What is Evidence-Based Practice and Why Is It Important?

What is Evidence Based Practice?

What is Evidence Based Practice (EBP) and why is it important? At Reset-Wellness we believe that our programs should be based on the best research out there. EBP is made up of 3 components that together make for the best outcomes.

  • Research.
    What does clinical evidence teach us? We use the SHA and the FMS to create programs that are grounded in evidence.
  • Clinical Expertise.
    Peter’s background and experience as a Physical Therapist is what sets us apart from most other personal trainers.
  • Client’s values and expectations
    If we don’t make a program that fits your needs, you will never achieve YOUR goals.

We combine the best evidence, and our 28 years of experience to create a programs for you, to reach your goals and satisfy your needs. By working together we will achieve the best outcomes possible. You will have to do the work, you will have to make the lifestyle changes, but we will guide you along the way and together we will #UpgradeYourLife

Source: What is Evidence-Based Practice and Why Is It Important?



Reset Wellness is keeping up with the trends in Health and Fitness:

  • HIIT: part of every workout we do
  • Bodyweight training: we offer TRX
  • Outcomes: using FMS to identify your areas of improvement and then we re-assess to see if we accomplished our goals
  • Outdoor activities: when weather permits we train out door
  • Core Training: We incorporate core in to everything we do. It’s at the core of what we do.
  • #ACSMFitTrends

Source: WORLDWIDE SURVEY OF FITNESS TRENDS FOR 2016: 10th Anniversar… : ACSM’s Health & Fitness Journal


Detox Waters

Try adding the below 5 naturally detoxifying ingredients to your water and take your detox game to the next level.

To detoxify means to remove toxins. Our bodies do a pretty good job of this already, and is why we have livers, colons and kidneys to filter and help remove our waste, but some people like to help the process along, especially when they’re feeling sick, bloated or low energy.

You can use a variety of sources to Detox. Different teas are a popular; Juicing; Eating only raw fruit and vegetables are other common detox routines. But the most safest and possibly best way to start a Detox is to drink lots of water. Our body is mostly water and staying hydrated can assist our body to cleanse toxins from our system

Lemon, Citrus, Cucumber are great additions to water to help detoxify.  Read more

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You need more than HIIT

HIIT or low intensity, long duration training?

I have been reading more about HIIT versus Cardiac Output workouts.

This article on LinkedIn really made me think even more about this topic. I’m curious to see what others think on this topic? Here is another Great Article on this topic.

I think that HIIT is not enough. You can improve your recovery in between workouts, but building a solid cardio foundation with long duration, low intensity workouts. Not as sexy, but key to a more balanced approach to working out.


Check out our Wellness Programs


From Detox to Vacation Bootcamp

Whether you’re looking for weight loss, sport nutrition or healthy aging, we’ll coach you the whole way!  During detox week you spend a week with us at the Bed&Breakfast and we help you to re-boot your wellness.

Read more


Is the Paleo Diet a Fraudulent Fad or the Healthiest Diet to Hit Mainstream? 

Paleo Diet

Came across this interesting article. The Paleo diet has been around for years. The popularity of Cross Fit brought this diet more into the mainstream. like many other diets there is no real credible research to show that it works.


What do you think?

Source: Is the Paleo Diet a Fraudulent Fad or the Healthiest Diet to Hit Mainstream? Could It Be Both? | Peter de Smidt, PT, DPT, Cert. MDT,MTC,STC | LinkedIn


Vacation bootcamp?

Five reasons why bootcamp could help with weight loss

Rather than slogging it out at the gym for months, attending a weight loss bootcamp has a number of benefits and will leave you feeling completely rejuvenated

The idea of focusing on nothing but health and fitness for 24 hours a day may seem a bit intense, but attending a Vacation Bootcamp is a brilliant way to kick-start a new exercise regime.

Rather than embarking on months of post-work gym sessions and morning runs, and getting gradual results, you can fully devote yourself to the cause. It’s like giving your car a full service and a new engine.

Read More


Functional Cupping

About ten years ago, Pieter de Smidt was looking to add to his array of manual therapy skills for soft tissue treatment. 

de Smidt, PT, DPT, Cert. MDT, MTC, owner of Reset-Wellness Physical Therapy in Houston, TX, was well-versed in instrument-assisted soft tissue mobilization (IASTM), which still proved painful for some patients. But after seeing the benefits of ‘distracting’ the tissues by using taping, he decided to expand that repertoire. 

“Cupping seemed to be an obvious answer,” recalled de Smidt. “I figured maybe we should try distracting the tissue rather than always shearing the tissue. This was something people could tolerate.”

These days, de Smidt still tends to start with an IASTM-based treatment, but if this proves painful, he can do a simple contrast with IASTM on one side and cupping on another, and asking the patient which feels more comfortable. 

What is Functional Cupping?

While cupping may be somewhat new as a modality of manual therapy in Western medicine, the concept itself has been traced back as far as 1500 B.C., when the ancient Egyptians were said to have utilized the process. A specially-designed cup — don’t just pick up any instrument — is applied to the skin for a few minutes under suction, allowing it to affect the underlying tissue, particularly the fascia.

Functional cupping works by applying the cups in relevant areas followed by initiating dynamic, functional movement and affecting positive change in movement restrictions. The goal is to restore movement while decreasing pain in areas of previous restriction. Simplified, the cup is placed where restriction is felt, allowing the practitioner to move the body to the outer limits of that particular movement. As a result, tissues begin to soften, increasing the range of movement. 

Best of all, the client or patient has a strong degree of control over their own movement with the cups in place, and can dictate and control their own levels of discomfort. Many times, people assume cupping is a painful experience due to the prevalence of dark, purple spots that will appear on a person’s skin in areas where the cups were applied. However, this is simply the result of blood flowing to the affected area due to the suction pressure. Some believe the darkness of these spots has relevance as to how the injury is progressing, though this theory is not commonly held in Western medicine.

Read More:


Different Types of Cupping-part 3

More Dynamic Cupping: TDM

TDM is “Tissue Distraction with Movement”, so we are distraction the tissues as we are gliding the cups over the area that is treated. This is typically very comfortable and very different from patients have felt before. This is one of the reason I like to use it when I hit a plateau: introduce something novel, something that feels good to gain some more mobility and reduce pain and muscle tone even more.


Different Types of Cupping-part 2

Dynamic Cupping

Cupping does not have to be static, you can add movement!
We can move the cups, or we can have the patient move while the cup are statically in place.

We start with clocking: move the cups in all directions of the clock: from 12 o’clock to 6 o’clock, from 3 o’clock to 9 o’clock, etc. evaluate to see in what direction you get most resistance and focus on that movement.

Then we start moving the patient, while we have cups applied to the area that we want to treat.

Michael Phelps made cupping very popular

In this example we use the cat/camel stretch to improve mobility in the lumbar spine. With the cup we provide an additional sense of stretching, so even though the patient is not moving that much, the brain will experience a larger ROM as result of the cups. Since this is novel and non-threatening, the brain will allow for it by reducing its muscle tone. This reduction in tone will allow the patient to have less pain pain and more mobility.


Different Types of Cupping-part 1

Cupping has been around for thousands of years and has been used in different cultures to resolve a variety of conditions.
Cupping has some local effects by stretching the skin, fascia and muscle tissues. You also get some localized improved blood flow and metabolic changes.
Most benefit however is coming from the neuro-physiologic effects. Cupping can be used as a novel, non-threatening stimulus to reduce muscle tone in the treated area. As a results of this patients experience improved mobility and less pain.

Getting Popular!

In Western medicine dry cupping has mostly been used for the treatment of pain and to help with recovery. After the 2016 Olympics I have received a lot more requests for this treatment, because of #MichaelPhelps

There has not been much research on cupping, but the studies do indicate a possibility of pain relief. For me, these treatments are like any other Manual Therapy we offer, a great adjunct to make it easier for patients to move and exercise. You get temporary relief and a sense of improved flexibility and that allows for more effective and efficient movement.

Less is More!

I believe is “less is more”, so I start with a few cups for a few minutes and see how the patient tolerates it and how it affects the pain and movement. Then we progress, typically by adding movement…….see next post;)


Cupping Therapy

Cupping has been around for thousand of years, but slowly is making its way into the Western style of treatment for Musculoskeletal (MSK) disorders.

Cupping for Shoulder Problems

Cupping has a mechanical and neurophysiological effect and can help reduce pain, improve tissue extensibility and even aid in recovery. It needs to be part of a comprehensive treatment approach that has to include exercise therapy and not be a stand-alone treatment as the response is temporary, like all other manual therapy techniques.

If you have had no response to massage treatments or foam rolling and are looking a for a novel stimulus to help “reset”, cupping could be your best bet.

I teach cupping therapy to Physical Therapists all over the nation, because it simply works. See a snippet of my course here:

Source: https://www.linkedin.com/pulse/cupping-can-considered-evidence-based-practice-peter/


Cupping: Why We’re All Seeing Spots

I came across this blog post on the APTA website. Couple of paragraphs should out to me:

“As physical therapists, we want to maintain our position as evidence-based experts in the restoration, maintenance, and promotion of optimal physical function. To do so we must continue to uphold the value of well-established and rigorously investigated interventions in the face of the latest fascination in sports medicine.”

This basically suggests we should shy away from treatment like cupping, because there is no strong evidence to support it. Most things we do as physical therapists have no strong evidence to support it. Evidence Based Practice to me means a combination of my experience, patient values and research. Cupping meets that criteria: 1) My patients want it and report improvement. 2) I often do not have to use any other (more aggressive) forms of manual therapy that may even be contra-indicated; so patients are getting better with less aggressive treatment methods and become less dependent on me, while reaching their desired outcomes. So just because there is no strong evidence, we can not say it’s not Evidence-based as it meets 2/3 criteria.

“an underlying theme of the Choosing Wisely campaign is the benefit of active therapy over passive treatments”

Who says that cupping has to be passive? It can be and should be incorporated during exercises, like stretching and PNF-based treatments.

“we must be cautious that the general population doesn’t see cupping as a silver-bullet treatment for musculoskeletal conditions”

Education regarding our proposed treatment should be done first and foremost. Not just for cupping, for but for everything else. Any form of Manual Therapy has a transient effect. It allows patients to move more efficient and they will be able to exercise better and because they may have less pain should be able to make changes in their ADLs, work duties and sports activities; because that is where we will make the real changes that will result in long-term successful outcomes. Cupping is no silver-bullet, but it does have a silver lining: your patients will feel better, move better and if the APTA wants us to be the Experts in the Human Movement System, we better incorporate all possible treatments that are within our scope of practice and not just focus on those treatments for which strong evidence has been shown; We won’t be able to do much, because strong research is lacking for most of what we do.


Source: http://www.apta.org/Blogs/PTTransforms/2016/8/15/SeeingSpots/


Does blood-flow restriction training work, and who can it help?

Blood-flow restriction training has almost as many applications and names as it has uses.  From: https://www.elitecme.com/resource-center/rehabilitation-therapy/blood-flow-restriction-training-does-it-work/

Some call it occlusion training; others, hypoxic training. Bands, cuffs, and even ACE bandages have been used in attempting to utilize the benefits of the training for a number of desired outcomes.

Yet just about everyone agrees on one point – the practice is gaining popularity due to its effectiveness.

First things first: no matter what name you choose to use, let’s clarify how it works. People, for any number of reasons, may be unable to lift heavier weights or do extensive strength training for a period of time. Whether it’s an injury or another condition, blood-flow restriction training allows the patient to lift lighter weights while receiving benefits similar to people lifting heavier. 

“They can gain strength and hypertrophy without having to work at a particularly high intensity,” explained Pieter de Smidt, PT, DPT, Cert. MDT, MTC, who is the president and owner of Reset-Wellness Physical Therapy in Houston, TX. “That makes it ideal for physical therapy patients.”

De Smidt’s explanation is as follows: the accepted standard is that in order to gain strength or hypertrophy, a person must be able to lift weights that are at least 65 percent of the person’s maximum capacity for that exercise. For example, if you can lift 100 pounds, you must lift at least 65 pounds in order to see tangible benefits in added strength. 

Of course, for people coming off of recent injury or surgery, this is an impossible task. It becomes challenging for the physical therapist to allow these patients to strengthen themselves because of the reduced capacity for exercise and lifting. “I can’t make you work hard enough for the body to adapt,” explained de Smidt.

With blood-flow restriction training (BFRT), however, that same patient who is unable to lift 65 pounds while recovering or while injured can suddenly see benefits while lifting only, say, 20-25 pounds. 

How? Say you want to work your upper body. You wrap a pressure cuff or similar restrictive instrument around the upper portion of that limb, reducing the ability of blood to flow out of the working muscle. When properly performing blood-flow restriction training, blood is able to enter the muscle via arterial flow, but the veins are restricted so that blood is partially prevented from leaving the working muscle. 

“That’s the ideal scenario for repairing the tissues,” de Smidt explained. “But by lifting lighter weights, you’re not providing any mechanical stress or doing mechanical damage to your muscles. Everything you do goes toward growth.

It’s a great way to gain that strength safely, while slowly progressing toward your ability to lift those weights normally. It’s a temporary solution – you don’t need to be doing it forever, just until you’ve safely regained strength and the patient is able to lift heavier items again.”

De Smidt was originally attracted to blood-flow restriction training not only by its ability to create hypertrophy, but by the potential for utilizing the training for prevention in a passive state. “If I restrict your blood flow without anything else,” he explained, “while you’re, say, in a cast, you will not lose your muscle mass or strength if you do this training during immobilization. Otherwise, strength loss and atrophy can occur very quickly.”

Post-injury, post-surgical, post-immobilization – they’re all strong indicators for the potential benefits of blood-flow restriction training. “It works for anyone who has a reason why they’re unable to perform typical, high-intensity exercises can benefit,” said de Smidt. “But it can also be used in your athletic population.”

De Smidt outlined a pair of uses for BFRT in athletes – in-season training, when coaches and trainers are leery of players hitting the weights too hard, or use it as the finishing touch at the end of the workout to maximize the benefit of strength training. “You can reduce the mechanical stress component,” de Smidth said of the first example.


De Smidt cautioned against using the method with post-surgical patients before consulting with the surgeon. It’s also important to account for any cardiovascular restrictions, such as hypertension, before proceeding with blood-flow restriction training. PTs should avoid utilizing BFRT in areas with open wounds or impacted by lymphedema. ANy area with clotting risks or limbs with a dialysis port should also be avoided.


Years ago, patients would undergo surgery for vascular necrosis of the hip. These patients were too young for a total hip replacement, so the chosen procedure would require six months non-weight bearing, It’s easy to imagine the atrophy and loss of strength that would take place over that time.

“Initially, we started those patients on a passive protocol, followed by an aerobic protocol, and finally strength training,” de Smidt recalled. “Using BFRT, we saw significant differences in the strength loss as opposed to in the past.

“That’s how I got into this – they were immobilized, they weren’t allowed to do many exercises because of that initial fragility. This allowed us, for a few weeks, to get ahead of the atrophy. Slowly, we made the patients more and more active, and it was nice to see how BFRT helped in that process.”

PTs, OTs, certified athletic trainers, and personal trainers can all benefit by utilizing BFRT similarly with their patient populations. “As long as [the professionals] know how to use it, it can be very effective.”

De Smidt cautioned that each session shouldn’t exceed 10-20 minutes, and that this strategy should not be used as a primary strength-building approach. “If you’re healthy, and able, the research shows you should be lifting heavier weights to gain strength and hypertrophy,” he urged. “Once, twice a week in a healthy person, this can provide a different kind of stimulus because you fatigue much more quickly. You can use it as the finishing touch to a regular workout.”  

BFRT is great for strength training, hypertrophy, aerobic endurance – it can be used to increase a patient’s VO2 max in a short amount of time – and can be performed actively or passively. But by using it at the beginning of a session, de Smidt says you can reduce the patient’s pain, expanding their capacity for exercise throughout the session. After injury, the patient can start day one, while post-surgical patients tend to wait 1-2 weeks before starting through a slow progression. 

Lastly, a few safety precautions: de Smidt says the gold standard is usage of a Doppler to determine lymph occlusion pressure. “Say, at 200, we have no more pulse shown, we work at about 50 percent of that. We don’t want maximum occlusion –the key is doing this safely to maximize its potential.

With several decades of research behind the method, de Smidt says BFRT should likely be used more liberally within the clinical setting, but some practitioners have concerns about safety…

If you would like to learn more from de Smidt himself, sign up for one of his seminars by following this link.


Crossfit Movements-Clean

Lots of people ask me about different crossfit style exercises. Sometimes they feel intinmidated to go to a crossfit box, other times they want to learn on their own. I’m not a crossfit coach, but I help patients that have pain with lifting weights, or have pain and want to return to lifting weights.

The official crossfit website has a lot of information. Today, we will look at the clean. Often I find people that have difficulty with the front rack position, due to limited upper back mobility and/or limited flexibility of the lats.

A great way to start with this movement is using dumbells, before a straight bar. Click here to see a detailed description

Then you can progress to the barbell clean.

A variation that can be used is the hang clean, where you dont start with the barbell on the ground, which is great if the actual lift off the ground causes you difficulty.

The clean is typically combined with the jerk.

What is difference between the “clean” and the “power clean”?