Global Health

G: I can't believe Christmas break is here and I have 3 weeks off! This marks the longest time off school I've had since last September...and the last break I'll get until next Novemeber. I'm gonna enjoy it! In the meantime, here is something I wrote for the ethics submission of the research project I will be working on for the next 10 months. ("Dream Come True?" ~ November 2nd, 2005).

Off to the Caribbean in a few days...see you all when I get back!

Evaluating the Role of the Canadian Physical Therapist in Global Health: A SWOT Analysis

1.0 Introduction

Despite the increased presence of physical therapists in global health settings, their roles are not well outlined in literature – in Canada or elsewhere. This study proposes to synthesize the available peer-reviewed and grey literature, and conduct a series of key informant interviews to address this issue. This information will be integrated into a SWOT analysis framework in order to determine the strengths (S), opportunities (O), weaknesses (W) and threats (T) of Canadian physical therapists working in developing countries. This research study will attempt to address a wide range of professional and ethical issues, including viability, sustainability, professional autonomy, and scope of practice as related to Canadian physical therapists working in global health initiatives.

Significant discrepancies in population health and access to health services exist between developed and developing nations. The loss of billions of dollars each year due to disability and related losses in productivity is an expense that developing countries can ill-afford. In order to reduce the burden of care on society and maximize the productivity of its citizens, the gap in disease and disability between developing and developed nations must be reduced. Global health initiatives aim to improve the health of underserved or vulnerable populations. As experts in functional mobility relating to disability, physical therapists aim to improve the quality of life and independence of persons with disability, thereby maximizing their productivity within society. Potential implications of a healthy population reach beyond the individual level to shape economic and societal infrastructures. As such, global health initiatives aim to not only decrease disability, but also to invest into communities through the dissemination of knowledge and transfer of skills and resources.

The current trend in health care is moving away from the traditional medical model of care to a more community-based rehabilitation (CBR) strategy. The CBR model promotes a multi-disciplinary approach where physical therapy and other rehabilitation services may be accessed. The five basic principles of CBR include:

- Utilization of available resources in the community
- Transfer of knowledge about disability and skills in rehabilitation to people with disabilities, families and communities
- Community involvement in planning, decision making and evaluation
- Utilization and strengthening of referral services at district, provincial, and national levels that are able to perform skilled assessments with increasing sophistication, make rehabilitation plans, participate in training and supervision
- Utilization of co-ordinated, multisectoral approach

Despite increased interests in global health and CBR, the current and future roles that Canadian physical therapists could assume have not yet been described or explored. This study sets out to use a SWOT analysis to systematically evaluate the current and potential role of the Canadian physical therapists in global health, including CBR programs. These roles may include primary healthcare, as well as advocacy and policymaking in government and institutional settings. The results of this study will be used by International Health Division (IHD) of the Canadian Physiotherapy Association (CPA) at the upcoming World Confederation for Physical Therapy (WCPT) International Congress to be held in Vancouver in 2007.

2.0 Background

In 1978, the Declaration of Alma-Ata on primary health care declared that “an acceptable level of health for all the people of the world by the year 2000” was possible, but expressed the need for urgent action to protect and promote the health of individuals worldwide. The assembly boldly challenged the global community to eliminate the “existing gross inequality in the health status of people” within developed and developing nations. It recognized health as a basic human right entitled to all, asserting that global health was thus a “common concern to all countries”. More than a quarter century later, these objectives remain largely unfulfilled.

The International Classification of Functioning, Disability and Health (ICF) defines disability as an umbrella term to characterize all impairments, activity limitations and participation restrictions relating to the body, the individual and society. Today, it is estimated that over 600 million people in the world live with some form of disability, often in poor conditions and without access to basic needs for survival. The World Health Organization (WHO) reported that in 2005, 80% of persons with disabilities lived in low-income countries. Disability then, can serve as an indicator of health status, highlighting the substantial disparities in health between developed and developing nations. The changing global environment has drastically influenced disease and disability, making global health initiatives and efforts like the Alma-Ata progressively more complex. Amongst other factors, population growth, war and conflict, violence, environmental degradation, chronic conditions and an aging population have all influenced the nature of disease and disability worldwide, particularly in developing nations.

In an assessment of world health published by the WHO in 2000, estimates of disability-adjusted life expectancies (DALE) were reported for 191 countries around the globe. DALE measures “the equivalent number of years of life expected to be lived in full health”, providing valuable information regarding the quality of health of a population, rather than simply quantitative measures of life expectancy. Results of this study showed that Japan and Australia topped the list with healthy life expectancies of 74.5 and 73.2 years respectively; with Canada and the United States ranking slightly lower at 12th and 24th respectively (72.0 and 70.0 years). The lowest country out of 191 was the West African nation of Sierra Leone, with an average DALE of only 25.9 years. In fact, all 10 countries at the bottom of the list were from the continent of Africa, where it is estimated that 95% of disability is poverty related.

In an attempt to respond, the WHO held its 5th World Health Assembly (WHA) in May 2005 to address the issue of: “Disability, including prevention, management and rehabilitation”. Concerned with the rapid increase in the number of persons with disabilities worldwide, particularly in developing areas, the WHA urged member states to address the global rise in morbidity through the following actions:

- To develop their knowledge base with a view to promoting and protecting the rights and dignity of persons with disabilities and ensure their full inclusion in society, particularly by encouraging training and protecting employment;

- To strengthen national programmes, policies and strategies for the implementation of the United Nations’ Standard Rules on the Equalization of Opportunities for Persons with Disabilities;

- To promote and strengthen community-based rehabilitation programmes linked to primary health care and integrated in the health system;

- To investigate and put into practice, under their specific conditions, the most effective actions to prevent disabilities, with the participation of other sectors of the community;

- To research and implement the most effective measures to prevent disabilities in collaboration with communities and other sectors;

Historically physical therapy and rehabilitation have been – and still remain – low priorities in the developing world. The average physical therapist to population ratio in these areas of the world is 1:550,000 compared to 1:1,400 in developed nations. In the developing world, where basic medical care and survival are daily struggles, rehabilitation has traditionally been overlooked though it may present a key part of the solution. The severe shortage of rehabilitation services in these countries is compounded by financial limitations, negative attitudes towards disabilities and poor awareness of the physical therapy profession. It is estimated that tens of billions of dollars are lost each year due to disability and related losses in productivity. Kay et al. writes that “Developing nations can ill-afford the expense of the morbidity that a failure to rehabilitate causes”.

Current literature addressing the role of physical therapy in global health settings is limited in Canada and elsewhere. Despite the increased presence of physical therapists in global health initiatives, the role of rehabilitation itself is presently poorly defined in the global community. As experts in functional mobility and independence, there is potentially a large role for physical therapy and rehabilitation specialists in reducing disability and increasing the independence of individuals in developing countries. The goal of rehabilitation is to increase the quality of life of individuals living with disability, thereby maximizing an individual’s productivity and reducing the burden of care on society. Persons with disabilities should be seen as vital contributors to the community, and rehabilitation services should be considered an investment into society rather than merely a cost.

Ultimately, the role of the physical therapy profession is likely influenced by cultural context, political and economic milieu as well as the status of the country’s health and education systems. It is important to understand that health and disability are intrinsically linked to a nation’s productivity and prospect for development; and vice versa. A 2001 evaluation of the implementation of the UN Standard Rules on the Equalisation of Opportunities for Persons with Disabilities reported that currently only 1-2% of the developing world has access to rehabilitation and almost 30% of countries surveyed do not have national rehabilitation programs. The WHO issued a statement in May 2002 stating that “stable and prosperous societies cannot be achieved without investing in health". The prosperity of not only the national economy, but also the health of the population as a whole is fundamentally important to a country’s ability to develop and flourish. As such, the potential ramifications of disease and disability in developing nations reach beyond the rehabilitation sector and into the economic and social infrastructures of a nation.

Canadian physical therapists may be positioned well to use their professional skills and knowledge to contribute to the development of rehabilitation in global health initiatives. In Canada, the physical therapy professional roles have expanded into areas such as private enterprise, institutional support, primary care and health policy and administration. The extent to which these same skills may be applicable in global health settings – in CBR programs and beyond – warrant further investigation. Issues of professional autonomy and scope of practice remain unaddressed in development projects and questions of viability, sustainability and dependency arise; issues that are important for both the people receiving services and the physical therapy profession. As such, physical therapists working in global health settings encounter a wide variety of ethical and professional dilemmas that may not have clear answers. A gap in knowledge currently exists due to a lack of research and poor dissemination of experiential knowledge from those with experience working in developing countries. Research towards defining the actual and potential role of Canadian physical therapy can provide direction for future global health initiatives in rehabilitation, and support the professional decision making of individual physical therapists.

This study proposes to use case study design, key informant interviews coupled with a SWOT analysis methodology to attempt to address the current gap in knowledge regarding the present role and future opportunities that Canadian physical therapists have within the global health area. The results of this study will ultimately identify and evaluate the roles of the Canadian physical therapist in global health, which will in turn provide empirical basis for direction and strategy for the International Health Division of the Canadian Physiotherapy Association.

100th Post!

So apparently the counter on blogger says that this is my 100th post...wow!

It seems so long ago that I started this blog. August 31st, 2004 to be exact. 460 days exactly since I began to journal about my life, my thoughts and my struggles. That is an average of 1 post every 4.6 days. Not bad I guess, though my goal originally was to post twice a week, so I may be slightly behind that rate right now (especially in the last few months). 29 posts behind to be exact. So I guess if I can sit here all night and fire off 29 posts, I can put myself back onto the pace I had committed to...hehe...

Unlike some of my other posts, I will keep this short and to the point. Whether you've been reading along ever since my very first post, or this is post numero uno for you, I want to thank you all for your interest in my random thoughts. As random as they may be sometimes, I've tried to take you all beyond what everybody thinks they know about me to give you a glimpse of the real me - sans misconceptions, sans preconceived notions and sans interpretation.

I will leave you with a quote from one of my favourite songs all time, one of the reasons why I still continue to try to write whenever I can:

"Life's a journey not a destination, And I just can't tell just what tomorrow brings" ~ Amazing (by Aerosmith)

Here's to the next 100 posts of my life.

Thanx all, Peaz

Absence of GO(O)D

"Evil is the Absence of Good"

Have you ever heard this phrase before? Essentially the argument is that Good is a defiing quality, and that evil exists due to the lack of its presence. Similarly, like darkness is the absence of light, coldness the absence of heat and poverty the absence of resources, evil exists fundamentally as the absence of good.

Or rather, Absence of God...

In "Wine Before Breakfast" at Wycliffe yesterday morning, we spent a little time praying for our world. To be honest, it can be discouraging sometimes. There's some whack stuff goin' on out there in the world nowadays, and its getting worse. Perhaps it is that as we grow up, we become more in tune with what's really going on in the world; less sheltered from the "bad stuff" and more aware of "harsh realities"? But still, it just seems as if our socieity as a whole is going downhill, more corrupt and more violent than ever. Forget other cities in other countries...this is a problem here....even in Toronto.

It makes me think tho...Is it simply "just a coincidence" that the progressive atrophy of moral standards in our "modern" society is parallelling (is that a word?) our "progressive" secularization of everyday life? It seems that the more we have attempted to push God out of our culture and our identity, the worse our communities have gotten, NOT better. Its undeniable, you see it all over the front pages of the newspaper, on the evening news, and all over the internet. I can feel the erosion of moral decency and conscience.

Absence of God.

It seems as if the only times nowadays that it is ok to acknowledge God overtly in our society are at events like weddings and funerals. Religion is no longer alowed in school, or at work, yet the majority would find it absurd to not allow prayers in marriage or in death. Its funny, because even those who do not consider themselves "practising" in their faith (or even those who don't believe altogether) seem to entertain and allow the idea of religion and God, if only temporarily. Weddings and funerals are still usually held in churches and both are littered with religious symbology - from the reading of scriptures and prayer, to the overt acknowledgement of His presence, to the supplication of His blessings upon "His people". Perhaps it is the sanctity of weddings and funerals that allows religion to remain; very specific times in people's lives where something is so sacred that it is acceptable to allow the slightest hint of faith to penetrate, if only by tradition.

Until now. Lately, it seems as if even this sacredness is dwindling. The first sign was a couple weeks ago, when I heard of the suicide bombings that targetted families celebrating a couple's wedding in Jordan. A day that started out as celebration quickly turned into trajedgy. The bride and groom survived, but both their fathers did not. The second was about a teenager gunned down and shot to death...in a CHURCH, as he, family and friends were morning the death of another friend, also a victim of gun violence. This time it happened in our own very city of Toronto...

I used to hold on to the belief that deep within each and everyone of us was some sort of common conscience, that we complied to, even if at varying degrees. Throughout all the violence that has recently gone down in Toronto and elsewhere, I held some sort of fanatical belief that even in things like gang violence and terrorism, there was a certain unwritten, unspoken code that was adhered to, to govern mayhem; that perhaps there was still some of respect for the sacred. Was I just too naive? Before the last few weeks, I just could not fathom that even our world was capabable of such things.

Absence of God.

You may think this is odd, but I don't believe that these were acts of extreme evil by individual people. I am a big believer that people are not born terrorists or murders, rather they are a product of circumstance. These were crimes of anger, of last resort. Perhaps by a society that has screwed them over left them behind. It makes me wonder tho, what kind of societiy it is that breeds individuals capable of such heinous acts. The utter lack of regard we seem to have for one another and the sacred things in our lives just makes my heart drop. Perhaps it is time that society turns around and welcomes God back in.

"Dust and Ashes"

"Now, behold, I have ventured to speak to the Lord, although I am but dust and ashes." ~ Genesis 18:27

The following is a short excerpt of a short article I recently read in a newsletter sent out by CPTI (Christian Physical Therapists International). It wasn't like the most incredibly well written peice of work, rather it is simply some honest sharing by a Physical Therapist...a Christian Physical Therapist...Like me! To be honest, it really had nothing to do with International health, and oddly enough, it had nothing to do even with physical therapy at all. Yet there it was, on the cover of the CPTI newsletter. Front page...page one...most important.

"Dust and ashes.

I love that attitude Abraham had in prayer - the feeling that he had entered the treasure house of God and grasped heaven in his arms. To think that he, Abraham, had talked with the Lord of the universe! The thought itself was enough to lay him low and cause him to say, 'God, who am I? I'm only a little pile of dust and ashes in your presence'....Spiritual prayers have to do with conversing with the unseen Creator as though He were standing visibly and terribly in front of us. Spiritual prayer means talking to Someone who is real. That thought alone should drop us to our knees"

So how does this relate to me? Well, I guess for me, it seems like lately my prayer life's been dwindling down a road of apathy and obligation. Its dry...filled with formality and painfully lacking in the passion one would expect, considering that we are communicating directly with our Creator. Last year, I used to reserve 45 minutes on the train every morning to read my Bible and pray. It was an incredible habit that I managed to keep up for all of my first year of PT. Now...my devos have been replaced by reading the Metro...I still do my prayers, but its a mixture of praying and sleeping and daydreaming.

I've always believed that one's prayer life is a direct reflection of one's spiritual walk. How could you build a relationship with anyone, if you never talk to them? What kind of bond could you claim with whom you only communicate with out of obligation? A very weak one, no doubt.

Its not that that I've intentionally been denying God in my life - the majority of people I know don't fall away from God on their own volition - but slowly, you begin to slip further and further away. Its a gradual process you don't even realize until you've strayed too far. Maybe its something you've put on the backburner for a while, b/c things were going pretty good, but before you know it...a year could pass by and you realize that you've just become more and more distant from Him. The tough thing is that there is no caution signs posted or alarms warnings of danger ahead to direct you back to the straight road. Rather you gradually stray from the path, each step veering only a fraction more then the last...until you realize you've begun to walk in a completely differenl direction then you had intended.

Perhaps this is even more dangerous, or at least just a much. For which is worse...a person who temps fate by deliberately walking a path close to the edge of a cliff or a person who walks confidently along thinking he/she is on a safe path and ignorant of the impending danger?

For me, it's not as if things are going horribly wrong, actually things are looking really exciting - and I have to thank is God for all of this. But I think the current decline in my prayer life manifests itself in smaller ways. Maybe I'm just a little bit less tolerant a person these days; a little more easily agitated. I go to school a little less enthusiastic than I did in my first year, where God was filling my life with challenges and new spiritual endeavours. And lastly, I think I'm just more tired...not taking the opportunity for God to renew me each and every morning.

I have heard a pastor once describe the very feeling God gets when we decide to call upon him. We've all felt this way before, I am certain. Do you remember a time you waited expectantly for a phone call or an email from someone you desperately want to talk to? Maybe its from a certain guy or girl...or maybe its about university acceptancees or job interviews. When you finally get that call or email, your heart leaps!...its finally here!

Such is God's reaction each and every time we decide to call Him up...just to talk.

And all this...despite the fact that I am but "Dust and Ashes" compared to the Almightly God...c'mon Gary...what are you waiting for?...get on it...

Dream Come True?

I got some extremely exciting news last week!

It happened while we were all practising at school on Saturday for our practical exam coming up that week (btw, I passed!). A buzz spread throughout the lab as soon as word got out. Final year projects are up! There was a mixture of excitement and anxiety as we all took off immediately down to the computer lab to see where we've been assigned. The reason for excitement was obvious, but the anxiety was also understandable, for we will be working almost a full year on this research project, and getting stuck with something you're completely not interested in would well, SUCK.

When first I read my name on the list, my heart sunk...for it seemed like I had gotten a project that was one of my top choices, but not THE top choice. I began to tell myeslf that it was alright, but I decided to look again a little closer, and realized I had been mistaken, I had actually gotten my top choice! So for the next year or so (maybe more?), I will be invovled in an extensive research project analyzing the "Actual and potential role of Physical Therapy in global health initiatives".

Many of you know of my desire to get involved in International work, and I think I've shared with some of you that I'm thinking of potentially working for a few years Internationally after I graduate and before I settle back down here. However, to this point, I really had no idea as to how where to start, especially being tied down in school for at least the next year and all. But when final year projects came up, I knew immediately that I wanted to do this project as...I mean AS SOON as I heard about it. As I applied, I felt a sense of peace, knowing that if God wanted me out there in the world, that He would get me there and open opportunities for me - whether through this project or elsewhere. Still, I made up my mind that I was going to pray about it every day until the project assignments came out, and then see what happens. I tried my very best to leave this up to God, there was nothing I could do about it anyway. But of course inside, a part of me desperately wanted this one, for there were very few projects that interested me and I knew I would have been extremely disappointed with anything other than my top choice.

And God answered....WOW....there were so many people that applied to this one, and I have no doubt that God was working in this....WOW...I still really can't believe that I got this. I'm extremely excited about this opportunity, especially the part about making recommendations to the International Health Division of the Canadian Physiotherapy Association and hopefully getting published and stuff like that. I pray that God allows me to serve Him effectively in this role, whatever that may be. I will definitely keep you all posted.

Here is a little summary of what I will be involved in over the next year:

"The following objectives will be addressed in this proposed research study: (1) To comprehensively define the role of Canadian physical therapists in global health initiatives, and (2) To evaluate the role of the Canadian physical therapist in global health initiatives using a ‘SWOT’ analysis methodology"

"Despite the increased presence of PTs in global health settings, their role is not well outlined in the literature in Canada or elsewhere. The role of physical therapy (PT) appears to be dependent on the cultural context, political and economic milieu as well as the status of the country’s health and education systems. Internationally, the role of the PT has only modestly been established in community-based rehabilitation (CBR) projects and other related clinical service delivery models. However, in Canada, the PT professional roles have expanded into areas such as private enterprise, institutional support, primary care, and health policy and administration. The extent to which these same skills may be applicable in the global setting and warrants further investigation.....This research will attempt to address the gap in knowledge regarding the present role that Canadian PTs have within the global health area and project future opportunities. The results of this study will ultimately identify and evaluate the roles of the Canadian PT in global health, which will in turn provide empirical basis for direction and strategy for the International Health Division (IHD) of the Canadian Physiotherapy Association (CPA). This study’s findings will have multiple implications and serve diverse purposes: first, it will generate evidence-based strategic planning for the professional role in global health initiatives; second, it will inform the IHD’s efforts to support the network of Canadian PTs committed to global health; and third, it will facilitate relevant education within professional training programs. More concretely, the identified weaknesses of the role of PT will be addressed to the extent possible through IHD sponsored educational and/or programming initiatives."

More Randoms

"Monster Tri's"

Thanx to everyone who's been asking about my grandma. She is recovering quite well =D In fact, because she has had to use her arms a little more now to transfer in & out of bed, to the commode etc., she's developing monster triceps! At 94 years of age, I guess its never too late to become a body builder...hehe

"Friggin' Knee"

Also thanx to those who continue to ask about my knee. It's doing better! I tested it out tonight playing Division 1 vball (which is as high as you can get below varsity here)...man, was it intense...I loved it! But the knee didn't fair so well, it gave in on me a couple times...and even when it held, I just couldn't push of on it....there were 5-6 balls that I just couldn't get to in time to set properly...sigh...I just wonder if maybe we would've won the game if I was at 100%...Friggin' knee...I'm gonna see a sports doc next week...I'll let y'all know how it goes...

"Italians with Bats"

I went to an awesome small group leaders conference this past Sat in Missisauga run by Willowcreek Canada. The workshops were great, the speakers were absolutely phenomenal. But the highlight of the day was a conversation with a "local" I had during a lunch voyage. I made the mistake of not taking my name tag off as we went into town for lunch. Here is an actual conversation I had with a guy in Streetsville:

Guy: Whatcha sellin' there GARY?
Me: Ummm...I'm not selling anything....we're actually here for a conference at the church down the street
Guy: Oh...you mean over there? (pointing at a BAR named "Saucy")
Me: Uhhh...no
Guy: Do you mean over there? (pointing at Tim Hortons)
Me: noooooo.....
Guy: It's hard to imagine that even Chinese people are Christian...But they are!
Me: ....... (what the???? YOU FREAKIN' IGNORAMUS.....)
Guy: I guess it must've been those Italians eh? Travelled over into China way back when, with their baseball bats, converting people to Christianity

That was a history lesson I never expected to get...God Bless those bat-weilding Italians...I guess? I salute you and your baseball bats, pumelling my ancestors into Salvation

"Cuisine a la Henry"

Here is an actual email I received to my class list at school...Henry never mentioned it...so I had no idea until I read it...definitely made me one popular dude in PT....haha

MedLife is holding its first food and fellowship event of this year next week! Food and Fellowship essentially involves a group of faculty of medicine students getting together to cook and eat. Our first event will be hosted by a second year med student, Henry Siu, and the theme will be "Cuisine a la Henry Siu." Henry is a self-attested "gourmet" chef, and I am definitely looking forward to tasting his fine recipes) If you too would like to join us, the details are below, all you need to do is reply to this email with subject line: "I hope Henry can cook!"

When: Wednesday, October 19, start time: ~6:00pm, end time: ~9:00pm
Where: Diana Alli's place (condo on harbourfront at Bay Street)
What: Henry's very own yummy recipes, non-vegetarian**

Everything is provided...you just have to show up and have a good time!!

Jen and Amy

"Failure"

Follow these simple steps:

1) Go to www.google.com
2) Type in "failure"
3) Click "I'm feeling lucky"
4) Laugh

Disclaimer: This is by no means a political statement, nor does this necessarily reflect the views and opinions of the author of this site or the blogger.com corporation. Please simply take the wrench out of your butt and laugh.

G: Peaz out...until next time my friends

My Knee

I don't know how I've avoided it so far, but its finally happened. Being an athlete all my life, I dunno how I've avoided banging up my knee badly. But I guess I've just been lucky - cuz knee injuries really mess you up. (Although I'm pretty sure I tore the PCL (Posterior Cruciate Ligament) in my knee when I was smaller, but I didn't realize it then and its healed now, so I guess that doesn't count) But that streak came to an end on Wednesday...

It was our faculty's first intramural basketball game. I wasn't having much luck offensively so I thought I could at least contribute to the team by playing good defense. I took over coverage on a player of the opposite team I nicknamed "Baldy". He was probably their only other offensive threat second to "Asian Jordan" (on account of his #23 Jersey). I was playing pretty decent defense on Baldy and even peeled off him to take a charge from another player. But then it happened, and pretty quickly as it usually does. I went up to block Asian Jordan and got clipped at the knees. I'm still convinced the guy drove into me hard on purpose - maybe to draw the foul or something...I dunno, but he hit my knee so hard I was spun around and banged the other side of my knee on the floor.

I think I must've looked like a complete wuss down on the court screaming in pain, but shoot...it hurt! I've seen knees completely destroyed in pretty much the same manner; the all important ACL (Anterior Cruciate Ligament) of the knee completely ruined. Luckily, doing what I do, I knew right away that it wasn't my ACL that I had messed up. Rather it turns out that I've torn the MCL (Medial Collateral Ligament) in my right knee. The "trainer" at the game started poking around my knee and asking me if it hurt...LoL. So as politely as I could - given the intense pain - I simply told him I was a physio and if he could just go get me some ice..hehe....poor guy meant well.

Anyway, that's my wonderful knee story. I know I'm a nerd, but I'm going to track my progress..hehe...so here it is...a glimpse into my wonderful life as a physiotherapist...if you're interested...heh:

Day 1

Subjective
24 yr old male (wildly attractive) seen today, no acute distress, c/o right knee pain
following a collision in a basketball game

Ojective
Moderate swelling, warm to touch, no bruising

Passive Range of Motion (PROM)
-10◦ Knee Extension
100◦ Knee Flexion
Endfeel: Empty
++ Pain at end range Knee Flexion & Extension

Active Range of Motion (AROM)
-15◦ knee Extension
90◦ Knee Flexion

Manual Muscle Testing (MMT)
Knee Extension: 2+ (out of 5)
Quads Lag: 15◦

Varus Stress Test
Positive for Right MCL instability of the knee
Solid endfeel, pain at endrange