---

Background

My love for running and fitness is what originally sparked my interest in health science and, eventually, physical therapy.  As I started to shadow physical therapists (PTs) during my undergraduate degree, I grew more passionate about the field.  After being accepted to and beginning my education at UNC’s DPT program, my understanding of the populations PTs could serve grew. As I’ve come to learn how physical therapists can help people in a variety of settings with different abilities and concerns, I have also gained awareness of the gap between who PTs can help and who actually receives PT treatment.  My personal connection with running and my desire to improve my educational skills inspired my capstone. After seeing many friends and my younger self initially refer to orthopedic doctors for running-related issues, I wanted educate runners on the role physical therapy can play in their running careers.

---

Statement of Need

In all 50 states, D.C. and the U.S. Virgin Islands, physical therapists are granted some form of direct access, though policies vary by state creating barriers.¹  For decades, PTs have served as musculoskeletal (MSK) primary care providers in the military, resulting in decreased utilization of medication and imaging and increased return to duty rates.²  Though there is a lack of research studying PTs serving the civilian population in the U.S., PTs can diagnose, treat, and refer patients as needed, providing more efficient and cost effective care.³  Unfortunately, widespread inadequate education across health care providers and consumers has hindered PTs from being the initial provider for MSK issues.  Runners are a population that may benefit greatly from direct access to physical therapists.  Runners experience a high incidence of lower extremity injuries, ranging from 19.4 to 79.3%.⁴  With its easy accessibility, running is a very popular physical activity and one of the most efficient ways to improve physical fitness.⁵  If runners were better informed on the role of physical therapy, they could access PTs as needed, optimizing their health and movement patterns.

---

Learning Objectives

Create product(s) that

• Assist runners in identifying running-related deficits
• Inform runners about the profession of physical therapy
• Inform runners physical therapists can be seen direct access
• Improve runners’ confidence that physical therapists can provide effective care for musculoskeletal-related injuries and will appropriately refer out if necessary

---

Product Links for Runners

• Flyer: https://drive.google.com/file/d/1Wk72BR3VWTKzwPnYHl2RJVJ-S9wRl0YN/view?usp=sharing
• Movement Screen: https://www.youtube.com/watch?v=wY2TfUfK5iQ
• Glute Medius Exercise: https://youtu.be/fFZPNBxczlU
• Calf and Hamstring Stretches: https://youtu.be/Gr5xIdEqgEA
• Lunge Coordination Exercise: https://youtu.be/zd-seg9ZW7U
• Handout: https://drive.google.com/file/d/1Y7aIzz1rwQ2AWlTwU5wM7YhWPhUgdk76/view

---

Evidence Tables for Clinicians

Evidence Table 1: Direct Access Physical Therapy

https://drive.google.com/file/d/1_F1nuiTCPfqfbcPJSaJWa336h2-PA5lO/view?usp=sharing  

Clinical Bottom Line

Though more research is needed in civilian populations in the US, there is limited evidence in varying medical populations suggesting PTs and medical doctors agree on diagnosis and treatment choices for musculoskeletal injuries.  If PTs are accessed initially, treatment may be more efficient and avoid unnecessary use of imaging and medications.  Additionally, this could alleviate demand and decrease wait times of orthopedic and primary care physicians, improving the quality of the patient care.  Additional research is needed to confirm these findings.

Evidence Table 2: Most Common Running Injuries

https://drive.google.com/file/d/1NAgmeV6wxQjlEacCU7cgkruitimjEQHI/view?usp=sharing 

Clinical Bottom Line

Runners experience a high incidence of running-related injuries, specifically in the lower extremities with the knee being the most common injury location.  Common pathologies for distance runners include medial tibial stress syndrome, Achilles tendinopathy, plantar fasciitis and patellofemoral pain syndrome.  Though multiple studies have investigated risk factors associated with running related injuries, evidence has conflicting findings.  Without further research, runners should be evaluated for risk of injury on an individual level due to the lack of definite evidence-based risk factors.

---

Evaluation

Throughout the development of my capstone project, I received ongoing feedback from my committee members. Once the final products were created, I reached out to my target audience, runners. I requested runners watch my video, read my handout, and provide feedback in the form of three survey. Below are links to the surveys I created and responses I received.

Surveys

Movement Screen: https://docs.google.com/forms/d/e/1FAIpQLSeO0dN8b-j8z-QpsAOau8HqNX2Q6nkbG6xpPsxEr520CjieSA/viewform

Exercise Videos: https://docs.google.com/forms/d/e/1FAIpQLSdg-B9pp8iLQhEK8nRAHJFDfcHjSaK2ki8OFZVJjFD0_bexlw/viewform

Handout: https://docs.google.com/forms/d/e/1FAIpQLSfS75zUnNz6Q99cMWDReS-zb_h1w5Df9fw-11bdwn_R1yZsBw/viewform

Summary of Feedback

In general, the responses were positive. Instead of going over responses to each question, I will highlight comments suggesting areas where improvements could be made.

Movement Screen:

“Having a few clips of the exercises from different angles would help better see how you’re preforming them and assessing how your body moves”

“I liked the suggestion of having a chair to help with the single leg squat. However, showing a clip of how you would do that would provide good visual assistance!”

Exercise Videos:

“Lunge and calf stretching videos were great. Gluteus medius video was a little confusing because I wasn’t sure where the gluteus medius and why having a weak one matters for running.” ⇒ Future edits to the video could include an image of the glute medius muscle and further explanation of the role of the glute medius during running

Handout:

One response to “I understand I can see a physical therapist without a referral from a doctor” was “disagree.” ⇒ Future edits to the handout should explicitly say no referral is needed to see a physical therapist

---

Self-Reflection

My original plan for choosing a Capstone was to join a faculty member’s project. However, when I saw available projects, none of them piqued my interest. I was tempted to choose one anyway and avoid developing my own idea. Selecting research topics for the Evidence Based Practice II class helped me realize my passion to increase direct access of physical therapists. My Integrated Clinical Experience (ICE) class reinforced my need to improve my clinical education skills. I am glad I didn’t follow my initial plan of joining a faculty member, and instead developed a project I am passionate about. My educational skills were pushed by making videos that were informative yet basic and short to appeal runners with a range of health knowledge and minimal time. While there are always tweaks that could be made to improve the products, I am proud of what I created. I hope it will be used as a tool to increase runners’ access of physical therapists.

---

Acknowledgements

First, I’d like to thank my primary advisor, Jeff O’Laughlin. Jeff helped me turn the broad idea of a project centered around direct access of physical therapy into deliverable products for a population I care about. Thanks for committing your time to meet with me over zoom, respond to many e-mails, and guide me throughout the development of my capstone. After learning from you during ICE, I will always value your clinical expertise and commitment to patients and the profession of physical therapy.

Trey Harrison – Thank you for providing thoughtful feedback throughout the development of capstone. I greatly appreciate you devoting time to guide me despite your busy clinical and family schedules.

Jon Hacke – Thank you for being a part of my capstone committee. You may be the busiest man I know, and I am so grateful for your time dedication to my project. You were especially helpful with the phasing of my written products. You are always a source of encouragement and positivity.

Katie Magee – Thank you for lending a non-PT lens to my project. I can always count on you to help me out, whether it be for school or other life demands.

Taylor Sprinkle – Thanks for offering you “newscaster” worthy voice and filming help in the development of my videos.

Fellow Runners – Thanks to the many runners who watched my videos, read my handout, and filled out surveys to give me feedback on my final products.

---

References

1. Direct Access By State | APTA. Available at: https://www.apta.org/advocacy/issues/direct-access-advocacy/direct-access-by-state. Accessed January 7, 2021.
2. McGill T. Effectiveness of physical therapists serving as primary care musculoskeletal providers as compared to family practice providers in a deployed combat location: a retrospective medical chart review. Mil. Med. 2013;178(10):1115-1120. doi:10.7205/MILMED-D-13-00066.
3. Décary S, Fallaha M, Pelletier B, et al. Diagnostic validity and triage concordance of a physiotherapist compared to physicians’ diagnoses for common knee disorders. BMC Musculoskelet. Disord. 2017;18(1):445. doi:10.1186/s12891-017-1799-3.
4. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SMA, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br. J. Sports Med. 2007;41(8):469-80; discussion 480. doi:10.1136/bjsm.2006.033548.
5. van der Worp MP, ten Haaf DSM, van Cingel R, de Wijer A, Nijhuis-van der Sanden MWG, Staal JB. Injuries in runners; a systematic review on risk factors and sex differences. PLoS One 2015;10(2):e0114937. doi:10.1371/journal.pone.0114937.