Order Questions

Most of our musculoskeletal treatments fall within a ‘gray zone’ of effectiveness¹. Nearly none of our treatments are strongly effective all of the time and few have no benefit all of the time. This is one of the reasons we see outcomes that are consistently similar across well-designed musculoskeletal studies. To enhance treatment benefits and advance precision medicine, pain researchers have begun to move beyond the first-order question of “Does the treatment work?² and have begun studying second and third order questions such as “how does this treatment work” (second order) and “who does this treatment benefit” (third order).

Read More

In a popular video, a clinician demonstrates the vacuum phenomenon of the hip joint in a cadaver, moving the femoral head around to create suction and then pulling (clearly very hard) to demonstrate how strong that suction force can be. It prompts the question – if someone can apply that much force without any movement of the hip, what is happening during joint mobilization?

Seth Peterson, PT, DPT, OCS, FAAOMPT

The Motive Physical Therapy Specialists

Arizona School of Health Sciences, A.T. Still University

Read More

The Truth? Whose Truth?

Our impetus for writing this blog is our disappointment with modern United States news media outlets, how they report information, and how it impacts the public. Their extremist style of reporting has led to a division of thought within this country and an intolerance of middle-of-the-road beliefs. And sadly, we think this has influenced how we acquire and interpret information in physical therapy practice. In this blog we will show how extreme statements by dissemination sources have eroded the truth in physical therapy practice.

Although the news media examples we give are US-centric, they mirror what we’ve observed internationally. Please don’t misinterpret our purpose. This blog is not a call for censorship in thought nor does it single out a group of people or information sources. It requests a reflective, balanced, and tolerant evaluation of all views and available evidence. We feel that all ideas and beliefs deserve honest, candid, and transparent due process.

Read More

Patient: “That feels a lot better” he said. “What were you doing there?”
Me” “Some hands-on treatment for your neck – I suspected some of your shoulder pain might have been coming from your neck, and I think we just found the main source of your problem,” I said.
Patient: “I had lots of manual therapy for my shoulder, and it never helped the pain – why didn’t they work on my neck too?”
I have had a version of this conversation with many patients over the years. He has asked a good question; how should I respond?

Read More

What are Mechanisms?

The term “mechanism” reflects the theoretical steps or processes through which an intervention (or some independent variable) unfolds and produces a change in a patient. For example, a cortisone injection for a frozen shoulder works by stopping the release of regional molecules that cause inflammation and stopping the body from the immune response after an injury. Mechanisms studies involve a unique design that is frequently pre-clinical (animal-based or laboratory-based). The National Institutes of Health (NIH) defines mechanistic studies as designed to understand a biological or behavioral process, the pathophysiology of a disease, or the mechanism of action of an intervention [1].

Read More

Null statistical hypothesis testing aims to prevent confirmation bias [1]. The researcher creates the null hypothesis by converting the research question to a research hypothesis and then converting the research hypothesis to the null hypothesis. This should happen before starting data collection starts. The researcher should use statistical significance (p-values) testing to accept or reject the null hypothesis. Using significance testing to accept or reject a research question or hypothesis may lead to chasing statistically significant findings and confirmation bias. Researchers have called for the death of null statistical hypothesis testing. They have suggested replacing these methods with effect sizes, confidence intervals, and Bayesian methods secondary to researchers not following the intent of this methodology [2]. These different approaches have their strengths and weaknesses. The power of the null statistical hypothesis testing is that it can be a powerful tool used to rule things out [3].

Read More

Overview

         In this blog, I hope to show that there is no proper way to perform a sham orthopaedic manual therapy (OMT) study in a way that unambiguously allows a comparison between an intervention and therapeutic intent. The idea is good. The execution is likely not possible.

Read More

Myths and health

Accordingly to the Oxford dictionary, a myth is a widely held but false belief (or idea). We commonly encounter health-related myths in our daily lives. For example, despite what you may have heard, cracking ones knuckles does not cause arthritis. Coffee doesn’t stunt the growth of children and 10,000 steps per day isn’t necessarily the magic number when it comes to activity levels. Chocolate is not an aphrodisiac and muscle doesn’t necessarily turn to fat when you stop exercising.

Read More