Betty Roche

Physiotherapy Association of Belgium Points to Physical Therapy as Treatment for Childhood Obesity

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Childhood and adolescent obesity is a world wide epidemic. Exercise is the main treatment strategy for this condition and position statements have been released to support this. Physical therapists in home care and private facilities can play a key role in increasing physical activity levels via community programs.

A systematic and feasible approach to pre-screening and implementing exercise programs for children and adolescents is included in this clinical recommendation. The goal is to provide guidance for physical therapists to prescribe effective and medically safe exercise for children and teens with obesity. These programs will ultimately contribute to better health care and treatment of obesity in this population.

Complications of obesity in youth can include endothelial dysfunction, hypertension, insulin resistance, cholecystolithiasis, nonalcoholic fatty liver disease, respiratory and orthopedic disorders, and/or suffer from psychosocial/psychiatric problems, chronic pain, and lower quality of life. Decreasing obesity will put youth at lower risk for these life long complications.

AXXON (Physiotherapy of Belgium) has released these guidelines via the PT Journal.

Access the Guidelines Here

Clinical Judgement: Making the Best Clinical Decisions

mark

Clinical Judgement – Making The Best Clinical Decisions, India

Description

Key Features:

This course reviews the concepts of the uncontrolled movement theory. It uses patient demonstration to highlight how movement control assessment and rehabilitation compliments other therapeutic approaches. This details a logical clinical reasoning approach to integrate assessment and correction of dysfunction in the articular, myofascial and neural systems. It develops rehabilitation strategies to facilitate clinical problem solving and common areas of clinical difficulty are reviewed.

Learning Outcomes:

At the end of this course the participant should be able to:

1. Make 3 clinical diagnoses for patients with complex musculo-skeletal pain
Tissues / Structures; Movement Dysfunction; Pain mechanisms

2. Discuss the differences in clinical presentations of dysfunction in different tissues
Articular structures; Myofascial tissues; Connective tissues; Neural tissues

3. Understand the development of Un-Controlled Movement (UCM) and analyse the relationship between restrictions and compensation

4. Assess for and develop strategies to manage different pain mechanisms

5. Identify clinical indicators for possible presence of sensitisation & neurogenic pain and discuss management options for issues of neuro-dynamic sensitivity

6. Understand and discuss how clinical presentations determine priorities in management strategies

7. Recognise the clinical indications and discuss management options for:

-low threshold training of the local system as a clinical priority
– low threshold training the global system as a clinical priority
– Indications for high threshold training the global system as a clinical priority

8. Develop an understanding of using outcome measures and re-assessment tools to evaluate the effectiveness of interventions to manage symptoms, dysfunction, disability and demonstrate how these tools can help to guide the rate of progression of an individual patient through their rehab programme

The participant should demonstrate the ability to apply principles of assessment and motor control retraining to:

1. Use clinical reasoning to prioritise initial management and plan a progression of rehab

2. Demonstrate an understanding of the clinical reasoning behind the choice of therapeutic exercise options

Following this course tutor Mark Comerford will be teaching the Thoracic Spine and Ribs course on 6-7 February 2016 at the same venue

Tutor

Mark Comerford

Dates

4-5 February 2017

Duration

2 days

Venue

Academy of Rehab Sciences

Location

Mumbai, India

Contact

Hemakshi Basu

Tel.

aaoorrss@yahoo.com

9820023062

Link

http://www.kineticcontrol.com/education/modular-2016/modular-level-3/clinical-judgement-making-the-best-clinical-decisions

The Advice We Give

image credit

Do this drill: Ask yourself “Do you think that everything you believe or think about the world is the truth?” (Most thinking people will say ‘no.’) Follow-up with this question: “What are you wrong about?” … hmm…

We often think our way of thinking and understanding the world is correct. Well, we always think we are correct and act on it, but we know deep down that, since we are human, we cannot always be right. This is besides the point a bit, but this post deals with our advice, our own beliefs in what we and others should do. Sometimes there is a disconnect.

Often you will give advice, for example on how to move to reduce pain. Whether it be lower trunk rotations in supine for LBP, or isometric calf loading and posterior chain stretches for heel pain or manual maneuvers or modalities, etc. This is your advice to others, but do you do these things when you hurt?

What do you do? Is it different than what you advise? Perhaps because you have some sort of self motivation and movement curiosity, you just “hunt around” for things that work. That stretch. That squeeze of this muscle or that. I propose that this self -lead search yields the best results, yet we rarely say “Ok patient, please hunt around, try something. I’ll be back in 5 minutes.” (Caveat: this is what I do to work things out. See the first paragraph, perhaps this is not right, but I’m going with it.)

This advice-disconnect is clearly seen in gyms and personal training as well. The coach (who the client wants to look/be like) personally does simple, heavy, consistent, repetitive movements. Perhaps on a periodization, mixed with rest-weeks or sports-weeks, etc. The client, based off the advice of the coach, however, is doing some weird bosu ball exercise, then to a SwissBall, then to the cable column for some single-leg shoulder row thing with their eyes closed or whatever.

How does this disconnect occur? Do we think we know what others want? Do we assume they can’t handle what we do to address an issue or get strong, etc. I make assumptions daily that people want us to be involved and fix things and that if I asked them to hunt around for a motion, then they would be unsatisfied and not have the patience for the process. Am I wrong?

I am really starting to think that the process is where the magic is for pain reduction, the figuring it out, the learning, not necessarily the 3×10. The more self-lead then the more self-efficacy and internal locus of control is developed and the more permanent the outcome. And for strength and other exercises, know your purpose, your why. If you want strength, do a heavy 8×3 or 5×5, etc. Let the patient learn about the patience in the process. Just like you do it.

I simply ask you to reflect on the advice you give…

– Matt Dancigers, DPT

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic…

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Body awareness and pain habituation: the role of orientation towards somatic signals.

painmeds

Although body awareness and pain perception are considered to be parts of the interoceptive system, the relationship between them is unclear. This study examines the association between body awareness and pain habituation, hypothesizing that this association is moderated by pain catastrophizing and mindfulness. Sixty subjects received a mildly aversive electrical stimulus for 60 s, during which they were requested to rate the amount of perceived pain. Complete habituation was indicated by abolition of pain sensation; partial habituation was indicated by a decrease in pain sensation. Individuals who demonstrated complete habituation had lower levels of pain catastrophizing and lower levels of mindfulness. As hypothesized, the association between body awareness and pain habituation was moderated by pain catastrophizing: Among low pain catastrophizers, the higher the body awareness, the stronger the tendency to exhibit complete habituation. Among high pain catastrophizers, the higher the body awareness, the greater the likelihood to present partial habituation.

A Mechanism-Based Approach to the Management of Osteoarthritis Pain.

osteoporosis xray

Pain from osteoarthritis (OA) affects millions of people worldwide, yet treatments are limited to acetaminophen, NSAIDs, physical therapy, and ultimately, surgery when there is significant disability. In recent years, our understanding of pain pathways in OA has developed considerably. Though joint damage and inflammation play a significant role in pain generation, it is now understood that both central and peripheral nervous system mechanisms exacerbate symptoms. Evolving management strategies for OA address central factors (e.g., sleep difficulties, catastrophizing, and depression) with treatments such as cognitive behavioral therapy and exercise. In addition, emerging data suggest that antibodies against peripheral signaling neuropeptides, such as nerve growth factor-1 (NGF-1), may significantly alleviate pain. However, concerns regarding potential adverse effects, such as rapidly progressive OA, still remain. A nuanced understanding is essential if we are to make headway in developing more effective treatments for OA.

The Movement Fix Podcast Ep 12

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In this episode of The Movement Fix Podcast, I am joined by Dr. Erson Religioso, aka Dr. E, from themanualtherapist.com. edgemobilitysystem.com, and modernmanualtherapy.com. This is the second time Dr. E has joined me for a podcast. If you haven’t listened to our first podcast together, you can find it here. Click here to listen to the podcast!

I consider Dr. E a mentor of mine and it is always a privilege and a pleasure to have him on the podcast. This podcast was a very off the cuff conversation he and I had with no agenda other than talking about things that were on our minds, but here is a basic list of items we discuss:

Mobility as a skill
Why Erson only eats vegetables
Why stiffness during movement can be a GOOD thing
The importance of the relative stiffness
Erson’s thoughts on PRI
and MUCH more!

via The Movement Fix

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic…

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Spotlight on Kinetic Control, South America

2015 saw a huge rise in interest in Kinetic Control in South America and we have an expansive programme running across various locations including Argentina, Brazil, Chile and Mexico throughout 2016.

camilla We welcome to the KC team tutor Camila Luttges Sciaccaluga, who is looking forward to taking on the Kinetic Control Tutors role in Chile. Camila is passionate about spreading the message of the importance of movement control and movement impairments to her colleagues in her region. Camila completed her undergraduate training in the Universidad Mayor in Santiago, Chile and later did her postgraduate degree in Orthopaedic Manual Therapy in Santiago as well. She works with people with musculoskeletal disorders. She currently works for a private clinic in Santiago and teaches undergraduates in Physiotherapy; for Camila’s full biography click here.

In April 2016 KC Director and Senior Tutor Sarah Mottram joins Camila to co-deliver three of our new Level 1 Movement Impairment courses in Santiago:

Chile course schedule

18 – 19 April 2016:
L1 – SOLUTIONS FOR MOVEMENT IMPAIRMENTS OF THE LOW BACK AND HIP

20 – 21 April 2016:
L1 – SOLUTIONS FOR MOVEMENT IMPAIRMENTS OF THE NECK AND SHOULDER

22-23 April 2016:
L1 – MOVEMENT, ALIGNMENT & COORDINATION

These courses are organised by Rehactiva and KcChile and if you are interested in booking on please use the booking enquiry page on the Kinetic Control website or contact organiser Gustavo Torres on gtriveros@gmail.com or visit the Rehactiva website

sarah Sarah brings with her to Chile many years of KC expertise and is looking forward to helping Camila develop the new programme. As an international educator, clinician and researcher Sarah Mottram continues to make significant contributions to the development and ongoing emergence of the ‘Movement Health’ philosophy, now endorsed by influential organisations and individuals within the movement based field. This desire to place movement at the heart of all movement therapists’ patient and client management strategies is evident through her role as Director of Movement Performance Solutions (MPS) and the range of education and business development services this company offers. Read more about Sarah here.

In other South American countries Tutor Pablo Marinho has established a strong following and has an extensive teaching schedule throughout the next twelve months.

pablo pic Pablo is based in Rio De Janerio Brazil and works advising and supporting athletes, helping them to achieve their goals using risk analysis and injury prevention systems, and rehabilitating injured and chronic pain clients, whenever is necessary. He is a Physiotherapist from Brazil and runs ‘PBM Esporte’. Click on Pablo’s clinic logo below to visit his website and read his KC biography here.

In May, September and October 2016 Pablo will be teaching in Buenos Aires Argentina, delivering courses in Spanish for organiser Aptitud Formación, email contact: info@aptitudformacion.com and
telephone: +54 9 11 5638 9997

Argentina course schedule

21-22 May 2016:
L1 – SOLUTIONS FOR MOVEMENT IMPAIRMENTS OF THE LOW BACK AND HIP

10-11 September 2016:
L1 – SOLUTIONS FOR MOVEMENT IMPAIRMENTS OF THE NECK AND SHOULDER

22-23 October 2016:
L1 – MOVEMENT, ALIGNMENT & COORDINATION

One of the biggest increases in course participation this year has been in Brazil, thanks to the efforts of Pablo, who still has a couple of courses to deliver before the end of 2015.

In 2016 Pablo will be travelling to various locations to collaborate with organisers delivering an extensive programme, which includes the new courses with improved format and updated material; in addition Pablo will be teaching from his own clinic PBM Esporte. For the full run down of the KC Programme in Brazil, see below.

Brazil course schedule

2015

28-29 November 2015:
Belo Horizonte
L1 – SOLUTIONS FOR MOVEMENT IMPAIRMENTS OF THE LOW BACK AND HIP

5-6 December 2015:
Rio de Janerio
L1 – MOVEMENT, ALIGNMENT & COORDINATION

12-13 December 2015:
Brasilia
L1 – MOVEMENT, ALIGNMENT & COORDINATION

2016

12-13 March 2016:
Sao Paulo
L1 – SOLUTIONS FOR MOVEMENT IMPAIRMENTS OF THE LOW BACK AND HIP

19-20 March 2016:
Rio de Janerio
L1 – SOLUTIONS FOR MOVEMENT IMPAIRMENTS OF THE NECK AND SHOULDER

14-15 May 2016:
Rio de Janerio
L1 – SOLUTIONS FOR MOVEMENT IMPAIRMENTS OF THE LOW BACK AND HIP

25-26 June 2016:
Rio de Janerio
L1 – MOVEMENT, ALIGNMENT & COORDINATION

30-31 July 2016:
Rio de Janerio
L2 – MOVEMENT EFFICIENCY FOR LOW BACK AND HIP

24-25 September 2016:
Rio de Janerio
L2 – MOVEMENT EFFICIENCY NECK AND SHOULDER

15-16 October 2016:
Rio de Janerio
L2 – TARGETING LOCAL MUSCLE TRAINING

Pablo is delighted to be collaborating with organisers Bruno Leite & Marcelo Saliba of the Vitare Pilates Studio for his course coming up on 28 November, with the Insituto Cefisa on 5-6 December and again in March 2016 and with Totum Saude on 12-13 December 2015

Pablo can teach in both Spanish and Portuguese languages, and has created a short video, in Portuguese, for your viewing, see below. Look out for one in Spanish also, coming soon.

http://www.physiospot.com/wp-content/uploads/2015/11/Apresentação-sem-voz-Sistema-Kinetic-Control-201516-.m4v

In February 2016 Pablo heads to Puebla & Durango in Mexico at the request of organisation Helse Edu where he will deliver three KC Level 1 courses and one Level 2 course. See schedule below for full details, and contact email: helseedu@gmail.com tel: +52 1 55 6122 0655 to book on directly or enquire via the KC website booking page

Mexico course schedule

20-21 February 2016:
Pueblo
L1 – SOLUTIONS FOR MOVEMENT IMPAIRMENTS OF THE LOW BACK AND HIP

22-23 February 2016:
Pueblo
L1 – SOLUTIONS FOR MOVEMENT IMPAIRMENTS OF THE NECK AND SHOULDER

25-26 February 2016:
Durango
L1 – MOVEMENT, ALIGNMENT & COORDINATION

26-27 February 2016:
Durango
L2 – MOVEMENT EFFICIENCY FOR LOW BACK AND HIP

We are excited to be forging new links across South America and look forward to delivering more courses in the future. We will be posting feedback on how the KC programme is received by participants as it unfolds. Please get in touch with us if you are in South America and would like to discuss hosting a course at your venue.

Call for Focused Symposium Proposals!

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WCPT Congress of 2017 and the International Scientific Committee is calling for programme proposals in Cape Town July 2-4, 2016. Submissions are now open but due by February 28, 2016. Those selected for the symposium will be notified by June 15, 2016.

Proposals should be written for an hour and a half session by a recognised expert in the field. The chair of the proposal should manage inviting and leading a group of international speakers from at least three WCPT regions. Presentations should be evidence based and reflective pointing out clinical, managerial, educational, research or policy relevance. Five tracks are being focused on for topic selection and include: professional practice, global health, professional issues, education and research methodology.

Topics from the prior symposium included clinical trials, pain education, exercise adherence, disability across the life span, global health, interactive technology, health management services and more.

Random Bits & Big Hits

http://www.ncbi.nlm.nih.gov/pubmed/26550960

TTH are the most common type of headache. More than likely even if a patient isn’t referred to you for headaches, you should be able to help them some, if not fully, if you inquire more about any headaches. Dr. Arendt-Nielsen and colleagues do an excellent job at presenting the evidence on the role of muscle triggers (i.e. MTrPs) in specific musculature as nociceptor drivers causing symptomology. Acute and chronic sensitization from this barrage of information is described, as well as brief explanations on treatment options. I would suggest that nocioceptive input from several sources in the periphery is usually in the car, but may not always be driving it. A PT’s thorough examination of aggravating and relieving factors, as well as an objective examination, should lead to the right treatment approach and prognosis.

http://www.ncbi.nlm.nih.gov/pubmed/25355826

CAD seems to be the hottest topic in any discussion of the cervical spine, particularly manipulation. The consensus now, briefly speaking, is that we need to do a better job at discerning someone with a spontaneous dissection that is already occurring who seeks us out for headache/dizziness/neck pain, etc.; vs us causing a dissection through a mechanical event (i.e. manual therapy, objective examination procedures, etc). Giossi and colleagues present data that links individuals who had a spontaneous CAD with signs suggesting connective tissue abnormalities. This differs from a very similar study by Dittrich in 2007 (who found no correlation) but opens up 68 vs 25 detectable signs that can be picked up by a clinical examination. I still think examining the hemodynamics and overall symptomology gives me more valuable information, but I wonder if this is a big missing link in detecting if someone is at high risk of a spontaneous event.

As always, looking forward to your input.

You can see original post and all prior posts at http://intouchpt.wordpress.com

_Harrison Vaughan, PT, DPT, OCS, Dip. Osteopractic, FAAOMPT

Q&A Time! How Do I Get Patients to Stop Self Manipulating Their Spine?

Let’s get some myths out of the way first….

Is it safe to repeatedly manipulate your spine?

there are no studies that demonstrate repeated manipulation of the extremities or spine lead to degeneration, laxity, or instability
that would be like saying stretching does the same thing, or repeated end range loading, and they do not either

Is it effective to relieve pain or increase mobility?

the best inputs are ones the brain considers novel
after a while, especially if your patient feels the need to crack their neck, hip, or back, the need will increase to get the same “relief”
this is due to accommodation, which happens with any repeated stimulus
in other words, I educate patients that if you really “needed” to do this, you would not be here
this has to be emphasized with a healthy dose of Pain Science, regarding things not going in/out of place, etc…

Many years ago, I would have just gotten patients to perform their own repeated loading strategy and basically told them that this replaced the need to self manipulate. I erroneously disregarded their preference and the feeling of satisfaction they got from a manipulation. In some patients, this was effective, as they got relief; in others, where the need and belief was stronger, it was much less effective, or they continued to self manipulate.

A strategy I use now still involves

pain science education
repeated end range loading in regular doses
avoidance of motions/positions that temporarily increase their complaints
telling them to be mindful

Mindfulness is used in many conditions from persistent pain, to addiction. If you feel the need to yawn, or to eat, just “let it pass;” be mindful of the need, and you will realize that the “need” goes away. You no longer have the craving. If you do not feed the need for long enough, the need reduces or goes away. This has been an effective strategy to get patients to stop self manipulating. It’s not an issue because it’s unhealthy, promotes hypermobility, or any of those old school beliefs. However, the craving itself may be promotion of some Thought Viruses that things need to be put back into place in order to move and feel well.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic…

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