On Public Facing Physical Therapy

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This view might not be too popular among some but it is something that I think is worth mentioning.
I wish more people in our profession dedicated their efforts to creating content that targets the public or is public facing. As someone who oversees some of the largest groups for physical therapists (PTs) (here, here and here) it never ceases to disappointment me by how often PTs create new accounts which basically just repackage previously created content or ideas and then share them to other PTs.
While it is important that we discuss and share information among ourselves as PTs, how many accounts do we need that share the same information and content with dissemination strategies that are really limited just to PT groups? Come on man, at least be original or at least share content beyond the confines of the same PT groups! The real battle is educating and motivating the public (and other professions) to address the many problems facing our healthcare system upstream. It is not creating another for-profit or self-serving PT mentoring group etc.
This is not to lambaste people for creating such groups, accounts or content. Instead it is a call to action to use your creative efforts to take on a larger and more pressing challenge. It also might be to your benefit, the most successful pages and personalities in our profession are those that are more public facing (KStarr, Prehab Guys and Rehab Science just to name a few). From a business and marketing standpoint (in most instances) it is better if your content reaches or is more relatable to a broader audience. Think about it, there are only about ~250K PTs in the USA, while there are 325 million people in the USA (and 3.9 billion internet users worldwide). There is a rather smaller carrying capacity for marketing or sharing content just to other PTs.
You would be surprised by how many people are looking for information related to their health and health related problems online and through social media; and how often. And then we wonder why the collective mindset of the public retains outdated, outmoded or incorrect views/beliefs about the human body, health and disease; think of some of the things patients say about their back pain, or “toxins” etc. Those aren’t ideas or beliefs that they came up with on their own, it is likely something they read online or social media (or heard from a clinician). Because the people that most often realize the benefit of being public facing are the nonsense peddlers who prey on the staggering healthcare and scientific illiteracy rates in this country (and around the world). They have been successful because they have gone UNOPPOSED for years.

To quote the Physiological Society who in 2017 made a similar call to action to scientists:
In an era of ‘alternative facts’, it is our responsibility that the true (scientifically-evidenced) message is made public rather than allowing rampant myths to be propagated and not challenged by those with access to the wider public, who are, in the end, our target audience. We are in a privileged position whereby a lot of our research can and does have direct application pipelines and as such should reach the end-user directly from us.”

In summary, not only is this more public facing or direct to consumer approach beneficial for improving the status of our profession and potentially your own finances, it will help our patients by offering a discerning voice to the overwhelming amount of nonsense that exists. A light in a world of darkness. A compass in a chaotic healthcare system!

Stop telling people their rotated hips are causing their pain, seriously, stop it.

Worth Reading! #AntiToxin

The Logic of Rehab

I could not think of a better title for this article that did not involve profanity. That being said, I want to take a few paragraphs of your time and discuss an often stated, unfounded explanation given to patients as a cause of their pain. The narrative of a rotated hip joint (ilium on sacrum) causing some type of dysfunction is completely unfounded in the literature. I am going to argue this from three points that will hopefully give the reader an understanding of why this narrative is wrong, and potentially harmful to patients.

  • The ilium and sacrum do not move on a perceptible level
  • The special tests we have with which to determine movement likely rely on pareidolia
  • Words have a lasting meaning of patient’s perception of their situation

Moving joints

Continuing education classes and even prominent textbooks utilized in rehabilitation focused schools teach that rotated innominates, nutation, and…

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Support HB 4643: Direct Access For Physical Therapists in Illinois

To all of my friends and family read below.

HB 4643 has passed out of committee and will go to the House! This is the closest IL has every been to Direct Access for Physical Therapy Services. Please call the IL reps, even if you aren’t in Illinois. The more states that have direct access, the larger chance the states that do not will move toward it.

The Illinois Chiropractic Society has stated they are against PTs having direct access, mainly since this would put us on a fair playing field. We can pretty much guarantee every Chiro in Illinois will be on the phone to their reps, so lets do the same. All the info you should need is below.

We received great news today as our DIRECT ACCESS BILL PASSED OUT OF COMMITTEE. Now our DIRECT ACCESS bill heads to the House floor and we need your help NOW!
Below is a template letter that we would like you to forward to your House Representative in support of House Bill 4643. The full House will be voting on House Bill 4643 on Thursday or Friday.


Sample message:

I am writing to ask you to vote YES on HB 4643 as amended, which would provide direct access to physical therapists for Illinois residents. This is a practice which is already occurring in 44 states, several of which are not restricted in any way.
The amendments, in summary, provide that a physical therapist may provide services to a patient without a referral from a health care professional for 10 visits or 15 business days whichever occurs first. The bill also ensures that the physical therapist notifies the patient’s treating health care professional within 5 days, ensuring that all health care professionals in the continuum of care are informed of the patient’s treatment plan.
In addition, we have reached an agreement with the dentists and the chiropractors that addressed concerns relating to the treatment of temporomandibular joint disorders and length of care.
This important legislation will provide better and faster access to physical therapy for all populations, including Medicare patients, and will help in the fight against opioid abuse in Illinois, as physical therapy is a non-prescription, non- addictive way to reduce pain.


We appreciate all stakeholders work on this bill as well as the work of legislative staff to bring HB 4643 without any objections from any stakeholders.
Please email, call and fax your legislator TODAY. You can find your Representative’s name and contact information, by entering your address at: https://www.illinoispolicy.org/maps/illinois-house/

It is important that every legislator hear our message from many constituents.
The legislation gives the public Direct Access to physical therapists in Illinois. You can access HB 4643, House Amendment 001, 002, 003 at www.ilga.gov. Click on “full text” to read amendment. A new definition labeled 1.2. Physical Therapy Services, allows direct access. There are a few protections for the public and they are reasonable.

VMO? VM-No.

A classic post!

John Snyder, DPT

According to a retrospective case-control analysis by Taunton et al, of the 2,002 running-related injuries seen at a primary care sports injury facility, 42.1% (842/2,002) were knee injuries. Of these knee injuries, 39.3% (331/842) were due to patellofemoral pain syndrome (PFPS), which made PFPS far and away the most common disgnosis found in this large-scale study. Additionally, an older study done in 1984 showed similar results. Devereaux et al found that over a five year period, 137 patients presented with PFPS, which accounted for 25% of all knee injuries seen at this sports injury clinic. These two studies were conducted 17 years apart, giving support to the consistently high prevalence of this disorder, but the real question is, how are we treating these patients?

Based on a biomechanical study completed by Lieb et al in 1968, the vastus medialis obliquus (VMO) has been the mainstay of most physical therapy…

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On Difficult Cases

There was a discussion recently in a Facebook group regarding frustrations with difficult patient encounters and advice on how to best manage these cases. Here below, I have provided a brief list of advice imparted onto me by mentors of mine. Hopefully this helps…..


One of the best pieces of advice a professor of mine gave me was “that you cannot control how people act, you can only control how you react”. This simple quote or credo is so incredibly true and is a great approach to life in general. People can be irrational and their actions frustrating, both of which may become magnified surrounding episodes of poor health.

Another thing to consider, which is a message I’ve adapted from an icon of mine Cael Sanderson, is that every challenge that you face is an opportunity for growth and that we should look forward to challenges; they make us better. Difficult patient encounters are opportunities to learn how to manage difficult patient encounters and it will get easier. It’s also always important to consider that the people we serve could choose elsewhere. They don’t have to be in our clinics. Even in public or federal systems, the patient can still choose to not show up. Take it as a privilege that YOU get to SERVE them and even though they may state that they don’t want to be there, they still decided to show up. Also realize, (and I’ve learned this working with many disadvantaged populations) for many people, even getting to the clinic may be more difficult than you may ever realize.

Regarding verbose patients; there are many people who come to our clinics who have never had the opportunity to speak to a healthcare provider about their problems. Some may not have the opportunity to share their frustrations with anyone who cares or has concern for them. This issue of social isolation and loneliness is a real and growing problem in our modern society. Therefore, consider it a privilege that they are comfortable enough to be verbose with you. Just taking time to listen to them can go a long way. In terms of managing verbosity, because there are time constraints to clinical practice, what I have found to be useful is to try to steer their conversation around the goals for the session or intercede with questions that may help redirect it.  Always try to acknowledge what the patient has said before talking, this helps convey that you did listen to them (you really should be), which is important for building trust and rapport. This process can be difficult but it gets easier over time as well.
Regarding patients who are difficult to convince or establish buy-in for your plan of care, especially those who may believe in more liberal interpretations of physiology, be persistent and steadfast but always be respectful and considerate. Remember that few people possess the specific knowledge of human physiology to determine a falsehood from truth as it pertains to disease and 88% of US population is insufficiently healthcare literate. Given these factors, and others it is incredibly difficult to change someone’s views once they have internalized information; ie “You can’t sell meat to vegans and you can’t convince a carnivore to eat vegetables”. If their views interfere with your best judgment as a provider, consider referring them elsewhere; it’s probably best for both. We as a profession and field (healthcare) need to do a better job addressing this process of translating knowledge to our communities both at the clinic level and institutional level. But it all starts with a conversation and re-framing expectations with each individual. At the fundamental level, a clinician is an educator and motivator.

These are just some recommendations and tips. I don’t practice as much now but can recall how difficult it can be in the clinic and realize that things are rarely ideal and we all have our limits. However, if you consider some of these basic principles and perspectives, it helps make difficult situations a bit less stressful when they do occur.

 

(Image courtesy of Gomerblog.com)

What does CauseHealth mean by N=1?

CauseHealth

by Roger Kerry

N=1” is a slogan used to publicise a core purpose of the CauseHealth project. N=1 refers to a project which is focussed on understanding causally important variables which may exist at an individual level, but which are not necessarily represented or understood through scientific inquiry at a population level. There is an assumption that causal variables are essentially context-sensitive, and as such although population data may by symptomatic of causal association, they do not constitute causation. The project seeks to develop existing scientific methods to try and better understand individual variations. In this sense, N=1 has nothing at all to do with acquiescing to “what the patient wants”, or any other similar fabricated straw-man characterisations of the notion which might emerge during discussions about this notion.

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On Argument: Quick Tips

Maccari-Cicero

A little advice regarding the nature of discussions in this forum and elsewhere:

If one posts anything publicly, or really anywhere to a broad audience, one must realize and understand that individuals will offer both support and criticism. It’s part of the process and not everyone will view things the same way, for many reasons i.e. Knowledge base, biases, experiences etc. Few things in life are dichotomous in nature, where there is an absolute truth and false. Public discussion in any setting is NOT for the meek of heart. If one doesn’t possess the gumption to handle criticisms or contrarian views, they should perhaps reconsider participation in public discussion. Furthermore, if what one posts is so easily criticized, perhaps one should consider heeding the criticisms offered or at least reconsider the merits of what one one has posted. I would also wager (no empirical data to support this, this is based on the multitude of professional discussions and arguments I’ve participated in) that most people who decide to criticize (especially peers) do so out of genuine concern and a desire to improve.

Now I do agree that there should be some ground rules to discussion/argumentation for the sake of decency and purposeful argument, ex. criticisms should be purposeful, valid and follow a sound logical framework. One should also consider how incredibly difficult it is to change someone’s views on any topic, much less when those opposing are steadfast in believing their views to be true and when argument is done via textual mediums of communication. Being outright rude makes that task even more challenging. Why work against yourself? However, not everyone agrees with the same ground rules as I or anyone else; which one must also understand. However, one doesn’t have to respond to criticisms offered either, there’s always a choice.

You could heed this advice or not and continue to become overly offended and attempt to silence others who offer views that differ or continue to be unprofessional in discussions with peers. Ultimately it makes no difference to me, I will still continue to go about how I have regarding discussions. Just some advice. We accomplish little with categorical and unconditional agreement, iron sharpens iron. However, nor do we with shouting matches instead of purposeful, respectful yet incisive discussion.

Also, one should consider entering discussion or argument under the condition that what they argue may be wrong. One should be prepared to argue their point vigorously but be willing to concede when what they argue is shown to not likely be true. If one is not willing to make that concession, there is little point to engage in argument. This is actually a cardinal rule of formal argumentation. This cardinal rule is also something to consider, before posting publicly or one will have a hard time due to the nature of public discussion described above. One should also consider realizing their limits to the value of their opinion and degree of expertise, ie, acknowledge what you know, what you don’t know and that there are people who might be more versed on a given topic. Quick tip, if I engage with someone, I haven’t encountered previously, I usually do a quick search on who they are so I know who I’m discussing with and if I might be out of my league. That’s not to say that we should view the thoughts and opinions of experts dogmatically but it should be in the back of one’s mind that perhaps their opposition might know a bit more on a topic than oneself.