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Your cranky nerves: A primer for patients to understand pain

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Published on: June 10, 2013

Audience: Patients with any type of pain or injury

Purpose: to learn a little about pain and convince you that pain is not in your head even though your brain plays a big role

Why? Understanding pain helps decrease pain and helps us make better choices in the treatment of injury

Some brief pain information tidbits

  • you don’t need a leg to feel pain in that leg (e.g. phantom limb pain)
  • you always need a Brain to feel pain
  • pain can become a habit – and like all habits lots of factors help keep it going
  • Changes in how we feel pain can also come from changes in the brain and the nervous system
  • tissue damage or degeneration does not have to lead to pain – but it certainly can (more…)

Golf swing kinematics ebook. Implications for performance, training and injury

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Published on: January 26, 2013

A lot of my previous research (much unpublished) was on golf biomechanics and its the only sport that I am better than average at yet I never write about it.  So to rectify that I have attached an ebook.  Its nothing special, this information is out there, but it does bring a lot together for those interested.

I did a talk last year on this topic and have some of the rough notes I used.  Below is 40 page ebook on the lecture.

The majority of the graphs are my copyright from 3D kinematic data we collected on a study 6 years ago looking at the influence of static stretching on pelvis and thorax kinematics during the swing.  Please feel free to use my pictures however you see fit.

The ebook is a simple overview of how the spine moves during the swing.  It also reviews the academic literature on what kinematic variables of the swing are related to performance and what individual golfer variables are related to performance.  Last, I touch on injury but this is a murky area and I mostly avoid it.  We don’t have a lot of good research on injury mechanism (like most areas) so feel free to make up whatever you like like everyone else does. :)

Here it is:  golf biomechanics ebook compressed

A related link is at the mytpi.com (Titleist Performance Institute) website.  This is one of the best golf biomechanics/fitness websites around.  They have a huge amount of free information and its mostly very good – especially their biomechanics.

A review of Charlie Weingroff, his course and the SFMA

Purpose: To provide a very selective review of Charlie Weingroff’s course and how it actually fits with a neurocentric view of pain and function.

Audience: Therapists and strength coaches.  Patients who  have trouble sleeping.

Related Links

1. Jeff Cubos discusses SFMA, DNS and Lorimer Moseley and they inform his practice style

2. My and Bret Contreras’ minor critical analysis of the Joint by Joint Approach

 

Overview

I took 2 days out of Charlie Weingroff’s course, Training = Rehab, Rehab = Training course here in Toronto from MSK-Plus.  MSK-Plus is a  continuing education company run by Dr. Glen Harris.  Dr. Harris has brought in a lot of great educators over the years and this course was not an exception. (more…)

This physiotherapist’s approach to treating Persistent Pain

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Published on: October 30, 2012

Audience: Patients and other health care providers

Purpose: To explain my treatment approach to Persistent Pain Problems.

Overview of the Treatment Program:

  1. Pain Physiology Education
  2. Movement (Graded exercise/activity exposure)
  3. Manual Therapy (more…)

The relationship between functional tests and athletic performance: Part I – The single leg balance test.

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Published on: July 26, 2012

Background: Testing and assessing an individual is popular.  There is an old saying that if you aren’t assessing than you are guessing.  The assumption here is that the tests and assessments you do are somehow relevant and meaningful yet I would suggest that the majority of tests and the information gleaned from them hardly change (10% ish) a therapeutic approach once you have heard your patients history. I can have a patient with knee pain and run them through 30 different tests and the results of those tests may hardly change my treatment.  Tests have to provide us meaningful information that we can do something with. (more…)

Postural correction and changing posture. Can we treat our patients like puppets?

Audience: Therapists and Strength Coaches

Purpose: To justify the use of a variety of exercises (even general exercises) for training, rehabilitation and injury prevention and question the application of movement specificity principles.

The Gist of this Post: Specificity of training is an important component of rehabilitation and strength and conditioning but I think the application of specificity can be taken too far when we attempt to mold our posture. (more…)

A critique of Janda’s prone hip extension test

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Published on: April 13, 2011

Audience: Therapists and patients with too much time on their hands

Purpose:  Provide a mild critique of the utility of the prone hip extension test

 

Background

The prone hip extension test (or prone leg extension – PLE) is a very common clinical test in use for more than 20 years.  Two influential clinicians have advocated its use although for slightly different reasons.  Both Vladmir Janda and Shirley Sahrmann have described its use for decades.  This blog will focus more on the clinical rationale that Janda proposed.

(more…)

Shoulder Pathology – a diagnostic algorithm and summary of dysfunction

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Published on: March 28, 2011

Audience: more for me but anyone interested in the shoulder can read it.

Purpose: quick reference card for thinking about a functional shoulder diagnosis

The algorithm below is from Ann Cools work:

(more…)

What is injury treatment? The judicious use of stress.

Categories: physiotherapy
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Published on: March 5, 2011

Audience: Patients

 

What is this about:  Injury Treatment

 

Injuries can be treated a number of ways and many different ways are often successful. But if I am asked to be very simple about what treatment is I start with one basic assumption.  THE BODY ADAPTS TO STRESS.  (more…)

Chronic Pain – Do therapists contribute? An unsolicted rant

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Published on: February 9, 2011

Become invisible and walk into a Chiropractic, Physiotherapy or Massage Therapy office one day. Watch them speak with a patient who has back pain or maybe a little bit of knee pain. You may hear the following:

-you need stability exercises
-these muscles are very tight
-you need therapy as you don’t want this degeneration to progress
-no more running or arthritis will certainly flare up and you will have real problems down the road
-you have dysfunctional movement patterns
-your glut muscles don’t turn on
-oh, it hurts here (pressing on upper traps). There some adhesions in the muscle
-I need to see you 2-3 times a week for the next 4-6 weeks.

All of the above statements are from good, well meaning people. And some of these statements might even be appropriate under certain conditions. These statements typically are not from the quacks and crooks that look to exploit anyone who has been in a car accident or might have fallen off their bike when they were six (and therefore their spine is permanently in trouble because of this “trauma’).

My concern is how all of these things sound to our patients – which is different from what we hear. If you tell someone they need stability exercises they probable assume their spine is unstable. That probably does not sound good to a patient with an incredible amount of pain. When we poke on areas that are “tight” or “sore” in everyone (e.g. the upper traps, you can’t find someone who is not tender there) we catastrophize, comment on how tight it is and reinforce a pain belief with our poking and create beliefs in people that there is something wrong with their muscles.

Not encouraging patients to resume their normal activities and to keep active contributes to fear and movement avoidance.

Telling patients that the way they move is dysfunctional based on an arbitrary standard of how someone should move again creates the belief in people that something is seriously wrong when there is usually no serious dysfunction.

Seeing someone 3x/week for 6 weeks for whiplash or a simple backache. Come on. Common sense says this is bad practice even though it is somehow in many guidelines.

The bottom line is we  need to watch our words.  I am no exception,  I catch myself doing this too often.  An unstable spine means something completely different to a therapist than it does to a patient. The phrase degenerative joint disease should be banned – they have a joint that is changing like everyone’s joints  and most minor symptoms have nothing to do with those normal changes.

Just some thoughts,

Greg Lehman

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