This Blog was written together by Jukka Kangas and Wouter Geerse. INDIVIDUAL RESPONSE to patho-anatomical changes and movement dysfunctions Physiotherapists are aware that structural changes in musculoskeletal system don’t correlate directly with pain or functional capacity. In scientific world it is widely accepted that people respond individually to patho-anatomical changes (O’Sullivan 2005, Kangas 2011) and they adopt very different...

Is Manual Therapy beneficial in nerve related neck & arm pain? CRITICALLY APPRAISED PAPER (CAP) Adapted & commented by Michaela Neubauer PT, OMT, M. Physio, IMTA teacher (International Maitland Teachers Association), lecturer at the University of Applied Sciences St. Pölten. Neubauer_Neural-tissue-management_CAP_20170901.pdf Manual therapy_sideglide_NeubauerManual therapy & movement_Neubauer.

In one of our recent courses we had an interesting observation during inspection. (see picture in the title) A marked atrophy of the pectoralis major muscle and absence of the nipple was found. The participant told that he had the “Poland syndrome”. For more information, feel free to look it up in Wikipedia. In his case it mainly affects the sternal portion, which tested...

Most physiotherapists will tell you that there are a number of clinical syndromes that they particularly like or dislike, for whatever reason. What is your favourite group of patients suffering from a musculoskeletal disorder that you like treating, and do you know why? Early on in my career I happened to stumble over a range of patients with stiff shoulders,...

Tendinopathies are problematic to manage clinically. People of different ages with tendons under diverse loads present with varying degrees of pain, irritability, and capacity to function. Recovery is similarly variable; some tendons recover with simple interventions, some remain resistant to all treatments. (Cook&Purdam 2009) The classic description of the tensile load-bearing region of tendon includes 3 main components (Scott et...

Currently there is a lot of discussion about "Education" as a treatment option in the physiotherapy profession. There is evidence, that education seems to be more effective than other treatment options (Anneleen et al 2017, Babatunde et al 2017, Dolphens et al 2014, Louw et al 2017, Malfliet et al 2017).   BUT What does "Education" mean at all? Is this really...

Interesting case report about chronic achillodynie and the treatment with manual therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294940/pdf/ijspt-12-133.pdf

An useful tool for your Clinical Assessment! by Lisa   Dinamometro IMTA blog 2017

A critical look at Structural differentiation. Rolf Walter, private practioner CH-6834 Morbio Inferiore   The wish for structural differentiation is integral part of medical professions worldwide. Finding the anatomical structure driving the potential painful source of peripheral input may seem logical in situations where a distinct peripheral pain source is expected but observational and community based bias, false positives tests and mal interpretation...

Jornada de fisoterapia musculoesquelética 15 speakers spoke about clinical reasoning, rotator cuff related shoulder pain, mechanisms of manipulation, dry needling, motor control, neural mobilisation, subacromial impingement, anterior knee pain, differential diagnosis lumbar spine sacroiliac joint, the history of manual therapy in Europe and specialisation in manual therapy. Spanish and international speakers amongst which Jeremy Lewis and César Fernandez de...

2-minute video to understand why an asymptomatic rotator cuff tear can remain functional. References: Burkhart, S., Esch, J. and Jolson, R. (1993). The Rotator Crescent and Rotator Cable: An Anatomic Description of the Shoulder's “Suspension Bridge”. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 9(6), pp.611-616. Cook, C. and Hegedus, E. (2013). Orthopedic physical examination tests. Second Edition. Upper Saddle River, NJ:...

WHAT IS MANUAL THERAPY? IS IT ALL ABOUT OUR HANDS? 3 more mins to read...... Social media Last weeks I've read on social media some strange statements about manual therapy. Like "passive therapy is old fashioned", "it helps only the teachers & organisations", "it doesn't fit for chronic pain patients" or "it's all about beliefs and far from evidence based medicine /...

Physiotherapist as a scholar Since the physiotherapy world adopted the roles described in the CanMEDs Competency Framework, physiotherapists officially have a status as life-long learner, labelled with the term ‘scholar’. Long before this was defined, it was clear, that physiotherapists seem to belong to a species which never stops looking for new knowledge and skills. Compared to other health care professionals,...

“Neck or Biceps ? Who`s gonna be the pain driver ?” Short Case Description over two days of a Lithuanian professional Tuba player Last week we (Sandra and Jürg) had an interesting patient in the student patient session group during the Level1 Maitland course in Kaunas/ Lithuania. I give you a short description and some clinical reasoning thoughts about these two treatment...

Please watch the video for two different ways of self-treatment to increase hip mobility and reduce pain in patients with anterior hip impingement.

The clinical presentation of microinstability of the hip is like the presentation of instability in other joints (eg shoulder instability, lumbar instability) SUBJECTIVE EXAMIATION Main problem: hip pain in the groin, buttock, thigh, or in the “C sign” distribution, sometimes the patient is complaining about apprehension, sense of giving way or clicking and locking  (also signs for a labral tear) Aggravating activities: activities...

Did you think about instability of the hip joint? No, because the hip joint is a stable ball and socket joint. How can this joint be instable, beside traumatic dislocation or subluxation? Subtle anatomic abnormalities in the presence of repetitive hip joint rotation and axial loading as seen in sports such as gymnastics, ballet, football, golf, figure skating, tennis and...

A 20 year old female is complaining about intermittend ventral right sided hip pain. The symptoms are provoked with uncontrolled, quick leg movements during pole dance. Sometimes she has a feeling of giving way of her right hip during standing in end of range extension. There was an incidious onset a month ago during pole dance with the tendency of gradually worsening. No previous history of hip, pelvis or...

The question of whether a patient has improved or deteriorated is fundamental to clinical practice [1]. To decide which treatment is the best, making decisions regarding prognosis and evaluating our management, we have to gain information. But let’s start at the beginning! Usually patients, coming into our praxis, are searching for help (unfortunately they rarely show up for prevention...

Red flags are well known in physiotherapy world. As a profession, we are getting more and more independent. Is it enough to be safe? Are we sure we don’t not miss important symptoms? My friend had interesting patient in his office. Mr. T., male, 28, computer job, came with pain on the right side of the neck. Pain was in...