Julie Hereford, DPT

Can you give us a brief overview of your professional background and perhaps discuss any mentors who have been influential in your life?
I attended St. Louis University and graduated in 1983 with a BS in PT.  After my first year of work, I wanted to know so much more and so returned to grad school while continuing to practice.  I completed a Master of Science in Research in Anatomy and Neurobiology and continued in the doctoral program in 1989 during which I completed original animal research that investigated the effect of ultrasound with hydrocortisone on the morphology of joints.  This research was presented at national and international conferences. 

All through graduate school, I continued to work in outpatient rehab, working in orthopedics & sports medicine, working primarily with endurance athletes.  I also had an opportunity to work in the pitching staff of a Major League Baseball team.  I found that I was drawn to the more complex patient problems and eventually took a job working as a member of a multidisciplinary team at St. Louis University Pain Management program.  Working as part of this team was one of the most challenging and rewarding things I have done in my career.  It was here that I developed a real appreciation for interdisciplinary integration of patient care.  However, because of the ever-changing nature of the business of medicine, over a period of time, this program was dismantled, eventually opening the door for me to join with some colleagues in developing a private practice that operates along the same line.

As the profession has moved toward an entry-level doctorate, I decided that I wanted to have the highest credential of my profession and so I enrolled in the DPT program at Des Moines University.  I was the Graduate with Distinction in the 2007 graduating class from that program.  This degree has helped me to broaden my understanding of rehabilitation and to consider the patients underlying and co-morbid medical conditions in the development of a treatment plan.  Having a better understanding of what is going on with a patient systemically can have a significant impact on their ability to engage in and fully benefit from rehabilitation.

Mentors:
I have been very fortunate to have several outstanding mentors during my career.  First, my orthopedics professor, Mary Lou Kopp, has continued to mentor me throughout my career.  She has helped me to think through patient problems in a much broader and more complete way.  She has forgotten more about joint function than I will ever know.  We continue to meet regularly. 

While working as part of the Pain Management team at St. Louis University, Dr. Raymond Tait began to mentor me.  Dr. Tait is a Research Psychologist and he continues to teach me much about the world of research, especially in the area of pain management. 

Dr. John Yetter, a sports medicine physician and Dr. Larry Berarducci, a cardiologist, both have very similar treatment philosophies and have always been available to consult on a broad range of professional matters.

You currently own your own practice, CORE Rehab Services in St. Louis, Missouri.  Tell us about your practice.  Do you specialize in any certain area?
CORE Rehab Services was established over 10 years ago as an independent multidisciplinary pain management program.  My business partner, Mark Murray and I decided to open this practice in order to have some sense of autonomy in the ever-changing business of health care.  Working for a corporate health care company did not allow us to spend the kind of time we needed to with our patients.  We have purposefully kept our practice small and have few network contracts in order to allow us to practice as independently as possible.  Clearly, we must be doing something right, because we continue to be a thriving practice ten years later.

We frequently receive referrals from our colleagues in the area for some of their more difficult patient problems.  A typical patient referral may be one with multiple pain complaints and complex system involvement.  The patient that we often see has been through and failed multiple different treatment programs.  Other clinicians and facilities may find these patient types frustrating, but we excel at treating them.  We are fortunate to use a team approach, including biofeedback and psychological services to help us deal with the long-term effects that impact patients with these types of pain problems.

You are an experienced teacher at the University level and for continuing education. Can you tell us what courses you are currently teaching?
I am currently serving in an advisory capacity for a transitional DPT program working with students with their capstone projects.  I also have a series of continuing education courses that I teach offering an integrated approach to treatment of cervical, thoracic and lumbopelvic dysfunctions.  Additionally, I work with St. Louis University in the Practical Anatomy Workshop to develop and present a variety of course offerings that have an anatomical dissection component to the course.  Recent and upcoming offerings include ‘Anatomy of Respiration’ ‘Treatment of Non-Surgical Scoliosis’ and ‘Treatment of Tempromandibular Disorders’.  These courses include anatomy prosection and we always incorporate medical/dental aspects of these problems in the course program.  This sort of multidisciplinary teaching approach helps to engender communication among health care providers from various disciplines.

As you know, Postural Restoration is an approach that promotes ‘integration’ of the systems of the body as well as ‘integration’ of professional disciplines.  Who do you find it helpful to integrate with and why?
When I perform an initial evaluation, I always gather systems review information.  In accordance with the direction of the APTA, I believe that it is important to have at least a cursory knowledge of how various organ systems function.  As a PT, I know that there is much that can be done from a physical therapy perspective to influence these systems.  When I took my first course from the Postural Restoration Institute, I was very excited to see that this is definitely the approach of the Postural Restoration Institute.  The underlying philosophy of PRI fits in so well with the philosophy of CORE and I believe this should be the direction that the profession of physical therapy should go. 

CORE Services, Inc. was founded as a multidisciplinary practice, so we naturally integrate different disciplines into our regular treatment programs.  Our practice consists of physical therapy, biofeedback, neurofeedback and psychological services.  We also have relationships with a number of providers from other medical disciplines.  Specifically, we work with an neuro-optometrist, a pedorthotist, several dentists who specializes in TMD, a pulmonologist who specializes in evaluation and treatment of sleep disorders, several GYN’s and endocrinologists who help identify and treat endocrine disorders that have an impact on our patients neuromusculoskeletal problems and a neuropsychiatrist, who will be presenting at this course and who is a very skilled clinician that seems to be able to correlate many of these problems that we find in our patients.

Coming in April, PRI is hosting its 2nd Annual Interdisciplinary Integration course that includes you as a guest speaker.  You will be presenting on the 4th day – Rest Integration.  What do you plan on covering in this course?
We are planning to present an overview of sleep architecture and sleep hygiene.  In order for the attendees to understand how sleep impacts their patients, we will discuss the vital functions that sleep provides for optimal function.  We will discuss normal and disordered sleep and learn about sleep studies.  We will present examples of sleep studies and discuss how to interpret the studies and suggest how that interpretation might impact the rehabilitation process.  We will introduce the research that suggests that certain types and/or stages of sleep are critical for motor learning and motor planning.  The timing and quality of sleep seems to have a more important role in successful rehab than we might have understood before.  We will discuss some ways that course participants can recognize patients who may have sleep disorders and suggest some screening tools that can be utilized in an average clinical setting.  We will also discuss appropriate intervention and suggest ways for participants to identify individuals in their professional communities with whom they may collaborate to identify and treat patients with sleep disorders.

During this course you will introduce us to Dr. J. Paul Rutledge, MD who is a Neuropsychiatrist in St. Louis. He will also be presenting.  Tell us a little bit about him.  How did you two end up working so closely together?
Dr. Paul Rutledge and I have worked together for a number of years.  Dr. Rutledge has been practicing psychiatry in St. Louis for over thirty years.  During the course of our professional relationship, Dr. Rutledge and I have had the opportunity to co-treat a number of patients.  Through discussion with him, I was first introduced to the study of sleep and sleep disorders.  Many of the patients that we see together have sleep disorder as part of their problem set and Dr. Rutledge’s in-depth knowledge of this area has led to substantial improvement in patient treatment.  I refer patients to Dr. Rutledge who seem to have a sleep disorder and who may also have an over-arching depression or other psychiatric disorder, as is often found in patients with chronic pain disorders.  By adding this dimension to the patient’s care, we seem to have a better overall outcome.

What topics does Dr. Rutledge plan on covering at the Interdisciplinary Integration Course?
Dr. Rutledge will be discussing the evaluation of patients with sleep disorders and will discuss the interplay between sleep disorders and psychological and psychiatric disorders.  He will also discuss the impact of certain medications on sleep disorders and the role of various medications in the treatment of sleep disorders.

How do you see PRI and your area of expertise working together in the future?
As discussed above, I see a close relationship in the philosophy of the Postural Restoration Institute and the practice philosophy of CORE Services, Inc.  I believe that the integrative and interdisciplinary approach defines physical therapy.  We will continue to work with PRI to promote this approach.

Aside from the Interdisciplinary Integration course in April, do you have any other projects you are working on in 2010?
We continue to work to improve our facility and our delivery of patient care. 

We are working toward developing some new niche markets that are particularly appropriate for our area of skills.

We will be offering a number of community education classes including some in the areas of women’s health for those over 50.  This class series is called ‘Red Hot Red Hats. Other community class offerings will be geared toward the ‘weekend warrior’ athletes and we are hoping to do a ‘coaches clinic’ with Dr. Cyd Williams that will have a strong component of PRI concepts. 

We have a significant amount of continuing education projects, including expanding to level II courses for both the Lumbopelvic and the Cervicothoracic courses. 

My professional goals include becoming Board Certified through the APTA as an orthopedic specialist.  I will also be expanding my skills in the areas of manual and manipulative therapy.