I think it’s very important to have a feedback loop, where you’re constantly thinking about what you’ve done and how you could be doing it better. I think that’s the single best piece of advice: constantly think about how you could be doing things better and questioning yourself.
— Elon Musk

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

The “Other Side” Is Not Dumb

  • In lieu of the political environment we’ve all been apart of, this is an older article that covers how we are so accustomed to surrounded ourselves with people who have like-minded thoughts, leading to often aggrandized negativity to the other contrary opinions. It’s healthy to understand the other side, and not dismiss everything “they” say immediately.

  • “Online it means we can be blindsided by the opinions of our friends or, more broadly, America. Over time, this morphs into a subconscious belief that we and our friends are the sane ones and that there’s a crazy “Other Side” that must be laughed at — an Other Side that just doesn’t “get it,” and is clearly not as intelligent as “us.” But this holier-than-thou social media behavior is counterproductive, it’s self-aggrandizement at the cost of actual nuanced discourse and if we want to consider online discourse productive, we need to move past this.”

  • “On Twitter and Facebook this means we prioritize by sharing stuff that will garner approval of our peers over stuff that’s actually, you know, true. We share stuff that ignores wider realities, selectively shares information, or is just an outright falsehood.”

The biopsychosocial model revisited

  • Dave Nicholls discusses how the BPS model has it’s limitations and has many opportunities to improve. He isn’t proposing that the paradigm should be dismissed, but offers warning for clinicians to not 100% buy into the system.

  • “To position oneself within a social or humanistic paradigm is, in many cases, to oppose many of the principles of biomedicine.  So any model that neatly juxtaposes these often conflicting and contradictory positions, in the belief that they can sit neatly together in one basket, is perhaps both critically naive and deeply problematic.”

No, you’re not entitled to your opinion

  • Patrick Stokes explains how everyone may be entitled to their opinion, but if the opinion is not backed academically, it cannot be evenly matched with something with evidence. Using anti-vaccination theories as an example, he demonstrates how the media cannot portray the un-backed opinion of an individual against scientific evidence. I believe this parallels many things controversial in physical therapy and should overall encourage people to make educated opinions themselves with the current body of evidence or propose new evidence to help discover information closer to the truth.

  • “The problem with “I’m entitled to my opinion” is that, all too often, it’s used to shelter beliefs that should have been abandoned. It becomes shorthand for “I can say or think whatever I like” – and by extension, continuing to argue is somehow disrespectful. And this attitude feeds, I suggest, into the false equivalence between experts and non-experts that is an increasingly pernicious feature of our public discourse.”

Visceral Manipulation Embraced by the APTA

  • This article cites the APTA giving the green light to visceral manipulation as an intervention by physical therapist because of it’s anecdotal benefits, despite the lack of research to support its efficacy.

  • “In other words, “We don’t need no stinkin’ science! We support any treatment that can provide positive anecdotes. We believe the plural of anecdote is data. Instead of offering guidance, we’ll let our members sink or swim: we’ll make them responsible for knowing ahead of time how much evidence supports a treatment and deciding whether they believe it is sufficient to merit a personal decision to study it.”

Surgery isn’t always the best option, and the decision shouldn’t just lie with the doctor

  • Ian Harris and Paul Myles talk about surgery and how patients need to play a bigger role in the conversation of whether or not they should have the surgery done. The patient has the right to know more about the surgery because in our current system, surgeons do not have to abide to morally ethical decisions to promote or dismiss a surgery.

  • “Doctors should not perform surgical procedures and taxpayers should not have to cover their cost until there’s high quality evidence they work. It should be unethical for surgeons to introduce a new technique without studying whether or not it works. Unfortunately, the opposite is true: ethical approval is not required before surgeons can start performing new procedures, but it is required to study the effectiveness of that procedure.”

INTERVENTIONS ARE NOT IDENTITIES

  • Kenny Venere talks about the current state of physical therapy and how everyone is trying to get the edge on each other through marketing campaigns of ancillary treatments each clinician can provide. He talks about how a focus on these modalities really detract from our practice as a profession.

  • “When the profession over emphasizes ancillary treatments, novel (but often ultimately useless) modalities and other additive products as somehow being essential to physical therapy's professional identity while failing to improve the critical thinking, scientific literacy and understanding of the complexities of who and what a physical therapist works with — the profession misses the point. Physical therapy should focus less on adopting the latest trendy treatment or cure-all proprietary system and instead dedicate itself to refining the basics which serve as the foundation of the profession and allow the profession to succeed in a wide variety of settings — a commitment to evidence based practice, well reasoned utilization of low risk/conservative treatments grounded in science, patient centered communication, therapeutic alliance and being part of an interdisciplinary team.”

Student Loans…Not All Debt Is Created Equal

  • Joseph Reinke talks about how student loans and higher education comes with a huge price. This is a great article for students to understand beyond the idea that the government gives you loans and you pay them back later. Reinke provides a reality check that not all loans are great for your future.

  • “The loan is expected to be paid off over 30 years, which means that as you recognize your human capital asset in the form of wages, you will use it to pay off your student loans. After 30 years you are debt-free, but you also have not accumulated much financial assets.”

The Importance of Play for Motor Learning

  • Todd Hardgrove talks about the importance of “play” and it contributes to how the brain and body problem solve movement patterns in daily activities.

  • “Learning is essentially an investment in the future, and brains are programmed to make that investment only when things are looking pretty squared away in the present. By contrast, if you are under some form of stress that threatens survival, the brain is not primed to learn or play.”

  • “novel stimulus is more likely to get the brain’s attention and excite more neural activity in more areas of the brain. In other words, the stage is set for neural growth and new connections, which is what learning is all about.”

Play, Variability and Motor Learning

  • Todd Hardgrove provides an update to the above article and explains how “play” plays a big role in our neuroplasticity and ability to move more functionally everyday.

  • “Play involves focused attention, it is rewarding, and it promotes the development of novel movement and perceptions. These are all important preconditions for neuroplasticity. Play also activates brain derived neurotrophic factor, which stimulates nerve growth.”

Cognitive bias cheat sheet

  • Buster Benson explains what cognitive biases are, the overarching theme of most of them, and how they can be terrible or useful for our own thoughts and growth. It’s good to know how you, your colleagues, and your patients will often use each of these cognitive biases to make sense to new concepts and information.

  • “We are drawn to details that confirm our own existing beliefs. This is a big one. As is the corollary: we tend to ignore details that contradicts our own beliefs.

  • “We find stories and patterns even in sparse data. Since we only get a tiny sliver of the world’s information, and also filter out almost everything else, we never have the luxury of having the full story. This is how our brain reconstructs the world to feel complete inside our heads.

  • “Cognitive biases are just tools, useful in the right contexts, harmful in others.”

Orthopedic, Strength & Conditioning

The SAID Principle

  • Todd Hardgrove talks about the SAID (Specific Adaptation to Imposed Demand) Principle and how it is often misinterpreted in the physical therapy and training realms. Often as physical therapists, we try to be creative about the rehabilitative exercises for our patients, however it should be understood whether these ideas are truly efficacious for our patients.

  • “Let's use some examples. What about trying to become a better soccer player by using a swiss ball or other unstable surface to train your "balance." Study after study shows that training on an unstable surface confers no measurable performance benefits on the field of play that could not be obtained by general exercise.”

  • “if you want to get better at X, do X as hard as possible without getting hurt or overtrained. Be very skeptical of the carryover or transferability of "functional training" or even training that purports to be "sport specific."”

10 Phrases to Teach a Parrot to Recite to Injured Runners

  • Chris Johnson provides his 10 go-to concepts that he gives his injured runners.

  • “FIVE WILL GIVE YOU 20 – Heiderscheit and colleagues demonstrated that a five percent increase in step rate, relative to one's preferred cadence, leads to a 20% reduction in energy absorption at the level of the knee.

  • “ALL FOOT STRIKE PATTERNS WORK UNTIL THEY DON’T – All foot strikes are viable options when it comes to running, yet possess unique characteristics. One strike pattern is not necessarily superior to others in most cases.”

THE BIGGEST RUNNING MYTHS BUSTED

  • As in any sport, runners develop tons of misinformed ideas about their sport. Matt Phillips provides quick rebuttals to many popular myths that your patient may be coming in with.

  • Pre-run stretching, Post-run static stretching, Heel-striking, The wrong shoes, Magic number 180SPM

Proximal Hamstring Tendinopathy – exercise videos, infographic and podcast

  • Following Tom Goom’s team of researchers producing an update to proximal hamstring management, Tom shares posts by Chris Johnson and David Pope that help provide visual demonstrations and information based off the research article.

Hip Variations and Why My Squat Isn’t Your Squat    

  • Mike Reinold curates this awesome article on the hip and introduces ideas that I wish I knew earlier about how there are so many variations to the squat. This article is a one-stop shop for everything you need to know about hip mechanics and how there isn’t one correct way for the squat.

  • “The benefits of a deep squat seem to only be reserved for those who have the ability to express those benefits by accessing that range of motion without some other compensatory issue.”

  • “If they have trouble breaking 90 degrees, even if they move wider through abduction and external rotation, their active range is limited through multiple tests, and their ability to show you a squat shows a lumbar flexion at around 90 degrees of hip flexion as well, the odds of you mobilizing that tissue to produce a significantly bigger range may be limited.”

Is it OK to K tape…?

  • Adam Meakins goes on his rant about how kinesiotaping isn’t all that it is talked up to be and how it often distracts patients from pertinent information they should pay attention to for their rehab.

  • “The only thing I could consistently say about K Tape was the effects were ALWAYS temporary, ALWAYS small, and more importantly K Tape was ALWAYS without fail a big huge fucking distraction. So much so it became annoying for me to constantly have players and patients all giddy and amazed about this gawdy coloured sticky stuff I had just put on them, and it tended to distract them from focusing or paying any further attention to anything else I had to say, or ask them to do, which was always the more important stuff.”

Pain

An Introduction To Therapeutic Neuroscience Education

  • Cameron Yuen breaks down ISPI's Therapeutic Neuroscience Education approach in this article. He provides a great foundation on pain science education for people who are unfamiliar with the concept to build up from.
  • "Remember, this educational and cognitive intervention is only a piece of the treatment. It could be a very large piece, or a very small piece depending on the patient, but the goal, as always, is to arm our patients with knowledge, and guide them to help themselves and take an active role in their recovery."

Acupuncture for low back pain no longer recommended for NHS patients

  • Huge news that rocked the musculoskeletal rehabilitation world. Acupuncture is dismissed as a recommended treatment for low back pain. This doesn’t necessarily discount it’s effectiveness, but until there is clearer evidence for its physiological mechanism, it will not be supported by the NHS.

  • “But the new draft guidelines, now covering sciatica as well as low back pain, contain an unequivocal volte-face, stating: “Do not offer acupuncture for managing non-specific low back pain with or without sciatica.””

Is thoracic spine posture important for shoulder pain?

  • Bad posture is not predictive to pain. Here is an article by Peter O’Sullivan’s team on how evidence points towards the fact that thoracic kyphosis does not correlate with pain.

  • “The finding that thoracic kyphosis does not differ significantly between groups with and without shoulder pain goes hand in hand with other recent systematic reviews, which have demonstrated that shoulder blade position and muscle EMG activity do not follow a predictable pattern in people with and without shoulder pain.”

Strategies to Reduce Chronic Pain, Part One

  • Todd Hardgrove explains how therapeutic movements that are under the Feldenkrais method umbrella can provide novel movement stimuli that ameliorates pain in individuals who have chronic pain.

  • “Based on these facts, we can conclude that sensory gating will be maximally effective with active movement that is novel, interesting, rich in proprioceptive and sensory information, and near the site of pain, without aggravating the pain.”

  • “For whatever reason, the CNS obviously thinks that the painful move or position is a bad idea, and it is sending you a pain signal to discourage you from making it again in the same way.  One strategy to reduce the pain is to move in a subtly different way that does not threaten the CNS.”

Breathe. Exhale. Repeat: The Benefits of Controlled Breathing

  • Lesley Alderman writes in the NY Times about the benefits of controlled breathing. This is a very simple concept that can go a long ways in treating many of our patients.

  • “‘When you take slow, steady breaths, your brain gets the message that all is well and activates the parasympathetic response, said Dr. Brown. When you take shallow rapid breaths or hold your breath, the sympathetic response is activated. “If you breathe correctly, your mind will calm down,” said Dr. Patricia Gerbarg, assistant clinical professor of psychiatry at New York Medical College and Dr. Brown’s co-author”

The empty brain: Your brain does not process information, retrieve knowledge or store memories. In short: your brain is not a computer

  • This isn’t necessarily a PT article, but Robert Epstein refutes the idea that our brain functions like a computer. From a PT perspective, it’s a reminder that every patient I will encounter is unique and will need a tailored approach/perspective every time I evaluate and treat.

  • “This is inspirational, I suppose, because it means that each of us is truly unique, not just in our genetic makeup, but even in the way our brains change over time. It is also depressing, because it makes the task of the neuroscientist daunting almost beyond imagination. For any given experience, orderly change could involve a thousand neurons, a million neurons or even the entire brain, with the pattern of change different in every brain.”

Explainer: what is pain and what is happening when we feel it

  • Lorimer Mosely helps provide a simple explanation about pain. Though it is clear that I’ve read articles previously about the basics of pain, I found his thoughts useful for explaining to patients and colleagues about how it’s not “all in your head.”

  • “So is pain all about the brain and not at all about the body? No, these “danger detectors” are distributed across almost all of our body tissues and act as the eyes of the brain.”

  • “This is one significant reason there is no quick fix for nearly all persistent pains. Recovery requires a journey of patience, persistence, courage and good coaching. The best interventions focus on slowly training our body and brain to be less protective.”

A little knowledge can be a dangerous thing…

  • Adam Meakins provides his personal episode of back pain and how he relates his experience to his patients. A couple years back, I’ve experienced something similar and was told the wrong things by multiple physical therapists and physicians, only to learn that my body is more robust than I believed it to be and that my pain wasn’t necessarily anatomically related.

  • “However, what my psyche actually concluded was “fuck that” this amount of pain and level of disability means you have clearly suffered a massive lumbar disc herniation. In fact I bet you have probably suffered a huge disc explosion and have nucleus pulposus splattered all over your nerve roots like shrapnel from a bomb blast.”

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