[Eric Magrum]

Bone Stress Library builder (possible repost)

Attachments:

You must be logged in to view attached files.

[Eric Magrum]

What is pubic symphysis dysfunction?

Attached articles to review/discuss/add to library.

SIJ narrative one of my personal favorites in the past few years – discussed already.

Attachments:

You must be logged in to view attached files.

[Eric Magrum]

Hijacking the Discussion Board early with another article; partially for the pictures (who doesn’t love a good hip fracture pic); but mainly for the what it adds to Kyle’s case, the sequelae of this patient’s management, not just regarding bone health, but multi system influences.

OK – start this discuss please.

Nice case Kyle

Attachments:

You must be logged in to view attached files.

[Eric Magrum]

Article summary in 2.5 minute cartoon video

[Eric Magrum]

Great case with great discussion points; and a poorly informed Ortho making patient decisions.

This is the paper for your library; and the group doing the most influential research on this topic.

Have a read and discuss your clinical decision making; and points to discuss with this and future patients; and possibly this MD.

Attachments:

You must be logged in to view attached files.

[Eric Magrum]

Great post – authors to be familiar with (especially for this topic).

Well discussed points with recommendations for additional evidence.

How would you summarize what we discussed regarding screening/clearing in this region from Weekend 1?

How does this paper add to your clinical decision making with patients who your are going to treat the upper cervical spine?

[Eric Magrum]

I agreed – I would love to see a discussion lead toward clusters of special tests to rule out differential, and rule in primary hypothesis.

We know the metrics for other shoulder special tests are poor secondary to concomitant pathology, and inability to specifically load individual tissue.

Thanks again Taylor – please facilitate this discussion in that direction.

How do you “weight” the poor metrics of the “special tests” in your decision making for hypothesis generation?

E

[Eric Magrum]

Good discussion – keep it up
Hard to not think this is a compressive tendinopathy/IMP.
Rule out cervical/neural involvement for sure; but seems low on my differential.
I would primarily want to know the irritability/strength of the RTC (all components, all positions).
Maximize scapular positioning for RTC length/tension, and other impairments regionally that force the cuff to work sub optimally; then gradually progress strengthening/load of the RTC in the context of irritability.

Or just manipulate the thoracic spine.

Thanks again Taylor – anxiously awaiting additional objective info

[Eric Magrum]

Great discussion

Here are a couple additional articles in this shoulder post op protocol tract that should be in your library.

Thanks Kyle for facilitating this discussion.

Attachments:

You must be logged in to view attached files.

[Eric Magrum]

Great job guys – good discussion.

Interesting that a few (despite a well designed study) would still not change practice patterns? Why not.

It definitely makes me educate differently regarding the expected outcome of manual therapy, and what I have to offer that patient.

It definitely makes me clinically change how I reason through the benefits of manual therapy; if they are not responding (decreased pain, function, maybe improved ROM), then I’m much quicker to abandon (non responder) joint mobilizations, and emphasize education/exercise.

I hope other clinicians do change practice patterns with an article like this as part of the body of evidence.

I see many newer clinicians (not just residents), NEVER discharge some patients; expecting the outcome will continue to improve, or eventually a different outcome if they just keep trying, or keep trying long enough.

I agree that there is a sub group of Hip OA patients that benefit from joint mobilizations; but we definitely need to reason who those patients are if we are going to choose as a treatment tool.

Other thoughts?

[Eric Magrum]

Great discussion guys.

Helen – great example of something that you do in the clinic daily assuming it has evidence behind it until forming a clinical question to actually look at the evidence.

That all being said – why would you throw it out as a treatment tool? Maybe understand the limitations of the evidence, but continue to assess the value as a treatment tool understanding which specific patient presentations, and your previous clinical successes/failure to make decisions about who, and when you use that technique.

That’s EBP…So don’t chuck it out because it doesn’t have level 1 evidence behind it; but critically reason through what/why/who understanding the limitations of the evidence.

Maybe write up a case with that clinical question you were unable to answer through a literature review.

Another couple of things to think about – what about graft selection? and graft healing rates? as a few more points to think about/discuss when to “accelerate/delay” rehab.

One more thing – We discuss motor learning principles throughout (isn’t that what we do – teach people how to move more efficiency), in the framework of some of the principles brought up by Anna.

Have a read – discuss some key take homes for this population, and everyone else who walks in your door…

Morning and caffeinated

Happy Turkey Day

Attachments:

You must be logged in to view attached files.

[Eric Magrum]

“Final thought: I teach everyone lymphatic drainage techniques post op! There’s some good research on it actually making a difference.”

Please post that research, and describe what you mean by Post op lymphatic drainage techniques.

Thanks

[Eric Magrum]

Another question to help facilitate this discussion.

What criterion help you with decision making to “accelerate” ACLR rehab; what criterion help you with decision making to “delay” rehab – from the protocol guidelines from your specific surgeon?

Thanks for starting this discussion Anna

[Eric Magrum]

Good points Brian.

I think one key thing that I try and emphasize with NSE; is that is just another tool we have. I love that it forces us to reflect on our communication with the patient more specifically and tailor that communication.
But that specific prescription of TNE is a large component of the art. Not every patient needs TNE; and some may need 100% of their session to be pain education. Being aware and delivering the appropriate dosage of every treatment is the clinical reasoning part.

Thoughts?

[Eric Magrum]

Having a Pain Science Education “spiel” is only part of pain science education.
Obviously having a better understanding of the evolving science behind pain science to better formulate your education delivery was the goal of Lorimer’s presentations.
My feedback to those who “think they already have a good pain science spiel”; is that the message is always best delivered with a patient specific individualization integrated into your teaching. A pre conceived “pain education” script will be successful only a fraction of the time. Evolving your “spiel” with each individual patient functional goals, and the specifics of their individual “story”.

I have lots more thoughts after this weekend – keep the discussion going, especially while fresh in your brain.

[Author]

Posts