We all experience the odd night or two of poor sleep. For some this becomes a more regular occurrence, to the point of it being more regular than not. This is insomnia and people reach the point of dreading just thinking about going to bed, anticipating the repeated battle of tossing and turning most of the night. In discussing this with clients and other clinicians, the extent and effect of not getting a regular 8 hours sleep has clinically become apparent to me. Sure, you feel off your normal game if you miss a couple of nights, but if it is ongoing, the ramifications become much more serious. Take for example; Death/severe injury due to excessive daytime sleepinessIncreased cardiovascular...

'Stop if you feel pain.' 'Rest and give your new knee (post TKR) time to settle.' 'Be very careful when you do that movement.' 'You have the joints of an 80 year old.' These were some examples of poor communications reported by researcher Emma Karran at the 2019 physio conference in her presentation titled "Screening, scans and choosing words carefully: Optimising care for patients with low back pain". Suggested alternatives were; 'Movements will be initially painful like a sprained ankle - but will get better as you get active.' 'Your knee is strong and robust - let's take it for a test drive.' 'Our tissues heal, they respond best through loading - slowly increasing your walking is the very...

2019 Adelaide Physiotherapy Conference⁣ anatomy presentation As the invited ADNG national speaker (thank you to the ADNG for the invitation) this was first presented at the 2019 Australian Physiotherapy conference. With a tongue in cheek approach, I wanted to explore 6 muscles in 3 pairs that have similar referral patterns, but IMO one gets all the news while the other languishes in obscurity. High time to back the underdog! ⁣You can view the video here.

There are a few anatomical areas that require extra consideration and training when using invasive techniques like needling. The most obvious is when needling over the lung fields. Another area that exercises peoples' consideration is in regards to the kidneys, when conceptually needling the bladder channel or lumbar paraspinals. We discuss this safety aspect in great detail in our Level 2 Advanced Spine and Lower Quadrant Course but I would like to explore some aspects in today's blog. A 2017 article (can be accessed via Research Gate) by Chia & Haberberger examined the anatomy of the kidneys and needling in relation to the bladder meridian, which involves needling in the sagittal plane...

When you think of great leaders, who comes to mind? Are they social, political, professional, athletic or business leaders. Perhaps, Mahatma Ghandi, Margaret Thatcher, Pope Francis, Nelson Mandela, Usain Bolt, Benazir Bhutto, Stephen Covey, Martin Luther King or Rosie Batty. What are the qualities, values or attributes of leadership that you so admired in these people, that elevates them for you to being a leader? Perhaps you identified qualities like compassion, conviction, wisdom, honesty and passion. It is interesting when looking at what defines a leader that it can be as simple as someone that has followers, after all, you can't be a leader if you aren't leading someone else! What about...

Sorry about not sending out my normal July email. Tomorrow is the last day before submitting my PhD thesis and I confess to burning the candle at both ends through most of July. However, the process of writing, revising and rewriting, has made me consider the importance of reflective learning/practice. In the case of my thesis, reflective learning challenges me; to read a section of thesis material/resultsapply the pub test - does it feel right and evaluate my results within the context of the broader literature and thenput into writing how this new information does or does not change my approach. You could apply the same process to how you react to a complaining client, your teenager decide...

We have all had that client rock into the clinic with a 'spasmed' neck, that came on soon after waking. It was an amazing fact that 9 years ago when I started looking into relationships between sleep posture and waking spinal pain, I couldn't find any research to guide me. Ah I thought, now that is interesting.....plenty of anecdotal stuff, but nothing on which to base clinical advice. "Herniated lumbar disc. The preferred sleep position depends in part on the position of the disc. For a paracentral disc herniation (most common), people tend to do better lying on the stomach." Complete online article written by Dr Richard A. Staehler, MD can be found here. Really! Clinically would you tell a...

****Would $125,000 help employ your next clinician?***** That is the amount of money on the table being offered by the current government, to attract allied health professionals into rural and remote locations (well basically anywhere other than metro centres) to improve the quality and availability of services. An awesome idea, because the further you move from our capital cities the worse health outcome become, the more expensive accessing health services becomes, the shorter life expectancy becomes and all because access and diversity of health services reduces. Effectively Triple $$ Dipping So putting $$ towards employing and retaining allied health professions is a no brainer....

Following on from the Upper Limb Clinical Neurological Examination blog here are the details for my Lower Limb examination. Comments in regards to increasing neurological tone in regards to using the Jendrassick maneuver apply here also. See the Upper Limb neurological examination blog for further details. For power testing I use the following; Iliacus L2 (femoral nerve), Quadriceps L34 (femoral nerve), Tibialis Anterior L4 (deep fibular nerve | sciatic), Extensor Hallucis Longus L5 (deep fibular nerve | sciatic), Fibularis Longus/Brevis L5S1 (superficial fibular nerve | sciatic) and Triceps Surae S12 (Sciatic nerve). How weak is weak? For me it is not so much that the test is...

So what are your criteria for conducting a neurological examination and what do you include when you do complete one? Like all questions there are provisos, so rather than list them all I thought I would explain my basic neurological examination and depending on the results I build from that. When to check? Generally, if symptoms extend beyond the shoulder or hip, I would consider at least a basic examination. If the history included descriptions of pins and needles, and numbness then again I would include a neurological examination. How long should it take, around 3-5 minutes. Here is my upper quadrant examination. In my type of clinical practice, I am focusing on the hard signs of a neurol...

As part of our quality of client care, most allied health practitioners maintain their annual CPR. But what about your first aid skills? Q: Given our range of deadly snakes and V8 lawnmowers with fins, what animal kills the most humans each year? (answer below) As a kick off you will most likely enjoy this if you haven't already viewed - "Video Come to Australia" As part of our quality of client care, most allied health practitioners maintain their annual CPR. But what about your first aid skills? Q: Given our range of deadly snakes and V8 lawnmowers with fins, what animal kills the most humans each year? (answer below) As a kick off you will most likely enjoy this if you haven't already vie...

If you have an interest in dry needling and acupuncture, it is worth utilising the auto email Table of Contents function from AIM (you can set it up here). One of the articles that grabbed my eye in a recent eTOC list was the one reporting on dry needling of rectus abdominis to treat primary dysmenorrhoea. The viscero-somatic reflex is one of the topics that we examine in the Level 2 Spine & Lower Quadrant Course and this is a great example. As a bit of background, it would be worth having a look at an earlier 2014 study that used wet needling (lignocaine). The results were pretty amazing. Participants initial details were age, 22 ± 2.5 years and mean VAS pain scores 7.49 ± 1.16. After t...

How did you explain to them what their 'non specific low back pain' diagnosis means. I understand the 'medical' reason for this term, but hey, when you just look at the words, it is so 'No-Brand-Vanilla'. How do I respond? A good question and I recently stumbled on what seemed a good analogy and will share it with you. Firstly however, I must stress that it is important to clarify they don't have a fracture, infection, inflammatory condition or tumor. This is an important part of our primary contact practitioner role. Back of the envelop calculations indicate, that if you see on average 3 new clients per day, and have 4 weeks holiday a year, you will be seeing on average 5 people a year that...

You may have seen this picture on Instagram (https://www.instagram.com/p/BmtadOungGB/) and it does show obvious issues with pillows, however, when it comes to educating our clients about making good decisions in regards to sleep, we need to have an broader understanding of the situation on the complexity of sleep posture and symptoms. Here are some thoughts. "Hi guys nice pics, but there are some broader points worth considering for our clients' benefits. True, 57.3% of healthy people wake with cervical symptoms while sleeping on their normal pillow – so potentially not a good choice (Gordon and Grimmer-Somers 2010). True, the pillow functions to support the head and maintain a neutral cervi...

If you prescribe exercises for improving spinal mobility or strength you will find this abstract of interest, but before we get into it, you need to understand how these loads are measured. Usually due to burst lumbar fractures/tumors, participants have their VB and IVDs replaced, in this case with a vertebral body replacement e.g. Synex. Build into this replacement is a telemetry chip capable of collecting and exporting load data in vivo. This has enabled the researchers to capture load data for a huge range of ADLs and they provide all this data free. Awesome. Spinal loads during post-operative physiotherapeutic exercises Rohlmann A, Schwachmeyer V, Graichen F, Bergmann G. Abstract After s...

While driving to work along lovely country roads each morning, I take the opportunity to catch up on what the rest of Australia has been doing. ABC radio national and ABC news are my favourites and it is hard not to shake the head each morning, after hearing the latest revelations from the banking royal commission. CommBank charging $120 million for no-services or charging services to dead people for 10 years ..... There seems to be a major disconnect between fund managers, financial service advisors and those other 'professionals' providing financial advice and their clients. What has happened to professional ethics in the financial profession? Looking in from outside, it seems they have co...

Research & Your Advice For the past 3 weeks I have been conducting a systematic scoping review for my PhD on the topic of "The relationship between sleep posture and waking spinal symptoms of pain, stiffness and bothersomeness". A scoping review is similar to a systematic review, except it is better suited for new areas of research and areas in which the aim is to identify gaps in our current knowledge base. What's amazing to me, is that as a clinician I have been doling out advice about corrective sleep postures for years and yet there is basically nothing with a research base, on which to construct this education. Hence the scoping review and my PhD. There is a reasonable body of evide...

At the start of our Strive & Thrive in Private Practice course, participants write down the three biggest challenges they are experiencing as a new and recent graduate. "Time Management" perennially features highly, but so does "feeling guilty" – recently expressed by Chloe in these words; "taking on the patients' problems personally and blaming myself for being the reason why they are not responding quickly enough" Let's look at this in two parts.Take the first part; "taking on the patients' problems personally and blaming myself"Now I see this statement as coming from a clinician with a big heart, who, however, is heading towards a train wreck. Why? As clinicians, most of us got into t...

I was recently asked what in my experience were the top 4 benefits of dry needling. Tough call, but when I reflect on the clients that have been assisted, it comes down to the following mix. Neurophysiological effects There are many aspects to this component. Here are three. Firstly, It is unlikely that we are actually having a direct effect on the muscle (if that is what you are needling). In the same way, that the muscle is unlikely to be the tissue at fault. Most likely the muscle is reacting to and protecting some other irritated tissue and as a result of unaccustomed static activity became symptomatic. We know trigger points have a build up in neural sensitising metabolites and lower pH...

Here are a couple of case study vignettes. This is what gets me out of bed in the morning. I would be interested in what you thought about this aspect of your practice. Last week I was referred 2 very different people, yet both were on struggle street with their injuries and perceived futures. One was a younger person that significant foot, tibia and knee injuries due to a mechanical accident. After 18 months of surgeries (foot reconstruction, tibial fixation - internal and external, skin flaps and grafts, ACL cleanup) he presented on two crutches, not wearing a shoe, foot NWB and pretty much blue and sweaty. He had constant pain, was online gaming pretty much all day, went to bed around 2-3...

Hey! The transition from student to private practice professional can be a real jolt, what with all the new and added expectations. Actually, it is often overwhelming. So, what makes being in private practice daunting for new and recent grads? To get the ball rolling, here is a quote from one of our Strive & Thrive in Private Practice participants; "When I first started I found it difficult to combine a meaningful assessment, whilst thinking to myself the direction I was going to take with the treatment and then being able to effectively communicate with the patient without seeming like I wasn't confident. I guess it was all pretty overwhelming" Understandable when university undergradua...

With the commencement of our current cohort of students undertaking the Strive & Thrive Course in Private Practice, one of the biggest issues being raised repeatably is time, or more specifically the lack of it. Reality says we have 24 hours max, and for mental and physical well-being most of us need to sleep around 7.5 - 8.5 hours (+ extra hour if you are pregnant). We discuss many strategies on during the Strive & Thrive Course but as I see it, there are two sensible ways to immediately improve your efficiency. Maximise Productivity To do this you first need to determine when you are most effective mentally (lark or owl) and use that time for high demand activities. I am generally ...

You are probably familiar with the turn of phrase 'we walk on the shoulders of those that went before'. Which expresses a significant amount of humility in acknowledging and appreciating the work that others have prior undertaken, to enable the 'we' to achieve the new things they are achieving. Now turn that phrase around. 'Encourage those behind, to take bigger strides than those in front'. Not as eloquent I accept, but essentially, if we want individuals, organisations, profession, and humanity to achieve more positive outcomes, then the leaders of today need to challenge, encourage and support others to take aim higher than they previously considered possible. One of the ways I believe th...

I recently completed a teaching block of 6 days dry needling in Perth, split between two venues. The lovely outlook over Lake Monger was a great setting for learning and sharing of new skills. What a great mix of students! Internationals from India, Hong Kong, Brazil, Singapore, and locals from both the east coast and west coasts of Australia. With the new course structure (Level 1 Introductory, Level 2 Spine & Lower Quadrant, Level 3 Spine & Upper Quadrant and Level 4 Master Needling Course), plus the integration of new technology for teaching there were lots of positive comments about the improved learning process: ​Online prior learningPalpation skills review was greatLoved the bo...

If you missed the first part of 'MSK Medications: Alternative Opportunities' you can catch it here. When considering what medications to use, individuals need to make informed decisions, balancing the research, the pros and cons (often a long list of side effects) and also examining alternative evidence-based options. Here are some alternative measures that can be used to modify pain. Analgesic Alternatives Pain Management Education Now I must admit that a lot of people just want to pop a pill and part of our responsibility is to explain the obvious, that is, having a longer term plan (with more than one strategy) for a longer term problem. Research has shown that as load/stress (physic...

We are calving on the farm at the moment  Like anything to do with kids, it brings a stretched emotional spectrum of highs and not so highs. Yesterday (Friday) was one of those days - well evenings actually. Just on dusk, I was doing a pasture check and noticed one cow with a feeding calf, acting distracted and flicking her tail. Pretty late to be bothered by flies I thought, so I wondered over to check it out. Oh no - she couple of hoofs sticking out and judging by the activity of her other calf, it had been like that for several hours. So with the last glimmers of sunlight fading away, I set up the yards, the gates and tried to coax mum and calf towards them. Not going to happen was t...

Qualifier: I am not a pharmacist or GP, so my drug knowledge is limited. That being said, being a primary contact practitioner it is important I have an awareness of the effects and side effects certain medications my clients might be taking. Also, not being 'brought up' with a script book in my back pocket, I am comfortable looking at alternatives and providing these suggestions to my clients. They can then discuss this with the other members of their medical team or do their own research. I recently had a client present with ongoing low back pain who was consuming 4 pain modifiers (including a patch) and 1 non-steroidal anti-inflammatory (NSAID) - all prescribed. In our practice, there are...

At the start of our Strive & Thrive in Private Practice course, we ask participants to look into the future and list the three most important wishes they want to achieve from completing the course; sort of a goals list. Most of us are in different phases of live, and this means we are often seeking different outcomes. However I believe strongly that regardless of your phase is life, if you want to achieve positive change and lead a fulfilling life, then you need to consider what this means to you. No map, no direction. Here is what Ken wrote when he started the course, and I love it. Ken, through experience, has identified several 'sensitive spots' about being a private practitioner and ...

Never, ever attempt this technique One of the most common areas in which I am asked to provide a professional opinion, is in regards to needling and pneumothorax or haemopneumothorax. The cause is poor or no technique and is usually due to a lack of specific training. If you have learnt manipulation of the thoracic spine, you would not then assume you have the skills to manipulate the cervical spine. Different anatomy, Different precautions. In much the same way practitioners, that have learnt to needle supraspinatus are not qualified to move an extra couple of centimetres to needle upper trapezius or levator scapulae. Now, if this picture had occurred in just about any other publication and...