Resident Member Profile: Brandon Messerli, DO

Name:   Brandon Messerli, DO
Undergrad:  University of St Thomas
Medical School:  Ohio University College of Osteopathic Medicine
Graduation Year:  2007
Internship:  University of Washington
Residency:  University of Washington

Q: What is your hometown?  Minneapolis, Minnesota
A: What first attracted you to Physical Medicine & Rehabilitation?  The care requires the most comprehensive understanding of not only the patient’s medical conditions, but also their functional, vocational, social, and psychological factors.  We truly address quality of life issues more than any other specialty.

Q: Why did you chose your residency program?
A: I applied to UW because of it’s reputation and location.  I chose UW because my interview day gave me a strong sense that the residents were happy, were very well trained and scoring at the top in the Boards, and were going on to top-notch jobs and academic positions.

Q: Why did you join AOCPMR?
A: As the health care industry is undergoing major reforms, advocacy is more important than ever to ensure Physiatry and Osteopathy maintain and gain recognition by the various parties.  Advocacy can only happen with strength, numbers, and money.

Q: What is one goal you have for AOCPMR in the coming year?
A: Allocation of resources and reimbursement is increasingly being linked to proven achievement of quality health outcomes.  We need to advocate to Congress that Physiatry has a pivotal role in developing and implementing these improved quality health outcome measures for clinical practice, and subsequently prove that our care helps patients achieve these outcomes.

 

Journal Club- August 2011: The treatment of acute low back pain- bed rest, exercise, or ordinary activity?

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Acute low back pain is one of the most common reasons for consulting a primary care physician in the industrialized countries. The direct cost of medical care and the indirect costs to society of absenteeism from work due to backache are huge. Physicians commonly prescribe bed rest for acute low back pain, although only a few controlled trials have assessed its effectiveness. Among military recruits with acute low back pain, bed rest led to more rapid recovery than remaining on foot. In a family practice, patients presenting with acute low back pain did not benefit from either bed rest or isometric flexion exercises. Two days of bed rest produced as good clinical recovery as did seven days of rest and, moreover, was associated with fewer days lost from work. In patients with acute low back pain, back-extension exercises were superior to education about back care, but a study comparing exercise therapy with placebo found no difference.

The controversy persists over the relative merits of bed rest and exercise in the treatment of acute back pain. Many leading experts suggest two days or less of bed rest, whereas others advocate back-extension exercises. The present study was designed to compare bed rest with rapid mobilization in the management of acute backache. We conducted a randomized, controlled trial of the effectiveness and costs of two days of bed rest as compared with those of light back-mobilizing exercises in patients with acute low back pain. A third group of control patients was advised to avoid bed rest, not to engage in mobilizing exercises, and to continue normal activity to the extent that they were able to tolerate it.

Article title:
THE TREATMENT OF ACUTE LOW BACK PAIN - BED REST, EXERCISES, OR ORDINARYACTIVITY?

 

Authors:
Antti Malmivaara, M.D., Ph.D., Unto Häkkinen, M.Sc., Ph.D., Timo Aro, M.D., Ph.D., Maj-Len Heinrichs, R.N., Liisa Koskenniemi, M.D., Eeva Kuosma, M.Sc., Seppo Lappi, M.D., Raili Paloheimo, M.D., Carita Servo, M.D., Vesa Vaaranen, M.D., Ph.D., and Sven Hernberg, M.D., Ph.D.

Journal/Source:
N Engl J Med 1995; 332:351-355

Discussion:
Acute low back pain is one of he most common primary care physician consults in industrialized countries.  This study looks at three modalities for treatment: bed rest for two days, back extension exercises, and continue with ordinary daily activities as tolerated as the control.  Most experts suggest up to two days of bed rest, while others advocate for extension exercises.  Here, a randomized study was performed to evaluate the most cost effective method for treating acute low back pain.  The findings were that having the patients continue with ordinary activities within their limit of pain lead to more rapid recovery at both three and 12 weeks from the initial visit, in terms of missed days from work, the ability to work, and tolerance for back flexion.

Questions:
What were the exclusion criteria for the study?
Even though the study was randomized, how were the groups different?
In what spinal pathologies would you prescribe flexing exercises, and when would you prescribe extension exercises?

Reviewer:
Richard C. Swedarsky, OMS-IV, NYCOM, Educational Committee Co-Chair, AOCPMR Student Council

Attending Physican Member Profile: Jose S. Figueroa, DO

Name: Jose S. Figueroa, D.O. (Joe)
Undergraduate: Iowa State University (graduated 1989)
Medical School: Des Moines University (graduated 1995 after doing an OMM Fellowship)
Internship: Des Moines General Hospital (no longer in existence)
Residency: Michigan State University
Additional Degree: NMM/OMM Board Certification, since 2005

Additional Training:

  1. Teaching Fellowship during my senior year of Residency
  2. Myofascial Trigger Point Injections
  3. Prolotherapy Injections
  4. Specific Exercise Prescription as an adjunct to OMM

Q: What first attracted you to Physical Medicine & Rehabilitation?
A: The specific nature of the specialty to focus on FUNCTION via the neuromusculoskeletal system.

Q: Do you practice a specific specialty?
A: PM&R and OMM

Q: Why did you join AOCPMR?
A: I would love to help in the training of D.O. PM&R physicians, physicians in training and students. I would also love to promote the use of OMM in the PM&R practice.

Q: What do you love about belonging to AOCPMR?
A: The networking with colleagues, the training sessions and the ability to contribute through teaching.

Q: What do you like to do in your free time?
A: Spend time with my family (wonderful wife and wonderful 5 children), spend time learning and teaching about my relationship with God, spend time practicing and teaching a martial art (Choi Kwang Do; which is great for practical self defense and health), play harmonica with different bands.

 

Resident Member Profile: Shounuck I. Patel, DO

Name: Shounuck I. Patel, DO
Undergraduate: The George Washington University – Bachelor in Business Administration
Graduate School: Drexel University – Masters in Medical Science
Medical School: Midwestern University – Chicago College of Osteopathic Medicine
Internship: Northshore-LIJ/ Plainview Hospital, Plainview NY
Residency: UMDNJ-NJMS/ Kessler Institute for Rehabilitation

Q: What is your hometown?
A: Kendall Park, NJ

Q: What first attracted you to Physical Medicine & Rehabilitation?
A: Entering medical school, I was originally interested in Neurology and Psych. As I learned about and became intrigued with Osteopathy and the musculoskeletal system. I was torn between the mind and the body until I found out about PM&R which embodied the best of all worlds. With an interest in business, the interdisciplinary nature of Physiatry was attractive. The cutting edge of medical technology in the field added excitement. But what solidified it for me was the majority of the patient population that is unique in its motivation for recovery, be it for returning to sports or reintegration into society.

Q: Why did you choose your residency program?
A: UMDNJ-NJMS/Kessler is simultaneously a challenging and rewarding program. We have a vast array of experiences ranging from our several MSK/pain/EMG rotations with renowned attendings (including two VA locations), to Children’s Specialized Hospital (filled with zebras), to the freestanding Kessler Institute (which is a model SCI and TBI system). And though my interests remain fairly steadfast in the musculoskeletal arena, I wanted to get as thorough an education as possible in all aspects of physiatry.

Q: Why did you join AOCPMR?
A: Although my residency program has a lot to offer as aforementioned, it is not perfect. All of my attendings thus far have been accepting and even enthusiastic about OMT, but none of them are DOs. And since I am a firm believer that Physiatry and Osteopathy are intimately related both conceptually and practically, I joined AOCPMR to foster that bond in myself and our communities. The AOCPMR provides the perfect opportunity to cultivate the Osteopathic tenants that resonate through PM&R.

Q: What is one goal you have for AOCPMR in the coming year?
A: The goal that I am going to strive for is to strengthen our benefits for our resident membership.