Improve physical therapy Improve physical therapy - Page 2

starting strength gym
Page 2 of 3 FirstFirst 123 LastLast
Results 11 to 20 of 24

Thread: Improve physical therapy

  1. #11
    Join Date
    Nov 2015
    Posts
    4

    Default

    • texas starting strength seminar september 2020
    • wichita falls texas december seminar 2020
    I am so early in my career I feel that I can't provide an accurate statement about physical therapy's past and present issues, but from what I have experienced so far, much of what you say in your article is accurate. Every PT who has spoken to me about exercise prescription has emphasized that we tend to not push people hard enough, although they do not emphasize how to go about providing sufficient stress. However, for a patient I can hardly convince to lift their heel off the bed, it's hard to imagine creating a program with which they'll comply but will also provide sufficient stress, adaptation, and recovery. Most people who come to these forums, read Starting Strength, etc. are looking to work extremely hard. Those who are in the hospital for extended periods or complain of general knee pain often don't have the same expectation. This speaks mostly to how our profession needs to get better at emphasizing that functional improvement does not happen without sufficient stress, but also helps explain how some PT's fall into the trap of prescribing 30 straight leg raises, twice a day.

  2. #12
    Join Date
    Jul 2007
    Location
    North Texas
    Posts
    42,531

    Default

    For hospitalized patients, well, you don't get to fix everybody. But when a post-op patient comes into your office and gets "quad sets" for some bullshit diagnosis about her patella "detracking" or other such insanity, your office is part of the problem.

  3. #13
    Join Date
    Nov 2015
    Posts
    4

    Default

    Although quad sets for someone with anything approximating a normal thigh are an odd therapy choice, I'm curious as to why you view patellar tracking issues as BS. Patellar dislocations are very real and are an extreme version of what people term patellar tracking issues. Given that the quadriceps tendon attaches to the patella, issues with thigh strength and obviously hip control could logically affect the knee and addressing them (as with squats and other activities that stress those muscles) is what decreases patients' knee pain. I am not suggesting that you need to completely isolate those muscles, but that their weakness logically affects the knee joint. Are you more concerned about the type of training prescribed or the PT's concern with tracking? I'd be interested to see the research that refutes it as an issue affecting knee pain.

  4. #14
    Join Date
    Aug 2010
    Location
    Olympia, WA
    Posts
    2,109

    Default

    Quote Originally Posted by Mark Rippetoe View Post
    For hospitalized patients, well, you don't get to fix everybody. But when a post-op patient comes into your office and gets "quad sets" for some bullshit diagnosis about her patella "detracking" or other such insanity, your office is part of the problem.
    I've started having several hours a week blocked off for me to take patients to the gym and teach them how to squat, deadlift, Olympic lift, etc.

    All anterior knee pain patients here at our clinic (regardless of therapist) are given patient education plagiarized heavily from the moment model of barbell training and are taught how to squat correctly.

    Any back pain patient I have, with the exceptions being serious pathology, are taught how to properly lift objects, again, primarily using SS-BBT as the foundational text. The more motivated patients are progressed to performing deadlifts and loaded squats. Somehow, these patients have very good outcomes.

    Ironically, multiple consults come in every week specifically asking for me, as patients have heard from other people that there is a therapist here that has their head screwed on straight.

    Now, there are a few patients throughout the week that I am forced to give "standard of care" to, including quad sets, theraband exercises, etc, because there is no expectation of them ever allowing themselves to do something physically difficult. We all deal with patients like that, but, I've made it my practice habit that after they do their bullshit exercises that I attempt to convince them to allow themselves to progress and do something hard. Sometimes it works, sometimes it doesn't.

  5. #15
    Join Date
    Jul 2007
    Location
    North Texas
    Posts
    42,531

    Default

    Quote Originally Posted by gophole View Post
    Although quad sets for someone with anything approximating a normal thigh are an odd therapy choice, I'm curious as to why you view patellar tracking issues as BS. Patellar dislocations are very real and are an extreme version of what people term patellar tracking issues. Given that the quadriceps tendon attaches to the patella, issues with thigh strength and obviously hip control could logically affect the knee and addressing them (as with squats and other activities that stress those muscles) is what decreases patients' knee pain. I am not suggesting that you need to completely isolate those muscles, but that their weakness logically affects the knee joint. Are you more concerned about the type of training prescribed or the PT's concern with tracking? I'd be interested to see the research that refutes it as an issue affecting knee pain.
    I'd be interested in seeing the research that establishes "patellar detracking syndrome" as a cause of knee pain. This would necessarily be more than just a guy saying it's the cause of knee pain. We just teach people to squat, as Will mentions, and knee pain of this type is not a problem. "Quad sets" are an amusing therapy.

  6. #16
    Join Date
    Aug 2010
    Location
    Olympia, WA
    Posts
    2,109

    Default

    Quote Originally Posted by Mark Rippetoe View Post
    I'd be interested in seeing the research that establishes "patellar detracking syndrome" as a cause of knee pain. This would necessarily be more than just a guy saying it's the cause of knee pain. We just teach people to squat, as Will mentions, and knee pain of this type is not a problem. "Quad sets" are an amusing therapy.
    Patellar maltracking can happen as a result of rupture of the retinaculum....but that usually results in a rather stark, acute orthopedic condition. I probably see the "patellar tracking" diagnosis from PCMs and orthopedic surgeons several times a week, but I have been reasonably successful treating them with low bar squat technique and explaining to them that overloading the patellofemoral joint with shitty squat technique is why their knees hurt. They start squatting using Rip's technique and their knees feel better in about 2 weeks. Again, this goes back to stress-adaptation, just in the opposite direction from strength training. You offload the joint by teaching proper squat mechanics and magically these knee issues get better.

  7. #17
    Join Date
    Jul 2007
    Location
    North Texas
    Posts
    42,531

    Default

    Quote Originally Posted by Will Morris View Post
    Patellar maltracking can happen as a result of rupture of the retinaculum....but that usually results in a rather stark, acute orthopedic condition.
    Absolutely. I had it. Motorcycle wreck. But the insurance salesman whose knees hurt a little and who ends up with this bullshit diagnosis is the guy we're talking about.

  8. #18
    Join Date
    Sep 2012
    Location
    internet
    Posts
    1,763

    Default

    I, too, had patellofemoral tracking syndrome for about three years. I was playing in a basketball tournament and on a fast break lay-up some asshole pushed me hard while I was in the air. The result was my right knee slamming into the wood as I fell. The MRI only showed a bone contusion, but I soon after developed PFPS. After years of anguish, it spontaneously disappeared two years ago. To this day I am puzzled as to how I developed it. Hyperinnervation of the region perhaps? I did PT for a year, strengthening my gluteus medius and doing a lot of "quad sets", and it did absolutely NOTHING.

  9. #19
    Join Date
    Jul 2007
    Location
    North Texas
    Posts
    42,531

    Default

    Quote Originally Posted by umairsemail View Post
    I, too, had patellofemoral tracking syndrome for about three years. I was playing in a basketball tournament and on a fast break lay-up some asshole pushed me hard while I was in the air. The result was my right knee slamming into the wood as I fell. The MRI only showed a bone contusion, but I soon after developed PFPS. After years of anguish, it spontaneously disappeared two years ago. To this day I am puzzled as to how I developed it. Hyperinnervation of the region perhaps? I did PT for a year, strengthening my gluteus medius and doing a lot of "quad sets", and it did absolutely NOTHING.
    You had Knee Pain. You were diagnosed with patellofemoral tracking syndrome. How long have you been lifting? Wouldn't be 2 years, would it?

  10. #20
    Join Date
    May 2013
    Posts
    2,103

    Default

    starting strength coach development program
    Quote Originally Posted by Mark Rippetoe View Post
    How long have you been lifting? Wouldn't be 2 years, would it?
    Hah! Clearly you are not familiar with Umair's work here. Let us not continue derail the thread with his posts any longer, unless it's to further solidify the point for which it was created.

Page 2 of 3 FirstFirst 123 LastLast

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •