Manual Therapy Forum

Interview with Jim Meadows BScPT, MCPA, FCAMT

For this interview, we have the pleasure of speaking with Jim Meadows BScPT, MCPA, FCAMT.  The following is a biography that can be found on his website:

Jim was chair of the Canadian Orthopedic Division‘s Education and Specialization Committees for 12 years and a past Examiner and Instructor with the Canadian Orthopedic Division. Jim is a co-founder and a Senior Faculty Member and Senior Examiner with the North American Institute of Orthopedic Manual Therapy (NAIOMT). He is a past faculty member of the University of Alberta and current adjunct faculty at the Texas Women’s University, Andrews University, the Massachusetts Institute of Health Sciences, and the University of Maryland at Baltimore. He also visits and lectures at the University of Pittsburgh. He has presented at National and International Conferences on Manual Therapy and has published in numerous journals. His video series Manual Therapy and textbook Orthopedic Differential Diagnosis in Physical Therapy are sold throughout North America.

You won’t want to miss this interview as Jim is willing to share his opinions regarding many topics in a fearless manner.  Some of the things we discussed are:  the importance of reflection and how vital it is for clinician development; which area of physical therapy is the MOST unique (and possibly most important) to our profession; how and why manipulation is effective (despite what research might suggest); thoughts on chiropractors and physical therapists; and a more simple way to make anatomy and clinical instruction more effective in entry-level programs.

If you would like to learn more about Jim or find out where he is teaching next, you can check out his websites:  www.swodeam.com, www.impact-fellowship.com, and www.creekside-physio.ca.

Enjoy!

 

Matt

My bout with a kidney stone

I reckon this could be our first case report to share on the blog.  Below, you will find my account of battling a kidney stone recently.  Please share your thoughts, questions, comments below!

 

Isn’t it funny some of the things that happen right before you go on vacation?  Last week, (Thursday night to be specific) I just finished telling my wife good night and rolled over in bed when I felt a sudden pain.  A pain like I had never felt before!  The epicenter was at my left upper abdominal quadrant.  What did the pain feel like, you ask?  Well, simultaneously being the patient AND the clinician at that time made for a funny internal dialogue:

me (the clinician):  “how would I describe this pain?”

me (the patient):  “I don’t know… it hurts!”  (more colorful language was used)

me (the clinician):  “oh come on, it can’t be that bad… THINK!”

me (the patient):  “I can’t describe it as just one thing.  It feels deep, achey, sharp, spasmy and burney.”

me (the clinician):  “Alright, is there anything you can do to relieve it?”

me (the patient):  try laying supine – “nope”… try laying sidelying on either side – “meh, not really”… getting frustrated, get up and walk around – “no, dadgum it”… lean over the bathroom counter – “no”… sit down, sit up tall, slouch, bend, twist, etc. – “no, negative, nope, nuh uh, DAMN IT!”

me (the clinician):  “Okay, the fact that this is nothing like you have ever felt before (meaning it didn’t feel strictly musculoskeletal), start feeling around to see if you can isolate where it is coming from by palpating…”

me (the patient):  “Uh, okay (with trepidation)”

me (the clinician):  first thing noticed was how my left upper abdominal quadrant felt lilke it was in spasm, but the rest of my abdomen was not.  Second thing I tried to do was to see if percussing different organs would make a difference (it did not).  “Oh $#!+, I hope it’s not something like my spleen!”  Keep palpating, doesn’t seem to be my stomach or large intestines.  “Hmmm, maybe it’s my kidney.”  Wack myself in the kidney a few times.  “Nope, that didn’t change anything.  Okay, fine then… it’s been 30 minutes and it’s only getting worse.”

At this point, my dear wife, who is a therapist herself and was staying up with me to see if there was anything she could do, had drifted off to sleep next to me because she was already exhausted from the day’s events.

me (the clinician):  “Hun… babe… hey, wake up.  I’m gonna go to the ER.  [Discussion about how to get there]  No, don’t worry about taking me, you’d have to wake up the kids.  I’ll be fine.  I’ll let you know something when I find out what’s going on.”

 

So, I drive myself down to the ER.  At this point, it is midnight (are all ERs the busiest at this time of night???).  I park my car across the street and walk in, mind you I’ve never been into an ER… let alone the one at the medical center where I work… so I have no clue what to do or what’s gonna go on.  Get checked in, then the triage nurse does a subjective and I’m trying to say things that may make a difference and get me back quicker (fat chance of that).  I think I tried to say anything possible, short of telling her I was having chest pains and difficulty breathing (could’ve said that and got back sooner, I’m sure!).  At this point, my pain had grown to a solid 6-7/10 and I could not walk upright because it hurt so much.

Side note – as a clinician, have you ever noticed that almost each and every time a patient says to you “… but, I have a high pain-tolerance” that they are the biggest wimps that come into your clinic?  It seems to be that way with some of my patients… or maybe it’s some bias on my part.  Anyway, this being in the back of my head I couldn’t help but think how much of a wuss I felt like I was being.  Surely, this can’t be hurting THAT much… can it?  Quick mental check….. oh yeah, this hurts like a m0+#3& #@*3$^!

I’m in the ER waiting room and it’s not slam packed, but there are certainly many other people in there and when I was speaking to the triage nurse, she mentioned something about how some people had been waiting a few hours… WHAT?!?  So, I ask for a pillow because that’s about the only thing that can vaguely provide some relief… to compress it against my abdomen.  She gives me this long plastic tube with a hard plastic ring around the top and says “if you feel like you have to vomit…”  (I couldn’t help but think of the movie “Wayne’s World” where Garth says “if you’re gonna spew… spew into this [holds up a tiny paper cup]).

Remember my side note about feeling like a baby?  Well, this is where that feeling really kicked in to high gear.  Here I am, doubled over in a chair moaning and groaning (quite a bit I might add) because of the pain I was feeling, and everyone else in the waiting room was sitting around fairly quitely like they were in no distress whatsoever.  How the hell is it taking so long for them to bring me back?  I’m obviously the person in most pain here!  By now, the pain had gotten worse and was radiating around my flank and I could start to feel it radiate down to my pubis (not my groin).  Not only that, but it felt like it was coming in waves (for a few minutes I’d be relatively okay, but then it would kick back up into high gear).

My name gets called.  HALLELUJAH!  Oh, wait… that’s just the phlebotomist calling me in so she can take the blood tests the triage nurse got orders for.  DAMN IT!  Get blood drawn, go back out in the waiting room.

Meanwhile, I’d started to become nauseated.  Not quite to the point of vomiting… yet.  At this time, the up-chuck reflex was emerging and I grabbed the puke tube.  Dry-heaving is never a pretty site, or sound.  Maybe that is why the waiting room cleared out around me after that.  I’m sure it was also my moaning and groaning prior to this too.

My name gets called again.  PRAISE JESUS!  Whoops… just some office personnel putting some paper in front of me that I need to sign to get treated.  For all I know, it could have been me signing my kids away to this woman… I barely looked at it to make sure it had the letterhead of the medical center on it.

Back to the waiting room again.  Pain check – wow, this is really getting worse.  I don’t want to say it, but it’s a solid 8-9/10 at this point (trying to keep in mind my previous thoughts about pain tolerance).  Oh geez, here comes the up-chuck reflex again.  This time, my dinner came up, and I got even more space around me cleared out.  With each lurch the pain gets worse and it’s a thought of “Oh crap, here we go again… this is gonna hurt!”

This whole time, I continually am pestering the triage nurse about how my pain is getting worse, how much longer, I can’t wait any longer, etc, etc.  To their credit, all of the staff in the ER were extremely professional and courteous.  I’m sure they’ve dealt with worse… at least I hope!

Finally, I get brought back.  THANK… YOU… GOD… The nurse helping me said the physician on duty ordered pain meds, anti-nausea meds, and a CT scan.  Wait, what?!?  A CT scan???  What do they think I have??  Then, he reassures me that it sounds like a kidney stone.  How the hell did I get a kidney stone?  That may have been what I was thinking, but at that point, probably the only thing that came out of my mouth was something like “pain meds… yes… please…”

The ER nurse inserts an IV to give me the meds (Dilaudid and toradol, as well as Zofran for nausea).  Before that got going though, the physician comes in and is chatting quickly with me, getting information.  He says they really suspect a kidney stone and that everything should be okay, but they’ll get a CT scan to make sure.  Then, he goes to do the kidney precussion test… YUP, felt that one… definitely positive!  Pain meds get administered and I get much happier.

After maybe 30 minutes, a radiology tech (I think… he could’ve been the janitor for all I know at this time) came to get me and wheel me down to the CT machine.  Do the scan and get taken back to my place in the ER.  I’m sure I passed out from exhaustion at this point, but the nurse checks in on me.  Sometime afterward the physician comes in and says “Yep, it’s a kidney stone.  It’s pretty low at this point, and it’s even smaller than a grain of sand.  Should pass sometime soon.”  WTF?!?!?  Smaller than a grain of sand???  Then how the hell do I hurt so much?!?!?  If I hurt this much from something so small… now I know I am a wimp!!!  However, the nurse did tell me that he’s personally seen patient’s with kidney stones that were massive (many millimeters big) and that almost all the patients that come in with kidney stones present exactly the same way I did.  Okay, maybe that makes me feel a little better about myself, but not really.

After all this, I had been in the ER (waiting room included) for almost six hours.  I get discharged and on the wait out, the security guard says something like “Hey, you look a lot better now.”  Thanks buddy, I feel better.  I hang around the main lobby and wait for my wife to pick me up later in the morning after my kids have slept to a more appropriate time to wake them up.  Later that day (Friday), I pass the kidney stone, which didn’t hurt too much.  It mainly felt like a lot of burning (although may not have been too painful because I did have 800 mg of ibuprofen in me after getting home because the pharmacy wasn’t open yet).

 

So, my bout with a kidney stone… worst pain I’ve ever felt before!  Other things I learned:  listen to your body… when something doesn’t feel right, go get checked out; try and be courteous to staff always (I made an effort to do this, but felt like I was annoying them quite a bit because I was in pain and wanted to get back there); I am definitely not a tough guy; kidney percussion tests were negative right away… only when the full effect of the pain experience kicked in and radiated and spread further was that test truely positive; speaking of such things… I doubt I would EVER see a patient in the clinic coming in with that as their primary complaint… seriously, when you hurt this bad, going to physical therapy is the LAST thing on your mind!  Other things I learned, pain meds are good… and they help!  However, the narcotic did give me constipation after one dose in the ER… crap (not literally… although, I wish at this point).

Hopefully none of you have to experience having a kidney stone.  It was certainly not fun for me, but a good learning experience for sure.  How better to have empathy for the patient in front of you than to go through some significant pain yourself?  However, if you have had the pleasure (or misfortune?) to go through something similar, please share your story with us and other readers in the comments section below.  That way, we can all learn!  Oh well, back to re-hydrating for me…

Cheers,

 

Matt

We want you!

More specficially, we want to hear from you!  The blog has been up and running for a couple of months now and we’ve slowly put out some half-way decent content (maybe I’m bias though).  However, I do want to hear from those of you that follow this blog or routinely check in to see what is new.

Are there any specific topics you would like to hear or see more about?  Any particular manual therapy figure that you feel is important and would like to hear an interview with?  Any other thoughts on what we can do to help all of you readers and listeners out there?

Would love to hear your thoughts!

Thank you,

 

Matt

Interview with Gregg Johnson PT, FFFMT, FAAOMPT

Welcome back!  In our next interview, we speak with Gregg Johnson.  He is co-founder and co-owner of the Institute of Physical Art (IPA) with his wife, Vicky Johnson PT, FFFMT, FAAOMPT.  Gregg is also one my main mentors as I have completed some of my manual therapy training with the IPA’s curriculum in residency, but also because I got to spend a year with him as a mentor during my fellowship with the IPA.  As well as the years since, as an instructor for several IPA continuing education courses.  Below is his biography as seen on the Institute of Physical Art’s website:

Co-Founder Functional Manual Therapy®
Co-Founder/Co-Director Institute of Physical Art
Co-Owner Johnson and Johnson Physical Therapy, Steamboat Springs, CO
Partner/Owner IPA Manhattan, A FMT® Physical Therapy Services Clinic
Partner: Vardan Functional Manual Therapy® Services, New Delhi, India
Board Member, Functional Manual Therapy® Foundation
Director, APTA Credentialed AAOMPT Functional Manual Therapy® Fellowship Program
Honorary Fellow:  AAOMPT:  November 2012

Gregory S. Johnson, PT, FFFMT, FAAOMPT, graduated from the University of Southern California in 1971 and completed a one year residency program at Kaiser Vallejo under Maggie Knott.  He remained as senior faculty for six years.  Mr. Johnson is best known for his identification of the need for Physical Therapists to integrate treatment of the facial system into manual therapy and the development of the first Soft Tissue Mobilization course for Physical Therapists in 1980.  In addition, Mr. Johnson utilized his extensive background in PNF to adapt standard manual therapy techniques of Joint Mobilization and develop the dynamic techniques of Functional MobilizationTM and Resistance Enhanced Manipulation™ (REM) techniques for joints, soft tissues, and neurovascular restrictions.  Mr. Johnson has trained or directed the training of over 40,000 therapists in the USA and internationally.  Gregory Johnson is the co-founder and President of the Institute of Physical Art, the co-developer of the Functional Manual Therapy® approach to patient care, and the Director of an APTA credentialed AAOMPT Fellowship program in Functional Manual Therapy®.  He has published multiple chapters and articles on Soft Tissue Mobilization, PNF and the Orthopedic Patient, Functional MobilizationTM, and Functional Test for the Lumbar Patient and is currently involved in several research projects on Functional Manual Therapy®.

Enjoy this interview as you get to experience wisdom and insight from a truly unique figure in the world of manual therapy.  From my time with Gregg over the past six to seven years, I’ve heard many stories.  Plenty of our conversations have been in a personal setting while together teaching (or during my fellowship) where it was just the two of us.  I can honestly say there are stories in this interview that I had not heard before!  Oh, and I added a little bit of intro music to this interview [other interviews will have the same thing from now on]  🙂

Cheers,

 

Matt

Seated CT junction gapping HVLAT technique

Hi again!  An interesting thing happened in the clinic today.  A friend and colleague shared a video he had seen on Facebook of another therapist teaching a manipulation to a group of chiropractic students and asked what my thoughts were on the technique shown.  Not to be overly critical, but in my humble opinion it incorporated poor positioning and locking of the patient’s head/neck.  In addition, the choice of thrusting hand, direction of thrust, and amplitude of thrust were all done very poorly… and at great risk to the patient!  For those reasons, I wanted to create a video to demonstrate how I believe this technique can be done more properly; and ultimately, safer for the patient.  Below are two videos, the first is a detailed description and demonstration of technique, and the second is a live demonstration without description (more of what would occur in the clinic… sans pre-manipulative dialogue).

 

 

Comments, critiques, questions?  Please let us know below!

Cheers,

 

Matt