Choose wisely!

Choose wisely!

http://www.sciencedirect.com/…/article/pii/S1836955317300164

The Australian Physical Therapy Association just put out this article, “Wise Choices”, about the problem of low value healthcare in physio.

Physios are usually optimistic about the benefits of their diagnoses and treatments, but sometimes underestimate the costs. These costs are not just in time and money, but also the cost of making a person into a patient.

The authors say that physio curricula should include material on the concept of low value-healthcare, and the dangers of overdiagnosis and overtreatment. And, crucially, strategies to avoid these things, because it’s easier said than done!

For a brilliant full discussion about this, listen to this episode of @ptinquesthttp://ptpodcast.com/pt-inquest-episode-104-the-costs-of-l…/

-Tom

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Upright and Uptight!

The physio world can be a bit of a bubble sometimes, so we think it’s really important to think things through from alternative perspectives. I wrote this article taking a long view on the topic of posture. A lot of the practices that have been handed down to us have a truly weird history… And there’s plenty of lessons to be learned about the way we do physio today.

View story at Medium.com

View story at Medium.com

Enjoy!

-Tom

Ted talks for physios!

TED Talk 3 – A very simple resource for tech savvy patients to learn why exercise, lifting weights and getting a good nights sleep is very important. I have utilised video’s like this for patient education when appointments are short and when I don’t want to overload the patient with information in session. It is very simple but somewhat interactive. It might not suit every patient but what treatment/education does?

if you know of any similar resources feel free to contact us or comment below.
– Eoin

Spinal flexion!

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This picture might make some physios wince! Would this exercise (with less weight of course!) ever be a good approach for someone with back pain? Or is this taking it a bit far?

Arguably, if this movement is scary to a patient, that is a good reason to do it! As long as it doesn’t provoke a flare up. This could be part of a graded exposure approach to back pain, for patients who are particularly fearful. George and Zeppieri have written an explanation of this approach for physios: http://www.jospt.org/doi/pdf/10.2519/jospt.2009.2983…

Of course, just because we know the spine is designed to flex, doesn’t mean we should go ahead and do it in every case… If you are interested in the “spinal flexion” debate, Greg Lehman has written an excellent summary here, where he considers both sides: http://www.greglehman.ca/…/revisiting-the-spinal-flexion-de…

One good way to think of physio debates is like a pendulum. Sometimes, we are so eager to distance ourselves from one position that we end up taking an extreme position on the other side. For example, some have moved from saying that “pain is not an issue in the tissues” to saying “pain is in the brain”, which is going a bit far in the opposite direction! Where do you stand in the spinal flexion debate?

-Tom

Tendinopathy

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In recent times, especially in the world of sport, a plethora of evidence has been released on increases in load leading to the occurrence of injuries. Tim Gabbett has been the leader in this area and his use of the acute: chronic ratio has garnered a lot of interest. In his formative work found here – http://bjsm.bmj.com/content/50/4/231 he showed that week on week spikes in loading above a certain level increased the possibility of an athlete incurring an injury by a tangible amount.

Continue reading “Tendinopathy”

The role of the brain in chronic pain

No 1 on our must watch list for the Best Physiotherapy/Health related TED Talks. Lorimer Moseley is someone who takes complex pain science and makes it simple and applicable. He makes Physiotherapy education enjoyable and definitely creates more than a few laughs. A must watch!

How does acute pain become chronic?

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By now we are all aware that most people have structural “abnormalities” like bulging discs, arthritis, and torn muscles. In fact they’re so common, you can’t really call them abnormalities! But if these things are so common, why do some people end up getting pain and others don’t? Here is the late, great Louis Gifford’s take.

Does this explain the mystery? Or is there more to it?

-Tom

Mechanisms of manual therapy

Manual therapy has become a controversial topic in recent years, to say the least! There is no doubt manual therapy does something, but does it do what we think it does, is it the only way of getting those effects, and is it really good for patients in the long term?
In this paper, Mechanisms of Manual Therapy by Bialosky et al., the authors move away from the idea that manual therapy is putting things back into place, or changing structures. Manual therapy is more like talking to the nervous system!
Does this change how we use manual therapy?

 

-Tom

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