There has been a flurry of interest in the value of exercise as a therapeutic remedy in some sections of physiotherapy social media in recent months. Some of this, at least, appears to be a reaction to what have been called 'passive' treatments, and a neoliberally-inspired desire to see people take more responsibility for their future health and well-being. Exercise is clearly a very valid and appropriate intervention for some people. It has been for as long as human civilisation has walked erect, and it almost certainly will continue to be useful into the future. But a recent special edition of the journal Qualitative Research in Sport, Exercise and Health has cast doubt on some of … [Read more...] about Exercise is medicine
Last week, the National Institute for Health and Care Excellence (NICE) updated its advice on the use of autologous chondrocyte implantation for treating symptomatic articular cartilage defects of the knee (link). Perhaps amid all of the other newsworthy events of last week, this announcement passed you by? In reporting on the announcement, however, the CSP's statement said something interesting. It said; The treatment ... is used to help patients with an articular cartilage defect – or early arthritis in the knee – which tends to affect people in their 20s and 30s, often as result of a sporting injury. But the NICE guidance stresses that surgery should only be considered once … [Read more...] about Physiotherapy as process, not event
Not so long ago, physiotherapists had a very close, perhaps paternalistic, relationship with the medical profession. But it seems now that our quest for professional autonomy is pushing us further away from physicians and surgeons. There are few in the profession, I think, that would dispute the obvious benefits of greater independence for physiotherapists, but this is a critical ideas blog, so I'm going to do just that. Physiotherapy has, for much of its history, been wedded to medicine. Indeed, the modern physiotherapy profession only survived and later prospered because its founders made subservience to medicine a condition of entry. Memberhip of the Society of Trained Masseuses … [Read more...] about Doctor knows best
In this post, physical therapist Keith Waldron Jeffrey Bishop's article Rejecting Medical Humanism. In this article, published in 2007, Dr. Bishop writes eloquently of the metaphysics of medicine, referencing the works of Nietzsche, Foucault, Heidegger, and Deleuze, and how they relate to today’s biopsychosociologisms. He puts forth a compelling argument against the use of the humanities and narrative medicine as an add-on, or a compensation for the mechanisation of medicine. He writes of a continued dualism that no longer distinguishes the body from the mind, but instead focuses on the dichotomy between meanings and mechanisms. Dr. Bishop reflects on the ever-increasing emphasis … [Read more...] about Keith Waldron – Rejecting Medical Humanism – 30DoS #29
In a recent article by titled Listening-touch, Affect and the Crafting of Medical Bodies through Percussion, Anna Harris discusses the effect that technology has had on the loss of doctors' physical assessment and treatment skills. The article focuses on the technique of percussion - the 'listening touch' as she calls it, that comes from percussing the chest to perceive the density of underlying tissues. Here's the abstract for the paper, and here's a link to the paper itself: Abstract The growing abundance of medical technologies has led to laments over doctors’ sensory de-skilling, technologies viewed as replacing diagnosis based on sensory acumen. The technique of percussion has … [Read more...] about What skills are you losing?
Think about how much time you spent learning about the 'normal' body in physiotherapy school. Think about how much time you spend in clinical practice assessing people to see what's 'abnormal.' And all of those clinical trials that develop sensitive, reliable and valid measures of activity, bodily function, movement and pain; all based on some universal notion of normality. Tests and measures have to assume that there is one universal normal for them to be universal. So, in principal, a score of 13 on the Modified Borg Scale means the same thing in Afghanistan as it does in Alaska, and a BMI of 28 is obese no matter where you live. Physiotherapists learn the principal of … [Read more...] about New: Normals
We can already hear the objections. The term fascism represents an emotionally charged concept in both the political and religious arenas; it is the ugliest expression of life in the 20th century (180). Not my words, but those of Dave Holmes and Stuart Murray in their fabulous paper Deconstructing the evidence-based discourse in health sciences: Truth, power and fascism. The author's argument is that we desperately need to unmask the 'the hidden politics of evidence-based discourse' (181). A recent Australian report on the efficacy of homeopathy (link) has shown that "There was no reliable evidence from research in humans that homeopathy was effective for treating the range of health … [Read more...] about Evidence-based medicine or micro-fascism?