OA knee naa- Non-specific knee pain

1.       Stop taking x-ray to diagnose OA knee- it is just silly- well-read theory of when to use diagnostic test
2.     We now know – there is no correlation between cartilage damage and pain and disability. – so stop looking at the x-ray as though it is giving you some insight into your patients3.       Stop telling your patients not to sit on the floor or walk less – please understand the patient accesses health care to become less disabled not made more disabled by us.
4.       Remember it is exercise therapy- it means exercise is given to reduce pain and disability – so please tell them exercise should be done when they come to you- not at the end of 10 days or when the pain is gone.
5.       Exercise –works and one the few conditions we have high quality evidence to prove it
6.       Waxing and waning are part of diseases like these- educate your patient about  it not knee anatomy and x-ray finding- these can help them in not catastrophsing about the condition.
7.       Remember we are a quasi-mechanical system, even though we cannot run away from physics the biology adapts- so don’t make clinical decision based on mechanics- they are always inadequate- well see what has happened to manual therapy
8.       Don’t use nocebo terms – collect the term which harm them in your vernacular and try to use alternates for that
9.       If you get a chance to write in vernacular don’t – please don’t write – the joint has worn off (or in Tamil thengupochu)- the joint is not a cycle tyre
10.   I believe just like- how we are calling back pain as – nonspecific back pain we should call OA as non-specific knee pain

Love
Hariohm

Things we need to stop in the coming years

I love making a list, even though no one care- I usually post it:

1. ·         Read a book other than Facebook post, YouTube video or a whatsapp forward. And for god’s sake don’t forward videos of some white guy doing a manual technique.
2. ·         Stop saying- “I have seen it” – well I have not seen gravity, o2, atoms, even hormones like serotonin, insulin and much more. So you see, seeing or not seeing is not the hallmark of science. Many therapists are infatuated with the idea of “seeing is believing”. Remember even a carnival magician can fool us all into thinking he just pulled a rabbit out of a hat.
3. ·         Taking as though the non-contractile elements have ability to undergo plastic change makes us look like fools among the medical community. You don’t have to believe the evidence for K-tape, or many variation of fascia osteopathic nonsense- use your elementary knowledge of physiology, and some physiology of pain and think whether whatever the “expert” vomited makes any sense. So, stop talking gibberish!  
4. ·         Stop calling each other us experts- most of us or in the 40s and 30s it will take another 20 years to know we don’t know much- then we can call ourselves as “legends” and other adjectives
5. ·         Ooo please no more awards- it is well ….. I don’t want to say no more
6. ·         We should stop talking gibberish like muscle release, reorganization of non-contractile elements, moving mountains like Hanuman- I am talking about moving the cranium etc
7. ·         Stop posters and paper presentation on things we have never done, conditions no one has ever heard and exotic technological mumbo jumbo
8. ·         Stop writing “research” paper on the SPS and stop being proud of publishing in IJOPT and other OA journals
9. ·         We should not get into an echo chamber, where all of have the same bias
10. ·         I should stop making list and stop cribbing about things

   Love
Hariohm

Happy new year folks

  

Wake up

The sad thing about physiotherapy in India is the lack of evolution in its scientific basis. When I went to college most of the teaching was –do what is say, learn by seeing probably by observing. Only few teachers and PT looked beyond “how to apply in my patient” giving less importance to the science behind it. The problem with this attitude is: it becomes difficult to understand whether the treatment is effective, am I harming my patients, and what happens when it is does not work and how I do it a different group of patients etc.  Beyond the obvious one, the problems are lack of original scientific thinking or stifling it and believing every “expert” or authoritative figure –either a PT or a surgeon who we perceive is more learned.    

This, I believe led us to our current conundrum. Every day I see someone teaching alternative magic to physiotherapist and poor idiots gobbling them. The current fade is Diploma in “O” or “C” or acupuncture.
So what is the problem?

Let’s take the obvious- if they can teach you in weekends or through online and in six months and you get a diploma in that “medical philosophy” – you should be either a highly gullible person or your UG education should have been very poor.

The next issue is – aren’t we the people who fought against diploma in PT taught in street corners and we don’t seem to have a problem with this? Diploma in “O” taught by some charlatans and a snake oil selling idiots from "abroad" and India? The hypocrisy is beyond words.

The third issue is- these courses are fraught with nonsensical science and from moving joints (which usually begs the question- so what or can you move it) to vital organs. Well if you education was so poor in UG you can’t discern the difference between a vital organ function and what the hell is manipulating it will lead to – you should not be allowed to practice the great science of PT. you should be locked up in Kilpauk.

I understand PT science is also many a times poorly understood and sometimes downright wrong but the comparing to alternate magic is just sad. shouldn't we be all trying to evolve our PT science rather than consuming the crap of the world? 

This begs the last question: why are these idiots allowed to corrupt and ruin PT science in India without any resistance.  Don’t some of the states have a associations, councils or something- why is everyone silent? Because we think well this is evolution? Or because well why do I care or well I don’t attend so I don’t care?

whatever your reason it is time to wake up and smell the shit in our neighborhood. 

  

Love
Hariohm

 

What next- 2017 world PT day post

When there is a lack imagination, poor understanding of health science and leadership- then the weeds grow. That is what is happening to us in the last few years. PTs are led to believe the next step is to wed alternative magic like osteopathy, dry needling, SI with PT. When a science has to grow it grow with incorporating other science not magic. So, you ask me “pray tell us what is next in PT”

Well my take on what and how PT is going to shape up in the next decade

1.       NCDs are a major health hazard and the numbers are increasing alarmingly in countries like India. All health care professional has to play are in prevention, management and rehab. I believe until now we have narrowed ourselves only to management or rehab. This should change- we should be actively involved in preventing diseases, especially NCDs.

2.       In spite what your certified instructor told you- we know exercise are good and works wonderfully in many conditions. What we don’t know is how to make our patients comply with the exercise program.  In the coming years we are going to borrow ideas and theories from behavioral science and evolve programs. These programs are going to have better influence on our patients to comply with our exercise

3.       As part of the earlier point- our education of patient in pain, post stroke, prevention of NCDs are going to better than what it is now.

Happy world physiotherapy day

musculoskeletal system physiotherapy and I

So these are my take on musculosketal-physiotherapy without much of explanation

1.       There is no mechanical pain- all pain or bio-psycho-social

2.       There is no core- all muscles are vital and they all work for a context- so stop calling a group of muscle as core. It also makes us look uneducated when we say one group of muscle is important.

3.       Difficult to predict or prevent injuries (including sports).

4.       Ergonomics consists of nonsense and some good science- difficult to differentiate, so start afresh. Leave the designer chairs, mouse and other animals and come up with ideas based on science – not what you observe.

5.       Impairment exercise seem to be the norm- so PTs who want to start a career in musculo-skeletal PT  should start from Motor control and motor behaviour not from pain science

6.       Fascia, muscle and other soft tissues are nearly difficult to stretch and change its length, so don’t over claim and over do them

7.        Learn plasticity of brain before – pain science

8.       Learn brains-on treatment rather than hands-on. Any monkey can learn to stretch but only humans can understand complex interactions of many sub-systems- so go to a course were they teach you to use your brain

9.       Craniosacral therapy, needling cupping are not concepts- they are faiths, please don’t insult Physiotherapy science or the word concept

10.   Shut up and teach exercise for all patients on the day of their first visit – not the 10^th or 5^th .

11.   Tools in my tool belt is one of the often repeated sentence -you are not a mechanic you don’t need more tools- you need better understanding of the human body- so learn- bio-psycho- social issues is the next step, not putting sticker or needle or a tea cup or screw driver

12.   All exercises are good no exercise is superior to another (for all those people who are experts in pilates, etc (as I can’t remember the myriads of names)

13.   Don terrorize the patient – so stop saying – don’t ride the bike or riding bike lead to back pain, don’t squat, don’t sit on the floor etc. he or she came to improve his activity limitation not increasing it.

14.    As an addition note to the earlier point- leave the posture alone, stop making religious statements like good posture bad posture and evil posture. Remember no one change posture and all postures are good (well that looks like a Buddhist theological statement)

15.   Learn the difference between impairment and causal relation. Example multifidus not working in LBP is an impairment- it did not cause back pain, hence improving multifidus  will not lead to betterment of back pain (this is been proved again and again by 100s of trials on back pain)

love

K. Hariohm

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