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RE: Talk to me about ASTYM
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RE: Talk to me about ASTYM - April 15, 2008 7:18:45 PM
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proud
Posts: 920
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Josh,
Nope. The comparison group "protocol" is not consistent with what is currently known about patellar tendinosis. Look up Khan for a reference.
That tendon has to be loaded. Lot's. With pain. And it takes up to 12 weeks for the outcome.
Of course, I have never read the study. Is the "therapuetic exercise" eccentric loading I wonder?
But most definitely, the timeframe for resolution is inadequate....4 weeks?
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RE: Talk to me about ASTYM - April 15, 2008 9:21:08 PM
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rwillcott
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From: Canada
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I would be weary of any research conducted by the company itself. Although, the results do look promising. However, as proud had mentioned, what is therapeutic exercise? It would have to be eccentric loading in order to make a fair comparison. For all we know therapeutic exercise my have been quad setting, isometric hamstring and calf raises. I would also like to look at long term outcomes between groups.
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RE: Talk to me about ASTYM - April 15, 2008 9:30:25 PM
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TexasOrtho
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I recently did a quick literature search on eccentric loading and tendonoses. There may be more out there but the articles I found didn't blow my socks off in terms of methodology. I need to keep looking.
Sorry for the tangent there. I too am wary of company sponsored research. Give it some time and the facts will filter out. That way you end up on the cutting edge, but not the bleeding edge, of technology.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Talk to me about ASTYM - April 16, 2008 1:38:07 AM
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bonez
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Pardon the evidenced based Chiro wading in on this topic but from a distance I thing it is important to shed a little light on the topic. First I don't believe this is a Chiro gimmick. On contacting the company they do not offer there training to Chiros. I personally know Dale Buchberger, DC, DACBSP, ART, and he very likely got his exposure to this through his P.T. degree. He also carrys certification in a dubious tissue treatment strategy (ART) from or profession.
The "designer" behind this new tool, David Graston has what seems to be a colorful history in self treatment ,miracle design skills and even better marketing skills.
All of these popular tissue treatments revolve around profit driven strategies to sell EXPENSIVE hardware and SPECIAL staus (certification) to empress the customer base.
Our Canadian sports fellowship holds a yearly session of workshops to expose members to the new trends in these areas without actual certification classes. As a result I have witnessed the snake oil sales for ART and Graston. Both will contradict the other on points in the tissue healing pathway and perform amazing feats such as Mike Leahy "palpating" individual nerve fibers laying on the subcapularis muscle three inches in through the axilla.
The study mentioned regarding patellar tendonosis fails to examine this treatment against other similar soft tissue treatments ie Graston, ART, or Proud with his wife's ice cream ladle and pat of butter. I wonder if this would show that they all average out to about the old gua sha like recovery.
For any one who like me sees value in saving their hands then visit your local retailer of high end kitchen utensils. With a creative mind you will find all kinds of tools in stainless steel that offer all the shapes necessary to get into every cranny your little heart desires. You will also save considerable expense. Legally don't call it "THE TECHNIQUE" explain what your doing and why and proceed. If "THE TECHNIQUE" is truly successful then your patient will thank you for speeding their recovery and go on their merry way.
Just don't forget to give your patient the correct static and dynamic stretches for their condition and the right eccentric loading activities after you dug into them. I think you will find like I do that the real success is less likely just the instrument and more likely the correct tissue loading after the treatment.
Just my two cents worth now I will go off to my corner and lurk again!
< Message edited by bonez -- April 16, 2008 1:41:52 AM >
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RE: Talk to me about ASTYM - April 16, 2008 7:20:20 AM
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proud
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Thank you Bonez....
Well, isn't this interesting. We have a chiropractor letting PT's know about true critical, acedemic thought. I think a few PT's on here should take notice.
I cannot remember the "exact" phrasing but I recall a speech Robin McKenzie gave back in the 80's where he proposed that as evidence based practice became more important, we would see many Chiropractors transition to more traditional treatments( exercise, and evidence based manual therapy).
He warned that PT's may be tempted to step in and fill the void of "fringe" treatments because there will be a demand for it. The problem is that eventually, as healthcare dollars and spending dries up, these fringe treatments will not be paid for and PT's would be left as yet another wackey trade comparable to subluxation theory chiropractors, massuers, applied kinesiologists etc etc. He did not predict a timeframe for this healthcare crunch, but I'm predicting 2015-2020? All one has to do is look at North American population demographics. We are top heavy so to speak. Tons of old people in need of healthcare and fewer and fewer tax payors to fund it.
In many ways....Robin McKenzie has been correct. PT's moved into the wackey PIPVM/PAIVM market supposedly finding minisucle segmental movement dysfunctions. We did not call it subluxation, but it is certainly a variant. PT's have begun performing CST, MFR and other fringe treatments to lure an unsuspecting client to their clinic. All I can say is thank goodness for some more recent PT's in the States who seem to "get it"( Childs, Flynn, Cleland etc).
ASTYM. Well, it's not nearly as wackey as when I hear a PT claim that they can determine if a lumbar segement is hypomobile and then tell me the "type" of hypomobility. It's not nearly as wackey as CST and MFR. But the tools are wackey and the salesmanship is wackey. I still beleive we have far too many PT's willing to swallow ANY type of treatment they hear of without critical analysis. I think it's because many PT's get poor outcomes and they know it. So they try to find some "magic" new treatment. In all liklihood, their outcomes are poor due to either a lack of knowledge or perhaps even just their patient population?
You see, we can't cure everyone who is in pain. Many many patients have way more complex issues than a simple mechanical problem. But many PT's don't truly understand pain. They think if the patient is not cured, it's because their mechanical treatment must have failed. So they search for the next great magic treatment. And there are plenty of shysters willing to sell you something. Be wary.
Anyway, thanks Bonez. I read your insights on the medical complexity threads. Excellent.
< Message edited by proud -- April 16, 2008 7:49:28 AM >
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RE: Talk to me about ASTYM - April 23, 2008 8:58:50 PM
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jsalva
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I appologize in advance for revisiting an issue that may have "died", but felt the need to post. I realize the need for EBP...have taken 3 EIM courses, and subscribe to their Evidence Express, an also continue to use ASTYM with pt's.
I have personally met Rob Wainner, and Larry Benz, 2 of the co-founders of EIM (Evidence In Motion if unfamilliar). Prior to selling his share of KORT (40+ clinics), Larry had ALL of his therapist certified in ASTYM. Rob Wainer has also taken the course and uses it with pt's.
Is this proof that it is a valid treatment- NO. Is it a sign that we should keep an open mind and wait for the evidence to catch up with treatment - I think so!
ASTYM is just a tool. Is it overpriced?...almost definitely. Does it help in treating pt's?...I see a difference. Others may choose not to use it, but that does not mean it is not a valid option...Havn't seen research that indicates it is a "sham".
John
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RE: Talk to me about ASTYM - April 24, 2008 5:38:06 PM
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Kaden
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Jsalva,
It is nice to hear that leaders in evidenced based practice are willing to look at techniques/methods that have some decent theory and incorporate them into practice prior to all the research being done. It doesn't mean research should not be done but it should also not mean we should entirely crap on all things not validated in a RCT.
...and lets be real folks. If one were to soley practice evidence based medicine as many on this forum consider (i.e. validated in a RCT) you wouldn't be treating a whole heck of a lot. It is a good goal and one we should all strive for but if anyone states they are 100% an evidenced based clinician then they are either full of it or turning away a host of patients.
A lot of what we do has yet to be validated. Does that mean we should be turning away these patients until evidence shows what we do, say for the elbow, is beneficial. I say no. What it means is that we need to continue to incorporate the current evidence as it comes to light and be willing to throw away techniques we have held onto when the evidence tells us they don't stand up to the rigors of a RCT.
We have a profession that originated on a lot of theory and reasonable thought, but not based on evidence, and thus it is going to take a while for the evidence to catch up.
I know we would all like to see that any new philsophy/technique/idea go through the rigors of becoming validated via clinical trials but this will never happen. Therapy is a business first and foremost and as long as one can introduce and idea such as ASTYM and make money doing so prior to providing research to support it then we will continue to see this kind of practice. It may even be that initial monetary success will allow the research to be done.
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RE: Talk to me about ASTYM - April 25, 2008 1:17:38 PM
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jlharris
Posts: 469
Joined: April 12, 2006
From: Nebraska
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quote:
...and lets be real folks. If one were to soley practice evidence based medicine as many on this forum consider (i.e. validated in a RCT) you wouldn't be treating a whole heck of a lot.
Kaden, Kaden, Kaden...your totally off the mark. EBM isn't just RCT. It's using the best evidence AVAILABLE to make treatement decisions. Good treatment choices do not need to have RCT to be good treatment choices. If all we know about rehab of a specific condition is you clinical experience, then that is the best available evidence and should be used. However, I can't think of anything off the top of my head where all we know evidence wise is clinical experience. The point is you start at the top and work down to find the best evidence (RCT --> clinical experience/physiologic plausibility). Not the other way around (clinical experience --> RCT).
I think some of us are just afraid to do the work and figure out what really is the best evidence available and then maybe have to give up what we are comfortable with. Now, I don't believe those who contibute here are that way, but many of our profession are.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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RE: Talk to me about ASTYM - April 25, 2008 2:48:32 PM
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Jon Newman
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From: Amherst, WI
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Hi Jason,
I think a crtical element that gets left out of the equation (top->down) in EBM discussion is the idea of looking to see where "the evidence" is converging. It is not wise action to hang a practice pattern on the single best designed study. I'm presuming here that "the evidence" we're talking about is the information available across a variety disciplines.
Does that make sense or am I wearing number 7?
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RE: Talk to me about ASTYM - April 25, 2008 3:03:57 PM
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TexasOrtho
Posts: 467
Joined: December 22, 2007
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I couldn't agree more Jason and John. It amazes me how misconstrued EBM can be among providers despite a widely accepted operational definition. I would suggest looking into the following website for a good treatment of the subject. I think many people see evidence as a means to suit their own agenda. I find this ironic in that the strength of EBM is that there is no agenda if used in the manner in which it is designed.
EBM is not practicing based on "a study". We need to move past this fairly elementary fact in order to realize the benefits of using it properly.
< Message edited by TexasOrtho -- April 25, 2008 3:09:46 PM >
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Talk to me about ASTYM - April 25, 2008 4:07:24 PM
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Kaden
Posts: 289
Joined: June 17, 2007
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Jason,
I agree with you. I was just trying to make a point and don't believe I said EBM was only what is validated in a RCT. I was saying the many people, including some on this forum, put themselves on a pedestal when anyone dare mention that they used "clinical experience" to guide them in their daily practice. As I said in my previous post, we need to combine clinical experience with emerging evidence.
I agree with your definition of EBM and was not trying to imply EBM soley equaled RCT so if I did that was not my intention.
I do however feel that there are many in our profession who do define EBM in this matter and get caught hanging there entire treatment philosophy and available techniques at their disposal on one or two RCT's. You may not and I may not practice in that manner but many do.
We rip on those who ignore the evidence and simply provide stabilization exercises to lumbar patients regardless of presentation. However, is it really much better when a clinician out there manips the lumbar spine and provides ROM exercise b/c someone met the CPR for lumbar manip....but then goes on to ignore that the patient could benefit from any other intervention.
The CPR and classification system should guide you to start with manip but to ignore that the individual may also benefit from other common interventions is also an ignorant approach.
The clinician who uses evidence to guide them but ignores clinical experience and refuses to when needed to "step out of the box."
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RE: Talk to me about ASTYM - April 25, 2008 5:10:11 PM
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TexasOrtho
Posts: 467
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Well put Kaden...I think this is what EBM represents.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Talk to me about ASTYM - April 25, 2008 9:46:42 PM
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jlharris
Posts: 469
Joined: April 12, 2006
From: Nebraska
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Good points Kaden.
EBM is the "skeleton" or foundation of our decisions. It helps us decide what is MOST likely to be beneficial. However, we are working with humans and what is most likely isn't always what will work. THAT is where clinical knowledge, experience, and the art of practice really comes into play. And maybe a little ASYTM 
< Message edited by jlharris -- April 25, 2008 9:51:17 PM >
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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