Note: This post is an adaptation of an article that I wrote for the February 2011 issue of the Austin Runner’s Club Newsletter.

When training for or competing in any event, be it your first 5K or your 10^th marathon, there are always going to be some nagging aches and pains. It is a reality of training. As you place demands on your body, it has to then recover from the training sessions and adapt to the imposed demands. During this cycle of training and recovery, your muscles, bones, and tissues undergo transformation. There may be times when the rate of recovery and adaptation is diminished relative to the actual training demands. It is at this time that an “over-use” or “under-recovery” injury may occur.

But how do I know that what I am experiencing is an injury? I have little aches and pains all the time. I need to know which aches and pains should be considered an injury that would benefit from the advice of a health care provider – and those which don't require that level of attention. And I definitely don't want whatever this is to limit my training. How do I know that this is something that I need to have assessed?

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Life. Death. There is a strange irony here, a paradox of sorts. Death defines life. Full stop, carriage-return-line-feed. If it wasn’t for the experience of death, we would not have boundaries to define the exquisite nature and beauty of life itself.

Death is a reality that we all must face sometime in our lives. It will take place around us, in friends and loved ones and acquaintances and family. We will watch it happen to our icons and our trusted role models and our enemies if we have them. It is something that, if you live on the planet long enough, will enter your world. As the saying goes, there are two things that you can guarantee in life – taxes and death. Death knows no boundaries, Democrat or Republic, Christian or Muslim.

Sadly, it can take a death for many of us to fully realize the beauty that is our own life. It brings a focus on the power of love for those around us, something that can be lost at times in the reality and distractions of our day.

Once again, I was reminded of the fragility of our world and our tenuous hold on that which we call life. In its sadness, and in the memories that are surely stirred up within, I was reminded of the importance of – now.

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The end of football season is almost upon us. In a week’s time, the Green Bay Packers will face off against the Pittsburgh Steelers in Super Bowl Wow-That-Is-A-Lot-Of-Roman-Numerals. I have to go back to high school math to remember what Super Bowl number we are up to anymore. Not that it typically matters, because I can count more lousy Super Bowl games than I can count good ones – roman numerals or otherwise.

Today’s Rhubarb has a football slant to it. It’s a deep slant, just like a good post pattern – all puns fully intended, of course.

1. This year’s AFC and NFC conference championships featured games that were completely “old school”. You had some of the classic NFL teams of a bygone era – Green Bay, Pittsburgh, New York, and Chicago. With that goes some legendary rivalries. But best of all, you had games played outdoors without the perfect conditions that dome stadiums bring with them. You had game-time conditions that conference finals should be played in – snow, wind, and cold. Ah “the frozen tundra of Lambeau Field”, as NFL Films calls it. Get muddy, get dirty, let the strong survive. Now THAT is football.

2. In the “focus required” category, there is the inimitable Bud Adams. Remember, he’s the owner that moved the Houston Oilers to Tennessee. That was a decision that I could never understand, but I also don’t have millions of dollars to throw at football, either. They drafted Vince Young as the savior of their team – and rightfully so when he was, without a doubt, the greatest college football player of all time. He is a natural winner. Somehow, that was hampered by his “relationship” with Coach Jeff Fisher. One spat turned into another, and head games seemed to be the norm. Young was never given an environment in which he could excel. Fisher never did really build an offense around this franchise player on whom Adams was spending a lot of cash.

So then Bud Adams decides to let Young go. How a team could ever get rid of Vince Young, I’ll never know. But wait, the story  gets better.

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It’s an intriguing stance to take at this juncture in our professional development as physical therapists in the United States. And it’s a stance that will most certainly be misinterpreted in the backroom discussions amongst lawmakers and lobbyists.

According to the American Physical Therapy Association (APTA), 46 states currently have what they call “some form of direct access”. I am not sure what, exactly, “some form” means. If you look at the states that have “unfettered direct access” – which is also a misnomer unto itself – you are looking at about 16 at last count.

Texas is considered a “direct access” state. I can tell you right now – it simply is not, in any way, shape, or form. But the APTA continues to put Texas (and many other states) in this nebulous category of “some form of direct access”. Sure, you can do an evaluation of a patient without a referral – but what good is that if you can’t then treat the patient without someone else’s consent or approval?

Telling the media, legislators, lobbyists, and worst of all, patients – that patients have “direct access” to physical therapy – is simply not telling the truth. When we go back to legislators and tell them we only have “some form of direct access, but we need to expand it”, should we really expect them to do so? “Well, you already have it according to your own professional association”, I can hear them saying. One would have to wonder if this in fact impairs our position in the health care world instead of enhancing it.

You either have direct access to a physical therapist – or you don’t. There’s no in-between. You can either access a physical therapist, by patient choice, without limitations and referral requirements and other silliness – or you can’t. You can either make full use of their skills and training within their scope of practice – or you can’t.

It’s that simple.

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What a difference a year can make. Case in point: the University of Texas men’s basketball team.

I, for one, really didn’t expect much from the Horns this season. After last season’s 17 – 0 start and 7 – 10 flame out, and a few key starters graduating, I really didn’t think that they would have much to work with this season. Sure, they had some highly-regarded recruits – which then became two freshman starters – and in many circles, that could be considered a recipe for disaster. Of course, that would never compare to the disaster that was last season.

Wow. Was I wrong. And I stand corrected now. This team is good. And deep. And, frankly, these kids can play.

But even with that said, it has been a pretty simple equation for the UT men against Kansas. Zero wins, nine losses. There have been some heartbreaking results over the years, and I have sat through all of them. There have been some games in which Texas was blown out, and others when they took Kansas to the final buzzer, only to register a loss in the end.

Now, it has all changed. The Phog that covered Texas has disappeared, once and for all. They have finally put up a win against the Jayhawks.

It was the way that it happened that was most stunning.

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If you bring up the topic of government, or legislation, or Tea Party for that matter, I would bet you will have your fair share of debate and some “eye rolling” as well. Lo and behold, both the federal and state legislators are once again “hard at work” (and I use that term loosely) and before you can blink that rolling eye, there is already plenty of insanity with which to contend. Be it Washington or Austin, the fun just never stops.

When in doubt, always follow the money trail to find the Rhubarb. Trust me on this one. I am sure it will lead you to plenty of tasty treats over which legislators (and lobbyists) will wage battles that will, in the end, rarely accomplish much of anything for the benefit of their constituents. On the top of that list of battles these days is health care reform. Yes we can? No we can’t? Maybe we will? Do our legislators have any clue?

In this episode, let’s take a quick and annoying peek at what our reps are up to on the state and national levels. Between health care reform nationally and super-sized budget deficits in the state of Texas, we have plenty of hypocrisy to roll our eyes over.

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Health care is, at it’s core, truly about the needs of the patient. As the Seton Family of Hospitals has noted, it should be person-centered care, which is “not hospital-centered, doctor-centered, technology-centered, or disease-centered”. This sounds like a great concept, no?

This would require a patient having access to health care first and foremost, something that in the state of Texas is a significant problem. Texas ranks dead last in access to health care. The primary care physician supply ratio ranks 47th in the nation.

Two groups of practitioners – physical therapists and advanced practice nurse practitioners – have proposed valid solutions to this growing dilemma. If a patient has direct access to appropriate care within these providers’ current scope of practice and education, more patients will have access to necessary care and patients will have choices regarding their care.

In Texas, the 82nd Legislative session is upon us. Health care will almost certainly be an important issue. Once again, direct access to physical therapy will be a topic of discussion amongst legislators. But there is another debate being waged on similar battle grounds - with a common foe.

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