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We have a new clinical care standard for the management of knee OA (link here).  It’s something that is fully consistent with how I practice and what I teach.  It couldn’t be more bias confirming and I should not be happier.

I just put out a Movement Optimism Podcast on whether Physios suck at exercise prescription. It is in response to a trend over the past few years where I hear physios/rehab pros being criticized. The criticism is that Physios don’t understand the basics of Strength and Conditioning and that if they knew these better they would get better results with their patients.

Is Movement Optimism for Movement Morons?

This is a good question – a tad insulting but lets let it slide. Because we should challenge Movement Optimism. But first we need to look at what Movement Optimism is (good old blog here).

As someone who has literally been reading research for 30 years this is an odd opinion to hold.  I love reading research papers.  I’ve been a nerd for a long time.  But…I think the pressure put on working clinicians to stay “up to date” is for the most part totally over cooked.

You click bait jerk. I know. But hear me out.

Apologies for the length of the post. It was meant to be a microblog but it morphed into pre-course reading for those taking Reconciling Biomechanics with Pain Science.

I know many people hate the term non-specific low back pain. The assumption being that if you know the anatomical source of pain you can give tailored treatment to your patients. But not only do I think that doesn’t matter much in the spine (there are exceptions and I wrote about that here) but it also doesn’t matter much at other joints. Let’s talk about the knee for example.

Why this blog: This is a bit of thought experiment. Bear with me.

ASSUMPTIONS ABOUT PAIN, INJURY AND RUN TRAINING

1. Tissue injury/failure is considered to be a cause of running related injuries and pain. It is assumed that building tissue strength will decrease our injury risk. Hence, we say things like injuries occur when Load exceeds Capacity. Yes, there are issues with the term Capacity but that’s another blog

Traditional physiotherapy has often looked to find “deficits” in someones function and then suggested those deficits are what is causing pain. Deficits are typically any type of physical functions or attributes that deviate from averages. Typical examples being altered postures when you are standing that deviate from neutral (e.g your head might be forward, your pelvis might be tilted more anteriorly than average, some muscle is weak or range of motion is less than average).

As someone with persistent pain (and a few traits that predispose me to pain) and a therapist for 20 years I am a proponent of resuming meaningful activities and exercise even when its painful…sometimes. I think that for a lot of people with persistent pain it is not only safe but its actually the thing that could help them most with recovery.

Below you will see a picture from a 2007 handout I would give for talks about running injuries and stretching. I had been anti-stretching for at least a decade. At least, I was anti-people telling others they needed to stretch to prevent injuries. I’ve also written about it here, here and here. It never made sense to me (it still doesn’t) so I enjoyed saying that the research at the time didn’t support stretching as an injury prevention method (again, it still doesn’t in runners)

Part 1: Running is Rehab: why running is part of the “fixing” 

In Lehman’s Terms: When you are injured a primary component of recovery should be the activity you love. 

It can be that simple some time.  Running is one of the stressors that catalyzes your healing and your preparation to return to full time running.

From my extremely unscientific observation it appears that 67-74% of my patients have been told their glutes are inhibited.  It seems to be an epidemic.  I had to cancel my Runner's World subscription because the onslaught of glute inhibition articles was too depressing.

he Kinesiopathological Model or the “Movement Quality” model might be viewed as the opposite of the biopsychosocial model of pain and injury. But I would say like most debates this ends up being a false dichotomy. I’m of the opinion that most agree that the biopsychosocial (BPS) model is relevant for pain and injury AND most therapists would also agree that biology/biomechanics are sometimes relevant for people in pain. But the true debate might fall into two related areas where people will fall somewhere on a spectrum:

Non specific low back pain is often a diagnosis that clinicians might feel sheepish about.  As if they have failed.  As if acknowledging uncertainty is a bad thing that leads to bad care.  This isn’t true.  It is quite often the only appropriate diagnosis and is the one that is the most accurate.  Other acceptable diagnoses are non-specific shoulder pain.  Or non-specific knee pain.  Because when we say NSLBP we are acknowledging that NO ONE knows the specific anatomical source of nociception/pain.  This is not really a debatable issue

've been triggered.  I guess I'm delicate.  It seems like I can't exist without being covered in the bullshit of physiotherapy, personal training and chiropractic musings on pain and injury.