I have no special talent, I am only passionately curious.
— Albert Einstein

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!


A Simple Approach to Running Analysis for Clinicians

  • Chris Johnson discusses his simplified method of treadmill analysis for runners featured on Mike Reinold’s website. He shares his Four S’s of Running Analysis which are: sound, strike, step rate, and speed.

  • “The idea is that by increasing the number of steps while keeping running velocity constant, a runner can effectively reduce the magnitude of each individual loading cycle despite increasing the total number of loading cycles for a given training session.”

 

14 myths about back pain debunked by experts

  • Chris Maher, Mary O’Keefe, Peter O’Sullivan share their expertise on back pain and provide salient information on common back pain misconceptions

  • “There is no evidence that back pain is caused by a bone or joint in the back being out of place, or your pelvis being out of alignment. For most people with back pain, scans do not show any evidence of discs, bones or joints being ‘out of place’.”

 

We are not cars…

  • Adam Meakins puts down the analogy that physical therapists are car mechanics explaining how PTs don’t fix people and that people’s injuries and pains are way more complex that the components of a car.

  • “NEVER see patients as a life long customers or clients, who need regular maintenance. As a therapist ALWAYS strive to make yourself redundant with every patient as soon as possible.”

 

Don’t Freak Out: Treating Pain with Simple Fundamentals

  • Probably my favorite article of the month, Greg Lehman explains his fundamental concepts in treating pain and his supplemental strategies.

  • “After ruling out the pathologies, I can view the body positively. Regardless of pain levels, I can tell the patient that their tissue is strong and start treating the whole person. I want to change their beliefs about their body and convince them in the above axiom. The human body isn’t a stack of blocks that will fall apart if there’s something slightly off.”

 

What’s beer got to do with sports injuries?

  • Tim Gabbet, expert on injury prevention, provides an analogy of Beer Tolerance when explaining Load Tolerance on Adam Meakin’s blog.

  • “As you become more confident in your partying ways, you decide to experiment with more exotic drinks. You attempt tequila ‘shots’ and become sick (immediate effect) and hungover (delayed effect). You are quickly learning that not all alcoholic beverages carry the same risk. You quickly learn that having a tolerance to beer, does not automatically provide a defense against alcoholic spirits.”

 

Why Useless Surgery is Still Popular

  • New York Times article covers the work of Dr. Jeffrey N. Katz on meniscal surgery’s lack of efficacy.

  • “Patients should be told that physical therapy is a good first-line therapy for pain relief, Dr. Katz said, but that surgery also relieves pain. Pain relief can take longer with physical therapy, he says. With surgery, he said, patients have to recover from the operation but are likely to be back at work within two weeks.”

 

Do Tight Hip Flexors Correlate to Glute Weakness?

  • Mike Renoid discusses Glute Weakness and its relation to Hip Flexor “tightness” by reviewing a study published in the International Journal of Sports Physical Therapy. The study found moderate indirect correlations between hip flexor tightness and glutes EMG activity.

  • “If trying to strengthen the glutes, it appears that you may also want focus on hip flexor mobility, as is often recommended.  While a common recommendation, I bet many people skip this step.”

 

Understanding Dynamic Valgus

  • Erik Meira explains dynamic valgus and how it doesn’t have to be the villain that many therapists make it out to be. Erik spends time challenging commonly accepted views on dynamic valgus.

  • “In my opinion, if someone has really good strength, power, and load tolerance overall (not JUST quads but AT LEAST quads), you have probably done more for them than you would by “fixing” their techniques. People are weird and unique. What works for one person may not work for another. This variation is beautiful and wonderful and should be embraced.”

 

The Role of the Clinician in the community; selling meat to vegans.

  • Richard Severin talks about the role we should embody as physical therapists. As educators we have a responsibility to avoid the use of debunked, inaccurate, and out-of-date information to explain interventions to our patients.

  • “A clinician at the core is a motivator and an educator. As an educator sometimes what’s right isn’t popular and it’s not easy to tell or convince someone that they’re wrong. However if someone is wrong it’s important that they are told so but it should be done in a respectful manner.”

 

The silent epidemic

  • Tim Cocks and David Butler of NOIgroup discuss the chronic low back pain epidemic and how it’s been swept under the rug.

  • “We hear it sometimes, ‘yes, pain is a big problem, but it doesn’t kill people’. Our response is a resounding BULLSHIT. Pain kills people, opioid overdose deaths have quadrupled in the US between 1999 and 2014 with 165,000 people dying over this period. “

 

Looking through keyholes

  • Tim Cocks discusses how specializations can lead to biases and how the generalist has it’s advantages

  • “The danger of expertise and specialisation then, is beautifully summed up in the quote above. The deforming keyholes that we look through can take on many shapes, from professional titles such as doctor, surgeon, physiotherapist, psychologist, chiropractor, to subprofessional specialties – neurology, orthopaedics, musculoskeletal, cardio-thoracic, pain (of course, we are players all, on this stage), and so on.”

 

The Decline of Manual Therapy Skills?

  • Mark Kargela writes critically about the current outdated nature of physical therapy and how he continues to practice as a manual therapist with evidence based approaches.

  • “IF motion palpation and palpatory positional diagnoses are so important then why has research failed over and over again to prove they are reliably detected and associated with outcomes.”


Moving Manual Therapy Forward – Building from Maitland’s Pioneering Work

  • Mark Kargela responds to criticism from his previous post (listed above) and gives a thorough explanation of the merits of the Maitland approach.

  • “We have an absolute duty as professionals to keep our practice up to date with science even if it conflicts or brings us discomfort as we challenge our current practice patterns.  This especially applies to those who teach manual therapy coursework.”


How Sleep Deprivation Harms Memory

  • eLife publishes an article by Robbert Havekes, PhD on how 5 hours of sleep deprivation leads to impaired connectivity of neurons and the hippocampus which can be linked to memory.

  • “Their analyses indicated that sleep deprivation significantly reduces the length and spine density of the dendrites belonging to the neurons in the CA1 region of the hippocampus.”
     

Pain Management – it’s a sham

  • Louie Puentedura discusses how he alongside Adriaan Louw’s team sought out to review sham surgery as a way to explain the brain’s capacity to alter pain.

  • “It is also imperative that everyone realizes the review focused on the sham vs real surgery effects on pain and disability, and not on whether neurological deficits or other serious medical issues were restored. Surgery and the powerful rituals surrounding it are likely to involve a powerful placebo response.”

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