The good bad and the ugly-2016

The good bad and the ugly-2016

So what did this year bring to us?

The good:

1. More excited students but “I don’t care” colleges and teachers #screweducation

2. More young therapist who are slowly realizing they are losing their soul

3. Still PTs striving to buck the trend and trying to do good for the community and medicine #krishnachandar

4. More PTs interested in research and ethical practice #kudosPT

5. Well can’t resist it – on a personal note lost 7 kgs in 3 months

The bad:

6. Well we are still afraid of evidence and are in deep denial that they exist- what did it bring more -Post evidence treatments # postevidence

7. More awards- Probably everyone in my age group has got an appreciation award (just for being here?) #congrats

8. More internationally certified instructors who can teach us-Post evidence treatment and pseudoscience #post_evidence_instructor

9. More research papers with cooked up data # cooking_evidence or #rat_race

10. As a side note more PhD without a clue of what is medicine or science

The ugly:

11. Still reading books which became outdated when I went to college- Dena Gardnier, cash and what not

12. Still attending course which were never science or outdated when I went to college- #NDT #SI

13. Sticker, needle and tea cup boys are sticking to us like a bad infection #science _resistance

14. Clinicians thinking sticker, scratching, tea cups are the latest- whatever that means

15. More people who are thinking- I should find this guy who is writing these crap and kick him

love

Hariohm

Post- truth

Post truth

The world of the year according to oxford dictionary is post- truth. A sound wonderful isn’t it- post truth. Well if you are too tired to Google post- truth- it means telling a lie repeatedly even when facts are shown and appeal to people’s emotion. Basically demonetization  TV debate in India.  Even though the concept was popularized by people in the right- Brexit, trump campaign, all Indian election- it is right in our ally in PT science and medical science.

Evidence, data and experiments are the hall mark of science and thereby proving something. Medicine and in particular physiotherapy is always afraid of the big bad wolf- the science. There may be socio-political reasons for it but we are slowly changing (I hope).

But the biggest impedance for that change seems to what I call as the post-evidence arguments and our inability to confront it. Let me explain what I mean by post-evidence. Whenever you hear people say things like- well evidence is not there but what do you feel, how does your patient feel after sticking the tape or after moving the sacral joint?
 You answer  "But sir, all the experimental data shows these don’t work"…..
Well do and then tell me… 
You then you add "how can a tape which is in parallel to the skin lift it- it is not physical possible" or "sir that is not a immovable joint"… 
well do it then you will see we have great results in our clinic". That is what I mean by post-evidence.  
You can show them umpteen numbers systematic reviews, trials and physiological reasons- they quickly turn around the argument saying well my patient feels better- certainly my business is booming. These are the latest- is an wonderful argument which touches the emotional nerve of any just- out- of- college PT or well anyone- well who needs evidence when you have the –latest. The sub-argument for that is- well you have not practiced it, learnt it so you don’t know what you are talking about- attach the person who questions the validity of the science. Confusing casual relation with correlation – trigger point argument- well why there is pain- because of trigger point- why is there a trigger point because there is pain. It makes your head spin so much you don’t know whether you or the person who is making the argument is less educated.

Well if you can’t spot it- post- evidence or post-truth arguments then they are here to stay with us. It is difficult to become a proper science. I believe this year the post-evidence argument has attained the peek. From the SI people to the – who want to put children in the dark because they are hyper active to sticker people they have learnt to talk the post truth. They have made inroads into our business practice- I just hope they don’t derail the academics also, well come to think of it they are already have. Case in point the horrible conference of pseudo-science in the name of PT they just had in a college, with full attendance from the world of nonsense experts.
#Post_evidence 

Love 
Hariohm

Climate change denial and physiotherapy

Climate change denial and physiotherapy

                I and my son were hooked on to CNN for the last several months- when the US election was at its full speed. The mudslinging and post truth made it addictive for us. Well this post is not about politics- and I rarely write about politics in social media. Donald Trump in one of his speeches while talking to (it was in the rust belt if I remember correctly) huge crowd ,was complaining- when I wear hair spray in the confines of my room (house) how will that affect the environment and lead to problems in the ozone layer. He had far worse ridiculous things to say (and made him the vijakanth of US politics in my mind) but this is one of his claims- climate change is hocus pocus. Well not only Donald trump whole bunch of people in the right in US are (including the presumptive energy secretary).In spite of overwhelming evidence many politicians, the energy lobby is- climate change deniers. Many groups even produce “research” backed by the energy lobby to say climate change does not happen. There was a senator in US who brought in snow to say well how come we are getting snow when there is global warming. I was shocked to see the amount of stupidity of all these- just because you have seen snow- the globe is not warming?  

Well bear with I am nearly there. Scientist and sane people are taken aback by these climate change deniers, scientist, climatologist and others think these people are crazy and are in the pocket of big money. The climate change deniers are a minority, especially in countries like India, you can hardly see them. The Paris accord which was ratified even by India- but I hope it has lots of trouble implementing it- just have a look at the pollution rate in Delhi-but it is in our collective intrest to do something about the whole mess.

Unlike in climatology science, in medicine evidence deniers are the norm. not the other way around. Everyone thinks – who the hell needs evidence when I have seen the change. PTs usually think research is done by someone who has never seen a patient or the patients what they see is not what the loser researcher saw. They keep on saying my treatment works- why should I change.  Well because like - globe is warming- the health system is in peril. Patients all over the world are getting less than optimal treatment and many a times –harmful treatment- like the idiot who did cupping on child to reduce spasticity, the moron who taught it or the group who invites him to teach it.
We usually think like the senator from Oklahoma, I have seen the snow- so the globe is not warming. What you see is not the truth is the first and foremost thing they taught us in literature not just in science (From The great saint poet Valluvar to Kanadasan sang about it).

I hope heath care workers move away from – see I have a snow ball in my hand- so there is no global warming- to following the evidence. If there is no evidence- get your Paris accord and do something (research) about it and stop complaining

But we still have evidence deniers in medicine and PT specifically. Here is my list of cult group and lobbies who deny evidence:

1.       My all-time favourites- The NDT cult- after 40 years of research and more research- they are the original deniers- they were the last to convert to the weakness cult in UMN lesion

2.       The scientologist of therapy – SI

3.       The K-tape – people who keep on changing the goal post and still can’t find what they are looking for and the people who keep on following them saying others are too ignorant to see what they see.

4.       Stretching and passive movement people- well I am not sure these are evidence deniers are plain ignorant

5.       The manual therapist who are still putting the spine in the right/ normal place. Well, what can I say when pioneers in the field have moved away (Butler comes to mind) people who have learnt from people who have learnt from, people who have learnt from Butler are not changing.  

Not taking about the alternative treatments like needling, chiropractic, osteopathy visceral manipulation and other exotic nonsense- as by definition these are based on faith not on science.

For all the young therapist – don’t fall into the trap of climate science denial, look into the data, critically analyses it- then make your decision. 

https://www.youtube.com/watch?v=9SLbEDMZMAk- watch homers take on global warming and below is the transcript

HOMER: Gee, Lisa, looks like tomorrow, I’ll be shoveling 10 feet of global warming.LISA: Global warming can cause weather at both extremes, hot and cold.
HOMER: I see. So you’re saying warming makes it colder. Well, aren’t you the queen of crazy land! Everything’s the opposite of everything!
(Homer dances, twirling and waving his arms.)
HOMER (singing): La de da de da. I’m Lisa Simpson! La de da de da!
LISA (muttering): Really? Really?

Love
K. Hariohm

My chronic back pain experience

When i was doing my under-graduation, i suffered a injury in my left side- lower back. The physician and my college principal assumed i had suffered from multifidus strain.  PTs told me to have some rest  and do some exercise- which i promptly forget to do after the third day- when my back pain had gone.
Later on the back pain slowly developed into a sticky issue with many flair-ups in the last 25 years. I dont have constant back pain- but episodes of pain- which is mostly self limiting. I have tried all sorts of sensible treatments including some pharmacological interventions also. But i dont seem to be getting better- with no lessening of the recurrence.
yesterday, with my back acting up i was in a irate mood and then it happened. My pen fell down under the table and i bent down and picked it up. when i came up i bumped and hit my head on the desk.
well to my surprise my back pain had complete gone. I was surprised and i did not know what to make out of it. Well as my reader know i am a closed minded idiot who always  thinks we need a scientific rationale for medicine. Well i searched and  asked all my friends- no one was able to come up with a good answer. some even suggested i was just pulling there leg- suggesting that i was lying. well i got irate and told them to "go to hell"- as i know what has happened to me.
Then i opened my mind-i came across this theory- my CSF flow may be restricted leading to pain in the back and neck The theory was written by a renowned myotracopathy researcher. I also noted that it is possible to move my cranial suture and "make the csf flow properly". ooo i was stuck- how come i have never heard of this scientific revelations before? I was angry with my teachers who did not teach me these.
Well long story short- i think when i bumped my head my cranial sutures were naturally manipulated to the "normal position" and the csf started to move in its right rhythm.
If students and clinicians want to practice this wonderful method they should learn from masters and genius in our profession-who are certified instructors and not from quacks.


with bliss
Hariohm (without pain in the black)

The Olympics post

What the Hell? Another fade is going to ruin us

A word of caution:  I don’t care about Olympics- Well no one cares for most of the sports in Olympics expect in the Olympic year. Just look at the sports which involve horse- really those are sports and they are awarded medals for it. But of course like all life’s ironies- I love watching it. So with that……

Every Olympic throws never stupidity- after last Olympic games people who were selling stickers went gaga that some poorly educated athlete was wearing a sticker- that lead to exponential increase in uneducated experts and their followers here. After many trials which has found they are just a sticker (my personal opinion –if you are a researcher and did a RCT in k-tape you should be ashamed of our self) there is no let down of these been taught. If you think the hours of training, the support staff who teach about diet, coping etc- a sticker lead to better results- well that is stupid if you have studied PT. However, I don’t have any qualms with the athletes. Most of them are duped by trainers, PTs and other snake oil selling people. Sportsmen are inherently superstitious- wearing the same right shoe always to wearing the same coloured underwear is common- as the results are random.  

So this time when a elite swimmer-gets moxibution before starting – is going to lead more people to say – proud to be a PT with a cup, come and learn the newer way – the cupping therapy as moxibution is –well too complicated.

The first issue – we should not be proud- we can make a elite athlete get better- we should be proud when we are part of the heath care team- which prevented stroke or made a SCI injury patient finish college.

Second is just because many people are using it does not make it right- it makes it popular. And what we have learned in the last 20 years anything which is popular with very little science falls flat on the back. Examples- pilates, MET, NDT (the newer avatar, the older own had a strong science, sadly it became outdated), K-tape and all the hands on treatment. Science is not popularity contest- it is being meticulous and producing hard data.  So before you go and give the idiot expert tea boy (short for cupping therapy) – ask not who is using it- ask for where is the science, where is the data. Be an informed therapist .

I was wrong all along

I have been wrong all along

I have been a vocal opponent of impairment based treatment like NDT, brunstromm ad others. I also advocated we cannot be touching and guiding our patient by either keeping our hands on pelvis or the scapula – it will not bring about “Normal movement”.

But I have been proven wrong. Latest research published in the journal of alternate to alternative medicine (JAAM) has univocally said these are absolutely possible. That is if you keep our hand long enough on the pelvis or control the trunk movement the patient will become “Normal”. Many patients in the trial (videos are attached- pre and post) are in distinguishable from normal people I booked an appointment with my eye doctor.   

How is this possible – how did we have never seen in our practice any change in circumductory gait- they were able to get it. Commenting on the article one of the lead authors said- that is because they used the latest science in learning and motor control. He added, the motor control literature clearly says you gait is in the pelvis and the big toe, likewise the upper limb movements are controlled by your scapular and truck movements, and most of the researchers have not put that into practice. He also said the used cutting new technology like holding the scapula, kinematic analysis by seeing which made a huge difference to their study.

I was heartbroken- it looked my book is a fraud and I had to apologize to hundreds of people who have been duped by me. With a heavy heart I say – I may be wrong!

In my next course i have to teach what i learnt in my 90s how to hold the pelvis, look into the alignment of the trunk and important perils. 

Click here to read the full article

Love
Hariohm

Really you thought the blog was real 

 love 
hariohm

where are the women?

Where are the women?

When I went to college- the TN Government had a quota system of 12 girls and 12 boys in each class, later on the ratio skewed more towards boys. In the last 10 years the number of girls pursuing PT is more.  Well this is not a blog on the gender ratio in classroom but in research.
Few years back we wanted to know the research production of Indian therapist and we did some research to unearth it.  But when I was going through the list of first authors- to my surprise most of them are men. I would like to add we did not do any gender analysis, so my saying “most of them” is just informal guess.
When I look around I hardly see women in research in Tamil Nadu and probably in India. I can understand woman don’t sell products like NDT, K-tape and others (I know some use to) as there may be some issues with travelling etc. I understand there are some women in research and the sports therapist in Guru Nanak university come to mind immediately - but where are all the brilliant hard working women? I am assuming many of them have let the country (like cynthiya kesevan) or they are trying hard to leap out in the man’s world. 

Any how I just hope our research scene get more of the brilliant women we see in our class room.
I would also be happy to get a women’s perspective on this – anyone?

Love
K. Hariohm

When you play with pseudoscience- one day we will become one.

The UGC under the direction of PMO has said yoga should be in PT curriculum.  Some time back there was talk we are part of AYUSH (the department of fairies for medicine) and some of the PTs also thought it is good idea.

Even though I think the idea of yoga in our curriculum should have come from some right wing nut, I also blame this on us. For the last 3-4 decade we have been running bachelor course and in the last 5 years every idiot with master’s degree (which most of them got it by not stepping into the collage) is doing or finished Phd (again most of them, without doing the actual thesis).  But we have not done anything to promote our worthiness as serious people of science. We have sporadic diligent people doing good work- shut down by other – and serious research. As noted earlier our MPT went from the toughest course to pass to the easiest course to pass in less than 5 years (well you don’t even have to come to collage what more to say) and we are using the same model for Phd.

The course done outside the college- those “workshops” are just flourishing which you would think would have made us all smarter. Well hell no one idiot is teaching the whole of India to put needles, other one is selling stickers and we have my perennial favorites- NDT (the treatment which never works but it cost 4 lakhs- when taught by vellakaran and 25 thousand when taught by your neighborhood Indian therapist). Add to this we are the growing market for the junk of the medical world like osteopathy and chiropractic (which I am pretty sure is illegal to practice in India) and experts in this crap (home grown and vellakaran).

Well all this leads to a big bullshit that is PT education today.  if you have any doubt search for sticker (k-tape), NDT, chiropractic and any other bullshit which is trough at us- the answer is always same- these are outdated science, these are not science these are not legible sentence will be the answerers. We have not promoted science, we have not promoted motor control, learning etc in neurology, and we have not promoted pain science in ortho and what we are left with people selling snake oil.

The newest threat to my beloved science is introducing yoga- not just the postures which are exercise but the philosophy – including study of Bhagavat Gita, Upanishads and what not.  Well happy to have known you all folks as PTs folks in the next few years we will be treating imaginary disease with imaginary breathing power. Come to think about it we are already doing it.

Love

K. Hariohm

I have seen it in my practice

Galileo's Leaning Tower of Pisa experiment and clinical experience

One of the common arguments I encounter from PTs (probably also from patients and others) is personal experience and “i have seen it” argument.

Why is I have seen it argument flawed most of the time:

One of the common notions in Indian and eastern philosophies is the idea of “mayai” or illusion.  An illusion as we are well aware is – what you see is not the truth. I am not going in the philosophical arguments (you may read J. K if you really want to understand) but the scientific one.
I am going to use a simple example which we all learn in school

When you drop a feather (a lighter object) and a ball (heavier object) you will see the ball dropping to the ground faster than feather. The observer may conclude the heaver object falls faster than a lighter.  However anyone who has done 6^th standard physics will know the gravitational force is a is a constant- hence the above statement cannot be true.
So you end up tearing yourself- whether what I have seen is untrue or whether the physics I have read has an “alternative”.  Well the physicist does not tear themselves- they look into the flaws and the confounding factors in the observation – they just don’t say- sometimes the G force is behaving badly.

 Well the physicist do not tear themselves- they look into the flaws and the confounding factors in the observation – they just don’t say- sometimes the G force is behaving badly (for this observation)

Well when the same thing happens in clinical setting to most of us. We see our patient getting better with IFT, traction, the K-tape, SI and all the other one hundred things people are selling. But most of the time the justification for all these treatments are flawed, pseudoscience or plain ridiculous.

In medicine most of see something happening to our patient and when it is good, we look for justification. When the physiology or the science is not able to justify we fall back on the alternate ridiculous answer.

These are the top 5 ridiculous statements i like:

1.       Jane Ayres – sensory diet- can’t stop laughing even now

2.       The internal organs are all in the hand and feet- just a insult to one’s own brain

3.       K-tape will facilitate muscle action- really the brain, the psychological factors, the social factors etc is just a joke?

4.       Hands are the physiotherapists most important organ- he touched the patient and he got better- really?

5.       Last but the most ridiculous – Cranio-sacral therapy- should check with your neurologist if you think this is “therapy”

I can hear people screaming- I have seen these being done, seen patient getting better with these magic (could not get to type therapy). Remember the G force is constant – lighter objects don’t fall slower; it is just that we have not controlled the n- number of factors in our observation. That is why you need experiments- with controlling all these parameters in medicine and science in general. Don’t take the easy route in finding alternates to why it happened- rather question first did it happen?- that is did my patient get better or is it an illusion because of the “n” factors- including natural recovery, fooling your brain, fooling patients brain or just wishful thinking. Then think of explanation for what you have observed and not the “alternative one”- the real answer which is hard, cumbersome and hard to come by. Then we will call ourselves as practitioner of science we call Physiotherapy.

PS- the Galileo thought experiments and the moon experiments gives us the right answer why the feather falls down and the remove the illusion and help us see clearly

watch the hammer and feather drop experiment on the moon: https://en.wikipedia.org/wiki/File:Apollo_15_feather_and_hammer_drop.ogg

one of the most interesting videos

love
Hariohm