[Kyle Feldman]

this topic so hard when other professionals such as MD’s and chiro’s are tell the patients this and we are going against everything they have been told in the past. The worst part is we have many in our own profession telling patients these things or even that they have cranio-sacral issues or other things with no evidence behind it. We have such an uphill battle to climb trying to get patients more aware of their body

I have not seen done many sleep tips besides breathing or positional changes with pillows. This is a great resource!
thanks!!!

[Kyle Feldman]

Eric- Great job this year. I liked the conference even more!

It was nice to meet all of the residents again.
You guys are doing awesome.

I have not been doing as many running videos or mechanic breakdown so this weekend reminded me of how important this is. I do not want to be “one of those therapists who just tried to throw something else at them” Instead get to the source.

I think the key with these videos is to not split hairs, the big things will show themselves.
Does everyone use Hudle for videos?
I have not used it yet.

[Kyle Feldman]

I just read this thread and It was great.
I agree with everyone that this is a huge aspect of PT that we are finally tapping into.
I have seen a few MDs that were skeptical about the concept and said that we could be on a slippery slope to saying to much and overstepping out boundries.

I feel that if we get overconfident we could go into the clinical physiology area and maybe say things that we shouldn’t.

I have seen Aaron do a great job with this and based on how Eric set up the goals with his patient he did it the correct way.
As a recent grad myself I know that we need to be careful and make sure to keep everything within our scope of practice while we help the entire patient

[Kyle Feldman]

I love these videos
I have had some good feedback from patients when they watch these

[Kyle Feldman]

great read and video Stephanie
I think it is very true that we have gone full circle around what to do for pain and movement.
Finally people are learning that we need to get people to know the facts about the spine and that movement is good

I will be sharing this with my patients

I am also very pumped to be going to AAOMPT
Hopefully his lecture is great

Is anyone else attending AAOMPT? VOMPTI happy hour???

[Kyle Feldman]

I am very confused how this article is 2015 when none of the new graduates are DPT’s
This must have been conducted many years ago or is it because it is in australia?

It also seems to me that the psychosocial skills of a PT are learned in con ed or past experience. I would have liked to have had a better background of each therapist to know where they have learned and studied

It is frustrating when people assume every works comp patient has psychosocial issues which is why they are workers comp. I have worked with a lot of these patients and when you treat them as a normal patient and just listen to them they end up doing so much better. This article looked like the therapists lumped these patients into that psychosocial category
In our clinic every workers comp patients gets an FABQ. After this study I am wondering if every patient should get some sort of form

I feel that this article supports the need for pain neuroscience education courses. I think identify the issue is the first issue and those courses really help therapists do this.
I know as a new grad I did not put psychosocial factors high on my list (I was trying to make the diagnosis my priority) But with experience this is almost more important it seems like.

I agree with some of the PTs in this article that we are not a clinical psychologist and if the symptoms are severe we should refer out. However I disagree 100% that we should do nothing once we refer. I would say <5% of all patients that walk in the door would benefit from a referral. The rest would benefit from our screening and understanding in conjunction with the PT care.

[Kyle Feldman]

Casey I love the defense of both points of view. Makes both strategies sound effective depending on what irritability looks like

I am with you on the article about the only way to truly effect the pattern is to perform it. But like you said staying under the threshold
Could also see breaking it down with the one leg kickbacks keeping neutral spine or other partial tasks like those

How did the patient do the next few visits?

[Kyle Feldman]

that is a great question
I have tried to do the whole task and break down task training from the beginning
Trying do put it all together and break it down each visit

I think I got this strategy when working with children on my last rotation. The combination worked well
What has worked well for everyone else?

[Kyle Feldman]

great case and article was great too.

Big thing i took from the article. Stronger hip abduction correlated to less pelvic motion.
She does not appear to have much pelvic motion or hip strength based on the video and what you talked about above
She looks like she gets all the motion up the chain at her TLJ and thoracic spine

I see that her shoulders are very elevated
Almost looks like a compensation pattern for scapular and thoracic/TLJ weakness.
Maybe combining some of the hip strengthening with TrA and multifidus (side plank clamshells, bird dogs on half foam, SLS with hip abd) could help

I am wondering if working on her UE mechanics (penny pinchers) and scapular stability with strengthening and motor planning (mirror for cues) will help with this pattern.
I know that hip is #1 but i bet working more on the external feed back may help. Just an idea

[Kyle Feldman]

I am with Casey
I try to explain in the beginning what we are trying to achieve from the program and how they are using the body to help determine how much to progress
You give a guideline for the medicine but let them have some control of “how they are taking it”
Sometimes the HEP is tricky because you are throwing such big numbers at them. I have started using the statements Eric Kopp used in the lecture to make 30 reps about 45 seconds to 1 minute. So I will say to try to do the exercise for maybe 2-3 minutes with breaks as needed or 3 sets of 1 minute. The smaller numbers keeps the patients calm.
Just an idea

[Kyle Feldman]

we have an aide which helps a ton so we can keep an eye on them but not need to be right by them and set up each exercise

[Kyle Feldman]

Great article after the Eric Kopp course AJ

I liked how it explained the cost benefit right off the bat for high dose ther ex. Great article to show insurance if they begin to question why we are only doing 4-6 exercises but billing so many units. It also explains why it is skilled care with the PT in the room and that each exercise is specific for the patient in front of you.

11 articles seems pretty good for this specific exercise type with most having 1 year follow ups

endogenous analgesia is a great term I have not used but something that would be great to explain why this much exercise is good and can help with pain by releasing opioids

Also great that they hit on the psychosocial component with the patients who suffer from depression and anxiety. This is more and more common as I have learned more about it

In clinic I had been using some of the MET principles and exercises but since the course with Eric I have a better understanding of why the more reps
Most of the routines I give have more reps to increase that pattern. I also am trying to do better with global and semi global exercises for each patients. At times I will focus so much on the area of the body (such as knee and hip for a knee patient) and not do as much core or full body work. I am working to be more balanced with every patient.

I have seen that MET is great for patients who are stiff or guarding because the more reps seems to calm down the tissue and allow the pattern to improve with the more reps. Also has helped well with patients with poor muscle activation or motor planning. More reps improves the form and muscle activation.

Overall I could see MET being the main principle that therapists use to program for patients.

[Kyle Feldman]

good stuff Cam
Sometimes a different voice and a similiarty can help get those points across

[Kyle Feldman]

I am all about telling patients a healthier way of life. Talking about drinking more water, balanced diets, vitamins

Things that we learned even in undergrad are things many of these poeple are not exactly familiar with. We have an upper hand with our knowledge that we can give some basic information to them but in the end can be huge
NO, We are NOT dietitians or nutritionists but we are living our own healthy lifestyles and can give basic recommendations to help guide people down a better path.

Like the mentors talk about, we are treating the whole person and this is another aspect

What is everyone elses thoughts?

[Kyle Feldman]

I have a 23 year old runner who is having LBP with running with poor lumbo pelvic control, decreased hip ext and dural signs. I gave her basic lumbo pelvic HEP and she did not do because she said she got frustrated and quit. She does not want to modify activity and has cried in 2 of the 3 visits. She wears orthotics and full support shoes (since she was 15) and says she could not run without them. She is type A to the max

I had to sit down and talk to her about PT and what we can do to help these symptoms

After reading this article there are some great points I can use about why we are shutting her down (to reduce the stresses on the irritated tissues), why we are adjusting form (she is not 15 anymore and her daily routine is not school and sports), and why strengthening these muscles with motor control is so important.

Even though I do not think she is having stress reaction I think this brings great talking points

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