. Each CobbleFoam board is 16” x 16” and features foam blocks of varying heights that create uneven terrain to stand on or traverse across. The CobbleFoam board/s simulate the uneven surfaces we encounter in everyday life and can be used safely and comfortably in the clinic, studio, gym or home.

Conducting any balance exercise on an uneven surface like CobbleFoam immediately increases the benefits of the movement. Due to the variability of the uneven surface, the brain and muscles will be engaged at a deeper level to keep the body upright and balanced. In addition, the deep intrinsic stability system of the foot-ankle-knee complex will be activated to a much greater degree, building strength and joint integrity.

To make balance exercises even more functional and life-like, combining an uneven surface like the CobbleFoam board/s with other fitness tools like weights, steps, balance pads and hurdles to develop an “obstacle course” is a highly effective approach to developing and improving functional balance.

The key to the most profound overall benefits

The use of both unstable and uneven balance training products offers incredibly beneficial outcomes for patients and clients. When combined with functional movement that is most similar to activities of daily life, patients and clients will realize the most profound overall benefits.

To explore all of OPTP’s 40+ balance training products, visit optp.com.

Using Mindfulness and Acceptance to Mentally Cope with Chronic Pain

By Joe Tatta, PT, DPT, CNS

Over the last century, a belief has developed that people living with chronic pain are broken, they need to be fixed, and pain must be completely eliminated in order to achieve a sense of freedom and vitality.

Things that are broken require fixing. When you view pain as a problem, it will naturally require a solution that promises to fix it. But what if the ways you’ve tried to mend or fix your pain are actually making things worse? Consider that possibility for a moment. Struggling to control pain can place a tremendous amount of strain on your body and your life. Each failed fix or promise of a solution to stop, control, or eliminate pain takes a toll. It lets you down, shattering your expectations into a thousand pieces, leaving you spent and drained of energy.

An Alternate Path: Mindfulness and Acceptance and Commitment Therapy

A modern exploration of human suffering suggests chronic pain isn’t the enemy and that it doesn’t need to be stopped, eliminated or controlled to live a rich, meaningful and active life. Rather than focusing on changing physical or psychological pain directly, approaches such as mindfulness and Acceptance and Commitment Therapy seek to change the function of those events and the individual’s relationship to them.

The following metaphor will help you recognize how ineffective the struggle with pain control really is. It also shows you a surprising alternate path out of the struggle—a path that can help you return to an active life.

Activity: Letting Go of the Rope

Fighting to control or eliminate pain is like being in a tug-of-war with a huge pain monster. In between you and this big, ugly monster is a deep, bottomless pit. Losing this tug-of-war means falling into the pit, where you’ll be trapped forever.

Imagine grasping the rope tightly with both hands and beginning to pull. The harder you pull, the harder the pain monster pulls back. You tighten your grip further until your knuckles are white. Your elbows contract and your shoulders rise with tension. Your back braces as you dig your heels into the ground and begin to pull.

As the struggle continues you become more and more exhausted and begin to feel the pain in your body. Your arms are tired, your face is red and you’re sweating as you continue in this fight for your life. As the struggle continues, you edge closer and closer to the pit. The pain monster is winning.

Finally, you are pulled to the very edge of the pit where you stare into the depths of darkness. Your mind searches for solutions—telling you to pull harder and not to give in until you’ve won the struggle. Yet, there is an option you probably haven’t considered; You don’t need to win this tug-of-war.

What if you decide to let go of the rope and give up the fight?

Imagine yourself dropping the rope right now.

Notice how your body feels as you drop the rope.
Does the tension in your body increase or decrease? Does your energy level go up or down? You’re now free to use your hands, feet, your entire body, and your mind for something other than fighting pain. The pain monster hasn’t gone away just because you stopped tugging. He may still be holding one end hoping that you grab hold for another round. There may be times when you re-engage in this battle simply out of habit, even without the pain monster taunting you.

Focus on the Important Things You Care About
Dropping the rope will allow you to save your energy to focus on the important things you care about—relationships and activities that are waiting to be discovered or rediscovered. Goals and dreams that you have put on hold because you were busy in the battle with the pain monster. Take a moment and think about all the people and activities that have been waiting while you’ve been involved in the tug-of-war. What projects have you put on hold? What vacations have you canceled or put off planning? Is there a friend you no longer see or a child who needs your support? Start a list or simply visualize the people and places that make you feel excited about life again. How would dropping the rope give you more time, energy, and space to connect with who and what is important to you?
Letting go creates space for something new to take its place, or for something you once cherished to return. When you shift your focus from trying to control pain, worrying about when pain will return, or whether or not activities will cause more pain, you create space and energy to move toward the full and active life you desire. You are free to create the life you want.

August is National Wellness Month. Make wellness a priority with self-massage techniques using a foam roller. For centuries, massage has been helping people feel good, and medical research confirms the health benefits of massage to enhance function, assist healing, and promote relaxation and wellbeing.
 
According to Angela Kneale OTD, MA, OTR/L, in her book PRO-ROLLER Massage Essentials, “One single massage decreases your stress hormones. Twice-weekly moderate pressure massages improve range of motion, decrease pain, reduce depression and anxiety, and enhance immune function.” These three foam roller techniques can help you experience the benefits of self-massage during National Wellness Month and beyond.
 
 
Forearm Massage
Release tightness in forearms while improving forearm and wrist mobility.
 
1.     Kneel on the floor with your hips flexed and place your forearms on the roller.

2.     Moving your body from your hip joints, gently press your forearms into the roller to move it away from you and draw it back. Roll with palms in, and then rotate palms up to roll outer forearms, and down to roll inner forearms.

 
Low Back Massage
Release tension in the low back while increasing comfort and flexibility and improving posture.
 
1.     Place the roller crosswise beneath one side of your pelvis. Keep your knees bent and feet flat on the floor in front of you, with your forearm on the floor behind the roller to support your upper body.

2.     Reach your other arm to your knee, slightly rotating your torso. Gently roll the roller up and down next to your spine at your lower back. Repeat on the other side.

Hamstrings Massage
Release leg tension while improving leg and lower back movement and comfort.
 
1.     Place the roller beneath the back of your thighs, with your hands on the floor behind you.

2.     Slowly roll down and up the back of your thighs, from your hips to your knees.

 
Find these and more self-massage foam roller exercises in PRO-ROLLER® Massage Essentials.
 

Empowerment Through Education

In 2016, Deborah Riczo retired from MetroHealth Medical Center, where she worked for 30 years, serving as a physical therapist, providing program development, and helping with administration duties. Yet, when she talks about her schedule it’s clear that she’s anything but retired. “I worked yesterday, I’m working today, and I’m getting materials ready for a one-day course on sacroiliac pain and pelvic girdle pain that’s being hosted by the Academy of Pelvic Health Physical Therapy,” she says.

The work Deborah does is through Riczo Health Education, the organization she founded in 2011. In addition to speaking engagements, writing and continuing education courses, she serves as a volunteer physical therapist for Womankind—a Cleveland non-profit that provides medical care and social support to pregnant women who don’t have health insurance. She also sits on the board of directors for several organizations.

Deborah has dedicated her physical therapy career to empowering women through education, and it all started by empowering herself through education.

Deborah Riczo in 2020.

Following her passion

Deborah’s career started in marketing, working full-time to put her husband through law school. When she was offered a sales position (a role the company rarely offered to women at that time), Deborah turned it down knowing it wasn’t her passion and that she wanted to complete her undergraduate degree and do something related to science and healthcare. “I went to the library and researched different careers,” says Deborah. “Physical therapy is what spoke to me—the more I looked into it, the more I realized that that's what I wanted to do.”

When her husband John secured a job in law, Deborah was able to go back to school. She needed to take an entire year of prerequisites before she could even apply to the physical therapy program. After a year of taking the required classes, she was accepted into Cleveland State University, where she graduated with her physical therapy license in 1980.

Empowering women through prenatal and postpartum education

Deborah’s first job out of physical therapy school was at MetroHealth Medical Center in Cleveland, Ohio. A therapist at the hospital took Deborah under her wing, asking if she and another therapist wanted to be involved with the postpartum program; Deborah said yes, and the three eventually launched a business called Contemporary Physical Therapy Services. With contracts at three area hospitals, Deborah and her colleagues led classes that included prenatal and postpartum exercises and education, including the importance of relaxation and deep breathing—putting conscious relaxation into practice.

“That’s where it all started,” says Deborah—with prenatal and postpartum education. Ever since then, women’s health has been what I’ve focused my entire career on.” For Deborah, that has meant being a source of knowledge and support for women during an extremely important time in their lives—while they’re dealing with the emotional and physical changes that happen during pregnancy and postpartum.

She and her colleagues successfully ran Contemporary Physical Therapy Services from 1983-1993. During that time, Deborah returned to Cleveland State University, where she earned a Master’s Degree in Education and had two children of her own; a daughter named Alexa, and a son named Christopher. When one of her colleagues decided to move out of state in 1993, the women closed the business and Deborah ramped up her hours at the hospital.

Deborah presenting to a community exercise class in Cleveland in 2003.

More than 30 years of serving as an advocate for women’s health

Deborah worked at MetroHealth Medical Center for more than 30 years. As an advocate for women’s health, she helped shape a rehabilitation program for women recovering from breast cancer and worked with women struggling to recover after childbirth. “Many women have their direction in life change after they have a child because they may have problems with their lower back and their pelvic girdle—and that affects how they’re functioning, their self-esteem, and their body image,” says Deborah. “They may struggle to get their weight down, have abdominals that are weak, and it can affect their relationship with their husband, or even with their children, if they aren’t able to be as active as they used to. So, I feel like if I can intervene with some simple education and techniques it can be extremely beneficial.”

Deborah working as a clinician and coordinator of the Industrial Rehabilitation Program at MetroHealth Medical Center in 2013.

Using a patient-centered approach

Deborah says her focus has always been to help her patients meet their goals using a patient-centered approach. “If a patient comes in I instruct them on how to get changes in their body themselves. Sometimes I would do hands-on therapy, but then I would show them how to do that for themselves at home.”

Her passion for women’s health and the reputation she had gained as an expert on women’s health issues provided Deborah with the opportunity to present at national conferences, including the APTA National Conference for the Section on Women’s Health, which has recently been renamed the Academy of Pelvic Health. When she returned to school once again, working on her doctorate in physical therapy at Marymount University in 2007, her capstone project focused on an exercise approach she was using successfully at the clinic, which she later named the Pelvic Girdle Musculoskeletal Method, or PGM Method.

Deborah presenting a 2-day lecture/lab course to physical therapists at Ohio State University for the Women’s Health Section in 2016.

Expanding her reach through Riczo Health Education

Deborah graduated with her doctorate in 2009 and founded Riczo Health Education in 2011. Her goals with the company are to provide consumer health education on sacroiliac pain, pregnancy and postpartum, breast cancer, and health and wellness. She also provides continuing education courses to health professionals, presentations to consumer groups, and consulting services to healthcare organizations.

Deborah presenting a morning lecture as part of the Women’s Leadership Conversation Series at Cleveland State Alumni Association in 2018.

Reaching a wider audience through books

Deborah published her first book in 2018, Sacroiliac Pain: Understanding the Pelvic Girdle Musculoskeletal Method, and her second book in 2020, Back & Pelvic Girdle Pain in Pregnancy & Postpartum. Her desire to continue educating women and to reach the most people with a non-pharmaceutical, non-surgical approach was the inspiration for the books because, as she says, and as her long and successful career proves, “I’m a true believer in the power of education and empowering the individual to take back control of his/her health, to make healthy choices and lead a healthy lifestyle.”

A prepared mind leads to a life filled with chance discoveries

“Chance only favors the prepared mind.” These words were spoken by Louis Pasteur, the French biologist known for his scientific discoveries. It’s not surprising that the quote is a favorite of Brian Mulligan, a legend in the physiotherapy world who has made his own important discoveries—including manual therapy techniques that have made a profound impact on the field.
 
Brian says the Pasteur quote applies to almost every aspect of his life, including his introduction to the field of physiotherapy and his achievements throughout his career that’s spanned more than 60 years. He attributes it all to chance and a prepared mind.
 

A prepared mind and a false start

Growing up in New Zealand during World War II, Brian’s greatest aspiration was to join the army; he took all the subjects necessary to be accepted into officer training and was devastated when he failed the eyesight test. His dreams dashed, Brian joined a large chemical company where he was encouraged to take classes toward a commerce degree. Working at a desk all day, while studying subjects like bookkeeping and company law at night, Brian says he was an “unhappy chap.”  
 

A prepared mind leads to the discovery of a new career

 
“I went to see this guy, and I saw his practice,” says Brian. “He had all this fascinating equipment and was very successful and confident. He was treating all these different patients and I thought, gosh, this is far more exciting than sitting at a desk all day!” Brian applied and was accepted into the New Zealand School of Physiotherapy, where he began classes the following year. “That chance discovery was just wonderful,” he says.
 

A prepared mind leads to a new way to treat patients

After qualifying to practice in 1954, Brian began making connections with other young, enthusiastic physiotherapists, including Stanley Paris and Robin McKenzie (who had also been a childhood schoolmate). The three connected with Freddy Kaltenborn, a physiotherapist who was learning manual therapy techniques and teaching them to other up-and-coming therapists in Europe and, later, on trips to New Zealand.
 
This led Brian to Helsinki, Finland, in 1970, where he attended Freddy’s classes—later returning to New Zealand to teach everything he had learned to his eager colleagues. “I had never taught anything in my life and that was my introduction to teaching,” says Brian.
 
Manual therapy became Brian’s area of expertise, and to this day, he credits the late Freddy Kaltenborn for his excellent handling skills. “To bring about change using my hands was really special to me and Freddy was an excellent teacher—he certainly made an impact on me. He gave me all my handling skills and I would never be where I am today if it wasn’t for my ability to deal with joints as Freddy taught me,” says Brian.
 

A prepared mind leads to a new technique

These hands-on treatments led to another chance discovery that was made while treating a young basketball player who came to Brian sometime in the mid 80s with a grossly swollen, injured finger that she couldn’t bend. After treating it with ultrasonics, Brian tried a manual technique to see if he could get it to move. “I tractioned and I did anterior and posterior translations and I was getting nowhere,” says Brian. “Then I remember grabbing her finger and just translating the distal surface medially, which she said was painful. When I translated the surface laterally she said it did not hurt. While sustaining this, I asked if she could bend her finger. I was amazed! Her finger started to bend straight away.”  
 
Brian went home and thought about how the technique had worked—even dreaming about it that night. “When the techniques I was initially using didn’t work and then something did work—I certainly had a prepared mind,” says Brian. “I thought, good heavens, why did that happen? I’ve got to find out why… and I found out why.”
 
When he was able to make sense of it, he began treating other injuries using this method. With a prepared mind, he started to reposition joint surfaces in pain-free directions and sustain the repositioning to see if he could get results. He says the results were amazing. Almost every day he would do something that he had never done before, and after some months was able to try this new approach right through the entire body.  
 

A prepared mind leads to more new treatment techniques  

Chance and a prepared mind had led to a new way to apply manual therapy techniques: Mobilization with Movements (MWMs). “There is no other manual therapy approach being taught in the field of musculoskeletal medicine, that when indicated gives an instant pain-free result,” says Brian. In the ensuing years, this approach helped Brian make more discoveries, including the Pain Release Phenomenon (PRP), the Squeeze technique and a special hip muscle technique.
 
Already teaching conventional manual therapy, Brian felt strongly that any new technique that could help patients be active, functional, and pain free should be taught and made available to the public. This led to the formation of the Mulligan Concept Teachers Association (MCTA) in 1995. The organization helped meet the huge demand from therapists wanting to learn his techniques, while ensuring high teaching standards. Currently, there are MCTA colleagues teaching in over 30 countries and last year there were over 5,000 course participants in Europe and the UK alone.
 

A prepared mind, an exciting career, and a happy retirement

After more than 60 years in the field of physiotherapy, Brian says he’s most proud of receiving the Geoffrey Maitland Award, which he was honored with in 2016. He’s also extremely proud of his teachers who are teaching all over the world in 30 different languages. “They’ve found things that I haven’t found, and they’ve improved my concepts,” says Brian.
 
Last year Brian traveled to Africa, Spain, Mexico and Taiwan to teach, but after turning 87 he decided to stop and let his teachers carry on his work. Although he still has his license to practice and sees patients every now and again, Brian says he’s mostly retired. His time is spent golfing, gardening, reading, playing the piano every day, and spending time with his wife and family, including great-grandchildren.
 
“It’s been a privileged life,” says Brian. “I have doctor friends who had to give up medicine when they were in their 60s. And here’s this old so-and-so still traveling the world, teaching and enjoying life. Looking back, I could not have had a more exciting career.”
 
Brian has developed a variety of mobilisation tools for use in physical therapy. He is also the author of several books including The Mulligan Concept of Manual Therapy and NAGS, SNAGS, MWMS, etc. 
 

There are so many great benefits of partner-assisted stretching, but what do you do if you don’t have a partner to stretch with, or you don’t want to pay the expense of visiting a stretching studio? That’s where a stretching strap comes in. Stretching straps are made of durable nylon and have multiple loops that permit deep, gradual stretching of major muscle groups, providing the benefits of partner-assisted stretching, without the partner.

Benefits of using a stretching strap include:

• More control – The strap features various loops to hold onto; the tension in the strap allows for controlled movement of your limbs.
• Go deeper into the stretch – The additional length provided by the strap allows you to move gradually into a deeper, more effective stretch.
• Better posture while stretching – Reach into poses without tensing or rounding your upper body.
• More stretching options – The control provided by the stretching strap allows you to reach into poses you otherwise would not be able to.
• Perform contract-relax stretching – Tense the muscle group you want to stretch while pressing into the strap, relax for a moment, and then slowly and gradually stretch. This type of stretching has been shown to improve both flexibility and strength.

Here are 3 simple stretches you can do with a stretching strap:

Hamstring Stretch

Start: Place the center of the Stretch Out Strap beneath your left foot and reach the left leg straight out. Sit tall with neutral spine and bend the right leg to place your right foot against your left inner thigh. Hold loops of the Stretch Out Strap with both hands. With neutral spine, hinge forward from your hips.

Stretch Out: Press the back of your left leg into the floor, tensing the hamstrings. Relax for a moment, and then lean your upper body further forward. Continue contracting, relaxing, and stretching your hamstrings 2 to 3 times, and then hold the stretch for at least 10 seconds.

Quadriceps Stretch

Start: Hook one Stretch Out Strap end loop around the middle of each foot. Lie face down, bend both knees and hold the center of the Stretch Out Strap behind your head.

Stretch Out: Try to straighten both knees, tensing quadriceps muscles, while resisting with the Stretch Out Strap. Relax for a moment, and then bend your knees further, as if reaching your feet toward the middle of your back. Continue contracting, relaxing, and stretching your quadriceps 2 to 3 times, and then hold the stretch for at least 10 seconds.

Chest & Biceps Stretch

Start: Stand tall with the Stretch Out Strap behind your back. Each hand holds the first or second loop from the center, with palms facing forward. With your arms straight, reach back as far as comfortable.

Stretch Out: Tense the chest and biceps muscles as if pressing the Stretch Out Strap forward, without moving the strap. Relax for a moment, and then reach your arms further back behind you. Continue contracting, relaxing, and stretching your chest and biceps muscles 2 to 3 times, and then hold the stretch for at least 10 seconds.

Find these stretches and more in a free stretching guide that comes with the purchase of The Original Stretch Out Strap from OPTP.

The simplest actions often make the greatest positive differences. Playfully rolling on a foam roller can help your body feel more relaxed, aligned and resilient as you release soft tissue and encourage tight areas to soften and lengthen. Read on for three foam roller exercises to help release stress and tension, recommended by Occupational Therapist and Certified Pilates Instructor Angela Kneale.
 
Middle Back Massage
Release tension between your shoulder blades while improving posture and flexibility.
 
1.     Sit on the floor with the roller behind you, and lean back onto the roller at the lower edge of your shoulder blades. Hands behind your head for support, reach your elbows toward the ceiling.

2.     Lift your pelvis, and slowly roll up and down your middle back from the top of the shoulder blades toward the bottom of your ribcage. Experience the support of your core muscles during movements.

 
 
Hip Rotator Massage
Release hip tension, increase hip mobility and improve posture.
 
1.     Sit on the roller crosswise, knees bent, and arm supporting on the floor behind the roller. Lean to one side and place that ankle on the opposite knee, rotate your hip outward as much as is comfortable and angle your knee down toward the floor.

 
2.     Slowly roll from top of your pelvis down toward the top of your thigh, relaxing and releasing deep hip rotator muscles. Repeat on the other side.

 
 
 
 
 
Low Back Release
Release lower back tension and promote segmental spinal mobility while improving posture.
 
1.     Stand tall and place the roller crosswise behind your low back. Hold the roller with your arms, palms facing forward.

 
2.     Gently press your arms forward and arch your back over the roller, adjusting roller placement for comfort. Maintain position for a few slow, deep breaths.

 
Find these and more relaxation exercises in PRO-ROLLER® Massage Essentials by Angela Kneale, OTD, MA, OTR/L, NBC-HWC.
 

Following Fate

 
Emilio Puentedura (who is fondly known as “Louie”) was first introduced to physiotherapy through his older sister Vicky who had contracted polio at the age of 18 months. Seeking better healthcare for her, Louie’s family uprooted from Madrid, Spain, and moved to Melbourne, Australia, in the early 1960s. Unable to sit up on her own, Vicky was enrolled in a school for children with disabilities at the age of seven and began working with a physiotherapist who provided in-home hydrotherapy treatments in extremely hot water. Louie, who was only five years old at the time, remembers wanting to get into the hot water: “I would say ‘I want to go in! I want to go in!’ and the physio kept telling me that I couldn’t. And then I’d put my feet in—and they would fly right out, and I’d yell, ‘it’s too hot!’” remembers Louie.
 
He also remembers the wood and steel brace his sister was required to sleep in. “When she didn’t sleep in it, it was leaning up against the wall—in the dark it looked like a scary monster,” said Louie. “I remember crying a lot because I was scared of that damn thing,” he added. Although they seemed scary at the time, these events helped shape Louie’s future professional life.


Louie at 10 years of age.
 

Physiotherapy: a life changing experience

Within several months of treatment, Louie’s sister was walking with the help of a walker and continued to become stronger over the years—eventually securing a full-time job, getting married and having three daughters. Vicky’s physiotherapy experience was life changing for her, and made a profound impact on Louie, too. “I think subliminally I must have realized there were some cool things being done for my sister and ultimately, I think that experience inspired me to go into medicine,” he said.
 
Being only one point shy of getting into medical school, Louie enrolled in a core program in physiotherapy and liked it so much he decided to stick with it. Transferring into the full-time physiotherapy program required an interview with the head of the school, which seemed to bring Louie’s path full circle. During the interview, the head of the school had a big smile on her face and asked Louie if he remembered her—he didn’t. “The last time I saw you, you were five or six years old,” she told him. “I recognized your name, and you look just like the little boy I remember.” That’s when Louie realized he was meeting with the physiotherapist who had helped his sister walk for the first time so many years before.
 

Manual therapy as a systematic way to evaluate and treat people

Louie’s transition from school into his professional life included a job at a school for children with disabilities, followed by a job working with geriatric patients. Eventually he settled on orthopedics, and in 1983 he completed a graduate diploma in manual therapy—which is one of his areas of specialty. “Manual therapy was covered very little in my undergrad program because there was a belief that it could hurt people or wasn’t really effective,” said Louie. “But when I learned more about it and started using it, I realized how effective it really can be. It’s a systematic way of evaluating and treating people—and it’s not dangerous if you use it with common sense and sound clinical reasoning,” he added.
 
Although a proponent of manual therapy treatments, Louie began to come across patients who suffered from such severe chronic pain that they couldn’t be touched due to their heightened sensitivity. This led Louie to pain science—and the work of Geoff Maitland, Louis Gifford, Lorimer Moseley and David Butler. It also led him to Adriaan Louw, who became a good friend and a co-worker when Louie signed on to teach at Midwest Spine Therapists—a seminar company Adriaan and his wife, Colleen, were running. Around 2006 the organization became the International Spine and Pain Institute and some of Louie’s courses, including Thrust Joint Manipulation, have since been incorporated.


 

Marrying into a family dynasty of physical therapists

Fate seemed to step in once again when Louie was working in Ballarat, Victoria, where he met and eventually started working for Peter Rice, a physical therapist who was very skilled at manual therapy and spinal manipulation. Louie was introduced to Peter’s daughter, Danielle, and was so fond of her that he proposed four years later. “I married into an incredible family dynasty of physical therapists,” said Louie. “Both my father-in-law and mother-in-law were physical therapists and my wife’s grandparents and great-grandparents way back at the turn of the century—the 1890s—were physical therapists in Australia,” he said.  
 
An opportunity to work at an outpatient clinic in Yuma, Arizona, brought Louie and his wife Danielle and their three children Ben, Georgina, and Alexander to the U.S in 1995. He completed a post-professional Doctorate in Physical Therapy at Northern Arizona University in 2005 and after receiving a job offer to teach, he decided he needed to further his education. He received his PhD in Physical Therapy at Nova Southeastern University in 2011 and served as a faculty member at the University of Nevada Las Vegas for 10 years, as Assistant and then Associate Professor of the Doctor of Physical Therapy Program. 
 

Shaping careers and changing lives through teaching

Now a Professor at Baylor University in the accelerated hybrid-model Doctor of Physical Therapy Program, Louie is inspired to help young PTs with a passion for learning to become the best they can be by helping them learn clinical reasoning skills, along with manual handling skills. In this role, he is helping shape the course of many students’ careers and providing them the opportunity to go out and make a positive difference for people who are struggling with pain and physical challenges; Call it a profession. Call it a mission. Call it fate. Whatever you choose to call it, it certainly seems like it was meant to be.
 

Valerie Phelps is a physical therapist whose career path has come full circle. From the time she was a young girl she wanted to be a brain surgeon—now she’s providing physical therapy care in a neurosurgery clinic two days a week. “I grew up knowing I wanted to take care of people,” Phelps says. “But when I looked into becoming a brain surgeon I got really discouraged because everything about it seemed overwhelming. Then I began volunteering at a hospital and realized that I got sick at the sight of blood,” she adds. At the urging of her mom, she began investigating physical therapy as a potential career field.
 

Finding a calling, not just a career

“What really called me to the physical therapy profession is the fact that you’re always working for the betterment of somebody, you’re always helping somebody improve their life—and that’s on both a physical and mental plane,” she says.
 
But the thing that made Phelps realize she wanted to be a physical therapist is the opportunity to establish a relationship with each patient, which isn’t necessarily the case with other occupations in healthcare. “Talking to your patient and getting to know them as an individual and as a person, not just a patient, is such an important part of the healing process,” Phelps says.  
 

Searching for a better way to treat patients

After graduating from the University of Minnesota in 1981 with a B.S. in physical therapy, Phelps says she floated around for almost seven years searching for the type of treatment that would work best with her patients. “I was an enthusiastic young clinician and I took every course I could and researched every concept out there. I went through periods of treating with a Maitland approach—then Barnes, then McKenzie, then Kaltenborn—and the list goes on,” she says.
 
Things fell into place on an unlikely trip to Aruba where Phelps attended an International Academy of Orthopedic Medicine (IAOM) conference. “I thought I already knew everything there was to know about the shoulder, so I went to this conference thinking I might learn a few things, but mainly I’d have a good time. Instead I was introduced to a whole new way of practicing and I was like—oh, wow, this is a philosophy of treatment based on anatomy that involves looking for patterns in the clinical setting and then matching treatment to the specific patient. Up until then, what I had studied involved using the same technique on every single patient,” she says.

 
Valerie consults with Physical Therapist Phillip Sizer in the late 90’s.

Discovering a treatment philosophy that fits

Phelps describes the IAOM approach as a concept that isn’t a one-person based program but a solid, multi-planar, anatomical approach that looks at movement, the biomechanics of the joint, the structures that cover the joint, the muscles and the myofascial structures that move the joint, and then other influences on the joint. “It’s just a really great system that looks at the whole kinetic chain,” Phelps says.
 
When she started studying with IAOM, Phelps says it became clear that if she knew what she was treating, she could select techniques from any of the specific areas of manual therapy she had studied. “Suddenly, I had hundreds of tools to utilize based on the patient,” she says. “IAOM’s treatment philosophy is that ‘it all fits,’ and the expertise comes from knowing when to use a particular technique, and with which patient.”  
 
Phelps was so impressed with the philosophy and the results she was seeing in the clinic that she trained to be an international instructor for IAOM in 1994. Eventually, she founded the U.S. branch of IAOM, where she serves as education director, delivering courses and lectures throughout the U.S. and Europe.


Valerie presenting at an IAOM conference.
 

Providing patient-centered care in the clinic and beyond

Another way that Phelps puts her patient-centered care into action is at Advanced Physical Therapy—an employee-owned practice that she founded and where she serves as practice director. With five locations throughout Alaska, the practice is made up of physical therapists, occupational therapists and massage therapists who customize treatments and provide education for patients with physical problems ranging from simple to complex, or as Phelps describes, “We treat everything from the big toe to the head.”
 
Her quest to help people experiencing pain doesn’t stop in the treatment room. Phelps helped develop the SI-LOC^® support belt after years of working with patients experiencing sacroiliac joint pathology and not having an effective support to offer them. At the time, the only support option was a brace with a large triangular pad over the sacrum, which she says didn’t make biomedical sense. This inspired her to create a more effective support belt.
 
“Imagine holding a cone in your hand,” explains Phelps. “When we hold an ice cream cone, we don’t have to squeeze it very hard. If we create a little ring with our hand it just snuggly fits in that ring. That’s where we came up with the idea for the SI-LOC. It’s a simple but effective ring for the wedge of the SI joint to snuggly fit into and it only needs about 20 pounds of force to stabilize the joint. The SI-LOC works beautifully as a temporary assist for external stabilization while you’re working on internal stability, which can take a few months to several years,” she says.


Valerie presents with Phillip Sizer, PT, PhD, at a conference.
 

Coming full circle

After almost 40 years of practicing, Phelps says she loves physical therapy as much today as she did the day she graduated. “I probably love it more now because I know how much I don’t know. When you get out of school, you think you have all the tools you need and that you’re going to get everybody better, and that it’s completely dependent on you,” Phelps says. “But it’s a process and we’re always learning. I taught a course this past weekend and some colleagues I’ve known for at least 20 years flew in from across the country. It was really nice to sit down and share what we’re doing and to continue to learn from each other.
 
This is a profession that gives us the opportunity to learn more every year and as we discover more we understand more, allowing us to help improve patients’ lives—and that’s what I set out to do from the beginning.” 

Conversations about bowel, bladder and sexual function are all in a day’s work for Physical Therapist Sarah Haag. Because her job as a pelvic health specialist involves talking about deeply personal problems, her role has a bit of a therapist quality to it, “But you certainly would not want to come to me for help with relationship or life issues,” she says, laughing. 
 
Sarah helps patients who are experiencing problems with basic, everyday bodily functions. “When those basic functions aren’t working well, it can really affect your life,” says Sarah.  “Plus, there aren’t many places to talk about these topics. People come to me with problems they find embarrassing and they don’t want to tell their doctor—or they did tell their doctor, who said, ‘Well, that’s no big deal.’ Or, ‘That just means you’re old.’ I let patients know that it’s okay to talk about it and that they can get better,” she adds. 
 

Discovering a way to help people

The ability to help people get better is what drew Sarah to the physical therapy field in the first place. As the daughter of parents who both work in the medical field, she had exposure to what nurses and doctors do, but it was a volunteering opportunity at a local hospital during high school, and encouragement from her grandmother, that solidified Sarah’s interest in physical therapy. “I was volunteering and observing the physical therapists, and I thought—this sounds great because literally my job gets to be helping people do things they want to do and helping them feel better,” she says.  
 
Knowing that physical therapy was her ultimate goal, Sarah enrolled in a direct admit program at Marquette University, first completing her sociology degree, followed by a Master’s degree in Physical Therapy, which she completed in 2002. After completing a stint at the Texas Back Institute directly out of college, Sarah accepted a position at the Rehabilitation Institute of Chicago, where they were just starting a Women’s Health team that they asked Sarah to join. “I said, ‘Absolutely!’ And it was amazing because it was just a perfect fit,” says Sarah. “I was really inspired and excited to help people experiencing problems with these basic, everyday bodily functions. It's just an absolutely amazing part of the profession to be involved in,” she adds.  
 
Sarah feels that her success helping pelvic health patients is partly due to her ability to talk about difficult topics, which she says is a result of her upbringing and her background in sociology. “Studying sociology made me aware that the relationships people have with those around them impacts their lives and that we're all different,” she says. “So, for example, if you grew up in a place where women don't exercise, that’s important for me to know. If I have a better understanding of that culture, that upbringing, or that value system, it can really be useful when I’m trying to help you figure out a way that’s okay to start exercising. It’s not just looking at people as bones and joints and muscles, but rather looking at them as people who are trying to figure out how to change their bones and joints and muscles in order to feel better.”
 
Sarah Haag teaching fellow clinicians.

High volume clinics with lower quality care

Getting to know her patients in order to provide better care was difficult when working in high volume clinics in the early years of Sarah’s career. “The hardest part was helping people navigate and better understand the healthcare system,” she says. “Sometimes there’s a disconnect between what good health care is, what health insurance will pay for, and what a healthcare provider is actually able to do,” she explains. 
 
Because there are so many moving parts, Sarah says providing quality patient care can be tricky and that a lot of high volume clinics don’t do a great job because many clinics expect the PT to see four or five people at a time, patients can’t get an appointment as frequently as they should, and treatment isn’t individualized because the PT doesn’t have time to sit down and listen to them. “When I was in that environment I realized that I was working in a system that wasn’t working for me anymore. I wasn’t able to give the care that I thought was best,” she added. 
 
These frustrations led to a series of conversations with Sarah’s friend and fellow physical therapist, Sandy Hilton. The two shared their thoughts on treatment approaches and principles, and the challenges that are present in the healthcare system, which, ultimately, resulted in the decision to open a clinic together. “We wanted to provide health care in a way that is more efficient and effective,” says Sarah. In 2012, they opened the doors at Entropy Physiotherapy in Chicago, Ill. 

Sarah Haag presenting at the Third World Congress of Sports Physical Therapy.

Helping people feel less like patients, more like people 

“People come in and say it doesn't feel like a clinic,” says Sarah. “We have normal living room chairs and exposed brick and exposed beams. The whole idea was to have people feel less like patients and more like people who are just trying to work out some physical problems, because another thing we tend to do in the system is medicalize people. And although some problems are ongoing, we shouldn't have people stay patients forever,” she adds.
 
Helping people get better and get back to their lives as usual involves taking the time to really get to know them, which Sarah has the time to do at the new clinic. “Really understanding why a patient is having trouble doing their home program, really understanding why it's hard for them to make that change, and then working with them to figure it out—that's where we actually have the biggest impact,” says Sarah. 
 

Doing what she set out to do—help people

For Sarah, the process of helping people feel better starts with humanizing the medical system. Here’s an example she shared: ”I just had a patient this morning who told me, ‘I don’t know why I always cry when I’m around you,’ which sounded really terrible. And then she said, ‘No, I just feel really safe and comfortable here.’ I think that’s beneficial—and I think that comes down to my ability, especially in the setting I work in now, to shut up and listen and let patients know it’s okay.”

 

Introducing PROfiles, a series highlighting health and wellness professionals who are making a difference.

Adriaan Louw is a self-described introvert, but you wouldn’t know it by talking to him. That’s because the South Africa native speaks a mile a minute and has made it his life’s work to spread the message about Pain Neuroscience Education (PNE), which he speaks about often and enthusiastically. 

 

Physiotherapy: An Accidental Profession

Dr. Louw’s introduction to his area of specialty was almost as accidental as his introduction to physiotherapy. As an undergraduate student at the University of Stellenbosch in Cape Town, he had a strong interest in medicine and sports but struggled with some of the chemistry classes required for med school. After a school counselor suggested physiotherapy, which Dr. Louw didn’t even know about at the time, he enrolled in a physio class and was immediately hooked by the idea of gaining the skills and knowledge to help people in pain. He completed both his bachelor’s and master’s degrees in physiotherapy before beginning his career in a hospital outpatient department in Cape Town. 
 
After practicing traditional physiotherapy for many years, Dr. Louw was introduced to PNE when his manual therapy skills didn’t seem to do enough for some of his patients. “Manual therapy is nice because you can often see the result immediately, but the reason I got interested in pain neuroscience is because manual therapy is limited when it comes to treating people with chronic pain,” he says. “I had been practicing for a long time, so people started sending me the more difficult patients and I got to a point where I felt like, ‘I don’t know what to do with them anymore.’ I needed a new paradigm, I needed a new way of helping people,” he says. 
 
This roadblock led him to other notable physiotherapists and leaders in the pain science movement: Dr. David Butler and Dr. Lorimer Moseley. “These guys were super nice to me,” says Dr. Louw. “And I worked with them for many, many years on the whole pain science movement before we started doing more of our own work individually.” In addition to becoming a mentor and friend, Dr. Butler encouraged him to enroll in a PhD program in therapeutic neuroscience education and spinal disorders, which Dr. Louw completed in 2014. 

 

Pain Neuroscience Education—A New Way of Thinking 

The PhD program at the University of Stellenbosch solidified Dr. Louw’s belief in the PNE movement which is contrary to the common way of thinking about pain. “The old-school thought was we always tied injury to pain. If you have an injury, you’re going to hurt. I mean, if you hurt you must have an injury,” says Dr. Louw.  “And we now know that 30% of people experience pain with no injury. There are emotional times in our lives when our nervous system will protect us by producing pain, for example. So, we've taken on the concept that we separate the health of our tissues from the experience of pain.”
 
“It’s just the concept that we’re treating human beings, we’re not treating a joint or a muscle,” Dr. Louw added. “You know we always say, ‘Every joint has a brain. Every joint has a family.’ In the past I treated the joint—all I cared about was this joint in front of me. But we forget that that joint has a person attached to it—that there’s a human being we’re treating and we’re so into the joint or the muscle, we forget about the person. And what pain science has done for me, is it’s humanized the pain experience. It’s a human being here that we have to help,” says Dr. Louw. 

 

Sharing his Knowledge Through Books 

Dr. Louw’s research resulted in his first book, Your Nerves are Having Back Surgery, which he wrote as a pre-operative pain program for individuals preparing for spinal surgery. The publication of that book resulted in letters from people requesting a book for those who weren’t preparing for surgery, which led to the publication of the book Why Do I Hurt?. This resulted in requests for more books that addressed other types of pain. Dr. Louw feels the success of the series—which now includes twelve patient books, as well as a clinical text and teaching system—is because the books are short, inexpensive, and provide a quick route to understanding and treating pain. “I think we also found a nice voice for clinicians who were looking for the right words to use with patients in the clinic,” he says. 
 
In addition to writing books and research papers, Dr. Louw travels all over the world teaching classes and speaking at conferences. He’s also building post-graduate programs in pain science and working with a lot of students. He and his wife, Colleen Louw, who is also a physical therapist, own the Ortho Spine and Pain Clinic in Story City, Iowa, where they provide PT services to members of the community.

Adriaan Louw teaches a class about pain neuroscience.

A Movement with a Message 

Dr. Louw’s goal as a physical therapist is to make the world a better place by teaching people who are in pain about their pain. “When I work in the clinic, I may see 15 patients; I can impact 15 people that day,” he says. “But through my teaching, writing and speaking in front of thousands of people—maybe I can be part of a movement that can mobilize to take this message out to more people. That’s probably the biggest thing we’re doing: can we get the next generation trained to train the next generation about PNE, and help more people who are hurting?”  
 
“Therapists and healthcare providers can get down really quickly,” Dr. Louw says.  “You know, there’s the opioid epidemic, and people are struggling—the doctors are getting frustrated—there’s a lot of negative out there. But when I do commencement speeches, I tell students all the time, ‘The future looks bright. There’s a lot of good happening in this world. I know we’re faced with some serious challenges right now, but there’s so much good happening and we’ve got an incredible opportunity to make this world a better place, including for people in pain.’” 
 
Fortunately, this self-described introvert who discovered physiotherapy by accident has found his voice and is willing to use it, because the pain epidemic is a global challenge and his message could help some of the millions of people who are affected by it.