Posts Tagged ‘Chronic pain’
Pain 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 MoreUnderstanding Delayed-Onset Exercise-Induced Pain in Individuals with Chronic Pain Syndromes
Introduction Two patients with chronic musculoskeletal pain and Ehlers-Danlos Syndrome (EDS) recently demonstrated similar but unexpected responses to routine exercise interventions. Their experiences prompted me to reexamine my understanding of exercise-induced pain in individuals with chronic musculoskeletal conditions. Patient Case Studies Patient A: During a physical therapy session, a patient with EDS performed a spinal…
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 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…
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