Pot-Pourri

[CalDude]

I think that PT itself is a wonderful and helpful and potentially helpful profession.

I don't think we should be sticking needles into each our patients or adhering to the dictates of those who WRONGFULLY contend that "bad" posture or weakness leads to pain. The problem is far more complex than that.

We haven't progressed as a profession due to laziness, willful ignorance and a lack of curiosity.

When a new DPT knows nothing of modern pain science I can only draw the conclusions I have.

I've met many.

There is far less science going on in any of the other professions or scientific fields than you understand. Here's what the typical post-doc goes through:
http://sciencecareers.sciencemag.org...redit.a1300256

Medicine isn't doing much better:
http://www.amazon.com/dp/0349123756/...I2IHK7EORYYWJI

There is a general stagnation in Western science that many have noticed. For instance, we invented the SR-71 in the 1950s but the Chair Force scramjet project is in its fourth decade of failure. We can't get to the moon today due to bureaucratic and civilizational incompetence.

Re: the DPT: in other professions, the PhD is generally a 'pile it higher and deeper' degree and the finest scientific minds I've met have had only a BS but a mastery of the basics. Certain friends I know who've obtained a PhD to work in industry now work on worthless solutions to problems that can be solved much more easily through behavior modification. Others are in academia publishing useless research on problems that have a simple behavioral cure. I mean no offense to anyone who has one I've just seen too many horror stories and feel I have to tell the truth.

Knowing nothing about PT, I can't say whether the DPT is adding any value. The general trend towards worthless credentialism in our society probably means that the DPT is retarding the PT's development as a professional by delaying years of practical experience.

The same is largely true in my profession. Getting a MS or PhD just means slaving away for the academic bureaucracy for peanuts while all the interesting problems are being solved in industry. The industry is now largely overseas which means people my age have less opportunity than our parents. We push the technological boundary but I can't say these technological advancements are improving quality of life at this point. Quite the opposite. They're enabling us to ignore one-another in public spaces and target weapons from much further away.

To summarize, every field has these problems (stagnation, laziness, pointless credentialism). There are obviously a lot of smart people on this forum whose minds need to be used on something, why not this?

[Johnny_Nada]

If I have a student uncertain or confused how to work with someone that has a persistent pain condition I will remind them to always perform a good medical screen/differential/rule out red flags/etc, do a general movement screen and then read this.

[drmarty]

That was a great link Matthew.

[Johnny_Nada]

I work in the outpatient setting….and I've never seen an individual where physical therapy was "medically necessary."

Therefore I've come up with what I think "medical necessity" is….

"Creative writing to make physical activity sound like rocket science for reimbursement purposes only"

[Evanthis Raftopoulos]

haha, nice

[Johnny_Nada]

After reading one of Barrett's threads, I looked through Edzard Ernst's web site. I think many in the physical therapy profession may be mis-representing themselves...

"As effective as" is very different than "equally ineffective"

Many are comfortable talking about the former, but wouldn't be with the latter….

[John W]

Quite right, Matt.

In this thread, Matthew Danziger cited yet another study(systematic review) showing that conservative treatment for lateral elbow pain is...wait for it...ineffective. Kory then cited a study showing that steroid injections and surgery were worse than ineffective treatment by a PT.

Lesser of evils is nothing to write home about.

[Evanthis Raftopoulos]

"As effective as" is very different than "equally ineffective"

as mentioned in the other thread it depends what the goal is. if we are talking about pain resolution within a short period of time then equally ineffective makes more sense when talking about specific interventions for many msk pain diagnosed conditions. But I think there are other goals more attainable, such as helping one achieve self management status. That's what effectiveness means to me. If during that time pain resolves then great, but quite often that's not the case.

[mortene]

In this thread, Matthew Danziger cited yet another study(systematic review) showing that conservative treatment for lateral elbow pain is...wait for it...ineffective.

Why can't we accept natural history of conditions? If we just understood our limitations - we can't heal/fix/repair sh*t - and started guiding, explaining, reassuring to adjust expectancies and avoid frustration, and hopefully long term disability and persistent pain. If we could just stop shooting (read lasering, USing, shock waveing, injecting, bullshitting) ourselves in the foot...

[Johnny_Nada]

Why can't we accept natural history of conditions? If we just understood our limitations - we can't heal/fix/repair sh*t - and started guiding, explaining, reassuring to adjust expectancies and avoid frustration, and hopefully long term disability and persistent pain. If we could just stop shooting (read lasering, USing, shock waveing, injecting, bullshitting) ourselves in the foot...

Well in the US, insurance doesn't have a billing code for those things….we have billing codes for "stuff"

[Thinking_Chiro]

Great thread! :thumbs_up So much of what is posted above is going through my head every day!

[Evanthis Raftopoulos]

as mentioned in the other thread it depends what the goal is. if we are talking about pain resolution within a short period of time then equally ineffective makes more sense when talking about specific interventions for many msk pain diagnosed conditions. But I think there are other goals more attainable, such as helping one achieve self management status. That's what effectiveness means to me. If during that time pain resolves then great, but quite often that's not the case.

as an added thought to the above: I think one should feel proud and accomplished when he/she has achieved self management status (I like how that sounds btw) with the help of the PT, even when pain is still present. It’s not a small thing IMO knowing about pain mechanisms, specific msk conditions, rehab exercise principles, and other self care advice. Anything that we are doing together with the patient should be supportive of these teachings, including hands on care. Perhaps it’s our fault when some patients don’t feel this way in that we might have not set these goals together early on or we (the PTs) become doubtful of our ability to help the patient.

[Johnny_Nada]

After participating in the final 20 miles of a 50 mile trail race without training, (keeping a friend company) the concept of RSI or 'injury' in the absence of trauma is making more sense. And by more sense, I mean, calling it an 'injury' (something Barrett has discussed here before) should be questioned.

I was doing quite well with low grade soreness in the medial aspect of my patella until mile 15. The pain built up to a level where I was incapable of flexing my left knee without laughing. You read that correctly, laughing. As someone that understood there was no trauma or damage to the tissues, I actually found it humorous to experience something so intense, resulting in my walking. I immediately began searching for a movement or position to complete the 20 miles (keeping up with my friend). My running gait must have looked horrible without left knee flexion and scooting along. Just an amazing alarm system performing exactly like it should, to protect me.

I do not or would not see a physician, physical therapist or running 'expert' for this. I was not damage, but I had exceeded my potential and tolerance. My system was simply protecting me. I was able to override for the last 5 miles, but had I not understood it, it would has stopped me for good, most likely resulting in me seeking medical attention for something perfectly normal.

As a result, today I am experiencing allodynia (normal), hyperalgesia (normal) and continuing to hunt for movements that are tolerable (walking with toe out on the left and one stair at a time).

As Kyle alluded to via Jason S, it's important for us to experience these things once in a while.

[Johnny_Nada]

Okay, I know this would be defined as insane by many but;

What if the public and healthcare had a non-Cartesian, biopsychosocial understanding of pain?

and

healthcare only provided medication or invasive procedures supported by research?

[Keith]

Okay, I know this would be defined as insane by many but;

What if the public and healthcare had a non-Cartesian, biopsychosocial understanding of pain?

and

healthcare only provided medication or invasive procedures supported by research?

Can I respectfully tweak your question a bit?

What if the public had a non-Cartesian, biopsychosocial understanding of self? What would happen if this was taught from an early age, in health class for instance? Rubber hands, visual and auditory illusions...get their attention early, and often. Would the public still demand medications and invasive procedures if they better understood how their experiences were manifest?

Respectfully,
Keith