Recurring hamstring strains, adductor tendonitis and hernias

[alophysio]

Hi sharileedahl,

Yes, you make a good point. I was thinking about that as i wrote it but deciding to press "post" anyway.

A few points as to why.

1. I am older and more cynical. I have simply been around too long and heard too many stories of physios who have "trained" their patients in "core stability" and the patients have no idea.

Now, you might say "the patient got it wrong" and i agree - that is usually the case right? Well, when they come in with a sheet of exercises showing you what they are to do, then there is more evidence.

Then you might say "but maybe the physio explained it and didn't write it on the sheet". Again possible but when you question the patient to clarify how it is taught to them, the patient is clear on what was taught and what wasn't taught.

And BTW, i do this in a manner that tries not to undermine the other physio. I am a professional after all. Here i am annon so it doesn't matter so much.

What i do is ask the questions and don't make comments about what i am thinking...like "huh?".

Then when you actualy meet the physio and have a good old chat about physio, you realise that they really don't know what core stability is.

Also, a lot of people like Stu Magill's work because it is very much like gym based programmes but it lacks the motor control element. In actual fact, apparently (so i have heard), Stu Magill actual does teach motor control but doesn't realise it! On this sidebar, try a cocontraction brace that he advocates - that is back extensors on and ab flexors on. Now try to rotate. you can't unless you decrease the brace to allow you to move. That is motor control!

anyway, i digress...

2. You will note that i said trained with RTUS or a good physio.

Let me emphasise that i do NOT own a RTUS. I might buy one in the future to play with (see what is going when i do certain things) but not for retraining...although there is some recent research which says it might be helpful...

A good physio can train TrAb and LM and pelvic floor (PF) without gadgets. I haven't met too many who get the TrAb or PF contraction right first go. Even when you tell people a 30% contraction, they still bring in interal obliques. And i have been on many courses over the years.

Even worse, i have only met 1 personal trainer/pilates instructor/yoga instructor/GSR/athletic trainer who could do it and it was only because they were specially trained due to injury. Even worse, i have personally trained some trainers multiple times and emphasised the theory and practical etc and review with them a few months later and they go back to their old habits.

I am tired of beating my head on a brick wall. Perhaps my cynicism is unjustifed...

3. Training with RTUS actually lets you see what is really going on. i have been fortunate to have access to RTUS if i need it. I have been fortunate to have been able to play with RTUS to test different things. I have been able to validate my own palpation skills and correlate strongly with RTUS for different muscle contractions. Therefore i have confidence in my palpation skills as being accurate.

How many people take the time to do such "playing"??

How many people think "clams" in pilates does glut med? If you aren't sure, get on the RTUS and have a play. It's pretty hard to get away from the research which says that TFL is the main ABD in the hip...

4. As for my denigration of our profession...a profession that has been good to me for many many years, you are right and i apologise for that.

There are many many physios who have much better skills in different areas to me. They have good ideas on movement and exercise and soft tissue work and visceral work etc. I am a lifetime student. With each pice of knowledge i aquire, I realise more how much more I have to learn. It is only because of giants in physio (and other professions) that i have been able to learn what i have.

5. you are right, there aren't many bad physios. but one post i replied to earlier today said her physio said her shoulder pain should take 12-16 months to get better and to keep coming to physio. She already had it 18months and there was no frozen shoulder diagnosis mentioned. Even then, it should start to thaw on its own...research shows that physio is not going to help frozen shoulder get better faster. Physio is only good for helping the other areas under stress from the frozen shoulder. Based on the very little information i have at hand, i can still make a statement saying "I have NEVER told a patient to keep coming to me for 12-16 months for treatment". Never.

6. New grads. Love 'em and everyone is one to start out on but i can't hire them. My practice is too sophisticated and too specialised to take them on. I have tried in the past. I have met some recent graduates who have potential but still they were 2-3 years out of college and had done courses i wish i had done at the same stage. But they still lacked the experience i required.

The issue is time. You need time to get the patients under your hands. You need time to learn assessment skills. you need time to understand clinical reasoning better. Time is needed for learning new treatment and rehab skills.

The problem has never been intellectual ability...just experience.

7. Attitude is a problem amongst all professionals. Your patients will love you whether you are good or not to be honest so long as they get better.

I once had an employee who never did continuing ed and the patients loved him. They got better very slowly (?natural recovery?) but they did eventually. He was great at explaining what was wrong and earnt their trust and did everything a new grad would and more. He tried hard and didn't have an ego.

Then i have seen and employed physios who were "too big for their boots". They were right and that was that. How dare i suggest alternative diagnoses or question their judgement? Bad attitude. Get fired.

If we tell the patients something and they hold onto it, it is in our best interests to be "right" because if we are wrong, it diminishes our reputation in the eyes of the patient. The right way to go about it is to obviously don't back yourself into a corner but to be cautious in your words but some go the easy way, make a diagnosis and then are stubborn to let it go if they are wrong.

I am sorry if this doesn't make sense but it is currently 1am in the monrning here! Also you have hit on a nerve (can you tell?? )

8. A degree is simply the piece of paper that qualifies you to learn MORE. Too many people see it as the end of their educational journey. Graduation is the BEGINNING of the journey.

9. Lastly, about you sharileedahl. you strike me as the kind of physio i want to hire. I appreciate your comments both here and in other posts. I am guessing that you are about 2-5 years since graduating and no doubt better than i was (am?) when i was there. I only guess you re youngish becasue you are not as cynical as i am!

Thank you and look forward to more discussions over the days, months and years

Sorry to hijack this subject!

[sharileedahl]

Alophysio -
Amen brother!!! I agree with you +++ on it all. Just wanted to step in and defend the new grads out there. It is tough to have them in some positions / clinics but they need to know that they have the base skills that will get them there...sooner than later!
As for me...thanks for the job offer (haha) but I don't think my farmer husband and daughter are looking to relocate!!! Been at this profession for going on 8 years now and because of my "gypsy" lifestyle while single, I have had the opportunity to work with many different therapists in various settings...a learning experience in itself. Have to say too, that I still LOVE, LOVE, LOVE what I do which is why I can suppress some of the cynicism (but can understand where it comes from)!

Anyway...back to the original post...SCOTT - WHAT'S GOING ON??