Announcement

Collapse
No announcement yet.

Entering Chaos

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • smith
    replied
    Wasn't sure where to put this. Yesterday, at a ceu conf. in a hospital where I live, a MD gave a talk on electrodiagonstic EMG's in sports med. I live in north Jersey. He started with a power point reading - 1% of all sport injurys are neurogic. I believe he meant structural. He then did a good talk.

    At the end, I finished the Q/A part with the statement, "since all ankle injurys will have peroneal involvment, how do you differntiate it from the tendon?" None of the MD's, PT's, ATC's or chiros challenged the statement. I think the MD giving the talk liked the statement. After all, that's what he does.

    Leave a comment:


  • Barrett Dorko
    replied
    For the record, my son Alex tells me that his son, Michael, chose FGC in his bracket because "eagle" starts with an "E".

    Sounds like perfectly appropriate reasoning to me, and it worked out.

    Michael is not yet three.

    Leave a comment:


  • advantage1
    replied
    Kory, I love your March Madness analogy. Now we have Florida Gulf Coast to add to the uncertainty.

    Leave a comment:


  • Barrett Dorko
    replied
    Kyle, You're probably right.

    What of his attention to cause?

    Why doesn't he ever talk to us?

    Leave a comment:


  • Kyle Ridgeway
    replied
    Originally posted by Barrett Dorko View Post
    Eric Robertson's assertion is that we become "safer" when we follow the rules in response to careful exam.
    When he said that, I am pretty sure he was referring to the CPR's to assess the need for imaging in pseudo-trauma situations to rule out occult fractures in the ankle, knee, and cervical spine. I would have to check the video though.

    Leave a comment:


  • Kyle Ridgeway
    replied
    Great points Joe and everyone else. Definitely an intriguing concept. I felt off of my game last night, so I hope I was somewhat clear in my explanations. I think we definitely need to consider nominal vs. essential diagnoses, the actual content of the interventions we are studying (from the assessment to the "intervention"), mechanisms, expectation, and pain in general. Joe brings up some very specific methodological and interpretation issues.

    In reflection my closing thought or 30,000 foot view take is this...

    If CPR's and thus the TBC are taught and implemented without an eye towards mechanisms, we build an attachment to an intervention(s) on the assumption of effectiveness of the intervention itself (manipulation, "stabilization"). Personally and professionally, this poses a challenge to modifying our understanding and treatment over time. It breeds confirmation bias, where we assume an intervention works based on the proposed theory, or an assumed theory, or a name (stabilization!). And, if a study shows it "works" and it appears to work. Voila, we know have a confirmation in our mind that will be difficult to break (I introduce you to manipulation….)

    Our interventions for pain always contain boatloads of non-specific effects, and rarely do we truly understand their range of mechanisms. Yet, our explanatory model and thus our clinical reasoning for utilization can be grossly wrong. But, the appearance of effectiveness may remain. Further, why would we ever think a single intervention product studied in isolation would prove to be robustly powerful in the long term clinical treatment of an individualized pain experience? That is not at all how pain nor even clinical practice works (as we currently understand it). Yes, CPR's have a place (especially predictive and diagnostic), but prescriptive? Unless that CPR is helping validate a process of care....I am skeptical.
    ----

    That's what I was trying to communicate. Emphasis on trying. Don't think my point was presented clearly enough in the moment. Trying to refine and write some more....stay tuned...

    I enjoyed the discussion and it definitely has spawned some further thinking and analysis. Definitely some interesting implications and concepts on this topic.

    Leave a comment:


  • nickmPT
    replied
    My buddy in the PT program (who shared a lot of the skepticism I had) always joked he was going to PA school after all of this.

    He was only half kidding.

    Leave a comment:


  • zimney3pt
    replied
    Originally posted by nickmPT View Post
    I always found my uncertainty with telling a patient why they are having said pain and the excuses I gave them troubling. Oh your shoulder hurts? That is because your rotator cuff is weak, your scapular stabilizers are weak, your joint capsule is tight. I wish I had stumbled across this website and the neuromatrix sooner, I would have embraced this uncertainty far sooner and I believe my patients would have benefited far better.
    The good thing is that you have found this website and understanding of the neuromatrix (which puts you ahead of 99% of your colleagues) and your patients in the future will benefit far better.

    Welcome to being a deadman.

    Leave a comment:


  • nickmPT
    replied
    I always found my uncertainty with telling a patient why they are having said pain and the excuses I gave them troubling. Oh your shoulder hurts? That is because your rotator cuff is weak, your scapular stabilizers are weak, your joint capsule is tight. I wish I had stumbled across this website and the neuromatrix sooner, I would have embraced this uncertainty far sooner and I believe my patients would have benefited far better.

    Leave a comment:


  • zimney3pt
    replied
    Just to stick with the March Madness idea there is this article.

    FRIDAY, March 22 (HealthDay News) -- Many sports gamblers consider their extensive betting experience and insight into college basketball a slam-dunk for success during the three-week U.S. championship dubbed "March Madness." But that sense of control over their wagers is an illusion, according to a new study.

    "Sports gamblers seem to believe themselves the cleverest of all gamblers," Professor Pinhas Dannon, of Tel Aviv University in Israel, said in a university news release. "They think that with experience and knowledge -- such as players' statistics, managers' habits, weather conditions and stadium capacity -- they can predict the outcome of a game better than the average person."

    Dannon and a colleague found, however, that these gamblers have no advantage.
    Let reword it a little and see if sounds familiar:

    FRIDAY, March 22 (HealthDay News) -- Many therapist consider their extensive patient experience and insight into the human body a slam-dunk for success during the treatment intervention dubbed "March Madness." But that sense of control over their treatment is an illusion, according to a new study.

    "Biomechanical therapist seem to believe themselves the cleverest of all therapists," Professor Pinhas Dannon, of Tel Aviv University in Israel, said in a university news release. "They think that with experience and knowledge -- such as biomechanics, fascia, posture and muscle imbalances -- they can predict the outcome of a treatment better than the average person."

    Dannon and a colleague found, however, that these therapist have no advantage.

    Leave a comment:


  • nickmPT
    replied
    Again, I think we need to become more 'therapist' than 'physical.'

    Would a talk therapist tell a patient, "I am going to do this to you to help alleviate the mental problems you have." I don't think so.

    So should we as Physical Therapists say the same thing to a patient?

    Leave a comment:


  • Barrett Dorko
    replied
    As I predicted (I'm being ironic here), the CPRs grew from the notion, perhaps a preference, that the body's reaction to method is linear and predictable. At least to some percent.

    Eric Robertson's assertion is that we become "safer" when we follow the rules in response to careful exam. I think we become safer when we practice conservatively, that is to say, in a potentially harmless manner. This isn't always easy, and it has little to do with the use of CPRs.

    I also heard Eric use the word cause.

    Big mistake.

    Leave a comment:


  • joebrence9
    replied
    So when I do PTTV discussions, my objective is keep a discussion going amongst practitioners, but not to inject too much of my own personal beliefs or understanding.

    Here is my beef with the prescriptive CPRs:
    1. Little to no follow up studies or validation of the rules.
    2. Some lack face validity (IMHO). For example, the lumbar stabilization CPR includes the prone instability test (which at face, tells me very little. It has not been validated as an individual test and it relys on the belief that instability results in pain---its a provocation test at best) and "abarrent movement". Every patient with LBP has some form of abarrent movement (is this a valid measure of instability?)
    3. The CPRs are only as good as the outcome tools which are used to determine a "successful outcome". For example, the CPR for lumbar manipulation is designed to predict a 1 week, 50% improvement on an Oswestry. Most manual therapists can recite the criteria for this CPR, but can any of them tell us what it predicts (do you guys know)? This is concept is often "lost". So remember this: the lumbar manipulation CPR predicts, that when the variables in the rule are present, an individual has a 95% chance of getting a 1 week, 50% improvement on an Oswestry. We are not talking about a long term improvement in low back "pain". We are talking about a perception of "disability". Important distinction.
    4. They ignore the "patient response". Lets think about this. It is an operational mode of practicing. You fit the rule and "Im going to do this to you...".

    This stated, I am very grateful that Eric and Kyle both added to this discussion. I plan to continue with these and am really excited about next months talk. Will disclose soon as we get folks on board.

    Leave a comment:


  • zimney3pt
    replied
    Great time for this thread considering it is during March Madness...my bracket already shows that some things are impossible to predict - Go Harvard!!!!!!!!!!!

    Leave a comment:


  • Barrett Dorko
    replied
    You're right Randy. The computers themselves have predicted that prediction of some things is impossible.

    At least, for now.

    Leave a comment:

Working...
X