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I had a female patient come into the office the other day complaining of left ankle pain following tripping on the ice the day before after leaving her home having an inversion ankle injury.  She was currently being treated in our clinic for balance and hip pain, but hasn’t sought care from a medical physician […]

Any manual therapists in the physical therapy / physiotherapy world should know the influence of Dr. James Cyriax.  Essentially, he can be the reason that our profession has the ability to perform manual therapy, especially manipulation.  He has been quoted to say, “physiotherapists were the most apt professionals to learn manipulative techniques”.  Some may say that he […]

There has been quite a bit going on in the field of Physical Therapy and great news from some of my personal colleagues that deserve recognition. Dr. Justin Dunaway, a fellow fellow-in-training, recently started his own non-profit organization, STAND: the Haiti Project, to provide the citizens of Haiti with musculoskeletal healthcare and to eventually establish a […]

I wrote a post several weeks ago giving readers history and objective findings of a difficult chronic low back pain case.  Revert back to it before reading on. Patient was treated in physical therapy for 3 weeks with no expression of improvement per SANE scale, no change per GROC, only short term centralization phenomenon but […]

I polled my readers several weeks ago asking them what they thought the tissue source was in low back pain?  Thanks to everyone who responded and provided feedback!  Results are: An overwhelming winner at 41% “none: pain does not equal tissue damage” So my next thought is: with this rationale, how would you treat an individual coming […]

Like it or not, the first class obtaining a Diploma in Osteopractic from the Spinal Manipulation Institute graduated this past month. We are all physical therapists, hopefully soon to be Fellows in the Academy.  Our subspeciality is Osteopractic, which means we have completed an evidence-based post-graduate training program in the use of high-velocity, low-amplitude thrust manipulation and dry […]

“How do I minimize confirmation bias?” was a question directed to me by my current doctoral intern. The terminology was brought to his attention after I told him that a patient being seen for initial evaluation did not achieve the best treatment due to his preconceived confirmation bias.   What led to this conversation? -He told […]

As I speak with more clinicians, I get wider and wider views of what the tissue (soft tissue or inert) source in low back pain.  For sake of this post, let’s say chronic low back pain…dubbed non-specific low back pain. The most common answers are the: 1. Intervertebral disc 2. Facet joints 3. Myofascial 4. […]

I recommend reading part 1 here and part 2 here prior to reading further on a challenging differential diagnosis case. Below is a copy of this patient’s lumbar spine MRI. Based on subjective and objective findings from part 1 and part 2, as well as a Normal MRI of lumbar spine as noted above, what is […]

Subjective History: 35 y/o female presents with hip and back pain.  She had no injury or accident but has been dealing with back pain for 5-6 years.  She sought care from surgeon who ordered MRI (5-6 yrs ago) that showed DDD but that she was too young for surgery and has to deal with the […]


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