I’m wondering if how I set up my current calendar of appointments and assessments is efficient. Right now, the patient has to book an assessment first (30min) so I can get an idea of what’s going on. Then they book a classic appointment (60min) where we actually do the rehab and treatment. Any thoughts on how to do this better? I am open to all suggestions.

If you could change something that would make you like your job more, what would it be? It can’t be money or time off.

Hey everyone, I’m currently in my first year working in the industrial setting for Amazon. I’m limited to “first aid” treatment (ice, heat, non rigid support, massage). I’m coming from 4 years of working in the secondary school setting, so the transition has been interesting. I was treating a package handler with lateral wrist/thumb pain, could classify as De Quervain's. Pain started at an 8/10 on day 1. Pain reproduced with thumb flexion, radial deviation, supination, wrist flexion, resisted thumb extension. She was limited to ~ 60* wrist flexion (posterior wrist tension). Treatment included STM/TPR of the thenar eminence and posterior/lateral forearm, muscle activation techniques targeted to the wrist and thumb extensors and opponents pollicis. Wrist flexion improved to 80-90*. Pain decreased to 1/10 - she described it more as irritation. She ultimately elected to see a physician since she remained in a 1-5/10 pain cycle depending on her work duties for the day. I feel that if I was free to prescribe exercises, her symptoms would’ve resolved with progressive loading of the wrist and thumb extensors. Are there any other manual therapy techniques that others would have tried? Other assessments that I missed.

Hey guys! Want the group calls to be a huge value add to the group, even if they aren't attended by all! My hope is even if we get a couple people on, to record those and allow that to be a "podcast" we all can have to listen to! With the calls being so low attended recently, just wanted to ask What would you guys want to make them more used? Is it the timing, the content? I feel like the chat is great, but we can grow even more together in real time, or at least with audio listened to later! Any ideas guys?? Just want to make this a huge win for everyone!!

Need some clinical brains on this one. I'm working with a volleyball athlete with a 2-year history of anterior shoulder pain that has consistently been diagnosed as long head biceps tendinopathy. About 6 months ago, she underwent a 7–11 o'clock SLAP/labral repair with four anchors. Three weeks after surgery, she told me the surgery hadn't changed her pain at all—it was still in the exact same spot over the long head of the biceps. She's now seen 7 different doctors, had 4 MRIs, and none of them have provided a conclusive answer. On evaluation, she had: • 7/10 pain at 90° of glenohumeral external rotation over the long head of the biceps tendon. • Significant tenderness to palpation over the biceps tendon and throughout the anterior deltoid. • Pain reproduced with shoulder flexion, shoulder extension, resisted glenohumeral internal rotation, passive shoulder extension, and resisted elbow flexion. Treatment included soft tissue work to the anterior deltoid, biceps, pec minor, subscapularis, supraspinatus, infraspinatus, teres group, and latissimus dorsi. We also performed sternoclavicular joint mobilizations, glenohumeral joint mobilizations, thoracic mobilizations to improve extension, and corrected a right hip hike of approximately 2 inches. Immediately afterward, her glenohumeral external rotation improved to 125°, and her pain dropped from 7/10 to 4/10. The fact that the pain changed immediately makes me think there's still a modifiable mechanical component, but I'm curious how others would approach this. If this patient walked into your clinic tomorrow, what would be your next assessment or intervention? What do you think we're potentially missing?