One major facet of effective communication is education. If you ever step foot in my clinic you will quickly see texts like Explain Pain, The New Rules of Lifting for Abs, and Painful Yarns – to name a few – lying around.

Other educational pieces you will find are this article on “10 Things You Don’t Know About Pain” and this patient summary on “Diagnostic Imaging for Low Back Pain”.

I’ll admit that it takes a lot of patience when trying to effectively educate and communicate but in the long run, your patients will thank you.

So for those of you that want to learn more about patient education, and particularly as it pertains to pain, I highly suggest you take the time to listen to this presentation.

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Content

• Assessment and Training of Faulty Movement Patterns bridges the gap from acute care to injury prevention to skills training. This program is ideal for any musculoskeletal practitioner who works with patients or clients that want to enhance their results. Learn the art of functional assessment of the kinetic chain and how this relates to sports function as well as injury rehab. Particular emphasis will be on the groundbreaking work of Pr’s Janda & McGill, Gray Cook, Michael Boyle and other leaders in athletic development.

Several of the Topics to be Covered

• Subcortical Reprogramming of Movement Patterns
• The Frontal Plane and Knee Instability
• The Transverse Plane and Upper Quarter Syndromes
• Kolar-McGill: Biomechanics and Neuro-Development
• Cortical Plasticity and the Neuro Matrix

Workshops Covered

• Deadlifts vs Squats: How to stabilize the SI Joint and Knee
• Acetabulo-Femoral Sensory-Motor Amnesia: Identification and treatment of this underdiagnosed proglem
• Anterior rib cage dysfunction and shoulder impingement syndrome: the key role of the diaphragm
• Scapulo-thoracic stabilization, faulty respiration and neck pain
• Integrating the Core with lower quarter training to address Janda’s Lower Crossed

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For more information and registration, click here

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Is Junk Food Really Cheaper

• Sometimes the truth hurts. This article from the New York Times was published last year but I was reminded of it when I bought a 2lb bag of organic carrots last night for $2. Thats more than $1 less than a bag of chips.

Recognizing Fractures (and describing them)

• This was shared by Jas Randhawa, a great strength coach and soon to be fellow chiro. Going through these slides reminded me of when I was studying for my Fellowship exam but you truly can never review them enough. For those interested in more, a great site to check out is auntminnie.com. Just go to “Education” and click on “Case of the Day”. Note: It is a registered site for health care practitioners.

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Packing the Shoulder

• Here is a VERY interesting post by David Whitley on packing the shoulder. Using an example visualized by fluoroscopy (thanks to Mark Toomey), the importance of this maneuver is demonstrated in overhead pressing exercises showing the likely mechanism of acromioclavicular injuries such as osteolysis that is so common in lifters

There’s a Reason There’s a Box

• As someone who strives to think of the most effective and practical means to help my patients and athletes get better, I often find myself attempting to “think outside the box”. Here is a really good read by Mike Boyle to remind me to keep myself in check and make sure that I’m not getting too out of hand.

What is the Difference Between a “Confidence Cure” and a Mere Placebo?

• A very good read from a very good site. This is just an example of Paul Ingraham’s work. Some of which may move you, others of which may make you uncomfortable. But all of which will educate you.

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For detailed information on this course, please click here -> Musculoskeletal Pain Syndromes

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• How Yoga Can Wreck Your Body – New York Times

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Thoughts

• So What Do You Think About Yoga – A previous post of mine

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Possible Solutions

• FMS Yoga Solutions – Another previous post of mine

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The Video

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Study Title:

Authors: G. Bronfort, R. Evans, A. Anderson, K. Svendson, Y. Bracha, R. Grimm

Journal: Annals of Internal Medicine

Date: 2012

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My thoughts

• First of all, seeing this study capture the attention of many manual and rehabilitation therapists through the power of the internet reminded me of the old “Start the Car” ikea commercial.

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• As a chiropractor that highly values exercise and rehabilitation, most would assume that I too would take this paper, “start the car”, and run away with it. Unfortunately, I wanted to read the actual paper and see what all the hype was about beyond the good publicity from the New York Times.
• There’s no question that I strongly believe manipulation and exercise may be better alternatives to medication in some if not many “pain” presentations, however, overtime I have learned to become more attached to patient-specific care more than anything else. Patient-specific care may indeed call for meds, manipulation and exercise – but patient-specific care may also call for reassurance, education, and / or soft tissue therapy.
• Now having read the actual study, the authors did do a relatively good job to prescribe individually based exercises but I do think they could have been more thorough. Gentle stretching and scapular retraction exercises, as well as neck and possibly (although not convincing in this paper) thoracic manipulations don’t cut it when it comes to sending a message that SMT and exercise are better than meds. I understand that this is a research paper so I will accept some limitations in the study.
• While there was significant difference in follow up at 6 months, no significant differences were found at the 1 year mark of follow up when compared to baseline. To me, this likely indicates symptomatic relief or treating the DP (which I think is ok)…but what about the root cause? And what about integrated care? Because how often do you just manipulate or just rehab? I know quite well many of you who read this blog also combine the two. But you probably combine other therapeutic approaches as well. What I don’t want to see is manipulating people’s necks for the simple reason that this paper said it was more beneficial. If it is indicated, and the patient consents, then by all means. But if not, don’t “start the car”. We need to be more precise and we need to be accountable.
• Again, it is a research study and I get that we can’t control for everything in research but I do think we can be a little more responsible when drinking the kool-aid. And responsibility means taking an objective, rather than emotional opinion…especially on social media. So please feel free to advocate that SMT and Exercise may sometimes be better a alternative than medication for neck pain (and that meds are often unnecessary), but please also recognize that generalizing the study’s results to all of your patients is an act that is no different than advocating for meds alone.

Bronfort, G et al. (2012). Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of Internal Medicine, vol 156; 1-10.…

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Thankfully, the folks at Precision Nutrition and Livestrong have put together clear and concise lists of such considerations.

Have a look:

Top Lessons for 2012 – Precision Nutrition

The 10 Rules of Living Healthy – Livestrong

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As always, these interviews will be held on a weekly basis and will profile the following world-renowned experts in our field.

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…and the best part about it is the cost.

It’s FREE!

The teleseminars will start on Jan. 17 so make sure you head on over to the sign up page to register!

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• The repeated and massive blows to the abdominal region were simply too much for Brock Lesnar to handle and as a result, Overeem defeated the former heavyweight champion by technical knockout.

The possible explanation:

• Pain Science: While nociceptive input from the abdominal region may previously have been regarded by Brock’s brain as non-threatening and therefore non-painful, the nociceptive (and possibly non-nociceptive) input he experienced through such abdominal blows may likely have been interpreted interpreted as threatening and subsequently painful as a result of his recent experiences with diverticulitis.

The analogy:

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Today I visited a really great friend, Thomas Lam of FITS Toronto. Having no real agenda planned other than a little lift session, I was more than aware that there would be plenty of discussion as always. What I didn’t know was that I would be there for 7 hours.

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www.fitstoronto.com

Joining us was the wife/boss/sugarmomma, former CIS football star and current strength coach Cory Kennedy, and student extraordinare, Ricky Singh.

The unique thing about Thomas and I is that when we both sit down to chat – regardless of who we are speaking with and especially together – we always go off on tangents. Sentences become paragraphs and paragraphs become chapters. There really is no such thing as a period in our discussions.

Amongst the endless variety of topics discussed, the following question was asked: “what were the 3 things that I learned in 2011″.

Here were my answers:

1. The importance of being able to truly read people - In the clinical setting, patients come in with a variety of presentations. Many will be musculoskeletal in nature, others will be more psychosocial. Some will be neurological and few, if not more, will be cardiovascular. Because we as humans are multidimensional and each of our systems are interrelated, there exists a continuum where each of the above – and our other systems – sit. So where our patients and their given presentations sit within this continuum becomes perhaps the most significant variable that we must uncover during each patient visit. To me, this is accomplished through the skill of “reading” people.

2. The effect of what we say is highly influenced by how we say it - As we are clinicians – and strength coaches for those who are reading - we too are teachers. We are interactors who constantly communicate with whom come in contact (i.e. our patients). Much of our clinical interactions are learning experiences. Learning experiences for our patients and learning experiences for ourselves if we are willing. And what I’ve learned is that what we say only matters if we put it in a context that reasonates well with our patients. If stated it before and I’ll state it again, if a patient is not compliant I think it is more important that we look in our own mirrors prior to looking in theirs.

3. Context Specificity - In this age of information, there are endless exposures of successful anecdotal clinical experiences. Unfortunately, with this comes plenty of opportunity for criticism. Over the past year and especially over the last several months, I have realized that unless we are present, we truly do not have a complete understanding of each others’ experiences. I, for one, used to be a member of the critics anonymous society. Maybe not publicly but certainly privately. I’ve learned to get over myself and understand that a success story is a success story, regardless of whether or not I truly understad the system or methods used. I still believe that certain principles must be respected, but again if it works, it works. And if it works, I probably need to study it.

What were the 3 things you learned this year?

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