Pot-Pourri

[Diane]

Hi kristian,
I'd like to invite you to start a thread in the welcome forum to introduce yourself.

[Jo Bowyer]

Johnny performed a spinal manipulation

I educated the patient I could 'try' a technique.

They wanted to proceed and there were some cavitations.

I no longer use HVLAT.

My current approach is to warn the patient that there may be cavitations, but that essentially they are meaningless; at which point I tell a Prof Haines story, there are many, he was an extraordinary man.

Joint cracking hits the news again
https://www.somasimple.com/forums/sh...d.php?p=202038


My ENT patients get "closure" from cracking in the eustachian tubes and sinuses during cranial osteopathy.

Closure appears to be the issue, whether or not it is "real". Nowadays there are few who see life as a journey, they want their transactions and interactions done and dusted rather than open ended. I don't charge for interaction via email, a surprisingly small percentage of those I see engage with it. Those that do often find that they need less visits.

[Johnny_Nada]

I no longer use HVLAT.

Jo,

I like to think I don't either. If a manual therapist were to have watched me, they'd have called it a grade 4 mobilization.

After reading Paul's article and thinking of 90% of the people I see: "this person just needs to get on with their life and stop seeing people trying to fix them. They'd be better off not seeing a medical provider or anything alternative for that matter."

Here is the US we are required to document skill. Skill is defined by insurance providers based on much of the non-sense Paul refers to. Skill for many clinicians is identifying impairments, performing manual therapy to 'reset the nervous system' or correct a mobility impairment, utilizing a neuro re-education technique to promote improved motor control and finishing off with therapeutic exercise to maintain all the wonderful things provided. The entire process is recited to patients and documented in a similar way.

How about this skill? (which is what I'm thinking in the clinic for the 90%)

Nothing is "wrong" with you in a life threatening kind of way
Start moving the body part in a way you prefer like a dog with a painful paw. Unload, load, re-load, test, assess, repeat.
Keep doing everything you want to do
If it hurts modify it
If modifying doesn't do what you want, stop doing the task
If you are hell bent on doing it, accept it may hurt, suck it up and do your best.
If you do those things you may or may not feel better.

If you continue with me (or anyone for that matter) you may or may not feel better.

[Jo Bowyer]

Here is the US we are required to document skill. Skill is defined by insurance providers based on much of the non-sense Paul refers to. Skill for many clinicians is identifying impairments, performing manual therapy to 'reset the nervous system' or correct a mobility impairment, utilizing a neuro re-education technique to promote improved motor control and finishing off with therapeutic exercise to maintain all the wonderful things provided. The entire process is recited to patients and documented in a similar way.

This is tragic.

[Barrett Dorko]

There's nothing tragic or comic, good or bad about what the insurance companies insist upon.

This is just what therapists live with. No amount of evidence, sense, knowledge, scientific progress or innovation is likely to change that.

Any change that occurs will have been unexpected.

[Jo Bowyer]

This is just what therapists live with. No amount of evidence, sense, knowledge, scientific progress or innovation is likely to change that.

There is no good reason why your status as first contact practitioners cannot be legalised by government if Australia, the UK and Canada managed to do so in the 1970s, I believe that WCPT are working on this in countries who want it.

The insurance companies are a different matter as there is little anyone anywhere can do about them, unless a patient is in a position to suggest that they are thinking about placing a huge contract elsewhere.

[Johnny_Nada]

One stop squat talk

So simple...

[YT]Av3LO2GwpAk[/YT]

[YT]KGEKRjlZKf8&t=408s[/YT]

[Johnny_Nada]

Some different teaching styles

[YT]yWRkBH_q_Ag[/YT]

[YT]2ME8gEN54Ao[/YT]

[YT]LV8ZxGICsL0[/YT]

[YT]MQIAzzMDhSI[/YT]

[YT]pvv4uk9XbsY[/YT]

[Johnny_Nada]

A couple more individualized approaches

[YT]4GxtcRIIRzE[/YT]

[YT]JftyKFFZho8[/YT]

[Johnny_Nada]

Your research stop. One hell of a stop...


https://www.strengthandconditioningr...ercises/squat/

[WildBear]

http://strengtheory.com/how-to-squat/

Greg Nuckol's guide on the squat is quite good as well. He even recommends the painscience.com guides for pain issues if you can't see a good physical therapist.

[WildBear]

Johnny_Nada, you told me about Tim Gabbett's work possibly showing that the deloading at the time of injury may possibly be more dangerous than keeping the workload up in a different thread. Sorry for just responding just now, anyways assuming you are talking about studies like these.

http://bjsm.bmj.com/content/early/20...ts-2015-094817
http://bjsm.bmj.com/content/early/20...15-095788.full

The way I am interpreting this is that the "chronic" workload is what the athletes are adapted to, their work capacity. So it makes sense that a sudden acute stressor greater than this could cause injury.

However, can we really apply this study on healthy elite athletes trying to prevent overuse to people who already present with overuse?

Although, they are elite rugby players, healthy for them may already be with lots of overuse conditions.

[Johnny_Nada]

The way I am interpreting this is that the "chronic" workload is what the athletes are adapted to, their work capacity. So it makes sense that a sudden acute stressor greater than this could cause injury.

However, can we really apply this study on healthy elite athletes trying to prevent overuse to people who already present with overuse?

Chronic workload: callous
Acute workload exceeding chronic workload: blister

I don't know why we can't apply this to non-athletes. Loading is loading. While absolute loading may differ between athletes and non-athletes, relative loading may be similar.

Exceed chronic workloads and blisters may form. Stay near your chronic workload and the callous has a protective effect. If a blister has formed, rest and recovery are indicated. Loading is still allowed but most likely it will be an unloading

[WildBear]

Chronic workload: callous
Acute workload exceeding chronic workload: blister

I don't know why we can't apply this to non-athletes. Loading is loading. While absolute loading may differ between athletes and non-athletes, relative loading may be similar.

Exceed chronic workloads and blisters may form. Stay near your chronic workload and the callous has a protective effect. If a blister has formed, rest and recovery are indicated. Loading is still allowed but most likely it will be an unloading

Yes, I wholeheartedly agree with the above. I believe I misunderstood you.

So the real challenge is, how to decide how much loading keeps you in the Goldilocks zone.

[Johnny_Nada]

So the real challenge is, how to decide how much loading keeps you in the Goldilocks zone.

Trial and error, tracking workouts, experience

Gabbett has a stress measure he uses for his athletes. Simplistically its RPE x duration of activity. Intensity/speed can and should also figured in. Listening to a few of his podcasts it sounds like he tracks athletes using GPS for extra details.