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

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 Continue reading

Single Blind Study – Scientific Reasoning in the Clinical Exam (Part 2)

So we all know that our patients experience pain relief from many placebo based mechanisms. A little bit of joint cracking, needle tapping, and (insert modality here) can go a long way towards providing a patient some temporary relief which gets us to our main goal of restoring movement.

There has been decades of research on the aspects of placebo:

  • 2 sugar pills better than 1 for reducing gastric ulcers(1)
  • 1 injection better than 2 sugar pills for reducing gastric ulcers(1)
  • Higher priced items are more effective than cheaper ones, but only when people know they are the higher priced meds.(1)

Just more fun facts… Continue reading

Poor Posture Equals Pain, Right?

Img Cred: India.com

If you’ve been anywhere near a peer reviewed Journal in the past years you are well aware that the idea of positions equaling pain has been fully debunked (Eyal Lederman, Greg Lehman, Todd HargroveSportsDietPain ) The concept of poor posture = pain is still widely used (I won’t even list here…) but it is not backed-up by pain science.

Or is it?

Poor posture can indeed increase the chances of pain. Now, posture is a state.  An act.  A positioning of one’s self. Psychology tells us that if we stand tall with a smile then we will feel more powerful and be a more agreeable person.

“Kahneman writes about test subjects given a pencil. In one set of tests the subjects are asked to hold the pencil between their teeth horizontally. In another the same subjects are asked to purse their lips around the eraser end of the pencil. Then the subjects were shown cartoons from Gary Larson’s The Far Side. Those in the first group, with the horizontal pencil, were more likely to find the images funny than the second group, with their lips pursed around the pencil’s eraser end. What’s going on? The researchers concluded that clenching the pencil horizontally yielded a “smile,” with cheeks pinched back and the outer edges of the mouth turned upwards. Those holding the pencil’s eraser end in their mouths yielded a “frown.”” The Observer

So our body position affects our perception of reality.  And pain is perception of stimuli as well.

It makes us feel better to have “correct” posture. (recommendation: spend 20 min with this TEDtalk)

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

Hey, Where is that Pain From?

Have you ever asked someone where they are from?  Sure, you have.  Have you noticed a breadth of answers in terms of history time-line?

For example: Some might say

  • “Oh, I’m from Hillcrest Neighborhood” (immediate History)
  • “I’m from Virginia” (current History)
  • “I grew up in Boston” (Childhood / Distant History)
  • “My family-line is from Poland” (Distant History)
  • etc… and on.

How far back do we normally go?  Perhaps it depends on who is asking the question, and what the context of the conversation is about.   Continue reading

Aquatic MIRAGE

aquatic-mirage-pt-brain-trust

Oh man!  I had a great day today.  So my current clinical experience is made up of 40% aquatic physical therapy.  I think it’s fine, the research on it, from what I can find, seems to support its efficacy and validate it’s use.  But that’s not what I’m excited about.

Have you heard of the MIRAGE arthritis study from Univ.  Nottingham? Continue reading