Lee Schneider

Physiotherapy is becoming more psychologically-informed and this is a good thing. However, the common overlap of pain, anxiety, depression and past-trauma often means that if we are to address the psychological-contributors without psych-input we are venturing beyond our scope.

@Dr_OliverT_PhD @Retlouping @PeteOSullivanPT @NSaraceniPhysio @GregLehman That’s a great study. I hadn’t heard of roentgen stereophotogrammetric analysis but I have to agree bring it back! From 1989 but seems to suggest some movement (though very little) and no difference between symptomatic and asymptomatic side europepmc.org/article/med/29…

Does the SI joint move? If it does, is this movement clinically meaningful? My understanding was no to these questions though it has been challenged recently. @PeteOSullivanPT @NSaraceniPhysio @GregLehman Recommended papers to read in this space?

@Retlouping @PeteOSullivanPT @NSaraceniPhysio @GregLehman Thanks David looks like a lot of work went into this thread. Had a PD with senior physio at work regarding SIJ and honestly I could not feel what they were talking about. Tough situation.. threads like this are very validating!

@LSchneiderPT @PeteOSullivanPT @NSaraceniPhysio @GregLehman There’s always a thread 🧵 (it includes motion references)

@GregLehman @PeteOSullivanPT @NSaraceniPhysio Appreciate that Greg, will have a read 👍

@LSchneiderPT @PeteOSullivanPT @NSaraceniPhysio It moves a little bit. The best paper on the topic is here pubmed.ncbi.nlm.nih.gov/31355883/

@MervTravers @PeteOSullivanPT @NSaraceniPhysio @GregLehman Thanks Merv I know Valdi and the team have done great work in this space and has largely shaped my thinking around SIJ. Will come back to read this paper 👍

@LSchneiderPT @PeteOSullivanPT @NSaraceniPhysio @GregLehman Hi Lee, try this one: pubmed.ncbi.nlm.nih.gov/31355883/

@MervTravers @PeteOSullivanPT @NSaraceniPhysio @GregLehman Cheers Merv. I’d say that matters a lot.. if the best biomedical option we have does not outperform placebo what does it say about interventions that hope to stabilize this joint.

@LSchneiderPT @PeteOSullivanPT @NSaraceniPhysio @GregLehman And does it matter if fusing it does not outperform placebo? thelancet.com/journals/eclin….

@AdamMeakins @apaphysio Stay in your damned lane EPs!

The insecurities and inferiority complexes the @apaphysio must have to publish this pathetic document that tries to undermine the many superb Exercise Physiologists out there is both sad and disappointing! Physios and EPs should be working TOGETHER not disparaging each other!

@JoeBarryPhysio True that’s a good point. I learnt a lot from this one too.. definitely makes me want to learn more about the mechanical cause of OA.. the points about repair were interesting to me. I wonder how much is reducing sheer force and how much is bolstering adaptation 🤔

@LSchneiderPT This is a great podcasts Lee, learnt a lot from this one. Makes sense to me clinically. Ie, why we tend to brace the upper limb more than lower . Ie open chain w more mobility exposed to more shear force

Monday bias challenge: Shear force at the joint could be the ticket to osteoarthritis development and global contributors (smoking, weight etc) more likely impact repair mechanisms. podcasts.apple.com/au/podcast/the…

Great clinicians do not care about loading the toolbox They are masters of the patient relationship Then add: -Mastery of the basics - Ability to identify red flags - Understand complexity of pain - Solid clinical reasoning Losing toolbox mindset = path to clinical mastery

@physiojack @MicahWong_DPT Thanks Jack, Have you found that patients in this cohort (generally) are open to and respond well to active management strategies? Also, have you come across any issues with funding for these patients either privately or publicly? I’ve heard this can be hard..

@LSchneiderPT @MicahWong_DPT Challenges: - Fatigue & pain management - Differentiating MSK issues and Inflammatory issues - comobidities Perks: - Working with rheumatologists/mdt - widely variable conditions - if nothing is working a steroid is usually an option 😉😆

Calling all rheumatology physios! Considering this as a specialty area as I’ve been seeing a number of patients in outpatient musc with dx AS and other rheum conditions. Find it very interesting. What are some challenges/perks of working in this space that you’ve found?

@arothschildpt “It’s my L3/L4” is a yellow flag imho

Unpopular stance: Sometimes it's the patients that are overly-pathoanatomically focused. The forward-thinking clinician will have a greater challenge providing evidence-based care with these pts than those that are still stuck in the old models of practice

@thomas_jesson It can take some time.. though here’s what we can do now to help you manage now.

A secret: Laying on the couch is just as effective as those fancy recovery tools. And much cheaper.

@paintoolkit2 classic 😂

So how’s your Tuesday morning going 🙃

Perk 2 of public health (at least for me and where I'm working). Multidisciplinary team, all located on the same ward, all vying for the same outcome.

@DerekGriffin86 @JoeBarryPhysio I partially agree. Though if we take empiricism seriously we are all underwhelming. Everything we do is very underwhelming. Improvement of 1.5 on a VAS = statistically significant, though a very underwhelming change for the person in pain.

@LSchneiderPT @JoeBarryPhysio It's an empirical question. Does mindfulness improve pain, function & QoL for people with pain? Mechanisms are great if they actually translates to outcomes. The evidence is underwhelming.

Interesting conversation on how meditation can influence mechanisms of predictive processing and pain. Only 20 (ish) mins long..Similar to the daily minimum effective dose for meditation 😎👌 open.spotify.com/episode/0iZCwK…

@Roger_OToole Short I'd say.

@LSchneiderPT Given that it is quite difficult to do one without the other, or in a disproportionate manner, how long were the bouts of learning? 🤔

We learn more when we are breathing in versus out 😳 Some of our oldest systems phylogenetically are our olfactory. Breathing in meant sensing the world. And now, it’s domain general (as far as we know). Can it help with sticky internal models? Pain? osf.io/38bpw/download…

The worst advice I ever received: “Don’t run, it’s bad for your knees.”