Be Strong Physio Geoff Ford

What's wrong with osteopathy
This episode was based up on the paper What's wrong with osteopathy (link here)?
We explored some of the topics within the paper including 5 key problematic areas for osteopathy:
Its weak theoretical basis Inherent biomedicalism  Mono interventionism  Practitioner-centredness Predilection for implausible mechanisms  You can find Dr Oliver Thomson on Instagram here.
You can find more of his papers here.

Today I welcomed Dr. Tom Cross and Andrew Wild. Today we discuss the Cross Bracing Protocol (CBP), recent CBP research updates, how some ACL ruptures can heal using the CBP, the MRI classification system of ACL injuries that has been developed by Tom and his team, how to manage an acute ACL rupture, criticism of the CBP and Tom’s response to this criticism and much more.
Heal ACL Website: https://healacl.com/

On this episode I sat down with Cameron Faller, physical therapist and educator to discuss some of the shortcomings of the current approach to evidence-based practice and how a move to process based therapy may be the answer. 
We went through the following topics:
Q 1: To begin with, do you mind if we dive into some of the issues or shortcomings of evidence based practice as we know it?
Shortcomings of the current approach to therapy (biomedical model)
Focussed on biology 
Has saved lives 
Struggles to capture the interplay between biological, social and psychological 
Reductionist problem solving 
 
Mechanistic world view 
View body like a machine 
The focus is on fixing isolated parts 
 
The idea that we can understand individual trajectories by understanding normal and the
 deviation from normal. They thought that between subject variability was a good estimate of within subject variability. 
 
Falsely homogenized group and situationally decontextualised individual units 
The Bell Curve of the collective only to decontextualized individuals (which is no one) 
Normative concepts may not be applicable to specific individuals (as they are non-ergodic) 
It's a kind of individualism but not related to a real individual 
 
Question 2: Issues with the application of the biopsychosocial approach to clinical practice
 
Question 3: What is process-based therapy?
 
What core biopsychosocial processes should be targeted with this client given this goal in this situation, and how can they most efficiently and effectively be changed? 
Process based therapy approach: 
What creates the problem for the individual 
What historical factors may have contributed 
What are the factors that maintain the problem 
Create a network of nodes of possible factors [network functional analysis] 
What strategies can we use to perturbate this complex system? How can we introduce healthy variation or retention?” What treatment kernels do we have available to us to do this in the particular context?
We are aiming to perturbate the system to turn it from maladatpive to adaptive.
This has to be done in the right context. 
What is the network in the process that you are targeting?
Use data to track progress and to test hypotheses. 
Adjust as needed.
ACT - incorporates functional contextualism - what works (functions) in a given situation or context. 
Unique to the individual 
Does this work in this moment? Is this moving us towards the type of life we want to have? To reduce suffering and engage in our values
Q: How does it address some of the issues with the current approach to therapy? 
 
Q: Does a systems based approach bastardize Evidence-Based Practice? Does it come down more to clinicians appreciating the evidence then being able to skillfully apply it to the person in front of them and their individual context? 
 
Q: To help me and any of the listeners understand how it is actually applied, do you have any examples we could run through? 
 
Q: Example of a network analysis? Eg thought of keeping back in neutral when bending. 
 
Q: What can we do with this information from a network analysis to create positive change of an individual ? 
 
Q: For listeners who want to learn more about process based therapy - what can they do / where can they go to learn more?
You can find out more about Cameron here: https://www.instagram.com/camfallerdpt/?hl=en
 
You can find out more about the Human Rehabilitation Framework here: https://hrfhome.com/

On this episode I spoke with Jeff Morton who is a physiotherapist Advanced Lower Limb Practitioner in the NHS in the UK and shares some great content on social media around movement science, biomechanics and complex systems theory with some cracking memes. 
You can find Jeff here: https://www.instagram.com/jmortonphysio/
We dived into a discussion about ecological dynamics, which considers the body as a complex system that interacts with its environment. 
Jeff shared some great insights including how he uses ecological dynamics in the clinic as well as some great examples of how he uses constraints to target key areas such as the quadriceps during ACL rehah. 
An outine of ecological dynamics follows:
Human movement can be viewed as the emergent result of the interaction between the athlete and its surrounding context. 
The athlete performs in a context that is shaped by three types of constraints 
Individual constraints 
Environmental constraints 
Task constraints 
Individual constraints 
Height 
Weight 
Strength 
Limb length 
Fatigue 
Anxiety 
Environmental constraints 
Terrain 
Light 
Weather
Boundaries of the field 
Task constraints 
Goal of the task 
Any rules such as for a sport
Objects or rules that specify or constrain the athletes response dynamics, eg actions of other players 
 
Movement is not produced by an athlete in isolation, but emerges from a dynamic coupling between the athlete's characteristics, the stimulus-rich environment, and the desired actions (ie tasks). 
There is a non-linear relationship between changes in constraints and the produced movement. 
Self organized movement, perception and action are inherently coupled and cannot be studied in isolation. Expert athletes aren’t just proficient movers, they excel at perceiving information from the environment and executing actions accordingly. 
I really hope you gained as much from this episode as I did! 
Geoff. 
 

On this episode I had Ben Darlow to discuss the impact of what clinicians say on their patients and how we can work with patients to find solutions and make sense of their pain. 
Ben is a prolific researcher and has produced some papers that have had a huge positive impact on the way that clinicians practice, particularly how they consider the impact of their narratives on patients. You can find more of his articles here.
An outline of our podcast follow:
What are some common negative beliefs that people in pain have?
How have they developed these beliefs? 
What is the impact of these beliefs? 
Unhelpful beliefs about LBP are thought to underlie many of the psychological factors that are associated with pain and disability. 
Belief that the back is fragile and needs protection - associated with higher levels of pain related fear and avoidance behaviors. 
May lead to conservative management such as taking time off work and bed rest 
Finding solutions with patients 
We discussed the opportunity to explore patient narrative and the sense they make of their pain to help them find a solution. 
 
Ben shared some great clinical pearls about how he applies the leanrring from his research in clinical practise. 
If you found this episode helpful, please consider sharing a 5 star review on your favourite platform so more people can find it!
You can find Ben on Twitter @BenD_NZ
Geoff
 

On this episode I was joined by Dr Stephanie Filbay to discuss all things ACL rupture.
Dr Stephanie Filbay is a physiotherapist, and Senior Research Fellow at Univeristy of Melbourne and is a leading researcher in knee ACL managment including emerging research on ACL healing. 
The following is an outline of our chat.
Reminder: if you enjoyed this episode please consider leaving a 5 star review so that it appears higher in the charts and therefore more people can find it and have access to up-to-date healthcare information. 
QUICK FIRE QUESTIONS 
Do early ACL reconstructions lead to better patient outcomes?
Are ACL reconstructions necessary to return to sport?
Do ACL reconstructions prevent further knee damage?
Do ACL reconstructions reduce the chances of osteoarthritis?
Are there currently too many ACL reconstructions performed? 
Can ACLs heal?
 
Cross bracing protocol 
What is the cross bracing protocol including rationale for it?
Study and results.
Shortcomings of this study and what future research do we need?
What are the implications of this research?
 
Decision making aid 
Decision making aid for patients and clinicians in light of this new research.
What are the consequences of ACL rupture?
What are the objectives of management - 
Restore knee function
Address psychological barriers 
Prevent further injury and reduce risk of OA
Optimise long term Quality of Life
What management options do people who have just torn their ACL have? 
Do outcomes differ depending on what management approach is chosen?
Knee laxity and functional instability 
Return to sport
Does early surgery prevent additional meniscus and cartilage damage - what does the evidence we have say about this belief?
Preventing further knee damage and long term OA
Discussing management options and expectations for someone who has just torn their ACL - Steph what do you wish someone had told you when you first tore your ACL? 
Eg all patients of 181 expected to have normal knee function after ACLR and 91% expected to return to sport - is this realistic? 
Are there any practical steps that people can take after injury if they want to consider participating in the Cross Bracing Protocol?  
Are there any less extreme options open for people who want to help their chances of healing but don’t want to have their knee in a brace for 12 weeks? 
You can find Steph on Twitter (@stephfilbay).