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ɹǝʇlnoԀ pıʌɐᗡ 🚴🏻 🇺🇸 🇦🇺 🇬🇧 Profile picture
@Retlouping
Aug 11, 2021 • 13 tweets • 3 min read • Read on X
Just to be clear, there is a big difference between “directional preference” (DP) and assuming a position that relieves your symptoms (accommodation positions)
DP is defined by any position or repeated movements that beneficially affects your symptoms and or mechanics during….
And remains better afterwards. DP when present also has an affect on other movements and positions in a beneficial manner.

AP on the other hand is a position that gives symptom relief at the time, but rarely if ever improves the overall presentation and in some case…..
You may feel worse as a result of assuming this position afterwards. AP is a normal human instinct, we assume positions of less pain. This is similar to trapping a finger in a car door and opening the door for relief, but never removing the swelling finger. The door closes again
And the finger hurts worse than before.
DP actually slides the finger out of the door and allows the door to close without hitting the finger again.
DP has been shown in studies to be a sign fo good prognosis.
It is the hallmark of the McKenzie “derangement syndrome”
AP is more suggestive of tissue trauma and an acute inflammatory reaction.
Both are acceptable self treatment strategies in the active presentation. One must beware when using AP that it is not making your condition worse afterwards.
As usual, thanks for reading hope it was useful.
Update example
Addition for context
Maybe we also need to unlabel symptom modification from the word “exercise”????
Also important to remember that the McKenzie method of MDT is not just about symptom modification
Also worth a read
For anyone interested here is the clinical process I propose.
A thought to ponder 👇

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More from @Retlouping

ɹǝʇlnoԀ pıʌɐᗡ 🚴🏻 🇺🇸 🇦🇺 🇬🇧 Profile picture
Mar 8
New editorial: BUT I am not convinced the authors have this one right. A placebo and a sham are not the same thing, and there lies one of their problems. A brief 🧵

Sham treatment? Should it be redefined for its use in manual therapy clinical studies? tandfonline.com/doi/epdf/10.10…Image
The authors of this editorial confuse palcebo and sham, I discussed this in my recent blog about the paper we wrote on contextual effects here
A placebo and a sham are not the same. Both have their clinical effect based on din context and thus the contextual effects are what gives a clinical response Image
Read 8 tweets
ɹǝʇlnoԀ pıʌɐᗡ 🚴🏻 🇺🇸 🇦🇺 🇬🇧 Profile picture
Feb 27
(A thread 🧵 to ponder) has word shielding gone mad?

What is a “disease?”

How do you define it? Image
Now

What is a “syndrome?” Image
And

What is a “condition” Image
Read 15 tweets
ɹǝʇlnoԀ pıʌɐᗡ 🚴🏻 🇺🇸 🇦🇺 🇬🇧 Profile picture
Feb 23
After a bit of prodding, here by special request is a thread 🧵 on the dreaded “shoulder impingement”, a brief look at the history, the evidence against, the current suggestions and the difficulty clinics have adapting to change. Off we go, enjoy the ride. Image
So where did it all start? Well way back in 1934 with that Dr you probably associate with the swinging dangling pendulum exercise Codman. Then 38 years later Dr Neer formally proposed “impingement syndrome” and of course both had a surgical fix 😃 Image
I trained over 40 years ago & back in the day we used to diagnose “impingement” using yes you guess it “Impingement tests” Neer’s impingement test & Hawkins Kennedy test were the standard. Well it’s time to say good by to them because they are as useful as a chocolate tea pot.
Read 24 tweets
ɹǝʇlnoԀ pıʌɐᗡ 🚴🏻 🇺🇸 🇦🇺 🇬🇧 Profile picture
Mar 3, 2024
A ponderance thread 🧵:

I’m going to suggest that there are significant differences between mechanical compromise to a nerve root and a nerve trunk (nerve true). Hence we need to use radiculopathy for root and neuropathy for nerve, they are NOT the same. Image
Evidence shows that the nerve roots & nerves act differntly
“However, compression of the cauda equina and dorsal rhizotomy proximal to the DRG do not induce significant pain, whereas in the spinal nerve and peripheral nerve, injury distal to the DRG does induce neuropathic pain.”
The paper here
Read 13 tweets
ɹǝʇlnoԀ pıʌɐᗡ 🚴🏻 🇺🇸 🇦🇺 🇬🇧 Profile picture
Sep 1, 2023
A ponderance 🧵

When we talk about “exercise” what exactly are we talking about?

Systematic reviews often lump every man & his dog under “exercise”

I have long held that a movement performed for symptom modification compared to a movement done with resistance are like 🍏 v🍊
Self movement aimed at pain relief eg a preferred direction of loading movement that decreases your pain in the here and now, should be labeled “self treatment movements “ NOT exercise per se. Image
Self movement as shown in the diagram above is part of the empowerment Force/loading cycle.

It seems facile to compare a self movement aimed at treating one’s symptoms in the here and now, with a resistance exercise or cardiovascular exercise which have different intent.
Read 8 tweets
ɹǝʇlnoԀ pıʌɐᗡ 🚴🏻 🇺🇸 🇦🇺 🇬🇧 Profile picture
Apr 18, 2023
A new thread 🧵 based on the last 48 hrs and me consistently saying that pain is reduced in many cases before or without any strength gains from resistance exercises. Is it true that weak muscles don’t mean pain? Do. You need to be stronger to get less pain?

Enjoy the ride.
So lets do LBP first, is there an association between decrease pain and improved strength and function? Apparently NOT
Well what about weakness around the knee and future incidence of pain?
Yep in women possible in men no. Confused yet?
Read 15 tweets

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