I missed this post last week, but a friend of mine forwarded it to me asking for my thoughts. It even got some likes and shares from my fans over at that simple site!
I am all for calling someone out on how they practice, IF I watched them in action, or had a good idea of what they do regularly. Apparently, I said something (or many things) that did not resonate well with fellow blogger Allan Besselink. Read his post here, The One Approach That Works With All Patients.
Gee Allan, if you're going to call me out, you can at least link back to my blog. I've shared enough of your well written posts over the years! I am not quite sure how you think I practice, since we have never even spoken in person and you have never taken any of my courses. Nothing like completely critiquing a clinician and teachings you have never been exposed to.
I, like you, use MDT as my critical thinking cap first and foremost, and put my other strategies purely within that framework. Forgive me if I am wrong, but I assumed that you used MDT as a practicing framework from your blog posts.
Over the years I have abandoned what research has told us to, palpation, special tests, passive therapies, negative words, and pathoanatomy. If you were really sticking to evidence, you'd only be using MDT for the lumbar spine, then the cervical spine, and... let's not forget the case reports on MDT for the extremities. Are you using it because it works? Or are you using the method in every part of the body because the framework is scientific, logical, simple, and empowering? Despite the lack of evidence?
Let's make a list of what you are against according to your recent post:
- a reliable classification system that directs treatment and enhances clinical decision making
- an interactive, involving patient model
- education on the realities of pain perception
- looking at movement regionally and not only the site of the pain
- empowering the patient with self treatment
- painless manual treatments designed to make the self treatment as comfortable as possible to ensure compliance
- learning from the beginning of day 1 and through repetition that every manual technique and exercise has only transient effects, and the patient must maintain the improvements
I am always realistic about what I teach and promote. Is there high quality evidence for IASTM, soft tissue manipulation, neurodynamics, etc? Not at all... yet these treatments make the patient move easier, and often a painful MDT repeated loading/unloading strategy is now nearly if not completely pain free; thus they are more compliant and able to self treat more effectively. I am paraphrasing my buddy Charlie Weingroff who very succinctly defined science based practice as this...
- if you make a desired change with something only 94% of the time, is that bad?
- just because something is not published, does not mean it is not scientific
- one of the tenets of MDT and the SFMA is test-retest
- we have a question
- we make a hypothesis
- we intervene
- a change is made, desirable or not, and we make observations based on the changes that happen
Keeping it Eclectic....