Applying the evidence to your clinical practice:

• What prognostic factors do you focus on? How do they influence your POC development? Do you communicate the factors to the patient, referring provider, or your colleagues who may co-treat?
• How do you assess a patient’s confidence level with respect to the body region they primarily experience symptoms (e.g. confidence in their knee when they have knee OA)
• Is stretching part of your in-clinic or at-home programming? If so, how do you determine the dosage (duration, intensity, and number of sets)
• How do you assess the effectiveness of your manual therapy techniques?

Links to the studies:
https://pubmed.ncbi.nlm.nih.gov/35717179/
https://pubmed.ncbi.nlm.nih.gov/35713515/
https://pubmed.ncbi.nlm.nih.gov/35694390/
https://pubmed.ncbi.nlm.nih.gov/35719196/

Please leave a rating and review, share the podcast with fellow clinicians, and check out future episodes!

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In this episode, physiotherapist, consultant, and researcher Dale Whelehan shares his research and thoughts on sleep and heuristics. We discuss how bias and heuristics can aid clinicians when used correctly. However, when sleep deprivation enters the equation, critical thinking Is heavily Influenced.

Dale received his Ph.D. (after recording this episode) in Behaviour Science at Trinity College Dublin. He focused on surgical performance with respect to the objectivity of performance, the influence of sleep deprivation, clinical decision-making, and fatigue risk management approaches to enhance performance. He is now a Human Capital Management Consultant for Deloitte.

*This episode was recorded in 2020 and originally aired on the first iteration of the Clinical Gap Podcast on September 1, 2020.

Where to find Dale:
Twitter, LinkedIn, Physioplus, Research Gate 

Interested in receiving short health and fitness research summaries? Subscribe here
For full in-depth reviews, subscribe to my Medium articles here
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Applying the evidence to your clinical practice:

• What movements do your patients fear? How do you implement graded exposure for those movements?
• When and how should you hold conversations arguing for conservative care first in common surgical situations (ACL, Rotator Cuff Tear, Knee OA, etc.) 
• How do you stage your education throughout a POC?
• Do you track physical activity guideline adherence? Should you? How would you?

Links to the studies:
https://pubmed.ncbi.nlm.nih.gov/35661387/
https://pubmed.ncbi.nlm.nih.gov/35655691/
https://pubmed.ncbi.nlm.nih.gov/35647883/
https://pubmed.ncbi.nlm.nih.gov/34746955/

Please leave a rating and review, share the podcast with fellow clinicians, and check out future episodes!

Interested in receiving short health and fitness research summaries? Subscribe here
For full in-depth reviews, subscribe to my Medium articles here
Follow me on Instagram and LinkedIn for more content
For fitness equipment, I highly recommend Rogue Fitness (affiliate link)

In this episode, I speak with Lars Avemarie about critical thinking and translating research. We discuss the propensity of misinformation across mass and social media and how to remain accountable to the information we provide patients and fellow physical therapists. We also tackle the state of manual therapy research (in 2020). As with any good conversation, I am left with more questions than I started with. The points Lars made have led to a lot of personal reflection about my clinical practice and how I teach.

*This episode was recorded in 2020 and aired on the first iteration of the Clinical Gap Podcast on September 1, 2020.

Where to find Lars:
Website, Twitter, Instagram

Interested in receiving short health and fitness research summaries? Subscribe here
For full in-depth reviews, subscribe to my Medium articles here
Follow me on Instagram and LinkedIn for more content
For fitness equipment, I highly recommend Rogue Fitness (affiliate link)

The Clinical Gap Podcast is back! This is the first Research Recap episode (keep a look out for Residency Roundups starting in mid-September and past interviews). 

This Research Recap dives into many topics regarding plan of care development and appropriate exercise selection, taking into account neural health, self-efficacy, metabolic health, and training goals. Here are some practical questions to consider and help you apply the evidence to your clinical practice:

• How do you decide if spinal manipulative therapy is appropriate for your patient?
• How can you enhance exercise self-efficacy?
• What strategies do you use to enhance motor learning? How do you bias myelination vs. remyelination?
• How do you structure HIIT and MICT exercises? How do you involve patients in the decision-making process for exercise?

Links to the studies:
https://pubmed.ncbi.nlm.nih.gov/35633383/
https://pubmed.ncbi.nlm.nih.gov/35622474/
https://pubmed.ncbi.nlm.nih.gov/35635130/
https://pubmed.ncbi.nlm.nih.gov/35399102/

Please leave a rating and review, share the podcast with fellow clinicians, and check out future episodes!

Interested in receiving short health and fitness research summaries? Subscribe here
For full in-depth reviews, subscribe to my Medium articles here
Follow me on Instagram and LinkedIn for more content
For fitness equipment, I highly recommend Rogue Fitness (affiliate link)

In this episode, I take a look at MRI studies in various regions of the body. The results are consistent. MRI “findings” do not explain pain. While the MRI is a phenomenal invention and can provide life-saving information, it can also cause unnecessary harm and waste billions of healthcare dollars.

This episode is the start of a shift in the podcast. Instead of focusing exclusively on clinicians, this podcast will now tackle health misinformation for everyone, regardless of their level of training and education. My mission is to tackle health misinformation and this podcast is a step in that direction.

Blog Post

Music by Quentin Walston

Studies included:
Yao, W., Zhang, Y., Zhang, L., Zhou, J., Zhang, Y., Zheng, X., & Ding, J. (2020). MRI features of and factors related to ankle injuries in asymptomatic amateur marathon runners. Skeletal Radiol. 

Blankenstein, T., Grainger, A., Dube, B., Evans, R., & Robinson, P. (2020). MRI hip findings in asymptomatic professional rugby players, ballet dancers, and age-matched controls. Clin Radiol, 75(2), 116-122. 

Bacon, K., LaValley, M. P., Jafarzadeh, S. R., & Felson, D. (2020). Does cartilage loss cause pain in osteoarthritis and if so, how much? Ann Rheum Dis, 79(8), 1105-1110. 

Turk, O., & Yaldiz, C. (2019). Spontaneous regression of cervical discs: Retrospective analysis of 14 cases. Medicine (Baltimore), 98(7), e14521.

Fritz, J. M., Brennan, G. P., & Hunter, S. J. (2015). Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges. Health Serv Res, 50(6), 1927-1940. 

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., . . . Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol, 36(4), 811-816. 

Summary:
In this episode, I speak with one of my former professors, Dr. Ainsley Rossi. The interview is focused on maximizing formal education and translating education to clinical practice. Ainsley shares her experiences practice in multiple states and countries. We discuss clinical gaps students and experienced clinicians face. Ainsley challenges both students and educators to embrace doubt and uncertainty.

Topics:
0:00 - Intro
3:00 - Start of Interview
3:50 – Ainsley Introduction
6:00 – Difference in treatment approaches in different countries and states
12:45 – Preparing for the NPTE as an experienced clinician
15:30 – Teaching and training for exams vs. clinical practice
21:30 – How various experiences influence clinical practice
26:40 – Focusing on education we are interested in
28:25 – Learning vs. regurgitating information
30:30 – Variability of patient presentation
32:10 – Synthesizing clinical information
33:30 – Treatment effects of clinical assessments
36:00 – Using modalities in clinical practice
38:50 – Conviction in prescribing treatment
40:10 – The value proposition of physical therapy
41:20 – Influence of student debt
45:00 – Clinical gap from classroom to clinic
47:55- Burnout, Dunning-Kruger, and Sunk Cost Fallacy
51:45 – Clinical gaps for experienced clinicians, continuing education, multidisciplinary education
1:01:45 – How to connect with Ainsley
1:03:15 – Closing thoughts from Zach

Quotes:
“Let’s consider what the patient in front of your presents like.” (“it depends” substitute for students)

 “No patient looks like a textbook.”

 “When you graduate PT school it is just the start of the journey. Your patients are going to teach you.”

 “Don’t be scared of not knowing everything…and stop asking what’s on the test.”


Connect with Ainsley:
Twitter, LinkedIn, Quinnipiac University


Books Mentioned:
How Not to Be Wrong: The Power of Mathematical Thinking by Jordan Ellenberg (Amazon Affiliate Link)

Music by Quentin Walston

Summary:
In this episode, I speak with Dr. Nicole Surdyka about current misconceptions in ACL rehab, return to sport treatment, and injury prevention strategies. We kick off by discussing clinical debates on social media and in person. We discuss issues around one-size-fits-all treatment approaches in any stage of treating athletes (prehab, in-clinic rehab, return to sport). Nicole also shares her experiences of mentorship and entrepreneurship.

Topics:
0:00 – Intro
2:52 – Nicole Introduction
4:00 – Heavy loading versus blood flow restriction training
5:50 – Arguing against our biases and beliefs
7:25 – Social media clinical debates and changing viewpoints
10:10 – In-person clinical debates and disagreements with medical doctors
14:05 – Misconception in anterior cruciate ligament (ACL) rehabilitation
16:50 – Stretching and foam rolling
19:55 – Insurance versus self-pay
21:25 – Showing our value and using modalities
22:15 – Injury prevention
26:15 – Return to sport criteria issues
29:35 – Developing return to sport decisions
36:10 – Differences between in-clinic and on-field rehab
37:15 – Return to sport expectations
40:10 – Programming vs. home exercise programs
50:50 – Injury prevention programs
54:10 – What is a functional activity?
55:25 – The largest clinical gap from school to clinic
1:01:05 – Pursuing Entrepreneurship
1:02:25 – Finding Mentorship
1:07:10 – Connecting with Nicole
1:09:02 – Zach’s closing thoughts

Quotes:
“I think everyone should have to create an argument that is against their biases”

“I don’t care what exercises someone chooses as long as we are achieving the adaptations we are looking for.”

“You’re never going to prevent all injuries. The only way to prevent an injury is to have someone stop playing a sport.”

“A stitch in time saves nine”

Connect with Nicole:
Website, Podcast, Youtube, LinkedIn, Instagram, Facebook, Twitter

Resources Mentioned:
The Science PT Course
Clinical Athlete Forum

Music by Quentin Walston

Summary:
In this episode, I speak with Dr. Patrick Berner, PT, DPT, RDN about integrating nutrition into physical therapy practice. Patrick is one of only a handful of dual DPT/RDN clinicians in the United States. He provides a valuable perspective for any physio seeking to provide a comprehensive plan of care for patients. Patrick discusses the importance of broaching nutrition conversation, the challenges of navigating nutrition research, and the benefits of building a collaborative approach and bridging the worlds of physical therapy nutrition.

Topics Covered:
0:00 – Zach Intro
3:25 – Start of Interview
4:25 – Physiotherapist vs. Physical Therapist
4:50 – Patrick introduction
7:20 – Why Patrick sought degrees in both nutrition and physical therapy
10:30 – Targeting physios or patients in nutrition education
12:20 – Building collaborations between PTs and Registered Dieticians
14:10 – General vs. specific recommendations
15:00 – Broaching nutrition conversation with patients
17:10 – Many ways to define “healthy eating”
18:20 – Issues in nutrition literature
20:30 – The influence of sleep and other factors on dietary success
21:50 – How detailed should nutrition conversations be?
23:40 – Celebrating small wins
24:45 – Cues and small changes
25:45 – Adding healthy vs. taking unhealthy food away
27:15 – Reading and translating nutrition research
31:55 – Using correlational data
33:05 – Using systematic reviews and meta-analyses to make clinical decisions
33:40 – Translating animal studies to the clinic
34:50 – Differences between US and Canada food guidelines and the influence of the food industry
39:15 – Consuming plant-based proteins
40:10 – Issues with a narrow focus on a single nutrient or food
41:20 – How a patient’s nutritional status influence physical therapy treatments
43:50 – Influence of fed state on treatment sessions
46:15 – Anabolic window following a workout
47:50 – Integrating sleep and lifestyle factors into clinical practice
50:45 – Spreading out evaluations and education across a plan of care
54:30 – What Patrick would tell himself as a new graduate
57:20 – The potential of modern physios
59:15 – Where Patrick is teaching and how you can connect with him
1:00:35 – Zach’s closing thoughts

Quotes:
“There’s a lot that can influence what a person selects to eat. It is very personal.”

“There are so many misconceptions within the nutrition research. It’s fun but it’s a lot to keep up with.”

“Adding something healthy is usually going to be easier than trying to remove something that would be considered unhealthy.”

“The reasons plant-based proteins are more beneficial is because of all the other things that you are getting with that food. You’re getting fiber, you’re getting the various anti-oxidants and phytochemicals. It’s all the other added benefits.”

“You’re never going to get everything you need to know on day 1.”

“The possibilities of what you can do as a modern physio…there are no limitations.”


Learn more about Patrick:
Fuel Physio, Twitter, LinkedIn, Instagram

Research:
Nedeltcheva et al.  2010. Insufficient sleep undermines dietary efforts to reduce adiposity.
Canada food guide

People mentioned:
Intro music by Quentin Walston: https://quentinwalston.com
Patter Attia

Summary:
In this episode, I address the importance of scientific curiosity. Doubt and curiosity are foundations to build knowledge. If we fail to remain curious, our emotions and bias take over. I discuss our curiosity is integrated into clinical practice and how it is used to help patients and grow professionally.

Quotes:
“The question of doubt and uncertainty is what is necessary to begin; for if you already know the answer there is no need to gather any evidence about it.” —  Richard Feynman

“It is our capacity to doubt that will determine the future of civilization.” — Richard Feynman

“Believe whatever you believe by day; but at night, argue against the propositions you hold most dear.” — Jordan Ellenburg

“The more I learn, the more I realize how much I don’t know.” — Albert Einstein

Books discussed in the episode:
How Not to Be Wrong: The Power of Mathematical Thinking by Jordan Ellenburg (Amazon Affiliate Link)

Music by Quentin Walston