[Kyle Feldman]

Barrett brings up a good point about discussions on social media and how the Strawman argument is often used.

When one person is trying to present the research and have a discussion and the other is trying to tell there guru knowledge or build a following there is often little to no ability to have a positive impact on the profession.

With your residency education and deeper clinical reasoning, how could you each help influence the profession in a positive way with social media?

[Kyle Feldman]

Great points Taylor and Anna.

MRI would be the best option and I like the reasoning of trying to rule out other pathologies.

You mentioned this may not be your wheelhouse.
Do you have other providers in your area who may be better with hands that you would refer them to?

We always think of referring to neuro, ortho, etc. Do you ever think of referring to other PTs?

[Kyle Feldman]

Great differentials

It looks like you are each on similar paths.

Imaging has been supported by all of you.

What imaging?

Would you send them back to the PCP and call saying your thoughts? Directly to an ortho doc?

If you think imaging, are you going to keep treating, put them on hold, or completely discharge?

When some therapists say imaging they believe there care is done. What are your thoughts on this?

Finally, any thoughts on bracing for this patient?

[Kyle Feldman]

Great addition Helen,
Its a hard balance. And you are 100% going to get the blame. If that happens, sometimes the docs will stop referring patients to your company and even try to tarnish your reputation in the community.

I went to a neuro MD the other day and talked about PT for vertigo.
He said he stopped sending to a group in town because they did not do what he said 1 time.
This was 6 years ago!
He completely wrote them off for 1 experience.

Sadly, a lot of this profession is about relationships not just with patients but in the community and with other providers.

[Kyle Feldman]

Great points Taylor
I think you calling was a great decision and he explained the reasoning

Having that tissue understanding is very valuable and can help you reason as you do progress after able

[Kyle Feldman]

great understanding and thinking

I liked that last question…… When you only get a protocol and a patient how comfortable do you feel to treat? In the private practice world it can sometimes be hard to get all of the notes/reports you need. How would you try to handle this situation?

[Kyle Feldman]

Hey Brandon,

I have been going back and forth with him for a few months on Linkedin because he continues to say he gets everyone one of his patients better with his self named approach. I am trying to challange him to question the mechanisms but he continues to be motivated by the “doubters”, so the more we post, the more he is going to think he has unlocked the “magic treatment”.

He is trying to build a brand and sell himself as a Guru. His whole focus is on himself and because of this it appears his clinical reasoning has become skewed.
His model is very similar to a lot of chiropractors on social media. They find there niche and try to get patients to buy in.

When you read or watch something like this, it is easy to get frustrated and find the issues. I challange you to find the positives also and then with that, find what you would do differently. You cannot stop him but you can motivate others to do the right thing and share the higher level ways to think and treat.

Positives from this video-
-patients are getting relief (even if temporary and poor education),
-he is not telling them they are weak or frail,
-he is giving them exercises,
-he is using access treat and reassess.

What I learned-
-SIJ can be a mechanism of pain and doing some distraction and PA mobs may assist with this pain.
-I want to make sure when I am doing muscle testing I block the joint above to avoid compensation
-Bias is powerful and can help get patients better (if you say to a patient this has worked 100% of the time for 10 years, they are leaving knowing they are getting better)
-adding more differentials will help me to limit having a bias and keep my options open (a zebra is always a zebra if thats the only animal I know)
-Following up treatment with specific exercises will help support my diagnosis
-Proof is in the results

The only way a guy like this would change is if he did mentoring and was forced to use a different approach and get to the same results. He is going to live and die by the sword of his protocol because he created it and truly believes it is the “holy grail”.

I challange each of you to try to put yourself in the other persons shoes when you see things like this. Think about the way you thought before you began further education. You may have had the same bias just on a smaller scale.
After that, try to find the positives and learning experiences for self growth.

[Kyle Feldman]

With pain science education, address the elephant in the room. If you are thinking the patient believes you are telling them it all in their head, say it. Say to them, I know you are thinking that I am saying “its all in your head” Emphasize clearly that this is not what you mean at all.
By addressing what they are thinking, you can help clarify and get them on your page.

Since adding this to my pain science education, I have had patients much more receptive and less guarded during our conversations.
Most patients will say, “I thought you were saying that, but when you mentioned it and tried to show the difference I understand better”.

Question for reflection:
Do you think that talking about something a patient relates to has any effect as to why the education is better (pain science vs biomechanical education)? When you talk about the labrum, flexion, rotation, and cartilage, how many patients have a strong grasp on these concepts?

[Kyle Feldman]

Great points everyone!
After reading your reflections, I feel that you each understand the deeper science of it more which makes you less sure of what you were doing before.
This will be the case the entire year.
As you become more knowledgeable, you will begin to be less confident and second guess your concepts from the past.
Keep this up!

[Kyle Feldman]

Erik and Jeff,
I think you both had some great points.

Jeff, viewing the apprehension test as a way to exclude instability is what I believe they were trying to do as well. This helps to make sure its more likely impingement as less instability.

The conclusions are great and prove that a strong subjective and alliance are a key foundation to treatment skills and selection.

[Kyle Feldman]

AJ and Myra

I love hearing your clinical experience with this patient population. As newer grads it is hard to know what to do without multiple experiences with this population.

I am starting to learn better strategies with lots of trial and error.

The best part of residency is learning from mentors and learning from your own mistakes and patient experiences.

Thanks for the post!

Kyle

[Kyle Feldman]

Tyler,

Great post. Chad was the keynote at the AAOMPT conference this year and he spoke a lot about this issue and his publication.

I think this just goes to show how we need to use our clinical reasoning and critical thinking in all aspects of our profession.

[Kyle Feldman]

Hey Katie

Looks like you have thrown a ton out at this case.

Sounds like immediate pain improved with chiro, how long ago did he stop chiro and did the severe symptoms lessen?

Also I agree it sounds dural and you have done almost everything dural to treat it
.

To me it sounds like an annual tear with constant inflammation. I am wondering if doing constant loading and overloading into the irritation is just upsetting it more. Annual tears can take a while to heal and calm down.

It sound like he does have motions and positions that are less symptomatic. I would try to work on doing less irritating activities with strengthening emphasis.

I would also consider trying to change the loading pattern he is in while standing. If he stands for 8 hours and has a strong anterior or posterior pelvic tilt he may be irritating the tissue after 4-5 hours and causing an inflammatory response. May need to help him to work on reloading and changing positions to improve tolerance to standing.

Have you worked on graded exposure to basketball to improve his tolerance and get him back to doing something he enjoys. Maybe free throws, elbow shots, lay ups without jumping?

[Kyle Feldman]

Great article.
With communication becoming so big in the PT world sometimes we have to even listen to our new verbiage and see if it could be improved on. I love how wear and tear now needs to be re-worded. It will be a constant review process. But like clinical reasoning, as long as you are constantly reflecting and reviewing what you do, things will continue to improve for you and your patients.

Having a student this summer helped me realize that what I was saying still had negative connotation.

Reflect in action and reflect on action. Never stop learning. Great article!

[Kyle Feldman]

Glad they talk about less imaging, less meds and less surgery. At least we can get that out to the mainstream.

Sadly, the easier reads are what the media writers can understand so they are more likely to pull those articles. They are also known to spin words to fit the story. Luckily we as PTs stay on the positive side of this one

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