Categories: physiotherapy

A critique of Janda’s prone hip extension test

Tags: No Tags
Comments: 1 Comment
Published on: April 13, 2020

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…)

Neuroanatomical Acupuncture for Stress Fractures - A case study

Categories: physiotherapy
Tags: No Tags
Comments: No Comments
Published on: March 31, 2020

Audience: Therapists and Patients interested in knowing one theory of how neuroanatomical acupuncture (dryneedling) works. 

 

A caveat:  Everything in this post id debatable.  I think that considering the prevalence of acupuncture’s usage it is not well validated and many basic studies need to be done.  That being said I think the post below summarizes one theory of acupuncture.  Do with that what you may.

 

Source of Information: The following article is completely stolen with permission from a friend, Dr. Andreo Spina at http://functionalanatomyblog.com/.  Dr Spina is a chiropractor and sports injury specialist.  For therapists looking for continuing education and looking to expand their anatomy, palpation and soft tissue treatment skills Dr Spina’s courses are and excellent introduction or great alternative to other courses you may have taken in the past.  I have worked with a lot of his instructors (some were students of mine but I learned more from them) in the past and they are dedicated to scientific rigor. (more…)

Shoulder Pathology - a diagnostic algorithm and summary of dysfunction

Tags: No Tags
Comments: 1 Comment
Published on: March 28, 2020

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
Tags: No Tags
Comments: No Comments
Published on: March 5, 2020

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

Tags:
Comments: 3 Comments
Published on: February 9, 2021

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

The Side Bridge: The best exercise. ever.

Comments: 3 Comments
Published on: January 3, 2021

Intended Audience:  anyone who has not already been doing this for years

OK, OK.  There is not just one perfect exercise for everyone.  But this one comes close and for reasons you don’t expect.  The side bridge is an exercise that is typically thrown into the category of the “core” and people think it is just done as a replacement for oblique ab crunches.  While yes, it is a great replacement for that exercise it provides so much more. (more…)

The danger of hip extension - self care for Labral tears.

Categories: hip pain, physiotherapy
Comments: 3 Comments
Published on: January 28, 2021

Audience: Therapists, Strength Coaches and Patients

Purpose: Pointing out that not everyone has tight hip flexors and stretching the Psoas may be a very bad thing

Anterior hip pain is common and many of us feel a pinching, catching or inside thigh pain with squatting and other hip movements.  Physiotherapists and chiropractors will see this everyday and it is often challenging to treat due to its multifactorial cause.  This pain can manifest during walking, squatting (a pinching sensation felt during a squat) or during different exercises. There are certainly many causes and one possible cause of this anterior hip pain is stress applied to the anterior capsule of the hip joint.  In severe cases this can lead to what is called a labral tear. Functionally, you can refer to the dysfunction as excessive anterior femoral glide. (more…)

page 1 of 1

Welcome , today is Wednesday, May 9, 2020
Powered by Netfirms
Performance Optimization WordPress Plugins by W3 EDGE