Good writing does not succeed or fail on the strength of its ability to persuade. It succeeds or fails on the strength of its ability to engage you, to make you think, to give you a glimpse into someone else’s head.
— Malcolm Gladwell

As a growing therapist, I believe it's crucial to take advantage of what the internet has to offer in terms of having access to knowledge of experts around the world. Here is a compiled list of the articles I've read in the month. Feel free to share with me articles that you found insightful and useful for your development as a person and as a clinician!


Paradigms

FPTA OXFORD DEBATE – CLOSING ARGUMENT

  • Derek Miles speaks at the FPTA Oxford Debate and delivers a salient closing statement calling for physical therapists to stop the perpetration of false benefits of passive modalities in order to truly embrace the idea of physical therapy being a viable alternative option for specific healthcare problems.

  • “If we continue to try and build fictitious bridges to nowhere how can we truly advocate to #GetPT1st? Let’s be completely honest with ourselves, this isn’t about the evidence, this isn’t even about patient outcomes, it’s about us being comfortable in our ways. We enjoy the convenience of passive modalities because we don’t have to think. But, if we can only truly get patients better by changing their behaviors, we have to first start with our own and perpetuating this bullshit isn’t going to fly.”

MALCOLM GLADWELL ON THE MORAL ARGUMENTS AT PRINCETON UNIVERSITY

  • In 6 minutes, Gladwell presents one of the stark problems with the current generation's confusion between harm and immorality. This is a great concept that many therapists exemplify when arguing that their placebo treatments could only make the patient better, and that false explanations of their mechanisms could do no harm. They follow the notion no harm therefore it’s not immoral.

  • “Gladwell argues that this is not how we make moral arguments today. Instead, we use harm as the criterion to determine whether an action is wrong.”

Therapist as operator or interactor? Moving beyond the technique

  • Diane Jacobs and Jason Silvernail write a strong article stressing how physical therapy cannot function as operators where the patient lies passive, but become more of "interactors" where the patient is just as active and participatory with their own rehabilitation as the therapist.

  • “As a result, we feel it is now incumbent upon the manual therapy community to acknowledge and embrace factors beyond the performance of a particular given technique as critical to clinical care, and to include these considerations in our educational curricula, research designs, patient education, and our therapy culture.”

Am I tight?

  • Bruce Martell is a massage therapist that explains the many myths of manual therapy. How many PTs have you worked with who came up and palpated your traps and state something along the lines of “OH wow, you’re tight.” Perceived tightness and pain are not correlated.

  • “Telling patients they have some sort of dysfunction with their tissue, or even alluding to it, can end up being a big nocebo. We don’t want people leaving us feeling defective or flawed.”

FASCIA SCIENCE: STRETCHING THE POWER OF MANUAL THERAPY

  • Fascia is trendy. Greg Lehman provides proper merit to the fascial functions and helps carve away notions that many educators may try to impress on you about the magic of fascia.

  • “By what means can your hands actually mold, shape or cause some change in fascia?  Why can't they do this in muscle - the far more responsive tissue to stress.”

Giving less and less…

  • Adam Meakins discusses the realities of a physical therapist and how fighting the right battle can be exhausting and eventually spiral out of control. He states how necessary it is to keep yourself in good shape before you can treat others.

  • "Being aware of our own mental and physical health as a healthcare professional is paramount. If you are not looking after yourself, you simply won’t be any good at helping others look after themselves. If you want to be in this job for the long game you need to work out how to manage this in a way that is right for you.”

My 10 Commandments for Physiotherapists

  • Another quick read from Adam Meakins. He lays down 10 necessary commandments that PTs need to embrace if they expect the field to move forward.

  • “However remember there is more to learning than reading alone, observe, listen, talk, get involved, discuss and debate with others. Interaction is a great way to learn, and remember you don’t have to agree, in fact I would recommend that you go and actively seek out those that hold opposing views and ideas from your own. You can learn a lot more from those you don’t agree with, I have, believe it or not…”

Evidence-Based or Person-Centered? An Ontological Debate

  • Rani Lill Anjum introduces the concept of causal dispositionalism that encompasses a more holistic and unique individualized perspective on patient care. Evidence based medicine tends to lean far away from this individualized attention, but Rani explains how it is notably important to incorporate into the patient experience.

  • “Because of their bio-psychosocial complexity and individual variations, these conditions resist scientific scrutiny by methodologies that mainly generate statistical results and group averages.”

The Weak Evidence Behind Brain-Training Games

  • Brain training games doesn’t correlate to promised cognitive gains. This parallels with research in physical therapy about how balancing on unstable surfaces doesn’t necessarily apply to increased proprioception and balance in sports. It raises the conversation on specificity and whether or not we are wasting our time with things that may not carry over.

  • “People get better at playing the games, but there are no convincing signs that those improvements transfer to general mental skills or to everyday life.”

Orthopedic, Strength & Conditioning

CHOOSING TO MOVE, MOVING TO LEARN

  • Israel Halperin talks about a very simple but commonly overlooked concept to help patients and clients adherence to exercise program. In this article, he explains how providing choices and client controlled variability is beneficial for the client’s motor learning experience.

  • “in addition to enhancing motor learning, choices also increase ones motivation to work out.”

Andreo Spina’s Functional Range Release

  • Aaron Swanson shares his experience at a continuing education course with Andreo Spina. Some really paradigm shifting ideas created by Dr. Spina has me really interested in taking his course.

  • “There isn’t a neurological trick you can do to change tissue in one session.  In fact, there isn’t any one input that will change tissue immediately.  To adapt and influence that tissue, you will need frequent, long duration, directional force inputs.”

  • “Flexibility is governed by the nervous system.  You have to train it in the gym, not manually fix it with your hands.”

The False Dichotomy of Open vs Closed Kinetic Chain

  • There is a point in every physical therapist student’s career that you believe that CKC > OKC, in terms of exercise. Often the example of the knee extension machine at the gym is used, and how it provides ungodly amounts of resultant forces at the knee joint that may cause more pain. Erik Meira does a great job in advocating for OKC exercises and uses that specific example of the knee extension machine as his support. This is a necessary read that just addresses how biomechanical intuition needs to be challenged.

  • “We don’t train the quadriceps by putting a load that is way beyond its capabilities. Instead we train the quadriceps at its optimal loads and we can fine tune those loads much easier with a leg extension machine.”

Why Rehabilitation and Fitness Should be Delivered in Parallel

  • Obtaining my CSCS will probably be one of my most useful certifications as a therapist looking to treat in an orthopedic setting. Most of the literature I read explains how exercise is the key for anyone’s rehabilitation. Here is an article by Charlie Weingroff explaining why it’s important to deliver proper exercise programs with rehabilitation to maximize the patient’s recovery potential.

  • “Rehabilitation and fitness operate on the same highway, running parallel. But they’re in different lanes. The bucket you reach into for the techniques used to manage a painful shoulder is totally different than the bucket you reach into for the techniques used to treat a healthy leg. One obstacle to a parallel approach is that people are willing to pay for fitness, but they’ve been conditioned to not pay for healthcare. They think they have to use their insurance.”

3 Ways to Improve Throwing Velocity by Enhancing Lower Body Force Production

  • Mike Reinold shares how strength, speed, stride leg stability training is essential for youth pitchers.

  • “Based on these two studies it is apparent that getting stronger isn’t the only thing needed to increase your pitching velocity.  You also need to be able to generate more speed and power.”

Simple Suggestions for Finding An Appropriate Running Shoe

  • Chris Johnson walks the walk, runs the run. He debunks many myths filled in the commercialized industry of running footwear and provides his unbiased expertise on how to select the proper pair.

  • “At day's end, how you run, and the decisions you make related to your running, far outweigh what's on your feet, provided that the shoe is ppropriately fit and free of defects. So, find a pair of shoes that feel comfortable, and don't get caught up in the hype of the purported benefits of various shoe features.”

One-to-one or strength in numbers – is there a best way to deliver exercise based physiotherapy?

  • Mary O’Keefe talks about how group exercise can be just as efficient as individualized training session. This is a good article to have in the archive in support of incorporating more cost efficient group classes into your clinical setting.

  • “Choosing the most cost-efficient and feasible therapy may therefore be reasonable, based on the evidence to date.  As a result, group interventions may need to be considered more often.”

Pain

Let’s not swing the opioid pendulum too far

  • Kory Zimney explains the current attack on opioid use and cautions clinicians to not create a black and white scenario between physical therapy and opioids. Each has their place, and both sides can be used improperly. Both opioids and physical therapy can be abused creating a dependency on each when their benefits to the individual is obscured by false promises.

  • “For PT to be the most beneficial for the person in pain, the therapist has to understand pain is part of an embodied conscious experience. We have to treat it based on top-down and bottom-up EBP interventions. The person as a whole, not their tissues, needs to be considered and cared for through shared decision making.”

  • “It could be seen as an “either/or” when it comes to opioids and PT, when many times it should be an “and” when considering opioids and PT to assist in treating a person in pain.”

Fatigue Is All in Your Head

  • Nick Heil discusses a research article done by Samuele Marcora that states how perceived fatigue can limit performance. It highlights our brain’s protective measures to shut down the down despite the body’s physiological capability to continue. A great example enforcing a “top-down” understanding of the brain.

  • “Marcora believes that perception is the regulatory mechanism and that it slows you down before you reach your biological limit. “There’s no physical reason for exertion to feel any harder, but when you’re mentally fatigued, it does,” he says. “Therefore you reach what you perceive as a maximal effort earlier.”"

WHY I PUT STRENGTH ON DYSFUNCTION

  • Greg Lehman challenges the popular notion that you cannot train an individual with dysfunctional movement patterns. Acknowledging the importance of biomechanics, Lehman explains that the pain often displayed in individuals with “poor movement patterns” are a result of sensory modulation more so than from biomechanics and movement dysfunction.

  • “If you tell them that have poor movement patterns, that their breathing sucks, their mobility is atrocious etc, then perhaps you are setting them up stay sensitive.  Instead, we can look at their training, their lifestyle and all their stressors.”

Pain Relief from Personal Growth

  • Paul Ingraham explains how personal growth in terms of an individual’s maturation process, personality improvements, and thoughts and reactions to circumstances are important to integrate and consider in an individual’s recovery and rehabilitation of chronic pain states.

  • “Manual therapies are usually aimed at a target tissue, with the goal of changing something specific in the body, whether that’s realistic or not. Personal growth, on the other hand, is general. It has the potential to affect — and change — almost anything about you.”

Living Mindfully With Chronic Pain and Illness

  • Melanie Greenberg explains the different contents of her books on chronic pain and explains the importances and the impact of mindfulness in overcoming many obstacles found in chronic pain.

  • “With practice, mindfulness can help us catch stressful emotions when they first arise. This keeps them from ballooning into elaborate stress-filled stories that have no basis in fact but which we believe without question.”

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