Keeping Up With The “Trends” in Physical Therapy Treatment

hot not


Trends can be a good thing or bad thing. It’s a good thing if we define trend as an update or upgrade. Old things are abandoned as new paradigm shift is welcomed. In science, it means that new studies present a more scientific fact nullifying those that have been previously believed and taught. Or trend can be a bad thing when it is described as fashion or fad. Here today, gone tomorrow because they don’t have scientific studies to back them up. In physical therapy, there had been numerous techniques once used and now being abandoned. That’s fine too. Which medical science does not evolve and advance, and still use same method of diagnosis or treatment for decades?

I am happy to be in the bandwagon in this journey of new trends in my profession. Some therapists just want to stick to what they are used to in their practice but I am not some therapists. I refuse to be left behind. Thanks to all of those practitioners who constantly push researches and studies so that physical therapy and physical rehabilitation practices will truly be evidence based and treatments based on psuedosciences be contained or minimized. Thanks to clinicians and researchers who are bold enough to call out and challenge the charlatans who provide training and products with unproven effectiveness as a way of monetizing the practice.

I am forever grateful to everyone who keep supplying oceans of new information to the community of PTs around the globe through facebook, twitter, and online forums. Not only from physical therapists but also from related professions like atheltic trainers, strength and conditioning coaches and massage therapists.  There’s always going to be arguments from different groups with different paradigms in the practice, Overtime, as I read discussions and sometimes join in these discussions, I have learned which side to choose. Yes, sad to say, there have been some inevitable divisions among physical therapists. But of course, we can all disagree with respect! Everybody is entitled to voice their opinions. At the end of the day, science wins by landslide.

So, over the years of following various clinicians and researchers, balancing the views of each one, I have come to embrace these trends in the practice, which form much of how I work on my clients and patients now – from assessment to explaining the what, why and how of my interventions.

1. Manual Therapy

Now, manual therapy is really not a new thing. It has been around for quite a while. Many manual therapy techniques are shared by a number of rehab professionals which includes osteopaths, chiropractors, physical therapists and massage therapists. Since manual therapy is simply the use of the therapist’s hands in treating various musculoskeletal conditions like soft tissue pain and injury, many have used these hand techniques in so many ways, some good and some plain ridiculous. I am not the one to point out which ones I think are unscientific but you can read some of them here!. Also, many manual therapists have given big claims on how can manual therapy works wonders, in which no substantial study to back them up. Stuffs like releases fascia, corrects malalignment, boost the immune system, among many others. How one can break up scar tissues and fascia when a surgeon needs to use an scalpel to do so?

I can say that if there’s anything new with manual therapy is it’s how we understand how it works. Manual therapy does not deform fascia, put back an out of place sacro-iliac, or release trigger points. Most of the effects of manual therapy are neural not mechanical or structural. We cannot mechanically deform fascia with hand forces but instead we stimulate skin mechanoreceptors which sends signal to the brain to allow a tensed muscle or soft tissue to “relax”. Most of the time it’s not the techniques that are flawed but how the mechanism of the techniques is explained [i.e., based on purely biomechanical models].

myofascial release

Also,  manual therapy has been made a panacea in MSK [musculoskeletal] physical therapy by many practitioners. But manual therapy is really just a means to an end. Manual therapy as a tretment is mostly passive and thus can make the patient dependent on the therapist all the time. That is why many manual therapists in other disciplines like chiropratic can keep their patients/clients for years or even a lifetime. I also know some physios who became osteopaths who tell me that they don’t prescribe exercises anymore. But the goal of pain and injury rehabilitation is to make the patient/client functionally independent and be able to mange their symptoms. That is why I don’t stop with manual therapy in treating my patients. I use manual techniques to address symptoms of pain, stiffness and limited joint motion, after which I proceed to what physical therapists are known for – movement!

Here’s an excellent article by Greg Lehman on fascial treatment fallacy.

2. Functional Movement Therapy

Physical therapy is the engineering of human body.

Physical therapy is the engineering of the human body.

Like I mentioned, manual therapy is not main intervention in many physical therapy treatment. Movement is. The goal in injury rehabilitation is not only to relieve pain but to improve movement. Injury, if not managed by movement therapy will impose risks of re-injury. Pain might be relieved but the abnormal movement patterns adapted thru the presence of pain or injury are not addressed. Thus, slight deviation in future tasks may trigger central sensitization causing pain to recur. Also injury not rehabbed properly has a higher change of re-injury. Proper rehabilitation cannot be done with manual therapy alone.

Movement, like manual therapy, is not a new thing. In fact it is as old as the physio profession itself. Physical therapy by definition, is all about movement. Just that movement had just got the attention it deserves in the recent past. Movement goes beyond prescription of therapeutic exercises to certain conditions [i.e., 3 best exercises for back pain, neck pain, etc]. They should be functional and diverse, addressing the specific goal of the patient/client – to continue with sporting activities, to be able to get back to dancing, to be able to carry out household chores pain free… the list goes on.

My movement therapy intervention starts with graded movement exposure. This process addresses patient’s fear avoidance of movement. Much of the rationale for graded movement has something to do wit pain neuroscience, which third but possibly most important in the list.

Once the patient/client has gained more confidence in movement, more complex movement patterns are taught and prescribed as next home exercise program. Movement matrices [movements in different planes and combination of planes], increased speed of movement, movement with resistances are developed and taught. For clients who have more active lifestyle or are involved in sporting activities plyometrics may be the final phase of movement therapy

3. Pain Neuroscience

no brain no pain

Understanding pain neuroscience makes pain and injury management becomes so much simpler and easier. Instead of coming up with ridiculous and unscientific biomechanical paradigm like postural pain, muscle imbalances, spinal units called vertebrae and disc going out of place, increased anterior pelvic tilts, unequal leg lengths, and many other fear mongering biomachanical phrases which can cause more anxiety to the already suffering pain patient, explaining pain in the context of neuroscience gives a better assurance to the clients that their condition is not that bad. It may take time to “heal” but with excellent prognosis. Pain science paradigm is also cost effective as it eliminates, in most cases, the need for expensive scans and imaging like X-rays and MRI.

In a nutshell [as condensed from words by Jason Silvernail], pain neuroscience is grounded in the notion that pain is a conscious feeling that motivates protective behaviour, not a discrete biological event that occurs when tissue is truly in danger. Thus, the relationship between true danger and perceived danger is modulated by the sensitivity of our protective system. Meaning that pain and injury are more not necessaruly correlated. Understanding these things decreases perceived danger and therefore pain, and positions a biopsychosocial approach to rehabilitation as the best approach to rehabilitation.

Read this primer on pain science here.

4. Preventative Healthcare

To some, physical therapy as preventative healthcare is something new. Many still see Physios as go to professionals if someone has serous injury, physically handicapped or has neurological problems. But physical therapists, sometimes in collaboration with personal trainers and nutritionists can help in prevention of many chronic conditions like stroke, diabetes, osteoporosis, falls and fractures in the elderly, and obesity, among many others. Proper physical therapy assessment and training can also help prevent or minimize injuries in young and professional athletes, weekend warriors, performing artists and other active lifestyles.

exercise is healthcare

Exercise is medicine…

Office workers and those whose jobs require them to either sit or stand for long hours can also benefit from the services of physical therapists. Moreover, children nowadays lack physical activity as they spend more time texting and playing computer games. Physical therapists can provide education and activity prescriptions to inactive populace, either children or adults.

So these are what comprise my approach in my physical therapy practice. In the past, I have been impressed with so many techniques my colleagues teach and use. I have tried to learn some of them. I felt sorry for the things that i couldn’t afford to learn. either through lack of money or lack of availability of the training. In some classes I attended, I was even taught a watered down version of what evidence-based practice is, just so they can justify the things they teach and do which lacks solid and strong scientific evidences.

As I stay within the scope of evidenced based practice, not only my interventions have become simpler but I have been seeing higher success rate, and happier, more satisfied clients and patients.

Dion’s Update: New Thinking and Some Paradigm Shift

Hello everyone!

Haven’t been actively writing the last couple of months but few interesting things have been happening! Since I started this blog, I have had a lot of encounters with fellow clinicians around the globe through social media, as well as personal interactions. Clinicians I have come to respect and follow based on the scientific evidences of what they teach or write about. And although I don’t get to see most of them in person [yet], our interactions are genuine and quite personal, really learning so much from them.

Hence, there would be some slight deviation and paradigm shift  from the stuffs that I have written about in the past which reflected how I practice my profession as a physical therapist. The way that I perceive and practice physical therapy now has been changing as I continue to learn from other clinicians, from workshops I have attended and intend to attend in the future, from recent studies and research, and from just about any discussions that I come across with on social media [which is one of the most available source of every information we need right now]. And yes, while I get so much information from social media, I am learning how to filter out these information, and  learning who to listen to… once again from the evidences they present – science vs. pseudo science, mentoring vs. guruism. I am not saying that I will completely abandon my method of practice and protocols – assessments, management, interventions, philosophy. But instead upgrade them, modify them, polish them…

Physical therapy is science, and as such is constantly evolving and progressing. What we learned, believed in and have used in the past might have slightly, or even totally changed by now… just like with many other branches of medicine. Even science in fitness and nutrition and almost about everything in medicine is changing and advancing! And just like any branch of science, physical therapy practice can be manipulated and abused, sometimes to ones’ selfish gain, either monetary or fame.

But physical therapy is also an art. A skill, And thus, requires utmost wisdom and intellectual discerning how to merge science and creativity and go with the guts in clinical decision making without getting into quackery and pseudo-science. I wince every time I read somebody promoting their practice as evidence-based while also promoting pseudo sciences like naturopathy, reiki, reflexology, While I don’t judge any of my clients who would want to consider any of these, I would not involve myself into these territories that obviously belong to someone else.

Okay, so the latter part has become more of a rambling. What I’m saying is, I’ve been learning a few new things here and there, now and then, and it’s an even more exciting season to be a physical therapist now, as availability of evidence-based knowledge and skills in the practice abounds. I guess the most significance of this are available forums and pages where other clinicians and researchers can voice their opinions about a certain topic/technique, and for us to weigh these information.

I owe everything to my patients and clients who believed in me, and has gotten better with my interventions and have since introduced and recommended me to other people – friends and family – who needed my services and expertise.

And grateful to all physical therapists [Physios] who remain true to the science of the profession, enlightening, equipping, encouraging, and strengthening the community of clinicians around the globe to be better PTs that we may provide authentic, evidence-based, science-based physical therapy services to the general public! And with regards to some of the differences in our training and approach in treatment, we can all disagree with modesty and respect.

Keep posted with these new models and paradigm shifts. Cheers!

Meme hijacked from  http://theawesomept.com

Meme hijacked from http://theawesomept.com

Five Social Media Platforms I Use For Professional Enhancement

social icons

Somebody once tweeted: If you are using Twitter (any networking platform), and you are not learning or inspired, you are using it wrong.

Social networks are here to stay. They have become integral part of international culture. They cross social, geographical, even religious boundaries. They can connect people what other medium can’t. Social media is no longer just a hobby. While before they are simply used to connect with families and old friends, make new friends either nearby or distant, chat online, play games, let people know what you’re up to… social media now has become an integral part of almost everyone’s life. People use it for making new clients, promoting business, learning new crafts, among many, many others. And while overuse or overexposure to social media can be unhealthy, proper use of them can be an advantage to someone’s craft and for professional and personal development.

As a physical therapist, I use social media a lot to gain new knowledge and insights, to interact with other clinicians, and to advance my profession somehow. Here are the 5 social media sites that I find most helpful to me [which are obviously, the most famous to anyone too!].

1. Facebook.

facebook evolution

Who doesn’t know facebook? It’s almost always a part of a conversation when meeting a new acquaintance nowadays! “Hi, I’m Dion, nice to meet you. What’s your name? What do you do? Are you on facebook?”

Facebook is one major site I use to learn about latest news and advancement in the rehabilitation and fitness world. Everyday, colleagues and clinicians post physical therapy and other healthcare related links that I often find useful – whether it’s a published research, a new blog article, some medical breakthroughs in the news, or someone’s own principle and ideas. Good thing is that many of these clinics or clinicians run a facebook page which one can follow and see what valuable information they share. I follow more than 50 of these pages and it takes a great deal of time to go through all of them as they appear on my newsfeed. Most of these links need to be opened to see what the article says. It can be time consuming but it can be worth it. Luckily, facebook has now a added a “button” where you can save a link to read later in case you have limited time. Sometimes I copy-paste the article for future reference.

Facebook is also dotted with particular groups you can join in. Once you join these groups, you can advertise, ask questions, or just interact with other people’s post in the group, depending on what the moderators allow. There have been many occasions when I get to ask opinions on a case I am treating or a treatment I am studying, and get pretty good advice and insights from the group members.

Here’s my facebook page:

2. Twitter

tweet n retweet

Twitter is equally useful, and in a sense works almost like facebook in that clinicians either tweet their own ideas and experiences, or tweet a link they have found to be worth knowing and sharing. Some speak of their biases and refute [politely, most of the time] those they disagree with. They’re very helpful to not only increase my knowledge in different areas of my profession but also to help mold my own treatment principle and clinical decision making.

There are also pretty good discussions among clinicians. One advantage of twitter is that the tweets are limited to 140 letters, so they are brief and concise and straight to the point so it’s easier to go through them in lesser time than facebook. There is also a “favorite” button which automatically saves that you tweet you favorite for future reference. Unlike facebook, tweeter is more of a site for professional use, more than for personal one.

Here are my twitter accounts:

3. Linked-in.

linked inI don’t use Linked-in as often or as much as I do with the previous two sites, but nevertheless has its own use and benefits. On the site, you can make a resume like profile for prospect employer or client to check on. I have had a few messages I have received informing me of certain job available. There is also a newsfeed type homepage where you see others share, though I find that it’s not as interactive as facebook. Meaning, use the same amount of time they use on the former two sites.

My favorite thing with Linked-in are networks or groups that you can join in where one can start a discussion and get to invite people to respond and interact. Professionally, there are groups for pediatrics, sports physical therapy, among many others that you can join in. I find the group “Evidence-based Physical Therapy” to the most active and interactive of all the groups I have joined in.

4. WordPress.wordpress

WordPress is a free site where you can run a blog. As influenced by the many clinicians who run their blogs to educate the masses and share their expertise to fellow clinicians, I do run my own blog on wordpress. It may not be as elaborate and exhaustive as others have, but I do keep track of my progress, write about some few things I’ve been learning about, and just let my possible clients know what I do and what I specialize on.

Some prefer Weebly but what I like about WordPress is that there are many other physical therapists I know who use it and we can follow each other’s blog. And those I follow appear somewhere on my page which makes it easy for me to visit. In fact, there is a reader’s page which is the very first thing you see when you log in to your blog. It acts as a newsfeed that shows new blogs created by those you follow.

5. Youtube.

Subscribe

Yeah, definitely. This should really be number one in the list in that its influence and use for me is massive. Since it is a site for video posting, you actually get to see a demonstration on how a certain physical therapy treatment or exercise is done. Whether a case I’m working on is common or unfamiliar, I often consult youtube for whatever new or additional treatment technique I can use for my patients.

Of course, I just don’t pick up randomly without using strict clinical judgment. When you type on the search engine “Treatment for Patellofemoral Pain Syndrome” for example, you will be given lots of videos to choose from, not only from physical therapists but everything from athletic trainers  to personal trainers to massage therapists to chiropractors, etc… So clinical discerning and reasoning is of utmost importance. I’m not saying that I only pick the ones by PTs, I’m just saying I pick up the ones I know makes sense according to my own knowledge on not only the specific conditions, but the specific patient or client I am working on. Fortunately, most of those that I follow on facebook, twitter, Linked-in and wordpress also manage their own youtube channels so I know who exactly to look for first.

Runner-up: About.me

about.me

About.me is actually some kind of portfolio where you can write a short bio about yourself – what you do, what your expertise are. Then you can put widget or link of all the social media sites you use or run – your facebook page, tweeter account, linked-in profile, blog site, instagram portfolio. So it’s like a summary of your professional profile in one page.

My portfolio:

So there you have it. The social media platforms I use for professional development as a physical therapist practitioner. But really, whatever your craft is, whether a musician or entrepreneur, a mother or a student, social media can be a great tool in polishing your social or professional skills and be even better at what you do. Time is gold. If we are to be on facebook and other social networks a lot, might as well use it for our growing. Make it a place to gain knowledge and insight and thus, increasing your productivity.

What other social media site you find particularly useful?