When I think about Teagan, I get a little misty eyed. I first interviewed her for a co-op position a year before she arrived on Oahu. She was very quiet and reserved. Honestly, I was concerned that she wasn’t ready for the experience of being so far from home so I recommended that she apply again the following year. She ended up traveling to Hawaii with her family and visited our facilities. She contacted me and again expressed her desire to join us. Her determination to join us was evident and I offered her the position gladly.
Throughout Teagan’s six-month employment with us, her skills, along with her confidence, grew immensely as she worked closely with our patients and staff therapists. What amazed me the most about Teagan, was her ability to adapt. Due to multiple unexpected changes, she was asked to deal with changes to her schedule, including moving locations, and working with different programs. She definitely displayed a level of maturity that impressed us all and became one of our most versatile, multi-skilled clinicians that patients embraced as their own.
Here’s what she wrote about that experience.
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I’ve traveled my whole life and never lived anywhere very long. I’m honestly not one to jump at a chance to travel more, but I couldn’t pass up an opportunity to revisit the place where I was born. After my co-op with Fukuji and Lum I was really glad I had taken the trip to work with them. F &L is truly a family, one that includes the patients that we cared for. I was able to work at Lower Atherton’s Outpatient Clinic and in Aquatic Therapy at the pool.
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[one_half_last][/one_half_last] With the F&L family I was able to solidify my skills in the outpatient clinic and learn a lot about clinical decisions from Jamie, whom I worked closely with. It was great to see things from her perspective as a newer PT and learn some tips along the way.
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Down at the pool I had the ever-amazing Rachael Hyland to guide my learning. She helped me grow from a nervous student to someone who was ready to take on clinical education with confidence.
It was amazing to see how much could be done in an aquatic setting, from ROM to conditioning and balance, and how creative the field could be. I was grateful that I could have such a positive experience in the field I’d like to specialize into.
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[/one_half_last] The things I’ve learned as a co-op student aren’t the only things I’m thankful for either. Everyone shared their part of Hawaii, whether it was food from our lovely patients, Colleen opening her doors to house us or Ryan and Talon showing us the social life. The staff went out of their way to really make this a wonderful experience for all of us. Being back in classes definitely isn’t the same as being on an island but after this experience I’m much more motivated and have valuable insight. I look forward to a chance to return to Oahu and hopefully make it a more permanent accommodation. Mahalo, Teagan Ferguson
On Saturday, August 15th, F&L’s team entry into the Spartan Race Hawaii completed the Sprint category for the first time. Five brave souls joined over 3000 participants to complete in the two day long event held at Kuuloa Ranch on the northeastern side of Oahu.
The second annual race was spread across 4,000 acres on the working cattle ranch. It began early Saturday morning and consisted of three different courses: the Sprint, the Super, and the Beast. Each race increases in distance and number of obstacles. Obstacles included rope and wall climbs, sandbag carries, monkey nets, spear throws, and tire drags. Click here to see a list of the various obstacles.
The Sprint is the shortest of the races, usually a little more than 3 miles and includes about 20 obstacles. The Super is roughly 8 miles and 25+ obstacles and the Beast 13+ miles and 30+ obstacles. Should some crazy souls feel like they could complete all three of the races, they would become a member of the Spartan TRIFECTA Tribe.
The F&L team consisted of myself, Jamie Ford, Joy Yanai, Ross Suyemura, and Stacey Hertzog. We trained hard for the past two months to prepare for both the distance of running on hills and attacking the expected signature obstacles. We knew that interval training combined with practice on various obstacle components of carrying, climbing and pulling would help us conquer the course. We even practiced the spear throw!
The race turned out to be exactly what we expected. Running through the changes in elevation and attacking each obstacle were physically and mentally challenging. Rain throughout the week provided for an extremely humid Saturday and running through the open fields definitely required a strong cardiovascular effort. There were a few racers who cramped up.
The obstacles that proved to be most difficult were the ones that required the most practice: the rope climb, spear throw, and the monkey bars. Each of us was able to complete every obstacle but we also were subject to the dreaded burpees.
Burpees are a full body exercise where you transition from a horizontal position laying flat, face down in a push up position to a vertical position with hands over head and feet off the ground. Not sure who decided that failing a Spartan obstacle requires 30 burpees but they definitely created a strong motivator to avoid failure! Burpees challenge your entire body and stress your cardiovascular system. For Spartans there are no fails, just burpees.
The Spartan Race turned out to be an awesome experience despite the burpees. It was fun running through streams and rolling in the mud. There were parts of the race that mess with your head and conjure fear of failure but ultimately they bring feelings of accomplishment when completed. It was helpful to have teammates that would motivate you to keep up and support you when the humidity and hills challenged you. It was a great community to be around and the beauty of Kuuloa Ranch is often breath taking.
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F&L did have one Trifecta entry: Talon Tengan. Talon competed in the Spartan Race held in March at Aloha Stadium and completed the Super and the Beast at Kuuloa Ranch. His experience in the previous race was one of the main reasons why I entered the race. I will lean heavily on his experience for next year, as we will enter a team to compete in the Super AND the Beast!
Congratulations to all the finishers of the Spartan Race and good luck to all the qualifiers who will compete in the World Championship in Lake Tahoe in October! Hope to see all of you at the next race in Hawaii!
Cody Gilliss arrived in Hawaii early in January 2015 and began his 6 month Co-operative experience at F&L’s Windward Occupational Rehab Center (WORC). I had interviewed Cody four months prior and knew that he would be a great fit for the unique setting that WORC has to offer. After returning to Boston a month ago, Cody took some time to reflect on his experience and share it with us.
Having the opportunity to work at Fukuji & Lum Physical Therapy was a once in a lifetime experience for me, and I can’t thank everyone at F&L enough for my 6 months in paradise. It’s sad to believe my short time with F&L is already over and I’m back in Boston, but Hawai’i, the memories, and the friends I made along the way will be with me for years to come.
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Being my first real move from home, I was worried how I would fit in with the culture, the people, and everyone I was working with. Fortunately for me, I was lucky enough to work with some of the best people I’ve ever met – and had the opportunity to work with so many amazing patients. Thank you all for making my move to Hawai’i truly a breeze.
Prior to this work experience, I knew I wanted to experience something different than what I would get at home in Boston. I was greeted by a crew of talented and passionate forward-thinkers that really revolutionize and break the mold of the physical therapy practice. The WORC clinic uses a lot of cutting-edge and exciting new methods to rehabilitate their patients, and it was a pleasure to be a student learning from everyone there.
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Every day I knew that I would learn something new, or have a new book sitting at my desk. The amount of knowledge and insight I have gained through everyone at F&L is amazing and I am very grateful. Mark emphasized to me that it’s important to forever be a student, and now I realize how true that really is. I learned you should always strive to be better, to learn more, and to be responsible for your own education.
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Working at F&L under Mark, David, Stacy, Jessie, Lisa and Ross taught me so much about how to be a great physical therapist and a great healthcare provider. They work so hard to put the patient’s health and wellbeing first, and it’s something I look forward to providing for my patients in my professional future down the road.
Every patient that walked through the door seemed to be a part of the F&L family, and it was a blessing to be a part of that family, or Ohana, while I was there. I now definitely understand what it means to practice physical therapy “with aloha”, and it’s something I will bring back here to the mainland!
Sports Day at WORC
Speaking of things I want to bring back to the mainland, there are so many things I want to bring back here. First and most important – my favorite Hawaiian snack… Foodland’s very own, Spicy Ahi Poke. I’m currently looking around the local fish markets to recreate it on my own. Thank you again to Jessie and Lisa for the extra furikake and poke-mix! It will be put to good use, I promise!!!
Cody’s Homemade Spicy Ahi Bowl
There isn’t a day I spend without thinking about my experience in Hawai’i and how it has made me a better person. The people, the ocean, the weather, the culture, and the Aloha spirit – It’s a time in my life I’ll never forget and it’s something I’ll take forward with me every day. Thank you all again for making it so special. I can’t wait for the day I can come back to Kaneohe, hopefully this time for much longer.
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Sarah Agustin is a student of Northeastern University and recently returned to Boston after spending the last six months working at our Aquatic and Honolulu locations. She is the first Co-op student originally from Hawaii. Sarah wrote about her Co-op experience at F&L:
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Being born and raised on the Island of Oahu, I had an amazing opportunity to return to the islands and work as a co-op student at Fukuji and Lum Physical Therapy. Fukuji and Lum is unique in many ways as they stand by their mission statement “ to deliver fun, happiness and compassion in serving our patients and community”. While being apart of the F & L Ohana for the past 6 months I was exposed to various settings such as: Outpatient Clinic, Aquatic Therapy, and Work Hardening Plus Program.
I had the opportunity to work at the Kuakini Clinics in Honolulu and Aquatic Therapy Program in Kaneohe, each with an amazing staff. As a student and employee I was challenged daily to work closely with patients and to better my clinical decision making skills. From observing many initial evaluations with our staff members, to assisting patients with therapeutic exercises, I can say that I have learned a tremendous amount that I know will help me become a great future physical therapist. Working closely with Art Lum, I was introduced to NAIOMT (North American Institute of Orthopedic Manual Therapy) where I was able to see first-hand some of the manual techniques and how to apply it to therapy. F & L offered many in-services to their employees to learn about new and developing fields such as Graston and Gameready. F & L also valued and stressed a personal physical fitness program. Early morning work outs challenged the staff but at the same time, it kept the staff in top physical condition. The entire staff at F & L was open and willing to share all of their specialized knowledge with me. They answered the many questions that I had and in returned challenged me with connecting the classroom knowledge with our daily work routine. F & L Staff went above and beyond during this Co-op experience to make this entire process an amazing learning experience.
Even though I was born and raised in the islands, I took advantage of being home with family and friends and exploring more of what the island has to offer. I went on many new hikes though out the islands over the past 6 months such as Kalalau on Kauai, Halawa Valley on Molokai and Waipio Valley on the Big Island. Each of the hikes was an experience that I will never forget. Being away from home for the past year in Boston, I definitely missed my local grindz, so of course I dived right into all of the local foods that the islands had to offer and made sure I ate enough to last me the next 2 years in Boston.
Working at F&L has made a tremendous impact on my career. It was hard to leave such an amazing staff and company and I look forward to see what the company has for the future.
Connor Pokorney is one of two new co-ops from Northeastern University that will be with us for the next six months. He joins Victoria Ruvolo as the newest members of the family. We asked Conner to tell us a little about himself and why he is interested in the physical therapy field.
What school did you attend in high school and what’s your current college? I graduated from Nashoba Regional High School, in Bolton, MA and am currently attending Northeastern University.
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[/one_half_last] What drew you to physical therapy? I have always been interested in the medical professions and was originally drawn to physical therapy by its connection to athletics. I also enjoy the aspect of helping others help themselves to recover and get back to performing their day-to-day tasks and participating in whatever they are passionate about.
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Why did you want to do your co-op in Hawaii? I wanted to come to Hawaii to experience a culture and environment different from that of New England. I loved where I grew up, but was eager to see what else the world has to offer. Living in Hawaii allows me to do things that I love like hiking, kayaking, and golfing in a new environment, while also trying new foods, and embracing the diverse cultures here.
What has been your experience like so far? My experience has been incredible, so far. I’ve already been to several beaches and been hiking and kayaking. I got to enjoy the 4th of July at Kailua Beach and have tried lots of new foods.
What’s the strangest thing that you’ve eaten since arriving? I tried paiai at the farmer’s market.
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What is on your to do list while here? While in Hawaii I hope to attend a luau, watch a surf competition on the North Shore, go rock climbing, try surfing, snorkeling, and stand up paddle boarding.
What are your outside interests? My biggest interests outdoors are rock climbing and backpacking, but I also really enjoy kayaking and canoeing.
What kind of therapist do you hope to be? I hope to be a therapist that can motivate patients and instill a sense of positivity during their rehab. I want patients to be able to rely on themselves as much as they can rely on me to get them better.
Who is your greatest influence in your life? The greatest influence in my life has been my grandmother. She has worked as a physical therapist her entire career and has traveled the world, visiting all seven continents. Hearing stories about her work and the gifts she brings back from across the world has inspired me to both study physical therapy and to travel; the two reasons why I am co-oping here at Fukuji & Lum.
For the past 7 years, F&L has been in partnership with Northeastern University’s Physical Therapy Cooperative Education Program. Twice a year our organization accepts outstanding NU physical therapy students as full-time employees and gives them the opportunity to gain valuable work experience in an outpatient orthopedic clinical setting. These students primarily assist our highly qualified physical therapists with outpatient care at our clinic locations in Honolulu and Windward Oahu, including the outdoor heated pool at the Kokokahi YWCA. The journey to Hawaii will offer students tremendous life-changing experiences as they strive to balance work, play and new discoveries during their 6-month employment.
This semester brings us two new co-ops, Victoria and Connor. This week we introduce Victoria Ruvolo.
What school did you attend in high school and what’s your current college?
I attended Our Lady of Mercy Academy in Syosset, NY, and I am now a student at Northeastern University in Boston, MA.
What drew you to physical therapy?
I am drawn to physical therapy because I love being active and helping people. I also really like the variety of settings and ways that PT can be used to treat people.
Why did you want to do your co-op in Hawaii?
I wanted to do my co-op in Hawaii because Fukuji & Lum is a great clinic where I will have a lot of opportunities to learn and gain experience as a physical therapy student. I also love traveling and trying new things, so Hawaii seemed like the perfect choice!
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My experience has been awesome! I’ve been hiking, gone to the beach a lot, and done some exploring around the Windward side and Ala Moana. I’ve already learned so much and had a great time working at the clinic.
What’s the strangest thing that you’ve eaten since arriving?
It’s probably a tie between purple potatoes and Poi (I’m still not really sure what it is).
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What is on your to do list while here?
I definitely want to take some surfing lessons, do lots of exploring, and get a nice tan!
What are your outside interests?
I love to run, stay active, and just hang out with friends.
What kind of therapist do you hope to be?
I hope to be a therapist who is very knowledgeable, caring, and well-rounded. I want my patients to be able to trust and relate to me.
Who is your greatest influence in your life?
My greatest influence is my family, for always pushing me to try new things and do the best I can.
Please give Victoria a warm Aloha when you see her at the pool or the Kaneohe clinic.
“The secret to living is giving.” – Tony Robbins,Awaken the Giant Within
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It’s that time again! Every six months we say Aloha and goodbye to the Northeastern University (NEU) Co-Ops that have been with us as part of our affiliation with their school. F&L is now in our eighth year with its partnership with Northeastern University’sPhysical Therapy Cooperative Education Program.
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Our company accepts NEU physical therapy students as full-time employees and gives them the opportunity to gain valuable work experience in an outpatient orthopedic clinical setting. They primarily assist our highly qualified physical therapists with outpatient care at our clinic locations in Honoluluand Windward Oahu, including the outdoor heated pool at the Kokokahi YWCA. The journey to Hawaii offers NEU students tremendous life-changing experiences as they strive to balance work, play and new discoveries during their six-month employment.
Our most recent Co-ops, Cody, Sarah and Teagan, were with us from January to June and were an integral part of our team. Cody spent most of his time at WORC and was an outstanding contributor in working with injured workers. He also was an integral part of the Performance Plus Program in training our F&L membership base in a personal training. Cody proved to be a quick learner and developed skills in instructing patients with tools such as sandbags, kettlebells, and suspension trainers.
Teagan spent her time in the Aquatics program and with our private care patients at Lower Atherton. She definitely found a love for the pool and demonstrated the unique ability to work with the wide diversity of patients that are a part of Aquatics. She expressed to me that she may have found a career path with her time spent at Kokokahi.
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Sarah was our first homegrown Co-op student, having graduated from Iolani Schools. She was our utility Co-op bouncing from the Windward side at the pool and our Kailua clinic to working exclusively at our Kuakini clinics. The Co-op experience is valuable for students who haven’t experienced the islands so this was the first time that we had someone who was with us primarily for the clinical experience. Look forward to reading about her experience, as well as the others, in an upcoming blog.
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F&L’s relationship with NEU’s co-op program is unique. F&L’s commitment to the physical therapy profession is one reason why we dedicate our time and resources to this relationship. Each staff member is responsible to contribute to the growth and learning of the co-ops so that the profession continues to expand to higher levels. This responsibility is not listed on anyone’s job description but it is a large part of our culture and values. There is no richer emotion in life than the sense that something you have said or done has somehow enhanced someone’s life. We recognize our staff’s contribution to the NEU program as well as the how these young professionals enhance our lives in such a short time.
We wish the three students our best wishes and thank them for their hard work and dedication. We hope that our paths cross again and that one day we employ them again.
We greet our new co-ops, Connor and Victoria (look for more about them in my next blog).
I’m often asked by patients “What’s THE most important exercise I should do?” My answer changes as my experience as a physical therapist evolves throughout the years. I would normally tell my patients to do some form of stretching or strengthening, until recently, when I started doing deep, abdominal breathing exercises as part of my morning routine. I now tell my patients that abdominal breathing is one of the most important exercises they can do.
There are a number of contributing factors that make abdominal breathing so important. A couple of years ago, I began focusing on abdominal or diaphragmatic breathing after studying Heart Rate Variability (HRV)which is a measurement of the balance between your sympathetic and parasympathetic nervous systems. By measuring your HRV, you are able to assess your body’s response to stress. The body reacts to stress by changing breathing patterns, which leads to physiological changes including hormonal responses and neurological patterning.
In normal breathing patterns, we SHOULD use abdominal breathing, which is focused on using the diaphragm, a muscle located below the lungs. This muscle is controlled by our parasympathetic nervous system via the Vagus nerve. Because of the daily stresses of life, we’ve adapted our body’s most vital need: to breathe. Abdominal breathing has such profound effects on our ability to handle stress, anxiety and physical activity. However, some of us have changed our breathing patterns and use more of a thoracic breathing pattern. This pattern is shallow, shorter and typically used when we are reacting to a “fight or flight” situation and triggers the production of cortisol leading to a weakened immune system.
“Habitual chest breathing not only reflects physical and mental problems. It creates them. It mildly but chronically over-stimulates the sympathetic nervous system, keeping the heart rate and blood pressure too high, precipitating difficulties with digestion and elimination, and causing cold and clammy hands and feet.” – David Coulter, The Anatomy of Hatha Yoga
I often see this shallow breathing pattern in my patients. Pain is a factor in changing the way we breathe and we unconsciously respond to pain by holding or shortening our breath. When I see this response, I spend time educating the patient on focused abdominal breathing exercises which helps moderate pain.
One of my favorite references on how to breath correctly is Jill Miller’s The Role Model. Her book is excellent in explaining how the body breathes, the anatomy involved, and how to correct your breathing pattern. I incorporate her “Breathing Primer” into my breathing exercise routine each morning and it has positively affected everything that I do.
After learning about the importance of breathing correctly, I discovered Breath Reset, a type of meditative breathing that helps me to focus my thoughts, settle my body, and allow me to get in touch with my body. This breathing practice has been performed by many for centuries and has been the foundation of Buddhism.
Chapter 4 of The Breath of Life
One who has gradually practiced, Developed and brought to perfection Mindfulness of the in-and-out breath As taught by the Enlightened One, Illuminates the entire world Like the moon when freed from clouds.
(Theragatha 548)
Each morning, I perform a routine of meditation, yoga, body weight exercises and reading while drinking my Bulletproof Coffee. This routine usually takes about an hour which is why my alarm goes off every morning at 5 A.M., even on the weekends. But the most important part of my routine, is my “belly breathing”.
I start by walking out to my backyard deck, a place that is quiet and peaceful. A regular spot in your home will help your routine become permanent. I usually sit with my back supported and with my legs crossed. With my eyes closed, I begin by taking a long inhale through my nostrils and exhale through pursed lips. I focus on my abdomen drawing in and out, trying to feel as if my diaphragm is elevating and depressing. My thoughts usually wander which is normal. I think it’s impossible to expect my brain to stop having random thoughts or emotions, so I don’t put pressure on myself to suppress them. Instead, I try to focus on feeling my body breathing.
During my breathing exercises, I am able to quiet my mind, induce a relaxed feeling, and trigger the hormones in my body that create an improved level of function. I start every morning this way so that I can control my thoughts and emotions throughout the day. The value of this ten minute practice is more valuable to me than an extra hour of sleep. It has helped me become more focused, productive, and clear about what my life’s journey is about. It has also improved my posture, breathing capacity and has taught me how to reduce my stress level at any time. No other exercise has had as much profound affect on my life as meditation and breathing. It is a simple practice that anyone can learn to improve your life immediately.
References:
Wikipedia contributors. “Heart rate variability.” Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 4 Jul. 2015. Web. 5 Jul. 2015.
This past Saturday, F&L held it’s 4th Annual Free Car Wash at the Kokokahi YWCA. Each year, F&L offers a FREE car wash as a service to our Windward community. It’s our way of saying “thank you” for supporting our organization. This year is extra special, as we celebrate twenty years of providing physical therapy to our community.
The car wash was the perfect event for our patients to watch us sweat as we washed their dirty cars. My favorite moment happened when one of my current patients enjoyed bossing me around by pointing out spots that I missed on her car so she could return the “favor” of working hard in therapy. She was determined to make us feel the wrath of her commands even though her truck was already spotless! We all had a great laugh!
Community events like the car wash are great ways for F&L to express our company values. F&L has always placed our values at the forefront of our commitments. Nurturing relationships is perhaps our greatest value and expressing gratitude toward those that we serve can be a powerful reminder of that value. Seeing our patients arrive at the car wash allowed us to interact with them in a different setting, which often brought on smiles and laughter.
We look forward to continuing our tradition of free car washes for many years to come. The feeling of declining to accept donations was fulfilling and continued to bring disbelief among patrons. See you all next year with your dirty cars!
Please look for information for next year’s car wash on our website and Facebook page.
On May 17th, I was fortunate enough to spend some time with one of my mentors, Erl Pettman, PT, MCSP, MCPA, FCAMP, co-founder of NAIOMT (North American Institute of Orthopedic Manual Therapy). Erl has been coming to Hawaii for the past 8 years to teach NAIOMT courses. In addition to being a Senior Faculty member with NAIOMT, he has been a certified manual therapy instructor for the Olaf Evenjth system since 1990.
I first met Erl in 2007, when I started taking NAIOMT courses. Since then, I’ve taking all four NAIOMT Level courses and have been lucky to have Erl as my instructor. He has made a tremendous impact on my career and continues to be influential toward my performance as a physical therapist and clinical instructor. I’ve always wanted to sit down and chat with him about his life, career and thoughts regarding our profession and am honored to have Erl as part of my first F&L blog interview.
Here’s a transcript of our conversation:
Mark: I’m just going to ask you a few casual questions to get started.
Erl: Yeah, that’s what the police always say (laughs).
Mark: Haha. You has been a mentor to me since I attended the Level I class NAIOMT course. Thank you so much for joining us today, Erl. I know that you’re here this week to teach a Level I NAIOMT course. How is it going?
Erl: Very well. Good group. It’s one of the larger groups we’ve had for a long time. Good interaction with the old group and some newbies.
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Mark: Let’s start off by talking a little about your professional career. You graduated from Nottingham School of Physiotherapy in England in 1972. How was your experience as far as physical therapy school is concerned?
Erl: I think the most valuable part was the emphasis on anatomy. And that’s followed me throughout my career. From a disappointment point of view, it was the lack of emphasis on anything orthopedic. There was no mention of manual therapy at all. So I had to catch up with it once I qualified.
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Mark: And what was it that drew you to become a physical therapist? What motivated you to choose Physical Therapy as a profession?
Erl: Nothing motivated me, it was pure accident (we both laughed). My father hired a physio for one of the jobs he was a manager for. And I had quit school and was just working. He was concerned that I wasn’t going to get back into academics, so he suggested I look into physiotherapy (aka physical therapy). And that’s how I got into it.
Mark: So you’re first job was as a staff therapist in a hospital in England. What were your memories of that first job?
Erl: Mostly the post-surgical side. Because in England, we were involved in a lot of chest care. And that was very big. It was mostly neuro and post-surgical. So, not my favorite.
Mark: Do you have any funny memories of your first year as a physio?
Erl: No that was a long time ago, I’ll have to think about that one.
Erl: I got this idea in my head that we could start this North American institute so I approached Cliff, Jim and later, Ann Porter Hoke and the late David Lamb to see if they would help me get it going and help me teach. And Diane Lee was originally with us too. So there was quite a number of people that helped us establish the orthopedic division in Canada. And they ended up teaching for NAIOMT.
Mark: What were your thoughts in forming the organization? What drove you guys to have this educational model?
Erl:We had a number of friends in the United States who wanted a much more structured system that they could find in the U.S. and they looked at the Canadian system which was very structured and not biased to anybody. Nobody’s name was connected to it but we had levels, we had exams, and a system set-up. So they asked us to come down and start a similar system. So initially, it became known as the Canadian System, then eventually we changed it to the North American (Institute of Manual Therapy).
Mark: The last time you were here in February, I watched you do an examination for the Level Three Examination. It’s considered one of the toughest exams as part of the certification of NAIOMT. What makes it so difficult?
Erl: The level 3 exam is clinical reasoning and contains a lot of biomechanics. The emphasis is on why you would do something and what’s your reasoning for the assessment and treatment given, so it’s not just a practical exam which is why a lot of the people find it extremely challenging. But our reasoning is because it’s a competency exam, a reasoning exam and reckoned to be one of the tougher exams of any system in North America. It’s still largely based on the Canadian system, but even a little tougher than that one.
Mark: Yes, you’ve said that when I was going through the courses, NAIOMT was one of the toughest certifications in manual therapy that one can go through. Besides that exam, what else makes it so tough?
Erl: It’s the only system that has an examination at every level and there are a number of courses that you have to take to get through those test procedures. For example, there are ten courses, each with tests on level one, level two, etc… In many cases, in the United States, you can get certified after a few days. But in NAIOMT, it’s going to take you a few years. And that’s a BIG difference. And of course that makes it not popular with everybody.
Mark: After years of doing quite a few examinations, you must’ve seen some interesting things happen. What are some examples of the interesting or humorous things you’ve seen during the exams?
Erl: Well, people faint (laughs) so you always have to be ready for that! One of the most common responses in the exam is when people can’t speak. So we’ve learned over the years that making people feel comfortable is a huge part of becoming an examiner so that they don’t freeze up. Some people can’t remember anything for their exam when they’re going through it. Just a blank. So you can really see how much stress people can be under when they’re going through the exam. We’re very careful in choosing our examiners so that they’re capable of first making people comfortable and then able to ask them questions that will get the most of out of them.
Mark: Great. Everyone has asked me to ask you this question. They say that they feel like you’ve got or you’ve stated that you have aphotographic memory. First of all, do you feel like you have a true photographic memory? And second, when did you know that you had that gift in you?
Erl: Well, I know people with a true photographic memory and I don’t have what they describe as a true photographic memory where you can just look at a page and remember it. But what I do have is a real retentive memory which is a better way (to describe it). I only have to read something once or be told something once and it’s pretty much in there forever.
Mark: Have you always had that?
Erl: Yeah. I think that’s been a feature since school. I didn’t always use it in school as much as I could’ve (laughs).
Mark: I as well as many others, view you as an icon in our profession and you’ve had a huge influence on my professional development. Who has been a major influence in your professional development?
Erl: Apart from my teachers Kaltenborn and Evenjth, the main people were the ones that started the orthopedic division of the Canadian system. The first one I ran into was John Olden. And as I mentioned, we knew nothing about orthopedics at school so he was amazed at my ignorance at manual therapy and was so affected by it, that he actually gave me his brand new copy of Textbook of Orthopedics by James Cyriax and that opened my mind like crazy. Then my association with Cliff Fowler, who’s become more like a brother than a friend. From a clinical perspective his innovative soul and mind has really turned me on. And Dave Lamb was probably the biggest influence in teaching and I could listen to him over and over again for hours. It’s his passion to get people to learn and enjoy work. Those three people have probably influenced me the most over my career.
Mark: One of the things that I’ve realized about our profession, is that more and more our worth as professionals is dictated by others not in our profession. Where do you see our profession going because of this trend?
Erl: If I look at the profession internationally, I see a trend where we are going to be unquestionably the next line of medical specialty. I think we’ve got the history, the background, and gradually we’re getting more and more researchers in the field. And our profession as a whole is getting far more scientific. So I actually think we’re getting prepared through our historic development to be the next specialist. And I think our title will be physical medicine specialist.
Mark: Where do some our professionals need to be coming from? Do we need more people invested in the clinical research or perhaps the administrative government side?
Erl: I think we need everything (laughs). Traditionally, physios have lacked PhDs and clinical researchers. I would like to see the PhDs be more clinically directed because sometimes they aren’t. But again, we’ve been very poor in political involvement. I think efforts in Washington show that when PT populace gets involved you can actually change the law and change the way we are viewed as a profession. So I think of those aspects. I think we’re doing extremely well from a clinical, investigative perspective and inventiveness is a strength but I think those are two of our major weaknesses.
Mark: Do you think it’s a product of what our professional educational system? Whenever I take students, I’m often surprised by the limited progression of the education. Do you see that as well?
Erl: Yeah, obviously as a teacher you are aware of the weaknesses of the post and pre-professional systems but I’m also aware of the fact that they have limited time and resources, so they have to try to develop a framework for a physio to be developed. So really when they come out, it’s really unrealistic to expect them to be expert clinicians. I think what we need is to train people that have that…that future to be expert clinicians. So, if there’s anything I’d like to see, it’s an emphasis on biomechanics, because that’s my bias (chuckles).
Mark: Are you familiar with some of the more recent systems like SFMA?
Erl: Yes, I’m familiar with them and for some instances I’ve run into some of these PTs and always been enriched by them because they have a different opinion. But from a change of perspective from a professional, it’s a little too late for me. You know that saying about an old dog learning new tricks (laughs).
Mark: So at this point of your career, what do you feel you have a lot left to do? What is it that motivates you to teach?
Erl: I think when you mentioned about the way my brain works, one of the other features I have is a very three- dimensional mind. And I can see biomechanics, human biomechanics in a three-dimensional perspective. That’s not something that’s shared by a lot of people. One of the things I’ve dreamed about and hopefully when I get less busy in the clinic, is to be able to set up a computerized system of teaching biomechanics in a three-dimensional manner. So if there’s anything left to do, that would be it.
Mark: That’s interesting because when I graduated from PT school, my graduate thesis was a 3D presentation on cervical biomechanics. And this was when 3D animation had just come out and I taught myself how to create short videos on how the cervical spine moved with cervical flexion, extension, sidebending and rotation. I thought that’s where the profession would go as far as the teaching part of it but it really didn’t expand that way. I mean, there have been some programs that have come out with 3D animation but there hasn’t been as much change as I expected.
Erl: No it hasn’t and I think it’s because a lot of people don’t view anatomy and biomechanics in three- dimensional perspective and if you do, you’re very lucky. I think because the vast majority of people still see anatomy in a two dimensional thing from Gray’s Anatomy. That’s one of our biggest challenges. And once we have something that people can utilize, even on the undergraduate level, I think that’s where the interest will be. But I think that people can’t get that view. But you’ve never shown me that.
Mark: Haha, I’ll have to dig that up somewhere. So you’ve been coming here since 2007 when I started taking the level I and you’ve been coming back every year since. What is it about Hawaii that you are so fond of?
Erl: Well, obviously I’ve built up a huge circle of friends in Hawaii over 20 something years. It’s a beautiful place to come but it’s also a nice atmosphere. It’s just been great to be a part of a developing professional culture that is being created in Hawaii, almost the embodiment of what NAIOMT wants. If we could create in the rest of the U.S. what we’ve created in Hawaii, we would be very, very happy. And I’m not just talking financially; I’m talking about from a professional point of view and our impact on the future of the profession.
Mark: Alright, I just have one question left. I love to read and I’m always reading two or three books at a time. What books would be the biggest influences on you? They don’t have to be physical therapy related, just any book.
Erl: (Laughs) Obviously I don’t have any obvious ones ‘cause I can’t think of anything in physical therapy (laughs). But unquestionably, Gray’s anatomy has to be a favorite and I still read that and I still get caught reading that at lunch time. Some of the others, the new books on pain…Dave Butler’s Sensitive Nervous System. And probably I think Diane’s book on her approach to therapy especially about her approach to treating the pelvis. I always like the detective books, books on crime…
Mark: Like Sherlock Holmes?
Erl: Yes, like Sherlock Holmes (laughs).
Mark: Well I want to thank you for allowing me to pick your brain. Hopefully we can do this again.
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Mahalo, 
