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Developing Efficient Habits - using the Eisenhower Matrix

One of the commonest challenges mentioned by new grads is overwhelm , described as the sense of treading water and just about going under, in relation to demands on time. This is not unique to recent grads. Even experienced clinicians experience the buildup, but have learnt techniques to manage these crunch times. One such technique is the Eisenhower Matrix (EM). So why the name? Dwight D. Eisenhower was the 34th President of the United States from 1953 until 1961 but before becoming President, he served as a general in the United States Army, as the Allied Forces Supreme Commander during World War II and later NATO's first supreme commander. It can be assumed the guy experienced time pressu...
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Emergency First Aid: having the skills to save a life

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...
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Dry Needling & Dysmenorrhoea

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 ...
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Will you treat someone with back pain?

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...
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Sleep: Pillows & Posture

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 cer...
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Spinal Exercises - Make use of this Amazing Research Tool

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 Aft...
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Royal Commission into Physiotherapy?

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...
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Research | What would you advise? | Beware Neurological Mousetraps

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...
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Responsibility to Improve - Yours or Your Clients?

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 int...
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Top 4 Benefits of dry NEEDling

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 p...
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Developing Mental Toughness

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...
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Transitioning into Private Practice

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...
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Time Effectiveness - How to grow Yours!

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 ...
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Thank you | Helping others when we can

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 ...
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Dry Needling Course Review

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 learning Palpation skills review was great Lov ed th...
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MSK Medications: Alternatives Part 2

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 (physi...
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On the Farm - A Research Parallel

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 ...
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MSK Medications Awareness

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 ar...
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Building Success in Private Practice

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 ...
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Never, ever attempt this technique

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...
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New Dry Needling Course structure hits the Mark

We have just finished the first Introductory Dry Needling courses in Perth using the all new format of online theory and practical preparation, followed by a day of face to face training and case studies, complemented by a 2-hour wet lab at the University of WA. "Theory and preparation work was very interesting and informative" Tim Castles "Lecture series of theory and practical prior to attending practical workshop" Greg Hearn "The pre-reading and broadening handouts were excellent" Ed Butcher "Online course reinforced with practical sessions. Good repetition" Georgina Reed A strong focus in the course remains on developing practical, hands-on skills and linking good palpation technique to ...
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Building Independence & Confidence as a New Clinician

In this piece, we are looking at one of the more common concerns expressed by new and recent graduates. To get the ball rolling, here is a quote from one of our Strive & Thrive in Private Practice participants, answering the question "'What does it mean for you, to be working in private practice?' "Having the opportunity to grow independence and confidence in my abilities as a young new graduate. Everyday is a challenge, but I look forward to going to work and learning something new everyday". Does that sound like how you feel? If so, you probably will find you benefit from the following information. Here are some other participant's challenges and suggestions on how to overcome them. Pr...
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Fishing in the Wishing Well of Motivation

Here is a common example of a start point for a participant on our Strive & Thrive in Private Practice, when listing the areas of their concern as a new and recent graduate: The Strive & Thrive in Private Practice 8-week course looks at all these concerns, but I wanted to focus this piece on the subject of motivation . When we interact with our clients there are two aspects of motivation to consider. One is the clinician's and the other is the client's. A motivated clinician is one who is looking forward to their day ahead, the clinical challenges, the paperwork and the chance to help their client's move forward along their pathway of optimal living. Is that you? The second aspect of...
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Between Stimulus & Response is the ability to Choose

October is 'mowing-meditation-month' on the farm, where I get to drive round and round cutting hay. I now find myself 12 months on, considering the same situation. Approximately 12 months ago I was told that due to a 'limited amount of space' in InMotion, that APP Education (and other providers) would be unable to advertise courses to the broader membership. Strange. I had been a member for 25 years, providing PD for the past 15 years and supporting the APA through advertising and venue hire. It was a mutually beneficial relationship, a win/win in business terms. What had changed? Money or Members First? After asking the executive and in conversation with members, it became clear that the AP...
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Deep Dry Needling & Chronic Non Specific Neck Pain

Two papers recently just published bring together important information in regards to needling effectiveness and research design. Paper 1. The first discusses a long standing issue in the area of complementary and alternative medicine (CAM) e.g. needling research - that being, are we looking at the right method of assessing these interventions by using the gold standard of a double blind randomised controlled trial (RCT). One of the biggest issues relates to blinding the practitioner - pretty difficult when performing a technical procedure like inserting a dry needle! Another issue relates to the importance of the context of the treatment. A RCT aim to isolate and standardized one 'key' fact...
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Trigger Finger Needling and Management

Abstract A 2016 paper titled 'Acupuncture for the treatment of trigger finger in adults: a prospective case series' by Motohiro Inoue et al., reinforces what we treat in our Advanced Upper Quadrant Course in relation to managing digital stenosising tenosynovitis, or as it is commonly called 'trigger finger'. You can read the full abstract here: http://aim.bmj.com/content/early/2016/07/11/acupmed-2016-011068.abstract Background Trigger finger is a degenerative condition in which there is thickening of the restraining A1 pulley (A = annular ligamentous structure) and local inflammation (pain and swelling of synovial structures) resulting in catching of the long finger flexor tendon. This resul...
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Effective Communication with Your Referrers

Whether  you are working within a government organisation or a private practice, a varying component of your referrals are going to be directed to you from colleagues and other medical practitioners. In the case of hospitals, there will be protocols in place about appropriate reporting content and frequency. But what about in private practice? How often do you write? What information do they want?  What information do they not want? How do they want to be communicated with? How technical do they understand? Step 1.  Know Your Referrers In essence, I would suggest you do what we did. Firstly contact you main 5-10 referrers in person. For the most part this will require an appoi...
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Awareness of Hypermobility in the Clinic

I recently had three clients present with recurring spinals symptoms , for which they had been receiving manipulative therapy for varying degrees of time. They were finding that their symptom control was becoming less and less with this form of intervention. I will often see a client with this presentation, but what was different with this group, was their young age and ease of symptom provocation. After a comprehensive examination, it was determined they had no underlying red flag pathology, not PMH or history of trauma, but they all had benign hypermobility syndrome. A hypermobile joint is one whose range of movement exceeds the norm for that individual, taking into consideration age, sex ...
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You are a Manual Therapist - But will you Survive?

So you're a manual therapist  health professional. Congratulations, it is an incredibly rewarding career. There are 27543 physiotherapists and 4998 chiropractors (plus 9097 and 1894 students respectively) in Australia. The graph shows the relative number of registered physiotherapists in Australia across 5 year periods. Given the average practitioner takes about 5 years to develop reasonable competency in clinical practice, we can break down their working life into two major epochs of 20 years each, so 25-44 years and 45-65 years. What becomes startlingly obvious , is that only a small percentage of physiotherapists transition from the f...
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AAP Education: Recommended On line Resources

​A question that I am often asked about relates to what information do I follow online. Well to be truthful that varies a heap, depending upon what area of interest you are asking about. So I have cut out farming, my PhD, online education and scuba diving but the list seems still pretty long. Perhaps consider it a shopping list and look to pick and choose those bits that interest you at this point in time. Blogs Creating Clinical Success https://www.aapeducation.com.au/blog/categories/clinical-kit-newsletters.html An eclectic blog by yours truly with information pertaining to dry needling, rural physio practice, MSK, sports, business, marketing and sleep related clinical information. The Spo...
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So what do you do in your bedroom at night?

Telling someone at a dinner party you are studying a PhD, has a similar result to telling them you are an accountant (professional apologies, but true). However, when I say I watch people sleeping in their bedroom at night, the normal buzz of dinner conversation drops as others tune in. Creepy. Voyeurism. Interesting. Depends on people's perspective.  Given we sleep (or for some, attempt to sleep) approximately 1/3 of our lives, it is amazing that we don't know more about what individuals do in their own bedrooms ..... after shutting their eyes. Now, most people that are crazy enough to embark upon an 8 year plan of study, have a personal burning motivation. It seems that I am weir...
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Clinical Kit 106 - Employment Contracts - Are you Legal or Not?

In discussions with new and recent graduates, this would have to be one of the most common questions that I am asked while on lunch breaks at courses. Options being discussed include; Contractor Wage/salary employee based Commission employee based Facilities & Services Agreement First and foremost, This information although well intentioned is not legally definitive advice and is only provided in an educational manner. Once you have a feel for your situation, it would be then best to discuss with your employer and legal advisor if you feel your situation needs reviewing. Let us tackle the employee or contractor aspect first. Contractor or Not? The important issue(s) here is that the ATO ...
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Clinical Kit 105: What do they all do?

And that's why birds do it, bees do it Even educated fleas do it..... In shallow shoals, English soles do it Goldfish in the privacy of bowls do it.... The chimpanzees in the zoo do it Some courageous kangaroos do it”                                                             Selected lyrics from “Lets Do It” by Cole Porter So exactly what are they all doing? Well the obvious answer is - breathing - Jokes aside, the importance of breathing crosses all domains in life (by definition no breath no life). As a developing swimmer of the 2.5 -3.0 km range, I marveled at the effect prolonged and regular breathing has on my own state of mental hyperdrive. After a day of clients, emails, creative writing and number crunching,...
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Clinical Kit 104 - Understanding Your Client

Do you Understand What Your Client Truly Wants?   The psychology of selling   What the .......!! If you don’t like your job, then stop reading now. However if you enjoy it and want to be successful, I suggest you read on. I can hear some of you saying, “Hey Doug I didn’t sign up for your Clinical Kits to learn about selling. I am a health professional. I help people, I don’t sell them anything!” With entrenched mental pictures of used car salesperson (ranked 30 th ) or politicians (ranked 25 th least trust worthy in an annual poll of 30 professions ) this is totally understandable. Given the top three positions in this same poll are medical or allied...
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How to treat Neck Pain: 9 of the Best Clinical Tips

This eZine 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 are Shaun's 9 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 muscle someone can mention which you haven’t heard of. A challenge...
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Clinical Kit 103 - 'High' Ankle Injuries

This edition of Clinical Kit focuses on the less common but generally more troublesome 'high' ankle sprain - that involving the syndesmosis. New research looks at the correlation between MRI and palpation and finds that with a good knowledge of anatomy, your palpation skills are extremely diagnostic. Something that I am always banging the drum about. Oh - if you were wondering, you are welcome to attend one of our Living Anatomy Wet Labs to assist you in upskilling :) To start with some background information on how to conduct a comprehensive assessment . Good review article on ankle on assessment techniques and their relevance can be found here; Assessment of the Injured Ankle in the Athlete Then by way of...
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Our APA's Role in Professional Development - Going Forward

It is clearly the current position of the APA executive to make money from professional development and this goes to the very top of our organisation, regardless if this disenfranchises members. "In my role, I am responsible to the CEO to provide a revenue stream of $3.9M in 2015 from professional development. Servicing around 93,000 hours cpd, we offer some 800 events nationally. The expectations of the CEO for the professional development division is that we will grow revenue to $5M over the coming years"James Fitzpatrick GM of Professional Development I remember the days when the APA was in the red and on the brink of complete collapse in the 1990s. At this stage state branches were being...
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***Complacency or Creativity? What would you choose?***

Imagine at the upcoming Federal election, either the Liberal or Labor governments had; Control of 95% of the media (but denied any unfair dealings when preventing other parties from advertising) Control of the Australian Electoral Commission and set seat boundaries to their advantage The ability that after winning government (fancy that), to determine their own salaries and entitlement packages Worried if this happened in Australia? Sound a bit like the Zimbabwe regime? Well maybe, but actually this situation is also how our APA is fashioning itself. The APA denies any unfair dealing with members in relation to advertising . Yet their policy is "If your course competes with ours, no advertis...
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Clinical Kit 102 - Dry Needling: What's in a Name?

You maybe aware of the simmering debate about dry needling and acupuncture . One point of view is provided here; Dry needling versus acupuncture another here; Dry needling is acupuncture When it comes to the broad family of needling techniques the obvious common element is the use of a thin, solid, metallic needle inserted into tissue to create a desired effect. There are a few needle types but a plethora of needling techniques. Translated acupuncture means needling, needle prick or needle insertion. Dry needling is a name used to describe the insertion of a needle without injection of other substance cf. wet needling. Dry needling has occurred for thousands of years in Asia and China. Appar...
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Clinical Kit 101 - APA: Our Organisation, Their Job

Is the APA an Association of Members or a Business to make Money? The APA needs to determine if it primarily is a membership organization providing services to members or a business, making a profit. A membership organization needs to be financially responsible, but the focus in on member services. Current APA actions indicate a process of cross subsidies within aspects of the APA, which is resulting in confusion to members who are being excluded from the APA by these cross subsidy actions. As a financial member, the InMotion publication would seem to fall under the member service banner (there is no additional fee as is with InTouch or Sports publications). In it relevant health news is dis...
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AAP Education - APA M'Ship | Your 2016 PD Calendar

APA Membership & Support Thank you so much for the countless emails, lamenting the decision the APA has taken. Members are definitely NOT happy based upon the volume of emails and blog hits/comments that we have been receiving since November. We have advised members to renew their membership for 2016. Some have chosen not to and let me know; "I will not be renewing my membership due to the proposed changes to restrict non APA courses being advertised via APA and also their restriction on using APA premises. I think it anti competitive, a backwards step and have been disappointed with the APAs response to members on this matter. I will be taking out independent insurance. I will renew mem...
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Clinical Kit 100 - 23/12/2015 - Christmas Roundup & the APA

Christmas Wishes It is coincidental that the 100th Edition of Clinical Kit falls at the end of this year. I have been writing these fortnightly emails for over a couple of years and have enjoyed immensely the feedback and support from AAP Education members over that time. Membership has grown to 3000 and we are continuing to offer an increased range of professional development training to clinicians around Australia (and occasionally internationally). 2016 is going to be even better, with not one but 2 international presenters touring Australia, plus more and a greater variety of local presenters. APA Member: To be or not to be? The end of this year has certainly seen a flurry of professiona...
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Does our APA LISTEN or SPEAK to members?

Driving home with my son from basketball at 10.30pm last night , we caught part of ABCs LNL with Phillip Adams. He was talking with Gloria Steinen about her new book "My Life on the Road". You can hear the full interview http:/www.abc.net.au/radionational/programs/latenightlive/gloria-steinem/6998434 ">here Gloria highlighted an important realisation she had when it came to negotiation and mediation. To paraphrase; when discussing an issue with parties in different positions of power, it was important that if you had more power, you listened and talked less i.e. consult more, dictate less. If you were in the situation of less power, you needed to talk more and listen less i.e. speak your vie...
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Urgent Action - Protect Your APA

APA Putting $$s Before Members' Choice Senior APA members (including myself) are concerned that the issue of our APA enacting restrictive behaviour on members access to professional development is alarming and largely unrecognized. Whether by intent or timing, this significant issue has slipped under the radar for many APA members being pre-Christmas. However, those members we have spoken to are largely gobsmacked and appalled at this behaviour. I was informed, that as a result of the APA member survey (which I also completed as a member), PD was voted hands down as one of the more important issues for members. The online webinars have been a positive new service for members. However, member...
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Clinical Kit 98 - 24/11/2015 - APA Restricting Your PD Access

AAP Education has been informed by the Australian Physiotherapy Association (APA), that because we provide courses that compete with courses conducted by the APA, we will no longer be able to advertise our courses in APA publications, nor will AAP Education be able to rent APA facilities, starting January 2016. This apparently will be the same for all non-APA providers. The APA is a member-based organization . We have spent many years working on different APA committees in a voluntary capacity, presented numerous talks and weekend courses, helping the APA in a small way to grow as a professional association. To us, the APA’s key role is to foster the development of its members and this decision is a very backward step...
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Clinical Kit 97 - 4/11/2015 - Vestibular Course Learning Experience

As part of the 2015 Vestibular Program we offered a $1000.00 scholarship to rural and remote physiotherapists wanting to attend the Melbourne Basic 5 day course. One of the successful recipients was Jono Prowse from NT. Here is a pic of the happy camper with his man sized cheque and his account of Day 1. My learning experience started day 1. Brief introductions and we hit the ground running , delving straight into the anatomy and physiology of the vestibular organs. My experience in the area was limited to observing and assisting colleagues with the Epley, or as I now know it the Canalith repositioning maneuver, and listening to inservices which never seemed long enough to get around what is clearly...
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Clinical Kit 96 - 21/10/2015- Vestibular Rehabilitation

Vestibular Rehabilitation - Part 1 I recently had the opportunity to attend a 5 day "Basic" course in vestibular rehabilitation that AAP Education was hosting in Melbourne and I must admit that I thought the commitment of 5 days was a bit over the top for the needs of a small rural and remote practice. Most of you will know that I am a MSK physiotherapist with divergent interests in feet and dry needling and that my area of PhD research is exploring the association of spinal pain and sleep postures, so where would vestibular rehabilitation fit in? Having attended, let me explain why I now believe this topic to be important. But first let me introduce the Vestibular Faculty. From...
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Clinical Kit - 22/9/2015 - The Hands Have It

'I h and it to you', 'He has the whole world in his hands', 'Give him a hand' .... the metaphors relating to the importance of our hands are extensive and in common use. Practically without good hand/thumb control, the elbow and shoulder are of limited use. When I was studying physiotherapy, the Australian Physiotherapy Association's logo was an icon of a stylised hand and person within (the hand being much larger than the person) and we all know about the relative sensory representation of the hand on the homunculus . Yet when studying undergraduate and postgraduate physiotherapy, bar the 10 carpal tests, we glossed from the elbow, basically right past the hand. In clinical practice (in a rural situation) we...
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Clinical Kit 95 Acupuncture Safety in Pregnancy

Acupuncture Safety and Pregnancy For those of you that are dry needling or practicing acupuncture, one of the delicate clinical areas is the interplay of needling during the first 3 months when the rate of spontaneous abortion is highest (20%). Along with good clinical practice (good communication and gaining client consent before needling) research is indicating that there is probably no link between needling and spontaneous abortion, in fact possibly the opposite. This has previously been discussed in a Clinical Kit newsletter. Another area relates to the needling of traditional chinese medicine points that have been graphically termed 'forbidden points'. Just published is an open source document in Acupuncture in Medicine http://aim.bmj.com/content/33/5/413?etoc titled The safety of obstetric acupuncture: forbidden points revisited....
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Clinical Kit - 9/9/2015 - Lateral BPPV

As a musculoskeletal therapist working in private practice, I first became aware of the positive influence we could have on clients with vestibular conditions , when preparing for my Specialisation exams in 2009. This area of clinical practice was something not covered in my undergrad nor postgraduate degree in Manipulative Physiotherapy, yet had become an area of ‘expected understanding’ within the domain of a modern musculoskeletal physiotherapist. I suspect mostly as a result of the common symptom of ‘dizziness’ and the potential of overlapping causes. So with a ton of background reading and some clinical observation (thanks Alec!) I became aware of the magical reversal of the debilitating symptoms generated by dysfunction in the peripheral vestibular apparatus. Once you have helped...
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Clinical Kit - 31/8/2015 - Fascial Manipulation -What Part Does it Play?

Todays Clinical Kit is a guest piece written by physiotherapist Diane Rowan on her experience with Fascial Manipulation. Physiotherapy is ever changing. I believe this is the direct result of the many physiotherapists and researchers who are constantly striving to improve outcomes for the individuals who trust us on a daily basis to improve their function. As with most things in life, however the deeper you explore something the more you realize there is more to explore. This continual exploration is driving physiotherapy into perhaps one of the most exciting times in its history. Physiotherapists are recognizing, researching and unlocking previously disregarded or mystifying areas of the human body which are having profound impacts on the end user – our patients....
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Clinical Kit - 23/9/2015 - Exercise Prescription Made Easy - VideoXs

Call it the farmer in me, but when faced by a challenge I am looking for the simple and sensible solution. There is usually more than one option, but I am guided by simple and sensible. Daisy is lead in my focus group on the farm, and will pretty well let me know when I am heading in the wrong direction.     How do cows talk? - Through their action and by my observation . Ovulating - ride other cows, in pain - hang to the back, hungry - moo when I come in eyesight, curious - lift their heads and sniff, danger - facing the direction head on. Being herd animals, I am always looking for the cow that...
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Clinical Kit - 19/8/2015 Getting Activity into your Community

With Inactivity passing Smoking as the leading cause of mortality in Australia ,  we can expect different levels of government to become involved in 'educating the nation' on this vital long term factor. But what about at the grass root level, our community? As I was driving around sewing our hay paddock a couple of months ago , along with my bones this thought was bouncing around in the tractor. What would be a fun, challenging and spectator based activity that would promote the benefits and fun of sport? I have seen Tough Mudder, Cross Fit and a few others of similar ilk. There are some great themes; teams, challenges, problem solving, participation emphasis but it needed to be simpler and...
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Clinical Kit - 30/7/2015 - Part 2 Employee or Contractor: Are you who you think you are?

HOME | DRY NEEDLING PROGRAM | CERVICAL SPINE | FASCIAL MANIPULATION | MULLIGANS | MSK & RT ULTRASOUND | NEURODYNAMIC SOLUTIONS | THE SHOULDER | VESTIBULAR PROGRAM | LIVING ANATOMY WET LAB WORKSHOP | . Here is the second part in the series looking at status of employment as individual or independent contractor. If you would like to follow up on the first one you can read it here . Specific Q & As Q: Is the difference in employment status based on a legal or accounting principles? A: There are many accountants who offer compliance solutions without understanding this is a legal issue. The Tax Legislation over arches the PSI legislation and the interpretation of its compliance regime has been...
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Clinical Kit - 16/7/2015 - Part 1 Employee or Contractor: Are you who you think you are?

You may have noticed or read that the ATO is currently in the process of writing to a number of taxpayers who are providing personal services, to clarify if provided as a business or individual. A bit confused about the difference then read on.. Employee or Independent Contractor - What's Your Status? In talking with lots of physios over the past 18/12, there is some degree of confusion in regards to the status of individuals either as employees or contractors. As a result of this  I have asked Workforce Advisors Group to help provide some clarity in this area. Due to the volume of the information I have divided this into 2 parts. The first part will provide background information and...
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Clinical Kit 13/5/2015 Men's Health Week | Ubble Risk Calculator

'MoMENts In Time' - Men's Health Week June 15-21 2015 Looking at men’s health across age groups there are several challenges, important to identify, that we can choose to become involved in.     Younger Males Suicide accounts for slightly more than one-quarter of all male deaths in the 20-24 year old age group. Action: As participants in society, we all need to remain alert to the challenges facing our younger males and help them develop the necessary skills to manage a changing and complex environment .   Research shows that fathers as role models have a particularly strong influence on encouraging healthy eating patterns in children. This is the same for exercising, reading, communication and manners. Action: Develop and encourage...
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Clinical Kit 31-5-2015 An Unusual Presentation

If you live in rural Australia and practice acupuncture or dry needling it won’t be long before you have someone present with ‘unusual’ symptoms asking for a magical cure. It probably happens in metropolitan environs also, but talking with colleagues it seems more common in a rural situation. Presentation In this situation it was a lady in her mid 50s and her left eye was completely closed . She proceeded to explain that in addition to her eye closing, she had developed increasing frequency and severity of headaches on the L side - frontal and temporal. This had occurred over a period of a couple of months. It culminated in a GP visit while traveling in N.S.W. and was admitted to...
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Clinical Kit - 13/5/2015 - Habits, HRV & Resilience

As you may know I have been interested in heart rate variability (HRV) for several years and first presented some concepts in relation to using acupuncture to positively influence the autonomic nervous system at the 2013 APA Conference in Melbourne. At that stage to purchase a monitor enabling HRV measurement, meant spending $10,000+; outside the range of most physiotherapy practices! Fast-forward a few years and with an appropriate Bluetooth transmitter plus smartphone app, you are setup for under $100. So what is HRV? Fluctuations in time between heartbeats, specifically the 'R' part of the QRS complex, is called heart rate variability or (HRV). Previous monitors averaged your heart rate - so it would say 60 beats per minute (bpm) and then...
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Clinical Kit 23-4-2015 What's Your Paradise?

  Perception, Perspective, Passion and Paradise - How do they relate? This thought started after assessing a client who had just moved to Esperance, three months post an ACL reconstruction, toe walking, having had no rehab and with a grand total of 20 - 60 degrees ROM. Being in her early 20s, unemployed and in constant pain this wasn’t turning out how she had imagined. She was bitter with the surgeon and annoyed with the system. = Perception . After examination and scoring her Hospital Anxiety and Depression (both > 11), Orebro MSK Questionnaire (> unlikely to return to work) and explaining where at 12 weeks the average person is functionally at (lots of tears), I summarized she was young, graft...
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Clinical Kit - 8/4/2015 - Infraspinatus Safety & Technique

  Infraspinatus is one of the more common muscles needled around the shoulder blade and a good one to start on because of the relative safety of solid bone as a depth stop. But wait you say, about 8% of the normal population have defective fossa floors (see 3D CTS picture). Clinically I would also add that a defect is probably more common in those over 60 years of age, due to osteoporosis and a general deconditioning in the upper limb with resultant bone loss in the scapular floor. Remember those undergraduate boxes of bones and how many had translucent scapular fossa floors? The concern in this situation is the potential of a pneumothorax or haemopneumothorax. Yes we have to be...
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Clinical Kit 25-3-2015 Novel Classification of Trigger Points

Hi Here is the second article on 'Trigger Points' exploring a previously unmentioned idea that not all trigger points are the same. You can review article 1 here . Novel Classification of Trigger Points (hypothesis) Rather than considering all trigger points the same, I am exploring the idea that trigger points present similarly, but potentially with different underlying mechanisms. I have divided trigger point presentations into 2 groups; Non traumatic and Traumatic. Non Traumatic In my opinion this is the much bigger of the two groups and I have divided it into 3 subgroups . These trigger points occur without any notable force, incident or direct injury and as a result I wouldn’t expect stimulation of the bradykinine/histamine system. Clinically these...
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Clinical Kit 11-03-2015 Acute Achilles Rupture - What would you advise?

I am not sure about your situation, but in our practice and small rural community , we are occasionally faced with the situation of providing professional advice on the management of acute achilles injuries, including ruptures. I have previously blogged on managing tendonopathy, you can review these; Clinical-kit-30-9-2013-Achilles Tendinopathy Clinical-kit-5-11-2012-Achilles Tendonopathy Clinical Kit 26-2-2014 - Achilles Tendinopathy while this Clinical Kit will be focusing on acute achilles rupture. Achilles Rupture Background : To date, studies directly comparing the rerupture rate in patients with an Achilles tendon rupture who are treated with surgical repair with the rate in patients treated nonoperatively have been inconclusive but the pooled relative risk of rerupture favored surgical repair. In most studies the ankle is immobilized for...
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Clinical Kit - 18/2/2015 - Trigger Points: You can feel them, but what are they?

Hi First up, these next two Clinical Kits are an aggregation of ideas that have been brewing for several years and brought about from clinical observation and trying to make sense of the available research in regards to trigger points and myofascial pain syndrome. Many of you will appreciate there is plenty of discussion going on about the nature and relevance of trigger points. For this reason don't take these ideas as gospel. We can’t deny the existence of trigger points, but the how and why is very much under discussion. I happily confess to have mostly looked at this from a clinical standpoint, and then gone looking for information that might explain what I see - so there is a...
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Clinical Kit 30-1-2015 Too Fit to Fracture Exercise Recommendations

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...
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Clinical Kit 15-1-2015 All for One and One for All?

Hi Study identifies best way to treat neck pain Johns Hopkins Medicine, 24/1/2014 (based on the study – Cohen et al. Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain - A Multicenter, Randomized, Comparative-effectiveness Study. Anesthesiology (2014); 121:1045-55 Clinicians need to be able to see through the sensationalism of research! Commentary by Dr. Shaun O’Leary FACP APAM It’s always useful to read a bit more in depth when claims are made in the media regarding new “best ways” of managing health conditions . If one was to quickly scan the title and content of this article summary in MDLinx Orthopaedics , they could be mistaken that a new best approach has been developed for the management of...
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Clinical Kit 14-11-2014 Discerning the Truth of What You Read

Hi Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial. Llamas-Ramos R, et al. J Orthop Sports Phys Ther. 2014 Nov;44(11):852-61. doi: 10.2519/jospt.2014.5229. Epub 2014 Sep 30. Weblink: http://www.ncbi.nlm.nih.gov/pubmed/25269764 Abstract Objectives: To compare the effects of trigger point (TrP) dry needling (DN) and TrP manual therapy (MT) on pain, function, pressure pain sensitivity, and cervical range of motion in subjects with chronic mechanical neck pain. Background: Recent evidence suggests that TrP DN could be effective in the treatment of neck pain. However, no studies have directly compared the outcomes of TrP DN and TrP MT in this population. Methods: Ninety-four patients (mean ±...
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Clinical Kit Grading & Recording Your Dry Needling Treatment

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...
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Clinical Kit 16-9-2014 Needling & Dysmenorrhoea

Hi In the Advanced Lower Quadrant Course we look in detail at the involvement of the abdominal muscles and 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,...
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Clinical Kit 18-08-2014 Acupuncture & DN - Linked by Anatomy

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...
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Hand Hygiene Australia: Free Online Learning & Resources

Hi 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 important Describe when they should perform hand hygiene List the 5 Moments for Hand Hygiene List the common products which are available for hand hygiene Describe how to perform hand hygiene Explain the consequences of failing to perform adequate hand hygiene Explain the...
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SATNAV & Dry Needling

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...
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Clinical Kit 30/6/2014 | Flying under the radar - latent trigger points

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...
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Clinical Kit 13/6/2014 | Thawing a Fozen Shoulder - Management Options

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 ....
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Clinical Kit 29/5/2014 | Don't Miss the Psoas Connection | Case Studies | Video of Jump Response

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...
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Clinical Kit 15/5/2014 | Tumor Alert | Slacklining, Stroke & Outcome Measures

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...
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Clinical Kit 29/10/2014 Useful Vestibular Resources

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 Workshop Vestibular Basic 5 day Course Vestibular 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...
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Clinical Kit 3/10/ 2014 Cranial Nerve Testing

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...
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Clinical Kit 29/4/2014 Faulty Needles & Clinical Relevance

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...
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Clinical Kit 26-2-2014 - Achilles Tendinopathy

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-tendinopathy clinical-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...
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Clinical Kit - 16/2/2014 - Dry Needling & Possible Mechanism for cLBP

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...
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Clinical Kit - 26/01/2014 - My First Quadratus Femoris

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...
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Clinical Kit 14/1/2014 How do you Learn?

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...
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Clinical Kit - 15/4/2014- Miracle Muscles and Neuropraxia

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...
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Clinical Kit 18-03-2014 Needling & Safety During Pregnancy

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...
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Clinical Kit 5/1/2014 Treating cLBP

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...
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Clinical Kit 28/12/2013 THR Caught between the Bedsheets

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,...
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Clinical Kit 16/11/2013 - WA Health Department - Common Sense Prevails

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...
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Clinical Kit 2/11/2013 Acupuncture ANS & Sea Turtles

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...
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Clinical Kit 30-9-2013 Achilles Tendinopathy

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...
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Clinical Kit 16-9-2013 Lateral Elbow Tendinopathy

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...
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Clinical Kit 30-8-2013 The Meaning of Exercise

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...
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All Has Not Been Quiet On The Western Shore!

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...
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Clinical Kit 29-7-2013 Obesity a Disease?

Hi Background Last month the American Medical Association sparked headlines when it voted to officially classify obesity 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...
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Clinical Kit 16-7-2013 Concussion

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...
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Clinical Kit 28-6-2013 Safety & Needling

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...
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Tax Time Benefits & VideoXs

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...
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Clinical Kit 24-5-2013 Outcome Measures

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...
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The Importance of Being Exercised!

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...
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Clinical Kit 14-5-2013 Dry Needling & Acupuncture Research - The Sham Challenge

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...
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Clinical Kit 30-4-2013 Needling and Chronic Low Back Pain

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...
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