Are you a relatively new runner beginning a self-structured running program? If your answer is yes, listen up! A recent study out of Denmark observed 629 novice runners over the course of a year and found some interesting results related to hip strength and knee pain.¹ One of the most common knee injuries among runners is known as Patellofemoral pain (or PFP), and it is a diagnosis that still is not completely understood.¹

PFP is often the diagnosis given if you have pain where your kneecap (the patella) and your thigh bone (the femur) contact. There are many different factors that can be at play in PFP, including abnormal patellar tracking, tight muscles around the knee and weak muscles of the thigh and hip. The group of researchers who published this study sought to investigate whether the strength of hip abductor musculature, the ones that help lift your leg straight out to the side and stabilize your hips when you are standing on one leg as you repetitively do while running, varies among people who do and who don’t end up developing PFP.¹

Now, to the important stuff: the results. After testing the runner’s hip strength before they started their running program and then following up with them throughout the year if they began developing knee pain, the researchers had a large database of information.¹ Upon sifting through all of their data, the researchers found that participants with higher eccentric hip abduction strength seemed to be associated with lower risk for being diagnosed with PFP during the first 50 km (about 31 miles) of their running program.¹ After that distance, there was no significant difference between the higher strength and lower strength groups.¹ This highlights the importance of making sure that your hip strength is adequate in order to potentially forestall knee pain before you begin a new running program if you are new to the sport.¹

Although there are many other factors that could possibly be related to the knee pain, this factor of hip abduction strength is one piece of the puzzle. Make sure you speak to one of our physical therapists if you are embarking on a new running program, in order to find ways to train the hip abductor muscles and get screened for other risk factors for developing Patellofemoral pain.

1. Ramskov D, Barton C, Nielsen RO, Rasmussen S. High Eccentric Hip Abduction Strength Reduces the Risk of Developing Patellofemoral Pain Among Novice Runners Initiating a Self-Structured Running Program: A 1-Year Observation Study. J Ortho Sports Phys Ther. 2015; 45(3): 153-161.

As we wind closer toward Memorial Day and the Iron Horse Bicycle Classic, cycling is on a lot of people’s minds. In respect to preventing injury while you’re training for this race (or even if you’re not!), I came across some interesting information related to resistance training and seat height, and their effects on cycling performance and injury.

One hot topic in cycling is resistance training and whether or not it can help or hinder your cycling performance. A review from 2010 in the Journal of Strength and Conditioning Research set out to look at the effects of resistance training on the performance of elite cyclists, and they were able to assess results from five articles.¹ A summary of the findings indicated that “well-designed resistance training programs” can lessen the reduction of type I muscle fibers and connective tissue, which can ultimately help to reduce injury.¹ The review notes that, although the evidence is limited, a cyclist would benefit most from a resistance training program that involved “explosive” movements at 30-40% of a person’s one rep max, as these movements might be more sport-specific to cycling.¹ Exercises that would fit in this category would be plyometrics, heavier load/low repetition, or Olympic style lifts with the goals of increasing force production and improving performance.1 If you are a cyclist that wants to add resistance training into your current “off-bike” training program, it would be best to consider these types of explosive resistance exercises for making this year’s Iron Horse your best.

Another popular discussion in the world of cycling is what the ideal seat height is for each person. Another recent review from 2011 sought to find out what the effects of seat height were on knee injury risk and cycling performance, as there is much disagreement from scientific and coaching communities regarding this topic.² Without going into the fine details, the main conclusion of the review was that, with the limited evidence they were able to find, the optimal range of knee flexion (or bending) when you have your leg in the “bottom dead center” position while seated on the saddle is 25 to 30 degrees.² This range of knee flexion has been related to lowering the knee joint load and improving your cycling economy (or efficiency) in previous studies.² There are other factors at play when it comes to seat height and proper ergonomics on a bike, and it is prudent to get evaluated by a therapist in order to make sure you are using the most appropriate position for your body.

To all of those folks out there who will be competing in the upcoming Iron Horse Bicycle Classic: good luck and have fun! If we don’t see you in the clinic before the race to make sure that you are doing your best to prevent injury during your training and racing, we will see you on the other side in Silverton!

1. Yamamoto LM, Klau JF et al. The effects of resistance training on road cycling performance among highly trained cyclists: a systematic review. J Strength Cond Res. 2010; 24(2): 560-566.
2. Bini R, Hume PA, Croft JL. Effects of Bicycle Saddle Height on Knee Injury Risk and Cycling Performance. Sports Med. 2011; 41(6):463-476.

As the majority of “baby boomers” enter retirement age, we are seeing more and more people that are eligible for our government’s Medicare benefits come to physical therapy for help with various pain complaints, joint stiffness, and other impairments. In fact, in 2012, Colorado had over 650,000 residents that partook in Medicare benefits, and it’s safe to say that the number continues to grow.¹ As a provider that treats Medicare patients, it is important for us to comply with the various rules and regulations that are ever-evolving in order to provide the most efficient treatments for our patients and clinic alike. One of the most recent changes was the addition of a Fall Risk Assessment as one of the factors that we must address anytime we treat a person who uses Medicare benefits.

The new standard for addressing safety in adults over age 65 requires that a Fall Risk Assessment take place at least once per year. What this means for you, the patient, is that you will be asked about any history of falls in the past year. In this case, a fall is defined as, “a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force”.² If you answer that you have had two or more falls in the past year, the next step involves checking your blood pressure and assessing your balance, as well as assessing your answers to a questionnaire called the Falls Efficacy Scale, which basically asks you to rate your confidence during certain activities.

If it is determined that you are at risk of falling based on our assessment as described, we then have to come up with a plan of care. The most important part is figuring out how we can best help you prevent any future falls! The Medicare guidelines write out that the plan of care must take the following things into consideration: vitamin D supplementation, balance, strength and gait training.³ The great thing about this is that, as physical therapists, we normally would be addressing balance, strength and gait as part of our standard of care, so there is nothing new required from us on this front. However, we will likely be referring you to your primary care physician to discuss vitamin D supplementation, if that is not already part of your medication regimen.

Hopefully you have not experienced any falls in the past year, and none of this would be applicable to you! However, we know that “life happens” and, unfortunately, falling can be part of life for a number of reasons. Please contact us today whether or not you have had a recent fall, to be evaluated by one of our skilled physical therapists as well as to find out what you can do to prevent a fall from occurring in the future.

1. The Henry J. Kaiser Family Foundation. State Health Facts. Total Number of Medicare Beneficiaries. 2015. Available here: https://kff.org/medicare/state-indicator/total-medicare-beneficiaries/ Accessed Mar 11, 2015.
2. American Medical Association. Measure #154 Falls: Risk Assessment – National Quality Strategy Domain: Patient Safety. 2014. Available here: https://www.apta.org/uploadedFiles/APTAorg… Accessed Mar 12, 2015.
3. American Medical Association. Measure #155 Falls: Plan of Care – National Quality Strategy Domain: Communication and Care Coordination. 2014. Available here: https://www.apta.org/uploadedFiles/APTAorg… Accessed Mar 1, 2015.

Whether you are new to Durango or were born and raised here, one thing you learn quickly is that the Iron Horse Bicycle Classic is a big deal in town. The race was started in the 1880s and originally began as a race between the famous Durango Silverton Railroad and a cyclist to see who would could travel faster up to the mining town nestled in the mountains. It has since evolved into a multi-day event, and the race this year is held from May 22nd through the 25th, which also happens to be Memorial Day weekend. The race attracts thousands of cyclists to Durango to see if they can beat the train, as well as celebrate the great sport of cycling through the weekend full of events.

Now that we have rolled into late March, the race is only a little over a couple of months away. As folks get geared up and prepared for beating the train, there are some important considerations to keep in mind regarding appropriate conditioning and training for injury prevention in the sport of cycling. A recent 2012 study out of Spain kept track of injuries in active top-level road cyclists for a period of four years, and they found some interesting statistics based on the group of 51 cyclists that they studied.¹ Only eight of the 51 cyclists stayed injury-free during that time, with an overall 103 cycling-related injuries reported in the injured bikers.¹ Over half of the injuries were overuse injuries, with the other less than half of injuries related to trauma.¹ Of the overuse injuries, just over two-thirds of those were in the lower limbs and about 90% of the overuse injuries occurred during training periods.¹ Looking at those numbers, it is easy to see that the injury risk is high for, even those professional top-level athletes!

Even though the above study did not look at amateur or recreational cyclists, one might suppose that the injury risk translates to this group as well. What that means is that as you cycle on your trainer, at the gym, or on the road as the weather warms up and the recent snowfall melts, it is of crucial importance to figure out what you can do to prevent your risk of injury as you train for the Iron Horse. If you need help figuring out the best things to prevent injury for your body, don’t hesitate to have one of our licensed physical therapists evaluate your risk for injury or address any current issues that you may be experiencing as you ramp up your mileage. Also, look out for an April blog entry where I’ll talk about some specifics regarding seat height, as well as resistance training, in relation to cycling injuries.

And finally, for more information on the Iron Horse Bicycle Classic please go to their website here.

1. De Bernardo N, Barrios C, Vera P, Cesar L, Hadala M. Incidence and risk for traumatic and overuse injuries in top-level road cyclists. Journal of Sports Sciences. 2012; 30(10): 1047-1053.

If you have ever had any experience working with physical therapists, you may have noticed that we come from different practice, education and training backgrounds. Our clinic in particular is made up of a very diverse group, which is helpful in terms of collaborating on our various areas of therapy focus and continuing education. To add to this diversity of training and specializations, I will be sitting for my Orthopaedics Specialist (also known as Orthopedics Specialist) certification examination on March 14th, 2015 in Santa Fe. In the field of physical therapy, specialization was created to formally recognize advanced clinical knowledge, skills, and experience.

To be eligible to sit for this specialist examination, one is usually required to have three years of experience, with at least 2,000 hours spent in Orthopaedic Physical Therapy. I have fast-tracked this process. However, by completing an American Physical Therapy Association (APTA)-accredited post-professional clinical residency with a focus on Orthopaedics. This residency program, which I completed at the University of Utah, was a year-long program in which I worked with patients for 30 hours a week, and spent another 10-30 hours per week involved in didactics, weekly mentorship, specialty observations in niches of Orthopaedic care, clinic observations with Orthopaedic and physical medicine and rehab (PM&R) MDs, and assistant teaching in the Doctoral Physical Therapy program. Needless to say, I was very busy! However, the amount of opportunities that I had to learn and practice more in the world of Orthopaedic Physical Therapy were bountiful, and I walked away from that program with improved clinical reasoning skills and a much larger knowledge base than when I started.

Sitting for the Orthopaedics Specialist certification examination is the culmination of my year of blood, sweat, and tears (okay, maybe not so much blood) in the residency program. I am excited to have this test under my belt and, with a passing score, earn my specialist certification and add three more letters of accreditation to my name (OCS). Upon receiving notification of my passing in June, I will be joining Ellen as the second specialized PT currently in our clinic.

If you see me in the clinic before March 14th, wish me luck! If you want to be evaluated by one of our specialized and diverse physical therapists, please call us to schedule your appointment today.

As the temperatures start dipping, many people turn indoors for their fitness and recreation. One way to get a great workout indoors is by playing racquetball, which is a sport that about 5.3 million US citizens play every year.1 As anyone who has played racquetball knows, it can be a sport that provides a great cardiovascular workout in a competitive manner. With any participation in a sport, however, comes the risk of injury, especially if you are not conditioned well going into it. Having the right equipment and knowledge before getting onto the racquetball court may be beneficial to make sure you are ready for this winter-friendly sport.

There are certain equipment measures you can take in regards to preventing an injury in racquetball, such as wearing protective eyewear, having appropriate racquetball shoes, and of course having an appropriately-sized and well-maintained racquet.^1,2 Other things to consider are the technique of your swing as well as making sure you are appropriately warming-up and cooling-down before and after you play.^1,2 I’m no racquetball aficionado, so I’ll leave the technique aspect of this sport to the experts.

However, as a physical therapist, I have a lot of experience dealing with overuse injuries and discussing ways to prevent them from happening in a racquet sport. One of the most common racquetball injuries is lateral epicondylalgia, otherwise known as “tennis elbow”². Even though there are differences between racquetball and tennis, the mechanism of injury is hypothetically the same. One of the more common theories of the cause for lateral epicondylalgida is that if the size of racquet handle is too small or too big, your wrist extensor muscles that attach (via tendons) to the outside of your elbow can end up being overstressed, causing physiological issues which can lead toward this common type of pain.² Making sure you have the appropriate sized handle is an easy way to prevent injury in this sport. Also, one of the more common causes of tennis elbow has been reported to be using a one-handed backhand swing as well as having an excessive wrist snap during your swing.2 To prevent irritation of these tendons, a two-handed backhand is recommended, as well as avoiding too much flexion of your wrist while you are swinging the racquet.²

Another important aspect of preventing lateral epicondylalgia because of overuse is to look up the chain to the shoulder and make sure that you have adequate flexibility and strength of the muscles there, especially in the rotator cuff.^1,2 A good physical therapist will want to evaluate your shoulder as well as your neck when you come in with elbow pain. But why look at those joints if they don’t hurt? Because, the shoulder and neck can oftentimes be the true sources of the problem that caused your elbow to hurt in the first place, so it’s always worth a look to rule them in or out as a part of the whole picture.

Whether you are already an avid racquetball player with or without pain, or you are thinking about picking up racquetball as a way to stay fit indoors this winter, call us a Rakita Tomsic Physical Therapy to schedule an evaluation to assess your readiness to start this high intensity sport or troubleshoot ways to decrease any aches and pains you may currently be experiencing.

 

1. Mitchell T. What a racquet! Racquet sports injury prevention. Working Well. https://www.working-well.org/articles/pdf/tennis.pdf, Accessed November 20, 2014.
2. Mitchell T. What a racquet! Racquet sports injury and treatment. Working Well. https://www.working-well.org/articles/pdf/tennis_2.pdf, Accessed November 20, 2014.

One of the common questions that I start to get from patients this time of year is, “Will I be able to ski when the season starts?”, which of course has a varied answer depending on each person and their type of injury. As our thoughts turn to snow, it’s important to think about readiness to ski whether or not you are being treated for an injury. Last year, in my pre-Rakita Tomsic PT days when I was an orthopaedic resident at the University of Utah, I was lucky enough to be an instructor in a fun, dynamic, and challenging ski fitness and conditioning class. I was able to learn a lot as an instructor for that program, mostly in what types of activities are necessary to be adequately prepared going into the ski season.

An injury to your anterior cruciate ligament (ACL) of your knee is one of the more common snow sport injuries. In fact, there are estimated to be more than 20,000 ACL injuries each year in the US that are associated with skiing and snowboarding.1 Because the incidence of this type of injury is so high, there has been a lot of research devoted to prevention. This research has been a great help in the world of physical therapy so that we can provide accurate and effective guidance on how to prevent an ACL-injury if you haven’t had one (or prevent re-injury or injury to the other leg if you have already torn your ACL!).

One of the things that interests me most is what type of elements are essential for a quality injury prevention and conditioning program. Based on the research, here is a breakdown of what types of exercises should be included^2,3,4:

• Aerobic Activity: this includes anything from cycling, running, rowing, stair-climbing, and swimming. Basically, anything that gets your heart rate and breathing rate up to a good, aerobic level.
• Strengthening: it is important that all target muscle groups in the upper and lower body are addressed with strengthening exercises. This doesn’t necessarily mean that you need to be on the machines at the gym, as there are many ways to effectively strengthen your muscles at home without any fancy equipment.
• Core Strength: the “core” is a group of muscles from your pelvic floor and hips up to your diaphragm at the bottom of your rib cage. Strengthening of all of the muscles (and not just your “six-pack”!) is an important component of ski conditioning.
• Plyometric Exercises: jumping, jumping, and more jumping. Plyometrics are a dynamic form of exercise that focuses on all types of muscle contractions in order to build more strength and power.
• Agility Training: quick movements and adjustments are crucial for improving your reaction time, especially when you are on the slopes.
• Balance Activities: try standing on one leg in a safe place, first with your eyes open and then with your eyes closed. For most people, this is not quite as easy as it sounds! The nice thing about balance is that you can train it, but it does require a lot of practice on your part.
• Flexibility: don’t forget about your stretching! Different types of stretching before and after activities are another effective component of a good ski training program.
• Education: this one is the easiest, because you are doing it right now! Education on the things you can do to improve your readiness to ski this season is one step in the right direction toward an effective injury prevention program. Further education on alignment principles and other tools you can use to incorporate all of the other components of a well-designed injury prevention program is where physical therapy can enhance this even further. We would love to see you in the clinic to assess your current conditioning program and further educate you on what you can do to make it even better in order to effectively prevent an injury this ski season.

1. Vermont Ski Safety. Tips for Knee Friendly Skiing. https://www.vermontskisafety.com/kneefriendly.php. Accessed September 16, 2013.
2. Bien D. Rationale and Implementation of Anterior Cruciate Ligament Injury Prevention Warm-Up Programs in Female Athletes. J Strength Cond Res. 2011; 25(1):271-85.
3. Myklebust G, Steffen K. Prevention of ACL injuries: how, when, and who? Knee Surg Sports Traumatol Arthrosc. 2009 Aug:17(8):857-8.
4. Sadoghi P, von Keudell A, Vavken P. Effectiveness of Anterior Cruciate Ligament Injury Prevention Training Programs. J Bone Joint Surg Am. 2012; 94:769-76.

Although snowboarding can be sometimes thought of as a “relatively new” sport in comparison to alpine skiing, the number of snowboarders in the USA has been rising steadily and catching up to skiers. During the 2012/2013 season, there were an estimated 7.3 million snowboarders compared to 8.2 million skiers at US resorts.¹ However, even though the number of total snowboarders is behind skiers, the rate of injury in snowboarders is two to three times higher than in skiers and has been reported to be between 1.16 and 4.2 injuries per 1,000 snowboard days.¹

So, what types of injuries are snowboarders sustaining? A recent study brings up that, in regard to the types of injuries that can occur while snowboarding, there seems to be a difference depending on your skill level (e.g., beginner versus elite snowboarders).¹ The study reports that beginner snowboarders are more likely to injure their upper extremities, especially their wrists and heads, while more experienced snowboarders are susceptible to lower extremity injuries that are typically more severe in nature.¹ One of the biggest differences between these two groups is the mechanism of injury: beginner snowboarders are more likely to be injured during an isolated fall while elite snowboarders tend to sustain injuries while landing from high amplitude jumps.¹ With these higher-impact landings, the joints and bones in your legs have to absorb more of the force, which is why it makes sense that elite snowboarders injure their ankles and knees more often than beginner snowboarders.¹ The study also found that goofy stance riders need not fret, as there was no difference in regular versus goofy stance in terms of injury rates.¹ However, it is interesting to note that, regardless of which leg you have forward, the leading leg is more likely to be injured if you happen to sustain a leg injury.¹ Why that is the case is still yet to be determined.

Now, knowing that snowboarders are susceptible to all kinds of injuries which vary somewhat according to skill level, the big question is what to do to avoid injuring yourself while riding? One of the most obvious answers, especially for beginner athletes, is to make sure you wear a helmet and wrist guards when you get out on the hill.^1,2 According to a recent systematic review, the other important factors besides using safety equipment in snowboarding injury prevention include education and knowledge, awareness and behavior associated with risk, experience, and third-party involvement (e.g., the ski patrollers on the hill taking initiatives to educate riders on safe riding practices).² This review made a special point to acknowledge the fact that there is a paucity in research that looks at the effectiveness of specific exercise and conditioning in order to prevent snowboarding injuries even though it is reasonable to assume that improved physical fitness and strength can help you be more prepared before you hit the slopes.²

As physical therapists, we thrive on being able to identify exercises and training routines that will help our patients feel more confident as they head out into their favorite recreational activities, including snowboarding. Although there is no specific research pertaining to snowboarding injury prevention and exercise, we can use our experience to come up with an appropriate training and conditioning program based on each person’s individual needs and injury history. Here at Rakita Tomsic Physical Therapy, we would love to see you as this season gets underway so that we can help you come up with the best individualized program with the end goal of being safe and having fun on the hill this winter.

 

1. Wijdicks CA, Rosenbach BS, Flanagan TR, Bower GE, Newman KE, Clanton TO, Engebretsen L, LaPrade RF, Hackett TR. Injuries in elite and recreational snowboarders. Br J Sports Med. 2014;48:11-17.
2. Hebert-Losier K, Holmberg H-C. What are the Exercise-Based Injury Prevention Recommendations for Recreational Alpine Skiing and Snowboarding: A Systematic Review. Sports Med. 2013;43:355-366.

This time of year, when the sidewalks and roads tend to become ice-covered after recent snowfalls and colder temperatures, our attention turns towards falling and especially the risk of falls in older adults. A study in Sweden, the land of ice and snow for a good portion of the year, found that over 50% of traffic-related injuries in adults over 60 years old were associated with a slip and fall and that females were more likely than males to slip.¹ Falls have a huge effect on our health care system, as they can often result in debilitating injuries that may lend toward secondary impairments of loss of independence or even death.² This is why it is imperative for all people, but especially adults over 60, to think about fall prevention when you are out facing the grocery store parking lot or trying to cross the street whenever there may be ice or snow on the ground.

One type of training that can be done to reduce your risk of fall is called perturbation training.² Merriam-Webster defines perturbation as, “a disturbance of motion, course, arrangement or state of equilibrium.”³ In physical therapy, we use perturbation for many different purposes, but it is especially important during any fall prevention training. With this type of training, the central nervous system adapts both proactively and reactively to control your stability and resist a fall.² These adaptations can happen fairly quickly and sometimes even within a single training session.²

A recent randomized control trial sought to find out how well perturbation training in a lab translated to actually decreasing fall risk in older adults over the span of a year. Participants were hooked up to a harness system on treadmill that was designed to induce “slips” and were monitored to assess their ability to recover from these perturbations.² One group was only subjected to one “slip”, whereas the other was subjected to 24 “slips” within a single session.² After monitoring the amounts and types of falls that these groups sustained during their daily lives over the next year, the researchers found that the group that was trained with multiple “slips” was able to significantly reduce their falls by 50% in contrast with no significant change in the group that only experienced one “slip” in the laboratory.² The evidence also suggested that the perturbation training had a more profound effect on participants that had a history of a falls versus those that didn’t.²

These types of high-quality studies are important because they reinforce the types of training that can take place in physical therapy in order to reduce a person’s risk of falling, and they show that this training can be done rather efficiently. Although we do not have a fancy laboratory with a treadmill designed to induce slipping, this type of training is easily performed within the clinic and can be of great benefit for people of all ages but especially if you are 60 or older. If you have experienced falls in the past or are feeling wary about your ability to stay upright on those icy days, schedule an appointment with one of our qualified physical therapists to begin perturbation training and reduce your fall risk. Remember, don’t take it personally if we give you a nudge or shove to test your balance in the clinic: we are just looking out for your well-being!

1. Gard G, Lundborg G. Pedestrians on slippery surfaces during winter- methods to describe the problems and practical tests of anti-skid devices. Accident Analysis and Prevention. 2000;32: 455-460.
2. Pai Y-C, Bhatt T, Yang F, Wang E. Perturbation training can reduce Community-Dwelling Older Adults’ Annual Fall Risk: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2014 December;69(12): 1586-1594.
3. Merriam-Webster. Definition of Perturbation. 2014. Available at https://www.merriam-webster.com/dictionary/perturbation, Accessed December 17 2014.

 

With the end of 2014 comes the end of an era for physical therapy in Durango. Dave Rakita, PT, OCS, Cert. MDT, is retiring as of January 1st, 2015. As Durango’s longest practicing Physical Therapist, we are all going to miss him and his wealth of experience here at Tomsic Physical Therapy. His contributions to the Physical Therapy profession and to the Durango community have had a positive impact on many.

To prepare for his upcoming retirement, we had a Q&A session to get his thoughts on retiring from this great profession.

How long have you been a PT in Durango?
42 years, since December of 1972.

What have you enjoyed the most about working with the Durango community?
The accessibility and friendliness of the medical and physical therapy providers in town. Also, the active outdoor Durango lifestyle has been enjoyable, as well as the patients that come along with that.

What will you miss most about your daily work as a physical therapist?
The contact with patients to help them solve their problems and treat their injuries as well as the intellectual challenges in determining the best course of physical therapy treatment for each patient.

What do you plan to do to fill up all of your “free time” after you retire?
Home projects, triathlons, travel, hike the Colorado trail in segments, volunteer more in the community, and organize a triathlon at Lake Nighthorse if we can get access.

Is there anything else that you would like to share as parting words before you retire?
I feel very fortunate to have been able to partner with Ellen Tomsic for these past 10 years. She has added countless dimensions to the practice that I could not. She will continue to successfully guide the practice in the coming years to provide the best possible care. Working together has been a most fulfilling experience.

I have enjoyed the academic and professional growth of the physical therapy profession during my years of practice, as our profession has become more autonomous. It has been encouraging to see specific research becoming more prevalent, and providing objective data to health care providers and the general public demonstrating the value of physical therapy.

We all wish Dave the best as he embarks on new adventures as a retiree, and we look forward to seeing him in and around the community as he continues to enjoy all that Durango and the nearby mountains have to offer. Good luck in retirement, Dave!