Primary Care PT. Board Certified in Ortho, Neuro, and Sports PT, Fellowship Trained OMPT. AAMT/SMI Associate Director + Senior Faculty. Outdoor sports fanatic
Posted with permission.
Positive Inverted Supinator Reflex and Hoffman’s reflex.
Pt referred for carpal tunnel and balance issues. Likely diagnosis is cervical myelopathy.
Exercise in patients with acute low back pain is not superior to sham ultrasound, SMT, advice, or education booklets.
Either we suck at everything, or need to stop doing SRs on SRs of heterogeneous issues.
Thanks
@PhysioMeScience
Very interesting to see how fast Pain Neuroscience Education gained so much traction and emphasis, with little evidence to support.
The Lancet with an excellent update
Thanks again
@PhysioMeScience
Study of the week
Cortisone is worse than sham for knee OA.
“2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain.”
It is much, much easier to blame pain on the brain and expectations, and think that patients just need to move and all exercises are equal, than to actually help a patient find a solution to their problem. This is the problem w PT in today’s age.
Weekly post of studies you didn’t think existed
Phantom limb pain is a peripheral issue, responding to nerve blocks but not sham. Refutes the common theme of this issue being a “brain problem”
Thanks for this one
@OnlinePhysios
"MWM, tape and exercise showed significantly greater improvements in pain, functional dorsiflexion ROM, FADI score, dynamic balance compared with a group receiving a sham MWM, sham tape and exercise in patients with ankle sprain"
@rbaeske
#PT
#mulligan
Week 3 on studies you didn’t think existed
“Physical therapists who were more biomedically oriented and believed there is a stronger relationship
between pain and disability had improved patient outcomes.”
It is only a matter of time until the PT profession becomes the chiropractic and law profession, the way schools are increasing class size and cost simply to gain revenue.
Chris Nikic became the first person with Down syndrome to complete an IRONMAN. Incredible 👏
🏊♂️ 2.4 mile swim
🚴♂️ 112 mile bike ride
🏃♂️ 26.2 mile run
(h/t
@IRONMANtri
,
@ESPNUK
)
@AnthoneDuty
@stephena013
@KirkHerbstreit
@bigten
Before the bowl games:
Wisconsin 12-1. Lost by 6 in conference championship to a 2 loss conference champion. No great wins.
Bama 11-1. Lost by 12 to a 3 loss team. Didn’t make conference championship, 3rd in conference. No great wins.
Eliminate bias, and this is a no brainer.
Are we starting to see that exercise for pain is not the same beast as exercise for physical preperation?
Probably need basic advice over fancy programmes
Having an excellent time with brilliant DPTs, NPs, Fellows, FITs, and Physical Therapy legend Dr. Eduardo Enriquez talking pain science and treatment in Ann Arbor! All while Rocking Penn State in Wolverine land
#dpt
#weare
#dryneedling
#painscience
#aamt
Yup. The social media warriors posting “foam rolling is worthless because the IT band doesn’t lengthen on a cadaver, everything you learned in PT school is wrong, come take my CEU course” is getting old, and shows little understanding of research, mechanisms, and physiology.
I don't understand the anti-foam roll crowd. Here's another study via US in JSCR showing vascular changes, albeit short-term. Athletes could do worse things for sure.
I feel a disturbance in the FORCE 😱
The McKenzie method for (sub)acute non‐specific low back pain
“Thus, we can conclude that the McKenzie method is not an effective treatment for (sub)acute NSLBP.”
It is difficult to attempt a true placebo/sham with dry needling. Especially in a world where placebo is defined inappropriately so often
This study shows benefit vs a TRUE sham, where pts were completely blinded as they were put under general anesthesia
Had a great weekend going over new, evidence based treatments with Dry Needling for Achilles, patellar, and rotator cuff tendinopathies after failed PT treatment and more in Dallas with
@osteopractor
Can’t wait to be back!
Had a great time teaching during week 1 intensive for AAMT Fellowship this week. Excellent co-instructor and great group of PTs furthering their clinical reasoning and skills!
Wonderful weekend in beautiful Miami discussing evidence based pain mechanisms and dry needling treatments for Knee OA, lateral hip pain, plantar fasciitis and more
Yet the PT profession will still not change
“Exercise therapy is 2% worse in function than sham/control”
“Exercise therapy group was less than one percent better regarding pain than sham/control”
Physical exam would easily show the difference. Stopped a patient with a hip problem from having a knee replacement last week. Was scheduled for surgery based on subjective reports and imaging. No physical exam
Having a great time in San Antonio with a brilliant group of PTs and OTs discussing pain, research, dry needling, and evidence based treatment for multiple neuromusculoskeletal conditions! ☀️
@danrhon
@AdamMeakins
Funny thing is- Meaks loves Manual therapy! Especially for treating those pesky trigger points in that pesky piriformis syndrome!
Another “oldie but goodie”.
Poor outcomes due to non-matched directional preference reverse when switching to matched DP.
Therefore, the whole “it doesn’t matter what you do, just move” notion is non-evidence based for LBP
@EnvivoPT
@DrEscaloniPT
Great weekend in beautiful Denver discussing AAMT’s results on the superiority of SMT and DN for subacromial pain syndrome at DN-1
#AAMTFellowship
#DryNeedling
A THREAD: Per Childs et al. '05 & '07, board certified PTs AND PT students are more knowledgeable about orthopedics than most practicing physicians, second only to orthopedists. This exam was made & created by physicians, so this isn't biased towards PTs... (1/11)
Parental and patient consent ✅
Further on (osteo)chondral injury -
14yo, sudden onset lateral retropatella pain after awkward single leg landing with hyperextension & valgus
POCUS video - well defined lateral trochlear groove acute chondral defect
MRI - loose body in
Well aware stretching not well rec’d for tendinopathy- but is there any evidence it makes tendinopathy worse? Not talking about compressed positions for 2 hours, but the ten sec stretches patients do that say relieves pain for hour or two. If these are implemented as adjunct
Great weekend in Chicago with 35 PTs, PCPs, and chiropractors learning mechanisms of chronic pain, migraines, and many other spinal and UE conditions!
@DrTamaraCopes
@DrEscaloniPT
Supine MRIs are only 25% sensitive for neural encroachment. Should not be used as a gold standard. Results in claims such as neural encroachment doesn’t matter. Tawa 2016
The presence or absence of disc herniation or nerve root compresssion on MRI DOES NOT differentiate favorable/unfavorable outcomes in people with "sciatica".
Had a great weekend in Dallas with 30 PTs, Chiros, and physicians discussing research based DN for tendinopathies, OA, neuropathic pain, and more with AAMT and Spinal Manipulation Institute
#AAMTFellowship
The effectiveness of mobilization with movement on pain, balance and function following acute and sub acute inversion ankle sprain – A randomized, placebo controlled trial
👀👀🦶🦶👇👇
Great weekend at DN-1 with AAMT in Sunny Ft. Lauderdale teaching AAMT
@DrDunning
research on superiority of SMT and EDN for Subacromial pain!
#AAMTFellowship
Posted w/permission.
Every pt referred for balance must be screened for myelopathy
+Hoffman’s reflex shown (combined w/age over 45 + balance deficits) yields 30.9 +LR in this pt sent for gait/balance
#AAMTFellowship
@DrDunning
@osteopractor
@chadcookpt
@Brad_Neal_07
Because too many people listen to their idols blindly without analyzing the evidence themselves. Same reason a lot of people currently think pain neuroscience Education is an effective treatment for pain, and that all we have to do to rid pain is to ‘move’.
It’s always easier to say it doesn’t matter what we do or how we do it, regardless of the research. We can try to blame everything on contextual factors, expectations, nonspecific effects etc etc.
In the end it only serves the provider while the patients continue to suffer
@PaulBliton
@BillingMartin
@OMPTGUY
All the papers you’ve given suggest “press slightly harder if tolerated”. I’m befuddled people think people consider this is particularly skilled or mentally demanding.
People need to stop acting like MT is hard or complex. Have any of you played sports before or coded…?