Henk Tempelman

@marklaslett_NZ Hence, business as usual.

@Henktempelman1 Not phantom leg, just referred radicular symptoms with nociception arising from thr root & dura mater

Today I saw a 40 plus lady with radicular syndrome in the left leg. Pain in the calf and numbness in the foot. Daily business, except for the fact that this lady has a left above knee amputee for 20 or so years. I guess still business as usual.

@Retlouping @marklaslett_NZ This situation did not have DP. Tf injections didn't help. Time did not help either. She is a surgical candidate.

@marklaslett_NZ @Henktempelman1 And, in the past I have asked if centralisation would occur in these cases?

@Retlouping No deadlifts? 🙃

I’ve been married to my wife for over 38 years, she still has no idea what I do 😂 Now that her low back is better, today she asked me to have a look at her stiff sore neck. Pain left side into scap, major loss left rot, & ext, mod loss right rot. 1/2

@marklaslett_NZ Oh, sorry. Never doubted your results. Niceley done 👊

@Henktempelman1 Yes this happens! However the complete recovery in a day or two confirmed it in these two I think

Two of the acute severe back pains I saw last week who were rapid flexion responders on initial assessment attended today for follow up. Both are completely asymptomatic and have full painless ROM in all directions. Anterior derangements are so good to treat!

@Stanz1980 @marklaslett_NZ They are rare. But don't forget to test flexion. Almost always a good idea. Very revealing for yes/no derangement, fear and function. So it helps with clinical reasoning as well with coaching.

@marklaslett_NZ Am I missing anterior derangements in the general population? I feel like I get less than a handful per year, when I should be getting, what, 10-20% of my caseload?

@PhysioMeScience @JaredPowell12 @JeremyLewisPT Collegues who prescribe strengthening exercises for elite swimmers with rotator cuff injuries because of overuse, never made sense to my. Specially with the message: you need to get stronger. These swimmers trained 10k a day plus strengthening exercises already. More is better?

Rotator Cuff–Related Shoulder Pain: Is It Time to Reframe the Advice, “You Need to Strengthen Your Shoulder”? 👀👀👇👇 jospt.org/doi/abs/10.251… @JaredPowell12 @JeremyLewisPT

@omidrezaNouri @marklaslett_NZ @Retlouping Mdt is not a cookbook. Please enjoy a course and learn to do the clinical reasoning.

@Henktempelman1 @marklaslett_NZ @Retlouping This is true, but should we tell the patient to do flex 10 times for 2 hours as HEP until the last physical therapy session? What if we don't find a DP and we do a series of general exercises and after 1 week we don't yet find any DP again?

@Retlouping @Henktempelman1 @marklaslett_NZ Have you guys experience sth similar? "My friend : DP in MDT is not reliable. I find DP for Ext in lumbar and without doing repeated EXT, i do something else like Dry needling , stretch , massage .... and yet check again DP is Flex"

@marklaslett_NZ @omidrezaNouri @Retlouping Might be to simplistic. 1 set? 3 sets? Overpressure? Mobs? Time period? Fear? Different starting position? Mdt is more than just a bunch of flexions and/or extensions.

@omidrezaNouri @Henktempelman1 @Retlouping It's really simple. Do sets of 10 movements or sustained position in one direction & determine both symptomatic & mechanical response. Do the same for the opposite direction & determine there if is a DP effect. Repeat the whole thing. If it's repeatable/reversible you will see

@omidrezaNouri @marklaslett_NZ @Retlouping If at all possible, please try to follow a course.

@marklaslett_NZ @Retlouping @Henktempelman1 You mean this can't happen? Can't the change of DP happen at all, for example, after 2 treatment sessions? Do we have to check every session?

@omidrezaNouri If its not a problem. Don't fix it. However he sleeps or sits. So, assess the patiënt and act accordingly. Good luck.

@Henktempelman1 Hi I have two questions regarding Lumbar MDT : a Patient with Ext DP. 1 - should we change sleep position When he sleeps on his side with knee flex? 2- should we use lumbar roll at work wenn he sits 5 h ?

@omidrezaNouri If clear clues in hx for derangement. Allow 1-3 sessions. Consider more rep, more sets, force progressions and alternatives. Consider opposite directions to prove yourself wrong. And, listen to the patiënt.

@Henktempelman1 Can you please tell me how many rep should we do to find DP? I thought 10 is enough!

29 y/o f. 2 years of bp with intrmt legp l and r. After deadlifts (no joke). Endless strengthening, graded activity and cardio. W/o result. 30 reps of ext in lying with ther overpressure abolished pain and restored rom. I guess directional preference is still worth checking.

@omidrezaNouri The answer is in the case. Staying active, keep working en walking the dog. If no DP like in this case. Listen to the patiënt to what does work for him/her.

@Henktempelman1 I have 2 old Questions : 1 - what do you do with this Pt? I mean when after DP finding the DP did not reaponse 2 - what do you do when you do not find DP in first or 2nd session?

35 y/o back and left leg pain. Worse after a week of ext exc. Much better when stopped exc and returned working (active and lifting) and walking dogs. Worse on his days off. He will have some happy dogs during the holidays. No directional preference in this case.

@Retlouping @omidrezaNouri Fair point. But a patiënt doesn't know it needs DP. Test for DP first. But don't go chasing it when its just not there. Too many mdt therapists are 'afraid' to conclude that no DP is present.

@omidrezaNouri @Henktempelman1 Assess the patient and their needs.

@Henktempelman1 @Retlouping Hi I passed this CFT course, I also passed MDT course. But I have a question when a chronic LBP patient comes, should I go to find DP or should I do relaxation for all Lumbar MVM according to CFT ? Do you have any experience? Thank you all

Hopelijk maakt iedereen het goed. #fysiotherapie #manueeltherapie

The McKenzie Method Is an Effective Rehabilitation Paradigm for Treating Adults With Moderate-to-Severe Neck Pain: A Systematic Review With Meta-Analysis ncbi.nlm.nih.gov/pmc/articles/P…

Still going strong and still expanding. MDT can be taught everywhere. To appropriate treat a patiënt you need a patiënt and a well trained clinician. Most of the time nothing fancy is needed.

@Writingwrongs18 @AdamMeakins @marklaslett_NZ Not sure this was for me. But i am suggesting that a 2 year severe shift won't improve with the McKenzie system or any other exercise based therapy. No guarantees with surgery but probably your best option. Good luck.

@Henktempelman1 @AdamMeakins @marklaslett_NZ I’m having surgery so should imagine that will deal with it but I’m guessing you suggest the mckenzie method

You can now listen or watch the recent fiery debate between @marklaslett_NZ and myself on disc injury, back pain, and the ability to be specific in our diagnosis or treatment! iTunes podcasts.apple.com/gb/podcast/the… Spotify open.spotify.com/episode/0eDaAP… YouTube youtu.be/zgHUHFu3wCA