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. Continue reading
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
I forget frequently of how often it is not about me… and by extension, it is not about you either. As is human nature we take all interactions personally with a strange self-importance to their substance. But it is rarely about us.
We forget the 8 things that the patient did over the weekend that could have affected their outcome, and only lay importance on the TherEx we gave or the joint mob we did on Friday afternoon. We rarely consider the random activity the patient did, the medication effects, the visit from the favorite sister, the mother-in-law that just moved out of their home… no, it was us that had the most impact on them.
And the patient believes it too. Because we mention Continue reading
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? Continue reading
How do I help my patient get better? It may depend on many things, the disease, injury, co-morbidities, etc. And in many cases it can be hard to ignore big factors that “stand in the way” of recovery. Some patient’s are just tough. Complex. Hopeless.
Of course, we make sure to keep a mask on. We attempt to prevent our patients from seeing Continue reading
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 Hargrove, SportsDietPain ) 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)
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
We all have a nervous system who is our boss and our buddy. One of it’s jobs, as an organ and part of the whole, is to protect us and alert us to danger. This is biologically advantageous, no doubt. We want some level of protection so we don’t ignore tissue and other damage. One way of protecting us is to limit movement in a predicted pain-causing manner, or to cause movement away from danger.
If you have too much vigilance, however, movements are stifled and restricted and life gets a little scary. The body environment becomes a little hostel while in this overly vigilant state. To illustrate this, let me paint an image for you… Continue reading
Stephen’s post on Central Sensitization got a lot of attention, and it is well deserved. Part of getting results in this population is explaining how the nervous system works. The following metaphor is a nice way to get the idea across. Continue reading
When evaluating and interacting with patients there will inevitably come the part where they ask “So, what’s wrong with me?” or “What’s my problem?” It is our job, no, our duty to educate the patient and inform and discuss with them their condition and prognosis to the best of our knowledge. Continue reading