[Eric Magrum]

Attached is another editorial/article that I posted a few months ago; as our residents had similar discussions/decision making about 1 piece of new evidence the decision maker to make practice changes.

New and exciting doesn’t necessarily mean practice changing.

So just wanted to add this editorial to the discussion as we continue to be consumers of the evidence for clinical decision making.

Cheers – Thanks Taylor

Thoughts from everyone else?

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[Eric Magrum]

The best way to improve your thinking/reasoning is to think about it – reflection.

Reflection on action progressing to reflection in action.

The goal of the development of this reasoning form is to help with reflection on your decision making; and continually improve your reflection during all aspects of patient care, making it a subconscious process eventually.

[Eric Magrum]

Files attached again

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[Eric Magrum]

Great discussion last journal club – please keep it up for this one.

Think about ways to change the pathomechanics that persist the ankle effusion/synovitis, with resultant IMP at the sinus tarsi – think her foot type, what causes that IMP in the region, and how to control those pathomechanics.

Minimal intra articular differential with an apparent persistent synovitis – should make you think more intra versus extra articular pathology.

Manual Therapy to improve the pathomechanics that are causative for IMP, not just impairments found necessarily.

[Eric Magrum]

Looking forward to a great discussion today

My questions are:

– If this case is primarily biopsychsocial (which it seems to be) – does the specific diagnosis matter?
– How do you specifically change your exam when you realize that this is a primary bipsychosocial case?
– How do you change your communication?
– How do you change your treatment plan specifically?
– What strategies have been sucessful, and unsucessful with a primarily biopsychosocial approach with similar patients?

[Eric Magrum]

Thanks Casey

Do any of the findings/”impairments” matter when the biopyschosocial components seems to superseed any accuracy for those objective findings?

How would you modify your communication, exam, and treatment direction when the biopsychosocial/fear components is the primary diagnosis?

Looking forward to a great DISCUSSION at Journal Club – ideally about how to change treatment planning/communication for this high fear patients.

Thanks

Eric

[Eric Magrum]

As expected – young enthusiastic clinicians biased against any clinical findings that contradict what you have learned/practice.

What kind of bias’ are we looking at here, and how can we critically reason our individual treatment decisions/clinical practice based on these findings versus just look for anything to contradict a well done study in a high impact journal.

Cheers

[Eric Magrum]

Here’s one more Hip article to read/discuss.

How do you take this evidence into your clinical decision making?

Well done study (feel free to critique methods); well authored clinical researchers, in a HIGH Impact journal, with very specific conclusions.

Does this make you change what you do, or how does this change with this population?

Happy New Years

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[Eric Magrum]

Happy Holidays – Another hip article to read/discuss clinical implications.

This is one of my favorites – even though apparently only I treat this patient population.

Have a read, stick it in your library; post some thoughts about the article, specifically the clinical reasoning/differential diagnosis; treatment decision making.

Cheers

Eric

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[Eric Magrum]

Good discussion – another point I try and emphasize in this OA case; especially in the patients with Gluteal Tendinopathy is understanding how to use the evidence to make clinical decisions.

Here is a Gluteal/EMG article systematic review.

How do you use this info to prescribe exercise for this population (gluteal tendinopathy)?

Progressive tendon loading is the hallmark of tendonopathy management.

I.e. – if someone has glute medius tendinopathy how would you use this research conclusions for treatment decision making (versus clamshells to death)

Please post thoughts/discussion

Eric

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[Eric Magrum]

Test post –

[Eric Magrum]

Great job guys – some really well thought out discussion here.
Cameron stole some thunder posting the link; we discussed a bit in class last weekend.
So here is the “Sticks and Stones…” editorial.

Please have a read and post a specific patient/clinical example of where this thinking discussed in the editorial, helped/or hurt a specific patient experience.

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[Eric Magrum]

Tyler – you should post the specifics of the case to better organize the reasoning components more for you upon re evaluation, treatment direction/progression; and to frame this discussion of specific questions better as well.

Thanks

[Eric Magrum]

https://www.clinicaledge.co/podcast/physio-edge-podcast/082LIVE?utm_source=ActiveCampaign&utm_medium=newsletter&utm_campaign=ACPE082&utm_term=ACPE082&utm_content=ACPE082&utm_source=ActiveCampaign&utm_medium=email&utm_content=Podcast+-+What+do+Achilles+tendinopathy+++gatecrashers+have+in+common%3F&utm_campaign=PE082

Here is a great Podcast from Seth O’Neil on the Achilles/isometrics study that Mike referred to a few times, and (group of Podcasts from this group); he discusses the study, some questions we have discussed already regarding carryover of research conclusions to various regions, etc.

Thanks Justin for starting the post about take home/clinical points from the past weekend.

[Eric Magrum]

Before this discussion goes to much further along this thread (to manipulate or not); I would make sure manipulation (Grade V techniques) were truly his expectations (“they popped and manipulated my muscles and it got better, I haven’t had trouble with it until now”); and his presentation is similar (non radicular this time); and indicated by a cluster of findings.

Not to derail the conversation/discussion; but here is a great library builder article with some things to think about with this case and similar patient presentations, especially when multiple directions of movement reproduce.
In my experience, this differential/thought process about the tissues is rarely on the minds of residents.

Think how it changes your treatment decision making versus add more energy into a system that is acutely inflammed inside the joint.

Food for thought – good article to review.

Keep up the discussion

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