No announcement yet.

Do Biomechanics Matter?

  • Filter
  • Time
  • Show
Clear All
new posts

  • Originally posted by Josh View Post
    Treatment of acute LBP.
    1) Rule out bad stuff
    2) Encourage activity and movement
    3) Emotional support through active listening
    4) Answer questions honestly
    5) Give a hug or handshake and card as they leave in case anything comes up down the road
    Hey!...that's my philosophy in a nutshell:

    1) Rule out bad stuff
    2) MERG (motivate, educate, re-assure and guide)

    Easy solution to the needless cost of conservative NMSK:

    1) Isolate only one approved provider of care (so no more multiple options; Physiotherapy, Chiropractic, Massage therapy, Osteopathy, acupuncturists etc etc): Find only one

    2) Cap sessions for that provider at 6...six I said.

    3) Pay those providers an appropriate fee (like 110$ per session)

    What I think you would see with this is that the provider of choice (Physiotherapy of course) would then be less inclined to get involved in utter nonsense just to remain competitive in the pseudo-science marketplace that has been created....enter things like TDN)

    Pipe dream of course.


    • What's with the obsession of tight and tender muscles in our profession?

      The therapists at my clinic are all about working out these tight and tender muscles on patients. They're constantly trying to find ways to decrease the tone and sensitivity of these muscles. The word they use is "release". Massage, IASTM, dry needling, PNF, strain/counterstrain, "active release", foam rolling, lacrosse balls etc. They use all of these to try to "release" the tone of the "tight" muscles.

      Everyone has a few muscles that are tender to the touch. I do. I can dig into my armpit and my subscapularis is extremely tender. There are times when I'll rub a tender spot on a patient and they tell me it feels better afterwards. Just today I was working with a post-op RTC repair patient who had some very tender muscles, afterwards, his range of motion increased significantly.

      What exactly happened there? Why did his range of motion increase? What did I do to his nervous system?


      • Depends who you ask:

        Could be afferent novel input.

        Could be descending inhibition

        Could be changing brain maps

        Could be placebo

        Could be structural/physiological creep

        Could be expectation violation

        Could be stretch tolerance

        Could be improving blood flow

        Could be.......
        "The views expressed here are my own and do not reflect the views of my employer."


        • Hi Johnny!

          I love the "could be" list.

          You put together more complex possibilities in such a straightforward and simple way that, if I were your patient, figuring out you know your stuff so well would be reassuring, even in the absence of a definitive answer. It suggests to me your confident enough to be honest enough to acknowledge the presence of these "could be's."

          The old line "give it to me straight, doc" reflects not just the patient's ability to handle any diagnosis, but also his insistence that the medical professional not bullshit him.


          • On the issue medical treatment:

            I have shared this story before, but now I can retell it from a slightly different perspective.

            Of all the doctors who have treated me over the years, my most memorable experiences have been of check ups with our neighborhood doctor, Edwin Pisarski. My memories of those check ups were a waiting room filled to capacity with middle class folks who all paid him in cash and didn't mind the long delays. And what they paid was what he asked for, which was always dictated by what he knew of the family situation, and what those families could afford.

            Once it was my turn to enter one of his two back-and-forth offices, I looked forward to how he checked my heart. He did the normal stethoscope on my chest and back, but then always ended up putting the stethoscope on my nose. He kept doing that right into my teenage years.

            As a kid, I liked what he did because it was personable, different, and playful. He was having fun with me.

            Now as I look back on those visits, I wonder if that behavior may have been as good for him as it was for me. Maybe it was his reminder not to let a monotonous routine performed countless times each day cloud his judgment or cause him to lose focus.

            The families in my south side Chicago neighborhood loved that guy for many reasons, but I think one of those may have been his ability to find some way to make people feel good who came to see him not feeling good.