Time

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There is no such thing as Time Management. There is only Self Management, time goes on as it will, no matter your intentions for it.

So what can happen over time? Time is one of these factors that is hard to account for, but does a lot of the treating of a patient for you. (see: It’s not ALL about you).  The biology of tissue healing occurs over a timeline and it occurs at a pace that is affected, but not determined, by us or your patient.

Just an Action Potential…

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We need to keep in mind that there is no pain signal coming in from the periphery.

Pain is not an input. It is simply (and complexly?!) a nerve being stimulated, sending an action potential up to the spinal cord and then brain, where the brain interprets those signals.

…and that’s where it get’s sticky… because what is

Pain, Re-framed.

I had chronic low back pain.

Had.

The first incident was years prior in college: randomly getting up from a nap on the couch (college!) and my back grabbed me and put me on the floor. 9/10 P! Never happened before, so I just lay there for a bit and crawled around until I could relax enough to stand.

Fast forward: after college I would try to

Lost in Translation

In reading Spencer’s recent posts (particularly Part 2, but also Part 1) I am struck by an interesting theme.  The information was there. It was just somehow interpreted wrong and dispersed wrong, or received wrong… like a game of telephone.

Spencer mentions that the IASP definition of pain “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” is clearly presented in education. Since it is there all along… how does it get lost in translation? Can we blame the

The Hollow Homunculus

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I’ve been looking at the above image for years. You have too. There is almost nothing left to notice…but I just noticed how hollow the homunculus is.

There is no representation of your

Let’s take a look at your X-Ray: A Case Story

It was his 3rd visit in for his back pain, but it was the first time I had seen him. I ask how he’s feeling that day.

“I’m hurting, not much different since last time. I’ve had back pain for 5 years, it’s gotten worse in the last 3. I had an X-ray by a gastroenterologist done a few years ago and she saw my spine on the image. She asked if I had back pain.  I said ‘yes, yes I do.’ She said she could tell, because my lower vertebrae were fused together, L4 or 5 or something. She said I’d have back pain for the rest of my life because of it. I’m about a 5-6/10 pain today.”

It was the same story he’s told to every practitioner, over and over again. I know because

The Punnett System

Oh Lord, I have heard the claims!

I have listened to the persuaders, the charmers, the charismatics.  Most of their ideas make sense and can follow logical patterns. (see How To Fool a Smart Person by Erik Meira)  I have a thirst for knowledge, and for universal truths… so I’m listening!

But I have one helpful tool that I use to quick-check these fantastic claims: The Punnett Square. The marriage of factors combined to make truth babies.  Hypothetical genotypes producing theoretical phenotypes. (I don’t know what all that means…)

The punnet Square is commonly used in biology (I’ll let Khan Academy teach you about that here,) but we can use it in our own evidence based practice.  Here’s how: Let’s take the claim that poor posture = pain and make a Punnet Square.

It’s Your World

Nociception is subject to all the truths and flaws of any other input system.

Patients never have this view, since their pain has been described to them in terms of body parts and structures.  However, the tissue is as important in pain as the eyeball is in what we see.

This past week’s viral internet subject is a great example of all that (Black ‘n’ Blue dress).  Vision is simply our brain’s decision based on the information available to it, including, but not limited to, the light waves of objects.  The eye itself is simply an

Tell me a story: A metaphor for understanding analogies

Start here, with this TEDtalk-

I like to use a story or analogy to explain things to patients.  It helps me come into their world and attempt to contact them on their own turf.

It’s not that patient’s are dumb, and can’t understand concepts or facts and figures. Stories are just a great way of conveying information. Adriaan Louw points out that when we are little children we have stories read to us (Aesop’s Fables and the like) that illustrate points, morals and teach concepts. You listened to the story and you got the point to that story, so it starts very young.

When you are on a cruise or on a bus or meeting people for the first time at a restaurant, why do you tell stories?

You Should Be Using Music with Your Patients with Brain Injury

Image: Xiao-Xuan Yang Dancigers

Music has the ability to go deep and move us.  We have all been on the dance floor when “our jam” comes on and you just have to pick up the pace and move with the music.  You had no choice.  Contemplate that for a moment, why is that?  Why does it feel so good to match your movements to the beat?  Let’s dive in…

We will use the research study: Interactions between auditory and dorsal premotor cortex during

synchronization to musical rhythms, by Joyce L. Chen, Robert J. Zatorre, Virginia B. Penhune, 2006 in NeuroImage to explain the premise.  (open source!)

To start off- some background information on