The sport activity has to be the problem. That in itself has to be related to the cause of my low back pain, even without a specific mechanism of injury. Oh, it has to be because I [insert here: am not flexible enough, have a weak core, or any number of deficits].
These are the words of countless active patients (and the clinicians that work with them) that suffer from low back pain. Both groups will create magical scenarios for the onset of an episode of low back pain with mechanisms that have little to no chance of actually existing. But they sure sound good, don't they?
Sometimes, it’s the daily stuff that is most important. With that said, let's take a look at the Case Of The Sitting Runner.
One of the greatest problems in health care, including complementary alternative medicine, is the oftentimes arbitrary nature of treatment and the proposed rationale for its usage. There are certainly some magical mechanisms purported to provide some rather intriguing (and often unsubstantiated) treatment effects.
Although clinicians like to use phrases like "the right treatment for the right patient", there is oftentimes a lot of arbitrary clinical decision-making that takes place. Of course, this is a reality when you fail to utilize reliable strategies and clinical decision-making algorithms for assessment and treatment selection - but I digress.
At times, you would think that there are a lot of treatments being thrown at the wall, hoping that something will stick. This is what happens when you use the black box of treatment.
When texting and tweeting became a part of our daily lives, I can't say that I thought they would have much value in terms of effective communication. Let's face it, they are both, in many ways, highly impersonal and almost passive-aggressive at times. They also contribute to what is rapidly becoming a wide-diameter firehose of digital data that is exceedingly difficult to control.
For many, texts and tweets have become the bane of our existence.
But I have come to appreciate both of them. Their benefit may not lie in the ease of interaction, but in the skills that can be gained. Brevity is everything.
Hey, I know you. You are a rational, logical person. You have followed a series of methodical, logical steps in your clinical decision-making. Your thought processes have brought you to the edge of the proverbial cliff in your thinking.
You glance over the edge. It's a big jump, a bit of a leap of faith if you will, to make the next step.
There is one logical step to make to move forward. But what happens when you walk to the edge? Do you take the step forward and follow your clinical reasoning through to its next logical progression? Or do you step back from the edge?
Welcome to one of the biggest challenges in clinical reasoning - and life in general.
When I listen to clinicians, I sometimes have to wonder how Homo Sapiens ever survived the past 250,000 years. With the clinical minutiae that exist these days, it's a wonder that we haven't become extinct long before now.
Walk into any of countless chiropractic, massage therapy, and physical therapy offices around the world, and you will hear the woeful tales of asymmetries and mal-alignments. You will hear of the maladies of the kinetic chain and the hypothetical relationships and regional interdependence from great toe to TMJ and all points in between. You will hear descriptions of two degrees of varus at the subtalar joint which, since it has been uncorrected for the past 40 years, has now created micro-trauma that has evolved into your back pain, your headaches, your arterial insufficiency, and your eyes being divergent.
I have no idea how we managed to survive the onslaught of those two degrees. I suspect the species is doomed. Who needs an ice age when the scourge of two degrees of varus is upon us?
It's not just a Republican thing. And it's not just a Democrat thing.
When you get right down to it, consumer access to physical therapy could - and should - be an issue with bipartisan support nationwide. Both sides of the aisle should absolutely love it for very different reasons.
But it becomes readily apparent that they don't - at least not consistently from state to state. With a mid-term federal election cycle and plenty of state-wide elections soon to be upon us again, it would be helpful to understand why.
In health care, there is much talk of control. One of the biggest issues is controlling the spiraling cost of care.
In the same breath, we have become transfixed by outcomes for any given episode of care. This is thought to help control costs – the costs that are faced right now, what I call the upstream costs.
But over the long-term, the control we need to discuss is locus of control. This is the control that will ultimately provide health care with true, epic reform.
Up to 60% of runners will sustain an injury within any given year. Poor running mechanics, in conjunction with poor, ineffective and outdated training methods, can pose a significant injury risk. "RunSmart" was written to address these issues in the running community.
"Running Injuries: Etiology And Recovery- Based Treatment" (co-author Bridget Clark, PT) appears in the third edition and fourth editions of "Clinical Orthopaedic Rehabilitation: A Team Approach" by Charles Giangarra, MD and Robert C. Manske, PT.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.
Top 5 finalist in three categories: "Best Overall Blog", "Best PT Blog" and "Best Advocacy Blog".
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