Misc
When the “Protective” Position Isn’t Protective: A Counterintuitive Observation in Rotator Cuff Tendinopathy
A single-patient observation suggests that muscle–tendon length may influence shoulder pain more than we assume. A Counterintuitive Patient Response A patient’s answer to a simple question about her shoulder pain stopped me in my tracks. When I asked what eased the pain, she replied: “When I position my arm above my head, it feels…
Read MorePain Severity vs Pain Irritability: Why the difference matters in musculoskeletal care
A recent patient with shoulder pain persuaded me that pain intensity does not always reflect the clinical seriousness of a condition. Pain irritability – how easily pain is triggered and how long it lasts – often matters more for guiding treatment decisions. A 65-year-old male reported right shoulder pain. When queried, when did it start…
Read MoreHow to mitigate risks & enhance benefits of DIY care of non-traumatic musculoskeletal pain
My January 2026 visit to my healthcare provider was shocking: my coinsurance deductible is twice as much as last year. My health insurance company increased my premium by 25%. Around the same time, I am doing a “do-it-yourself” repair of my Wi-Fi system. My Physical Therapy practice is a one-man shop. So, one of my…
Read MoreHow 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 MorePhysical Therapy telehealth lessons learned mistakes made
My perception of my abilities in providing telehealth video conferencing Physical Therapy or Physical Therapy service online follows the Dunning-Kruger effect. The Dunning-Krueger effect is a process of overestimating and underestimating our abilities and competence. When I began offering telehealth Physical Therapy in 2017, I initially overestimated my abilities. Over the past seven years, I…
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 MorePain – What does it feel like? How this information can guide intervention
When describing your pain details can include location, type, severity/intensity, frequency, duration, triggers, and impact on life. When describing the location of the pain it may not be accurate. Pain can be perceived in an area that is distant from the tissue source of the pain. This is described as referred pain, when the pain…
Read MoreOrthopedic surgery is not always necessary – coper vs non-coper
A diagnostic image such as an MRI can show significant structural damage such as a complete tear of the anterior cruciate ligament (ACL), a complete tear of the rotator cuff of the shoulder, a herniated spinal disc, or other musculoskeletal tissue damage. In 1983 Frank Noyes and colleagues in a seminal study of patients without…
Read MoreMovement-evoked pain measurement for adjustment of interventions for chronic musculoskeletal pain syndromes
If chronic musculoskeletal pain syndrome is like diabetes, then what is a self-administered test to adjust interventions? A thought-provoking article by Jermey Lewis and Peter O’Sullivan suggests “Is it time to reframe how we care for people with non-traumatic musculoskeletal pain” they suggest we have a lot to learn from how other chronic medical and…
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