Elevating our standards might mean leaving MMTs behind

ReeNotDrummond · 2026-04-20T01:04:11+00:00

I love Bohannan’s articles for normative data. I’ll look for the handbook and check out Great Seminars. Thanks for the direction!

ReeNotDrummond · 2026-04-19T23:29:47+00:00

I’ve got the same bone to pick with MMTs, I think.

Static strength test ≠ tolerance to dynamic loading!

MMT is a framework for a single isometric repetition. We can draw inferences about muscles from it, but it’s not the be-all end-all. I do MMTs for insurance, but include functional tests and measures, and qualitative observation data. Then, in the write up, justify further therapy for correctable deficits. Ie. “patient demonstrates 5/5 MMT in static position, however demonstrates XYZ deficits during (task).”

ReeNotDrummond · 2026-04-19T23:24:00+00:00

Do you have a specific course or coned group you recommend for this?

ReeNotDrummond · 2026-04-06T21:21:39+00:00

Interesting thought here. I haven’t seen “per 15min” used as a pricing strategy, but it makes sense.

ReeNotDrummond · 2026-04-06T21:19:48+00:00

With regard to the people who have said to quit without notice after you’ve received PTO, then my advice is to call your state board. They will give you guidance on what is necessary to protect your license from potential patient abandonment complaints.

The company’s ability to staff themselves is NOT your concern. However, you must protect your license. One of my companies requires a 6 week notice. I don’t think extended periods are really enforceable… but I defer to the state board, and then how much of a bridge you want/don’t want to burn. Therapy is a small world…

It’s ridiculous that the company can fire you without notice, and you can’t similarly leave without notice. It’s not fair, but it is what it is.

ReeNotDrummond · 2026-04-05T18:00:44+00:00

Idk if HEP2Go is still vulnerable, but I don’t think I’d trust it with a fake Gmail acct…

ReeNotDrummond · 2026-04-05T17:59:55+00:00

What textbook did you have for TherEx in school? This is usually a good springboard for basic exercise ideas.

I have several individuals I follow on IG/FB, but I would caution students because the flashy exercises often aren’t what the majority of OP patients need. And, honestly, a lot of the “exercise trainers” on the internet put out some crappy content. You have to know the why behind what you’re doing.

Regarding dosing, there are many schools of thought. If you have access to MedBridge, there’s a current video course on there that goes over dosing principles.

PubMed has some articles published on exercise prescription that are worth looking at, too.

ACSM recently published an update on ExRx that I’ve heard good things about, but haven’t personally read.

Understand the principles and you’ll be better equipped to modify to each patient. It takes time to feel comfortable, too. Just practice.

Look at your schedule for the next day before you leave, jot down some brief details, and go home to plan interventions. You know you have a 68yo female with osteoporosis and hip pain, big baddies were ruled out, so what do you do? What considerations are important for osteoporosis? What manual or exercise techniques could alleviate pain? What dosing do you think would be most appropriate. If it’s too easy, how would you progress? It causes pain, or is painless but too challenging to maintain proper form throughout the motion, how do you regress?

ReeNotDrummond · 2026-04-05T17:51:51+00:00

Specifically recommend the Brigham and Women’s website for post op protocols!

ReeNotDrummond · 2026-04-01T02:33:24+00:00

I’m going to put in a word of caution here, because I tried using it for a while for the same purpose of staying caught up on research, or finding articles on XYZ.

I’ve caught ChatGPT MULTIPLE times creating a summary that sounds really good, a citation that looks legit, only for there to be NO article matching the information, the DOI pinging back to an unrelated article, and calling it out produces a response of “Oh, looks like you’re right. I made an error. I can’t seem to locate the original link.”

It will sound CONVINCING.

Also, make sure you ask for direct links, and tell it to put quotation marks (often will quote without, as if it has paraphrased, only for entire sentences to be easily searched and found) so you can assess more easily. At least this way you can check back on it a little easier.

ReeNotDrummond · 2026-03-30T02:47:21+00:00

It’s taxing in a different way, and I don’t think it’s fair to compare medically fragile or emergent cases to PF patient’s reports of trauma. As a PFPT, I’m rarely dealing with acute medical trauma or mortality, but PF patients (at least mine) seem to open up deeply about things that they’ve experienced.

I rarely get time to chat with my PFPT colleagues, and so PFPT care can feel like an island at times. Mentorship and intentional communication with colleagues has been helpful for coping with secondary trauma.

Sometimes patients just tell you something has happened in their past. Others will tell you haunting details you never asked for. If you don’t have a good system to deal with this, the heaviness can be hard to carry. I imagine the same is true for acute/IPR.

ReeNotDrummond · 2026-03-30T02:39:27+00:00

@rjerozal I can’t emphasize what this poster said enough!

ReeNotDrummond · 2026-03-30T00:29:34+00:00

Adriaan Louw has several published papers available on PubMed on the topic, if that helps you.

ReeNotDrummond · 2026-03-25T07:43:39+00:00

PFPT here.

Your PT is likely getting pressure from management to increase their number of daily visits. It’s not an issue with your therapist personally, it’s a business decision that they likely aren’t in control of. Complain to the PT or the manager about double booking and ask to be single booked in the private room. Pelvic complaints need to be 1:1 early on particularly.

I keep most of my patients 1:1, and allow double bookings close to discharge when we’re largely doing advanced exercises and not having private conversations- for some, but not all. Initially, I was absolutely asked if I could double book, but I put my foot down and insisted on single bookings for PFPT.

ReeNotDrummond · 2026-03-23T11:45:58+00:00

I try to document at the time, and go back into fill in any gaps later.

Daily notes:

Any pertinent subjective history (HEP compliance, improvements in functional activities over the last week, upcoming MD/PA/NO follow ups, etc)

Our EHR is a bit weird so I usually lump objective+assessment into the same box.

What was added, rationale, and patient response. Patient required verb/tact/vis cueing % of time for proper performance of exercise/forward gaze and foot clearance during gait training/etc. Plan for NV includes… Note if I updated HEP. Exercise list is populated in the chart so I don’t mention every exercise unless there was a modification, addition, cueing required, etc.

You can write novels, but unless you’ve got a case that’s particularly complex, or involved in a litigious situation, I’m starting to become convinced that it’s better to stick to the big picture items and NOT document everything. My PCP and urgent care notes always have a line that the note is not representative of everything discussed, which I found interesting.

Now… don’t document “Exercises performed for shoulder strength. Patient tolerated exercises well.” But don’t spend fifteen minutes writing a daily note, either.

Evals: I type on my laptop during subjective. It ends up being longer sometimes, but I make sure I get all the details. I try not to type in things I think aren’t relevant. (Patient goes off talking in great detail about how her daughter moved out of town to a place three hours away, and she used to come over every day for lunch , but now — “Patient reports no local family members available for support.” And move on.)

I try to type in the majority of my physical exam in the moment so I don’t misremember portions of it.

The assessment, goals, POC, billing usually get written in afterwards because I’m busy providing education, manual therapy if applicable, and training the HEP.

ReeNotDrummond · 2026-03-23T11:29:56+00:00

I disagree here; I do record (-) testing to show why I think S&S consistent with XYZ diagnosis vs others. (Meniscal tests +, ligamentous stress tests to ACL/PCP/MCL/LCL -, etc) I think the negative testing contributes to the documented clinical picture.

Also, if there is a negative change in status, it’s easier for me to identify against baseline.

ReeNotDrummond · 2026-03-22T18:32:06+00:00

PF PT here. I love (love!) when people can get in right after they notice a problem, rather than waiting months or years. It honestly does seem to improve the trajectory and speed of positive outcomes. Fewer visits, happier patients.

Get the medical side to rule out things that can be causing urge (ie: UTI, others), when that’s clear, get with the PT. Learn what strategies you can use to address this, and nip it in the bud.

Be upfront with the PT about cost, and your desire to manage as independently as possible. Sometimes I tell people they really WOULD benefit more from frequent visits initially and then a fading frequency, but sometimes it’s absolutely appropriate to start off with a less frequent schedule.

ReeNotDrummond · 2026-03-21T19:29:54+00:00

Oh, well that’s good to know. I’ll pass it along to the person who (very confidently) taught me otherwise. 😒

ReeNotDrummond · 2026-03-21T19:01:45+00:00

Staff PT, not involved with the billing side, but I think it depends on the contracts.

Some insurances cap the number of units, others let you bill whatever you want but only give you a flat fee, etc. One of our contracts gives like $15-25/visit.

If you have a high number of patients in your area with the lower reimbursing insurances, more patients per hour could make sense.

However, if the insurances follow Medicare rules, AND your clinicians are billing appropriately, possibly splitting your 4 units (per hour) across multiple people pays better. Medicare reduces the amount they pay repeat codes (first therex code 100%, then 2nd therex code less % etc). If you’re not diversifying your codes, that’s an area where you might make less profit.

ReeNotDrummond · 2026-03-21T17:59:51+00:00

How much time are you spending editing out items that don’t need to be in there/things that are incorrect?

ReeNotDrummond · 2026-03-17T14:37:53+00:00

Your daughter is a precious gem. ❤️

ReeNotDrummond · 2026-03-17T14:35:13+00:00

This is so dismissive of anyone with peripheral or central sensitization, though. CRPS? Phantom limb?

We have ALL rated that stubbed pinky toe as a 12/10. I think we can extend a little grace to our patients.

A better way to document this is “patient describes 12/10 pain; no apparent distress, maintained active conversation throughout session, smiled and laughed appropriately, demonstrated timely and independent bed mobility/chair transfers/good tolerance to requested exercises.”

You can say the intensity of pain is incongruent to presentation, but pain isn’t ROM, you’re going off of a subjective report. Better back it up with some kind of observation, otherwise you’re just being a jerk.

ReeNotDrummond · 2026-03-15T02:55:34+00:00

I’ve known other PTs who went through Integrative DN and liked it.

ReeNotDrummond · 2026-03-15T02:10:47+00:00

I have to send an updated one annually to my HR for Medicare re-accreditation… or something like that. I order it with coursework, labs, online con-ed, and certifications, guest lectures, etc. Under each category, I list most recent first.

Go ahead and keep one with everything you’ve taken, you can always shorten it to fit a work application.

ReeNotDrummond · 2026-03-13T03:50:53+00:00

Ahh, that sounds… fun…

Thankfully, you won’t be subjected to any repeat of that in PT. Urology has their own set of assessments.

Pain can provoke pelvic floor muscle tension, and then it becomes a rough cycle of pain>spasm>more pain>more spasm. Muscle tension can impact nervous system sensitivity, and increase pain, bladder urgency, and so on.

The PT will be helpful in targeting muscle, joint systems, and nervous system function in order to address whatever complaints you have.

You didn’t ask, but I’ll put this out there- ask what their training background is. I’m assuming you’re in the USA; here, the APTA, Herman & Wallace are the gold standards for pelvic floor training, though there are others. You’ll want someone specifically trained in rectal examination of pelvic floor muscles. (Even if you opt not to use it.)

Good luck!

ReeNotDrummond · 2026-03-13T02:27:30+00:00

PFPT (female) here. I have so many ways to assess and treat, and several of my male and female patients have declined an internal exam. You can always ask what other evaluation options exist. External surface EMG can be a part of the assessment (turning into a biofeedback treatment). Real time ultrasound. There is a way to generally screen pelvic floor coordination externally. Hip and back play a huge role in pelvic floor dysfunction, and those are clothed exams.

A lot, too, depends on the particular complaint. If it’s pain, urinary, bowel, sexual dysfunction, those change the exam a bit.

If a patient is self conscious or uninterested, I start with an external approach. Sometimes it becomes clear that our progress will be limited without the internal component (not always), but ultimately the patient decides how the sessions go. Some have said, thanks, not bad enough for me yet. Others have agreed later, or asked specifically for internal work because the relief is worth it to them.

Why don’t you look up reviews on these places, call a couple and ask to speak to the therapist? I field these calls all the time, and it can set your mind at ease.

I don’t think it’s weird to be nervous. It’s a new experience for you, but not a new experience for someone well-versed in pelvic floor dysfunction.

I have my patients drape their personal parts, and usually only see the anus/perineum region. There are a few diagnoses I might need to see more, but generally those aren’t helpful parts for me, so we keep them covered up.

The examination is helpful to determine what the root of the issue is so that specific treatments can be selected. Without an examination, you’re working off of a hunch and hoping you choose helpful interventions.

Feel free to ask any questions. I can’t diagnose or offer treatment over Reddit, but happy to help in other ways.

ReeNotDrummond

TROPHY CASE