Hi Too Fit To Fracture: Exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Based upon guidelines available HERE Defining Activity and Exercise Not sure about you, but I find I regularly explain to clients the important difference between activity and exercise. Physical activity refers to “… any bodily movement produced by skeletal muscles that results in energy expenditure,” whereas exercise is defined as “… physical activity that is planned, structured, repetitive and purposive in the sense that improvement or maintenance of one or more components of physical fitness is an objective”. When looking at improving physical fitness components, the focus maybe strength, aerobic capacity, balance, flexibility or several at once. Guideline Recommendations For individuals with osteoporosis: Strongly recommend that...
Hi Grading & Recording Your Dry Needling Treatment Following many years of implementing dry needling into different practices, two questions repeatably arise. How do I quantify the amount of needling treatment and how do I succinctly record needling treatment in my notes? First lets look at quantifying your needling treatment in this Clinical Kit. The aim of an intervention is to use the minimum amount of input to achieve your treatment goals. Whether you are a superficial needler, a fascia needler or deep muscle needler, you are using dry needling techniques that evoke chemical reactions in your client’s body. Like reactions to bee stings or drinking alcohol, the result varies from person to person and we don’t unnecessarily want to provoke...
Hi In the Advanced Lower Quadrant Course we look in detail at the involvement of the abdominal musclesand their contribution to back and pelvic pain, plus the associated viscerosomatic reflex. This article demonstrates in young women, the potential contribution of abdominal muscle trigger points to dysmenorrhoea. Titled “Wet needling of myofascial trigger points in abdominal muscles for treatment of primary dysmenorrhoea”by authors Qiang-Min Huang, Lin Liu. Reference is “Huang Q-M, et al. Acupunct Med 2014;32:346–349. doi:10.1136/acupmed-2013-010509” The authors recruited 65 participants with primary dysmenorrhoea, average age of subjects was 22 ± 2.5 years and mean VAS pain scores 7.49 ± 1.16, over a 6 year period. Patients with other diseases and conditions of the reproductive and urinary systems, as well as...
Hi This all started when someone sent me a link to a YouTube animation in an email. You will need to click on pic and have a look to understand the following discussion and I would welcome your thoughts and comments on the related blog post. See details at the end on where to put your comments. mmmm. To get involved or not…. Do you respond when poked or rise above…. Will it improve the situation or muddy the waters……. There are good physios that are also trained acupuncturists, and my thought is that they would caution against a reaction. So rather this is a clarification of some points as they rolled off my keyboard. My thoughts are they (the cartoon...
Free Online Learning Hand Hygiene Australia is providing free online learning packages on hand hygiene for a range of professional groups. The packages cover all aspects of hand hygiene including the importance of practicing excellent hand hygiene and best practice. An online test and the ability to print a certificate of completion is included. On completion of the HHA Online Learning Package, the participant will be able to: Explain what hand hygiene is and why it is importantDescribe when they should perform hand hygieneList the 5 Moments for Hand HygieneList the common products which are available for hand hygieneDescribe how to perform hand hygieneExplain the consequences of failing to perform adequate hand hygieneExplain the importance of cleaning shared equipment The HHA...
Hi We have just completed 3 dry needling courses in Perth and 2 Living Anatomy Workshops at the University of Australia. I had just driven down with family after a couple of weeks outback holiday and was really looking forward to mixing it up with some great physios, chiros and osteopaths for the week. Not disappointed, this week of courses brought out a range of great new ideas. Introductory Course The first amazing thing about this course was participants age. Apart from 2, all participants had been out for 6 months or less. Dry needling as a skill in both private practice and hospital environments is becoming a 'must have' skill as evidenced from participants comments. Quite the change around from...
Hi What do you do about latent trigger points? By definition there are active and latent trigger points. They both exist in a taut band of tissue, are hypersensitive on palpation (pressure stress), display a local twitch on needling and palpation and have spontaneous electrical activity at rest (on EMG), but only active trigger points produce symptoms that the client is familiar with. In undergraduate days the active trigger point was a holy grail in regards to the requirement of ‘thou shalt reproduce the patient’s pain'. Like other holy grails, there didn’t seem to be many around, for me at least. So if a latent trigger point isn’t producing pain, is it of clinical significance? I am guessing that some would...
Hi Frozen shoulder/Idiopathic Adhesive Capsulitis (IAC) is one of the clinical areas that has long held a fascination for me, largely because of the paradox between pain and range of motion. Whenever it is mentioned I prick up my ears, hoping for a silver bullet to use to assist my clients. While no single Lone Ranger moments have occurred, I have picked up some interesting clinical pearls that I discuss below. This recent case report is a good starting point for discussion. Abstract Available Trigger Point Dry Needling as an Adjunct Treatment for a Patient With Adhesive Capsulitis of the Shoulder My Classical Presentation Female > male, presenting with increasing degrees of shoulder pain and stiffness over several months. Can’t recall...
Hi Titled “Electroacupuncture treatment of acute low back pain: unlikely to be a placebo response” and written by Dr. Kwan Leung Chia, from the School of Medicine at Flinders University in SA, you could be forgiven for passing over the abstract if you weren’t interested in or currently using electroacupuncture, however this case report leads to broader discussion. You can read the full case report here My Comment As others treating this age group and gender will agree, this type of history and presentation is not uncommon when the pain is in the buttock or lateral thigh. Often the onset is an unremarkable single legged, sudden overload situation; like a miss step, trip or hop. Pain is initially mild and builds...
Hi For this fortnights Clinical News I am providing links to several clinical resources for you to have a look at. The first three links relate to a series of blogs on different tumors presentations that I have encountered in the past few years. Less than 5% of primary care physicians routinely examine for red flags during their initial screen (Bishop PB, Wing PC. Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomized control trial. Spine J. 2006;6:282–288) and in 160 cases, 96% physical therapists examined 64% of 11 red flag questions, but routinely didn’t ask about weight loss (Leeraret, PJ et al. Documentation of Red Flags by Physical Therapists for Patients with Low Back...
I had a client present with Horner’s syndrome that made me think it appropriate to check all their cranial nerves. That made me realise I didn’t have a good recall of each cranial nerve function and appropriate test. So back to the books and I thought that I would share with you what I have learnt. Firstly yes, there are still 12 paired cranial nerves and here are some ways to clinically test. I was looking for quick tests that could be performed in the clinic, and I may well have missed a couple of easier ones. Please let the group know of your best/easiest test for each CN via the blog. Thanks. I Olfactory Sense of smell, but don’t use...
Hi In preparation for the upcoming range of vestibular workshops and courses, I have been looking around and collating information that I have found useful and perhaps you will also. I am sure this list amounts to only a feather on the chook's back in regards to what is out there, so I would really appreciate you adding additional resource links at the end of this blog post. Much appreciated. Upcoming courses that are available include; Vestibular Introductory WorkshopVestibular Basic 5 day CourseVestibular Advanced 3 day Course and while some of these might seem awhile away, people are already enrolling such is the popularity. Currently the first Introductory Workshop in December, is 50% full. Vestibular Resources Videos Anatomy Eye Movement and...
Hi Faulty Needles & Clinical Relevance You maybe aware of the current discussion about needle quality and based upon some of the high resolution needle tip pictures , wondered how far we have advanced forward from stone needles, in this area of technology. The discussion has picked up after publication of research in the current edition of Acupuncture in Medicine, titled “Examination of surface conditions and other physical properties of commonly used stainless steel acupuncture needles” by Xie YM, Xu S, Zhang CS, et al. (Acupunct Med Published Online First: doi:10.1136/acupmed- 2013-010472). You can see the abstract here and because it is open access you can see full paper here. In this paper, needles from 2 of the ‘most commercially available’...
Hi Past readers of my blog 'Creating Clinical Success' will know about my past incursions into the realm of achilles tendinopathy. If you missed out here are the blog links; clinical-kit-30-9-2013-achilles-tendinopathyclinical-kit-5-11-2012-achilles-tendonopathy Researchers MARC STEVENS and CHEE-WEE TAN have just published a paper in Journal of Orthopaedic & Sports Physical Therapy titled "Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial". The research comparison taken in this paper looked at the standard protocol of 180 eccentric heel drops cf. a Do-As-Tolerated protocol for 6 weeks. The short time frame is a bit of a weakness, as 12 weeks is standard. They used the The Victorian Institute of Sport Assessment-Achilles (VISA-A) as the...
Hi Another Possible Mechanism of Action for Dry Needling Dr. Ben Wand blogged on the Body in Mind site recently about a research project, that his team has just published in British Journal Sports Medicine. Method They looked at 25 people with chronic low back pain who were enroled in a randomised cross-over experiment. They compared the effect of acupuncture (using 14 needles in commonly agreed TCM points for back pain) delivered when sensory discrimination was optimised (by asking participant to locate on a picture where their needles were placed) to acupuncture delivered when it is not optimised (asked participant to relax and ignore the needling), on movement-related back pain immediately after each intervention. Outcome They reported that the average pain...
Hi Possibly my first presentation of Quadratus Femoris apart from the other ones that I have missed …… Clinical Presentation 51 year old male commercial painter with 2/7 Hx of pain. Not sure about cause of onset but had been painting a residential home (ladders, squatting, awkward positions) , plus moving around furniture day prior. Went to bed okay, slight sore in AM that increased as day progressed. Pain developed slowly and was described as a strong ache in R lumbar, lateral buttock with radiation to lateral thigh and hadn’t gone in the past 2/7. No PNN sensations. Over 24 Hr supine was fine, sidelying either side increased pain, walking was fine, but sit to stand or sitting increased painHad tried...
Hi Webinar cf. Course With the increasing profusion of information online plus greater demands on personal time, consideration is made about whether to attend a course or in some way gain the information via an online format. I certainly seek out a lot of information for my research online, not much shopping for IR cameras, access to research articles or experts in Esperance. When it comes to clinical education there are many reasons why I prefer to attend a course in person. The main one is that I am seeking to learn and therefore integrate or change a current clinical behavior. It maybe that I have recognized a skill set I need to develop – say occupational health or neurological treatment...
Hi Happy New Year and Welcome to 2014 Interesting Lower Quadrant Research Article Li J, Zhang J-H, Yi T, Tang W-J, Wang S-W, and Dong J-C. Acupuncture treatment of chronic low back pain reverses an abnormal brain default mode network in correlation with clinical pain relief. Acupuncture in Medicine 2013. URL: http://aim.bmj.com/content/early/2013/12/02/acupmed-2013-010423.abstract Abstract Summary Background Acupuncture is gaining in popularity as a treatment for chronic low back pain (cLBP); however, its therapeutic mechanisms remain controversial, partly because of a similar improvement in sham acupuncture control groups (but both sham and verum improve significantly more than 'usual care'). Resting-state functional MRI (rsfMRI) has demonstrated aberrant default mode network (DMN) connectivity in patients with chronic pain, and also shown that acupuncture increases DMN...
Hi I recently received this email from Tenielle Henson (with thanks), which coincided with a systematic review of the related literature, that I thought would be relevant, and of interest to a wider audience. “ I enjoy getting your news & research updates and having a read through. But I wonder if you have any info on the use of dry needling in pregnant women. As far as I was aware, all was okay as long as the patient had blood pressure managed & wasn't anywhere near the foetus & in general was asymptomatic for any vascular or neural related illness. However, I have a friend who is in the very early stages of pregnancy & who has an Achilles issue...
Hi Miracle Muscles and Neuropraxia When a client presents with noticeable weakness or other ‘hard’ neurological findings; abnormal sensation (temperature, light touch, pinprick), not just altered sensation or absent reflex, often I find clinicians jump to implicate a central nerve root involvement (dermatonal) without considering peripheral nerve compression or a somatic source. I think this just reflects the strong emphasis of our undergraduate training. This case report looks at the cubital tunnel and flexor carpi ulnaris as a source of peripheral nerve compression. No mention in this report is made of the anatomical variation anconeus epitrochularis, that would cause the same situation and as no MRI was conducted we are none the wiser as to which muscle was actually involved. You...
Hi Interesting Lower Quadrant Case 1 In the past 2 weeks saddling the Christmas period I have had a couple of interesting lower limb cases that highlight the usefulness of dry needling. I will outline the first now as between clients and send the other next week. He was a 70-year-old gentleman 2 months post L THR. Progress was good and he was very happy, nil pain and completing most of his pre-operation ADLs. Two weeks prior he was getting out of bed, right foot on ground and his left foot got caught in the sheets. He felt a severe left anterolateral hip pain and feared dislocation. On gentle passive movements he was largely fine but any active hip flexion, rolling...
Hi, Over the past few months I have been in communication with the WA Health Department in an attempt to clear up the situation of what regulations dry needlers and acupuncturists need to be aware of in WA. While physiotherapists and chiropractors are registered under Australian Health Practitioners Regulation Authority (AHPRA), in WA there is also a separate "Skin Penetration Code of Practice” (the Code) written in 1998 and based upon a NH&MRC 1986 document. The base NH&MRC document has since been updated several times, most recently in 2011. The Skin Penetration Code of Practice specifies who the code covers and specifically who it excludes. It reads; "APPLICATION OF THIS CODE, This Code applies to:a) All persons who perform skin penetration...
Hi ANS and Acupuncture Regardless of the types of clients you treat, the ANS will be there. Involved in the recovery from training and injury (sports & MSK), excessive daytime sleepiness (occupation health), anxiety (chronic conditions) and insomnia (20-30% population), you can see how important an understanding is. This webinar was recently presented to the October 2013 Australian Physiotherapy Association in Melbourne. As a one off special to Bronze Members this recording will only be available to you on this link for 2 weeks, then it will be added as a permanent resource for AAP Education Gold Members. Reviving Sea Turtles Jessica Seebauer sent in this photo from her friend's Australian Seabird Rescue Centre in Ballina, QLD explaining how they use...
Hi This is the second part of the Tendinopathy series. If you didn't receive the first part on the Lateral Epicondyle, you can find it in Member > Resources > eZine Archives after login. You can also view an earlier Clinical Kit on Achilles Tendinopathy and clinical interventions. Achilles Tendinopathy Toolkit This toolkit was developed by the British Columbia Tendinopathy Task Force comprised of; Dr. Alex Scott, Dr. Joseph Anthony, Diana Hughes, Michael Yates JR Justesen and Alison Ezzat. The Achilles Tendinopathy toolkit includes; A summary of the strength of evidence, key messages and recommendations for practice for an array of interventions used by physiotherapists (manual therapy, exercise, ultrasound, low level laser therapy, shock wave therapy, taping, orthotics, night splints and...
Hi September is Tendinopathy Month with Clinical Kits first looking at the up to date information and research on Lateral Elbow Tendinopathy. You can find a previous Clinical Kit about wet & dry needling of the lateral epicondyle and then later in the month we will look at Achilles Tendinopathy. Lateral Elbow Tendinopathy On our beef farm, tenderness along with flavor is the key challenge, in the clinic managing tendinous clients is usually a key challenge. A group of hard working researchers and clinicians called the BC Physiotherapy Tendinopathy Task Force, have assembled (both evidence-informed and expert-informed)and released their findings, translating research into clinical practice. I was fortunate to have worked with one of the authors for a year; Carol Kennedy,...
Hi Exercise means different things to different people. Exercise & Health Benefits Every day it seems that we are hearing about another benefit from regular exercise; both physical and mental. Just as frequently, we hear how our populations are getting fatter, eating poorer quality foods, dying more from preventable disease and suffering every greater stress levels. Not sure about Australia, but between 50 million and 70 million Americans suffer from sleep disorders or sleep deprivation, according to the Institute of Medicine, and in 2008, market research from Thomson Reuters found that sleeping pill prescriptions had tripled among people younger than 45. Given exercise has been shown to enhance sleep, mood, a healthy weight, self esteem and physical longevity, it is important...
Hi All Has Not Been Quiet On The Western Shore! Apologies, no Clinical Kit as spare time in the past few weeks have been tied up with preparation for presentations at the APA conference. Kinda newbie at this stuff, and it seems to take a fair chunk of time pulling together all required information. If you are also going to be there in October, would love to catch up. Masqueraders The hidden aspects of tumors presenting as musculoskeletal presentations has been one of my most popular blogs series (30,000 total + hits) series. I was fortunate enough to be studying Manips in Perth, 1992 at Curtin, when Mr Gregory Grieve visited. He presented a talk of the same name and raised...
Hi Background Last month the American Medical Association sparked headlines when it voted to officially classifyobesity as a disease. The question of whether obesity is a disease or not to me is pointless, there is no universally agreed definition of what constitutes a disease and solutions are way more positive. However, it importantly turns up the public discourse around the subject, especially as obesity recently overtook smoking as the leading cause of preventable death in the world. Obesity is a growing problem (excuse the pun), with an estimated 10,000 deaths per annum in Australia attributed to excess weight. “Obesity and overweight are widely prevalent in the Australian population, and this prevalence is quickly increasing.1 In 2004-05, more than half of Australian...
Hi Visitor Recently there has been a handful of genuine cases of early degenerative brain function in retired professional rugby union, league and AFL players. Overseas in the NFL there have also been legal cases on similar lines. While these cases focus on adults, my concern was with the younger cohort. It would seem logical later in life that any young concussed player will have some (small) risk of premature neurodegenerative diseases. Where is the balance point between allowing them to play, have fun, experience team involvement, physical challenges, push their personal limits and long-term safety? In the past few weeks while helping our son’s U16 football team, I have been involved in a fractured clavicle, possible ACL rupture, dislocated finger...
Hi Visitor In the past 15 years there have been a series of papers examining the issue of safety and needling. I have produced a Safety Series: Lumbar Spine & Abdomen webinar that is available to GOLD and higher members. Select Member > Resources > Resource Gateway > GOLD (or higher) > Webinar and I am finishing a Safety Series: Cervical & Thoracic Spine webinar. Starting with White A, Hayhoe S, Hart A, and Ernst E. Adverse events following acupuncture: prospective survey of 32000 consultations with doctors and physiotherapists. British Medicine Journal 323: 485–486, 2001. Seventy-eight acupuncturists, all doctors or physiotherapists, reported a total of 2178 events occurring in 31,822 consultations, an incidence of 684 per 10,000 consultations (approximately 7%). The...
Hi Visitor June is always a good month to consider personal, capital and software investments before rolling into the next financial year. On recent courses in both Brisbane and Perth, attendees were interested in how our VideoXs app worked and how their clients would benefit. I have for this reason included a detailed description of VideoXs. In addition to the program being fully tax deductible, it would also mean your iPhone, iPad or iPod would be - but check as always with your accountant! Have you ever felt constrained by your drawing skills or the proforma program available in your clinic when prescribing a home exercises program? Have you had clients come back, demonstrating 'one of your exercises', but you had...
Hi Visitor The following is a thought journey authored by Dr. Phil Gabel, about the pros and cons of how to choose appropriate measurements to assist in arriving at qualified clinical decisions. It follows on from the Clinical Kit Needling and Chronic Low Back Pain. If you decide or believe a treatment is effective or not, then you need to consider how you have arrived at that decision. In other words, how are you measuring it; intuition? personal opinion? or the patient said so? (subjective interpretation). Perhaps you are using a VAS (Visual Analogue Scale) or NRS (Numerical Rating Scale). It has been shown that a global rating of change scale (a single dimension or construct measure e.g pain, stiffness, effort)...
Strong research evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, breast and colon cancers, and shortens life expectancy. You may have heard this music as it is often repeated and has become somewhat like elevator music, heard but not understood. So how about we crank up the bass a bit; “more people die from inactivity in the world compared to those dying from cigarette smoking”. What! Sitting on the couch is more deadly than sucking a cig? Yup. A series of papers published in the medical journal The Lancet, details the deadly impact on health of being inactive. In fact, the papers suggest that...
Hi The Sham Challenge This Clinical Kit is looking at issues surrounding acupuncture and dry needling research from the perspective of sham interventions to create an effective control group. Medical researchers need to have a control group, as a basis for experimental comparison. Typically as participants are enrolled in a trial, they are randomly allocated to experimental and control groups. The control or placebo group, essentially mimics all metrics (gender, age, background) of the intervention group, thereby controlling for intervention bias or placebo effect. The control group either receives no treatment or sham treatment. In pharmaceutical trials, it is very easy to create a reliable control group intervention; have two pills, both same size, color and scour marks, with only one...
Hi In this Clinical Kit I am exploring the research related to the clinical utilisation of acupuncture & dry needling in low back pain, specifically chronic low back pain. The research papers are presented in order from older to newer and when possible I have provided links to each or an abstract for those wishing further details. This story starts with The Eur Spine J, 2006 15 (Suppl. 2): S192–S300 DOI 10.1007/s00586-006-1072-1 Chapter 4 European guidelines for the management of chronic nonspecific low back pain. The authors compiled a complete range of assessment & treatments guidelines for chronic low back pain. In their conclusions they couldn't recommend usage of acupuncture or trigger point injections as 'invasive' procedures, based upon the research...
Lateral Epicondylitis or 'Tennis Elbow' In this eZine I am looking at some current issues relating to treatment options for lateral elbow pain. The first paper compares PRP, steroid and saline injections. Then I look at the more common options of steroid and or physiotherapy management and finally in the needling area a SR examining acupuncture solo for acute pain. Rounding out the discussion is a look at the evidence of a support, either brace or sleeve. Treatment of Lateral Epicondylitis With Platelet-Rich Plasma, Glucocorticoid, or Saline: A Randomized, Double-Blind, Placebo-Controlled Trial. Reference Link Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. BACKGROUND:Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains...
Hi Visitor This is the first of two eZines, that focus on assisting clients presenting with complex neck complaints, by using a system of integrated solutions recommended by our guest presenter Dr.Shaun O'Leary. Here is the first part of Shaun's, 10 Handy Hints when Managing Chronic Mechanical Neck Pain When your patient complains of a 'heavy head', it is important to remember that without muscles, the cervical spine can buckle, under a mass of less than 1/5 the weight of their head. Bearing this in mind it is important to understand the anatomy of the cervical spine. During our training we are introduced to a wide variety of muscles and yet with the cervical spine, it seems there is always another...
Hi Visitor This is the second of two eZines, that focus on assisting clients presenting with complex neck complaints, by using a system of integrated solutions recommended by our guest presenter Dr.Shaun O'Leary. Here is the first part of Shaun's, 10 Handy Hints when Managing Chronic Mechanical Neck Pain A patient's emotional health may not only affect their neck pain experience, but may also affect their postural habits and subsequently, strain to their neck. Whilst we are not psychologists, coaching a patient to establish links with the various situations they find themselves in through the course of a day, may provide valuable information for self management. Our psychological and physical well-being is influenced by our cognitive processes. Having a healthy appreciation...
Hi Visitor This is the final case study in this series of how MSK US can be used to assist in diagnosis and also in the rehabilitation phase. This case study was kindly provided by Mr Peter Esselbach course presenter of our MSK US course. Move your scroll icon over each picture for associated text. Case Study 3 Mark is a 48 yo who presented with 2 years of intermittent LBP, groin pain and lateral hip pain. He was initially diagnosed with a likely herniated lumbar disc causing his referral pattern of pain into his groin and thigh. Initial treatment was to take NSAIDʼs, pain medication and have physiotherapy for his lumbar disc complaint. This involved a series of visits for...
Hi Visitor In this and the next eZine, we are exploring the clinical usefulness of musculoskeletal ultrasound or for those into acronyms, MSK US. These case studies have been kindly provided by Mr Peter Esselbach course presenter of our MSK US course. Move your scroll icon over each picture for associated text. Case Study 1 Sean is a 52 year old male who reported pain in his right upper arm after being pulled from the water abruptly while water skiing. He noticed bruising develop in his right cubital fossa and experienced pain with putting his right arm into internal rotation. He also had pain abducting his right arm above 90 degrees. His GP sent him for investigations and treatment, thinking he...
Hi We have just completed an Advanced Upper Quadrant Course in Perth and an interesting piece of information surfaced, that I felt was worth sharing with the wider clinical group. It is in relation to compression of the ulna nerve in the cubital tunnel. One of the course attendees, Ray Jongs from Sydney, works exclusively in the upper limb trauma and rehab arena and pointed out that there is a muscle present as an anomaly in approximately 20% of the population, that can cause compression to the ulna nerve (in addition to the FCU). Its called anconeus epitrochlearis. I have attached a link to a good 20 page review paper that looks at a wide variety of such anomalies in the...
Here is the third in this series of Red Flags - Tumor articles. The previous ones can be accessed via links
The other case studies in this series can be access via; Red Flag Number 1 - PancoastRed Flag Number 3 - Sarcoma Red Flag Tumor 2 23 February Physiotherapy S/E October prior year developed L lumbar pain. No recalled trauma or reason for onset. In January started getting tingling sensation in L) lateral, anterior and posterior thigh, calf and foot. Also present in R but not as bad. L) foot not able to lift off ground. Now February has constant pain 3-4/10, increase with turning or sudden movements - can take breath away. Has been seeing Chiro and OT for the past 2 months but has increased pain. Not pacing self or applying specific rest ratios. 36 yo female +...
This is the first in a series of tumor case studies that I have been associated with while in clinical practice. This is not an area of my expertise, rather interest and I provide these case studies to alert other primary contact practitioners
One challenging aspect of being a primary contact practitioner, is being aware of red flags; fractures, infections, inflammatory conditions and tumors, which may enter your clinical door unknowingly.
Following some recent questions about trigger point treatment and associated documentation, I have developed these themes for others interested in dry needling and acupuncture.
A difficulty expressed by newly qualified clinicians when conducting their examination, is knowing what to do next. What do I mean? Well, we are told that we live in the "Information Age", but I think that we have well and truly roared through it. Basically every test, procedure or disease - our body of knowledge, can be found on the internet. All the information is out there in a variety of forms. In the same way a client is the internet - they have all the information. We are now in the "Synthesis Age." As clinicians, we need to type in the correct search parameters (know the correct questions) and be doing this in a logical sequence, thereby adding or subtracting...
In "Clinical Kit 12/7/2012 - 7 Mistakes to Avoid Part 1" (which can be found in the Bronze Member Resource section), I outlined our important clinical roles in the synthesis rather than collection of information and discussed in the context of client communication (client expectations & functional outcomes) the importance of red flags (I am putting together a longer article specifically on tumors which I aim to have available as a Clinical Kit article).This week I am looking at Clinical Followup, Yellow Flags, Memory Retention and Over Testing. Clinical Followup I have had the benefit of working in practices both in Australia and overseas. Many of these practices were 'cutting edge" and often leading the way clinically in their provision of...
Subacute & Chronic pain in my mind is better described as complex pain. This is a simple acknowledgement that anyone with any pain past 6 weeks (subacute) and definitely 12 weeks (chronic) will have influences other than simple physiological pain. That means auntie with her OA knees, the electrician and his recurrent tennis elbow and the local football superstar and his popping out shoulder pain. All will have perceptions, beliefs & expectations, that to varying extents, will influence the outcome of our treatment. Perhaps "management" is a more holistic term.I just reviewed a young lady (32) referred to me having injured her lumbar spine 8 weeks prior while bending forward to look under her desk at work. She was a fly...
Here are a couple of iliopsoas trigger point case studies that you may find interesting that were treated with dry needling. Places are available in both Advanced Lower Quadrant Courses in Perth and Adelaide. Case 1 A 35-year-old woman presented with LBP in the midline low lumbar area, with pain radiating to both posterior thighs, not below knees. Previous chiropractic + massage treatments and three months of bed rest had resulted in no improvement. A prior LS CT revealed left L4 to SI herniated discs, which had been surgically treated 12 months before presentation. Pain was reduced by 50%, but ADLs were limited and she was unable to return to work. Repeat LS CT revealed no additional changes. Physical examination revealed...
Have you had the challenge of treating achilles pathologies? Perhaps found them frustrating?