Category: Rehab

GHOST RIDER

Ghost rider

This article will apply mostly to medical researchers. It is boring to read, but this is the type of stuff that I had to write while in the Doctorate program. I can sound smart at times. Enjoy or use it for toilet paper.

 

Alexander LL. Ghostbusting. AMWA Journal. 2008;23(2):54-55

  1. “’Biomedical communicators who contribute substantially to the writing or editing of a manuscript should be acknowledged with their permission and with disclosure of any pertinent professional or financial relationships’”

This quote still doesn’t denote that ghostwriting is a horrible topic. For instance, a person can ghostwrite by not giving permission to be acknowledged, based on the above quote.

  1. “There are two types of ghostwriting. Writing a paper for which you receive no author credit (but for which you get paid) and authoring a paper to which you contribute no work. The first type of ghostwriting is not illegal and is hardly unethical…the second type of ghostwriting is more troublesome’” This touches on the topic of payment. One of the other articles that we were to read also discusses payment and stated to the effect that being paid for services does not take the place of authorship.

 

Yoshikawa TT, Ouslander JG. Integrity in Publishing: Update on Policies and Statements on Authorship, Duplicate Publications, and Conflicts of Interest. JAGS. 2007; 55(2):155-157.

 

  1. “The principles of this document, including those related to overlapping (duplicate) publications, authorship, and disclosure of potential COI, apply equally to manuscripts for consideration in this Journal or in a separate supplement.”

I appreciate the straightforwardness of the above statement. There is no ambiguity in the statement and it simply states that these rules apply only to this journal.

  1. “authorship credit should be based on substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content; and final approval of the version to be published. Authors should meet all three conditions.”

The statement of “substantial contributions” has not been defined. This is left to interpretation in multiple studies. The use of the word “or” is powerful in that the author can partake in one of the three listed activities in the first sentence, but doesn’t have to partake in all activities. The author would have to be active in the drafting of the article and the final approval of the article for publication.

  1. “Within the Acknowledgments section and under the subheading ‘Authors’ Contributions,’ all authors’ specific areas of contributions should be listed”

I have read a lot of research articles over the years and do not recall reading this in any of the sections.

 

Wen Q, Gao, Y. Viewpoint: Dual Publication and Academic Inequality. Int J Applied Linguistics. 2007;17(2):221-225.

  1. “Some of our colleagues believe that submission of the same research findings in different languages is a violation of academic ethics: such a practice constitutes self-plagiarism”.

The authors are starting to make their case that they do not believe that submission in a separate language is plagiarism.

  1. ”We are among those who believe otherwise. In our view, this practice has little to do with self-plagiarism and does not violate intellectual ethics.”

I would disagree with this statement, as the authors are not performing anything new in the study, but simply translating a study from its original language. This should be listed in the article that the study is a translation and not an original work.

  1. “for the above reasons, we strongly propose a relaxation in the rule that international journals only publish “original” papers that have not been published anywhere before, taking into consideration the disadvantaged position of …”

I personally have an issue with this statement, as it is asking for a “relaxation of rules”. We discussed this semester how some ethical issues come to the forefront. It is persons like this, whom are able to rationalize plagiarism that ethics in action always has to remain at the forefront.

 

Geelhoed RJ, Phillips JC, Fischer AF, et al. Authorship Decision Making: An Empirical Investigation. Ethics & Behavior. 207;17(2): 95-115.

  1. “Both the 1992 and 2002 versions of the code state that ‘authors take responsibility and credit, including authorship credit, only for work they have actually performed or to which they have contributed’, with the 2002 version also qualifying the last word with the adjective substantially.

Again the word substantially is included, but is left open to interpretation.

  1. “Significant differences between groups regarding authorship decisions were noted when faculty assigned significantly more credit to students than did student participants and students assigned significantly more credit to the advisor than did faculty.”

I find this statement interesting. The faculty may be trying to assist the students with authorship publication, but this may set a poor

precedent, which continues to proliferate. For example, many of us have stated that faculty should serve as mentors, but would we agree that it isn’t appropriate to give first authorship to someone that did not perform all of the prerequisite work required to have the first authorship position.

  1. “38% of author positions were misplaced relative to their contribution…seven authors in the sample were given authorship credit when they had made no contributions to the study.”

This is a good example of how authorship may be misunderstood or confusing for some.

  1. “discussing authorship in the planning stage of a project while allowing for changes”

This is an excellent point that the discussion regarding authorship should start at the initiation of the planning phase for the study in order to reduce confusion or dissension

  1. “untenured faculty were more likely to report ath both power diffentials and a sense of loyalty or obligation influenced the decision-making process…untenured faculty more frequently reported that unwarranted authorship had been granted than did tenured faculty”

This demonstrates that a person’s place in the “pecking order” may dictate authorship.

 

Louis KS, Holdsworth JM, Anderson MS, Campbell EG. Everyday Ethics in Research: Translating Authorship Guidelines into Practice in the Bench Sciences. J Higher Education. 2008;79(1):88-112.

  1. “Issues related to authorship extend beyond disciplinary boundaries and relate to intellectual ownership and the competitive nature of the academic enterprise…academic researchers are awarded funding, prestige, prizes, promotions and tenure based almost exclusively on their publication history”

This may be the first issue with research. There is a “prize” at the end of the tunnel. We discussed in previous weeks regarding conflicts of interest. The fact that the “teachers” stand to profit from the research should be stated in the publication of the research.

  1. “most scientists are reluctant to exclude people from authorhip”

This is interesting. In our class, we discuss how the authorship should earned based on the requirements of publication, but scientists see no harm with assisting with the advancement of others, although they may have not performed the requisite work for authorship.

  1. high-impact compared to major journals

This is the first that I have seen a comparison such as this. I like how they defined each.

  1. Fairness “Authorship credit should be based only on (1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation…”

This is how we all seem to interpret the research based on the answers submitted for publication. Based on this alone, there should only be one author of the publication.

  1. “My rule of thumb that is somebody who would read the paper and be able to defend it, or defend their part of it”

This is an interesting part, in that some scientists don’t believe that all three must be met. An author only has to be able to defend the part in which he/she participated. This goes against the initial rule that an author must have had a say in the publication of the article, as this is not stated in the scientists opinion.

  1. “(Adding authors) has no negative effect on my reputation as a scientist if there are four names rather than three names (on a paper), but it can make a huge difference to a student or even a technician”

I agree with this statement. If someone performed work on the paper and the work was deemed substantial to the group, then the person should be added. This needs to be discussed prior to starting the study though.

  1. “Scientists have little, if any, motive to deny authorship”

This comment is comical. In PT, it is not uncommon to read 7-8 names in a study. This may be due to that fact that little is lost from including additional authors.

  1. Based on this article, all of the authors listed in the assignment may be entitled to authorship credit.

 

Washburn JJ. Encouraging Research Collaboration Through Ethical and Fair Authorship: A Model Policy. Ethics and Behavior. 2008;18(1):44-58.

  1. “It may be possible to avoid problems with authorship credit by explicitly discussing authorship credit and order, preferably at the outset of research collaborations.”

This point continues to be emphasized in articles. It appears that basic communication may be lacking in research.

  1. “they propose that for the same level of authorship credit, a greater contribution should be expected fro contributors with greater competence and less of a contribution should be expected from contributors with less competence”

This brings the issue of fair vs. equal. I don’t understand how this type of statement can be made. How can one grade fairness in terms of the sliding scale of competency?

  1. “…the policy proposes that contributions be weighted such that contributors with greater competence must make greater contributions for the same authorship position than those with less competence”

I completely disagree with this type of authorship. Someone with little input could be placed as the lead author because, although they provided little in terms of the actual publication, they have little experience, which would balance out the production performed. It doesn’t seem appropriate.

Feelings…Nothing more than feelings

Feelings…Nothing more than, feelings

 

This weeks article speaks to the importance of choosing your provider. Writings may be few and far between, as I am getting married the afternoon of this writing. Because we will be taking our honeymoon soon, there will be a pause in publishing more articles. FEAR NOT! I will return.  Thanks for reading

 

  1. non-specific “LBP (low back pain) where it is not possible to diagnose a specific cause”

 

This accounts for about 90% of back pain issues as stated in previous research. When a doctor tells you “you have a herniated disc”, “you have arthritis”, “you have spondylolisthesis” (sorry, I wanted to sound smart), they are simply telling you what another doctor saw on an image. What does this mean? It means that you have lived a life on this Earth and are no different than a majority of the population…okay the spondylolisthesis is not that common. Aside from telling you that you are normal compared to most people, they are telling you that your picture on an image (x-ray, MRI, CT scan) is not the ideal that is in the textbooks. The picture alone can not tell you with certainty that this is what is causing your pain. In other words, your pain is not specifically coming from anywhere, but it may be coming from any structure that senses pain and refers pain to that area.

 

Think of a heart attack. I picture George Costanza (Cant standja) from Seinfield. His imagined heart attack was complete with left arm pain and chest tightness. This is what we mean by referred. The heart, when upset, can send pain signals to other portions of the body…even though there is nothing wrong with the left arm or jaw or any other location that the heart tells the brain.

 

  1. “…experts have questioned whether the current paradigm is flawed”

 

We are right about what structure is causing your pain in about 10% of the cases..do you think that there is a flaw in the system somewhere? The first flaw is that the structure causing the pain actually matters. I know…I know, you want to know why you feel a knife slicing your spine in half or ants crawling on your skin, but in the end, if we turn off the pain…Does it matter?

I think the primary flaw is trying turn non-specific low back pain into something specific. There is plenty of research that demonstrates this: once you have an “answer” to the cause of your pain, you are quite willing to start blaming all of your problems on your disc or stenosis or arthritis or spondylolisthesis. “Sorry honey, can’t do the dishes…my disc bulge is acting up.” Actually…I may need to use this later. I RECANT ALL I JUST SAID. Joking of course…don’t take anything I write seriously.

 

  1. “Guidelines for the rehabilitation of patients with persistent NSLBP (that non-specific low back pain thingy from above) highlight the importance of practitioners encouraging patients to remain at work and stay as active as possible, with a key focus on self-managing their condition”

 

I of course will tell you that back pain will not kill you. It could in a very small percentage of the population be something so serious that it will kill you, but in reality it’s probably not you. (again, I am not a medical doctor, but a doctor of physical therapy, so if you think your back pain will kill you…go see your medical doctor). I can understand that some people just want a break from work. If this gives you good reason to take a break from work…Shhh…I won’t tell. Aside from the mental health days that you may want to take, don’t let back pain keep you from working. You are highly unlikely to make it any worse, or better for that manner, by working. Back pains due to disc herniations (bulges) are not the result of one massive injury, but the result of multiple small injuries over time. It’s like the old saying, “the straw that broke the camel’s back” (HAHAHA…it literally fits).

 

  1. “It is not known why physical therapists do not follow guideline advice”

 

This is my complete opinion here, but the patient’s don’t know any better. If the patient’s can’t tell the difference between good therapy and bad therapy, and if we then let the cat out of the bag and say that bad therapy pays more than good therapy, why don’t YOU think that the guidelines aren’t followed? There are some therapists that know the guidelines like the back of there hands, such as myself. You can see a previous blog in which I summarize the guidelines for low back pain, but there are other therapists altogether that don’t know that these guidelines don’t exist. I make this statement in a general sense and I extrapolate it from previous research that states that older therapists don’t have either the time or expertise to find a research article. If they can’t find it, then like the tree in the forest…it didn’t happen.

On an aside, I have to keep touching on the bad therapy pays more than good therapy situation. Our profession has historically been paid for what we do to you. Meaning if we give you an ultrasound…cha ching$$$. If we give you e-stim…cha ching$$$. If we give you a rub down…cha ching$$$. If we have you do exercise (whether we are watching you [the ethical thing] or a high school graduate aide is watching you [the pay is the same]…cha ching$$$. If we do all of the above and add traction…$$$. You get the point. We are finally starting to move to a system that if you have a knee replacement, then we will get paid a specific amount, regardless of what we do to you in that process. You will slowly start seeing all of the above disappearing over time because the effect is questionable and we would then be getting paid less per treatment approach that we use. ITS ALL ABOUT THE BENJAMINS BABY!

 

  1. “Practitioners’ attitudes and beliefs about LBP have been shown to influence their advice and treatment recommendations”

 

What this tells me is that we are treating based on tradition instead of the current evidence. Again, if you go to multiple doctors, you will get multiple opinions. The same thing holds true for PT’s. If you see a myofascial specialist…then you have a myofascial problem. If you see a manipulator…then you have a facet (back joint problem). If you see a MDT specialist…then you have a disc problem. We as practitioners have to know more than one system, but we better be good using at least one of the systems; otherwise we will just start mixing and matching systems.

 

  1. “Results have shown that practitioners’ professional group and practice setting appear to be associated with their attitudes, beliefs, and advice”

 

$$$$$$$$$!

If the practice setting values money over results, then the people working in that setting will have to reflect the values of their employers. It’s rough out there in this profession because it is hard to figure out which employer you are walking into until it is too late. There is such a huge pressure financially to make a living and pay off the hundreds of thousands in student loan debt, that the new graduate doesn’t know the difference between an awesome environment and one of financial manipulation.

 

  1. “ I would probably explain to her that it was most likely postural strain…there could be an underlying facet joint degenerative problem evident”

 

How confident are you in this practitioner’s opinion of your problem. It could be this or it could be that? I don’t really have a good reason for either, but “Hey, it’s usually this or that…so why not now?”

 

  1. “They believed that patients who exercises and kept active were more likely to avoid future episodes of NSLBP”

 

For future reference, please read Audrey Long’s article about the right exercise.

What if I told you that your therapist could be making you worse? If we don’t keep up with the research…it is possible. Not all exercise is good exercise. More on this in another blog.

 

  1. “Empowerment through education and pain control were clear subthemes…”

 

People…IT’S YOUR BODY! TAKE CONTROL. We can hold your hand, coach you, be compassionate towards you, but WE CAN NOT FIX YOU! You have to play a role. We can give you the tools to fix yourself, but if you don’t use the tools then WE failed TOGETHER. I didn’t fail, you didn’t fail…BUT WE FAILED!

 

  1. “’passive attitudes’…Therapists found working with these patients demanding, as from their perspective, patients with these attitudes were difficult to communicate with and, therefore difficult to educate and empower”

 

Please see # 9.

 

Excerpts taken from:

Jeffrey JE. Foster NE. A Qualitative Investigation of Physical Therapists’ Experiences and Feelings of Managing Patients with Nonspecific Low Back Pain. Phys her. 2012;92:266-278.

 

As an aside, I just saw that Nadine Foster is one of the authors. I absolutely adore this lady. I had to opportunity to hear her talk at the MDT conference in Austin. I really adore smart people, and she was impressive.

 

Boys…put your balls away

MORAL: Boys, put your balls away. Nothing more to add

 

  1. “Developing core strength has been emphasized as a valuable component in general and sports conditioning programs in addition to active rehabilitation programs for individuals with low back pain (LBP).”

 

What is the core? We all see the late night infomercials talking about core strength and see people with washboard abs. Is this core? Not exactly. Picture this: the strike zone in baseball. Not the MLB, because that strike zone is almost non-existent, but little league baseball. The old middle of the thighs to the letters of the jersey, that’s the strike zone. Now, picture all of the bones and muscles that are in this area. Do the same thing for the side of the body and the back of the body. Most everyone neglects the back and sides. We all want that beach body you know. Unfortunately, that beach body is all show and no go.

 

Core stabilization is more of a communication thing than an Incredible Hulk thing. The muscles of the “core” (strike zone) have to be able to transfer the amount of force that your legs are generating and apply it to something that your arms want to do. All of the body by Jakes or ab rockers won’t get you there. They will do a great job of strengthening your target muscles for that specific exercise, but they won’t do anything for making you a better athlete or better person for that matter.

 

  1. “Numerous studies have placed individuals on trunk exercise programs that in turn resulted in a greater increase in endurance and decline in reports of LBP episodes”

 

If you are a couch potato, than doing anything may be better than doing nothing. If this is you, then stop reading because the ab rocker is waiting for the next set. If you aspire to more than just couch potato, then doing unweighted trunk strengthening exercises may not be enough for you.

 

  1. “It is apparent that training while under unstable conditions does increase the activity of these (trunk) muscles”

 

Enter the Bosu ball or the Swiss Ball. This one statement has created rooms of balls in gyms and has spawned people marching in place while sitting on a ball in the physical therapy clinic. If you are one of these people and really think that you are being uber effective, then this article may be offensive. PUT YOUR BALLS AWAY!

 

But I can already hear you say: “increased activity” blah, blah, blah. Look, being busy is not the same as being productive. Increasing activity does not lead to increasing strength, unless you are increasing the load as well. When I say load, I mean weight. The kind of stuff of the legends of Paul Anderson, Franco Columbo, Kaz (he is so legendary that he only needs to go by his nickname). Look these people up. I can say with certainty that they weren’t training on balls.

 

  1. “Behm et al had subjects perform various trunk-stabilizing exercises with stable and unstable (Swiss ball) conditions. Results indicated that the abdominal stabilizers, LSES (back muscles) and ULES (upper back muscles) exhibited significantly greater activity with the unstable conditions. The 2 most effective exercises for trunk activation were the side bridge and superman”

 

Again is you are weak than doing anything is better than doing nothing. If you have weak muscles, then lifting a spoon is difficult and your muscles will get activated. “Only the strong survive.” I don’t want to activate, I want to get jacked. Why? Because someone that is strong will be able to get their butt off of the toilet at the age of 80, without the use of handrails. Someone that is jacked will not have difficulty getting off of the floor and being a stereotype like on the commercial. People…it is not about turning on muscles. I can turn on my butt muscles by squeezing my ass cheeks together. Activation does not equal functional and surely doesn’t mean strong.

 

The Swiss ball is one of the worst things to be introduced into our profession. That’s right…I said it! We as a profession spend way too much time training unstable situations when the patient needs to get stronger. I can hear the PTs arguing now: “What about balance patients? What about patients that need to walk on unstable surfaces?” Great! Do Swiss ball stuff for this purpose, but stop selling the unstable training as a means to get stronger. I am saying “I AGREE WITH YOU”! Ok, now get rid of the Swiss ball for all other purposes. We are doing the patient a disservice. The logic made sense years ago, but the research just isn’t there.

 

On a side note: I want as many patients as possible to read this blog. This way the patient can be armed with facts to go into the PT with in order to question the activities that are being performed in the clinic. If I can’t give a good reason for why I am doing what I am doing, then fire me! We are in a day and age in which results will be the driver of our profession. This is already starting to happen with “bundled payments for total joints” ( I highly suggest that you educate yourself on this also. I may or may not write about this soon). We need to make sure that as health professionals that we continue to get smarter and better at what we do. Patients need to continue to educate themselves about their health for two reasons 1. IT’S YOUR BODY! 2. You will challenge your health care provider to either get better or get lost.

 

The two most effective exercises for trunk activation are the side bridge and superman, said no strongman, crossfitter or strongman ever!

 

  1. “Swiss balls have been incorporated into strength training programs on the belief that a labile surface will provide a greater challenge to the trunk muscles, increase the dynamic balance of the user and possibly help to stabilize the spine in order to prevent injuries”

 

Coming soon: Humans on Mars. Same kind of statement. The above quote starts by talking about beliefs. Look, are we a faith or are we a science? We can’t have both. If we believe something to be true…it also has to be true. For a long time, the world was flat. We believed it to be true, so it was true. We have come a long way since Galileo. We actually have to test our beliefs to see if it is worth using.

 

I am a meathead. Swiss balls are fun to play tug-o-war or work on balance (such as advocated by Paul Check), but they are not good for building stability. To be stable is to be the opposite of mobile. We need to make our trunk opposite of mobile. We can do this by resisting a heavy load.

 

  1. “…one must ensure that their training regimen incorporates training specificity”

 

Joe Weider. The name brings back memories of the old Weider barbell sets sold at Sears. We had the concrete filled plastic weights. My how far we have come…and yet the same principles still apply. If you want to get better at throwing a punch, don’t work on kicks and if you want to be a better swimmer, don’t practice skydiving. If we want to be strong and stable (i.e. immobile), then we need to practice on being strong and stable.

 

  1. “The practical application of training the trunk stabilizers from a supine or prone position may not transfer effectively to the predominately erect activities of daily living”

 

If we pair point 6 and point 7, then there’s only one real reason to practice exercises in a horizontal position…you know what I mean (wink, wink).

 

Anyway, the new buzz words are functional fitness. The above statement is essentially saying that doing exercises that are not similar to what you would do during your day may not be functional. You hear the old joke about 12 oz curls, yeah I’ve heard it too. If all you do all day is drink grape nehi, then you don’t need to do anymore than that. It’s functional for you.

 

  1. “Perhaps a combination of relatively high-intensity resistance using free weights (light to moderate instability) can provide greater activation than the very popular instability exercises commonly used today”

 

DUH! Anyway, the authors are finally talking about a quantity of activation. There is no doubt that lifting a beer bottle will activate your arms and trunk muscles, but I’ll take the guy that is lifting kegs for fun if I was a betting man.

 

  1. “The 80% 1RM squat exercise exhibited significantly greater LSES EMG activity than all other exercises…exceeding the body weight squat, deadlift, superman, sidebridge exercises by 56, 56.6,65.5 and 53.1% respectively”

 

When compared to dead lifting, side bridging and superman, the squat is THE KING OF ALL EXERCISES! For lumbar spine muscles. Hear that all you bird-doggers! Hear that all you supermanners! There is nothing better than loading a heavy barbell with 45 pound plates and squatting down and standing up. I miss the sound of the 45 pound plates vibrating next to each other when you walk the bar out. I use bumper plates nowadays. Not as much testosterone as the steel, but a hell of a lot safer for my garage floor if I have to dump the weight.

 

Put it into perspective, this exercise is 50% better than most popular exercises. Everyone can squat. Everyone has to get off of the toilet. If you don’t, you will end up in a home because no one wants to help you off of the toilet and wipe your behind for free.

 

  1. “The 80% 1 RM deadlift exercise exhibited significantly greater ULES EMG activity than all other exercises”

 

There is a reason why powerlifters have such thick backs. They specialize in the 2 exercises that work both the lower and upper lumbar muscles.

 

  1. “…it may be unnecessary to add calisthenic-type instability exercises to a training program to promote core stability if full-body, dynamic, upright exercises are implemented in the program”

 

Time to turn off the t.v. Stop buying all of the infomercial crap and just get up off the couch…now sit down…stand up…sit down…stand up…sit down. Now go do the same thing while holding a can of soup. You are now stronger than you were yesterday.

 

Excerpts taken from:

Hamlyn N, Behm DG, Young WB. TRUNK MUSCLE ACTIVATION DURING DYNAMIC WEIGHT-TRAINING EXERCISES AND ISOMETRIC INSTABILITY ACTIVITIES. Journal of Strength Conditioning Research. 2007;21(4):1108-1112.

 

 

If it hurts it must be bad, or good, or whatever. Vincent Gutierrez, PT, cert. MDT

Louw A, Puentedura EJ, Zimney K, Schmidt S. Know Pain, Know Gain? A perspective on Pain Neuroscience Education in Physical Therapy. J Orthop Sports Phys Ther. 2016;46(3):131-134.

 

  1. “Pain is a normal human experience and essential to survival”

This portion is rarely spoken of in PT school and we spend our time in school learning how to shut down the pain, either in an ideal way of dealing with a mechanical problem or in a way in which we “trick” the brain of not seeing the pain for a short period of time. When working with patients, I often describe the gate control theory as the “Three Stooges” way of treating pain. For instance, if you have a headache and I hit your foot with a hammer, what happened to your headache. I stole the example from my dad, because this is how he would always respond if I told him my arm was sore after baseball practice. This was way back in the 1980’s and he was a laborer by trade. The gate control theory makes sense to most people, but we can also see the example and understand that it is probably not the best way to fix a problem, as we end up with a broken foot from the hammer.

 

  1. “The pain neuromatrix explained our knowledge and understanding of the functional and structural changes in the brains of people suffering from chronic pain”

To simplify, we have pain because our brains tell us that something is painful. This could be due to past experiences, actual painful stimuli eliciting Nociception, super excited nerves , so on and so forth.

 

  1. “biomedical models may induce fear and anxiety, which may further fuel fear avoidance and pain catastrophization”

It is very common for a patient to come into the clinic and say that he/she is avoiding a particular activity because of a history of a herniated disc. There is research that shows that a herniated disc can become “unherniated” (for a lack of a more layman’s term) over the course of 6 months. The patients are never educated regarding this point. Once a herniation, always a herniation is just not true. This biomedical or pathoanatomical (patho=bad and anatomical = body parts) model of health care is outdated and simply is not as useful to use with the general public because research demonstrates that the patient may become “sick listed” and from there stop participating in previously enjoyable activities.

 

  1. “a plethora of papers have been dedicated to a mere 20-millisecond delay of abdominal muscle contraction, yet despite the enormous amount of time, money and energy spent on this science, clinically it has yet to provide results superior to those of any other form of exercise for low back pain”

Doing the vacuum pose while lying down is no better than doing a general squat or learning how to utilize your diaphragm during breathing mechanics. As the layperson, there are many people that want to take your money in the health care industry. (I hate to say it like this, but healthcare is a huge business and the public needs to see it as so.) When the new fad comes out to solve back pain, don’t buy into the infomercial and as a matter of fact, turn off the t.v. and go get a book from the local library. You will spend hundreds of dollars less than what is proposed on the infomercial and be better off after having read the book. Nothing beats knowledge and the smarter you are at taking care of yourself, the better armed you are when you actually get in front of a health care practitioner. Remember, it is a business and we all want your money if you will give it to us. A better use of your time is to come educated so that I don’t have to teach you the basics of posture for 30 minutes, but can instead can teach you how to perform more high level movement patterns instead of sitting properly to reduce your pain. Oh wait, pain is normal. I’d lose my job if I sold this to all of my patients, but instead the patients need to be educated between hurt and harm.

 

  1. “In all health care education, be it smoking cessation, weight loss, or breaking addiction, the ultimate goal is behavior change.”

Speaking as a physical therapist, I can’t stress to the patients enough how the therapy experience is a team. Smart people call it therapeutic alliance, but I’ll settle for team. My part is to educate the patient and attempt to solve the puzzle of the patient’s pain, but it is the patient’s job to take the information that they have gained during the session and go home and apply it to their daily lives. For a patient to do nothing at home, AKA make no changes in behavior, and come to the following session thinking that the pain will go away is similar to :

 

https://spencergarnold.files.wordpress.com/2013/01/snatch-miracle.jpg

 

Patients may come hoping for a miracle, but it is not to be. The patient and therapist have to work together to attempt to solve the pain problem. If one side of the team is not doing their part, then the PT has to be willing to discharge the patient or the patient has to be willing to fire the PT.

 

  1. “…when PNE (Pain Nueroscience Education [pain is a normal human response]) is paired combined with either exercise or manual therapy, it is far superior in reducing pain compared to education alone”

From this I take that teaching the patient and then moving the patient is better than just teaching the patient. We can all agree that low level exercise is good for people. If we don’t agree with this, then we are saying that it is safer long term to live like a slug then to get up and walk around the living room. It just isn’t so. People will refuse to get up and walk around the living room when they start experiencing low back tightness, leg fatigue, or the dreaded “Fran cough” (look it up and btw I am an advocate professionally speaking). We as a society have to start moving more and learn about how our body is supposed to work. This can not be done from infomercials that have pictures of pulsating backs or frowning stomach fat.

And this is my two cents for the night.
If you are in need of physical therapy or would like to sign up for a complementary discovery session (a conversation to determine if therapy is right for you), contact me. 

Functional Therapy and Rehabilitation 

(Now part of the Goodlife family)

903 N 129th Infantry Dr. 

Joliet Il 60435

815-483-2440

Rehab post TKA

Piva SR, Gil AB, Almeida GJM, et al. A Balance Exercise Program Appears to Improve Function for Patients With Total Knee Arthroplasty: A Randomized Clinical Trial. Phys Ther. 2010;90:880-894.

Intro: 37% of TKA’s still have functional limitations p one year. Diminished walking speed, difficulty ascending/descending stairs, inability to return to sport are chief functional complaints. During TKA surgery several tendons, capsule, and remaining ligaments are retightened to restore the joint spaces deteriorated by the arthritis. Some of the knee ligaments are removed or released, which may affect mechanoreceptors/balance.

PURPOSE:

  1. To determine the feasibility of applying a balance exercise program in patients with TKA
  2. To investigate whether an F (functional) T (training) program supplemented with a balance exercise program (FT+B) could improve function compared to FT program alone
  3. To test the method and calculate a sample size for a future RCT with a larger sample size

METHOD: Double-blind pilot RCT (very strong evidence)

Inclusion: TKA in the previous 2-6 months (meaning not eligible for study if the TKA was before 2 months previous)

Exclusion: 2 or more falls in the previous year. Unable to ambulate 100 feet with an AD or rest period, acute illness or cardiac issues, uncontrolled HTN, severe visual impairment, LE amputation, progressive neurological disorder or pregnant (interesting exclusion criteria).

All went through a quadriceps muscle-sparing incision (cuts through the fascia of the patella instead of the quadriceps) this may be a factor in reducing rehab stay.

See the appendix for the protocol (6 weeks).

Testing measures:

  1. Self-selected gait speed (interesting, but probably not feasible for our clinic)
  2. Timed chair rise test (5 repetitions): easily added to our testing.
  3. single leg stance time: easily added in
  4. LEFS
  5. WOMAC

RESULTS:

  1. Adherence for both groups is 100% and the HEP adherence was similar (filled out logs)
  2. walking speed continued to improve over the course of 6 months for the FT+B group and was 25% better than the FT only group.
  3. The interesting fact is that improvement continued up to 6 months, when previous literature describes 3 months and done.
  4. Single leg stance: FT+B improved (as expected due to SAID), but the FT group either maintained or worsened on speed and balance.

DISCUSSION: FT+B demonstrates clinically important differences in walking speed, SLS, stiffness and pain, without adverse events. Subjects in the FT+B could balance on average 4 seconds longer than baseline. This may be important for weight bearing during the stance phase of walking. Performance-based measures should be used in place of subjective measures.

TAKE HOME: Patients will benefit from the addition of balance exercises post-surgically. It may be prudent to discuss with the surgeons of increasing the length of stay in therapy and decreasing the number of visits per week, as progress continues to occur past the 3 months initially surmised. Each patient should be tested with one or more of the following:

  1. SLS
  2. Chair rise test
  3. Gait speed: important indicator of function/independence/death
  4. Balance test (excluding Tinetti due to possible ceiling affect when the patient no longer needs an AD).

If you need therapy after a total knee replacement, you can contact me at the following location.
Dr. Vince Gutierrez, PT, cert. MDT

Functional Therapy and Rehabilitation (Now part of the Goodlife family)

903 N Infantry Dr.

suite 500

Joliet, IL

60435

815-483-2440