What is a bone stress injury (BSI) and how do I know I have one? How long will it take to get me back to running? As a physical therapist who treats a lot of runners and as a lifelong runner myself, I have always had a passion for keeping runners running. The act of running can make someone’s day tick along better, can help with consistent sleep, calm the nerves and can even make a runner more fun to be around. It can be social or an act of solitude. It can be alarming for a runner when they start to experience a nagging pain that doesn’t warm up or even worsens as they run. Pain that doesn’t dissipate with a warm-up routine or is vague at first but then becomes localized or intensifies through the run can be a sign of a bone stress injury or BSI. BSI is a general term indicating mechanical load is exceeding the bone’s structural ability to withstand the load. However, BSIs occur on a continuum. One end of that continuum is a stress reaction, the other end can be stress fracture or even a full fracture of the bone. The runner recognizes this as pain that isn’t normally present. BSIs can occur for many reasons whether due to biomechanics or from a nutritional standpoint or a combination of both. As high-school and college cross-country runners prepare now for this upcoming season, they should be aware of the common causes and ways to prevent bone stress injuries.
Mark Bouma, PT takes readers through the areas to watch out for while raking leaves. The fall changes in the PNW is a time of beautiful color but also typically wet and heavy leaves.
Patellofemoral pain is largely a diagnosis of exclusion. There can be many causes of knee pain and it is important for your healthcare provider to properly assess your individual condition. Many individuals have anterior knee pain with prolonged sitting with flexed knees.
There are three common provocative diagnostic tests that are most closely correlated with patellofemoral joint pain:
Squatting
Climbing Stairs
Eccentric Step-Down Test
Research has linked several key factors that may contribute to an individual developing patellofemoral pain. These factors are not present in everybody who has symptoms, but there are often impairments in one or more of these areas found during a physical therapy exam.
Victor Kollar, PT takes you through the areas to think about as you get ready for your annual turkey bowl football game.
The Seattle Seahawks have been dealing with a challenging season on the injury front, and the ankle injury to standout cornerback Tariq Woolen has added yet another layer of complexity. Woolen, a key figure in Seattle's defensive scheme, has demonstrated elite skills throughout the season, allowing a league-low 27.3% completion rate and an astonishing 1.7 passer rating when targeted. His injury has not only affected the team's defensive depth but has also posed significant challenges in maintaining consistency in coverage. In this article, we delve into the details of Woolen’s injury, its implications for the Seahawks, and what the team can do moving forward.
If you're a runner, you may have heard of the Female Athlete Triad, a term once used to describe a combination of low energy availability, menstrual dysfunction, and bone health issues. However, our understanding of these conditions has evolved, giving rise to a broader concept: Relative Energy Deficiency in Sport (RED-S). This condition is not just for elite female athletes; it affects athletes of all levels and genders. Let’s break down what RED-S is, why it's important, and how you can protect yourself as a runner.
“Speed kills” is a phrase often heard in the athletic world to emphasize the idea that the faster the athlete is, the more successful he or she will be. As a health professional and a performance coach, it is important to teach athletes that being fast does not always have to rely on genetic background. There are plenty of specific mechanics that can turn speed into a skill.
Progressive Performance Q&A
By Justin Ho PT, DPT, CSCS
I had a chance to sit down with Jimmy McCurry, head coach and owner of Progressive Performance Strength and Fitness in Woodinville, WA. I've had the pleasure of working with Jimmy in the past, helping our mutual clients and patients rehab from their aches and pains and return to lifting heavy and safely at his gym. Here is our conversation talking about Progressive Performance and how his community is adjusting with the pandemic.
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Me: Jimmy thanks for taking the time to sit down and chat with me today. I'm sure you've been busy adapting to the ever changing environment due to COVID-19. To get started, please tell us a little about what makes Progressive Performance different.
Jimmy: Glad we could find a time to chat! Progressive Performance is for people who don't know what they should be doing for their fitness journey and don't really know where to start. Maybe they've tried different forms of training that hasn't worked for them, or they've been battling with nagging injuries. We work with people who are interested in strength training and those who are looking for a personalized custom approach to their fitness that’s tailored to their specific needs. We do this in a small group environment that is community based. We take pride in meeting people where they are at fitness-wise, getting them stronger, helping them lose fat, and getting them the body of their dreams while also feeling great doing it.
Me: I understand you emphasize your programs around resistance training. Can you speak on that?
Jimmy: Our program is, as you mentioned, resistance training based. What we found is that when you focus on the resistance element, you can get really great results in body control, injury prevention, metabolism, and the ability to gain muscle. Our typical age demographic is between age 40-65, where resistance training to compete against sarcopenia and osteopenia is important. No matter where our clients start from, we can position them with a custom training program that's going to work with them specifically and progress their exercises appropriately so they'll continue to see improved strength and performance.
Me: That's fantastic. There is such a negative stigma behind strength training, but it's so important for individuals entering their 4th and 5th decade because of sarcopenia and osteopenia (muscle wasting and losing bone strength). When working with new clients, I'm sure you have many people coming in from different walks of life and fitness history. Tell us how you find a person's starting point.
Jimmy: With every new member, we sit them down with a coach for 1 hour to start. The first half hour is centered around goal setting and understanding their movement background and then during the second half of the hour we do a general movement screen. From gross moments to individual joint ranges of motions and strength. We formulate a custom warm up routine to address any limitations that we find so they can be as successful as possible with their lifts in the safest way possible.
Me: I understand during the first few months of the pandemic, you quickly switched your platform to online coaching and are still offering that to many of your members. As we are continually adjusting to the new normal due to the pandemic, I anticipate you're making a great effort to make your gym a safe and clean space. Can you expand a little more on this?
Jimmy: We have 5 clients to one trainer. In our facility, we set up specific boxes where people would train in. We have protocols in place where higher-touched surfaces are only in contact with our coaches. All of our coaches are required to wear masks. We open the facility, clients come in wash their hands and then go to the area they are assigned. All the equipment for that session will be already set up in the box the client will occupy for the entirety of the session. Nobody shares the equipment. We have 45 minutes of the session and a 15 minute cleansing time. We're doing whatever it takes to make our clients feel safe while they train.
Me: One of my patients mentioned that you were at the helm of getting smaller gyms like yours to open up earlier than originally planned. How did this transpire?
Jimmy: Yeah we actually spearheaded this effort to get small group fitness gyms into the earlier phases of re-opening. Originally we, gyms, were placed in phase 3; however we knew that with our set up we could definitely operate in an earlier phase while following all the precautions and limitations. We submitted a petition with 6500 signatures and sent it to the governor. We were actually broadcasted on local news and on a local radio station. So we thankfully were successful in sharing our message to the government that people are missing and needing their fitness. This ultimately resulted in getting smaller gyms into what we'll call phase 2.
Me: That's some incredible work. Well done!
Jimmy: For us it was more about what makes sense by science. Okay if you can sell a car or open a casino within a phase 1 situation, why can't you do something that's healthy for people. Why can't we let people invest in their fitness and help their immune system versus doing other things that would degrade their immune system. We are also invested in our clients results and invested in bringing greater health in the greater Seattle area. For us to do that, we had to fight the fight and get people back into the gym.
Me: I'm so glad that you had great success with this. Switching gears, I want to share one of my concerns as a physical therapist. You have people who have been either doing home workouts or not exercising at all for a few months. I am concerned that when they return or start up exercising again that they'll injure themselves simply because they've lost some conditioning. How do you plan on approaching this with your returning and new members?
Jimmy: When you're coming back to the gym, we are paying particular attention to the training stimulus. Understand that lifting 40-50% of your maximum ability is where you're going to start. You'll likely also be very sore after that first session back. The main theme is thinking light and easy. This applies both to decreased volume within the workout session and less frequency per week. The muscles remember where they were before, they'll eventually get back to their previous state in 3-4 weeks with steady progressive load. Our clients will be focusing on more full body workouts including pull, push, legs before focusing on individual groups per training session.
Me: That makes a lot of sense to me. Getting people more conditioned first before getting into strength work seems like a great recipe. Say that I wanted to get into strength training with Progressive Performance now, but I don't have any experience in any of those lifts or even the terminology, how do I start?
Jimmy: This is what we have our Jump Start program for. We have everything laid out in a 28 day program. New clients will come in for a movement evaluation, a nutrition evaluation, and they can come in as many times as they want to our small group sessions over those 28 days. Through our interaction we curate that program that's most appropriate for the new member. We'd recommend starting 2-3x/week and then building up to 4x/week. Here we discuss lifting form and make sure you receive live feedback on how to perform each of the exercises safely. After those 28 days, obviously we'd love to keep you as members, but for those who want to lift on their own at their gym, this is still a great gateway to understanding how to lift properly and safely.
Me: That sounds like a great way to get people who are interested in resistance training to do it right and safely. I really do believe your gym provides such a unique opportunity and gateway for individuals who may otherwise never think they’d be able to engage in weight lifting. Jimmy, it was great to chat with you today. Thanks so much for taking the time to sit down and work with me here!
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You can find more information on Jimmy and Progressive Performance Strength and Fitness at https://www.progressiveperformance.com/
Woodinville, WA 98072
GOLF IS BACK!
By Matt Sato, DPT, SFMAc, TPIc
As many of you know and have been greatly anticipating, golf is now allowed in the state of Washington! Just in time for the start of our glorious season here in the Pacific Northwest that many of us wait 6-7 months for. Unfortunately, due to the COVID-19 pandemic, our usual workout routines and activities that we would normally be doing have been disrupted as our gyms and access to health care providers have been greatly limited.
How many of us finished the last golf season with nagging injuries, aches and pains that we were unable to address this Winter and Spring due to staying at home with limited access to healthcare? I want to encourage everyone in this boat to take the time to take care of your bodies and make sure you are primed to start your season in peak physical condition.
Sometimes runners have a tendency to run and only run. For good reason. Running is fun, endorphins are released and running feels like an efficient use of your exercise time. If you are like me, I love putting races on my schedule to have something to aim for and to give me that extra push when I might otherwise not get out for a run. But to be a complete runner, one should think of running as going hand in hand with strength and stability training. Strength and stability training can be very beneficial to reduce the risk of injury as well as enhance running performance. Runners are often diagnosed with injuries including Achilles tendinopathy, patellofemoral pain syndrome, ITB syndrome, medial tibial stress syndrome (shin splints) and hip bursitis. Use of a formal training program has been found to decrease the risk of race related injury among half marathoners. Even elite runners have a strength and stability program built into their regimen.
Sometimes runners have a tendency to run and only run. For good reason. Running is fun, endorphins are released and running feels like an efficient use of your exercise time. If you are like me, I love putting races on my schedule to have something to aim for and to give me that extra push when I might otherwise not get out for a run. But to be a complete runner, one should think of running as going hand in hand with strength and stability training. Strength and stability training can be very beneficial to reduce the risk of injury as well as enhance running performance. Runners are often diagnosed with injuries including Achilles tendinopathy, patellofemoral pain syndrome, ITB syndrome, medial tibial stress syndrome (shin splints) and hip bursitis. Use of a formal training program has been found to decrease the risk of race related injury among half marathoners. Even elite runners have a strength and stability program built into their regimen.
Let’s first redefine stress in terms of tissue mechanics. “Stress is the resistance of a material to deformation. Often measured as a unit of force over an area.” Strain is the “deformation that occurs in response to application of an external load.” Load is defined as “ the application of force.”1 Types of load include:
· Compression
· Tension
· Shearing
· Torsion
· Bending1
Stress – we have experienced it at some point in our lives. A normal thing to feel, especially while navigating through a global pandemic. Stress can take on many forms. It could be what you feel during your Zoom work meeting, the adrenaline rush you get sprinting to the front door for your food delivery, or what you feel melt away when you’re biking down the Burke-Gilman on a sunny day. The effects of stress can greatly impact our lives. Understanding what stress is and how it can affect our mental state, physiological function, and motor control is our best way to use stress for our benefit.
Stress – we have experienced it at some point in our lives. A normal thing to feel, especially while navigating through a global pandemic. Stress can take on many forms. It could be what you feel during your Zoom work meeting, the adrenaline rush you get sprinting to the front door for your food delivery, or what you feel melt away when you’re biking down the Burke-Gilman on a sunny day. The effects of stress can greatly impact our lives. Understanding what stress is and how it can affect our mental state, physiological function, and motor control is our best way to use stress for our benefit.
Sometimes runners have a tendency to run and only run. For good reason. Running is fun, endorphins are released and running feels like an efficient use of your exercise time. If you are like me, I love putting races on my schedule to have something to aim for and to give me that extra push when I might otherwise not get out for a run. But to be a complete runner, one should think of running as going hand in hand with strength and stability training. Strength and stability training can be very beneficial to reduce the risk of injury as well as enhance running performance. Runners are often diagnosed with injuries including Achilles tendinopathy, patellofemoral pain syndrome, ITB syndrome, medial tibial stress syndrome (shin splints) and hip bursitis. Use of a formal training program has been found to decrease the risk of race related injury among half marathoners. Even elite runners have a strength and stability program built into their regimen.
Balance is essential to nearly all aspects of life. Sitting upright, standing, walking, running, jumping, and playing sports all require a coordinated effort from your neurological and muscular systems. Good balance is often taken for granted throughout day to day life, but poor balance can significantly hinder your mobility and ability to participate in your desired activities. More importantly, poor balance can lead to falls and injury. Fortunately, balance can be retrained and improved with practice.
Due to the COVID-19 pandemic, millions of people are now working from home and needing to get used to a “home office” instead of their normal “in-office” work space. We are so thankful that this is an option for so many people and want to make sure that the home office can be set-up to offer optimal work conditions. Poor ergonomics can make for a miserable work experience and can lead to/exacerbate neck and back pain among other musculoskeletal problems.
Sleep hygiene is a term that is becoming more popular as we learn how important sleep can be for our health. This term encompasses different strategies to establish daily habits that can ultimately increase the quality and quantity of your sleep providing you the necessary rejuvenation after a long day.
● Exercise
● Relax the mind
● Limit alcohol and caffeine
● Set your biological clock
● Set up sleep-friendly environment
● Limit naps and manage restlessness
Have you ever been so sore after a new workout or return to activity that you can barely sit down to use the toilet? This is your body adapting to a new load. This is a fairly simple, but important concept. If your body hasn’t experienced this load ever or in a long time, the chances that you will be sore range from pretty high to certain. Sometimes this scenario leads to 2 days of soreness (DOMS: Delayed Onset Muscle Soreness) and then you return to whatever activity made you sore. Great, your body adapted to the load! On the other side, you find your body was unable to adequately adapt and maybe you cannot return to that activity. Now we have an injury to deal with.
One thing that has been on my mind, and the minds of many other rehab professionals, is...will we see an uptick in injuries for athletes during and after the COVID shutdown? That all depends on whether athletes have been able to maintain their tolerance for the loads that they will be returning to (running, jumping, etc); and/or if they are able to return gradually enough to their respective activities giving their body adequate time to adapt.
Within the last decade, physical therapist’s role in concussion management has emerged. A landmark research article released in 2018 makes a strong suggestion that physical therapists are great entry points into the medical management of the recently concussed athlete, even within the first week.
Ellis’s research group published their article stating that contact with a physical therapist within the first week after their concussion can be important for athletes. The reasoning stems from the fact that physical therapists can administer and devise a rehabilitation program to help the athlete retain as much of their physiological conditioning during their recovery process. Ellis’s group cites an article that states after a short period of time without any exercise, there are deleterious effects to the athletes physiology and exercise tolerance.1
Neck pain and Physical Therapy If you are having neck pain, physical therapy is often recommended. After ruling out serious conditions by your physical therapist or your physician, the real work begins.
Manual therapy: to help with tissue healing and/or restoration of joint mobility.
Exercises: to help strengthen your neck and core to improve neutral postural alignment.
Pain relief: consisting of appropriate modalities such as ice, heat, ultrasound, or electric stimulation.
Patient education: on tips to help reduce stress on your neck in your work and home environment.
When asked about neck pain one of our favorite physiatrists Dr. Gary Chimes, MD stated that, “Neck pain can be one of the most debilitating issues that we see. It can not only effect your physical ability, but also create issues with sleep, mood, concentration, performance, and emotion.”
The best news of all is that insurance covers physical therapy sessions! A physical therapist can work with you and modify your treatment program until your goals are met. Come see a PT today!
In October we welcomed a new team member to our crew, baby Griffin! Having a baby around means a lot of holding and carrying a squirmy ~15 pound active little boy (and other heavy baby gear). While it’s not always possible to think about ergonomics, we thought it’d be helpful to share a few tips regarding this topic to try and protect any new parent’s shoulders, back and hips!
• Each time you carry your baby try to switch sides. This will protect one hip and arm from constantly carrying the load.
• Same goes for loading/unloading the car seat. If the car seat is in the middle seat of the car, try to alternate which side of the car you load and unload from. Also, try to load/unload in two steps instead of trying to maneuver the car seat in and out in one difficult motion.
• When picking up your baby from the floor, bend your knees and lift with your legs instead of from your back. Bring your baby in close to you instead of extending your arms out. This will protect your shoulders and upper back.
• Try to resist the urge to hike your hip and rest your baby on your side – or at least try and limit the amount of time you’re in this position. Over time, this position can lead to malalignment of your pelvis, hips, and back.
• Consider “wearing” your baby in a carrier. There are a lot of great online and in-person resources to learn the best (and safest) techniques.
• If possible, carry the diaper bag “messenger style” with the strap across your body instead of over one shoulder. Better yet, use a backpack diaper bag.
Lastly, let your physical therapist know if you are having trouble with any of these tasks. We can help you figure out the best mechanics for your body.
As popularized throughout sports, concussion has been a trending topic throughout all media outlets. In the last decade expert scientists, physicians, and other healthcare providers have strived to address the wave of questions and concerns raised by those affected and their loved ones.
Though most of the literature reviews and studies sports related concussions, I believe much of the information can be applied to the many individuals with general concussions. With winter in full effect, concussions can be caused not only from winter sports, but also from accidents caused by ice (motor vehicle accidents, slip and falls, etc).
This past summer, I attended a Seattle Pediatric Sports Medicine conference that had a panel of healthcare providers who manage patients with sports-related concussions. They discussed the current topics on concussion management and how they approach each case. Most members of the panel were a part of the University of Washington Concussion team.
The University of Washington does a great job in providing information on the background and general symptoms of concussion. You can access their tremendous resource here.
The main points I took from the conference is that current up-to-date acute treatment of concussion does not require the affected individual to sit in a dark room until symptoms to diminish. These individuals don’t require prolonged avoidance of TV or phone screens. Additionally I learned that chronic traumatic encephalopathy (CTE) is still in its infant stages of research and scientists are unable to conclude that multiple concussions are the actual causes of CTE. The most important fact I was reminded of was that concussion treatment requires a team approach, which can sometimes include physical therapy.
According to the most recent consensus statement released by the Concussion in Sport Group in 2016, “Sports related concussions can result in diverse symptoms and problems, and can be associated with concurrent injury to the cervical spine and peripheral vestibular system… the data support interventions including psychological, cervical, and vestibular rehabilitation.”1 You can read more here on the 2016 Berlin Concussion Consensus Statement.
Most concussion symptoms tend to resolve after 2 weeks. However if there are lingering symptoms, seeing a physical therapist may be a great option to help with an individual's recovery. Here is how we can help.
Sustaining a concussion can result from multiple types of head trauma. What affects the head likely affects the neck. The body will do everything it can to protect the head and often stiffen your neck. With pain playing the role of your alarm system, it’s with no surprise that the neck becomes extra guarded and irritated when you try to move it. Physical therapists can improve your cervical and thoracic spine mobility and implement strategies and interventions to decrease your discomfort. From manual therapy to progressed therapeutic exercises, PT interventions can help improve neck function.
Vestibular specialized physical therapists can help those after concussion who continue to feel dizzy or off-balanced. Symptoms may include but are not exclusive to dizziness, vertigo (room spinning), disequilibrium (off balance, nausea), and visual impairment. Seeing a physical therapist who specializes in vestibular rehabilitation can be a valuable member on your team. After a thorough evaluation, they can provide you strategies and exercises to help your vestibular system adapt.2
Benign Paroxysmal Positional vertigo (BPPV) is the most common vestibular pathology that can occur after head trauma. Symptoms include head motion-induced vertigo, normally triggered when rolling in bed or turning the head quickly. This vertigo lasts for seconds, often followed with a fog or lightheadedness lasting for hours afterward. If diagnosed correctly, this can be treated with great success by a trained professional.3 You find more information here.
Though not mentioned in the 2016 Consensus, within the sports concussion literature there has been growing evidence on how concussions may have an influence on future lower limb injuries. What is proposed is that after a concussion, the joints, muscles, and tendons in your legs have an impaired ability to detect where they are in space. Though this may not fall into the category of concussion rehabilitation, orthopedic rehabilitation can help address proprioception and neuromuscular control impairments for athletes who are looking to return to play.4
As for other common symptoms stemming from a concussion, other professionals including neurologists (migraine/headache specialist), neuropsychologists, speech therapists, and vision therapists would be great resources to consult. Ask your concussion management team if physical therapy is right for you and your symptoms and find a local clinic that has a clinician there to help you.
1. McCrory P, Meeuwisse W, Dvorak J, et al Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016 Br J Sports Med 2017;51:838-847.
2. Gurley JM, Hujsak BD, Kelly JL. Vestibular rehabilitation following mild traumatic brain injury. NeuroRehabilitation. 2013;32(3):519-528. doi:10.3233/NRE-130874.
3. Benign Paroxysmal Positional Vertigo (BPPV). American Physical Therapy Association. https://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=52822493-32f3-4d4c-8c56-8e18c41b2f85. Published September 1, 2015.
4. Kardouni JR, Shing TL, Mckinnon CJ, Scofield DE, Proctor SP. Risk for Lower Extremity Injury After Concussion: A Matched Cohort Study in Soldiers. Journal of Orthopaedic & Sports Physical Therapy. 2018;48(7):533-540. doi:10.2519/jospt.2018.8053.
Information provided on lakewashingtonPT.com and all of its web pages is intended for general educational and entertainment purposes and is not intended to be medical advice to you or any other person. You should always consult with your own medical provider about your health and medical questions and never rely on this or any other web site alone to make medical decisions. Never delay seeking medical advice or disregard any medical advice you have received from your provider because of anything you read or hear on this website.
Communication between patients and their medical providers plays a large role in a patient’s understanding of their diagnosis and management options. It can drive a patient’s decision to undergo surgery, start PT, or choose no treatment at all. Whether it is your PT or PCP, you are likely being infiltrated by words which may be scary and/or confusing. Some examples might be “disc herniation of L3-5, severe foraminal stenosis, degenerative disc disease, tibiofemoral osteoarthritis, etc, etc.”
Research has shown that when a more medically precise term is used to describe a patient’s condition, they tend to have a stronger preference for choosing more invasive treatment options even if this might not be the best option. Additionally, a person feeling fear or anxiety as a result of such terminology is going to have greater difficulty making informed decisions that let them be an active participant in their care. To keep the story short and sweet, try to not let words scare you. And if you do find yourself scared by your diagnosis and treatment option, ask for an explanation that helps you understand your diagnosis better and that lets you move forward with confidence in whatever treatment option you choose. Chances are your diagnosis may not be as bad as it sounds in words or on the MRI report you receive from your doctor; and it may have several conservative treatment options that would be beneficial. Be an active participant in your care and seek out the answers to the questions you have to ensure you’re getting the best possible treatment for your condition.
Citation: “Words do matter: a systematic review on how different terminology for the same condition influences management preferences”
We as physical therapists get a lot of questions regarding the letters after our names. Most commonly, you will see “Mary Jane, PT, DPT” if that person has graduated in the last 10 – 15 years. Breaking that down, “PT” simply indicates the person’s title of Physical Therapist and means that they have passed their national licensure exam to treat patients. “DPT” indicates the degree that person has earned and stands for Doctor of Physical Therapy. If you see “MPT” that person just graduated before the transition to “DPT” and is no less qualified to treat you. The MPT was traditionally 2 years post-baccalaureate whereas the DPT is now 3 years. The next question that inevitably follows is, “Oh! So, you have a PhD?” The answer to that question is “no”, but the semantics of it all can get confusing, so let’s clear that up.
The term “PhD” stands for Doctor of Philosophy and is the highest degree you can achieve in nearly every other discipline except medicine. This is a research degree which focuses on scholarly/professional development. People often go on to teach in their respective area after completing this degree.
A Doctor of Physical Therapy is typically considered a professional or clinical degree. It focuses on the development of skills / knowledge needed to carry out the requirements of their profession. This involves a didactic classroom approach as well as in-clinic experience under the license of supervising practitioners in the field. Also different from a PhD, though similar to the DPT, is a Doctor of Medicine (MD), a Doctor of Nursing Practice (DNP), and Doctor of Osteopathic Medicine (DO) degrees. Though these programs differ significantly in length and content of the curriculum, they also do not result in a PhD.
More on Caitlin and her other articles (click here)
