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Re: flexion contracture 6 weeks post TKR

 
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Re: flexion contracture 6 weeks post TKR - November 10, 2006 8:40:00 AM   
SJBird55

 

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whoa... [QUOTE]get them to someone who can help them or get them ready for a general exercise program[/QUOTE]How can you ignore literature that is out there in peer-reviewed journals and fully believe that the McK approach is THE approach? Out of curiosity, how often does "inconclusive" occur? I'd like to know the data around that classification and the frequency that it occurs. What about the most difficult of difficult patients - those with central sensitization? General exercise or pass them off?

I may not know of all the different subcategories of McKenzie, but what I do know is that there hasn't been a substantial amount of publication in peer-reviewed journals to make McK THE way I choose to practice. Show me the outcomes for a greater percentage of patients than those that respond to directional preference.

(in reply to ragempt)
Post #: 41
Re: flexion contracture 6 weeks post TKR - November 10, 2006 9:36:00 AM   
PTupdate.com


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Ooooh, and SJ goes for the jugular.

It's just a weird and condescending that has existed in our profession for some time. "This is THE way, and if you don't do it THIS way, you're WRONG"

If such amazing outcomes, that are superior to the rest of our treatment routines (which probably all work equally well), why didn't the Steelers fly some McKenzie god in this past pre-season to cure Chukky Okobi's neck HNP? Why aren't they saving millions in lost playing time due to meniscal injuries?

The Steelers organization uses UPMC as their health care provider, and people like Tony DeLitto, Julie Fritz, Scott Lephart, and Joseph Maroon can't be so clueless as to what works that they would ignore this miracle treatment, would they?

John Duffy, PT OCS
[URL=http://www.PTUpdate.com]www.PTUpdate.com[/URL]

_____________________________

John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com

(in reply to ragempt)
Post #: 42
Re: flexion contracture 6 weeks post TKR - November 10, 2006 10:55:00 AM   
rv36116

 

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And that list of questions is exactly what some of us ask as well...

It's not condescending. If there is a PT who can fix some one's knee with a "meniscus injury" (which is shown in research to have 76% occurrence in asymptomatic patients...), but no one lets them anywhere near the athlete's knee because the professional team's MD has said it's a meniscus injury and saying or trying anything to the contrary would make everyone run like a bomb was about to explode.

That's hillarious because honestly, we say the exact same thing you just asked and all there is to do is shrug your shoulders and say "oh well"...

[QUOTE]If such amazing outcomes, that are superior to the rest of our treatment routines (which probably all work equally well), why didn't the Steelers fly some McKenzie god in this past pre-season to cure Chukky Okobi's neck HNP? Why aren't they saving millions in lost playing time due to meniscal injuries?

The Steelers organization uses UPMC as their health care provider, and people like Tony DeLitto, Julie Fritz, Scott Lephart, and Joseph Maroon can't be so clueless as to what works that they would ignore this miracle treatment, would they?[/QUOTE]

(in reply to ragempt)
Post #: 43
Re: flexion contracture 6 weeks post TKR - November 10, 2006 11:39:00 AM   
Shill

 

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Can anyone come up with another SPECIFIC (read non-ecclectic) approach for mechanical neck and LBP that has more good research than the repeated movements/directional preference/centralization approaches?
SJ, there has been plenty of research in plenty of peer reviewed journals. If you cant find studies pertaining to these approaches (hint, you have to search more than McKenzie, you need to look at centralization, repeated movements, etc), I can provide you a list.

And Duffy, you know that NOTHING can help the Steelers. Of course, the same goes for my Packers. But wait 'til next year.......or something.

_____________________________

Steve Hill PT

(in reply to ragempt)
Post #: 44
Re: flexion contracture 6 weeks post TKR - November 10, 2006 1:29:00 PM   
ragempt

 

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hey

(in reply to ragempt)
Post #: 45
Re: flexion contracture 6 weeks post TKR - November 10, 2006 1:34:00 PM   
ragempt

 

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I could be wrong but there is no other theray treatment out there that has been researched more than the mckenzie method. also what's the differnce between directional preference and centralization?

(in reply to ragempt)
Post #: 46
Re: flexion contracture 6 weeks post TKR - November 10, 2006 3:00:00 PM   
SJBird55

 

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Shill, I have only read literature regarding repeated movements and directional preference with lumbar spine pathologies. I haven't ready anything yet with the McK approach for any other joint or body part. (Maybe I have read something on posters at presentations at the APTA meetings, but I can't recall.) I interpret Rob's writings to use McK for everything and anything under the sun, except for those "inconclusive" cases, which by the way he never did specify the frequency of that occurrence.

(in reply to ragempt)
Post #: 47
Re: flexion contracture 6 weeks post TKR - November 11, 2006 6:15:00 AM   
SJBird55

 

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The abstract doesn't really make sense. The "methods" and the "results" really don't add up to me with what was written. Someone should maybe find the actual journal abstract and make sure that what was in the journal is the same as this - it appears to me that 2 studies were combined? But anyways... so you can see that I do pay attention to McK stuff. AND, this is only on the spine.

Classification by McKenzie mechanical syndromes: a survey of McKenzie-trained faculty.

J Manipulative Physiol Ther. 2006 Oct;29(8):637-42

Authors: May S

OBJECTIVE: The purpose of this survey was to identify the percentage of patients with spine pain who can be classified by McKenzie-trained faculty as having one of either derangement, dysfunction, or postural syndromes. METHODS: McKenzie Institute International faculty members in 20 countries, who are highly trained and are experienced users of the classification system, recorded details on 15 consecutively discharged patients. RESULTS: Responses were received from 57 therapists in 18 countries (89% of potential sample), and details were collected on 607 patients with spine pain. Eighty-three percent were classified in one of the mechanical syndromes; derangement was the most common syndrome. Therapists recorded a mechanical classification in a mean of 82% (SD, 15.1; range, 44%-100%) of their patients with spine pain. CONCLUSIONS: For this study, the McKenzie mechanical syndromes were commonly diagnosed in a large consecutive group of patients at multiple sites by experienced therapists. This classification system may have valuable clinical use in managing patients with spine pain.

PMID: 17045097 [PubMed - indexed for MEDLINE]

(in reply to ragempt)
Post #: 48
Re: flexion contracture 6 weeks post TKR - November 11, 2006 6:33:00 PM   
PhysioThis

 

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I'm a little late to the conversation, but I must ask Rob: How do you find the time in your day to cure patients AND BOW TO AUCKLAND FIVE TIMES??? Have you made your pilgrimage yet???

Seriously, though, I am a McKenzie ignoramus, if you may, because the only thing I've studied are the cursory materials while in school. I just sense such an exclusionary tone in some of Rob's posts, I couldn't help taking a jab.

So let me understand, If Mckenzie has a big league and is supposed to be done to patients at the exclusion of everything else, what the heck is the institute doing offering A-E (or whatever) courses? Every pieker who wants to shell out $450 and a long weekend of time is messing up your game, man. I bet your upper traps are extremely tired (oh well)$$$$$$$$$

My kid just fell and cracked his head. I'll see you later.

_____________________________

Ed, PT, MTB-XC

(in reply to ragempt)
Post #: 49
Re: flexion contracture 6 weeks post TKR - November 12, 2006 4:45:00 PM   
rv36116

 

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SJBird, I would see if you can pick up a used book for McKenzie for the "other than the spine" treatments...
The Human Extremities: Mechanical Diagnosis and Therapy

http://optp.com/index.cfm/pageid/205

(in reply to ragempt)
Post #: 50
Re: flexion contracture 6 weeks post TKR - November 12, 2006 5:45:00 PM   
SJBird55

 

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Oh, I've seen the books... I haven't read them. The literature in which I am referring is anything in peer-reviewed journals that indicates efficacy. Also.. you haven't answered the "inconclusive" category. That is quite relevant - if there is a high amount of "inconclusive" then technically McK isn't necessarily the answer for assessing/treating.

(in reply to ragempt)
Post #: 51
Re: flexion contracture 6 weeks post TKR - November 12, 2006 5:46:00 PM   
SJBird55

 

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Forgot to add reliability of the assessment system - need to know both reliability and efficacy.

(in reply to ragempt)
Post #: 52
Re: flexion contracture 6 weeks post TKR - November 12, 2006 8:09:00 PM   
PTupdate.com


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SJ: I hear crickets a chirpin' while we wait for an answer to your question

shill: Steelers won tonight-HA. Almost 1000 total yards in the game, FastWillieParker ran for over 200, and Ben didn't throw ONE PICK!!

Rob: I'll buy that McKenzie book if you hook me up with the cutie doing the prone press up on your Mission page.

Robb: If the McKenzie method, when done pure as you suggest, is so perfect, why can't they provide the data to back that up? Are they making these claims, or are they sending an army of robots out there to do that? I am sure the institute hauls in some serious cash, so there is really no reason why this can't be done. After all, it done and shown to be exactly as we're told, they'll make millions more!

And, I don't buy that bit that McKenzie specialists are not involved due to someone's ego...at least on a consistent basis. Joseph Maroon has been a spine surgeon and pioneer in that field for years now. If he saw the superior results from this approach to spinal and extremity problems, he'd no doubt have that brought into the medical staff.

ragept: Going to a course does not make you a non-thinker, and nobody ever said that. Going to a course, taking everything they tell you as gospel without challenging it and asking for some type of proof is just plain scary.

And you know what guys? I'd love to take McKenzie ABCD all the way to Z, if I just had the time. I believe it would enhance my skills, but I'd NEVER practice with just pure McKenzie method

Duffy

_____________________________

John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com

(in reply to ragempt)
Post #: 53
Re: flexion contracture 6 weeks post TKR - November 12, 2006 8:59:00 PM   
rv36116

 

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Good for ya Duffy.

The "inconclusive" has no exact numbers... It's like asking "what percentage of patients do you send back to the MD because of red flags?"

Do you have an answer for that one? Neither do I. If you want me to give you a ballpark figure, maybe about 2 per month, last week I evaluated about 13 patients, treat about 10-12 patients per day...Maybe that can give you a heads up on the numbers you're looking for? I honestly don't know what to tell you for that one.

If you honestly don't think ego has anything to do with treating patients, you've got to be kidding me... What do you think this conversation (and others where McKenzie is discussed) shows with the tone it has evolved into?

I practice pure McKenzie, you guys don't, woo hoo, great. Yes, I use it for everything, back,neck,shoulder,knee,hip,ankle,elbow,wrist,s/p surgery, etc...


By the way Duff, I found in another post that you were hoping to enter the Diploma Program?

[QUOTE]posted January 06, 2006 07:46 PM Hey Charlie...congrats on the McKenzie diploma. I have wanted to get that for years now, so hats off to you!

Duffy[/QUOTE]Has this changed in the past year?

(in reply to ragempt)
Post #: 54
Re: flexion contracture 6 weeks post TKR - November 13, 2006 5:24:00 AM   
SJBird55

 

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Umm, Rob, I DO have the data for the percentage of patients that I refer back. Patients are referred back for a variety of reasons: 1) red flags 2) substantial change in condition in which PT services are inappropriate 3) recommendations for further diagnostic testing and 4) patient not responding as would be anticipated. I lumped ALL of those reasons together in my outcome data for 2002-2004. My data indicates that 18% of patients are discontinued from services with me for the above identified purposes. I can tell you that if you don't collect the data, you have no idea and you are just guessing. A HUGE institute should be able to produce efficacy and reliability information. If little me knows my outcomes and takes the time to know those numbers... then I believe that technically others can take the time to know theirs.

(in reply to ragempt)
Post #: 55
Re: flexion contracture 6 weeks post TKR - November 13, 2006 5:59:00 AM   
SJBird55

 

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Rob... Duff DID say he'd love to have the McK but he doesn't have the time...

(in reply to ragempt)
Post #: 56
Re: flexion contracture 6 weeks post TKR - November 13, 2006 8:32:00 AM   
rv36116

 

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Hi SJBird,

How many patients did you see during that time? Great job keeping stats.

I'm not sure if you read what I wrote, but I specified that I was guessing.

Glad you keep your data, good for little ol' you. Maybe I should start doing that...

Please participate in the McKenzie thread, and I'm sure Duffy can speak for himself about his opinions about McKenzie now vs. then.

(in reply to ragempt)
Post #: 57
Re: flexion contracture 6 weeks post TKR - November 13, 2006 9:24:00 AM   
PTupdate.com


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I told SJ to type that...she was sitting on my lap at the time :)

On this end, my opinion has not changed, and I would take all the McKenzie courses. As I said earlier, two of the best clinicians I ever worked with were McKenzie instructors. But, as I noted, they used other techniques as well, including Mulligan. They never once said that their method was the best, nor did they ever give the impression that using other styles was somehow wrong.

No doubt their humbleness and ability to consider many other options was one of the reasons for their success.

John Duffy, PT OCS
[URL=http://www.PTUpdate.com]www.PTUpdate.com[/URL]

_____________________________

John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com

(in reply to ragempt)
Post #: 58
Re: flexion contracture 6 weeks post TKR - November 13, 2006 9:43:00 AM   
Shill

 

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SJ,
Sorry, I misunderstood. I havent read the extremity stuff either.

Duffy. Nice game for the Steel Curtain. The Packers won too, so I think I will just start keeping my mouth shut.

_____________________________

Steve Hill PT

(in reply to ragempt)
Post #: 59
Re: flexion contracture 6 weeks post TKR - November 13, 2006 9:49:00 AM   
rv36116

 

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[QUOTE]No doubt their... ability to consider many other options was one of the reasons for their success.[/QUOTE]So, in that essense, McKenzie practitioners won't be successful in treating patients then?

What courses have you been able to complete so far? I'm interested because I want to know how much of the terminology and underlying structure for McKenzie you have already obtained... It would be great to start the discussion in the McKenzie topic to keep things in one place, my mind's elsewhere today after the sleepless night w/the baby.

(in reply to ragempt)
Post #: 60
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