I once had a patient at my internship as a Physio and assessed a 60 year old woman with problems going up and down stairs. During the exam I noticed a decrease especially in active ROM (especially external rotation and abduction) and let her walk stairs and noticed a Trendelenburg sign (pelvis dropping down on the other side of the standing leg) which indicates weak hip abductor muscles in close chain (especially M. Gluteus medius). The palpation showed a hypertension in almost all hip muscles. After the assessment I started by using a post isometric relaxation technique for the external rotators and abductors of the hip, which was effective, and then showed her close chain exercises for the weak muscles and wrote them down and gave her her home program (standing on one leg while trying to keep neutral pelvis, isometric side planks on knees and glute bridge). I told her to do 2 sets of those exercises every other day. After a few days on the second session the ROM in external Rotation and abduction increased by a mean of 5-10 degree and we followed the Programm that day. On the third session another Physio who usually is her Physio wanted to show me something important and had a couple of serious words with me: “the muscles are tight, so we want to loosen them up by Massage and stretching” “your exercises are too much (in like too intense)” and she then returned the paper with the program back to me. I tried to explain to her that she was improving, but she didn’t want to listen. Soo in conclusion: This patient will probably still have difficulty going up stairs, because of a lack of active therapy. Passive treatments should really only be implemented as an extra, right before the actual active treatment to potentially lower stress levels and therefore shortly decrease pain sensitivity. In most cases active treatments have a higher probability for longterm success and therefore have a better chance in increasing the life quality of the patients
This right here!!!! Im a student physiotherapist rn and I think a lot of PTs go too easy on their patients We gotta start being more active therapy oriented within evidence based research of course and avoid too much passive therapy
I experience this exact same scenario during my internship right now. It can make me feel so frustrated that some physio's aren't capable of or willing to understand and accept the importance of hands-off active treatment.
@@bryanlee1449 Why is he so bad? He's got decent principles but just does clickbait and sometimes gives generic info to sort out most ppl (not all tho) right?
@@johnsmith-yv7rp Yeap I totally agree with you when you said he's got decent principles and gives generic information to the masses. And I'm not really saying he's bad at all. My point was that he may give impressions that patients can get positive results instantly with suggested exercises and could potentially undermine all the hard work necessary to achieve meaningful outcomes in the long term. We all know there's no short cut in a field of rehab and the titles of some of his videos may create other rehab myths.
@@johnsmith-yv7rp Jeff Cavaliere is the reason I became a physical therapist. I’ve learned so much from him. But I have to admit he is guilty of the clickbait stuff.
I am not a physio but a patient. I went to see four separate physios who all prescribed a similar ice/stretch/massage solution for my achilles tendon. None of it worked. It was only when I saw your videos about progressive loading of the achilles tendon with exercise that I began to see an improvement. This leads me to think that many physios don't keep up to date with current research. It also makes it really hard for us patients to know which physiotherapists are good and who to spend our money on. The fact there are so many lazy physios out there actively puts me off seeking out another professional because I don't want to risk wasting yet more time and money. Thanks for your content - it has helped me a lot 🙂
Sorry you’ve had to go through so many steps. The video that helped you in the end is intended to help physiotherapists better help their patients. We know it’s inevitable that patients also watch our content but our goal is and will always be to help physiotherapists stay current with the literature and thus deliver better evidence based care.
I think this is extremely useful, thank you. I would only highlight that when you refer to ‘no amount of experience can replace keeping up to date with the evidence’ (paraphrasing): EBP comprises of three pillars, one being clinical expertise and the research being another. Evidence provides us with guidelines, not rules and therefore 30 years of countless successful results utilizing specific types of modalities still has substance and should be taken into account. However, I agree that all HCP must keep evidence based and up to date as much as they can.
These are all, of course, spot-on. I would add one more item: not understanding what we *actually* do as physios. Medical doctors treat pathology and diseases of the body, psychologists treat mental health, etc. But does the average physio actually understand what physio treats vs the tools of that treatment ("I stretch people, I give people exercise," etc)? We don't treat pain, and we don't even treat movement/so-called movent impairments, either: we treat the *experience* of movement. For our patients, their experiences may be that something hurts when they move, or something is strenuous or exhausting when they move, or they may not be able to experience the sensation of movement at all. When we expand our understanding beyond simply the things associated with movent (joints, muscles, bones, etc) and recognize the things that are more important in experience (sensory, motor control, cognitive/emotional domains, extero vs interoceptive, etc), we can finally perform at high levels of quality and consistency. We can only perform good work if we understand *how* we work. IMHO.
Nice Video - it‘s so important to go out of the „daily working bubble“ and reflect your language, assessments and used researches/evidence. Always try to make your work more effective for your patients and your own growth.
I always value the Holten (oddvar holten) Curve when designing a strengthening program to properly load my patients depending on if they are in the acute vs sub-acute vs chronic stage of an injury.
Another huge problem is not having a clear concept for communication. If you don't want to listen to everything a patient can tell, you must be sure to ask for anything you need to know. I've lost a lot of time with therapists who thought they knew it all, talked over me, only to notice something unusual after a lot of appointments and than blaming me for not telling. You can base your therapy on assumptions but that doesn't always match reality. And not every "but..." a patient says is a "cheap excuse" you can go over without lowering your quality.
Thanks for this video. Your talk reminds me of my University of South Australia Lecturers, they really pushed these messages. A good reminder of the basics. Thanks. On reflection, I'm a bit guilty of the under loading, it's a fine line to tread to not overload and progress too fast....Riddled with self doubt, until I step back and just apply the tenets of exercise prescription.
Danke ihr seid einfach spitze! Wir machen dieses Fehler alle mal mehr oder mal weniger es ist auf jeden Fall gut mal wieder daran erinnert zu werden! 👌👍
Yes to true under loading just like GPs saying 30mins a day inhospital exervises i wasway over qualified for they wonder why we in tears its in scjool too doing widths when i can do hundreds lengths swim already‼️‼️‼️i hate non medical terms im qualified in anatomy physiology As all eay through. I can check when i dont understand double check often they cinfuse things by using lay terms some times even use wrong words!
I once had a patient at my internship as a Physio and assessed a 60 year old woman with problems going up and down stairs. During the exam I noticed a decrease especially in active ROM (especially external rotation and abduction) and let her walk stairs and noticed a Trendelenburg sign (pelvis dropping down on the other side of the standing leg) which indicates weak hip abductor muscles in close chain (especially M. Gluteus medius). The palpation showed a hypertension in almost all hip muscles. After the assessment I started by using a post isometric relaxation technique for the external rotators and abductors of the hip, which was effective, and then showed her close chain exercises for the weak muscles and wrote them down and gave her her home program (standing on one leg while trying to keep neutral pelvis, isometric side planks on knees and glute bridge). I told her to do 2 sets of those exercises every other day. After a few days on the second session the ROM in external Rotation and abduction increased by a mean of 5-10 degree and we followed the Programm that day. On the third session another Physio who usually is her Physio wanted to show me something important and had a couple of serious words with me: “the muscles are tight, so we want to loosen them up by Massage and stretching” “your exercises are too much (in like too intense)” and she then returned the paper with the program back to me. I tried to explain to her that she was improving, but she didn’t want to listen. Soo in conclusion: This patient will probably still have difficulty going up stairs, because of a lack of active therapy.
Passive treatments should really only be implemented as an extra, right before the actual active treatment to potentially lower stress levels and therefore shortly decrease pain sensitivity. In most cases active treatments have a higher probability for longterm success and therefore have a better chance in increasing the life quality of the patients
This right here!!!! Im a student physiotherapist rn and I think a lot of PTs go too easy on their patients
We gotta start being more active therapy oriented within evidence based research of course and avoid too much passive therapy
I experience this exact same scenario during my internship right now. It can make me feel so frustrated that some physio's aren't capable of or willing to understand and accept the importance of hands-off active treatment.
Loving the screen shot of athlean-x ‘how to fix back pain instantly’ 🤣🤣
I used to love the channel when I had just started studying physio 3 years ago. Not so much now tbh LOL
@@bryanlee1449 haha yes totally agree. Its amazing how many people buy into his BS.
@@bryanlee1449 Why is he so bad? He's got decent principles but just does clickbait and sometimes gives generic info to sort out most ppl (not all tho) right?
@@johnsmith-yv7rp Yeap I totally agree with you when you said he's got decent principles and gives generic information to the masses. And I'm not really saying he's bad at all. My point was that he may give impressions that patients can get positive results instantly with suggested exercises and could potentially undermine all the hard work necessary to achieve meaningful outcomes in the long term. We all know there's no short cut in a field of rehab and the titles of some of his videos may create other rehab myths.
@@johnsmith-yv7rp Jeff Cavaliere is the reason I became a physical therapist. I’ve learned so much from him. But I have to admit he is guilty of the clickbait stuff.
I am not a physio but a patient. I went to see four separate physios who all prescribed a similar ice/stretch/massage solution for my achilles tendon. None of it worked. It was only when I saw your videos about progressive loading of the achilles tendon with exercise that I began to see an improvement. This leads me to think that many physios don't keep up to date with current research. It also makes it really hard for us patients to know which physiotherapists are good and who to spend our money on. The fact there are so many lazy physios out there actively puts me off seeking out another professional because I don't want to risk wasting yet more time and money. Thanks for your content - it has helped me a lot 🙂
Sorry you’ve had to go through so many steps. The video that helped you in the end is intended to help physiotherapists better help their patients. We know it’s inevitable that patients also watch our content but our goal is and will always be to help physiotherapists stay current with the literature and thus deliver better evidence based care.
I think this is extremely useful, thank you. I would only highlight that when you refer to ‘no amount of experience can replace keeping up to date with the evidence’ (paraphrasing): EBP comprises of three pillars, one being clinical expertise and the research being another. Evidence provides us with guidelines, not rules and therefore 30 years of countless successful results utilizing specific types of modalities still has substance and should be taken into account. However, I agree that all HCP must keep evidence based and up to date as much as they can.
Respect for the start.
I 100% agree.
These are all, of course, spot-on. I would add one more item: not understanding what we *actually* do as physios. Medical doctors treat pathology and diseases of the body, psychologists treat mental health, etc. But does the average physio actually understand what physio treats vs the tools of that treatment ("I stretch people, I give people exercise," etc)? We don't treat pain, and we don't even treat movement/so-called movent impairments, either: we treat the *experience* of movement. For our patients, their experiences may be that something hurts when they move, or something is strenuous or exhausting when they move, or they may not be able to experience the sensation of movement at all. When we expand our understanding beyond simply the things associated with movent (joints, muscles, bones, etc) and recognize the things that are more important in experience (sensory, motor control, cognitive/emotional domains, extero vs interoceptive, etc), we can finally perform at high levels of quality and consistency. We can only perform good work if we understand *how* we work. IMHO.
i see Overcomplication incredibly true
Perfectly summed up in what's wrong in our physio industry right now,great video !
Excellent summary. Thank you for spreading the messages. In the end PTs & patients dream of quick fixes!
Great video, I have made these same mistakes. Better evidence = Better outcomes
Man I am kinda proud of me that since 4 years I am not doing one of those mistakes..before that oh lord I did this stuff all over the place
Nice Video - it‘s so important to go out of the „daily working bubble“ and reflect your language, assessments and used researches/evidence. Always try to make your work more effective for your patients and your own growth.
I always value the Holten (oddvar holten) Curve when designing a strengthening program to properly load my patients depending on if they are in the acute vs sub-acute vs chronic stage of an injury.
Thanks a lot! The best Video about Physiotherapy I have watched until now!
Another huge problem is not having a clear concept for communication. If you don't want to listen to everything a patient can tell, you must be sure to ask for anything you need to know. I've lost a lot of time with therapists who thought they knew it all, talked over me, only to notice something unusual after a lot of appointments and than blaming me for not telling.
You can base your therapy on assumptions but that doesn't always match reality. And not every "but..." a patient says is a "cheap excuse" you can go over without lowering your quality.
Thanks a lot! It is so encouraging to see that you - after so much great work you already did - came to these particular conclusions!
Glad it was helpful!
Wow this is really helpful and provide great insight on my own practice! Thanks a lot! Please do more video like this
your video are crazy, everything you siad is backed by articles. Loads of effort in here i can tell. Please keep going, future physio need your video.
I appreciate that!
Great video and very helpful for Physiotherapist. Well said points which actually get missed during treating the patient. Thank you
For some reason I could not get my eye away from how Kai's left elbow is higher than right one
I think I found the best youtube channel to improve my English haha. Thx
Welcome!
Thanks for this video. Your talk reminds me of my University of South Australia Lecturers, they really pushed these messages. A good reminder of the basics. Thanks. On reflection, I'm a bit guilty of the under loading, it's a fine line to tread to not overload and progress too fast....Riddled with self doubt, until I step back and just apply the tenets of exercise prescription.
Almost everyone is guilty of the things we mentioned including ourselves, so no worries.
Danke ihr seid einfach spitze! Wir machen dieses Fehler alle mal mehr oder mal weniger es ist auf jeden Fall gut mal wieder daran erinnert zu werden! 👌👍
Thank you for sharing; definitely all things I could work on and improve.
Τhe biopsychosocial health model is a great resource for a smooth and correct treatment. Thanks for the daily, valid update.
Great video. Keep up the good work.
Very good and considered advice. Thank you.
Great vidéo and great content again !
Merci beaucoup pour tout ce contenu encore !
Great video, very helpful to hear as a new grad.
Thank you sir ,as a physiotherapy student it very helpful
Thanks for sharing ur experience
Thankyou sir for physio of next generation we need polynominal approach that is many physio treat one patient that is m is to one patient
Very useful information 👏🙌
A much needed video
Amen 🙏🏼
Do you recommend any evidence/research sites?
I feel like you guys are watching me work lol
Danke @physiotutors ✴️
Hi, may I know about HLAB 27.
Yes to true under loading just like GPs saying 30mins a day inhospital exervises i wasway over qualified for they wonder why we in tears its in scjool too doing widths when i can do hundreds lengths swim already‼️‼️‼️i hate non medical terms im qualified in anatomy physiology As all eay through. I can check when i dont understand double check often they cinfuse things by using lay terms some times even use wrong words!
Hahaha, i know who it is on 2:26
That caption tho 💔😂😂😭😭
The bitter truth
1:18 40 hours a week? I work 50 darn hours :(... Where can I apply?
Even crazier then!
sir. where can i find free research?
www.Physiotutors.com/research
Can i buy the book? Not ebook?
Yes as a Paperback. On Physiotutors.com
Subtitles spanish?
Im guilty :D
Seriously what happened to the good old physio tutors, this is just self praising media to sell your courses. Big drop off in content quality.
Think the rest of the people who have watched this video will disagree. Don't see any self-praise here either.