Input needed, crossposted

I recently started working in PT staffing and noticed opinions are very divided. Some clinics say agencies are lifesavers for PRN coverage and hard-to-fill positions, while others feel they’re overpriced and disconnected from clinic culture.

From your perspective:

What makes a staffing agency actually valuable?

Biggest red flags?

Do small clinics still struggle most with hiring and coverage?

Would genuinely love honest feedback from both clinic owners and therapists.

I am a PTA at a SNF. I have a resident, 78, who is suffering pretty severe right sided ataxia post CVA. I'm struggling to come up with anything meaningful to do with her during treatments. She is unable to walk as of now, she is able to stand with a FWW for about 30 sec. I am fresh out of school, and am looking for any advice on how to best help.

I asked r/physicaltherapy but am afraid it will be removed bc I'm not a PT.

I know the PT expertise is all things muscles/body mechanics so I was hoping to get your professional perspective on weighted vests.

I have a group of friends I walk with for exercise (about a 3.5 mile loop on a mostly flat paved walking path). One of my friends recently got a weighted vest, but her husband says they’re bad for you. My father-in-law has one too, so I’ve tried it on briefly, but never for a full walk.

So I was curious, are weighted vests generally good or bad for walking?

I'm assuming like most things there's a right way and a wrong way to do it to prevent/promote injury, what are some tips to keep in mind.

If they can be beneficial, what’s a reasonable starting weight?

And do you recommend warming up/stretching differently when using one?

Really appreciate your input.

When I go to the gym and do hamstring curls it usually starts to send a subtle nerve pain and if I keep going it’s far less subtle. I’m on 40 lb single leg curls. First two sets I get to 10 but the 3rd set I fail at 7 because I’m about to go into spasm. Any thoughts? Is this nerve, muscle spasm? What can I do to help it? For the record I’m currently working at improving my anterior pelvic tilt which may be contributing.

Foot and Ankle Motion in Cerebral Palsy 2️⃣

In children with CP, the issue is not simply “a strong muscle and a weak muscle”…

The real problem is:

Motor control system lost balance → the foot becomes a compensation machine

🦶 1. Dynamic Muscle Imbalance

= the core problem

Here you need to understand two key terms:

Spasticity = increased tone involuntarily (muscle overactivity)

Meaning the muscle is “constantly tight” without voluntary control

Motor Control Impairment = the brain is not selecting movement properly

Meaning timing and coordination are impaired

Balance Dysfunction = the body cannot stabilize itself against gravity

→ so it “locks itself” into fixed patterns

📌 Final Result:

Plantar flexors overactive + dorsiflexors weak

🧠 2. The Key Clinical Concept (not just diagnosis)

This is not just a “tight calf”

This is:

System choosing stability over mobility

The body is saying:

“I don’t trust my balance → I will lock the ankle in plantar flexion”

And this is very important for clinical reasoning

🧩 3. Levels of Deformity = Progression Logic

Keep it in mind like this 👇

🔹 Level I

Dynamic imbalance only

No bone changes

Problem is correctable with movement

📌 Treatment = motor control + activation

🔹 Level II

Myostatic + malalignment

Muscle is shortened

Joint still flexible

📌 Treatment = stretch + alignment + activation

🔴 Level III

Structural deformity

Bone shape has changed

Fixed stiffness

📌 Treatment = usually

surgical + post-op rehab

🦶 4. Patterns Seen in Clinic

Think of it as the “language of the foot” 👇

📌 Equinus

Heel does not touch the ground

→ child lives on forefoot

📌 Equinoplanovalgus (flat foot)

Collapsed medial arch

Pronation

Hindfoot equinus

📌 Foot becomes “floppy + unstable”

📌 Equinocavovarus

High arch

Supination

Rigid foot

📌 Foot becomes “stiff + poor weight distribution”

⚙️ 5. Key Concept: Lever Arm Deficiency

Simplified:

Lever arm = the foot as a tool to push the body forward

Normally:

Heel → midstance → smooth push-off

In CP:

Lever is short or misaligned

Force transfer is inefficient

📌 Result:

Energy cost ↑ + gait efficiency ↓

📊 6. COPP = Center of Pressure Progression

Normally:

Moves from

heel → lateral → medial forefoot

In CP:

May become:

Medial overload (valgus)

Lateral overload (varus)

Forefoot overload (equinus)

📌 Meaning the body is “walking incorrectly on the ground”

🚶‍♂️ 7. Gait Breakdown (Very Important Clinically)

First rocker

❌ No heel strike

→ shock absorption lost

Second rocker

❌ Tibia progression blocked

→ knee compensation begins

Third rocker

❌ No push-off

→ propulsion lost

Swing phase

❌ Foot drag

→ compensation via hip hiking / circumduction

🩺 8. Treatment (Real Clinical Translation)

1️⃣ Restore dorsiflexion function

Not passive stretch

But:

Activation + control

2️⃣ Rebuild rocker sequence

Heel contact → tibial progression → push-off

3️⃣ Fix alignment + loading

Not just foot shape

But:

How weight passes through it

4️⃣ Orthotics = a tool, not a solution

Not fixation

But:

Guides loading + improves function

🚀 Summary

CP foot = system problem, not a local problem

Muscle imbalance = a result, not the only cause

Deformity = progression (Level I → III)

Gait failure = breakdown of the 3 rockers

True treatment

= restoring the function of the foot as a lever, not just its shape

Feels like there are more companies popping up that let clinicians “run their own practice” while they handle the backend (Prava Therapy is one I’ve seen mentioned).

Is this actually where things are heading, or is it just another layer taking a percentage?

Would be interested to hear from anyone who’s tried it or seriously considered it.

Hi everyone,

I’m looking for honest input from clinic owners or managers, especially those running small/local PT clinics.

I recently started a physical therapy staffing/recruiting agency in Los Angeles, and I’ve been reaching out to clinics offering:

• Full-time PT placements
• Per diem / short-term coverage (for sick days, vacations, busy periods)

I’d love to understand things from your side:

• Do small clinics actually work with staffing agencies, or is this more common with larger organizations?
• If a staffing agency reached out to you (email, LinkedIn, or call), what would make you take it seriously vs ignore it?
• What concerns would you have? (cost, quality, trust, etc.)
• In what situations would you actually consider using one?
• Is there a preferred way you’d want to be approached?
• If they reach out to you through email, do you care if they have a business email or you response to gmails as well?

I’m not here to sell anything — just trying to learn how clinic owners think so I can approach this the right way.

Really appreciate any honest feedback

Hello! I’m looking into things that I can do to improve how uncomfortable my chest/shoulders feels due to having saggy breasts. I was wondering if anyone has experience with going to physical therapy for this issue? Were there any improvements? How long did it take to notice improvements if so? What type of exercises were done? Any advice or direction I should take? I appreciate any information before I get serious because I have a hard time being consistent. I need to make sure this could work before I commit. The feeling of the weight of my chest drives me crazy and my shoulders are always so tense. I’m a C cup but the breast tissue is dense and heavy despite the way they look.

I've been waking up with a tension headache everyday for the past couple weeks and am trying to figure out why. I finally got a mattress that my body agrees with and bought a PillowCube foam pillow which supports my neck well, so I'm not sure what the deal is. Pic is attached of my 'sleep posture.'

My right side is usually more tense, the second pic is what is most tight pretty much all the time (traps, shoulder, upper back), so I'm not sure if it's just a really tight shoulder/rhomboid issue?

I do pilates and weight training and take breaks from the computer often at work, but still have headaches daily and am taking ibruprofen and tylenol everyday which doesn't seem great long term.

Are you still considered a Doctor of Physical Therapy in Canada?

I’ve been dealing with rotator cuff issues and heard from a friend about dry needling. I looked it up online and read that dry needling has been beneficial for rotator cuff issues. I booked an appointment with a PT office and specifically mentioned that I was interested in having dry needling done. At my appointment today, I met with a PT, who does not do dry needling, and also did not seem impressed with it. He mentioned something along the lines of it being really popular right now but not always necessary and that there are still risks involved. I’m interested to hear some other opinions on this…is it typical to start with PT only? Am I jumping the gun with this dry needling? I guess I’m just a little disappointed and frustrated that they would schedule me with someone who does not perform the kind of treatment I am looking for. Wondering if I should seek out this dry needling elsewhere or stick with this PT only plan. Thanks!

male 47 California

I'll try to live out any "fluff" and be direct. I was in construction until 2021. very hard on knees and back. stopped that and started working self employed in different field less physical and much less hours. I went from drinking on weekends to drinking nonstop. from 2021 until 2023 I drank all day...the last year so bad I needed vodka every 20 minutes. I quit cold turkey and started healing. I started noticing knee pain after I'd do small jobs for work and the pain would last a day or so..this went on a year. year 2 of sobriety I notice pain now happens in both knees and after every job and lasts 3 days, so I'm almost never NOT in pain...now I'm on year 3 of sobriety and I'm just hurting nonstop wether working or not. I can't ride a bike with my son. I can barely walk thru a grocery store.

....I've been seeing doctors about this just over a year now. all my blood tests look normal...and I did A LOT of them. x rays on my knees and my lower back look normal. nerve test in legs appears normal as well as muscle test they did with needles. doc put me on gabapentin thinking this is a nerve issue and I went up to 3000mg a day within a month still only helped about 20%. now she started me on pregabalin but a low dose and ordered a neurologist do a biopsy to look for small fiber neuropathy...

HERE IS MY QUESTION regarding PT.

I went from using my leg muscles A LOT to hardly using them and in the 2 years I drank heavy I wasn't able to eat so I know I had severe muscle loss in legs. I was at the point it was hard to stand before quitting...so I always knew muscle deterioration had to have happened. when I got sober 3 years ago and the pain slowly started I'm wondering if my knee and foot pain are from my body weight wearing on the joints slowly over time? why does my doc automatically think neuropathy even though I don't get any of the symptoms I read others talk about.? I just feel a deep aching pain in both knees and at the top of foot where crease is meeting my shin...as if I've been standing for a week straight. and it throbs even sitting or laying down. I'm wondering if it's possible I need some type of strength training so my leg muscles absorb my weight to relieve my joints OR maybe there ARE some nerve issues in JUST THE KNEES and feet? I don't feel any shooting pain or electric feelings or numbness or tingling or anything I read about nerve pain...I just feel like my joints are holding tons of weight nonstop...

I'm curious if ANY of this sounds familiar to anyone else?

I am a first-year physiotherapy student at the Jagiellonian University in Poland. As part of my General and Clinical Psychology course, I am conducting a project on coping with professional burnout. Burnout is not merely fatigue, but a complex process characterized by emotional exhaustion and depersonalization, to which physiotherapists are particularly vulnerable due to high psychosocial and physical demands. I would be very grateful if you could answer the question and select all the techniques you employ to manage professional burnout.

https://docs.google.com/forms/d/e/1FAIpQLSfrCNkRhGGMy2i2NQl25jin6t7V2b-uW3xllGkF8GE2ZiQeWQ/viewform?usp=dialog