Clinical PT Talks

A measurement problem exists in the world of physical therapy. In some ways it is subtle, almost unrecognizable, yet pervasive. In others ways, it is clearly structural and perpetuated by systems that diminish or misunderstand its value. Both are harmful to our profession, and to patients. Join me in this 2-part podcast series as I explore what the problem is, how we got here, and what we should d...

Physical therapists love to report the wonderful results they have achieved with their patients. And rightly so. Singular cases stand out. The clinician is happy, the patient is happy, and sharing success with colleagues, patients, and anyone who will listen is fun and can be informative. Inevitably, however, someone is always quick to point out what seems obvious: "But remember, that's  only...

Psychological factors are always and irrevocably present in any clinician interaction with patients. They can be a help or a hinderance. In PART 1 of this series I spoke about common distortions of thinking that can get in the way of our understanding examination and treatment of patients and of what to do and why. In PART 2 I discuss a common underlying factor present with all treatments which th...

Psychological factors are always and irrevocably present in any clinician interaction with patients. They can be a help or a hinderance. When problematic, they can negatively interfere with intended treatment effects. However, they can also be present in clinicians as well. This can lead to distortions of thinking that alter our ability to properly interpret what we are doing, why, and what our re...

Not everyone lies, but patients lie more than we might expect. And we’re not good at detecting it. So, what is one to do, as a healthcare provider, when faced with this reality? Afterall, lies and failure to disclose vital health information can dramatically and disastrously impact our ability to provide quality care. Join me in this podcast as I discuss these issues and provide a perspective on w...

Patients come to us for a variety of reasons, not all of which are centered on a musculoskeletal complaint, or even necessarily centered on regaining full function. This confounds some healthcare providers, and it can lead to confusion, distractions, and misdirected effort. Much in the patient complaint and presentation needs to be unpacked and contextualized to make sense of what a particular pat...

What we know in practice is built upon our formal education, what we read of the scientific literature, what we glean from continuing education and professional development resources, and our participation in residencies and fellowships, but it also can be built upon experience. However, experience can be misleading if knowledge developed from our own clinical practices is not subject to some type...

An enduring and hard question in the world of physical therapy is: How long should beneficial therapeutic treatment effects last? This is a deceptively simple question. With many different patient presentations, treatment techniques, schools of thought, and approaches to patient management, however, results may vary. Join me in this podcast as I discuss 3 levels of intervention where we have the o...

Orienting oneself to the early career demands of treatment design in clinical practice can be an uncertain and daunting task for new graduates. This is made more challenging by lack of appropriate guidance during academic and clinical training. Thus, self-assessment is critically important for new graduates so that they can understand if they are progressing toward independence. Join me for t...

As professionals, how do we know what to do for any given patient problem? We of course are educated in physical therapy schools, experience increasing responsibility as interns, pass many tests, including licensure exams, and then are released into the world to ply our skills as best we can. We know to survey the literature to help answer our questions, including use of the PICO template to...

Do you measure your patient's ability to produce or manage forces? Why or why not? Ours is a profession of movement-oriented focus, and yet it often lacks investigation of basic concepts vital to movement, i.e. the forces involved. This is true regarding the ability to produce and control movement, and the decision-making processes regarding how much to prescribe and why. These issues are fun...

A man with over 2-decades of complaints related to an old traumatic ankle injury as a consequence of a motorcycle crash now faces a critical decision: surgery or no surgery to fix his problem? Except that it might not work. The uncertainty is backed by a history of a multitude of past incomplete or failed treatments and the reality of a worsening problem that includes increasing pain, loss of bala...

Patients with chronic musculoskeletal conditions are often thought of as resistant to treatment. This is true for both conservative and non-conservative treatments, including pharmacological interventions. In settings where this is not the prevailing thought, then the amount of change expected as a result of conservative interventions is often small and seemingly insignificant, especially if...

Many patients with chronic neuromusculoskeletal problems, including pain and disability, have been through the healthcare system and reached the dreaded impasse where 6 discouraging words tell them all they need to know about the path they are on: "We've done all we can do...." By this time, they have utilized more healthcare dollars and visits than other patients. The amount of improvement they e...

Pressure pain tolerance algometry can help with phenotyping pain, identifying responder patients likely to improve with a given intervention, aid tracking and monitoring changes in patients, and much more. Join me in this podcast short as I discuss what is perhaps the most underutilized, yet useful, tool in the neuromusculoskeletal toolbox. 

Musculoskeletal residuals. What are they? Join me in this podcast as I provide an introductory discussion of what they are, and provide some important ways to think about them which helps frame our understanding of their role in a rehabilitation science and clinical context. This is especially critical with regard to unrealized recovery. Know the right questions to ask, and what do with the inform...

Sometimes the origin of a problem can be unexpected, and sometimes treatments don't go according to plan. It's easy to get flustered, frustrated, and lost. But paying attention to important clues along the way, such as responses to special tests, and detailed symptom behavior, can help anchor our understanding of what is actually happening. Sometimes, it even offers us a glimpse of the bigger pict...

Treatment design is a complex problem facing every clinician. But how well do we understand this issue? What does the science have to say? How much can we rely on what is in the research literature? As it turns out, the answer is: it depends. Join me in this podcast short as I discuss some recent research findings regarding the completeness of treatment descriptions and what this means for treatme...

Biomarkers can provide much needed information that is critically important to our work with patients. One you need to know about, the Load Tolerance Test (LTT), may be among the most broadly useful tools at our disposal. It may also be among the least well-known. Join me in this podcast short as I discuss today's topic in more detail, and why you need to know more about this. 

What is mechanotoxicity? This term relates to mechanisms of injury. We recognize that mechanical insults to the musculoskeletal system occur in many different ways. Join me in this podcast short as I define, explain, and provide examples linked to the meaning behind some of the terminology we use within the framework of mechanobiologically oriented rehabilitation.

In orthopedic physical therapy, we have many options when it comes to measurements we might choose to acquire when we examine our patients. But what should we measure? And why? What is clinically relevant? Join me in this Podcast Short as I discuss these ideas and more as I provide an overview from a pragmatic perspective.  

Today's topic is about an emerging area of science and practice that may be new to many. It is one of special interest for me, and a domain within which I have been working, thinking about, writing about, teaching, and applying to patients since day 1 in the clinic. So, here a few questions to consider: Do you know what mechanobiology is? Do you know what mechanobiologically oriented rehabili...

Shoulder pain is common, and it can originate from a variety of sources. Join me in this  Podcast Short  as I discuss a quick differentiation technique that aids dichotomization of pain originating from one of two common musculoskeletal sources, i.e. those associated with shoulder structures themselves vs. another anatomical region.

A straightforward musculoskeletal complaint takes a surprising turn. One I did not see coming. But once it was revealed, it made a critical difference. This is our fourth story in an ongoing series. It illustrates lessons learned from a transformative moment in a PT's career. Like all of our stories, it is drawn from real-world experience. 

Chronological age is different than physiological age, also known as functional, or biophysical age. As we get older, we all tend to accumulate injuries. Some heal. Some do not. Some heal, but incompletely. These residual deficits add up. If left unaddressed, they begin to exert their influence in ways that we identify with being "old." However, it is possible to reduce, and even reverse, these bi...