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  • Originally posted by Jo Bowyer View Post
    I was advised as a student not to make waves and to keep my head down. I haven't heeded the advice, neither have I reached the highest level in either of my professions. I have had a great deal of fun on the fringe though
    The "fringe" huh? I have a feeling that's where I'm going to be for the rest of my career. How do I find clinicians who think like me?

    Comment


    • How do I find clinicians who think like me?
      It's much easier now than it was, due to the internet. Chances are that in the real world, you may have to wait until they find you.
      Last edited by Jo Bowyer; 02-11-2016, 03:22 AM.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • In case anyone was wondering, I was being sarcastic in post #103.
        Barrett L. Dorko

        Comment


        • Originally posted by FrustratedNewGrad View Post
          We had a therapist present on the SFMA today. The term regional interdependence was used, also, motor control issue vs. mobility issue and of course Dysfunction. It seems intriguing and complex and the therapist presenting it seemed very impressed with himself with his explanation and demonstrations. He thinks he's really smart. Supposedly I have dysfunctional lumbar rotation to my right but not to my left. I also have some dysfunction with my single leg stance with my eyes closed. Who knew that I was so dysfunctional? Pretty much everyone who he demonstrated on had some sort of dysfunction. Do any of my colleagues have injuries or pain? Is there any evidence that the SFMA can predict injury? I'm having a hard time finding any evidence.

          I asked him aloud, how do we know which dysfunction is causing the patient's pain? Can a cervical dysfunction somehow cause an ankle sprain? He didn't really answer the question but sort of went into ways in which one dysfunction can fuel other dysfunctions etc. I was going to bring up the nocebo effect but I didn't think my colleagues really wanted to hear me anymore. They probably think I just don't get "it".

          I also have one of my boss's patients on my schedule for the next few weeks. He was telling me how she had a lateral lumbar shift and how he was correcting it with a shift correction. When I told him I never learned how to do it he seemed surprised. "You didn't learn that in school?"

          I took the SFMA back in 2014. The evidence then was sparse and since then the emerging evidence is suggesting it's essentially useless in terms of predicting or preventing anything.

          As for the lumbar shift...the odd thing here is that if the shift is contralateral with leg symptoms below the buttocks...and the shift correction procedure results in the centralization phenomenon AND is tolerated well....it's one of the best prognostic indicators of rapid recovery we actually have in Physiotherapy (which of course is not saying much).

          The centralization phenomenon and it's prognostic value has been demonstrated in multiple studies. And for Physiotherapy...that's pretty good.

          I utilize it.

          It's no surprise it's not taught in university. I know my alma mater spends it's time and effort teaching students all about motion palpation.

          In an effort to pluck an old analogy from Barrett (I'll butcher it)....these poor students may as well have spent 2 years and 20,000$ learning how to bake pie crust. That's essentially how useful motion palpation is clinically...

          Comment


          • proud,

            I don't remember making the analogy, but it sounds good.

            The SFMA, it turns out, doesn't predict or prevent anything, but it makes the therapist appear smart, thorough and prepared to offer help. Sometimes they get lucky. We all do. That will be enough for many.

            Defense? What's that? (being sarcastic again)

            A interesting take on McKenzie's "lateral shift" correction has occurred here:

            Gifford goes on to describe the classic “lateral shift” often seen associated with lumbar and lower quarter pain. In such a case the shifting of the torso away from the symptomatic side and the loss of lumbar lordosis has been described as a response to intervertebral disc migration, specifically the “unloading” of the side containing the bulge. This is proximal reasoning. Evolutionary reasoning would consider whether the observed behavior was useful or not, and if useful, in what way toward which tissue. The proximal reasoning regarding lateral shifting ignores the fact that this posture does nothing to help the disc (See Does plate fixation prevent disc degeneration after a lateral annulus tear? Moore et al Spine 19(24) 2787-2790). Since immobility doesn’t help the disc, it doesn’t follow that a tear in the disc would lead to this behavior. If the immobility we see upon examination is instinctive and thus deemed defensive, efforts to extinguish it with manual coercion or instruction must be considered unreasonable.
            If the muscular response to painful output is a defense Simple Contact would be defensible.
            Barrett L. Dorko

            Comment


            • Originally posted by proud View Post
              I took the SFMA back in 2014. The evidence then was sparse and since then the emerging evidence is suggesting it's essentially useless in terms of predicting or preventing anything.

              As for the lumbar shift...the odd thing here is that if the shift is contralateral with leg symptoms below the buttocks...and the shift correction procedure results in the centralization phenomenon AND is tolerated well....it's one of the best prognostic indicators of rapid recovery we actually have in Physiotherapy (which of course is not saying much).

              The centralization phenomenon and it's prognostic value has been demonstrated in multiple studies. And for Physiotherapy...that's pretty good.

              I utilize it.

              It's no surprise it's not taught in university. I know my alma mater spends it's time and effort teaching students all about motion palpation.

              In an effort to pluck an old analogy from Barrett (I'll butcher it)....these poor students may as well have spent 2 years and 20,000$ learning how to bake pie crust. That's essentially how useful motion palpation is clinically...
              So that means we actually CAN reduce a lateral herniation with a lateral shift? Or is something else going on here?

              Comment


              • Originally posted by FrustratedNewGrad View Post
                So that means we actually CAN reduce a lateral herniation with a lateral shift? Or is something else going on here?
                I would not say so. I suspect there is a multitude of fractal things occurring such as threat reduction into the feared direction of movement, neural tissue offloading (given that the movement is in the "slackening" direction) and perhaps even some activation of DNIC pathways---->pain modulation----->earlier return to movement.

                Here is an old thread that meanders through some discussion on premise.

                Again, I keep spouting off that the key variable in any treatment is to avoid to the best of our ability any possible noceboic consequences. Thus I tend to limit my explanation on this one to "there is good research that suggests if we can centralize the leg symptoms....you have an excellent chance at a rapid recovery"

                Comment


                • Originally posted by FrustratedNewGrad View Post
                  We had a therapist present on the SFMA today. The term regional interdependence was used, also, motor control issue vs. mobility issue and of course Dysfunction. It seems intriguing and complex and the therapist presenting it seemed very impressed with himself with his explanation and demonstrations. He thinks he's really smart. Supposedly I have dysfunctional lumbar rotation to my right but not to my left. I also have some dysfunction with my single leg stance with my eyes closed. Who knew that I was so dysfunctional? Pretty much everyone who he demonstrated on had some sort of dysfunction. Do any of my colleagues have injuries or pain? Is there any evidence that the SFMA can predict injury? I'm having a hard time finding any evidence.

                  I asked him aloud, how do we know which dysfunction is causing the patient's pain? Can a cervical dysfunction somehow cause an ankle sprain? He didn't really answer the question but sort of went into ways in which one dysfunction can fuel other dysfunctions etc. I was going to bring up the nocebo effect but I didn't think my colleagues really wanted to hear me anymore. They probably think I just don't get "it".

                  I also have one of my boss's patients on my schedule for the next few weeks. He was telling me how she had a lateral lumbar shift and how he was correcting it with a shift correction. When I told him I never learned how to do it he seemed surprised. "You didn't learn that in school?"

                  To perform a shift correction place your hand on the side of the body the complaint is, press on it firmly and ask the patient to rotate toward you and resist them, then do the other way while saying "there, that is much better. How does that feel?"

                  That is basically all the manual therapy in a nutshell so change for body region as needed.

                  Make sure you wear a white lab coat and have a dusty stethoscope around your neck so you look the part.

                  Talk about alignment like the person is an old Chevy and you're golden.

                  Also don't listen to my advice as I ran from outpatient as fast as I could and now work inpatient at the VA and have zero desire to go back to lying to people for a living.
                  Michael Heinrich DPT.

                  My opinions and statements on this site are not a reflection of the Department of Veterans Affairs or the Federal government.

                  Comment


                  • Originally posted by Nomadic View Post
                    To perform a shift correction place your hand on the side of the body the complaint is, press on it firmly and ask the patient to rotate toward you and resist them, then do the other way while saying "there, that is much better. How does that feel?"

                    That is basically all the manual therapy in a nutshell so change for body region as needed.

                    Make sure you wear a white lab coat and have a dusty stethoscope around your neck so you look the part.

                    Talk about alignment like the person is an old Chevy and you're golden.

                    Also don't listen to my advice as I ran from outpatient as fast as I could and now work inpatient at the VA and have zero desire to go back to lying to people for a living.
                    This is great and resonates with me so much. It's also extremely depressing.

                    Comment


                    • Dear frustrated,

                      Some advice... the only thing you can control is how you show up... make sure you show up every day with the needs of your patients at the forefront of every decision you make... strive to be less wrong... you will never be right... learn to be okay with that... do this and you will be able to look in the mirror everyday and be okay with what you see...

                      ...and, perhaps most importantly, get out of your country from time to time... serve others in resource scarce countries by working with an organization like HVO USA... go and teach/train clinicians in places where they are hungry for knowledge... they will want to hear what you have to say and will actually listen and use the knowledge you provide... this will nourish you and keep you in the game...

                      ...without a way to cope, the outpatient clinic may just kill your spirit... truth.

                      If it is any consolation, i am still in the game at 45 so it is possible... and I plan to stay in the game... thanks to the advice I provided above.

                      Comment


                      • So we had a presentation on the effects of muscle energy techniques particularly on the SI joint. The therapist who presented on it is actually aware of the research. He suggested that we're probably not changing any joint mechanics or realigning anything. However, he still uses it because he always notices an immediate increase in hip strength afterwards. He demonstrated it on a student. He checked hip abduction before and after the muscle energy technique and sure enough, it was much improved after the technique.

                        Then another therapist said "ok watch this". He then took the students leg and compressed it into the hip joint and he said "now test his strength". The students strength decreased back to baseline. This therapist is really smug. "I just activated the mechanoreceptors in his hip which inhibited the surrounding muscles. It's the body's way of protecting it against compression forces into the joint."

                        I tried to find research into this type of thing and found nothing.

                        Another therapist says "I'll have them do exercises right after I distract the joint and before they walk because that just compresses the joint again."

                        Does anyone know of any resources on the effects of joint mechanoreceptors and their inhibitory/excitatory effects?

                        Comment


                        • Well sure, he initiated a brain protective mechanism. Passive stretching, train with intent to failure in the squat will also work to do the same thing, (initiate brain protective mechanism). It worked due to the brain protective mechanism and not mechanoreptors.
                          Last edited by smith; 21-11-2016, 11:59 PM.

                          Comment


                          • Can you explain that a little more thoroughly? Brain protective mechanisms?

                            Do you mean the effect is due to non specific factors and is mostly because if the context of the situation? That is what I think happened.

                            Comment


                            • FNG,

                              All show.

                              I had an individual ask me about copper for his wrist pain. I asked him for a penny. I proceeded to perform "applied kinesiology" to demonstrate how much more strength and stability he had on the right arm after putting the penny in his hand. He was impressed and couldn't figure out how that was possible. I explained it to him. I could've sold him that penny for five dollars.

                              It's the same shit they do in manipulation courses, dry needling courses, insert other non-sense courses. Take someone with non-clinical pain condition (better yet, make it a student....very gullible and wanting to please). Perform useless test/measure. Apply non-sense to gullible suggestible person. Re-test useless test/measure and add in the power of suggestions. Magic!

                              You'll hear the term "buy-in" used a lot. Its why people do it. I hate the term. I'm not selling anything.
                              Last edited by Johnny_Nada; 22-11-2016, 02:58 AM.
                              I may not be as smart as most people, but I'm sure as hell not as dumb....
                              "The views expressed here are my own and do not reflect the views of my employer."

                              Comment


                              • Originally posted by Johnny_Nada View Post
                                It's the same shit they do in manipulation courses, dry needling courses, insert other non-sense courses. Take someone with non-clinical pain condition (better yet, make it a student....very gullible and wanting to please). Perform useless test/measure. Apply non-sense to gullible suggestible person. Re-test useless test/measure and add in the power of suggestions. Magic!
                                Yep...they did this on the dry needling course I took.

                                I have always known that I have horrible glut strength. They tested me and were "astounded" at how weak I was.

                                They proceeded to stabbed my multifidus and various other muscles and then re-test.

                                No change.

                                They proceeded to say "he would need a few sessions".....they then moved along.

                                Comment

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