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it is hard to be decisive. Especially as you are learning and questioning.
But Eric is making a great point.Being decisive does not mean guessing when you are unsure. You must be systematic and come to a conclusion even when you are not 100% sure. Being decisive will allow you to learn from you decision and grow. When you stay on the fence you never know what would/could happen and how to grow from it.
Great post Eric Thanks!
Hey Scott, Great post!
A patient of mine was listening to NPR the other day and heard about this article. Right after I pulled it up and read it. I think it is a great follow up to the meniscus one done a few years ago. These should be done for every part of the body for elective surgeries.
I agree with you that it is very hard to change someones belief system. I think that the fist thing we need to do as therapists is read the patient. Some people are not willing or wanting to be told something else. You could show them every analogy, video, and explaination but they will just not believe it. Sometimes they just have a higher trust in a medical doctor over a doctor of physical therapy.
I think that having an article like this showing how the surgery did not help as much as just cutting into them makes a stronger point for those skeptical patients who need the “higher ranking” profession to tell them.
I really like this website for the education aspect. I think it answers some questions patients have when we talk about this pain science information.
The program was used in a study by Jo Nijs. They used it in a “protocol” for teaching pain science.
I am not a fan of protocols, but when you are new at something, making things black and white help you implement and then once you have an understanding, the clinical reasoning and skill of use can be added.
Great way to start with some patients when you have trouble articulating it youself
Hey Justin
I treated a baseball pitcher who was post op about 1.5 years ago. He ended up going back to throwing so I would say it was pretty successful.
We started mainly with manual along the scalnes, thoracic container and along the Ulnar nerve pathway.
Exercise was focused on primarily lower trap, lat, and cuff strengthening.
Pain and symptoms reproduction was the limiting factor.Once we progressed with shoulder stabilization and weight bearing we began the throwing return.
I used the Drew Brees return to throwing article by Reinold and Wilk
I think this is an interesting point Eric.
It is true that the best way to advance as a profession is to unite and do the same thing. Power of numbers. I agree 100% with that idea. However, I do not think that we really should have that much lack of variability.
The biggest thing I have learned the past few years is that every patient does not get better with one treatment style. Each patient has different needs from a healthcare provider. Skill of the therapist, personality compatibility, clinic model, and even male vs female are all factors that have nothing to do with what exam or treatment we use. With that said, we want our profession to have a model that promotes sound care and something everyone would be proud of in the profession.
I do feel strongly that CAPTE has worked hard to make sure a new graduate is coming out with some manual skills, some ther ex, general medicine understanding, and safety skills. Once a student comes out we can only hope they continue down the evidence based approach.
Sadly, some people graduate and do not have the confidence to perform some of the skills demanded in the profession so they seek “alternative” ways to treat patients. I feel this track is what decreases the unity. If we work to increase the continuing education programs that teach the evidence based skills better, we will have less people jumping towards the “guru” less studied styles.
instead of blaming the clinicians who are just trying to treat patients and get them better, I think we should look at the standards for continuing education programs to make sure that they are meeting the standards of our professions clinical pillars
Great reflection Justin and Erik
I think you both hit on great ideas about bouncing ideas off other therapists. Putting your ego aside and knowing that you do not have all the answers is key. Being able to listen to the patient and hear that they are actually till having issues is the first step.
You both did a great job figuring this out and going to another mind to get other ideas.Keep strong clinical reasoning and reflecting in-action and on-action as you move on in your careers.
I heard about this towards the tail end of my residency year and tried in two times. One of the patients I tried it just to see if we could load the joint more with less pain. She was able to do more exercises and felt less pain (but felt the pain of the compression)
I also used it on another young girl who had only 100 degrees of knee flexion and this was a last ditch effort to avoid a manipulation. I had tried everything and tried this to see if we could reduce the pain to get her more motion. The pain was better but the ROM did not stick.Jill Cook is a great author and I am really enjoying what she is putting out. Another great article.
I think that Eric is right about the fads and trends. There is so much talk about fascia right now that I am interested to see how long it sticks around.
I personally have become more skeptical this past year and what I have been doing is actually trying to learn more about it and trying to apply these techniques to see if they have an effect.
I think the big issue for me with these fads is that therapists tell patients what they think they are doing when in reality we do not know if it is what is going on a the anatomical level. I perfect example is the visceral manipulation. I have seen patients get better when you rub their belly. You will always have poeple who get better. But when a therapist tell them that they are moving the rotated bladder, that is not the truth. We do not have enough evidence to support this. Placebo is a powerful treatment, but as a medical profession we need to educate and treat with the best supporting research and proven ideas.
I talked to Sarah Baker about this form and what they do during their fellowship training. She mentioned that this form was modified over the years due to the military format of PT. They do a ton of evals and very few follow ups, so this was a way to work on reflection in the moment.
She mentioned they also do reflection after mentoring and do use the long form.
I agree with August about the idea of how SINSS and some of the key ideas in this form done over and over in the moment would be very effective for early learning.
Hey Nic Great case
I have had a few patients with athletic pubalgia. I had one here in fellowship that I wrote up.
Ended up treating with a pubic ramus AP mob and an SIJ manipulation which improved the pain. He was more irritable and had more provoking activities.i would def do PA assessment to fully clear lumbar and SIJ. Something that came up over and over in the literature on the topic
I had the same education as you up to this point so I would always use what you have been doing. But from what I have learned here, that seems to fit more with the lingo the neuro MDs are using.
Hey Justin. We had a lengthy conversation about radicular pain here a few weeks ago. The director here has worked a lot with neuro MDs and they are very strong on saying that in order to have radicular pain you have to have a radiculopathy. So by the medical definition, radiculitis is a stage of radiculopathy and not a lesser degree or something different. This may be why they don’t differentiate in the paper, because if you have radicular pain it is a radiculopathy (and apparently you do not need hard signs to call it one. it would just be a less severe case).
This concept was new to me coming here but I agree it is a terminology difference.
Great pie chart idea. I have been using that myself. Using it for the driver location as well as the type of pain (nociceptive, neurogenic, centrally evoked, etc.)
Great points. Its easy to “see” something when you want to see it or someone else tells you they see it too.
Great reflection. I am trying to do the same with other parts of the body too
I agree Myra. Its such a hard concept that its always going to be above that basic level. I think that lorimer is able to keep things simple but complex at the same time
Great Video!
Another one for the list.
Being at a hospital in inner city chicago with a large medicaid population I am learning how to present this. It is so hard and every patient needs a different explanation.
I am learning how to start simple and only adding as they understand. at first I wanted to keep throwing a lot of analogies and explain it all up front and then I would lose people.Just like with the highly irritable patient, less is sometimes more. Start with a little and add as you go.
To me, this video is not at a 5th grade reading level so it may only work for the highly educated patient. Need to keep that in mind as well
Good read
Very much an article on opinion and trying to play devils advocate to how people are practicing.
I agree with a lot of what they are saying, but I also disagree in some ways.
He walks about how gait is another thing that is hard to assess objectively and it is based on the eye and “motor control”. I feel that just because the research is poor on it, I don’t think we should bail on it. We are movement experts and it should still be a piece of the clinical practice and intervention. I feel the scapula is the same. It is not everything, but something we should address along with the transfer of load and what they talked about in this paper.Any more thoughts?