Experience and the Experiment

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“Dad, let’s do an experience” my 6.5 year old said to me this morning. “Let’s see how far away these walkie-talkies can go and we can still hear each other.”

“Do you mean experiment?” I ask. “Yes, ex-per-i-ment” she says. We go over its pronunciation a few times. It’s a mix between my daughter having no front teeth and that she just gets her word choices mixed up now and then. Experience. Experiment. It’s an easy one to slip up on, plus they could be viewed in the same category in her head. “I will have an experience and learn something.” “I will do an experiment and learn something.” Same thing, basically, to a 1st grader.

So, you can see this question coming: Do you get Experience and Experiment mixed up? Continue reading

The Claims Equation

I’ve finally figured it out, I’ve boiled it down to the simplest of terms: I dislike unsupported claims. From this simple seed, stems so many urges to engage in discussion, debate, conversation and reflection.

I could not figure out why listening to biomedical model explanations bothered me so much. I could not figure out why those using nocebic analogies drove me crazy. I did not know the reason that I loathed unsubstantiated predictions of the future (“You will need a knee replacement.” “You will have pain forever” etc). It comes down to the claim.

Maybe you could say I just enjoy truth, but truth is a complex part of this whole thing (personal truths, facts, outcomes, etc). To explain this best, allow me to use some math: Continue reading

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 Continue reading

Solving Uncertainty

\What does the search for certainty do to us as clinicians?

In searching for answers we are picking up patterns that let us go past that initial uncertainty.

And so Evidenced Based Practice serves this role… to solve the uncertainty.

We look to research to let us know unbiased truths.  Hey, this patient is not responding today, but if I stay the course science supports that I will see some improvement.

We can look to clinical training or algorithms to help us along. For example Continue reading

Searching for Certainty

This past week I had a few instances that made me feel quite inadequate as a therapist. The first was a patient with knee pain and the other was a patient with neck pain. In both visits I managed to use up everything I knew, every decision path and subsequent treatment solution. And I got… no within session change.


As it happens I was stuck with the uncertainty of their treatments, their prognosis, and the uncertainty of my ability to be effective. I knew what bothered them, I thought I knew Continue reading

You Should Be Using Music with Your Patients with Brain Injury

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 Continue reading

Was it the HVLAT? A Reflective Case Discussion

There is quite the debate these days about how manual therapy works and particularly what types are best or get different/better results or is it all just placebo. Here is a case,  n=1.

I’m evaluating a patient with upper back pain, medial to the scapular border and lateral to the spine, around T5-ish.  We all know where this spot is, right? The complaints are approximately 8 months in duration, 5/10 pain secondary to increased breast tissue (20 lbs) during pregnancy and post-partum time periods, per the patient. Continue reading

Patients per hour. What’s your speed limit?


Image Credit: http://www.flickr.com

The topic of one-on-one care vs a double-booked/overlapping/>1 care model is one of great emotion and opinion in the physical therapy community.

So, I am a huge fan of the one-on-one treatment model and it really seems to suit me.  Bias warning, I am drawn to this style of care.  This model is not pushed or addressed in school other than to say that most out-patient ortho clinics are >1 treatment model providers.  My experience has been as follows: I was a PT Tech in a clinic for two years that saw 3 pt/hour/PT and I have interned in a clinic with one-on-one care and am currently in a clinic that does 2-3 pt/hour/PT.  I recently posted on Twitter about not feeling I could ask as much from my patients in a >1 care model, since I was wasn’t giving them as much of myself.  I felt (and still feel) that if a patient comes in and I give them divided care, and not my full attention, that I could only expect the same in return from them.

I got some responses that were quite positive for the >1 model of treatment and it got me thinking about some of the pros and cons.  First off, I was happy to get the insights since I may be in a situation in the future (actually, as I am now in this internship) where I am practicing under the double-book model. Also with future health care regulations and changes, a double-book model may be the only way to operate and I want to be able to think positively about it.  So let’s take a look… Continue reading