jessephysio

Thursday was my second day at the conference and it was my favourite of the 3 I was in attendance for. To start the morning off we had Gray Cook talk about how we look at movement screening, testing, and assessing movement patterns. I wrote a full blog post on his talk that can be seen HERE .

After a break with exhibitors, I attended a specialist master class  pertaining to complex cases presentations. The presenters all described a real case which served as a great clinical lecture with real take home messages for me. Dr Trudy Rebbeck from Sydney Australia talked about a very interesting case of 15 year old football player who suffered concussion like symptoms after being aggressively tackled in a game. Any movement of the neck produced numbness and weakness in the arms and legs (yikes!). He was sent for an MRI which was “negative”. After a course of therapy including DNF exercises, gradual return to play re-training and balance training he was cleared to go back to his sport. The one detail that astounded me was after the initial MRI was cleared, the Physiotherapist (Dr. Trudy Rebbeck) wanted to see it because his symptoms just didn’t make sense to her. After she reviewed it and asked another radiologist to look at it, they clearly found out that this young boy had incomplete fusion of the arch of the atlas and small tears in the alar ligament. The condition is called Spina Bifida Atlnato and was completely missed by the first radiologist.
Moral of the story: We must exercise clinical judgement and we can’t believe everything is fine with our patients even when they are cleared medically.

There were other case presentations that dealt with similar situations. The overall theme of this class was to think holistically at the body and always to think outside of the box when treating any one specific joint. I.E anterior shoulder pain might be an issue with the rotator cuff, LHB tendon, cervical spine, thoracic spine, serratus anterior or lower trap weakness…the list is long and we have to differentiate to get a a true clinical diagnosis.

After that class the conference gathered back in the main room to witness Robert Elvey get the Geoff Maitland award for clinical excellence throughout his 40+ year career as a physiotherapist. He has been dumbed the father of modern neurodynamic therapy and has taught 1000’s of clinicians the art and science of OMPT all over the world. He was not in attendance to receive the award due to health matters, but his acceptance speech read by a friend and colleague of his was excellent. Congratulations to Robert Elvey on this distinction.

The last presentation of the day was called ‘Manipulation in the Thoracic Ring’ by Dianne and Linda-Joy lee. Unfornately I arrived just as they started and was forced to stand for the 2+ hour lecture with about 30-40 other people in the back. I could not write any notes down as I had no space to do so. Even with that in mind, I still highly enjoyed their talk. If you’re a physio in Canada, chances are you have heard of the lee’s. Diane lee is synonymous with the pelvis and they have been vital in their work of the theoretical model of thorax biomechanics. In a very large summery of what they said, their 30+ years of clinical experience has lead them to believe that many common orthopaedic conditions can be traced back to the thorax. It is their contention that the ribs can shift to the right or left… envision the rib-vertebra-rib-sternum complex as one complete ring. Therefore we have 10 complete rings from rib 1 to rib 10 (last 2 ribs are floating and don’t constitutive a true ring). They believe that subtle shifts in these rings can alter our positioning, creating muscle imbalance, join compression, and really many different problems. They used videos to demonstrate their ring re-positioning techniques on their patients with what seemed like miraculous results. The lee’s really made this concept look like the missing link that integrates all forms of therapy into one conceptual model. They showed video of a rower with a long history of LBP with rowing and long periods of sitting. In their video they showed the rower long sitting (like a rower position) and we saw his lower lumbar spine shift sideways with each rowing movement. L.J Lee then placed her hands along the side of the thoracic wall (which 2 ribs i can’t recall) and ‘repositioned’ the rings and told the patient to do another rowing motion. After her force was applied, the rower had no more pain in his lower back. All in all I left this presentation with so many questions as I always am skeptical of techniques that are advertised as cure-all’s. I’m not saying they out right said their form of treatment can cure everything, but they did have an almost mystic-like tone to their presentation. To learn more about their very interesting model, click HERE

In summary: This day and really this whole conference has been about the connection between research and clinical experience. We must use research to guide our practice, but we can’t let it be everything. Like the Lee’s said: RCT’s will never encompass or be able to examine the therapeutic relationship we have with our patients…and this is a very valid point indeed. This conference has also really been about thinking about the regional inderdependence of the body and to view it in a holistic way. Surprisingly, I didn’t hear as much as a I thought about specific manual therapy treatment. I heard more about functional movement assessment, integrated systems model (Lee’s), and the biopsychosocial model of pain.

Thanks for reading,

Jesse Awenus