Worth Reading! #AntiToxin
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
Continuing education classes and even prominent textbooks utilized in rehabilitation focused schools teach that rotated innominates, nutation, and…
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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.
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.
” No 10 – Health professionals talk a lot about the quality of care and making healthcare better for the future. However, you don’t increase quality by saying “yes” all the time and being overly positive towards every type of treatment, part of getting higher quality care is by saying NO to low-quality treatments”
So I’m pleased to give you another belter of a guest blog, this time from a good friend of mine who is a walking, talking pain science encyclopaedia. Lars is a man after my own heart as he isn’t afraid to question and challenge many things, including me, and this can at times make him unpopular. As someone who isalso unpopular for many things, mostly my views on shitty manual therapy and other passive treatments, I’m glad Lars has done this blog on his most unpopular opinions as they are mostly mine as well. So without further ado, it’s over to Lars…
I hold many science-based opinions, but most of them are unpopular because they go against the old dogmatic views that are within the pain management and physiotherapy profession.
As noted by Barradell 2017 physiotherapy (like other industries) has a tendency to be tied to specific ways of seeing…
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A classic post!
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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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)
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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