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ɹǝʇlnoԀ pıʌɐᗡ 🚴🏻 🇺🇸 🇦🇺 🇬🇧 Profile picture
ɹǝʇlnoԀ pıʌɐᗡ 🚴🏻 🇺🇸 🇦🇺 🇬🇧
@Retlouping
All my opinions are my own. Dislikes evidence based ostriches ( An evidence based ostrich ignores evidence against, whilst waiting for evidence to support)
25 subscribers
Mar 8 • 8 tweets • 3 min read
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
Feb 27 • 15 tweets • 5 min read
(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
Feb 23 • 24 tweets • 7 min read
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
Mar 3, 2024 • 13 tweets • 4 min read
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.”
Sep 1, 2023 • 8 tweets • 3 min read
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
Apr 18, 2023 • 15 tweets • 4 min read
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
Oct 12, 2022 • 6 tweets • 2 min read
On #worldarthritisday2022 so here are some thoughts 💭 Stop the wear and tear bone on bone rhubarb 👇
Oct 11, 2022 • 19 tweets • 7 min read
Sat here thinking it’s thread time.

So “old man shouting at the audible pop” is it all it’s cracked up to be?

A 🧵 Hot off the presses 👇
Oct 8, 2022 • 7 tweets • 3 min read
A patient edumacation 🧵 (basically so I have all these things in one place 😂

Telling isn’t teaching.

People want and need different forms of delivery of the same information.

F2F allows understanding in both directions, written words don’t

Enjoy the 🧵 I’m sure we’ve all experienced a version of this? 👇
Sep 23, 2022 • 22 tweets • 6 min read
Updated 9/23/22

Today’s twitorial In the old man screaming at clouds series.

Poulter’s paradox, the hips pelvis SI joint and lumbar spine. Some clinical types, suggestions and clinical gems, by ME.

The lumbar spine transitions……. Ito the semi rigid pelvis via it’s L5/S1 disc in most cases and its muscular and ligamentous attachements. The semi rigid pelvis transitions to the lower limb via the hip joint, which shares muscles with both the spine pelvis and femur. This area can be a complex and confusing Image
Jun 18, 2022 • 12 tweets • 3 min read
🧵
A provocative ponderance parable:

A man presents for assessment with a complaint of pain in his second MCP joint with restriction of the index finger movements and radiating pain to the wrist and down the forearm. Image After receiving a brief history the therapist examines the hand.

The index finger is definitely stiff with a fixed extension deformity, marked loss of passive and functional movements.
On palpation there is pain around the MCP joint & anterolateral wrist
May 27, 2022 • 11 tweets • 4 min read
A mini 🧵 plus a link to another thread enjoy the rabbit hole that is my thread with threads.

Old man ponderance on bone stress reactions.

Stimulated by this great thread. And my relies in this thread 🧵
May 19, 2022 • 8 tweets • 2 min read
“One or two hours of individual patient education probably makes little to no difference in pain and functional outcomes compared with placebo for patients with acute/subacute LBP”
Houston we have a problem?
One more time education is NOT telling people STUFF in 1-2 hr blocks
🧵 I talk to this point in this thread 🧵 👇
Apr 26, 2022 • 18 tweets • 6 min read
When PTs talk about screening for red flags 🚩 how good are we and do we miss the gorilla 🦍 in the room? Plus do we understand the difference between a red flag and the serious condition? A thread 🧵 I talk to this in this thread on clinical reasoning in LBP.

What is our index of suspicion and how common are serious conditions?
Feb 14, 2022 • 14 tweets • 3 min read
I hear that the PT twitter verse (I can’t see cos I blocked the protagonist) has it’s panties in a bunch over the famous professor of spinal biomechanics (NOT a medical doctor or clinician) and advice to pro NHL athletes to avoid tying their skates. A shortish 🧵 The notion of human lumbar si discs having “finite” amounts of lifetime flexion before they apparently herniate seem to come from this paper on “dead” pig cervical discs

breathe.edu.au/wp-content/upl…
Jan 16, 2022 • 10 tweets • 6 min read
Old man ranting at rainbows 2022 a thread 🧵 on running, movement cycling and the effects on joint health of the spine, SI, hip and knee. “Movement and loading is life” Running into bad for your hip joint. Great lets start with that.

3.0 T MRI findings of 104 hips of asymptomatic adults: from non-runners to ultra-distance runners

bmjopensem.bmj.com/content/bmjose…
Dec 19, 2021 • 16 tweets • 6 min read
I have been pondering on the Sacroiliac Joint and some clinicians fascination with it. I think that it is the source of more “evidence based ostriches” than any other joint.
Yes a brief thread
The SI joint and pelvis are not a “pubics cube” we do need to stop the madness. That said yes the SI joint can be sensitized and produce nociceptive output when stressed. But so many hypotheses abound about positional faults, laxity, dysfunction and fixation that it is bizarrely paradoxical
Oct 7, 2021 • 49 tweets • 12 min read
Last one I promise

From the Poulter’s PowerPoint files this one on “Scary Myths of low back pain” a Halloween conference presentation, and this time 2017.
interesting to see my powerpoint slides style has changed (for the better) 😂 ImageImage Image
Oct 6, 2021 • 16 tweets • 12 min read
In 2006 I presented this at a national conference on low back pain.
I think most of it is just as relevant today as then.

“Nothing new under the sun except the angle of approach”

What were you doing in 2006?

Things we did before twitter 😂 Image Image
Oct 6, 2021 • 36 tweets • 8 min read
OMG todays offering from the Poulter PowerPoint archives is this 2006 presentation on differentiating shoulder from neck. Remember this predates the McKenzie EXPOSS study by some 12 years but I did teach most of the people who did the study. 😂 enjoy a blast from the past. Image Image
Aug 26, 2021 • 9 tweets • 5 min read
A brief thread on recovery of motor deficits after Dc herniation , the evidence for early surgery is not clear, evidence for wait and see seems comparable in recovery type and rates

pubmed.ncbi.nlm.nih.gov/12358369/

Recovery of motor deficits after microdiscectomy for lumbar disc hernia Risk factor analysis for motor deficit and delayed recovery associated with L4/5 lumbar disc herniation

pubmed.ncbi.nlm.nih.gov/20924296/