Quiz time.  This device is:

A) An alternative to a life jacket which guarantees the wearer will not drown by keeper their head above water

B) A more accurate blood pressure machine which measures the carotid artery

C) A more pain-free method to beauty in some African cultures

D) A cervical traction device that claims to relax tight muscles, and relieves joint and nerve pressure

E) I bet Bridget is awesome at the game Balderdash

And the correct answer…… D! It’s a neck traction device sold from the website Taylor gifts.  (And E, I am really good at Balderdash).
The website states: “Say goodbye to neck pain by releasing neck pressure caused by pinched nerves, tension headaches, and osteoarthritis. Wrap the comfortable inflatable cushioning around your neck and inflate or deflate to the desired pressure with the attached easy to use hand pump. The stretching action gently relaxes tight muscles, and relieves joint and nerve pressure. If you have pre-existing conditions consult a medical professional before using this device.”
Hmmm, this thing’s only pro is it doesn’t look as much like a noose as other home cervical traction devices. (*The bones of the neck are referred to as the cervical spine so the terms neck traction and cervical traction are the same.)

Why do people need cervical traction? Not from having a “heavy head” as geekologie says the device is used for.  Our bodies are fully capable of holding our heads up, thank you very much.  But what about if your head was slouched forward, as so many of us constantly are doing with our poor posture?  Think back to physics…

When the head is held forward it moves the center of mass of the head forward creating a torque.  For those of you who have just said “huh?” the concept of torque is best explained with a hammer.  Why do you hold a hammer at the end of the handle instead of the head of it?  By having a longer lever arm it more effectively uses the force you apply to pull the hammer down to hit the nail.  So, by holding our heads forward we actually cause more strain on our neck than just the weight of our head.  This can cause the muscles in the back of your neck to do more work constantly than if your head was in proper alignment.  These muscles then may feel pain and fatigue from being overused in this way. Also, because some of the muscles attach to the base of the skull, they may be involved in causing cervical headaches and an overall muscle imbalance between the muscles that bend the neck.

Having a forward head posture can even affect the posture of your shoulders, as you can see how many of the muscles are connected to the scapula.  Also, look at this:

Picture this cervical spine with a forward head posture.  Those nerves would get squished wouldn’t they?  This would affect each of those nerves causing pain or numbness and tingling anywhere from your neck to your fingers based on nerve root compression. This is known as cervical radiculopathy.

Also, wouldn’t a forward head posture apply more pressure to the joints of the spine? (That’s the posterior zygopophyseal joint and posterior aspect of the intervertebral disc, for nerds like me).  That is how a forward head posture can cause increased pressure to the discs of the cervical spine which can speed up their degeneration.  Oh and don’t even get me started on what it can do to your jaw (aka TMJ-temporomandibular joint).

You might be asking yourself, “Bridget, I have a forward head posture, what do I do!?!??! Should I get that blue pump thingy??!?!?!”

Cervical traction has been found to be effective in treating symptoms of, pain, limits in range of motion of the neck and of cervical radiculopathy.  People have found relief in using home traction devices as is seen from the comments on this one’s Amazon page.  Several studies for home devices show good results, even one published in the American Journal of Physical Medicine.  However, I am a little hesitant of them because 1) They look like you could hang yourself on it 2) Do these devices come with a protocol on their use?  The AJPM study involved giving each patient a home program and demonstrating it’s use, not people just buying it from a catalog and figuring it out themselves. 3) They are only treating a part of the problem, whether it be by stretching the muscles causing cervical headaches, relieving pressure on the nerves or compression of the vertebrae.  A program solely of this home traction ignores other aspects of the problems like correcting poor posture and stretching to increase range of motion.  For neck pain a physical therapist would look at the whole picture and give exercises to help improve head posture, self stretches to increase range of motion and may look at the problems are affecting the shoulder as well.

Physical therapists use their hands to manually perform cervical traction.  You might be thinking “Woah, how do you do that?” See for yourself:

In my opinion by performing cervical traction manually it more effectively stretches the muscles which may be causing cervical headaches and neckpain and relieves pressure from the cervical spine because the motion is applied to the base of the skull.  Although I have never used a home cervical traction device, it looks to me that the motion is coming through the…. jaw?

Regarding more about physical therapy and neck pain, see these websites like WebMD and Cleveland Clinic.

You’ve heard of video games being used in physical therapy, but what about physical therapy in a video game?  Well ok, it’s only mentioned, but I’ll take what I can get.

My boyfriend is currently playing through the game Mass Effect 2 by BioWare.  It’s a fun, story-driven action role-playing game where you have a spaceship and go to different planets and do cool stuff.  When he showed me the first Mass Effect, I really liked it because it looked great and you can talk to almost everybody in the game.  Instead of a random person sitting at a desk or staring in space, you can have a conversation with that character and get to know them.  Andrew sent me this screen shot from Mass Effect 2:

The text reads: “… moons were the sites of many batarian labor camps during the Anhur rebellions, generating raw materials for the war. When the slaves were finally liberated by Eclipse, the mercenaries found abysmal conditions including whole camps that lacked mass effect fields to keep the gravity at habitable levels. The widespread bone loss among the slaves was part of their master’s final degradation — it would cripple them if they ever left for a standard-gravity world.
The plight of the slaves soon garnered galactic media attention, and several charities sprang up to pay for their physical therapy and find them gainful employment….”

Yay!!! Not only is PT mentioned in a game, but it also emphasizes the importance of bone density.   Bone loss due to uninhabitable gravity levels is not a problem most physical therapists typically face everyday, but bone loss due to osteoporosis and deconditioning is!  The calcium in bone is constantly being broken down and built back up by two different processes moderated by hormones.   Bones adapt to the forces being placed on them. Therefore if a bone is under less force due to immobility or lack of gravity applying forces through the bones this will cause the process of breaking down the bone to speed up more than it is built back up.  This results in a decreased bone density.  (Women are affected more by osteoporosis due the lack of estrogen post-menopause, but all people are affected by age-related demineralization of bone loss which can start in your 30s and increases over time).
The rate at which bone mineral is regained is significantly less than the rate that it is lost (the notes from one of my professors says bone density is lost at 1% per week of bedrest and takes 1 month to regain).  The same principle that bone adapts to the forces placed on it is used to recover lost bone density.  By gradually applying more weight to bone through exercise over time the process of building up the bone is increased.  Don’t forget to take your calcium everybody!

This goes to show why PTs are important in the hospital setting.  After someone has spent weeks in the hospital battling something nasty, their body has undergone deconditioning due to lack of physical activity.  Acute care PTs work to prevent these losses as much as a person can tolerate by keeping them up and active.  After a person has overcome their battle with whatever had them in the hospital so long (pnemonia, infections, organ transplant, all sorts of things), they need PT to help overcome the next battle of deconditioning.  The lack of physical activity not only affects bones, but muscle, joints and puts people at a greater risk of certain heart and lung problems.  PT is necessary to help each person fully recover to who they were before they came to the hospital.

I think the PTs in Mass Effect probably started by using a tilt table to help the former slaves’ bones gradually become strong enough to hold the weight of their own body.  They probably progressed to a gentle walking program and may have built up to some strength training to prepare them for their gainful employment.

Thank you BioWare for sharing the wonders of physical therapy with the world!  Since BioWare was founded by two doctors maybe they would be open to my game idea for a physical therapy video game, right?

Know someone with osteoporosis?  Exercise can be a great treatment.  Not all exercise is appropriate, especially since their bones are already prone to fracturing.  WebMD has a good page on which types of exercise are most helpful.  A physical therapist can help guide appropriate exercise to recover bone loss and improve all over function.

I didn’t want this to be my first official post, but realizing the 2-year anniversary of my Emory DPT interview is coming up, I thought this might be of help to some of the people going through that now.  My next post will be something more fun!

Physical therapy is a great career, but navigating the world of PT school admissions can be kind of rough. I hope these tips help!  Feel free to share your experiences or ask any questions! I’m no expert on getting into grad schools, but I can talk from my own experiences.

What major to have: My major was biology, but most people in my class have health/exercise science related degrees.  In any PT program there are a few people with really different backgrounds, for example one of my professors was a theatre major and is a great PT. I honestly think schools like having people from diverse backgrounds.  Whatever your background is, it will contribute to you being a better PT in some way.  Have a business degree?  You are off to a great start and will be the envy of all your friends in any management course.  Psychology/sociology?  You will have a better understanding of motivation and the teaching-learning process for each patient.  I really can’t think of a major that wouldn’t be good for PT, as long as you complete all of your prerequisites.  Coming from a non-health background just means you’ll have a little more catching up to do in some ways compared to your peers.  Just be prepared for that. However, you might be ahead of them in others, for example I barely needed to study for our genetics course compared to other classmates.

What classes to take: A problem with PT schools is that they all have different course requirements, although they all are similar.  Pick your top 3 schools and be sure to take their class requirements.  Contact the program if you have any questions about if a certain course will count before you take it.  Still apply to schools you don’t have all the classes for though, but you won’t have as good a chance of getting into those schools as ones you have the requirements for.

Grades/ GRE scores: I think a lot of people stress out about this, but I feel like grades are not the key deciding factor in admissions.  Most places look at the whole person, not just grades.  I feel it is more to see how well a person will do in grad school.  If someone struggled with grades in undergrad, PT school is A LOT harder, so they want to pick people who will do well in the program.  In Emory’s DPT program grades below 80% are failing (if I got a 79 on a test, that means I failed it). Bottom line: grades are important, but not life or death.

PT Observation Experience: All schools require a certain number of observation hours of a PT. I highly, highly recommend you split them up between at least 3 different physical therapy places, preferably in different settings.  Some schools might not care, but it will help a lot if you have a diverse experience before you come to school.  Each PT and clinic is different and does things differently.  There is no one way to do things.  If you get all of your hours at one place, you might get that impression.

Regarding different settings, observe in at least an outpatient orthopedic clinic and a hospital setting, maybe a nursing home too.  This varied experience will mean a lot more to you in the end believe me.  Also, it will give you more options for getting letters of recommendation from a PT and open you up to the diversity of the field.

Since everyone is busy, how do you make time for observation hours?  A lot of hospitals have PT on the weekends, so that is good.  Also, if you don’t take classes in the summer, that is a great time. If you are busy during the day, many outpatient orthopedic places are open late to accommodate patient work schedules.  I was able to get 40+ hours and have it count for course credit as my biology internship.  Maybe your school has independent study as well that you could do in a PT clinic.  A lot of people in my class worked at PT clinics, which really brought them ahead.  I tried and tried to find work in a PT clinic and could never find an open job as an aide or a tech.  But, it’s worth trying.

Letters of Recommendation: Make sure they are from people who know you well and have good things to say about you.  Get to know some faculty at your school well.  Taking on a research project or independent study in undergrad is a great way to do this, a good experience and a serious plus on an application.  Also, ask them for the letter way before you need it.  PT’s and professors are busy people.  You don’t want to miss a deadline because you are waiting on a letter of recommendation.

Paperwork/deadlines: Get everything together and send it in as early as possible, really! The earlier you get it in, the better.  I turned in my application for Emory in December, when it was due.  It turns out some people had already interviewed and been accepted by then!  You only hurt yourself by waiting.

The interview: Not all schools require it, but congratulations if you get one! Most schools interview way more people than they have spots for though.  In my opinion the key to the interview is to be yourself and be confident.  Practice with a family member, friend or record yourself in a mock interview so you feel more prepared for questions.  Some of the questions I remember (I’m a little rusty, it was 2 years ago) were

- “Why do you want to come to (insert school here)”

- “Why do you want to be a physical therapist?”

- “Describe a good experience and a bad experience you had during your observation hours”

- “Describe yourself in 3 words”

- “What makes you a good candidate for physical therapy school”

- “What are your plans if you don’t get into any PT schools?”

That’s all I can remember for now.  A lot of schools have group interviews, with 2-3 students at a time which has its pros and cons.  A definite pro is that while another student is answering it gives you time to think about your response.  A con is that they might say something really good that you were going to say and “ditto” is not a good answer.  Plus, it can be a little intimidating if there are multiple professors interviewing you, but that means you have multiple people evaluating you, instead of one person’s opinion.

It’s a good idea to research the school and find out their specialty and what makes them different from other schools. You can weave this into your answers if possible.  For instance, Emory’s DPT program has an emphasis on research, so it’s a plus to mention your interest in research during the interview if appropriate, and if you actually have an interest in research. Don’t lie or say things just because they will help you get in if they aren’t true.

An important part of the interview is not just what they think of you, but what you think of the school.  One school I interviewed at was my top choice before I saw the campus and realized it wasn’t a good fit for me.  Take the time to ask current students and faculty questions, they want to be of help to you!  Make friends with the other applicants too, you might be seeing them again soon!

My mom and stepdad came to my interview days, as did other parents.  If your information says it’s ok to bring family and they want to come, go ahead and make a trip of it.  I’d say less than 25% of people had anyone with them though, but I felt ok about it.  They liked seeing the campus and I appreciated their input on the schools.  They also helped me feel supported and a little less nervous.

What to wear: Dress professionally and wear comfortable shoes.  Most interview days involve a tour of the campus.  For some reason, most people wear black suits for their interviews.  When I see a group of students on a tour, it looks like a funeral.  If you like to go with the flow, than a black suit will be great.  If you are like me and like to stand out just a little, try a suit in neutral, brown, gray, beige or navy blue.

A note on non-traditional students: I’ve read where a lot of people are coming back to school after years of working and thinking about PT.  I think schools love non-traditional students and your years of experience will be appreciated as input in class discussions. Most physical therapy students are younger, in their 20’s, but will look up to you for sure.

Hope this helps!