St. Lukes Elks Rehab Blog

The growth of St. Luke’s-Elks Rehab is creating some great opportunities for experienced and new physical therapists alike. We currently have these PT positions open:

-Clinic Manager – looking for someone with excellent orthopedic skills who is excited to get out in the community where our new Hailey clinic is located.  The clinic is in a beautiful setting and a perfect home for those who love the outdoors!

-Staff PT- will work alongside the manager at our new Hailey clinic treating weekend warriors, school athletes, post-op, etc.

-Clinic Manager – We’ve got a fantastic new outpatient clinic on the East side of Twin Falls. OCS would be a bonus! This fine new facility is conveniently located in the same building as several physician offices!

-Staff PT – We’ve recently acquired an outpatient clinic in Ontario–and need a new PT or PTA. It’s a great hub city for the farm communities along the Snake River. Great place to get a diverse case load under the mentorship of our very experienced and talented clinic director.

-Sports Resident PT – that’s right, St. Luke’s-Elks Rehab has a Sports Residency program in conjunction with the APTA. You would work in our clinics and with orthopedic surgeons. Then in your ’spare’ time conduct research through the Boise State Bio-Mechanics Lab. Come out ready to sit for your SCS exam!

-Travel and PRN PT- and of course, we’re always placing PT’s for permanent or PRN positions in the region through Elks Healthcare Staffing.

I am happy to speak with you by telephone or email ‘almost’ anytime. I can tell you more about the locations, type of work, and all the great advantages of working in the Elks Rehab System!  Just remember: we’re the “Dedicated Rehab Experts”!!!

Claudia Weathermon Tester

cweathermon@elksrehab.org

208-407-1138

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During this in-service we will discuss what Sensory Integration is, how and why it is used, and how it can be functionally used in the home and school environments.  We will learn through lecture, open discussion, and hands on application. 

When: Thursday, February 4th

Where: St. Luke’s Meridian, lower level conference rooms

Registration Deadline: Friday, January 29th

*limited childcare is provided

Call Jasmynn @ 489-5880 to Sign-up!

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2010 promises to be another year of growth and opportunity with St. Luke’s-Elks Rehab. We continue in our mission to be the “Dedicated Rehab Experts.”  With the goal of serving as many people as possible, we’ve recently opened a new outpatient clinic in Hailey to reach more patients. We now have a total of 25 outpatient clinics from South Central Idaho to Eastern Oregon. It’s my personal mission to make sure we hire the best clinicians to meet the needs of every community we serve.

Some wonderful new additions include Matt Jaksetic, a Certified Athletic Trainer. When not helping treat and greet patients in our Hailey clinic, he’s reaching out to local schools and sports clubs to see how St. Luke’s-Elks Rehab can join their team to educate about injury prevention and more.

Cynthia Talbot, Speech-Language Pathologist, is another great new team member. She’s a creative and fun therapist who puts her skills to work in two very different clinics. At St. Luke’s-Elks Children’s Rehab in Nampa, she’s helping children overcome speech and language difficulties. Cynthia believes dealing with the rare medical condition of her own daughter allows her to have a special heart for the challenges kids and their families may face. But Cynthia is also very gifted treating adults with neurological conditions like stroke or Parkinson’s disease. Working in a system like St. Luke’s-Elks allows her to build and practice her skills in both areas.

If you’re a Physical or Occupational Therapist, or a Speech Language Pathologist interested in getting the best results for your patients, and want to do your work in a professional friendly and supportive environment–I encourage you to learn more about St. Luke’s-Elks Rehab. This web site is a great resource. I’d be happy to personally answer any additional questions you may have.

Our needs are constantly changing–so whether or not we have a current opening that might suit you, I’d love to talk about your skills and goals as a therapist. I keep track of good people! Here’s a sample of openings as of this writing:

-Regional travel OT

-PT, Clinic Manager

-Pediatric OT

-OT, outpatient (2)

-Physical Therapy Assistant

-Regional travel PT, (could be permanent)

-Licensed Clinic Social Worker, pediatric rehab (2)

Claudia Weathermon Tester

Recruiting Manager

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So you have a disc bulge in your back…

What does this mean?

Let’s go through some anatomy first. Your spine is comprised of a few different levels to include the Cervical (neck), Thoracic (mid back), Lumbar (low back) and Sacral (pelvic/tailbone).

We will concentrate on the Lumbar, or low back area, in this particular blog.

There are five segments, or levels, that make up the Lumbar spine. From the top down, they are numbered 1 – 5. Each spinal segment is comprised of a vertebral body with a corresponding disc in between those two vertebrae. Exiting off of the spinal cord at each level will be a pair of nerve roots which eventually form the nerves that innervate the muscles of your lower body. The openings that these nerves pass through as they exit from the spine are called the foramen. There is a foramen on each side and at each level of the spine.

The disc is comprised of an outer area called the annulus. The annulus consists of several concentric rings of fibrocartilage that encompasses the inner portion called the nucleus pulposa. The disc essentially acts as a shock absorber for the spine.

By definition the following diagnoses are the most involved progression of discal pathology. (See diagrams below for anatomy)

-         Bulging Disc:  A disc that extends out past its normal position. On an MRI these often look like a tire that is going flat.

-         Disc Herniation / Protrusion: The inner portion of the disc (nucleus) is pushing out through the outer layers, but is still retained to within the disc. These often look like a bubble sticking out from the disc.

-         Disc Extrusion / Prolapse: A progression of the previous Disc Herniation / Protrusion where the inner disc material (nucleus) actually physically exits through the outer rings of the disc almost as if it was squirted out of the disc like a jelly doughnut.

As diagnoses, there is typically a progression with the above disc pathologies in regards to the severity of symptoms. In each of these pathologies they can vary from quite mild to rather significant/severe in their nature. As a general rule the more significant the pathology, the more severe, (or significant) the potential symptoms.

• Disc Bulges are most often asymptomatic and quite normal within the general population. In severe cases, they can have an effect on the spinal cord or the nerve roots at times.
• Disc Herniations / Protrusions are more significant, but can, at times, be asymptomatic as well. Typically, there can be mild to severe symptoms in the back and into the legs.
• Disc Extrusions / Prolapses are typically the most significant, often causing more severe pains and leg symptoms than a disc protrusion.

Now that we have a little background in the area of anatomy we can talk about what these definitions mean to you and your Physical Therapist.

With a good patient history along with a careful physical examination, your Physical Therapist should be able to gain a good prospective as to what is going on with your spine in regards to not only the amount of pathology, but also to which levels of the spine are involved.

As a note, humans and their anatomy can be wildly variable from one individual to the next. Likewise, how an individual responds to pain and injury is quite variable as well.

From my experience, I have seen patients with very minimal pathology in the spine who, have had significant pain and other symptoms. Conversely, I have seen individuals with a great amount of damage to the spine that are very minimally affected.

As a note on the variation in an individual’s anatomy and their response to the potential pathology at hand, I would like to speak on imaging of the spine. In particular, I would like to talk about the limitations of MRI’s (Magnetic Resonance Imaging).

The MRI is often considered the most telling diagnostic test in regards to looking at one’s anatomy. In particular, it is very good at seeing soft tissue such as discs and nerves. With the skyrocketing costs of health care MRI’s have come under more and more scrutiny due to the shear number of MRI’s performed, their cost, and the frequent lack of conclusive results.

A recent study was published in the New England Journal of Medicine titled “Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain”. 

Jensen et al had collected 98 subjects for this study, all of which reported having zero low back pain.

They performed MRI’s on these 98 individuals and came out with rather astonishing findings.

-      Only 36% of the 98 individuals were considered to have a normal spine.

-      52% had at least one disc bulge.

-      27% had at least one disc protrusion.

-      1 % had a disc extrusion.

So, this begs the question, whose spine is actually normal? The answer is, probably very few of us. This is why it is important to realize that MRI’s can be very useful, particularly in finding abnormal anatomy in one’s spine. But an MRI is limited in the fact that it is just a snap shot in time. It is only a still picture of anatomy. An MRI does not always qualify or quantify one’s symptoms.

With so many people (even those of us without back pain) having some amount of pathology in the spine, your Physical Therapist becomes quite important in determining which pathologies in the individual’s spine may be the significant culprit. With this, your PT should be able to educate you and get you on the road to recovery from this injury while decreasing the likelihood of you having another episode in the future. 

 Kelly Jorschumb MPT, CSCS

Spine Specialist

Site Manager, Cloverdale/McMillan Clinic

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St. Luke’s-Elks Rehab is a great place to work whether you’re an experienced therapist or a new grad.  We employ physical therapists and PTA’s, Occupational Therapists and COTA’s, speech language pathologists and clinical social workers.  We also have on staff rehab techs, athletic trainers and clinical secretaries. 

We offer a competitive wage, great benefits, but more importantly a system of wonderful, caring professionals who are dedicated to being the best.  We are the “Dedicated Rehab Experts!” 

I’ll be blogging more in the future, but for now  I’ll list our immediate openings as of 11/6/2009:

 OT-full time-pediatrics

OT-full time-outpatient/home health

OT-full time-outpatient

PT-full time-outpatient

PT-full time-outpatient and inpatient

ATC/Rehab Tech-full time-community outreach Twin Falls

Medical Director-20 hours per week, Pediatrics

Neuro-Psychologist-full time-pediatrics, Boise

 PRN assignments through Elks Healthcare Staffing—new opportunities daily!!  We have requests for OT, PT and SLP in the great Treasure Valley, Idaho and the Pacific Northwest Region. You can do travel or temp work on a full time basis or PRN.

Please contact me if you’d like to discuss the options!!

Claudia Weathermon Tester

cweathermon@ierh.org

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Have you ever had a tingling or pain running down your leg that may have felt like an electrical shock, burning, sharp, or even a deep ache?
Most would call this “Sciatica”.

Sciatica is an umbrella term that is often used for nearly any pain or similar symptom that runs down a person’s leg.

More precisely, the Sciatic Nerve is the largest nerve of the body and is nearly the size of your pinky finger.
It begins its journey as a conglomeration of nerve roots that exit each side of the spine. These nerve roots from the 4th and 5th level of the Lumbar (low back) spine along with the Sacral (tail bone) nerves of S1, S2 and S3. They all join together forming the Sciatic nerve as it  passes through the pelvis heading downwards to eventually end at the your big toe (amongst other areas along the way).

Classically, symptoms commonly referred to as “Sciatica” is a pain, tingling, or burning that runs down the back of the leg into the calf and foot. It may also generically include groin pain, pain in you buttock, pain in your tailbone,  or pain on the bump on the side of your hip bone as well.

There are many potential causes of what we Physical Therapists call radiating pain (pain that a therapist can reproduce with testing) and referred pain (pain that cannot be reproduced). These definitions are important in finding the cause of your “Sciatica” symptoms.
The challenge is to find the cause of your leg symptoms. This is where a skilled therapist really comes into play. Your therapist should be able to assess you, and your symptoms, coming up with a proper diagnosis and cause of those symptoms.

There are numerous reasons as to why a person may develop their “Sciatica”. Some of them may include direct or local trauma to muscle, bone, or nerve tissue in the back, pelvis, or the leg itself.

There may also be local pathology to the nervous tissue to include compression of the spinal cord ( central stenosis of the spine), compression or irritation of the nerve roots as they exit the spine, (foraminal stenosis) and later downstream to the actual peripheral nerves (which control the individual muscles and give us sensation as well).
Disc compression/Herniation, muscular impingement/compression, bone spurs etc. could all lead to this.

Another cause is vascular in nature. Lack of proper blood flow in your legs can mirror “Sciatica” type leg symptoms as well.

Yet another cause of your “Sciatica” may be more mechanical in nature. In the spine there are a pair of joints above and below  each level that allow you to move through the great range of motion that we are given. Potentially, when a joint is dysfunctional (not moving in its intended manner) it may become irritated and cause leg symptoms as well.

Lastly, when a joint or spinal segment moves excessively and is not restrained by its normal mechanisms of joint, ligaments, and muscles it may become unstable.
Instabilities can easily cause leg symptoms that are also lumped into the “Sciatica” category.

One can easily see that there is a myriad of potential causes for leg pains that are all routinely lumped into the category of “Sciatica”.
Our job, as highly skilled therapists, is to sift through all of the information that the body gives us and find the true culprit as to your leg pain. Is it in your back? Is it in the pelvis? Is it in the leg itself?
Most often the leg pain that one feels has very little to do with the leg at all. This is sometimes challenging to grasp as one can put their finger on his/her pain, press, and cause it to hurt locally. Unfortunately, this is one way that the body can be very misleading. Buttock pain, Hamstring pain, Hip bone pain, calf pain, and medial (plantar fasciitis) pain are frequent examples of these pains often caused by the spine.

With this information from careful testing,  we will develop a strategy to best treat you, getting your symptoms under control and getting you on with your normal, functional life.
Much of our treatments will include work on posture, regaining spinal mechanics (mobilizations and manipulations) along with stabilization of the spine as well. Positioning, activity modification and other modalities can also play a helping hand in reaching the end range goal to rid a person of their “Sciatica”.

Kelly Jorschumb MPT, CSCS
St. Luke’s-Elks Rehab, Cloverdale McMillan Site Manager

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You may notice that we have a whole new look!  We have officially made the transition from St. Luke’s-Idaho Elks Rehabilitation Services to St. Luke’s-Elks Rehab.  We are still the exact same company, but we decided that we needed a makeover so that the people we serve could better understand who we are and what we do.  Although our original name and logo consisted of both our parent organizations’ names, we did not look like either of them.  We are a joint-venture between St. Luke’s and Elks Rehab Hospital, but our logo did not clearly describe this partnership.  Our new logo is simply both our parent organization logos next to one another.  Hopefully this will better demonstrate that we are an equal partnership dedicated to providing outpatient rehab services.  

We are very excited about our new look and shorter name.  Our new name allows us to cut our phone conversations in half- try it out- “Thank you for calling St Luke’s-Idaho Elks Rehabilitation Services, how can I help you?” versus, “Thank you for calling St. Luke’s- Elks Rehab…”  It makes a difference!  Because rebranding is quite the process, you have probably not seen the last of our former identity.  It is bound to surface for years to come, regardless of how hard we try to adhere to our new look.  But, what is important is that whether it is us old or new, we are still here working as hard as ever to provide the best rehab services possible.

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Now that the weather is getting warmer, we are starting to see the benefits of living in Idaho.  People are getting outdoors to hike, bike, swim, and run.  Baseball, softball, and other summer sports are starting, and  so are the injuries that accompany them.  At the beginning of the spring season, orthopaedic centers and physical therapy clinics all over the Treasure Valley “spring” to life.  Whether you are a pitcher, swimmer, goalie, or runner, you run the risk of getting an overuse injury or a muscle strain without proper conditioning. 

The hardest part of being an athlete is suffering from an injury.  Do I tell the coach?  Should I sit out of practice?  Will I still have my spot when I get back?  As a physical therapist, deciding whether someone is capable of playing is probably the most difficult aspects of my job.  To start, I look at strength and range of motion of the individual.  Then, I assess the functional needs of the athlete in relation to the sport that he/she is participating.  When the athlete is able to actively go through full range of motion and has good strength, we usually begin functional training.  This may include lunges, squats, agility drills, or even a throwing or running progression.  Making sure the athlete is strong enough to return is a big concern which is why these functional progressions are so important. 

 When rehabilitation has concluded, I try to insert the athlete back into practice while keeping a close eye on him/her to ensure that the injury doesn’t flare up again.  I encourage my athletes start with a good warm-up:  1. Jog and stretch.  2. Gradual increase to full speed running.  3. Agility exercises with gradual increase in intensity.  4. Gradual increase in sport specific movements.  Following those steps, the athlete can partake in regular practice.  Even when practice concludes, the athlete is still not done.  A cool down routine is necessary.  Usually, I ask athletes to cool down with jogging then stretching.  I also instruct the athlete to ice the injury following all activity for 15-20 minutes.

A good rule of thumb for returning to sports after an injury is:  If your injury is sore and swollen the day after practice, you should take the next day off, then lighten your workload for the next practice.  Coming back from injury too soon may cause you to miss more time. 

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