Thanks to this request from a reader who enjoyed the first post on 5 Articles That Changed My Practice.
There have been many articles which struck me as profound, or actually got me thinking enough to change something about the way I practice. Maybe it was using less force, abandoning a certain test, or thinking differently about why treatments work the way they do. Here are 5 More Articles That Have Influenced My Practice.
1) Increasing Muscle Extensibility: A Matter of Increasing Length or Modifying Sensation?
- this is a great review on several of the different theories out there on why ROM increases after different stretching techniques
- it reviews the classic mechanical (sarcomere addition, fascial plasticity), as well as more modern views on stretch tolerance, and lastly modifying sensation
- give it a read and hopefully it will change the way you look at stretching
2) The Modernisation of Manual Therapy
- ouch, yes it's a difficult read, and the author probably does not need to be as harsh as he may sound, but much of what he says is true
- we should mostly abandon our mechanistic ways both in practice, what is taught in school and even many post graduate con ed and fellowship programs and incorporate more Pain Science
- however, this does NOT mean we should give up manual therapy, just present it for what it is, a cheat to get someone moving and feeling better, reducing threat through positive interaction
- the full article no longer seems to be online, even directly from EIM's link
- if you have access (you should be a JOSPT member!)
- in your interactions with a patient, you should be avoiding particularly negative phrases like "slipped disc, degeneration, etc..." - or going over their scans
- this could adversely affect outcomes in the right patient - nocebo
- conversely, most of us unconsciously leverage placebo with positive interactions and words - this technique will get you moving and feeling better
- I just change the "why" it works to inputs to the CNS, as opposed to stretching capsule, fascia, or putting something back into place
- It's MDT vs SMT/advice with follow up 2 months, and 12 months follow up
- at least in this particular study, MDT had stastistically significant outcomes with both disability and global perceived effect
- yes SMT also had positive outcomes, but why the difference?
- my speculation is that MDT groups in general get self assessment and ability to self treat, which is more empowering than passive techniques followed by general advice (which also seems to work)
- Want to know what a systematic review concludes about centralization?
- even though most of what we do and love does not hold up to systematic reviews, the conclusions remain that
- centralization is a valid predictor of success along
- a lack of or peripheralization a predictor of poor outcomes
- it can be detected reliably
- a high percentage occurs in sub-acute versus chronic, but chronic was still above 50%
Again, these are just a snippet of articles that have influenced or changed my practice. There are a lot more where these came from! Have anything to add that gave you a paradigm shift? Comment below or on the facebook page!
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