It’s been a big year on noijam; our readership has more than doubled, we’ve published over 100 posts, and we’ve reached more people via social media than ever before. We’ve had a few surprises, and bit of controversy, but the support for our little blog has steadily grown and we think that we have achieved what we set out to do.
Because it’s that time of year for self-indulgent, nostalgic reviews here’s the top 5 posts of 2014:
At number 5 is a collaborative piece from David Butler and his good mate John Barbis; “an aging Philadelphian PT”. In John’s own words:
“The new knees were all mine as soon as I woke up and I was glad to say goodbye to the old ones. I wanted to be in total control. I didn’t want anyone pushing on my knees. There is no reason why someone else should have to push on someone’s knee to get range of motion”.
“I knew there would be nociception, I knew there would be neural flares but I knew they could be made safe. I avoided the total knee education class offered – it was scary”
“Overall, I worked on my brain more than working on my knees”
At 4, an emotive post in the midst of some difficult times. Along with some typical tongue-in-cheek invention of an acronym, there was deep personal reflection and a challenge to the physical therapy professions:
“Whiplash, which is really just “Sprained Neck at Speed with frequent Neural Irritation” (SNSNI) – is it really more difficult than a cancer to treat? Chekov looms – so many remedies offered by so many groups for the problem. Perhaps some of the problem starts when we whack the useless and danger enhancing metaphor “whiplash” onto it.
I guess this blog is all about asking people to reflect on where you want to be and where your moral compass lies; and to create a greater awareness of how the patient is the sandwich in the middle. In cancer there is no room for bullshit. Why should whiplash be any different?
Further reflections most welcome.”
The third highest read post was a classic, longer neuroscience narrative on brain smudging and neuroplasticity.
“At NOI, we have trialled, played with, and guessed at ways to tell people about their brain and pain. Like many clinicians out there, we have had some great wins –“Yes. I understand it now, of course that makes sense, thanks“… and some spectacular failures – “bloody physio thinks it’s all in my head”. Over time I think we are getting better and better at this complex intervention – future clinical studies will let us know. But for now, there is research from educational psychology and science that we can and should apply – there are ‘guidelines’ from evidence based multimedia to power up and improve our ‘made in the brain’ narratives. (We have written about these before.)”
At number 2, another reflective piece taking a look at the findings of a major study using the ‘motor control’ paradigm for chronic whiplash. The post was one of our most commented-on pieces for the year; possibly because it spoke to a topic at the core of what many clincians have been taught, and questioned a paradigm that has dominated physical therapies for decades. A bit overlooked however, was a section on the ‘bastardisation of education’:
“Nothing so detailed for training in the education group – this was 30 minutes which included reading the handout, answering questions and access to two explanation sessions. We have no information on the core educational competencies of the therapists, or whether they were even aware of and trained to answer the most common questions. Education is belittled – it is as though it is an accepted intervention which we are all competent and equal at!
We need to get serious about how we define education and how we research it. If the education group in the study considered educational competencies and modern pain biology educational interventions known to work, I hypothesise that the outcomes would be better than that of the 20×1 hour group work. Education based on motor freedom principles may be better and a realisation that that includes immune, linguistic, emotional, cognitive, creative, autonomic and endocrine freedom as well.
Explore the second last line in the Lancet paper – “Last, how to successfully deliver simple advice needs to be established”. Advice is never simple. A Steve Job’s quote comes to mind “Simple can be harder than complex. You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end because once you get there, you can move mountains”. A start would be to use the word ‘curriculum’, something rarely used in our clinics. If you are educating seriously you would have considered the notion of curriculum, both one-on-one or in a group. The word should instantly bring up content, delivery, timing and measurement. Perhaps educational psychology may be a new and better path to follow rather than health psychology.”
The most read post of 2014 took us by complete surprise. Perhaps it was the typo in the original posting, perhaps it was the clinically relevant video with the post, or maybe the topic itself, but this noinote on shin splints had an overwhelming response with tens of thousands of views and many thousands of shares across social media. But there was also some cause for consternation about the popularity of the post – “Will clinicians watch this and just treat all shin pain as if it was the same – one (neurodynamic) size fits all?” “Will therapists use this as a ‘script’ and leave out the thinking and clinical reasoning parts?” Hopefully there was enough of the thinking behind the technique to encourage clinicians to work hard to get their thinking “clean and simple”
There was just some basic clinical reasoning powered up by a modern, neuroimmune understanding of how pain works – or at least the best understanding available to us right now.
“The kind of pattern reported above is common and will usually ease with the simple principles showed in the video. If I had to have a go at the pathology, I would suggest some tibial nerve irritation, perhaps even a minor compartment syndrome in the posterior compartment which houses the tibial nerve. How simple it would be to suggest that the nerve and its connective tissue sheath were sticky, perhaps with limited oxygenation, some local immune inspired inflammation perhaps also related to slightly altered anatomy post fracture. But more than that – I suggest that the person’s perception of the problem has also added to the sensitivity both locally and in neuroimmune territory representing the meaning and the function of the leg.”
So there it is; knees, brains, necks, cancer and shins – an eclectic mix for the top 5 in 2014.
Because it’s also that other time of year, we’re running a little competition and giving you the chance to win an eBook version of Explain Pain 2nd Ed, The graded Motor Imagery Handbook or The Sensitive Nervous System. In the comments below, simply let us know what your favourite post from 2014 is and why, and mention which eBook you’d like a chance to win (if you have all three already, you can still nominate a book as a gift for another person). An independent judge will pick the three best comments and we’ll let you know the results. Entries will be open until 14 January 2015.