FUNCTIONAL F1RST
By FXNL Media
FUNCTIONAL F1RSTJan 21, 2018
Cardiovascular Screening in Musculoskeletal Practice
We speak with physiotherapist, Rich Severin [DPT, PhD(c), CCS] about the importance of screening for cardiovascular risk factors during musculoskeletal assessments. Rich discusses a case study demonstrating the impact that screening can have, how you can screen in your practice, and the #VitalsareVital campaign.
Find out more about Rich:
Twitter: @ptreviewer
Instagram: @pt_reviewer
00:56 Can you introduce yourself?
02:32 What made you interested in doing two specialties?
04:29 What got you started with the vitals campaign?
08:44 What is the education like in schools for cardiovascular screening in MSK?
11:24 Can you take us through a case study?
15:24 Were you screening regularly at that point or was it the history that prompted you to take blood pressure?
16:52 Do you take blood pressure in younger populations?
18:49 Is there anything that you include in your screen beyond heart rate and blood pressure?
19:35 Is there any pushback from clinicians about implementing this in an assessment?
24:50 What cutoff values do you use for blood pressure? When would you refer someone on?
27:53 Do you have a standardized method of screening that you use in your clinic?
31:35 How is high blood pressure diagnosed?
33:15 Guidelines are to measure blood pressure in both arms, what accounts for differences between arms?
34:06 How immediate are changes in blood pressure with exercise?
38:13 How long would it take to see long term changes in hypertension?
39:18 What equipment do you use for testing? With exercise?
43:49 Does hypertension have an effect on orthopedic conditions?
47:32 More on the Vitals are Vital campaign
52:38 Where can people find out more about you?
Using Virtual Reality to Treat Pain
We speak with physiotherapist, Dr. Daniel Harvie [B Physio (hons), M Musc & Sports Physio, PhD, Postdoctoral Research Fellow] about the use of virtual reality in the treatment of pain. Dan discusses the current uses of VR in acute pain, potential uses for persistent pain, and where he sees the future of VR heading.
You can learn more about Dr. Daniel Harvie on Twitter or LinkedIn
00:25 Can you introduce yourself?
01:29 Can you tell us about what you were doing for your PhD?
02:56 Can you tell us about your interest in virtual reality?
04:23 What is the history of using VR therapeutically in pain management?
09:18 Do you find that cost will be a barrier for using this type of technology?
10:02 Do you envision VR being used clinically?
10:41 What is it about the visual part of VR that leads to such a powerful effect?
13:24 Where would you like to see the future of VR going?
14:24 Can you tell us about the VR you use in the Brain Bus and how you use this to explain persistent pain?
16:14 Has there been any research with augmented reality?
18:10 How frequently would you have to use VR for pain for someone to have a therapeutic effect?
19:21 Do you have other areas of interest with research?
23:59 Are there normative values for two-point discrimination?
25:47 Are there biomarkers for pain that you think will show promise in the future?
Opioids and Musculoskeletal Pain
We speak with Pharmacist, Pene Wood (PhD, BPharm, Lecturer in Clinical Pharmacy at La Trobe University), about the growing issue of opioid dependence, appropriate uses for opioids, and alternative solutions.
00:27 Can you introduce yourself?
00:56 Can you give us an overview of what opioids are, what opioid dependence is, and why this is a big issue lately?
03:54 What are the appropriate uses for opioids?
04:40 What are the stats on opioid addiction?
05:30 Why has it taken so long to find out the dangers of opioids?
06:44 What are other medications or non-medicinal options for people?
08:03 How can physiotherapists and other HCP’s help people who have been taking opioids long term?
10:36 How much interaction do you have with patients about alternatives to opioids?
12:32 Are there any signs of opioid dependence?
13:39 Are there certain medications that are over prescribed? Nerve pain medications?
15:24 What is the process like for someone to wean off opioids?
16:16 Can you tell us about your pain experience with your fall off your bike and dislocated elbow?
18:52 Any new insights from this injury?
19:34 Any advice you have for people who have gone through an injury and then developed chronic pain?
The Future of Physiotherapy
We speak with Prof Dave Walton, PhD, an associate professor at Western University School of Physical Therapy. Dr. Walton has been a strong advocate for incorporating technology into physiotherapy practice. In 2017, he traveled across Canada for the Physio Move Canada project to address the future of the profession. He speaks with us about a wide range of topics including:
- Artificial intelligence (AI) in rehabilitation
- Virtual reality (VR) in therapy
- Biomarkers for persistent pain
- Evolution of physiotherapy education
- The use of outcome measures in clinical practice
- And much more!
Merging Performance Training Principles with Rehab
We speak with Canadian Men’s National Basketball Team Performance Coaches Charlie Weingroff and Karamvir Gill about their experiences working with the team, getting injured athletes back to playing, and how training = rehab.
Visit Basketball Canada or Charlie Weingroff's website for more info.
00:28 Would you like to introduce yourselves?
01:02 Can you talk about your experience working for team Canada basketball and how you approach working together?
03:58 What’s your framework for developing a well-rounded strength and conditioning program?
06:17 At what level of sport or what age do you think it is important for kids to learn strength and conditioning?
08:22 There’s a lot of overlap between rehab programs and strength and conditioning programs. Do you look at those separately or together? How do you approach that?
10:08 What about if a player was recovering from an injury?
12:27 For physios or clinicians who aren’t working closely with a team but may be treating athletes, how would you suggest they communicate with the team coaches/strength coaches?
13:06 How can a physio at a clinic help to integrate their athlete back into their sports program?
16:34 How do you transition athletes back to playing? How do you determine when an athlete is ready to play again?
19:46 Do you use an athletes pain level as an outcome measure?
21:43 Do you incorporate pain science education into what you do with your athletes?
24:08 What are your opinions on biomechanics and how do you incorporate that into an athletes performance?
28:01 What are your thoughts on traditional physio equipment such as therabands?
28:56 Some physio clinics you go to, theres a treatment table, theraband, and weights up to 10 lbs. Do you think that is enough to get an athlete back to a high level of sport? Eg. A basketball player.
30:47 For clinicians who have not been taught a lot of strength and conditioning principles, do you have any recommendations on where they can learn that?
31:34 Do you think that strength training fundamentals should be taught in physio school?
33:02 Is there any technology that you see up and coming in this field?
33:31 Is there anything that you would like clinicians who don’t have a great idea of what you do to know?
37:19 Anything else you’d like to add in?
Blood Flow Restriction Training in Rehab
We speak with Johnny Owens, PT, from Owens Recovery Science. Johnny gives a great overview of blood flow restriction training and its use in the rehabilitation setting. This podcast covers a lot of ground, including:
- The basics and science behind blood flow restriction
- How to use it clinically
- What patient populations can benefit from BFR
- Risks and contraindications
- Future applications and research
- And more!
To find out more, you can listen to Owens Recovery Science podcast.
00:25 Can you introduce yourself?
00:58 How did you get started with Blood Flow Restriction (BFR) and what made you decide to start an educational company?
03:09 What is BFR and how does it work?
07:13 Is the research in this area new or has it been around a long time?
4.What is the theory behind BFR?
5.What is the current research on BFR and what is still unknown?
08:33 What are the main populations that can benefit from BFR?
11:20 Are there any contraindications to using BFR?
13:39 Do you have to have a certain occlusion pressure to get the effect?
16: 32 What are the risks with BFR?
18:52 Any neural or sensory issues from the compression?
21:20 What is your opinion on the cheaper pump up cuffs without Doppler ultrasound to determine limb occlusion pressure?
24:29 Is there are a minimum frequency that must be achieved with BFR to make clinically significant changes?
25:50 If the cuff has to be proximal to the area that is worked on, how can it be effective for something like shoulder rehab?
29:01 A few studies cite the 30-15-15-15 protocol. Is this just a generic approach to prescribing BFR based on current research or is there more flexibility in prescribing BFR?
33:24 Would you do multiple exercises in one session with the cuff on?
35:34 If someone can lift over 75% of their max, do you not use a cuff?
36:11 What about using BFR for non-injured athletes (for performance)?
39:01 What are your thoughts on non-health professionals using BFR?
40:59 Are there screening questionnaires for BFR?
42:18 When after an injury or surgery would you start using BFR?
45:33 What are some big unknowns you hope will be answered with future research?
48:04 What about use of BFR in hospitals?
48:55 Where can people find out more about you?
Crossfit and the Pelvic Floor
“Restricting activity in the hopes of saving your vagina is not holistic womens health”
We speak with Antony Lo (Musculoskeletal Physiotherapist based in Sydney, Australia) about pelvic health considerations in the female athlete and Crossfit training and injuries.
To find out more about Antony, visit: http://physiodetective.com
00:28 Can you introduce yourself?
00:55 What got you interested in women’s health?
03:05 How often do you treat males with pelvic floor dysfunction?
03:59 How do women perceive you as a male in this career path?
05:24 How do you explain what you do to women?
06:53 How do you assess what the pelvic floor is doing without an internal exam?
08:32 What are some of the biggest myths about pelvic floor dysfunction that you are hoping to dispel?
14:01 What are your thoughts on crunches and sit-ups?
17:20 How do you teach women to control their pressure system?
19:29 How did you get involved with crossfit?
22:10 Sometime crossfit gets a bad reputation because of injury and the structure of the workouts, what are your thoughts on that?
26:37 Are there any common injuries that you see with treating crossfit athletes?
28:49 How important is modifying load as a treatment intervention?
30:28 Do you find athletes have a hard time with being told what they can/cannot do when they are injured?
34:48 What cues do you use to teach pelvic floor contractions to an athlete vs. someone who’s not doing a high level of sports?
37:36 How do you explain to someone how much they should be squeezing?
38:44 How do you get people to the point where they can use that contraction in a functional movement?
40:14 Do you think that the pelvic floor should be discussed at the beginning for anyone in sports, or just if there is dysfunction present?
43:40 How do you get people back to a higher level of sport?
47:23 What are your thoughts on breathing and lifting?
50:28 What do you think about the use of weight lifting belts?
53:32 Anything else you’d like to touch on?
Integrating the Pelvic Floor and Breathing Into Fitness
"'If you just hold your tummy tight you’ll be fine’…we’ve communicated, stiff equals strong, but really that dynamic quality is more like function and fitness, we move and so that system needs to move too to mimic that”
We speak with physical therapist Julie Wiebe about the role of breathing and the pelvic floor in the core system, and how this can be integrated into fitness. Julie also discusses common patterns she sees in assessments and how changing these patterns can improve someones function.
Visit JulieWiebePT for more info.
00:29 Can you introduce yourself?
01:53 What are your thoughts on pregnancy and exercise?
03:14 Can you explain the core system?
04:26 How does breathing and the pelvic floor work together?
05:57 Why do you call that piston science?
07:15 How can someone’s breathing pattern become altered?
09:40 What are some common breathing patterns you see?
11:09 Is belly breathing a good strategy to use?
12:52 When do you assess peoples breathing pattern?
15:20 How do you pick up a patients breathing pattern in an assessment? Do you tell them you’re looking at their breathing?
16:19 Do you think that someone’s posture has a big effect on breathing?
17:33 How do you get people back to sports/activities?
19:08 How long does it take people to change their breathing pattern without having to think about it?
21:09 How often do you get people to use these patterns to reinforce the strategy?
22:31 How do you help athletes going back to sports where they cannot use an optimal breathing strategy?
24:45 Are there good and bad ways of breath holding?
27:52 How do you know how someone is using their pelvic floor with sport specific movements?
29:38 Do cues for breath holding change if someone is wearing a weight lifting belt?
32:41 For non-pelvic health physios, when would you recommend they refer to a pelvic health physio?
35:07 How do you test core strength?
36:11 What are the basic movements you look at in a first assessment with someone?
36:49 What are your thoughts on knee valgus with single leg squat?
39:14 Is there any research that involves the pelvic floor and core/breathing system?
42:05 Where can people find out more about you?
Tendon Pain and The Brain
"If you use a metronome to pace your strength training activity, what you get are the changes that you want at a muscle and tendon level, but you also get the changes to your motor cortex."
We speak with Dr. Ebonie Rio [Ba. App Sci, Ba Phys (hons), Masters Sports Phys, PhD] about tendon neuroplastic training, how the brain is involved in tendon pain and what the future holds for tendon rehabilitation.
To learn more about Dr. Ebonie Rio visit LaTrobe University
00:25 Can you introduce yourself?
00:39 What are your main areas of research?
01:05 Can you describe how the brain is involved in tendon pain and rehab?
03:12 As physiotherapist, how can we address this brain involvement?
04:36 Why use auditory cues? Why not visual cues?
05:52 How can you use a metronome clinically with patients?
06:52 With patients are you starting with slower speed and increasing speed as they are able to load their tendon more?
08:17 What rehab phases do you feel are necessary to restore a tendon to full function?
11:08 Why are isometrics so effective in reducing pain?
14:11 Does the exercise you are using to do an isomeric matter?
15:33 If someone has pain with heavy isometrics, does that mean they don’t have a tendon pathology?
17:23 What protocol works best? (Isometric vs. eccentric vs. heavy loading)
18:43 Is strength training important in rehab for someone returning to a sport like running where they don’t usually do strength training?
20:11 How do you monitor tendon load clinically?
21:32 How much pain are you are okay with patients experiencing with their exercises?
25:00 How often do you suggest people do quick loading during rehab?
26:05 What outcome measures do you use clinically?
27:23 Are there general time frames for recovery?
28:39 Why is there more research with tendons in lower extremity vs. upper extremity?
29:40 Are the major principles of treating tendon injuries the same across different tendons?
31:38 What are your thoughts on bracing for tendon injury
32:46 Do you think that virtual reality can have any use in tendon rehab?
36:11 What is still unknown in the treatment of tendinopathies? Do you think these unknowns can all be answered?
38:15 Where can people find out more about you?
Tendon Pain, Injury, and Rehab
“Pain and pathology aren’t necessarily related. So you can have profound pathology, profound degeneration in your tendon and have no pain”
We speak with professor Jill Cook [PhD, Grad Cert Higher Ed, PG Dip Manips, BAppSci (Phty)] about tendon pathology, pain, and rehabilitation.
Visit LaTrobe University to contact or find out more about Jill Cook.
00:25 Can you please introduce yourself?
00:54 Can you clarify the terminology for tendon pain? (tendinitis/tendinosis/tendinopathy)
02:01 Can you describe the structure of tendons and what makes them unique?
03:28 What happens with a tendon when there is injury?
04:28 If tendons do not recovery, how do people have success with physiotherapy and tendon loading?
05:15 Why are tendon injuries imaged?
06:39 How do you explain tendon pathology to a patient?
07:34 Are pathologic tendons more likely to rupture?
10:17 What are the differences in outcomes for surgery vs. non surgery with tendon ruptures?
11:25 Is surgery ever indicated for a tendinpathy?
12:31 In kids you don’t see many tendon ruptures, you usually see avulsion fractures first, why is this?
13:54 If there is tendon change with age, should older adults load their tendons less?
14:50 Is there anything that can be done to prevent age related changes in a tendon?
15:49 Are there any risk factors for tendon pathology?
16:46 How do you engage patients in a rehab program when research suggests exercise is the best treatment?
18:15 What are your thoughts on injectables? Do they change tendon structure at all?
19:54 What are your thoughts on shockwave therapy?
20:46 What about the role of manual therapy in tendon treatment?
22:16 Is there anything clinically that should not be done when treating a tendon injury?
23:56 How do you balance tendon load vs. pain with loading?
25:33 Is pain reduction a good indication of recovery?
26:51 What is the importance of the kinetic chain in tendon rehab?
28:26 Does all of the research for lower limb tendon injuries hold true for the upper limb as well?
29:40 If a tendon is overloaded, how can loading it change pain?
31:08 Is there a prognosis for tendon injuries in terms of how long it will take to improve?
32:28 For people with longstanding tendon pain, is it common for them to develop central sensitization?
32:28 What has been the evolution of tendon rehab and where do you see it going in the future?
35:25 Is there any inflammation with tendon pathology?
36:35 Why does rest not help with tendon recovery?
37:20 How comfortable are you pushing people into pain with loading?
38:18 How often do you suggest people load their tendons?
Ice or Heat After Injury?
"Why are we trying to decrease inflammation? Inflammation, the last I checked, was an amazing thing, it's a good thing!"
We speak with physiotherapist, Dr. Bahram Jam [D.Sc.PT, M.PHTY, B.Sc.PT, FCAMT], about the evidence behind the use of ice post soft tissue injury. Bahram also discusses the effects of ice, heat, and anti-inflammatories on the body's healing process.
To read Bahram's article on Ice and for references to studies visit:
00:28 Can you introduce yourself?
01:03 Patients often ask if they should use ice or heat for an injury. How do you answer that?
02:10 Do you think that peoples preference (ice vs. heat) has an influence on their pain?
03:35 Can you explain how the inflammatory process works and how ice would influence that?
06:49 Is there any research that ice may have a negative effect after acute injury?
08:28 What are your thoughts on ice baths and whole body cryotherapy as a recovery tool?
10:41 What do you think is the best way to reduce swelling?
11:42 What are your thoughts on Rice vs Price vs Police post injury?
13:21 What would you suggest to help with recovery for people with mobility restrictions eg. Non-weight bearing or in a cast?
14:11 A common use of ice is post-surgery. What are your thoughts on ice machines post-op?
15:54 What about the use of heat post injury?
16:50 What are your thoughts on the use of anti-inflammatories post injury?
20:42 What about the use of topical anti-inflammatories?
21:31 Where can people find out more about you?
Pain Experts Answer Your Top Questions
You asked, they answered!
Three top pain scientists - Prof Lorimer Moseley, Dr. Tasha Stanton, Dr. David Butler - answer your burning questions about pain science. This episode is live from the Pain Revolution event in Australia.
Thank you to all who contributed questions and special thanks to the online communities who collaborated with us to make this podcast possible: Trust Me I'm a Physiotherapist, PhysioTutors, Rethinking Physiotherapy, GetPT1st, InfoPhysiotherapy and Exploring Pain Science. Check them out on Instagram, Facebook, and Twitter.
00:30 What is pain?
01:24 What do you tell a patient who answers you "So it's just in my head?"
02:07 How can we change people's general knowledge (before they become "patients") about pain and pain management?
03:09 What metaphors and analogies do you use with your patients?
04:38 How much is it possible to deliver in a 20-minute clinical education setting? What would you focus on?
05:37 What are some exciting new advances in pain science that you think will impact clinical practice in the near future?
06:22 What is one piece of advice you would give to someone suffering from persistent pain?
07:11 Those of us in the profession like to dig deep in the science and research, but what the overall public is interested in is far more practical - what can we do? Data alone hasn't convinced many, how can we better explain what's going on in a simple, understandable way?
09:24 What are some exciting new advances in pain science that you think will impact clinical practice in the near future?
10:43 What are the biggest barriers in making physio and pain management move forward?
11:56 How do you see the role of manual therapy in both acute and persistent pain - assuming an ethical and accurate explanation (as opposed to a PSB model approach)
13:35 What is the most effective way to implement a pain science approach in chronic regional pain syndrome (CRPS), and how should medications be used during implementation?
16:44 What can you tell us about pain thresholds? Could a pain threshold be more about coping/ pain tolerance or is there an actual inter-individual difference on a neurological level, such as our perception, or even a nociceptor level?
18:45 Does the health industry need to change the way it understands and treats pain? if yes - what are your suggestions?
21:18 With the biopsychosocial model, there is often a focus on the psychosocial factors, where does the bio fit into all of this? Where does it come into play or are they thought of very separately?
23:09 How do you explain pain to an uneducated patient who thinks treatment is a quick fix? My challenge is breaking down the information simply enough for such patients to understand.
24:48 What changes do you think healthcare professionals need to institute in the treatment of acute pain, in order to help prevent transition to chronic pain states?
26:29 What is your go-to one liner to explain Central sensitization to your chronic pain patient? How do you explain this on day one without loosing the patient?
29:37 Please explain fibromyalgia.
31:10 How does stress and emotion contribute to pain manifestation at different sites?
34:14 Mindfulness, how can it be used to work with people’s pain management/ perception?
36:32 I want to hear their answer on a question asked by Mick Thacker: If pain is a perception, then how does the neuro-physiology involved go on to be become a higher centre cognitive function?
40:13 Children who fall over in the playground experience a broad range of responses from their parents ranging from a "toughen up" type of indifference right through to overt and excessive concern. How might these paren
The Future of Custom Foot Orthotics
"Some of the biggest manufacturers in Canada and the US often claim to make custom product when they’re actually using stock item shells and creating orthotics that are not actually unique to the patients feet."
We speak with Aaron Tran, pedorthist and founder of Orthogenic Laboratories, about custom foot orthotics - what they are, what conditions they help treat, how they're made, and how to tell if they are truly custom.
To find out more visit http://orthogeniclab.com
00:25 Can we start by having you introduce yourself?
01:06 Can you give us an overview of what Orthogenic Lab does?
01:42 What are the differences between the types of foot specialists?
03:28 What are orthotics and why are they important?
04:35 What types of conditions can orthotics help with?
05:22 Can orthotics help conditions that are not foot related, such as low back pain?
06:25 Are orthotics a temporary or long term solution?
08:12 Do you recommend that if someone has orthotics they use them all of the time?
09:43 What are the components of an orthotic? What are the purposes of the different layers?
10:16 What are the common materials used in orthotics?
10:57 Can you tell us the purpose of the different parts of orthotics?
12:21 Is there a difference between hard and soft orhtoics?
15:00 Do orthotics make your feet lazy?
16:03 What are the different methods of casting orthotics? How accurate are they?
18:50 What is the difference between a weight bearing vs. non weight bearing casting?
20:02 Once someone is casted, what is the process of making the orthotics?
22:46 What type of process do you use at Orthogenic Lab?
24:35 Do you think technology will keep changing your profession?
25:33 Do insurance companies cover the cost of orthotics made using a 3D scanner?
26:44 What is the difference between custom and off the shelf orthotics?
28:26 There have been a few articles about off the shelf orthotics being advertised as custom made. What are your thoughts on that?
30:50 Is there a cost difference between off the shelf vs. custom?
31:28 What should patients look for when purchasing orthotics?
33:01 Are there any regulations for selling orthotics?
34:40 What healthcare providers can prescribe orthotics?
35:55 How can healthcare providers who don’t prescribe orthotics screen a patient to see if they may be appropriate for them?
37:16 Are there any online resources for healthcare providers to learn more about different conditions orthotics may help?
38:10 Where can people find out more about you?
What Is Pain Neuroscience Education?
“If there’s no bio (in biopsychosocial), why are there physios?...For a long time we said every body has a brain, meaning don’t forget there’s a brain attached, but we have to also go backwards and remember that the brain has a body”
We speak with physiotherapist Adriaan Louw (PT, PhD, CSMT) about pain neuroscience education, including layman's explanations and metaphors to help patients better understand their pain. Adriaan discusses the science behind pain education and current research in this area. He also addresses the biosychosocial model, and the importance of including the bio in a pain science approach.
For more information visit www.ispinstitute.com
00:24 Can you introduce yourself?
00:42 What was your PhD in?
01:21 How did you get involved with pain neuroscience education?
02:18 Can you define Pain Neuroscience Education?
03:14 Can you give us a 5 minute layman’s explanation to describe pain?
06:47 What metaphors do you use to help patients understand their pain?
07:43 How does neuroscience education actually work to change someone’s pain?
09:24 What is the latest evidence to support this as a treatment intervention? How strong is this evidence?
11:04 What are some common pitfalls when explaining pain neuroscience to patients?
12:24 How do you change your explanations to suit the patient in front of you?
14:10 How do you explain the difference between acute and chronic pain?
16:10 How do psychosocial and lifestyle factors influence pain?
17:26 How do you like to address Pain Neuroscience Education when working with patients who are highly invested in the belief that structural pathology/biomechanical flaws are the source of their pain?
20:44 If a patient is seeing other health professionals who have been given other explanations about their pain, how do educate them without undermining the other HCP’s?
23:20 Depending on where you practice, there is very limited time during a treatment session. Do you have any strategies for therapists to incorporate pain neuroscience in that kind of setting?
25:44 It seems that the pendulum has swung heavily in favor of addressing the psychosocial aspects of chronic pain. How important is the bio aspect in chronic pain?
28:44 How do you explain why you are doing manual therapy to a patient?
31:26 Are there any specific words that you feel should never be used when educating someone about their pain?
32:53 What treatment approaches do you find work best for patients with allodynia and/or strong central sensitization?
33:50 How important do you think movement and exercise is in treatment?
34:25 What research questions are you hoping that get answered in the future?
37:21 Where can people find out more about you or your work?
Tips to Succeed as a New PT
In this episode, physiotherapist Darryl Yardley (FCAMPT, B.Kin (Hons), M.Sc.(PT), M.Cl.Sc.(Manip), Chair Private Practice Division – Canadian Physiotherapy Association, Founder - Mentorship Bootcamp) answers questions from students and new grads. Topics include job hunting and applying for jobs, contract negotiations, salary, building a caseload, and mentorship for both private and public sectors.
To find our more visit http://cpaprivatepractice.ca
00:37 Can you introduce yourself and your background?
02:38 Today we are getting your answers to some student and new grad questions that were collected from physiotherapy schools across Canada.
02:50 The first question is: What is the best way to build a caseload when first starting out?
06:01 Do you have any suggestions on how new grad can market themselves when they don’t have much experience?
08:00 One of the biggest questions that was asked is: What is the difference between an independent contractor and an employee.
12:08 As an independent contractor, when should you incorporate?
13:35 How do you make sure your billing number is being used appropriately?
16:35 How do you know if there is someone else using your billing number if it is public information?
18:55 For physios starting out, is it better to learn through experience or take a lot of courses?
23:42 Do you have any tips for physios starting in a clinic where there are already established PTA’s?
26:02 For those working in publically funded settings, how do you maintain quality care given restraints?
29:25 It seems like every hospital job wants 1-2 years of experience in the field. Seeing as new grads have limited experience through placements, how can they possibly demonstrate that they have the skills and experience to be employable?
32:24 If a hospital or clinic does not offer mentorship, how do you suggest that students or new grads seek out that external mentorship on their own?
36:08 In a hospital setting, how can new grads get full time employment?
39:04 How difficult is it to transition from hospital to private practice and vice versa?
41:10 There seems to be a perception that private clinics lead to a bigger income compared to hospitals? Does this hold true in the long run (5-10 years) with benefits and pension factored in?
44:05 Where should new grads start when looking for a job?
47:11 Do you recommend applying for jobs even if you don’t have the required experience?
48:53 What is negotiable in a contract?
49:52 Are there any questions you feel new grads should ask in an interview?
53:27 What starting salary should a new grad expect?
55:55 How often should you renegotiate your contract?
58:24 Are there any ethical issues/business red flags that new grads should be aware of when job hunting or starting out at a new clinic?
1:02:56 How long should you practice before opening your own clinic?
1:07:15 What are some benefits of being a CPA member?
1:09:33 Where can people find out more about you?
An Overview of Medical Injection Therapy
"Degenerative change is not something we really want to put cortisone in and around if we can avoid it, because the pathology in that situation is not inflammation...On top of that you've added a drug that can be degenerative to tissue that already is degenerative, and for that reason again I'm reluctant to use cortisone in most situations."
In this podcast, Dr. Douglas Stoddard (MD, Sports Medicine Physician and Founder of RegenerVate) gives an overview of therapeutic medical injections, including: Cortisone, Prolotherapy, Viscosupplementation, Platelet-rich plasma (PRP), and Stem cells.
These injections are used to treat a variety of musculoskeletal injuries and are considered if conservative treatment fails. Controversy still exists around regenerative and non-regenerative injections. Conflicting research shows either favourable or unfavourable results depending on the type of injection. Whether medical injections will be standard in musculoskeletal medicine remains to be seen.
00:28 Can we start by having you introduce yourself?
00:44 So what are the different types of injections used in sports medicine?
02:01 What are the differences between the injections? How do you determine which one to use?
03:33 What are the physiological mechanisms of how these injections work?
04:30 Can you explain the procedure of these types of injections?
06:27 Are all the injections done using ultrasound guidance or just the PRP and stem cell?
06:57 With stem cells, are there different types of stem cell procedures?
07:35 What are the criteria for someone to be eligible for these treatments?
09:04 So for healthcare practitioners who treat that level 1, at what point would you say that they should refer a patient on to discuss injections?
10:16 How long do the results of the injections normally last?
11:15 For someone who does get an injection, do they need to then continue with those level 1 interventions, like physiotherapy, after the injection?
12:19 Are there are specific protocols that therapists should be following for patients post injection?
12:54 What are the risks of the injections?
16:01 Are there any patients who you would not give an injection to, for example someone with a lot of comorbidities?
17:55 What are you noticing clinically with your outcomes of these injections?
19:15 How do you determine whether an injection is successful? Is that largely based off of the patients’ report of pain levels and function?
20:38 What is your opinion on the use of corticosteroids in sports medicine?
23:05 For a patient wanting a repeat cortisone injection, would you direct them more towards the regenerative injections?
24:04 With any of these injections do you do imaging before to find out the condition of the tissue?
26:04 I know there’s a bit of skepticism around PRP and stem cell injections because they’re still consider new and there’s not a ton of research on them and they haven't been proven in clinical trials. So what are your thoughts on this?
29:37 Are there any regulations around the field of regenerative injections?
32:19 Where do you see the future of these types of injections going?
33:45 What is the training like to be able to provide these services?
34:37 Where can people find out more about you?
The Neurodynamics of Peripheral Nerves
"What I’ve learned is that when a muscle becomes wasted, its not just because of a lack of impulses from the nerve into the muscle, its not just a lack of activity, it’s being told by a trophic factor produced by the nerve to get wasted"
We speak with physiotherapist Michael Shacklock (DipPhysio, MAppSC, FACP, NDS Instructor and founding director) about neurodynamics, nerve dysfunction, the anatomy and physiology of the nervous system, diagnosis and treatment of peripheral nerve disorders, and patient education.
Check out the summary video we did with Michael on Why Do Nerves Become Hypersensitive?
To find out more about Michael, visit his website, Twitter, Facebook and Instagram.
Shownotes:
Neural Mobilization: Treating Nerve-Related Musculoskeletal Conditions
00:29 Can we have you introduce yourself?
02:05 Can you explain what neurodynamics are?
03:22 Are there any terms that are important to understand when discussing neurodynamics?
04:12 Can you provide a layman’s explanation of the function of nerves and how structure relates to its function?
05:17 What are the mechanical properties of nerves?
06:54 How much mechanical load can a nerve tolerate?
07:35 How do nerves become injured or sensitive? What is the physiological response in the nerve?
08:41 How about with ischemic injuries?
09:52 How does the nervous system respond to movement and why is movement effective?
12:13 Clinically can you determine elongation values?
13:14 Can you describe the difference between a sensitive nerve and a damaged nerve?
14:37 Do neurodynamic tests and medical tests if there’s a nerve condition look at the same thing?
15:37 What medical tests or subjective history may point to a nerve issue?
16:17 What constitutes a positive neurodynamic test?
18:40 Can neurodynamic tests selectively load or bias a specific nerve or nerve root?
19:45 What exactly is occurring in the body when you perform a sensitizing movement?
21:45 Can you explain what double crush syndrome is?
23:38 What has been the evolution in the treatment of nerve issues?
26:53 How important is treating the mechanical interface?
28:22 How long does it take a sensitive nerve to return to normal?
29:36 Can you discuss chemical irritation a bit more?
30:46 What are some common misconceptions surrounding nerves and nerve pain?
There are some common explanations that you hear when clinicians explain nerves, and we’d like your opinion on them:
32:34 - a nerve is like a telephone wire.
33:07 - Your nerve is stuck?
35:46 - When you’re doing neurodynamic exercises you’re stretching nerves
36:37 Can you give an example of how you would explain a nerve issue?
37:24 When hearing the word swollen, do some patients think that they have a big inflammatory resp
The Challenges of Starting and Growing a Rehab Clinic
Sanjeev Bhatia (CEO and co-founder of Clinic Space) returns as guest host to interview Charlotte Anderson (PhD(c), MScPT). Charlotte is a physiotherapist and owner of Alpha Health Services, a multi-disciplinary rehab clinic she started over 4 years ago. In this podcast, they explore the challenges of starting, managing and growing a private practice.
You can follow Sanjeev on Instagram @thesanjeevbhatia or find him on LinkedIn.
To find out more information about Charlotte visit https://www.alphahealthservices.ca
This Business Series is in partnership with the CPA Private Practice Division. Check out http://cpaprivatepractice.ca for more great business content and stay tuned for the next instalments of the business series.
The Mulligan Concept of Mobilization With Movement
"The real key with the Mulligan Concept and its effectiveness is that you know you're in the right place, doing the right technique, in the right direction, with the right grade while you're doing it, by symptom abolition."
We speak with physiotherapist Jack Miller [BSc(PT), DipMT(NZ), MClSc, DPT, FCAMPT] about the Mulligan Concept, including common terminology, techniques used, and current research. Jack also discusses the structure of the Mulligan Concept courses that he teaches.
To find out more about Jack Miller and the Mulligan Concept visit www.mulliganconcept.ca
00:24 Can you introduce yourself?
00:52 How did you get involved with the Mulligan Concept?
01:41 Can you explain what the Mulligan Concept is?
03:18 Can you explain the terminology used with the Mulligan Concept?
04:06 What body areas can this concept be used on?
05:16 What are the basic principles of the Mulligan technique?
07:15 How do you determine what technique to perform?
08:41 How do the techniques change when the condition is acute vs. chronic?
09:34 How do patients maintain any improvements that they get during treatment, are there specific Mulligan exercises they are given?
10:25 Is there any equipment needed?
10:42 What research has been done on the Mulligan Concept?
11:44 Why do you think the Mulligan techniques are effective?
13:33 When would you use a Mulligan technique vs. a passive manual therapy technique such as a joint mobilization?
14:35 What is your opinion on the relevance of manual therapy to patient outcomes?
15:46 What do you teach at your courses?
16:51 Where can people find out more about you?
How To Efficiently Run Your Own Practice
“You can give someone all the tactics, all the strategies. You can even give them the processes, the training material, get team buy in. But if you can’t execute, and you can’t deliver, then you’ve dropped the ball. So what I’ve learned is execution is everything.”
We speak with Sanjeev Bhatia (CEO and Co-founder of Clinic Space) about how to efficiently run and automate your practice and how the patient experience is the common thread that ties it all together.
You can follow Sanjeev on Instagram @thesanjeevbhatia and LinkedIn
This Business Series is in partnership with the CPA Private Practice Division. Check out CPA Private Practice Division for more great business content and stay tuned for the next instalments of the business series.
00:42 Can you introduce yourself?
03:25 How do you define clinic operations?
04:41 Why is it important to have your operations in place?
05:51 How do you systematize different parts of the clinic? Can all parts of a clinic work in this way?
12:05 Employee training would be important to make sure things run smoothly and to get a great patient experience. How do you make sure that is executed from an organizational level?
16:54 Part of patient experience is the treatment they receive. With big clinics, how do you reduce inconsistency between providers?
20:23 In your opinion, what separates a bad clinic from a good clinic, or a good clinic from a great clinic?
22:13 What are some top mistakes you see business owners make?
23:22 Why is it important for the clinic owner to understand about all of the clinic operations?
25:11 How does a therapist wanting to branch out into owning a business transition to that business owner role?
26:25 What are the most important things that you believe you need to have in place when starting a clinic?
28:12 Do you think smaller companies will have a harder time attracting new business with all of the larger companies that are expanding?
30:05 What role do you think technology will play in the future?
31:58 From a business perspective, where do you see the future of the therapy professions going?
33:43 With all of the advances in technology, how can current clinic owners keep up with all of these changes?
35:06 Many business rely on patients having benefits and insurance coverage for treatment. Do you see any trends towards declining insurance coverage?
37:18 What challenges do you see for the rehab profession as a whole?
38:46 Where can people find out more about you?
Myths and Facts About Pelvic Health
“Common is very different than normal…1-in-3 to 1-in-4 women struggle with incontinence…but its not normal, it means there is a dysfunction”
We speak with physiotherapist Carolyn Vandyken (BHSc (PT), Pelvic Health Physiotherapist, Owner & Instructor of Pelvic Health Solutions) about pelvic health, including common conditions, myths, prevalence in men and women, and how pelvic health physiotherapy can help. Carolyn also discusses what all rehab professionals should know about the pelvic floor and how they can screen for a pelvic floor dysfunction.
To learn more or to find a pelvic health physiotherapist go to http://pelvichealthsolutions.ca
00:24 Can you give a brief background of yourself and what got you interested in pelvic health?
03:16 Can you describe what you do as a pelvic health physio?
04:17 There’s a lot of myths surrounding pelvic health, what are your thoughts on:
04:27 is pelvic rehab is mainly for during/after pregnancy?
05:27 Is pelvic physio mainly for women?
06:40 Is pelvic physio all about the pelvic floor?
07:22 Are kegels the main exercise in pelvic rehab?
09:15 Should women who do not have any pelvic floor problems be doing kegels?
10:54 What are the different types of incontinence?
12:05 Many women think its normal after pregnancy to have some incontinence, is it normal?
12:48 Is incontinence normal as you age?
13:35 Can pelvic rehab be done at any age?
14:10 What are the benefits of pelvic rehabilitation?
16:38 What common conditions do pelvic health physios treat?
18:00 Are there any conditions that you treat that people may be surprised by that aren’t as common?
19:23 What anatomy is important to consider when discussing pelvic dysfunction?
19:51 What are some red flags for the pelvic region?
20:29 Are there any questions you think should be asked in a normal orthopedic exam to screen for pelvic dysfunction?
22:03 Are there any objective tests that should be assessed by orthopedic physios?
23:14 Do all pelvic floor assessments include an internal exam?
24:51 Do you assess breathing in your assessment?
25:14 Are overactive pelvic floors common in men as well?
25:55 What about in weight lifters and people who use a valsalva maneuver when they’re working out?
27:13 What are your thoughts on weight lifting belts or SI belts?
28:25 What are common pelvic physio exercises?
30:31 Is the treatment for pelvic pain similar to other areas of the body?
31:14 Do you see more persistent or acute cases?
32:39 In your article on sexual pain the average length of time to diagnosis was 8 years. Is that length due to patients not reporting their sexual pain or it being under-recognized by healthcare providers?
33:37 Do you find acupuncture helpful in treating pelvic pain?
35:08 What neurodynamic tests do you use for pelvic pain?
37:27 Is there any specific equipment you use in assessment or treatment?
38:30 How important is a multidisciplinary approach in treating pelvic pain?
39:20 Do you think other healthcare professionals are beginning to recognize the value of pelvic health physio?
41:38 What areas would you like to see more research in?
42:34 For someone not familiar with pelvic health physio, can you explain the patient experience when visiting a pelvic health specialist?
44:23 Is there an internal component during treatment as well?
45:01 How do you explain pelvic pain to a patient?
47:51 For patients who are on antibiotics for chronic bladder infections, should they be screend for pelvic floor dysfunction?
48:41 Is there anything that you would like potential patients to know?
49:52 What
How Vision Affects Learning and Concussion Recovery
"When I deal with a patient who's had a concussion, you're not just dealing with the concussion, you're dealing with the concussion plus all of the pre-existing history"
We speak with Dr. Patrick Quaid (Optometrist, FCOVD, PhD) about his background in optometry and his focused interest in vision rehabilitation for patients with learning difficulties and concussions. Dr. Quaid discusses common symptoms/complaints that may indicate an underlying vision issue in these populations, as well as treatment strategies used in vision therapy.
To learn more about Dr. Patrick Quaid visit Guelph Vision Therapy Center at http://www.gvtc.ca
For more information about vision therapy visit http://www.covd.org
00:26 Can you introduce yourself and give a brief background?
00:52 What got you interested in optometry?
02:25 Do you have a focused interest in your practice?
04:34 As an optometrist, how do you categorize or think of the visual system?
07:15 Are there different aspects within central and peripheral vision that can be assessed?
12:17 Is the fact that the visual system makes up 40% of the brain what makes it so prone to dysfunction?
17:26 Do you ever see balance issues the opposite to normal where if someone with a visual issue closes their eyes their balance improves?
20:43 Can you give us an overview of childhood learning issues and what you normally see in the clinic?
28:00 Are these types of issues tested in a standard eye exam?
31:30 Do you think that children with learning difficulties are slowly getting more help with vision therapy or do you think it is still an understated area?
34:40 Do you think there should be some baseline testing outside the standard eye exam for kids?
37:44 Are there any visible indications that can lead you to believe that someone may have an eye issue and should be tested?
39:54 How young do you start to treat kids?
44:11 Do you think the link between concussion and neck issues has any effect on the visual system?
49:32 Do you think it is plausible that patients who seek out physiotherapy treatment for neck muscle guarding may have some underlying vision issue?
52:16 Are there any red flags health care practitioners should be aware of regarding vision issues?
56:14 Are there any common statements that patients may make that may indicate a vision issue?
1:00:51 Is there any link between dyslexia and vision issues?
1:05:32 You used to hear the saying “don’t sit too close to the tv, its bad for your eyes”. Do you think the amount of technology that kids are using now can have an impact on their vision?
1:12:04 If you have laser eye surgery and you go back to putting a lot of strain on your eyes can your vision get worse again?
1:15:17 Why and when would you use prisms?
1:19:25 How do you get someone to the point of not needing prism or lessening it?
1:23:59 Where do you see vision therapy going in the future?
1:27:41 Where can people find out more about you?
Marketing and Branding Tips for Health Professionals
"By focusing on brand first you start to create a bit of differentiation, and you start to create a better position in the market for what you stand for"
We chat with Scott Marcaccio, CEO and Co-founder of Myodetox about tips on how to market, brand, and scale a rehab clinic. Scott was previously a marketing executive before jumping into the world of rehab/therapy. You can follow Scott on Instagram @scottmarkk and Myodetox @myodetox or www.myodetox.com
This Business Series is in partnership with the CPA Private Practice Division. Check out www.CPAprivatepractice.ca for more great business content and stay tuned for the next instalments of the business series.
00:27 Can you introduce yourself?
00:59 Can you tell us the origin story of Myodetox?
02:13 What is your opinion of the rehab industry?
03:15 How important is marketing to growing a clinic?
04:03 Why focus on brand first?
04:51 What is a brand? Is it all about the logo and name?
06:18 In terms of branding and marketing, what advice do you have on where to start when opening a clinic?
07:50 How can a clinic owner differentiate themselves?
08:29 Do you think that clinics should do their own marketing or hire someone else to do it?
09:41 Can you discuss Myodetox’s use of social media for marketing?
11:20 Can you talk about where Myodetox is headed now?
13:30 For someone who doesn’t have much time, how would they prioritize the different social media channels?
14:34 Besides online marketing, what are some other growth strategies that can be used to grow a business?
15:15 Should clinics involve their team in the marketing efforts?
16:40 Should therapists be marketing themselves under the businesses brand or their own personal brand?
18:36 What would be your advice for clinics to help retain their therapists?
20:10 Any advice for recruiting therapists?
21:25 Any advice for clinics on when they should be hiring new therapists?
22:30 How do you finance and scale a service based business?
23:50 Is there anything that a clinic should have in place before it expands?
25:41 How do you maintain company culture when you’re scaling?
26:46 What are the biggest challenges that you faced when expanding?
27:47 Why did you choose to expand Myodetox so quickly?
28:48 When you’re opening new locations what marketing strategies do you use to gain traction?
30:09 As the CEO of Myodetox, how do you keep up with that learning curve of growing so quickly?
31:02 Where do you see Myodetox going over the next few years?
Rapid fire questions:
31:32 Top 3 books?
31:57 Top 3 podcasts?
32:39 Top 3 software tools?
32:51 Biggest epiphany that changed your mindset?
33:31 Best advice you’ve ever been given?
33:46 Best advice you can give to a business owner?
34:42 Where can people find out more about you?
The Scientific Basis of Neurofunctional Acupuncture
"Traditional acupuncture is the bicycle, electroacupuncture is the motor bike"
We speak with Dr. Alejandro Elorriaga Claraco [MD (Spain), Sports Medicine Specialist (Spain), Director McMaster University Contemporary Medical Acupuncture Program] about the science behind both traditional and neurofunctional acupuncture and their similarities and differences. Alejandro also discusses his evolution as a clinician and his integration of neurofunctional acupuncture in the treatment of high-level athletes.
To learn more about Dr. Alejandro Elorriaga Claraco and Contemporary Medical Acupuncture, visit www.mcmasteracupuncture.com
00:24 Can you introduce yourself?
01:36 Can you give us an overview of how your approach to treatment has changed over the years?
03:04 How did you come to use acupuncture?
04:15 Can you describe the neurofunctional approach and what makes it unique?
07:37 Can you give us a specific example of how you would structure this approach when working with a patient?
15:16 Can you give an example of the different levels you would target, for example, for someone with a sprained ankle?
18:38 How would that approach differ for a persistent pain case?
22:37 There are a lot of research studies that cite the lack of quality evidence to support acupuncture and its use in treating pain. What are your thoughts on this?
29:54 Can you give us a background on Traditional Chinese Acupuncture and explain how your approach is different?
34:57 Are there any similarities between the two approaches?
37:36 Is there a scientific reason why the meridian points are so effective?
41:35 Can you discuss electro-acupuncture? How you started using it and what makes it effective?
47:50 For long term changes, is the amount of acupuncture treatments using electo-acupuncture less than with conventional acupuncture?
54:43 Are there any populations who you would not treat using acupuncture?
55:06 What can a patient expect to feel during an acupuncture session?
58:21 How would you explain the benefits of acupuncture to your patient?
59:48 Are there any risks to acupuncture?
1:02:04 Have you had a patient have a negative reaction?
1:03:04 How do you use the acupuncture approach when treating athletes?
1:06:53 Can you share a memorable story about using this approach in an athlete?
1:09:12 How can people find out more about you?
The Future of Physiotherapy Education: Canada's First DPT Program
We speak with Rob Werstine [HBA, BSc(PT), MSc(PT), Dip Manip, Dip Sport, FCAMPT], physiotherapist and co-director of Key Clinical Skills, a company offering Canada's first transitional Doctorate of Physical Therapy (DPT) program. In this talk we discuss the evolution of physiotherapy in Canada and how many countries are moving towards a more specialized designation - the doctorate degree. Rob discusses the challenges of introducing this program to Canada, how it fits within the current educational landscape, the reasons for creating this program, and much more!
To learn more about this program, visit www.keyclinskills.ca or www.EIM.com, and follow them on twitter @KeyClinSkills
00:28 Can you introduce yourself?
00:52 Can you explain what the DPT program is? What is its purpose?
01:22 From a greater perspective, do you see entry level program in Canada transitioning to DPT in the future, similar to the States?
02:48 Why did you decide to bring a DPT program to Canada now?
06:57 Does completion of the DPT expand a clinicians scope of practice?
08:23 What is the admission criteria?
09:11 What is involved with the program? Online or in-person?
12:27 What is covered in the weekend intensives?
15:02 Who are the instructors for these weekend intensives?
16:23 How does the DPT integrate with other post-graduate programs? For example FCAMPT?
18:42 What are the differences between this program and other post-graduate programs?
20:30 How long has this program been running?
21:20 How has the program been received so far?
22:09 Are the weekend intensive courses offered across Canada?
23:06 Where can people find out more about the program?
The Inner Workings of TMJ Dysfunction
"If you help a patient with back pain, they're going to be grateful. If you help a patient with TMJ dysfunction, they're going to leave you in their will"
Physical therapist, Dr. Erson Religioso III [DPT, MS, MTC, Cert. MDT, CFC, CSCS, FMS, FMT, FAAOMPT], speaks with us about the temporomandibular joint (TMJ) dysfunction, including anatomy, typical clinical presentations, and treatment. Erson also discusses business tips for those specializing in TMJ dysfunction.
To learn more about Erson, visit his websites:
Modernmanualtherapy.com
MMTmastery.com
IASTMtechnique.com
Edgemobilitysystem.com
Or connect with him on Twitter @The_OMPT
00:29 Would you like to introduce yourself?
01:19 Have you ever had a patient bite your hand?
02:26 What got you interested in TMJ dysfunction?
04:48 When marketing to dentists, did you get any pushback that you were encroaching on their territory?
08:43 Can you briefly describe the anatomy of the TMJ?
11:38 What are some typical patient presentations that you would see?
13:08 Can you explain how that disc works?
15:32 If someone has a click but they don’t have any other symptoms, would you still treat that?
16:30 Are there any common triggers that may lead to TMJ issues?
17:49 Do you see any post surgical cases?
18:40 For clinicians who don’t see a lot of TMJ patients, are there any red flags that they should be aware of?
20:17 How would you approach the assessment of TMJ?
21:58 Can you discuss posture and TMJ issues?
23:46 Do you use any modalities or acupuncture?
25:15 Is a lot of your treatment active?
25:56 When do you find it necessary to refer a patient to a different healthcare professional, such as a dentist?
26:47 Do you find most people respond quickly to treatment?
28:25 Are there certain dentistry procedures that can start or exacerbate TMJ issues?
29:38 What are your thoughts on mouth guards?
30:29 Are there a lot of co-morbidities associated with TMJ dysfunction?
31:36 So how do you deal with the psychosocial aspect?
33:19 Are there any common mistakes that clinicians make when dealing with TMJ issues?
34:44 Do you have an eclectic approach to the TMJ?
35:48 What language would you use to explain a TMJ issue to a patient?
36:30 Where can people find out more about you?
Therapeutic Alliance Enhances Patient Outcomes
"The way a patient responds to treatment is probably 50%, or maybe even more than 50%, directly related to our personal interactions"
Physiotherapist, Jasdeep Dhir [BSc(PT), TDPT, MClSc(MT), FCAMPT], speaks with us about therapeutic alliance, including the importance of interpersonal skills to improve treatment outcomes. Jasdeep also discusses strategies for making a good first impression, improving patient interactions, and evaluating your interpersonal skills.
To connect with Jasdeep Dhir, visit her LinkedIn (https://www.linkedin.com/in/jasdeep-dhir-0a2b5021/) or follow her on Twitter @JasDhirPT
Links to studies:
Pinto et al. Patient-centred communication is associated with positive therapeutic alliance: a systematic review. 2012. (https://www.ncbi.nlm.nih.gov/pubmed/22613237)
Ferreira et al. The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. 2013. (https://www.ncbi.nlm.nih.gov/m/pubmed/23139428)
Fuentes et al. Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. 2014. (https://www.ncbi.nlm.nih.gov/pubmed/24309616)
00:25 Can you introduce yourself and your background?
01:13 Can you define soft skills vs. hard skills?
02:20 Why are interpersonal skills important?
03:12 Can you share some of the current research on this topic?
07:05 Can these interpersonal skills be taught?
08:10 What do you think some common mistakes are that clinicians make when communicating with patients?
08:54 Can you give some examples of good and bad non-verbal communication skills?
10:05: Can you give some examples of good and bad verbal communication with patients?
12:00 So how do you make a good first impression with a patient?
13:26 What are some strategies for clinicians to evaluate their interpersonal skills?
14:20 What are some techniques that can be used to improve your patient interactions?
15:44 Any strategies to quickly establish trust and a healthy therapeutic relationship?
16:31 Any tips for new graduates to convey confidence with a patient?
17:36 Do you have any other interesting information or facts to share?
18:55 Where can people find out more about you?
Debunking Common Chiropractic Myths
"A lot of the things that we have to spend time dispelling in our practice are myths that patients come in with"
Chiropractor, Dr. Shawn Thistle [B.Kin (Hons.), D.C., Medical Acupuncture, ART, CSCS, F.R], speaks with us about common chiropractic myths. Shawn also discusses his business, RRS Education, and how clinicians can stay up to date with current research.
To connect with Dr. Shawn Thistle, visit his website www.shawnthistle.com and to learn more about RRS Education visit www.rrseducation.com
00:28 Can you introduce yourself and your background?
01:26 Can you tell us about your company, RRS Education?
07:12 Can you briefly describe what chiropractic medicine is and what it isn’t?
09:21 Many chiropractors and physiotherapists treat similarly, so what is the difference between the two?
11:37 What are the biggest myths that you have to dispel as a chiropractor?
What are your thoughts on the following myths:
16:55 - Chiropractors are back specialists only
19:02 - Chiropractors always do spinal adjustments
21:46 - Adjustments are scary
26:09 - Bones can slip out of place and getting an adjustment re-aligns the bones
28:25 - X-ray can show proof of misalignment and before/after x-rays can show a difference in alignment
31:21 - Chiropractors can treat nearly anything including diseases with spinal manipulation
34:27 Are there any other myths you’d like to discuss?
37:31 Do you think educational programs stay up to date with the evidence?
40:00 Do you have any tips on staying current with the research?
44:31 Sometimes you hear stories about marketing tactics by chiropractors such as long-prepaid treatment plans. What are your thoughts on this?
47:06 Where can people find out more about you?
How Does Concussion Affect Vision?
Optometrist, Dr. Shirley Blanc (B.Sc., O.D.), talks with us about the relationship between concussion and visual dysfunction, including prevalence, signs and symptoms, and treatment strategies. Dr. Blanc highlights the difference between a Standard Eye Exam and a Neuro-optometric Assessment, and explains how you can have 20/20 vision post-concussion, yet still have a visual dysfunction.
00:24 Can you please introduce yourself?
01:02 How did you get involved in concussion and neuro-optometry?
01:47 There is a saying that the eyes are the window to the brain? Would you agree with this?
02:51 Why is vision affected after a concussion?
03:30 What is the prevalence of vision problems after a concussion?
03:52 What vision symptoms can be present following a concussion?
04:32 Can a standard eye exam diagnose a visual system dysfunction?
05:23 What are some eye abnormalities that you may find in a more detailed occulomotor screen?
06:06 Can eye movements give clues between an inner ear vs a central problem vs other brain areas?
07:52 What are some treatment strategies for post-concussion vision problems?
08:28 How do you explain vision problems to a patient after a concussion?
09:33 How important is collaboration among different health professionals in this population?
10:29 When should a health professional who does concussion rehabilitation refer their patient to an optometrist specializing in concussion?
11:08 Can you share a little known fact about concussion and vision?
12:13 Is there anything else you’d like to share?
13:02 Where can people find out more about you?
The Many Benefits of Exercise
00:23 Can you introduce yourself?
00:39 What areas do you practice in?
00:52 What are the benefits of exercise?
01:44 What are the effects of exercise on mental health?
02:09 Are there specific types of exercise that are need to be done to get these benefits?
02:49 Does raising your heart rate from other means such as stress or caffeine provide the same benefits?
03:30 Can exercise negate or lessen the effects of unhealthy habits (e.g. Smoking, poor nutrition, alcohol consumption)?
04:14 Is sitting the new smoking?
04:57 What are your thoughts on standing desks?
05:25 How much exercise is needed to offset a sedentary lifestyle?
06:06 Are there studies to support this?
06:24 Do studies look at other variables in someone’s lifestyle (e.g. nutrition)?
06:48 What is your opinion on devices for monitoring step count and fitness levels?
07:42 Where did the number of 10,000 steps per day come from?
08:34 Are there different recommendations based on age or is it more so based on health?
08:50 What are the effects of immobility or bed rest in chronic populations?
09:44 Can you share the latest research for COPD and exercise?
10:49 Are there any populations for whom exercise may be dangerous?
11:47 Is there a science to breathing properly and does that have an effect on the body?
12:51 Do you think there will ever be a replacement for exercise?
13:13 What are some strategies that people can use to make exercise part of their day?
14:34 How about strategies for people with a sedentary job?
15:03 Is there anything lacking in research that you hope may be explored in the future?
16:16 Are there any interesting facts you’d like to share?
Exercise Is As Effective As Surgery in Rotator Cuff Shoulder Pain
"Shoulder special tests are not that special"
"For the vast majority of [shoulder] conditions...its probably impossible to be certain exactly where the symptoms are coming from"
We speak with Dr. Jeremy Lewis (PhD, FCSP, Consultant Physiotherapist, Professor of Musculoskeletal Research) about rotator cuff shoulder pain, including issues relating to shoulder special tests, medical imaging, and research which reports that, for most people, exercise is as effective as surgery.
To connect with Jeremy, visit his website http://www.londonshoulderclinic.com or follow him on twitter @JeremyLewisPT
00:25 Can you give us a brief background?
01:33 Can you describe each of the following hypotheses, how they started, and what the research supports?:
01:42 - Shoulder impingement
06:22 - Rotator cuff tears
07:23 - Shoulder special tests
09:56 - Shoulder imaging and pain
12:32 - Shoulder surgery
14:14 - Posture and shoulder pain
16:24 Why do you think that all of these hypotheses are still prevalent despite the research?
18:13 How did you come to question these hypotheses and how have they changed your practice?
19:10 Do you think that clinicians should change their practice based on the research?
20:37 Do you think that we should abandon the traditional shoulder special tests in assessments?
22:01 Do you think there is such thing as a bad shoulder exercise?
23:05 What about exercises people do in the gym that aren’t considered functional positions? (E.g. Behind the neck military press)
25:06 Can you explain your shoulder symptom modification procedure and how you incorporate it into an assessment?
28:18 Does the shoulder symptom modification procedure drive your management decisions?
29:10 How do you explain a shoulder issue to a patient who wants a specific diagnosis?
30:47 Do you feel is the biggest mistake that clinicians make when dealing with the shoulder?
31:39 Are there any specific kinetic chain factors you assess that may influence the shoulder?
33:29 What are some psychosocial factors that contribute to shoulder outcomes?
35:27 Can you share one interesting and little known fact about the shoulder?
36:51 What are some unknowns about the shoulder that you hope will be answered in future research?
38:57 How can people learn more about you?
Perfect Posture Is A Myth
Posture is important, but do we overemphasize its importance when it comes to injuries and pain?
We speak with Dr. Greg Lehman (BKin, MSc, DC, MScPT) to explore when biomechanics and posture are important and when they're not. Greg also shares current research on the relationship between biomechanical factors and pain, challenging common beliefs of both patients and clinicians.
To connect with Greg, visit his website http://www.greglehman.ca or follow him on twitter @greglehman
00:26 Can you introduce yourself?
00:55 What got you interested in biomechanics and pain science?
01:46 What are common beliefs among both patients and clinicians regarding posture, biomechanics and pain?
02:53 When do you feel biomechanics and posture are important vs not important?
04:20 What does the research support?
05:31 What are your thoughts on structural abnormalities (e.g. Scoliosis, leg length discrepancy) and their relationship to pain?
06:53 Should clinicians abandon the biomechanical model?
08:07 What is the non-biomechanical reason why posture can change pain?
09:55 If someone is in pain, why does changing posture help reduce it?
10:58 What are the biggest mistakes clinicians make when educating patients about their pain?
12:27 If I was a patient, how would you educate me on why changing my posture can help to decrease my pain?
13:11 Can you give us a patient success story?
13:56 Can you give a patient failure story?
14:54 Do you think biomechanics become more important for high level performance once a patient is out of pain?
16:40 Can you give some specific examples of high-level athletes or sport movements that don’t follow the normal “efficient” movement pattern?
18:07 What are you thoughts on movement assessment systems?
19:12 Can you talk a bit about your workbook?
20:10 What do your days look like now? What are you involved in?
21:03 How can people find out more about you?
Are Your X-ray and MRI Results Helpful or Harmful?
"I can't run, I have arthritis"
"It hurts to bend forward because of my bulging disc"
People are always blaming their pain on their medical imaging results, but how much do your x-ray and MRI findings actually correlate with your pain?
We speak with physiotherapist, Dr. Bahram Jam, about common medical imaging results, their correlation with pain, and how to incorporate these results into your practice. We also discuss the impact of imaging on the healthcare system and the over-medicalization of pain, which can lead to poorer patient outcomes.
To learn more about Dr. Bahram Jam, read his clinical articles, and download a free VOMIT poster (now titled "Medical Imaging: The Untold Truth"), visit his website www.aptei.ca
00:27 Can you introduce yourself?
01:03 Can you share your story of your evolution as a clinician?
02:49 Do you believe that everyone should get medial imaging for an injury?
04:10 How do you incorporate medical imaging results into your patient care?
05:25 Do medical imaging findings correlate with pain?
06:40 Are there any good research studies that support this?
07:50 For a specific patient, how do you determine if a structural abnormality on the scan is relevant and either a concern or cause of their pain?
08:42 What are common mistakes that clinicians make when it comes to interpreting medical imaging results?
09:45 Can you give us examples of imaging results that may be irrelevant?
11:38 In your experience, has there been a change in how physicians order and use imaging in musckuloskeletal medicine?
13:29 Does the amount of medical imaging have an impact on the healthcare system?
15:51 In your experience, what are patients’ thoughts and attitudes towards imaging?
16:59 As a patient, if I’ve had a scan that shows abnormal findings, should I be worried?
18:47 What language do you use to describe imaging/assessment findings to the patient?
22:10 Does language influence pain?
22:50 What are common mistakes that clinicians make with patient communication?
23:57 When is it ok to use a pathoanatomical explanation for pain?
25:14 Can you share a story of a memorable patient experience that is relevant to our discussion?
27:41 Can you tell us about your book
30:07 Can you tell us about your VOMIT poster?
32:06 How can people find out more about you?