[Kyle Feldman]

Great post
I liked how the article told the story and transformation of his practice. I also like how he started with the challenging deep thinking and then simplified to the less biomechanical treatment.
I would argue that if he had not done the higher level thinking about the biomechanics he would not have had such a deep appreciation and understanding of the anatomy and body. I feel that if you start with the more simplified methods you have capped your thinking at a ceiling. The best PTs I have worked with all started with knowing a ton of different ways of thinking and higher level training before simplifying and taking what they needed to treat a patient. If you only know one simplified method I feel it may limit you as a clinician.

I also am a fan of Jim Meadows thinking and liked his editorial the most. He is right about the practice based evidence over evidence based practice. I think he really is showing how clinicians should be the ones deciding research, not just the researchers. It becomes a political world and who you are connected with to determine whos papers get published and I don’t feel that is going to keep our profession at the front.

[Kyle Feldman]

August, Great reflection on your experience. Less is more and it looks like you learned that from this patient. You can always add, but it is much harder to take away once you do something.

Great post

[Kyle Feldman]

In past experience I have tried to actually articulate my thought process in the notes. If they had a problem with this I would have a conversation. If they are unwilling to listen to when I am trying to back the down and get them better (in this case the patient needed less, not more) then I think that referral needs a new place to send patients.
I think the MD is correct if they tell us that we are wrong for pushing the patient and going beyond the protocol because they are the one that performed the surgery and they know the quality of the tissue and the work they did. If they want us to do less, they have a reason.
However this article talked about the PT backing down and doing less to get the patient better. In my opinion, this is not something the MD would question if the patient is making gains.

[Kyle Feldman]

We started using this in fellowship.
They really like the test based on the article.

I think the endurance aspect of the test is really what is important

[Kyle Feldman]

Great Read. I saw this on Facebook a few weeks ago but only glanced at it.

I can tell you that this is the reason I choose residency and fellowship. Most PTs can get someone “better enough” or work them to a point. However it takes a higher thinker, a more caring person, a practitioner that puts the patient first and truly listens that will find what is needed for THAT patient to get them above and beyond.

I know that each of us would be reflecting throughout the process and knowing that after a few visits we were not seeing gains we would have tried to switch up the method. Keeping the ego out of it is the most important aspect of being a truly good practitioner from what I am learning now.

“The secret of the care of the patient is caring for the patient.” I loved this quote. One thing I struggle with is caring too much. And by that I mean thinking about them long after they left, second guessing what I did, and worrying I am missing something. It is great to reflect and never be satisfied, but I know that I need a balance and to trust that I am doing the right thing because I am using the best evidence based practice and constant reflection.

We are all on the right track. We just need to make sure we are never satisfied, letting ourselves get in our own way, and caring about how we care for the patient.

[Kyle Feldman]

great article to refute the need for surgery.
I feel that this is the direct we are going in the medical world. Trying to understand that we may be doing what we think we are doing, but the effect on the patient is not because of that. It is because of the central and peripheral processes going on in the patient.

Some huge names on the paper and they did that for a reason.
I wonder why they could not get this into another journal

[Kyle Feldman]

I love the concept of this pilot.
However, the methods could use work. They selected people from an AD, so they may have chronic pain but they are not chronic pain patients which I feel is a HUGE difference. The people who cannot manage are the ones that come to PT. It would have been even better to use this with actual patients.

On the topic of goal setting. I do agree that having the patients make the goals and putting then in their language is key. You need to get them to want to do it. If your alliance is not there, the patient will not be bought in.

I like the concept and hope they do a great job with the study.

[Kyle Feldman]

I had a lack of understanding of patients with cervicogenic headaches until listening to Cesar fernandez de las penas lecture 2 weeks ago.
There is so much behind a patient with headaches that you have to take a step back and subjectively understand what the patient is understanding first.

The easy way out is to assume that the patient is just afraid of headaches, but like the chronic pain patient, we need to assume that what they are saying is true and we are the only ones that believe them.

[Kyle Feldman]

Great read
I read an article this weekend about n=1 from a maitland article.
Talks about the same concept of thinking outside of the box.

I love how we are evolving and trying to find our own way to be the best

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[Kyle Feldman]

I have used this article with two runners now after a hamstring strain and it worked very well
I think the three exercises were simple but challenging enough for my weekend worrier patients.

Look forward to hearing your outcome

Kyle

[Kyle Feldman]

Crazy diagnosis.

I do not feel her presentation was anywhere near the level of the patient presented in the case (no torticollis, gross rotational limitations) but until we saw every image I would not rule it out at all.

I agree with Nick about being very conservative even without neuro signs just because it is something we are not familiar with and the risk of death in past cases.

Thank you

[Kyle Feldman]

Eric, Great read.
I have not seen many elite golfers or many hand patients, but having this for when the day comes is awesome.
I also feel that it will be great to reference for those avid gardeners or even tennis players with funky grip styles.

The biggest theme I saw in this post was that X-rays and CT’s will show the fractures, but all of those elite overuse issues need an MRI.

I did not see treatment approaches, but I feel that many of these begins with rest and controlled loading as well as manual/stretches to improve hypomobilities or limited motion. WOuld you all agree?

I feel that as PTs we have some money treatment options that clear 70% of the issues that walk in our door.
Having this research and going that extra mile gets those other 20% better. That last 10% I am still trying to figure out what to do

[Kyle Feldman]

I am with Eric on this one. I tend to refer all T4 patients to Aaron.

I want to also explain the similar patient what Aaron was referring to.
I evaled at 6 5 dentist who had a twist mechanism swinging a bat. It sounded disc in nature with this mechanism but he had trace reflexes and 4 heel raises. 3 days later when Aaron saw him he had no reflex and no heel raises. Things went down hill and his treatment was non aggressive SLUMP position sliders and prone press ups to try to continue centralizing from eval

I agree with nick and eric about young a healthy, but when things go south we need to know when you go to next route.

Sounds like your patient is not going either way. May need to see in a week what is going on and decide if you are making an impact.

[Kyle Feldman]

Back to the return to sport issue.
I had trouble with this as well for LE athletes.

After reading Phil Pliskys blog I felt more confident and began to use this mind set.

Check it out and maybe Eric can tell me if this is a wrong thought process but I have felt more confident when I clear someone with this idea.

http://philplisky.com/category/return-to-sport-and-discharge-testing/

[Kyle Feldman]

does hit on the major things that drive many of us to the profession.
There are some great educated therapists with no empathy or willingness to have that physical contact.

Being well rounded is so key.

Great reminder article

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