2012 in review

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 2,800 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 5 years to get that many views.

Click here to see the complete report.

A quick survey!

I am interested in how people decide where to go for their physical therapy. Let us know how you pick your provider and watch the results.  Should be interesting.  Knowing this information will help Custom Physical Therapy’s efforts to provide better services to our patients.  Thanks for your efforts.

Shoulder Instability – Part 2 of Shoulder Series.

We see many patients with shoulder instability thanks to either genetics giving them ligamentous laxity (you can’t pick your parents) or due to trauma causing a subluxation or dislocation (You have to live life!).

What is shoulder instability?

Recall the last post in which I described the bony structure of the shoulder as a basketball on a tea cup saucer – built for mobility. In an effort to keep the basketball centered in the tea cup saucer you have the rotator cuff muscles (“SITS” – Supraspinatus, Infraspinatus, Teres Minor, Subscapularis) functioning to control the biomechanics of the glenohumeral joint. The long head of the biceps muscle runs over the top of the humeral head (the ball) and attaches at the 12 o’clock position on the glenoid fossa (the socket). In addition, there are very strong ligaments within the joint capsule. This joint capsule surrounds the ball and socket like a rubber boot that encases the springs of a car – the entire joint is within the capsule. The ligaments within the capsule are the superior, middle and inferior glenohumeral ligaments. Then we have the labrum, a triangular shaped ring of cartilage around the glenoid fossa (the socket). It deepens the socket.

Such an incredible structure must have specific functions. Broadly categorized they are:

1. Create static stability – this is done by the ligaments, the capsule, the bony/labral structure.

2. Create dynamic stability – done by the rotator cuff and the long head of the biceps muscle.

Shoulder instability occurs when either static or dynamic stability is constrained. Let us look at two broad categories of shoulder instability:

1. Atraumatic Instability – failure of the static and dynamic stabilizing forces due to genetic ligamentous laxity and/or rotator cuff malfunction (weakness, poor proprioception). You may be aware of someone who does that age-old party trick of subluxating (partially dislocating and relocating) his/her humeral head inferiorly (downward) under his/her own muscle power. This creates a sulcus sign – a divot beneath the acromion (recall from the previous post?) as the humeral head drops downward. Why? The above listed static restraints are looser than normal and hence there is more movement in the joint.

2. Traumatic Instability – need I say this one really hurts!? If there is a blow to the proximal humerus (upper arm) forcing the arm into combined extension (backwards), abduction (away from the body) and external rotation (hand rotated outwards) there may be an anterior dislocation. The humeral head pops out of the glenoid fossa to the front. If there is axial loading of the humerus (a force directed upward from the elbow to the shoulder like falling forwards onto your outstretched hand with elbows locked or falling onto your elbows) while the humerus is adducted (across your body) and internally rotated (hand turned inwards), the shoulder will dislocate posteriorly (backwards). Very rarely is there an inferior dislocation and even less so a superior one – we will not cover these in this post.

What does physical therapy do for a patient with either an atraumatic or a traumatic dislocation?

1. Atraumatic dislocation: The primary goal in physical therapy is to maximize the rotator cuff function so that the dynamic stabilizers can compensate for the failed static stabilizers. Yes, this means improving the rotator cuff strength. This is, however, not enough. The rotator cuff muscles must work in concert with each other and with the primary (larger and stronger) muscles which move the shoulder e.g. deltoid, pectoralis major. Rhythmic stabilization exercises are done to train the rotator cuff to keep the humeral head centered in the glenoid fossa while performing a variety of both static and dynamic tasks in the clinic. The rotator cuff muscles must contract together to compress the humeral head into the glenoid fossa thus creating a secure scapulohumeral connection (recall last post?). They must also be able to contract selectively to resist the forces created by the primary movers of the shoulder so that the humeral head does not move off center too much. If it does move off center the shoulder could subluxate, dislocate or simply impinge tendons on the acromion thus causing pain and dysfunction.

2. Traumatic dislocation: The primary goal after a traumatic dislocation is to avoid surgical stabilization. However, this mechanism of injury frequently requires surgery due to damage to stabilizing structures. However, a well constructed rehabilitation program can prove beneficial in avoiding surgery or, at least, can maximize the range of motion and rotator cuff strength preoperatively which, in my experience, results in a significantly better outcome following surgery. The physical therapist will help the patient regain normal range of motion and strength while protecting any traumatized (torn?)(unstable!) structures. Techniques used by the therapist will be joint and soft tissue mobilization to improve the accessory motions of the humeral head within the glenoid fossa, appropriate stretching to regain full range of motion while protecting traumatized structures and then progressive strengthening of the rotator cuff musculature in a selective manner – for example, anterior dislocations need stability anteriorly so more focus will be placed on tightening up and strengthening anterior structures.

In summary:
1. If you need to choose between atraumatic or traumatic shoulder instability I would suggest the atraumatic variety! This typically responds well to an expertly designed shoulder stabilization program (which you do for the rest of your life!).
2. Traumatic dislocations of the shoulder frequently require surgical intervention.
3. Shoulder joint function is dependent on static and dynamic stability mechanisms functioning in concert.
4. When you go to physical therapy for shoulder instability you should be prepared to work really hard both in the clinic WITH the physical therapist AND at home doing a comprehensive home exercise program specifically designed for your shoulder and your needs.

1. Please forward this on to your friends, family members and co-workers.
2. Call us with any questions you may have regarding this post or stop by one of our clinics to get your questions answered.
3. POST something on this blog. Custom Physical therapy would love to hear from you.


Part 2: The Global Leadership Summit 2011.

Day 2 (see last week’s post for day 1 summary) of the Global Leadership Summit started with 3 incredibly different sessions highlighting 3 individuals who have done great things in their own sphere of influence while facing different obstacles. The message I came away with is this: We all face obstacles every day and it is how we view these challenges that makes us leaders and makes us accomplish great things.
The first speaker was the President and CEO of Compassion International, Dr. Wesley Stafford. Compassion International (www.compassion.com) is an organization that partners with church members all around the world to fight against poverty affecting millions of children around the world.  Children are helped through child sponsorship which allows individuals to link to a specific child in need through the kid’s local church. Their church serves as their safe haven in a very difficult and often dangerous environment.  His take home message:

1. Dedication to a cause, the one thing you find drives you to stay the course, to get up each time you fall down, is not easy and often may involve sacrifice.

Next up was Mama Maggie, the Mother Teresa of Cairo and Nobel Peace Prize nominee. She has spent more than 20 years serving the poorest members of Cairo. She works with kids living and sleeping and eating in trash dumps! She profiled families with nothing, absolutely nothing. Mama Maggie was quiet yet strong. She was the depiction of faith. She is a very strong leader as a consequence. She held the podium with ease in her calmness. Indeed, this is a woman who is the Founder and CEO of Stephen’s Children Ministry. What did I draw from her message?

1. Life can be hard but with faith we can all persevere.
2. The world around us needs people who are willing to give of themselves, to listen to others in need and to care.
3. We don’t choose where we are born but we do choose what we do with our lives.
4. Her guiding thought in parting:

“Silence your body to listen to your words.
Silence your tongue to listen to your thoughts.
Silence your thoughts to listen to your heart beating.
Silence your heart to listen to your spirit.
Silence your spirit to listen to His spirit.”

How does this relate to physical therapy? Clinicians need to be compassionate towards their patients. We must listen to them. There is not enough listening and too much “telling” in the healthcare environment these days. Patients must know they are going to get better if they give all they have got to the process. This means we need to have faith in what we do and who we interact with.

Next up was an interview with Michelle Rhea who, at 37 years old, was appointed Chancellor of the Washington D.C. Public School System. She founded StudentsFirst.org, a non-profit organization, with a mission to promote the interests of children in public schools.  Check out her web site: www.studentsFirst.org.  (She served as a consultant to Washoe County School District this past year, if my memory serves me correctly). Here are some of her words of wisdom:

1. You cannot lead if change isn’t happening.
I think this applies to all of us in leadership positions. Our job is to create change and take people through it by addressing their fears.  Physical therapists lead their patients from the challenging position of lacking function due to pain into a new place which frequently requires a change in habits.  It’s our job and we love it.
2. “I’d rather deal with anger then apathy!”
We see a lot of people who the healthcare system has failed. They have seen multiple physicians, had numerous expensive tests done, had various invasive interventions, had physical therapy which did not result in any benefit and are not happy with still being in pain months or even years later.  As with Michelle Rhea, I would rather deal with patients in this situation that have been angered and have taken charge of their care.  As I wrote in the blog posted on 18 July, 2011), patients often recognize that they need to get involved after the healthcare system has failed them.  I suggest you get involved by being educated and asking questions and demanding better care before you get angry.

Dr. Henry Cloud, a clinical psychologist, author and leadership consultant then took us on a journey through the different kinds of employees a leader may need to interact with. The categories may surprise you: The wise, the fool, the evil!

1. The Wise: They respond well to critique and appreciate the feedback which they use to better themselves. Strategies to help the wise? Talk to them, coach them and challenge them.
2. The Fool: They shoot the messenger, don’t own the problem and get angry following critique. Strategies? Get them to come up with their own solution to a problem or behaviour you need corrected within a set timeline. If this does not correct the problem after they have addressed it their way …… see you later.
3. The Evil: These people have organizational destruction in mind. Watch out for lawyers, guns and lots of costs.

Up next was John Dickson, author of the just published book, Humilitas: The Lost Key of Life, Love and Leadership.  He is the Director of the Centre for Public Christianity in Sydney, Australia.  His 5 points on humility seem easy so let’s make you think about your own humility and list them:

1. Humility is common sense.
He stated, what you know and can do is far less than what you don’t know and can do.
2. Humility is beautiful.
Think of a truly humble person and tell me that they are not beautiful. Think about someone who is not humble.
3. Humility is generative.
Truly humble people are in a place of flourishing.
4. Humility is persuasive.
To persuade someone you need to be trusted. To be trusted you must have a character full of humility.
5. Humility is inspiring.
I think of my hero, Nelson Mandela, a truly humble man of immense greatness. What of Mama Maggie!?
How are you doing with humility these days?

Patrick Lencioni, a very dynamic and funny speaker, kept us riveted on “Naked Service.” His book, Getting Naked, must be a very interesting read. Getting naked refers to allowing yourself to feel vulnerable by being who you are. We all have difficulties being ourselves sometimes for some reason and he listed some of them.

1. Fear of rejection.
Be vulnerable and go for it. Tell the truth.
2. Fear of being embarrassed.
“Do not edit yourself to manage your image.” Celebrate your mistakes as you learn from them. Ask lots of questions to gain understanding and hence educate yourself.
3. Fear of feeling inferior.
You must have a genuine desire to serve your clients. Honor your clients work. As a leader, be willing to do some of your employees’ dirty work.
Overall, you cannot enjoy success without the potential for some pain.
Finally, Edwin McManus gave a high energy talk entitled “Chasing Daylight.”  Think about this one.  Why do we wait for someone else to create a better future?  As leaders or, I might add, as members of the human race, we should cultivate human talent.  How can we interact with others to make them better people for no other reason than to help them have a better day?  He said something similar to Cory Booker (see last week’s post).  “There has never been an ordinary child born on this planet, ever! Most of us die ordinary!”


1. Look these speakers up on the internet and buy one of their books. You will not be disappointed.
2. How well do you “play yourself?”
3. How might you be more real to yourself?
4. Are you giving yourself “Naked Service” in your quest for better health, better happiness, a better life?

The 2011 Global Leadership Summit – Wow!

I have just spent 2 days at “The Global Leadership Summit.”  For those who are not familiar with this summit, it is a worldwide leadership summit held in August each year. It is put on by the Willow Creek Community Church based in South Barrington, Illinois (Chicago area) and beamed all over the world via satellite.  The goal is to develop leaders around the world, not just church leaders but all leaders.  That includes business leaders, community leaders, politicians, activists and, don’t forget, all who desire to learn. Yes, that includes all of us as we are all leaders somewhere in our lives each day.  We should all keep learning and have our cage rattled by something or someone.  This was such an event.

Day 1 lead off with Bill Hybels, Founding and Senior Pastor of Willow Creek Community Church, clearly defining strategies for dealing with challenging people. Here are some of his points:

  1. As leaders we must know where we as well as our employees are and indeed where our organization is on the “challenge level.”  Are we under challenged, appropriately challenged or dangerously over challenged.  Under challenged people will be bored and leave.  Appropriately challenged people will do well but will not be functioning at their best (no stress here!), Dangerously over challenged?  That leads to burn out, is unhealthy and unsustainable for any length of time.  The most efficient place to be is just above the appropriately challenged level.  There is some positive stress driving you or the organization to be better and better.  You are constantly pushing the sustainable limits just like an athlete trains their body to get stronger by pushing their physical boundaries.
  2. What plan do you have to deal with challenging people in an organization?  A plan is a must as the “key to the future of an organization is tied to fantastic people.”  Attitude busters must be faced head-on as their damage to the soul of the organization can be catastrophic.  Bad attitude requires a swift response with swift correction by the employee or they must move on.  Under performers should be given a maximum of 3 months to improve with the help of the organization or need to seek success at a more appropriate organization.  If there is no “talent elasticity” (under performers who do not want to stretch themselves) then organizational growth will be limited.
  3. As a leader, are you naming and facing and resolving problems within your organization?  Are you constantly looking at how and why you are doing things?  Every idea has a life cycle from being proposed, to accelerating into being, to really taking off and “booming”, to ….. decelerating as the idea becomes stale.  This ultimately leads to the idea falling precipitously to its death.  Leaders can intervene by spotting the decelerating ideas and reviving them through directed teamwork with members of the organization.
  4. An organization’s core is what drives its focus and hence its success.  Leaders should reexamine their organization’s core beliefs to keep the focus.  Try this:  draw a circle on a blank page.  Now, within the circle, draw and number 5 lines top to bottom.  On each line write one and only one word (not a phrase) that describes your organization’s core.  Ask others to do the same and compare notes.  You will most likely get varied lists and lots of discussion ensuing.
  5. Finally, all leaders should have their bell rung by something or by someone on a regular basis.  This will keep you moving forward, thinking, looking introspectively, learning, and reading, pushing yourself to be better and better at leading.

Next up was Len Schlesinger, President of Babson College and a Harvard Professor in the MBA program.  Wow!  He explained that entrepreneurship is in all of us and does not mean the unrealistic success stories of the likes of Steve Jobs of Apple, Mark Zuckerberg of Facebook and Bill Gates of Microsoft.  All entrepreneurship is, is an ability to act on an idea or plan within your financial limits taking small steps one at a time doing something you really care about.  His points of interest were:

  1. Know what you want.
  2. Act on it – do something!
  3. Work within the means you have.
  4. Be flexible with how you do it.
  5. Bring people with you – you cannot do it alone.

Next up was Cory Booker, mayor of Newark, New Jersey.  Now here is an educated man with passion that drives him and sucks you in.  He was educated at Stanford, was a Rhodes Scholar at Oxford University and attended Yale Law School.  That’s impressive but not what was outstanding about him.  He seems to be a regular guy who has a passion for making a difference.  A positive difference in his city is being made in improved education, reduced crime and more city services.  Here are some of his words of wisdom:

  1. “Stand up for something!”  We all must participate in something bigger than ourselves that will serve others somewhere, somehow.
  2. “Regardless of the storm you must be able to stand up!”  Keep standing up every time you are in a storm, no matter how big the storm appears to be.
  3. “Use your blessings to move forward with fearless hope.”  How hard is this one for us all!? Do you ever forget to count your blessings which typically look at us right in the face every minute of every day!?
  4. “The world you see outside of you is what is inside of you.”  This one is very thought provoking.  It made me look at myself and how I lead, how I react to the environment and how I think on a day-to-day basis.  How about you?
  5. Abraham Lincoln said, “everyone is born an original.”  Cory Booker said, “many of us die copies”.  Be yourself.  Don’t let TV, the news, your work environment or those you interact with everyday sour your outlook.  Be you and be comfortable with that.

Seth Godin then took the podium.  He has written many books on being different, standing out and going the extra mile.  The most notable one I have read: The Purple Cow.  It is an easy read and very thought provoking.  In his talk his points were as follows:

  1. We are living in a “new age of weird, a new age of tribes where people want to be in synch with each other and can be via the internet and all social media.” Tribe members want similar things, hence the formation of the tribe.  What an opportunity!
  2. The age of instant communication at phenomenal volume and speed challenges the old way of doing business.  No longer is it selling masses of average products to average people.  It is selling outstanding services or products to outstanding, discerning and demanding people.
  3. In your business, “build a culture, challenge it (constantly) and be clear where you are going.”  Make constant improvements in an effort to get better and better.  You want your business, your people and yourself to be outstanding because that’s when people talk about you to others.  If you are average they forget about you.  If you are really bad ….. they spread the word on that too.
  4. “Competence is no longer scarce. Competence is no longer sufficient to get a job.”  You must be outstanding.  You need to take risks.
  5. “Risky human acts of doing something you have never done before is what sets you up for success.”  You may fail but if you don’t try, you will never taste success.
  6. “If failure is not an option, then neither is success.”
  7. “Pick yourself!  Don’t wait to be picked!”  In other words, start something!  Don’t wait for someone else to create your success.

Next week I will summarize day 2.  Qhite exhilirating it was.


  1. Where are you on the challenge meter?
  2. What 5 words describe your own personal core?
  3. What is it that you REALLY want to do?  What is your passion?
  4. Describe the world you see.  Now what does that say about you, inside?
  5. What can you do today to be outstanding?
  6. As always, please let me know your thoughts on this post.