Hip & Knee
How Horizontal Body Proportions “Inverted Triangle” Can Relate to Back Pain
A current patient with recalcitrant back pain is challenging me to look for innovative strategies for treatment. This 29-year-old male has a 3-year history of low back pain. The pain occurs daily, with an average intensity of 3 out of 10. The symptoms are worse with prolonged sitting. Worse on days that he is more…
Read MoreEscaping the Drama Triangle: Practical Tactics for Direct Dialogue Between Physical Therapists & Surgeons.
Earlier in my Physical Therapy career, I joined a pain management team at a teaching hospital. Team members included an Anesthesiologist, Primary Care Provider, Physical Therapist, Psychologist, and others. We held team meetings to discuss chronic pain patients. Few would dispute that face-to-face real-time communication was a particularly effective way to provide care. Unfortunately, the…
Read MoreDownsides of steroid injections for hip pain – What 3 patients taught me
Three patients with chronic hip pain prompted me to dive deeper into the effectiveness and risks of the common intervention of corticosteroid injection for musculoskeletal pain syndromes. Patient A complains of difficulty lifting his leg to put his pants on when standing and difficulty lifting his leg to transfer into his car. He had a…
Read MoreHip-Spine vs Spine-Hip vs Both – 3 Case Examples Lessons Learned
An 80-year-young woman visited her primary care physician with “pain going down my leg”. She had difficulty grocery shopping, picking up her small dog. X-rays showed osteoarthritis in her lumbar spine, and she was diagnosed with “sciatica.” The doctor referred her to a spine surgeon, who ordered an MRI and gave her an x-ray-guided spinal…
Read More“Take my wife, please” – patient centered care consider significant others
After completing an initial Physical Therapy consult with a 62-year-old gentleman with osteoarthritis of the knee, I asked, “Do you have any questions, confusion, or concerns that we should go back over?” Before he could respond, a voice chimed in from the next room. “Tell him that you look like an old man when walking,…
Read MoreBalancing joint capacity and exercise load using synergistic muscle action
A key concept in managing and preventing hip pain is understanding the balance between the capacity of the joint to handle load and using exercise training load to increase the capacity of the joint. To modify movement, one can “load” it by adding external resistance. Or “unload” it by decreasing or eliminating external resistance. Or…
Read MoreMusculoskeletal pain which are important steps which are less important?
Thesis: Choosing a diagnosis is an early step in solving non-traumatic muscle and bone pain problems. A diagnosis helps guide treatment, predict how problems will progress, and improve communication. A diagnosis has many functions, including direction for intervention to solve problems, predicting how problems will progress, and assisting in communication. Antithesis: Medical terminology is notoriously…
Read MoreWhat is the alternative to I have fallen, & I can’t get up? – improve strengthen flexibility “just do it”
A patient with Parkinson’s syndrome, living alone expressed to me his frustration. He had fallen and was unable to get back up. He pissed on himself. He used his fall alert system via the internet to notify the rescue squad. In addition to the embarrassment, he felt about not being able to get back up…
Read MoreAdjusting the exercise load to manage musculoskeletal pain syndrome
Adjusting the amount of exercise load involves seeking a balance between increasing or decreasing the load. Athletes and healthy individuals the bias is towards increasing the load to improve capacity and performance. For musculoskeletal injuries, post-orthopedic surgery, or musculoskeletal pain syndromes, the bias is towards decreasing the load to facilitate healing and recovery. Tactics to…
Read MoreHow does the natural progression of osteoarthritis influence the management of osteoarthritic flares?
Case Example: Over the last year, on several occasions, a patient has sought assistance for recurring flaring neck pain. Radiographs show moderate osteoarthritic (OA) changes in the cervical spine. A history of mild to moderate scoliosis of the spine has existed since childhood. Over the years, the neck pain has alternated from long periods of…
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