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Posts Tagged ‘#solvept’

Rec Fem Causes Hip…


EXTENSION!

But that isn’t what this post is about…  Our models for understanding pathology are too primitive to be meaningful.  The background of what I’m thinking:

This article is a perfect example of how remarkably complex human motion really is.  And all I can help taking from it is that after explaining the mechanism to 3 people now, all have fired back with “So, how is that functional?”  Without even giving a minute or two to try to think about a circumstance when something like that might actually be functional.

“This is what I’ve observed.”  “It has to be this way because of the origin and insertion.”


Besides the actual function and clinical relevance discussed in the article, I like to think more about how many other parts of everything I’ve learned act as functional oversimplifications.

These over-simplifications are the basis, for instance, for much of how we model and explain very complex evaluative tools.  I wrote this post a couple weeks ago, and have been thinking about it since then, with a little feedback from a mentor.  At the same time, not too soon after, a friend of mine (@RGWooderson) forwards a blogpost to me called “A Few Tests To Toss”.  It is a great post that actually offered ANSWERS to some of the questions and things I’ve been thinking about.  A recommended read, for sure.

Now my purpose: 

The Low Back.  We try to model the mechanics of it, in all the spine’s complexities.  And evaluate the “motion” people perform by merely touching and observing.  I’m not bashing touching and observing.  I think touch and observation are our greatest tools – just extremely inaccurate, or inconsistent at best.  And seem to fail to achieve proposed/described biomechanical influences. And in the end we are frustrated or confused – as a freaking profession! – about why we can’t cure back pain.  Or why our outcomes for certain sub-populations aren’t better than surgery. 

I’m not satisfied.  Not with the methods of evaluation I was taught in school – like SI movement, low back quadrant testing, and evaluating based on assumptions of biomechanics that don’t hold true.  When I was learning it in school, and disagreed, I felt like I was out of the loop.  Like there was another lecture that I didn’t get to hear. So WTF? Am I an idiot?  Arrogant?  Hopeless? 

Pain I understand – and trying to create a more meaningful picture with provocation testing (see “A Few Tests to Toss”) makes sense to me, especially if it can be linked to treatments that are effective at reducing pain (are they?).  BUT trying to explain the mechanism of pain by assessing 1 – 2 mm of movement through centimeters of soft tissue doesn’t just seem useless, it seems irresponsible.

One answer, as I was hoping to hear (homework: revisit hindsight bias) was outcomes.  We have got to critically analyze our treatments and their outcomes as a GROUP, and hastily discontinue treatments that don’t yeild meaningful results – or as a practice we should be left behind.  Stop trying to explain the mechanism because it is very poorly understood.  Focus on what works, and be certain you are truly quantifying it. 


I started reading Doctors: A Biography of Medicine.  I haven’t finished (thanks, self, for sucking at modalities and cardio/pulm).  There were two main schools of thought regarding medicine.  Both wanted to help patients.  One school of thought was Hippocrates, who, as the father of medicine, and, as I understand it from the book, discusses change in patient condition and patients getting better as the focus of his practice.  The other school of thought in Pergamon focused on pathology, and, ultimately, did not produce a father of medicine.  Galen was more like an uncle of medicine.  Brilliant, to be certain, but wrong frequently about anatomy and physiology.  Understanding of pathology, cell models, etc… was too primitive to be meaningful then, and in many cases today, too primitive to be meaningful now.   I like the clinical prediction rules as a starting point for treatment because, while ignoring the ever elusive question of “why are you in pain?”  it still offers solutions which have documented improvements compared to older methods of treatment. 

Rant over.


Jumping back on the cardiovascular/pulmonary and modalities studying for the NPTE bandwagon.  Thanks for reading. 


-d


PUBLISHED!

We are officially being published in Clinical Biomechanics for our graduate research.  This is great news!  Adding it to my CV.

Article title: Altered Muscle Recruitment During Extension from Trunk Flexion in Low Back Pain Developers
Reference: *********
Journal title: Clinical Biomechanics
Corresponding author: Dr. Erika Nelson-Wong
First author: Dr. Erika Nelson-Wong

Dear Dr. Nelson-Wong,

Please find attached a copy of the “Journal Publishing Agreement” which you completed online on 25-JUL-2012.

If you have any questions, please do not hesitate to contact us. To help us assist you, please quote our reference ******** in all correspondence.

We are committed to publishing your article as quickly as possible.

Yours sincerely,
Elsevier Author Support

Inter-professional pissing contest.

First and last time I’ll ever engage in this conversation (I hope).


My friend @RGWooderson, sent me a link to a post by a physical therapist who has been in the profession a long time, and done a lot of cool stuff. You can read his CV on his website. He has been the CRO: Chief Revolutionary Officer since 2011 for a company he started – The Smart Life Project. Thank you Allen, for your insight into damned future of our profession. But who are you mad at? All I did was start applying to PT schools in 2008/2009.


You can read his post here: Was the DPT The Right Direction?


Here’s the problem I have with it, more than anything. We’re, as a profession, trying to elevate ourselves in the public’s eyes and through legislation. Blog posts like his only hurt our profession. While he is spending an evening trying to start an interprofessional pissing contest (which I’m sure won’t interest people in his “institute”), others among us will be working together to move forward.


Thomas Kuhn wrote a great book int he 60’s and coined the term paradigm shift, discussing the history of science and how exactly competing ideologies came about, and came to die in the face of new world views. He quoted Max Plank (long story) in the book The Structure of Scientific Revolutions, saying “a new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”


The conversation over the presence of DPT in the profession ended a while ago (whenever, I don’t know). Taking time away to engage people who have already made up their mind about a topic isn’t going to do anything but stir the professional pot, if you will. He’s an old guy. He’s treated 10,000 patients! He, and the rest like him, will be out of the profession and dead before I can even afford to retire.


Have a great week.


-d

The point is to participate!

Great post on social networking and HC: http://ping.fm/NpYfF One point I’d like to make: We’ll talk about you whether you participate or not. JoinOrGetLeftBehind physicaltherapists academia