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Consumer’s Guide To Health – Episode 44: Can MDT Save Health Care?

ab@allanbesselink.com (Allan Besselink) — Fri, 25 May 2012 19:42:25 +0000

The podcast “Consumer’s Guide To Health” returned to the airwaves in January. This biweekly podcast and live stream airs on BlogTalkRadio every second Thursday at 11:00am central time. Join the discussion!

Episode 44 is entitled “Can MDT Save Health Care?”.

The health care system continues to rant about prevention, but little is truly being done to address the issue. The health care system continues to rant about making care patient-centered, yet puts them in a passive role from the moment they enter the medical system.

MDT, or Mechanical Diagnosis And Therapy, provides a framework not only for assessment and treatment, but also for patient-focused competent self care and prevention. Today we will explore MDT and examine how widespread adoption of its approach - from consumer to clinician - could effectively and simply solve many of health care's woes.

All previous episodes of CGH are currently available on my BlogTalkRadio channel. You can subscribe via RSS and the podcasts are also available on iTunes. The next episode will be on Thursday, June 7.

Episode 44 Notes: Can MDT Save Health Care?

Welcome to the Smart Life Project's "Consumer's Guide To Health" for May 24, 2012. I'm your host, Allan Besselink, coming to you live from Austin, Texas (as I do every other Thursday at 11:00 am central time). This show is brought to you by the Smart Life Project, a health initiative based in Austin, Texas committed to providing sports science solutions for training, rehab, and life. Life is a sport - play smart.

Becoming a consumer of your own health and health care is critical in this day and age. The health care and fitness worlds can be a challenge to negotiate. But we are also in an era of accessibility to information, and as I always say, knowledge is power - if only we'd use it. Let's face it though - the inability to challenge our belief systems in the face of good scientific evidence is the primary limiting factor in the advancement of both health care and coaching, as well as human performance and injury prevention. And as I always say - don't shoot the messenger.

The primary goal of this show is to increase awareness of these issues so that people can become better consumers of their own health - from the grass roots level.

With that in mind, our call in number is (347) 843-4753.

Today's episode 44 is entitled "Can MDT Save Health Care?".

Those of you who listen on a regular basis know that consumer awareness is an important aspect of the show. In the United States, there are some significant problems with the health care system as we know it. Chronic - and oftentimes preventable - medical conditions such as obesity, heart disease, and diabetes put a huge drain on the medical system. Beyond that, if we look in the orthopedic world as but an example, low back pain is one of the, if not the, most common ailment on the planet and costs us billions of dollars a year. If you live on planet earth, chances are good you are going to end up with an episode or 10 of low back pain over the course of your lifetime. But I also like to call low back pain the poster child for everything wrong in health care these days - over-utilization of imaging, clinician ignorance of clinical guidelines, non-evidence-based care, limited access to care, excessive costs of care, and, overall, a very passive approach to care. Yet if we look at the problem of low back pain, the clinical guidelines and solutions are straightforward.

For today's discussion, I welcome our guest Curt Rickert. Curt hails from the Motor City - Detroit, Michigan - and he completed his bachelor's degree at Michigan State University - go Spartans! After becoming a PT 21 years ago, he went on to complete the Diploma in MDT in 2006, thus becoming one of 350 or so clinicians globally to attain the highest level of training in the McKenzie Method. In the next few weeks will be making the foray into private practice, opening Curt Rickert Physical Therapy in Kerrville, TX.

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Photo credits: joehardy

The APTA’s Vision 2020: My 12 Year Report Card

ab@allanbesselink.com (Allan Besselink) — Thu, 24 May 2012 05:13:52 +0000

We are now into year 12 of the APTA’s 20 year “Vision 2020” mission statement. With the APTA National Conference right around the corner, I think it is important to assess the accountability of the organization in meeting the goals of Vision 2020. I would like to believe that the association exists to serve the membership, and thus here is one member’s personal report card.

For those that need a refresher, here is what the APTA’s House Of Delegates put forth in 2000: “By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health.”

So with that said, let’s take a look at where we stand on all of this, 12 years down the road.

First, a quick history lesson of sorts. The entry-level physical therapy degree is that what is required to take the state licensure exam. Although you may have a physical therapy degree, you still have to pass a licensure exam in order to practice as a physical therapist.

A number of years ago, the entry-level PT degree in this country was a Bachelor’s degree. This is still currently the standard in most countries around the world. Also, it is important to note that foreign-trained physical therapists must still pass the licensure exam, regardless of their own entry-level degree, if they are to practice in the United States. Licensure is “the great equalizer” in terms of professional education.

Over time, the APTA forged ahead with a goal of having a Master’s degree as the entry-level to practice. With Vision 2020, the entry-level degree would become a Doctorate degree.

With that background information, here is my Vision 2020 report card. Each of the six primary elements of Vision 2020 are noted, along with their separate operational definitions per the APTA.

Autonomous Physical Therapist Practice. “Physical therapists accept the responsibility to practice autonomously and collaboratively in all practice environments to provide best practice to the patient/client. Autonomous physical therapist practice is characterized by independent, self-determined, professional judgment and action.”

If you are in a room of 10 physical therapists, you won’t get agreement on what professional autonomy looks like, yet in reality (and from a medico-legal perspective), all practice with “professional judgment and action”. For some reason, this has become more of a self image problem than anything else.

The defining issue of professional autonomy is the state licensure exams and practice acts.

Grade: F. A self-image extreme makeover would be beneficial.

Direct Access. “Every consumer has the legal right to directly access a physical therapist throughout his/her lifespan for the diagnosis of, interventions for, and prevention of, impairments, functional limitations, and disabilities related to movement, function and health.”

As of year 12 in the APTA’s 20 year “Vision 2020” mission, there are 17 states with real, gatekeeper-free direct access and professional autonomy. But interestingly enough, we had that same number (or thereabouts) at the start of this 20 year venture, doctorate degree or otherwise. Remember that 20 years ago, the entry-level degree was a Bachelor’s degree. A change in entry-level degree, yes, yet no change in access.

What makes this worse is that the APTA continues to talk about varying “shades” of direct access. As a consumer, you either have it or you don’t. And most don’t.

Grade: F. Ask the consumer about direct access. If they are even aware that the issue exists, let me know.

Doctor of Physical Therapy and Lifelong Education. “The Doctor of Physical Therapy (DPT) is a clinical doctoral degree (entry level degree) that reflects the growth in the body of knowledge and expected responsibilities that a professional physical therapist must master to provide best practice to the consumer. All physical therapists and physical therapist assistants are obligated to engage in the continual acquisition of knowledge, skills, and abilities to advance the science of physical therapy and its role in the delivery of health care.”

The operative terms here are that the Doctorate degree “reflects the growth in the body of knowledge and expected responsibilities”. If that is truly the case, then I am not sure how any foreign-trained physical therapists are surviving the licensure exam with their entry-level Bachelor’s degree. Just what does a 3 year doctorate – with fewer clinical hours than many of the old Bachelor’s degrees – actually provide in terms of “value-added benefit” for the graduate or, better yet, the consumer?

Graduates are now faced with a financial burden that is oftentimes in excess of $100,000 in student loans which, by the way, is on par with lawyers and with far lower return on investment over both the short- and long-term. An annual tuition of, get this, $43,000 is not uncommon. DPT programs have not provided any associated increase in the ability to earn greater income than when the entry-level degree was a Masters degree or, worse yet, a Bachelor’s degree. My $25,000 degree in 1988 would be worth $50,000 today given a 3% cost of living increase per year.

The profession was told, quite explicitly, that there would be a significant impact of the Doctorate degree on consumer awareness. The entry-level Doctorate degree was going to be the be-all-and-end-all to our professional autonomy. Sadly, the data has yet to reflect this claim. As it stands right now, I would call this a case of degree bloat – no more, no less. There is no increase in professional responsibility with a Doctorate degree, but there is a significant increase in financial investment.

Grade: F. Ask the new graduate about their return on investment.

Evidence-based Practice. “Evidence-based practice is access to, and application and integration of evidence to guide clinical decision making to provide best practice for the patient/client. Evidence-based practice includes the integration of best available research, clinical expertise, and patient/client values and circumstances related to patient/client management, practice management, and health care policy decision making. Aims of evidence-based practice include enhancing patient/client management and reducing unwarranted variation in the provision of physical therapy services.”

Educational programs continue to struggle with this. They continue to spend time and effort teaching students assessment and treatment interventions that have little to no scientific support. This is usually done under the premise not of clinical reasoning but that “you will need to be aware of this when you are practicing”. Educational programs could simply choose to not waste their time and efforts on these issues, and spend the time on important issues like clinical reasoning, thinking, and effective communication skills. Part of this is defined by accreditation standards which may or may not reflect evidence-based clinical guidelines.

Grade: F. Educational content has remained pretty similar over the years, but the entry-level degree has changed. Hello?

Practitioner of Choice. “Physical therapists personify the elements of Vision 2020 and are recognized as the preferred providers among consumers and other health care professionals for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.”

Patients will never see physical therapists as the practitioner of choice if they can’t freely access them. Patients don’t have the right to choose. They have to go to a gatekeeper first in 33 of the 50 states. Simply stated, our level of recognition as “practitioners of choice” will go hand-in-hand with direct access.

Grade: F. Ask a patient who their first choice is for back pain, and let me know what they tell you. Can you say “chiropractor”?

Professionalism. “Physical therapists and physical therapist assistants consistently demonstrate core values by aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication and accountability, and by working together with other professionals to achieve optimal health and wellness in individuals and communities.”

Fortunately, this has never seemed to be an issue with the profession. The APTA continues to be a strong advocate for professionalism. The profession, as a whole, seems pretty comfortable with this concept clinically.

Grade: A. Let’s all sing “Kumbaya”, we can celebrate our professionalism while we avoid the 800 pound gorilla(s) in the room!

Summary:

I have been a physical therapist for 24 years. I was trained in a different country, and practiced there as well. I have been a member of my professional association for the majority of the time that I have been a physical therapist.

I have the privilege of working alongside patients, other clinicians, and students – so I am not getting a limited perspective. I am practicing in a state (TX) that the APTA claims is a “direct access” state, but the practice act certainly does not reflect that whatsoever.

It is my professional opinion that the primary issue affecting physical therapists in this country – that of direct access and professional autonomy – has been mishandled and misguided over the past 12 years if not longer. The APTA's current stance on these issues is disheartening at best. While the academics are busy glorifying themselves with their advanced degrees, the profession as a whole is still in the dark ages in terms of licensure and autonomy.

With that said, and with accountability key, I would urge the APTA to use the next 8 years to revise their strategy. As they say, if you do what you’ve done, you will get what you’ve got. Sadly, what we’ve got isn’t much different than what we had 12 years ago.

Photo credits: amboo who?

RunSmart Video 16 – The Reality Of Running Injuries

ab@allanbesselink.com (Allan Besselink) — Wed, 16 May 2012 17:12:38 +0000

This is the 16th in a series of RunSmart videos. The series is on-going, with a new video released on a biweekly basis. These videos complement the material presented in the book “RunSmart: A Comprehensive Approach To Injury-Free Running”. The full series of videos can be found here. A compilation of the first 10 videos will be available on Vimeo as well.

For those of you that are interested in a more interactive learning environment, consider attending a Level One (half day), Level Two (one day), or Level Three (two day) RunSmart program. The Level One program is 4 hours and focuses on basic training principles, running mechanics, and injury prevention. The Level Two program is 8.5 hours and focuses on performance optimization and training program development. The Level Three program is a two day, 15 hour program that includes a comprehensive approach to running injuries. The next Level One program will be offered in Austin on June 30, 2012. The next Level Three program will be offered in Austin, Texas on August 17 - 18, 2012.

In this video, I discuss the reality of running injuries. The statistics are abysmal. The scientific research indicates that injuries are not related to biomechanical mal-alignment or that sort of issue. The key element to running injuries? Training.

I hope you enjoy the video series. If you would like me to address any specific aspect of the RunSmart approach, drop me an email or add a comment to this article.

Photo credits: abesselink

Is Physical Therapy In The United States Heading In The Right Direction?

ab@allanbesselink.com (Allan Besselink) — Mon, 14 May 2012 20:17:22 +0000

On April 24, physical therapists, physical therapist assistants, and students of physical therapy took part in a Federal Advocacy Forum on Capitol Hill. I for one applaud the efforts of this group in that they were able to present one small (yet at least united) voice to Congress. We certainly need a stronger voice in today’s health care world.

With that said, and with my annual APTA membership due for renewal, I am having my doubts about the direction that the profession is heading in this country these days, and the rate at which it is heading there.

I have now practiced in the United States for almost 22 years. The APTA’s Vision 2020 – the official vision statement for the profession – has now been in existence for 12 years. But when you look at the issues that are front and center with our Federal Advocacy Forum, you have to wonder where our priorities truly lie.

Here are the three primary issues that were being supported at the Federal Advocacy Forum:

1. Repeal of the Therapy Cap via the Medicare Access to Rehabilitation Services Act (HR1546 / S829). This legislation repeals a provision from the Balanced Budget Act (BBA) that set an arbitrary annual financial limitation on Medicare beneficiaries’ rehabilitation services.

2. Adding physical therapists to the National Health Service Corps Program via the The Physical Therapist Student Loan Repayment Eligibility (HR1426 / S975). This legislation would provide for physical therapists’ participation in the National Health Service Corp’s Loan Repayment Program. This would help to address the rising debt of physical therapists by encouraging them to serve in rural and urban underserved communities.

3. The Traumatic Brain Injury Act of 2012 (HR4238). This legislation would help individuals and families gain access to the most appropriate community-based services for traumatic brain injuries.

First of all, I am not saying that these aren’t important issues to the profession. But when it is almost impossible to get a group of physical therapists together, in one place, to lobby for anything, should the profession not be using that time and effort to focus on bigger issues? Should that time not be spent pushing our role in health care reform, direct access and autonomous practice, and the like?

Perhaps we should be looking at the mechanisms underlying these issues, and address those mechanisms first.

For example, health care reform, with physical therapy front-and-center, could have a huge impact on the services available to all patients, Medicare and otherwise. If patients had direct access to physical therapy, the initial costs would drop and patients could make better use of that “arbitrary financial limitation” regardless of where it is set. Having a free marketplace, and not one dominated by the gatekeeper model, would bring costs down even further. He who provides the best outcome at the best price wins in the insurance company’s eyes, no?

Our professional association should have given consideration to the debt load long before it moved to a doctorate program. When a degree in physical therapy now costs about the same as a law degree, you have to debate the return on investment. Of course, the educational programs are making their money either way …

That is a topic to be discussed further in an upcoming post.

Maybe I am missing something here. Maybe there is greater strategic political planning than that which I am aware. Sure, I will grant you that possibility. But now that we are 12 years into Vision 2020 – and with very disputable progress towards direct access to physical therapy nationwide – I have to wonder if the Federal Advocacy issues are really where our best efforts should be focused.

I think it may be time for an “Extreme Makeover” of sorts. Tune in over the next few weeks as I propose not only the big issues that need to be addressed in this makeover, but some solutions as well.

Photo credits: neuezukunft

Consumer’s Guide To Health – Episode 43: Is It Really An Injury?

ab@allanbesselink.com (Allan Besselink) — Sat, 12 May 2012 05:09:08 +0000

Episode 43 is entitled “Is It Really An Injury?”.

Most active people will resist the need to enter the health care system. Frankly, I wouldn't blame them at all! But this can take an acute problem and make it chronic, which then creates another set of issues. It would be very helpful to quickly assess "is this really an injury?" and then move on to the appropriate solution and pathway, be that self care strategies, further assessment, or both. How does a fitness participant know that this is something that they need to have assessed?

Episode 43 Notes: Is It Really An Injury?

Welcome to the Smart Life Project's "Consumer's Guide To Health" for May 10, 2012. I'm your host, Allan Besselink, coming to you live from Austin, Texas (as I do every other Thursday at 11:00 am central time). This show is brought to you by the Smart Life Project, a health initiative based in Austin, Texas committed to providing sports science solutions for training, rehab, and life. Life is a sport - play smart.

The primary goal of this show is to increase awareness of these issues so that people can become better consumers of their own health - from the grass roots level.

With that in mind, our call in number is (347) 843-4753.

Today's episode 43 is entitled "Is It Really An Injury?".

There is a significant problem faced in our country these days, and its name is obesity. With that said, many turn to walking and running as a means of exercising. That all sounds like a great concept, right? We are trying to promote health over obesity. But what happens when the pursuit of health creates more problems?

The statistics would indicate that running, as but one example, is displaying an increasing number of participants. There are now believed to be 38 to 40 million runners in this country. But those same statistics also indicate that a large % of runners - thought to be upwards of 60% - will become injured. Worse yet, up to 70% will have a recurrence of their injury, and 5% will actually lose time at work because of this activity-related injury.

In our good intentions to create a world of fitness, we may in fact be creating some significant health problems. Though they may pale in comparison to the long-term health ramifications of obesity, we must still acknowledge the presence of the problem and find some solutions.

Fortunately, we have solutions. Competent self care strategies can guide us. If you are, in fact, injured, competent self care strategies will be the best option for the vast majority of running- or fitness-related injuries. Most will be able to utilize exercise-based strategies to resolve their injury with some specific guidance and mentorship at most.

Most active people also resist the need to enter the health care system. Frankly, I wouldn't blame them at all! But this can take an acute problem and make it chronic, which then creates another set of issues. It would be very helpful to quickly assess "is this really an injury?" and then move on to the appropriate solution and pathway, be that self care strategies, further assessment, or both. Once a person has become motivated to be active, they definitely don't want whatever this problem is to limit their training or fitness activity. How does a fitness participant know that this is something that they need to have assessed?

[continued]

Photo credits: joehardy

Three Lessons That Physical Therapists Could Learn From Chiropractors

ab@allanbesselink.com (Allan Besselink) — Thu, 10 May 2012 05:07:01 +0000

A few days ago, I posted about the perpetuation of spinal myths in common mass media markets such as television. It just so happens that both video clips that I shared in the article involved chiropractors.

There are plenty of physicians and physical therapists out there that are quick to point their fingers at what chiropractors do. Many that are pointing fingers at chiropractors about practice patterns and excessive numbers of visits are the same ones applying ultrasound 3 times per week, using yellow theraband forever, and manipulating because they can – not because it is necessary. As the saying goes, when you point a finger, three point back at you … and who knows where the thumb stands on the issue.

With that said, I would suggest that the chiropractic profession has provided three valuable lessons that physical therapists could benefit from learning.

1. Professional autonomy is a united front. Sure, there are disagreements about treatment methods and the like, but chiropractors as a whole tend to provide a united front when it comes to professional autonomy and what that looks like. I rarely hear debates of whether they should or shouldn’t have autonomy. But with that said, I cannot believe the number of times that I have been in a large group of physical therapists that simply won’t agree on what professional autonomy is. Maybe I am wrong, but chiropractors appear to have it hard-wired into their professional-training DNA.

2. Major media marketing buzz = setting a standard with patients. Look at the recent episodes of Dr. Oz and Dr. Phil. Regardless of the information presented, they created a true media buzz about the profession. The average person views that as instant credibility. Sure, we can talk about how the literature supports physical therapy for back pain and all sorts of issues like that, but people will only realize when it appears on Oprah or something similar. If it’s hot and exciting, and front-and-center in the mass media, the referrals will go up and the demand will too. It will also provide patients with more reason to push aggressively for direct access to care.

3. The chiropractic profession took on the AMA - and won. It would be of value for all physical therapists to look at the legal battles waged by chiropractors against the American Medical Association. Take, for example, Wilk v. American Medical Association (1976), a federal anti-trust lawsuit. There are some very sordid tales to be found. In 1987, after 11 years of legal wrangling, the court held that the AMA and its members violated the Sherman Act by unlawfully conspiring to restrain trade.

Physical therapists, for all intents and purposes, are now the only health care provider that requires a gatekeeper’s referral in order to practice their trade fully and freely to the extent of their professional training. But does the gatekeeper model – otherwise known as a legalized monopoly – effectively become a restraint of trade issue for physical therapists? As I have mentioned in prior articles, just take a look at the “Scope Of Practice Partnership” and you make the call. The AMA continues to call it a “patient safety” issue, but they said that about the chiropractors as well. The precedence, as they say, has been set.

In the meantime, physical therapists continue to stand firmly in the middle of the road while being nice and “building relationships”. It might be time to learn a few of those lessons.

Photo credits: umjanedoan

RunSmart Video 15 – Shoes Or No Shoes?

ab@allanbesselink.com (Allan Besselink) — Thu, 03 May 2012 05:36:38 +0000

This is the 15th in a series of RunSmart videos. The series is on-going, with a new video released on a biweekly basis. These videos complement the material presented in the book “RunSmart: A Comprehensive Approach To Injury-Free Running”. The full series of videos can be found here. A compilation of the first 10 videos will be available on Vimeo as well.

For those of you that are interested in a more interactive learning environment, consider attending a Level One (half day), Level Two (one day), or Level Three (two day) RunSmart program. The Level One program is 4 hours and focuses on basic training principles, running mechanics, and injury prevention. The Level Two program is 8.5 hours and focuses on performance optimization and training program development. The Level Three program is a two day, 15 hour program that includes a comprehensive approach to running injuries. The next Level One program will be offered in Austin on June 3, 2012. The next Level Three program will be offered in Reno, Nevada on May 5 – 6, 2012 at the University of Nevada.

In this video, I discuss an issue that seems to be trendy amongst runners these days – barefoot running. We would do well to learn a lesson or two from the old-school track coaches. I think they may have had the right approach to running footwear 30 or more years ago.

I hope you enjoy the video series. If you would like me to address any specific aspect of the RunSmart approach, drop me an email or add a comment to this article.

Photo credits: abesselink

Consumer’s Guide To Health – Episode 42: Heat And Your Health

ab@allanbesselink.com (Allan Besselink) — Sat, 28 Apr 2012 19:50:06 +0000

Episode 42 is entitled “Heat And Your Health”. The temperatures are rising outside, The summer heat – and how to handle it – is a topic that can never be discussed often enough. en enough. Being safe in the heat is of utmost importance at this time of the year and you can never have too many reminders.

The guest of Episode 42 is actually a previous guest of the show - Dr. Shannon Mitchel. Shannon is a physician practicing occupational medicine and urgent care in Austin. She started running marathons in the mid 90’s and is now an ultra-marathoner, completing distances up to 100K. She also serves as medical director for ultra-marathons, including the Rocky Raccoon 100 mile race held every February. Dr. Mitchel has also recently written an article on training in the heat which is scheduled to appear in an upcoming issue of Austin Fit magazine.

Episode 42 Notes: Heat And Your Health

Welcome to the Smart Life Project's "Consumer's Guide To Health" for April 26, 2012. I'm your host, Allan Besselink, coming to you live from Austin, Texas (as I do every other Thursday at 11:00 am central time). This show is brought to you by the Smart Life Project, a health initiative based in Austin, Texas committed to providing sports science solutions for training, rehab, and life. Life is a sport - play smart.

The primary goal of this show is to increase awareness of these issues so that people can become better consumers of their own health - from the grass roots level.

With that in mind, our call in number is (347) 843-4753.

Today's episode 42 is entitled "Heat And Your Health".

It is that time of year again here in Austin. It's slowly, steadily, getting hotter, and when you walk outside, you just know in your gut that another stifling Texas summer is just around the corner. Many people will find themselves moving their fitness activities indoors for the next few months in order to stay active. Some may simply change activities completely, opting for sports and activities that can be done in the water. But there will be many that will trudge onwards with their cycling and running throughout the oppressive Texas summer .

In 2009, I discussed "Training In The Heat" in CGH episode 12. But the topic of heat - and how to handle it - is never a topic that can be discussed often enough. Being safe in the heat is of utmost importance at this time of the year and you can never have too many reminders.

Today, we will take another look at how to handle the heat. My guest for today's podcast is a previous guest of the show, Dr. Shannon Mitchel. Shannon is a physician practicing occupational medicine and urgent care in Austin. Shannon brings a broad perspective and insight to our show today. She began her career as a physical therapist in 1994, and in 2002 she started medical school at the University of Texas Health Science Center in San Antonio. She started running marathons in the mid 90’s and is now an ultra-marathoner, completing distances up to 100K. She also serves as medical director for ultra-marathons, including the Rocky Raccoon 100 mile race held every February. Dr. Mitchel has also recently written an article on training in the heat which is scheduled to appear in an upcoming issue of Austin Fit magazine.

Thanks for coming back to the show, Shannon.

The 100 degree heat is just around the corner, Dr. Mitchel. What do we need to do - or can we do - to start acclimating to the heat?

[continued]

Photo credits: joehardy

Perpetuating Spinal Myths - One TV At A Time

ab@allanbesselink.com (Allan Besselink) — Thu, 26 Apr 2012 05:02:21 +0000

Low back pain is now officially the poster child for health care mythology. It has come to represent all that is wrong with the health care world and many of the practitioners that work within that world. It reminds us of all that is wrong with reimbursement models. It is a fine example of paying lip service to clinical guidelines and research.

And with that said, all of these things that low back pain now represents are being perpetuated because it is now part of the collective psyche of the masses. It is now on TV, going out to millions of viewers.

Thank you, Dr. Oz and Dr. Phil.

It just happens that chiropractic care is the theme of both of these episodes. But it is not the chiropractic care that concerns me – it is the value system espoused and the promotion of passivity in a world of spinal pain that should be promoting active solutions that foster patient independence.

Let’s start with this video from the Dr. Oz Show:

Dr. Oz doesn’t just discuss chiropractic care – he includes spinal manipulation. It is “as effective as pain medication”, he reports. He discusses mal-alignment – a concept that has generally been refuted in the scientific literature as a cause of spinal pain. He mentions that “prevention is the key to avoiding pain” and that this involves “strengthening the core muscles”. Another concept with little to no supportive research. “Chiropractic is looking for the root cause of the problem”, it is noted, yet the practitioner performs 3 non-specific spinal manipulations bilaterally. “When we do that, we are allowing the tissues to heal themselves” … but really? That quickly? Isn’t that counter to the timeline of cellular physiology?

And if that wasn’t enough, then how about this video from the Dr. Phil show:

Self-healing is a great concept. But there is an intriguing (and very common) conundrum presented here. If you think the body is “self-healing” (and I would have to agree) then how do you rationalize seeing a patient “2 to 3 times per week” and “for 10 years now, at least twice a week”? 104 visits per year, 10 years, and how many dollars per visit? What happened to “self healing”?

Let’s reinforce passivity among the masses! Let’s have everyone manipulated for a lifetime! [insert sarcasm here]

Please note, this is not a diatribe on the chiropractic profession – far from it. I know more than my fair share of physical therapists, massage therapists, and physicians that would espouse similar philosophies of care, and advocate just as many treatment approaches with little to no scientific support.

The primary reason for bringing this to light is the fact that we have another two examples of how these myths are perpetuated by the providers and the media. The treatment of low back pain becomes one of “accepted community standards”, especially now that the media (and especially Dr. Oz and Dr. Phil) have picked up on it. In some ways, the public awareness of the problems and challenges of spinal pain is a great thing. But on the other hand, perpetuating the spinal myths may just set the cause back another decade or so.

Photo credits: schmilblick

Senator Nelson’s Editorial And Its Impact On Direct Access To Physical Therapy In Texas

ab@allanbesselink.com (Allan Besselink) — Tue, 24 Apr 2012 05:06:47 +0000

April 20 was the one year anniversary of Texas HB 637 receiving a public hearing – the first ever for a bill related to direct access to physical therapy - with the House Public Health Committee. Actually, it was more like the wee hours of April 21. Close enough.

The committee finally listened to the voice of patients and physical therapists across Texas, although it was a very brief and albeit unsuccessful listen. A one hour hearing at 2:00 am doesn’t tend to attract the general public that are up in arms over these sorts of things, but I digress. With that said, we are now one year later and a mere 8 months before the start of the next legislative session.

Last week there was an interesting editorial piece in the Austin American-Statesman entitled “Texas GOP's health care bill isn't like Obamacare”. It was written by Senator Jane Nelson, author of SB7 (the bill in question) and chairwoman of the Texas Senate Committee on Health & Human Services. If words and espoused principles mean anything at all, and oftentimes they don’t in politics, then we might actually be able to envision Senator Nelson supporting the efforts of physical therapists in the Texas Senate this upcoming session.

Why would I go so far as to expect her support at this point in the on-going (and highly ridiculous) struggle for direct access to physical therapy in Texas? Well, it comes down to her words, right there in front of me, on the written page, in the aforementioned article.

Senator Nelson notes in her article that

“Republicans prefer free-market reforms that contain our costs and preserve the freedom of individuals to make their own health care decisions.”

Let’s start with containing costs. In the world of health care, if you take away the referral requirement for physical therapy, you will save patients millions of dollars before even getting to the treatment itself. How about the freedom of individuals to make their own health care decisions? As it stands, patients can make their own health care decisions unless it involves a physical therapist - the only health care providers in Texas that require a gatekeeper to provide a referral before treatment can be initiated.

“Our plan contains costs, improves patient outcomes and protects patient choice.”

Once again, physical therapists already know how to accomplish this – the powers-that-be just choose not to be advocates for the solution. Give patients access to care and let the marketplace solve the rest, much as it has done with other health care providers like physicians and chiropractors.

“… rooted in conservative, free-market principles”

I fully agree with the concept of “free-market principles”. But I can tell you right now, Senator Nelson – limiting access to treatment by physical therapists is simply NOT a free market principle. It may be for the gatekeepers, but it sure isn’t for the physical therapists nor the patients who wish to see them freely and of their own volition.

So, Senator Nelson, I call on you today – one year after HB 637 - to stay true to your words and the principles espoused in your editorial. If you truly believe in these principles, and you are not just making political hay, then I would encourage you to wholeheartedly support direct access to physical therapy in the state of Texas in the next legislative session in 2013. It would be consistent with your stated goals for doing what is best for Texans and their health care. It is consistent with your stated goals of containing costs, improving patient outcomes, protecting patient choice, and free market principles. Patients across the state will appreciate your support.

There is, of course, the little devil in the details. Those details would be the fact that the Texas Medical Association is her number one campaign contributor …

… and we all know how much the TMA vehemently opposes direct access to physical therapy.

But there comes a time when actions will speak louder than words in the Texas Legislature. Now is the time for actions to be consistent with the principles that Senator Nelson has shared with us in last week’s Austin American-Statesman editorial.

Her words, right there in front of all of us.

My fingers are crossed that principles will prevail over lobbying dollars. Constituents, give her a call. I am sure she’d be glad to hear from you.

Photo credits: lordsutch

Allan Besselink | The Official Site of the Smart Life Project And Rhubarb Diaries - Smart Physio Blog

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