Writer's Block

Maintaining an active physical therapy blog takes time, energy, creativity and perspective on what is happening within the profession at any point in time.   Because of large time commitments to my clinical life, educational life and home life, I have not been consistently contributing to this site.   This is not because of a lack of writing though…I begin writing, and then hit a wall. Below are several unfinished pieces I began over the last several months before hitting a wall.   They are rough, unedited, thoughts.   I’ll let you finish the story.
Top 10 Postural Mistakes You Are Making That Your Physical Therapist Isn’t Telling You…
Ok.  I made a typo in the title of this article.   It should read, “The Postural Myths Someone May Have Told You Are Likely Wrong“.    Oh well.  You are here.   Might as well read the article, eh?
So recently in social media, I have seen a few “popular” infographics and articles about pain and posture.  While some may ask , “whats the harm in this”, I would say, “well…alot”.
Our understanding of pain has evolved quite rapidly over the past 20 years.  A significant amount of research has been produced by research groups such as BodyInMind, that has demonstrated the complexities of pain.  Despite this, some have difficulty letting go of the cultural belief that poor posture causes pain.   While this generally doesn’t “grind my gears”, I recently saw an infographic on Facebook, shared by the Supple Leopard, Kelly Starrett (I am not truly sure who developed the actual image, but it is linked to a group called “Standupkids”).
While my blood pressure is usually fairly normal, I likely reached hypertensive numbers as I read this infographic entitled “Sitting is an Orthopedic Perfect Storm“.  I could not get over this images fear-mongering, unvalidated claims and down-right offensive language (ie. “Douchebag Shoulder“).  But despite its inconsistencies with research, it has been shared through Facebook 1,471+ times.
So why is this image so wrong?  Well, it makes many “unsubstantiated” and downright incorrect claims such as:
“Too much sitting is the root cause of non-specific low back pain, stenosis and disc pathology.”

  • “Slumping over in a chair can creates internally rotated shoulders which can cause shoulder impingement, rotator cuff dysfunction, instability, “douchebag” shoulder and general shoulder pain”.
  • “…causing wear and tear to your spinal cord, disc degeneration, herniation, surgery, nerve damage, headaches, compromised shoulder function, and compromised athletic function”

While we have made some great strides teaching pain science, we still have a way to go.
 My Educational Journey
As some of you may know, I am quite involved in Post-Graduate education, being a partner and educator in the Nxt Gen Institute of Physical Therapy.
While I have acted as a lab assistant, matriculation tester and guest lecturer of graduate courses, I haven’t the opportunity to teach “my” course.  That was until now… I recently accepted a role as an adjunct role at Duquesne University (my alma mater), teaching a course in Differential Diagnosis (known in the syllabus as REHS 539).
The course will begin in May and is part of a reciprocal program Duquesne has with China.
In the journey of preparing for the course, I had to choose the “text” that I would utilize.  After sifting through some options, I chose to pursue “Differential Diagnosis for Physical Therapists: Screening for Referral 5e“. The text had some decent reviews on Amazon, and I had used an earlier version in my career, so I thought it would be a good fit.   I submitted the choice to the University (who places an adoption request) and contacted the publisher for the instructors version/materials (the publisher Elsevier has resources for instructors).   Upon submitting my request, I corresponded to emails for 2 weeks prior to being denied an instructor version (I had no confirmed book sales yet…).  Fortunately, the faculty at Duquesne is awesome…WRITERS BLOCK
When will we quit looking at Physical Therapy as an intervention?
 This morning, I read an article review published on Medicinenet.com called “Physical Therapy May Not Improve Hip Arthritis, Study Finds“.    After reading this article, I had several thoughts.   Here they are:

  • I suspect we can easily replace the words Physical Therapy with other interventions, such as NSAIDs, glucosamine, etc. and nod in agreement.  But what would happen if this author would have replaced Physical Therapy with the term “Western Medicine”?   I doubt it would have been published in JAMA…
  • I am tired of Physical Therapy being viewed as a consistent intervention, when in reality, there is very little consistency in the intervening patterns of license Physical Therapists.   This due to many reasons, including the individual nature of each individuals presentation.   Do we treat Osteoarthritis (OA)?  Or do we treat Individuals who present with hip pain or an inability to perform _______ with a radiographic finding of OA?
  • An individual within the article was quote as saying, “Azar noted that physical therapy doesn’t usually help arthritis of the hip. Injections of steroids and painkillers are more effective, she said. Physical therapy tends to be more useful with people who aren’t physically active or who have balance or other walking problems, she added.”   If anyone needs an explanation why, Ill be more than happy to elaborate in the comments. 
  • Is this study consistent with treatment plans of care typically prescribed by Physical Therapists?  This study had each participant complete 10 sessions over a 12 week period.  I am not convinced that we can conclude that much when we attempt to tightly control for internal validity.  The author of this review actually extrapoloated the results to state that an entire profession (Physical Therapy) may be unable to treat individuals with hip osteoarthritis effectivelly.

I hope the APTA will respond to this piece and define that we are a Profession WRITERS BLOCK
-Joe B

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  • Writing regularly is tough! I have lots of advice, coming from someone who blogs daily for the past 3 years. 1) Many of your readers, even the regular ones need repetition of good messages. This includes pain science examples, analogies, modern manual therapy concepts etc. 2) the shorter the blog and quicker the video, the more engagement you get. 3) be repetitive! Not every single reader reads and retains every single word you write! ps. be repetitive

    Erson Religioso III June 24, 2015 2:56 pm Reply
  • I’m currently going through something like this myself. I want each article I write to be of value to those reading it. This is hard to do! I also have found people love lists… “Top 3 ankle mobilizations to restore DF, my favourite gluteal exercises etc”
    I don’t know if that’s your thing, but it helps get readership

    jessephysio June 24, 2015 3:01 pm Reply
  • Agreed with Erson and Jesse. I bet that you have seen interesting cases clinically and have some interesting pearls in the way of patient management to share. I got called out today on Facebook about a grammical error of the improper way of using “your” in my post title instead of “you’re”.. On well, ateast it stimulated some kind of thought and they actually read the post, even if they commented on that rather than some clinically relevant comment. Hang in there, keep it simple, you’re a wealth of knowledge, just let it flow..

    Steve Goldrick June 24, 2015 10:39 pm Reply
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  • Joe,
    Great post and based on my recent contributions to the blog you can see that I am in the same boat. I also have several posts that I have started and not finished. Thanks to the other commenters for some good advice. Maybe I will move “write a blog post” further up on my to do list.

    Adam Rufa June 30, 2015 11:31 am Reply
  • Thanks for this article – it is very honest! I think it is common for people to feel the same, and often time runs away and before you know it you haven’t posted in a while – especially with things like blogs where you are never certain who your entire audience consists of – and also when you’re a bit of a perfectionist and want everything to be of high quality and useful for the readers. Thanks for sharing.

    Georgia December 20, 2015 2:07 pm Reply

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