[Kyle Feldman]

Great points both of you

so with this case, and with most cases, it is not 100% myo or artho.

Her driver based on the treatment plan was myogenic but once we hit a plateau, the joint treatment and motor control training allowed for more progress.

The key points that Laura is trying to present is that we NEED to be thinking pain drivers and differentials instead of just treating impairments!

[Kyle Feldman]

Sarah

Thank you for your research on this case.
I may not be able to make the call so I wanted to bring up these points for you to discuss on the call.

Looking further at this study, it shows the mobs were performed after ultrasound.
Did you perform the ultrasound on this patient (I haven’t seen a machine in 5 plus years so I am unsure how to turn one on)?

Also, mobs were written at a certain MHz. Are you familiar with how to create the temp?

Lastly, how long do you usually performs mobs on patients? I rarely see people spend 15 min straight doing mobs so would love to see how well this played out clinically.

[Kyle Feldman]

Sarah

Thank you for your research on this case.
I may not be able to make the call so I wanted to bring up these points for you to discuss on the call.

Looking further at this study, it shows the mobs were performed after ultrasound.
Did you perform the ultrasound on this patient (I haven’t seen a machine in 5 plus years so I am unsure how to turn one on)?

Also, mobs were written at a certain MHz. Are you familiar with how to create the temp?

Lastly, how long do you usually performs mobs on patients? I rarely see people spend 15 min straight doing mobs so would love to see how well this played out clinically.

[Kyle Feldman]

David- great points. we do not have to condone these types of additions that could lead to other issues.
But I recently had a patient using medical marijuana and reported 80% improved symptoms. I did not say that was the answer, but I also did not say stop either.

Yes, good idea of chewing
that made a big difference for her

[Kyle Feldman]

Great idea!
Yes, looking at the headaches more may find the myofascial driver for the jaw and may treat both!!

She has base of the skull and a headache in the shape of a crown around her head
The headache also goes into her temples/forehead

[Kyle Feldman]

Great idea!
Yes, looking at the headaches more may find the myofascial driver for the jaw and may treat both!!

She has base of the skull and a headache in the shape of a crown around her head
The headache also goes into her temples/forehead

[Kyle Feldman]

Great questions David

i think they are very valid and great to ask. You are placing great value in the psychosocial component of care and that is important here.

Q1- if she said she just deals with the stress and has a glass of wine at nigh to unwind, what would you do?
If she has no interest in adding a councilor or psych to her care, what would you do?

Q2- She stated she is not sure. What homework would you give her to figure this out? Do you want her to think about it? Change things?

[Kyle Feldman]

Great questions David

i think they are very valid and great to ask. You are placing great value in the psychosocial component of care and that is important here.

Q1- if she said she just deals with the stress and has a glass of wine at nigh to unwind, what would you do?
If she has no interest in adding a councilor or psych to her care, what would you do?

Q2- She stated she is not sure. What homework would you give her to figure this out? Do you want her to think about it? Change things?

[Kyle Feldman]

Based on our eval and the ortho MDs evals we both felt TFCC.

I saw him 2 years later and he still would get some pain with a jammed swing but about 95% improved

[Kyle Feldman]

only worse on no golfing days after he had golfed but golf was a main trigger

Manual and exercise only helped temporarily

He ended up being splinted and rested with an injection for 3 weeks

after that we slowly worked back into activity.

[Kyle Feldman]

David- good points.

Worse after golf and more at night vs in the AM

Any RD and UD with weight increases the pain also.

We did try the tuning fork and his symptoms were very inconsistent so it was not a clear positive sign.

[Kyle Feldman]

swelling is usually about 1 hour after playing and sometimes it starts at about hole 16

He has some constant pain when swollen, but once that goes away he do not have constant pain

So far symptoms are maybe slightly better but about the same as when he injured it because it keep happening when playing. It is better because for about 2 weeks he could not play.

Great idea getting ortho involved. We did that and imaging showed swelling in the TFCC region. We did not DC but worked with him during this process

any other thoughts after providing this information?

[Kyle Feldman]

Great points everyone. For some reason I did not subscribe to my own post so I did not see this.

I am treating a pitcher who had tommy john surgery and I am combining 3 protocols together to make his.

It allows you to be creative and tailor to the patient but still have a foundational research backed program. This helps if anything goes wrong, you can at least have support why you did what you did.

[Kyle Feldman]

Great point Helen

I had a patient sent for vertigo last week.
Symptoms seemed strange with neck and head symptoms. She reported she had a doppler set for the next day. I did not treat the vertigo and instead worked on balance and scapulae retractions.

She came back for visit 2 and learned she had 50% occlusion on that side.

Glad I did not Dix Hallpike her!

[Kyle Feldman]

Great thinking everyone

Steven… Spot on with the ocular assessment. This is huge for concussions!

I like the use of the dizziness handicap, functional testing, neck, and balance treatment.

We can treat her as long as we are making progress, if you plateua, go to the CPG for more ideas.

If you are still stuck…. you can always refer to another PT. Never leave the patient helpless, always offer another option.

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