Scrounging Firewood (and other stuff)

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Going to have to respectfully disagree with several points.
If your skeleton/spine is out of whack, all of the muscle exercises and pills in the world won’t put it back. You often need multiple forms of treatment to solve some issues. And if the medical professions would work together there would be better treatment plans and less pills. But we know big Pharma doesn’t like that so it won’t happen.

I think you missed the point I was trying to make. I stated that doctors - as a group - tend to be more consistent in their management of most problems than the allied health professions. I didn't make any statement about efficacy, which in the case of back or neck pain, most doctors are not well positioned to treat conservatively.

I'll give an example, let's take ischaemic heart disease (IHD). The reality is that one person's heart disease is fairly similar to the next. Coronary arteries clogged with crap to a greater or lesser degree, and it tends to respond in similar ways to certain interventions, and of course it is a very common condition. Therefore you can put together very large randomised controlled trials (RCTs) with great statistical power and can compare one intervention to a second and a control group and you can demonstrate that intervention A is more or less effective than B or control. The study methods are published and can be replicated by other researchers and should the results be confirmed then you have more or less proven that a certain intervention for IHD is effective or not. This can then lead to a change in management of the condition across the broader profession over time - hence my point that medical management will tend to be fairly consistent. The key to all this is to have study populations that are much the same. One person's IHD is much the same as the next but one person's back or neck pain can be wildly different to the next in almost every possible way, but most importantly, what it responds to. Therefore it is difficult to put together studies comparing, say, neck flexion (forwards) to extension (backwards) because the subjects within the study groups will be very different whereas in IHD, they're all much the same. Most studies into back and neck pain (especially prior to 2000) produced ambiguous results as a consequence but some more recent trials that are better designed are getting closer to the mark.

All that is not much use to the bloke with the sore neck who wants something done about it, though. There has never been a shortage of clinicians who think they answer and in the absence of hard evidence, developed their own theories about spinal pain based on personal experience. Because of the great variation between patient presentations, a clinician can have a spectacular success with some patients with a particular technique or exercise only to see it fail miserably with others. But, like the gambler or investment guru who has a system and likes to talk about the wins but not so much the losses, a number of guru clinicians rose to prominence, promoting their new answer to the mystery of back and neck pain. They accumulated followers, including within university faculties which tended to group together into cliques where people with other views were not welcome and it is still like that today. I went to the University of Melbourne where the physio faculty was heavily influenced by an Australian physio by the name of Geoff Maitland. Cowgirl, also a PT, went to the University of Queensland where they asserted that Maitland was out of date and core stability exercise was the future for spinal pain. We have subsequently concluded that UM and UQ are both off the mark.

So this is why I made my initial comment that it is too simplistic to say that "PT didn't work" (or that PT did work for that matter), since what one PT will do will often be vastly different to the next depending on his background - and it is the same for the other allied health professions. More accurate to say that the guy you saw was ineffective in your case, and the most likely reason is that he just wasn't very good but that doesn't make him representative of the profession as a whole. A good clinician will have new back/neck pain patients straightened out and taught how to self-manage in the future in 5 sessions or so on average, without any need for continuing 'maintenance' visits. My colleague that I suggested @MustangMike see is a well trained clinician (by which I mean, the same post-grad training as me ;) ) and he did a good job. How many times did you see Jim, Mike?
 
I think you missed the point I was trying to make. I stated that doctors - as a group - tend to be more consistent in their management of most problems than the allied health professions. I didn't make any statement about efficacy, which in the case of back or neck pain, most doctors are not well positioned to treat conservatively.

I'll give an example, let's take ischaemic heart disease (IHD). The reality is that one person's heart disease is fairly similar to the next. Coronary arteries clogged with crap to a greater or lesser degree, and it tends to respond in similar ways to certain interventions, and of course it is a very common condition. Therefore you can put together very large randomised controlled trials (RCTs) with great statistical power and can compare one intervention to a second and a control group and you can demonstrate that intervention A is more or less effective than B or control. The study methods are published and can be replicated by other researchers and should the results be confirmed then you have more or less proven that a certain intervention for IHD is effective or not. This can then lead to a change in management of the condition across the broader profession over time - hence my point that medical management will tend to be fairly consistent. The key to all this is to have study populations that are much the same. One person's IHD is much the same as the next but one person's back or neck pain can be wildly different to the next in almost every possible way, but most importantly, what it responds to. Therefore it is difficult to put together studies comparing, say, neck flexion (forwards) to extension (backwards) because the subjects within the study groups will be very different whereas in IHD, they're all much the same. Most studies into back and neck pain (especially prior to 2000) produced ambiguous results as a consequence but some more recent trials that are better designed are getting closer to the mark.

All that is not much use to the bloke with the sore neck who wants something done about it, though. There has never been a shortage of clinicians who think they answer and in the absence of hard evidence, developed their own theories about spinal pain based on personal experience. Because of the great variation between patient presentations, a clinician can have a spectacular success with some patients with a particular technique or exercise only to see it fail miserably with others. But, like the gambler or investment guru who has a system and likes to talk about the wins but not so much the losses, a number of guru clinicians rose to prominence, promoting their new answer to the mystery of back and neck pain. They accumulated followers, including within university faculties which tended to group together into cliques where people with other views were not welcome and it is still like that today. I went to the University of Melbourne where the physio faculty was heavily influenced by an Australian physio by the name of Geoff Maitland. Cowgirl, also a PT, went to the University of Queensland where they asserted that Maitland was out of date and core stability exercise was the future for spinal pain. We have subsequently concluded that UM and UQ are both off the mark.

So this is why I made my initial comment that it is too simplistic to say that "PT didn't work" (or that PT did work for that matter), since what one PT will do will often be vastly different to the next depending on his background - and it is the same for the other allied health professions. More accurate to say that the guy you saw was ineffective in your case, and the most likely reason is that he just wasn't very good but that doesn't make him representative of the profession as a whole. A good clinician will have new back/neck pain patients straightened out and taught how to self-manage in the future in 5 sessions or so on average, without any need for continuing 'maintenance' visits. My colleague that I suggested @MustangMike see is a well trained clinician (by which I mean, the same post-grad training as me ;) ) and he did a good job. How many times did you see Jim, Mike?
I totally agree with your first paragraph. I did try multiple PT's and had no luck with any of them. Several chiropractors ranged from extremely effective to not at all.
 
I totally agree with your first paragraph. I did try multiple PT's and had no luck with any of them. Several chiropractors ranged from extremely effective to not at all.

A series of duds, that's a bit unlucky but no doubt it happens. There's a practice in the next town half an hour from me with half a dozen physios in it and I don't rate any of them.
 
Katy Perry is putting on a free bushfire relief concert next week in the next town from us (pop. 4000). Amazing that she would do this. Cowgirl and Cowlass are going - they're pumped!

Good to hear . But is she doing it for free and the proceeds from the tickets get donated or are the tickets free
 
Good to hear . But is she doing it for free and the proceeds from the tickets get donated or are the tickets free

The tickets are free, you could only get tickets for yourself with ID proving you live locally and you could get tickets for dependent children who had to be on your Medicare card (everyone has a medicare card in Oz) so you couldn't just rock up and ask for 50 tickets. 1000 allocated to each town in the area, first come first served with a ballot for spare tickets. We spent three hours lined up yesterday. The girls are going, Cowlad is at boarding school and I'll be at work.
 
The tickets are free, you could only get tickets for yourself with ID proving you live locally and you could get tickets for dependent children who had to be on your Medicare card (everyone has a medicare card in Oz) so you couldn't just rock up and ask for 50 tickets. 1000 allocated to each town in the area, first come first served with a ballot for spare tickets. We spent three hours lined up yesterday. The girls are going, Cowlad is at boarding school and I'll be at work.
How does that benefit the brushfire victims?
 

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