markgibsonphysio

It is becoming a trend of mine to do a post in the last few hours of the year. Please ignore that this is my first post for 2017!

I have had a run of shoulder patients over the last few months, a number of which have been having treatment with other providers, the vast majority of them “setting” their scapula in a retracted position (in layman’s terms “pulling the shoulder-blade back and down”)…

Move on please….it is nearly 2017!

Last post for the year. My apologies for the low number of posts this year. 2016 has been a busy year for a number of reasons, most of them positive!

To finish off I am going to deal with my “favourite” topic that continues to relate to this view that “core stability” training is an absolutely essential tool in the management of patients with lower back pain. Here in Perth, Australia, there…

Some Question Marks Over Orthopaedic Surgery

  Let me start this blog post by stating that I am not a surgeon. You can tell by the type of car I drive……

The purpose of this blog post is not to run down orthopaedic surgery or our surgical colleagues as many of them do wonderful work. I also know some fantastic evidence based orthopaedic surgeons who are moving with the times and altering their surgical practice based on the evidence base or…

Blaming Pathology or Lack of Pathology

I have blogged a number of times about how there is generally a very poor correlation between the “pathology” we see on scans and pain. The lower back being the most commonly cited example but there are many other examples (see here, here and here)  and over time the list appears to be getting longer.

In recent times the pendulum has swung, correctly, to the brain and pain. I for one don’t…

Changing Pain vs Smoke and Mirrors?

One of the common things I see in clinical practice is therapists making patients adjust postures or movement patterns to see if it changes pain. Now i think that this is a very worthwhile way to approach patients. I do it all of the time. There is however a common error that I think we often make in regards to this approach, and I have regularly made it in the past.

As per how Jeremy Lewisand…

Wow the year has flown by quickly. I have to say that I feel disappointed that I haven’t posted much this year. My apologies for not doing so. I have great admiration for the physiotherapy bloggers out there who post such regular, well written posts.

To wrap up the year I thought I might reflect/muse on one of the useful approaches I have found particularly helpful in the management of patients.…

Mechanical vs Non-Mechanical Pain

I wrote a while back about posting in relation to the “Inverted Pyramid”.

The inverted pyramid principle is aimed at keeping what we do simple. I think as a profession we have a tendency to overcomplicate many things and “fluff” around doing and focusing on things that in some cases are of very little importance. Instead we should focus on the important stuff. Although maybe my brain just can’t…

Recommended Reading – Pain Classification – July 2015

Sorry for the lack of posts, I am busy with some updates of university lectures. As you can imagine I am a bit OCD about presenting up to date information in my lectures.

Given the time constraints at the moment I thought I might post the occasional article I come across in my lecturing preparations that I feel are worthwhile reads. This is the first one:

Low back pain: guidelines for the…

This concept is one that was introduced to me back in my postgraduate study days at the University of Western Australia. It recently came to mind again and is something that I find very useful. I plan to introduce it to this blog for the next few posts. Depending on how well it is received I might keep the theme up.

There are a few different interpretations of this concept, but the basic premise…

Some More Great Questions to Ask Your Patients

As a follow up to my last post I thought I might suggest another couple of questions that are worth asking your patients. Once again, these are not questions that I have devised myself, but rather have been suggested by me to other clinicians. I find them exceptionally useful in my clinical practice.

1. Do you think you can get better? or Are you positive or negative about getting better?Plenty…

Two Great Questions to Ask Your Patients

Thought I would take a detour from the usual “research evidence” post and write about something I have found incredibly useful in my clinical practice. I have also made a vague attempt at some humour….

I now regularly utilise key two questions in my assessment and management of patients, and without doubt they have given my clinical practice a major boost. They are questions that a couple of very…

“Over-Imaging” the Lower Back

Not a very imaginative title I know! But hopefully my final post on Imaging for a little while. Apologies if it has become a of focus on this blog recently, but I think it is a critical issue in musculoskeletal medicine.

I have outlined in previous posts that my interpretation of the research (systematic reviews) on this topic would suggest to me that basically:

The majority of imaging findings…

Imaging Findings In Asymptomatic Lumbar Spines – Research Update – January 2015

The plan this year is to shorten my posts, and post more regularly. Here we go……wish me luck!

Imaging findings in asymptomatic lumbar spines and other areas of the body, are recurring theme on this site. Mainly because of the experiences I have routinely had where patients are managed purely based on their imaging findings.

Here is some more research (free to access and download – follow the link…

Is Lifting Technique Important?

A common theme I continue to encounter in clinical practice is the belief from patients, and health care providers, that correct lifting technique i.e. maintaining a lumbar lordosis, is critical in the prevention and rehabilitation of back injuries.

I can recall this belief being around for as long as I have been practicing and studying (nearly 20 years now).

What really interests me is that when…

The Role of Manual Therapy

Now the most obvious key role of manual therapy is that it provides pain relief in some patients (for those interested in the research relating to the mechanisms of manual therapy this topic please see this previous post and this recent systematic review by Voogt et al (2014)). Pain reduction in patients is great, but there is something else that the patients response to manual therapy can assist…

The Core Stability Problem

When I refer to “Core Stability” I mean teaching patients isolated contractions of transverses abdominus and multifidus. This is then usually progressed (depending on the practitioner) to having the patient contracting these muscle in functional movement patterns. The end aim being reduction of pain and improvement in function.

From my perspective the “core stability” direction started following…

In Pursuit of Pathology

I have recently attended a couple of seminars that have mentioned how newer and better MRI units will begin to be used in the attempt to identify pathology in patients with musculoskeletal pain.

Now this sounds a fantastic and a worthwhile cause, especially if it enables us to identify symptomatic pathology in a patient population which can then lead towards a successful treatment (finding a…