Author:

Seth Peterson, PT, DPT, OCS, FAAOMPT

The Motive Physical Therapy Specialists

Oro Valley, AZ

We learn from our failures more than our success. In other times, we learn from our “almost failures.” These close-calls are the best events to learn from, really, because they can carry almost the same weight as a failure without the tragic consequences. Police officers hint at their knowledge of this fact every time they let you go without a ticket. There is a hill on my way to work that I always brake while going down, 8 years later; It is a location where I got off with a ‘warning’.

Read More

Author: Chad Cook PT, PhD, FAPTA

Physical therapists commonly compare two or more things to one another. For example, I’ve frequently heard the comparison of the diagnostic accuracy of one test to another, when defending or rejecting the use of a special test. I’ve also heard the reporting that one intervention is more effective compared to another; in most cases, incorrectly. Sometimes these judgments are not apples-to-apples comparisons and markedly depend on the context and type of the compared group. If you indulge me, I’ll give a non-physical therapy-related example to reinforce my point better.

Read More

Author: Dr Angela Cadogan, PhD, NZRPS, Specialist Physiotherapist (MSK)

Musculoskeletal physiotherapists have a therapeutic ‘bag of tricks’ that includes a range of interventions such as advice, pain science education, acupuncture, exercise and manual therapy to name a few. What turns a ‘trick’ into an effective ‘treatment’ is its application within a biopsychosocial framework, guided by clinical reasoning, informed by evidence within a person-centered, shared decision-making model of care.

Read More

Preface

         I have grown to despise systematic reviews/meta-analyses. I do not like writing them, I do not enjoy reading them (any more than I enjoy reading an instructional manual), and I especially hate explaining to people why they have so many limitations. I feel lazy and uninspired when I participate in systematic reviews. I hate that journals clamber to publish them, even papers with notable flaws. I was an author on a systematic review that included zero papers [1]; which I would argue is one of my better reviews. It disappoints me when people on social media assume that a review is biblical and fawn upon findings that support their biases or interests.

I do not like them. My goal in this blog is to explain why I loathe them so much.

Chad E Cook PT, PhD, FAPTA

Twitter @chadcookpt

Professor, Department of Orthopaedics, Duke University, Durham, NC. 27516

Competing interests: A portion of Dr Cook’s salary is funded by the NIH/VA/DoD and the Center of Excellence in Manual and Manipulative Therapy at Duke University.

Read More

In an editorial titled “Science or Cult?” published in PTJ in 1963, Hislop stated, “Observations are the principal data of clinical science. Sometimes observations are inaccurate and faulty. Inferences and concepts can arise from such observations which also may be indefinite and confused. For persons not well grounded in scientific thought and procedure, this kind of muddled thinking can result in the indefensible error of offering explanation and rationalization of undocumented and unproved theory.”¹

• What are our diagnostic paradigms?
• Are diagnostic paradigms based on scientific thought and procedure?
• Are we rationalizing the use of unproven theories in the diagnosis of musculoskeletal disorders?

Sean P. Riley, PT, DPT, ScD

Twitter @seanrileypt

Assistant Professor, Doctor of Physical Therapy Program, University of Hartford, West Hartford, CT. 06117

Competing interests: Center of Excellence in Manual and Manipulative Therapy at Duke University.

Read More

Learners of manual therapy (MT) are required to develop complex hands-on clinical skills underpinned by clinical reasoning, manual/physical assessments and palpation [1]. While much of focus in MT has been either on its effectiveness and/or mechanisms, not much attention has been given to how MT is being taught. Hence, it may be timely to think how to best teach MT as it is more than just techniques.

Dr Kesava Kovanur Sampath, PhD, M.Ost, BPT 

Twitter @kesavasampath 

Senior Academic Staff Member (Physiotherapy Program), Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand. 

Competing interests: part of the Leadership Group, Center of Excellence in Manual and Manipulative Therapy at Duke University.  

Read More

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