Call it the farmer in me, but when faced by a challenge I am looking for the simple and sensible solution. There is usually more than one option, but I am guided by simple and sensible. Daisy is lead in my focus group on the farm, and will pretty well let me know when I am heading in the wrong direction.     How do cows talk? - Through their action and by my observation. Ovulating - ride other cows, in pain - hang to the back, hungry - moo when I come in eyesight, curious - lift their heads and sniff, danger - facing the direction head on. Being herd animals, I am always looking for the cow that is...

With Inactivity passing Smoking as the leading cause of mortality in Australia,  we can expect different levels of government to become involved in 'educating the nation' on this vital long term factor. But what about at the grass root level, our community? As I was driving around sewing our hay paddock a couple of months ago, along with my bones this thought was bouncing around in the tractor. What would be a fun, challenging and spectator based activity that would promote the benefits and fun of sport? I have seen Tough Mudder, Cross Fit and a few others of similar ilk. There are some great themes; teams, challenges, problem solving, participation emphasis but it needed to be simpler and more condensed...

Wednesday and Thursday were the last 2 days in this 6 day block of dry needling courses. Congratulations to Allan for traveling from Sweden to undertake a full 6 days of dry needling training. Allan was pretty keen on surfing so have included a pararoma that I took camping the weekend before at Cape Arid NP - not too many other campers on this beach! Just us, waves, whales and one seal. Wednesday was a pretty full on day, with a 2 hour wet lab anatomy session at UWA. Judging from feedback this was really well received and the over whelming consensus was that it was better having the Wet Lab in the middle of the courses, rather than right at...

HOME | DRY NEEDLING PROGRAM | CERVICAL SPINE | FASCIAL MANIPULATION | MULLIGANS | MSK & RT ULTRASOUND | NEURODYNAMIC SOLUTIONS | THE SHOULDER | VESTIBULAR PROGRAM | LIVING ANATOMY WET LAB WORKSHOP | . Here is the second part in the series looking at status of employment as individual or independent contractor. If you would like to follow up on the first one you can read it here. Specific Q & As Q: Is the difference in employment status based on a legal or accounting principles? A: There are many accountants who offer compliance solutions without understanding this is a legal issue. The Tax Legislation over arches the PSI legislation and the interpretation of its compliance regime has been tested...

An amazing couple of days with a group of experienced and enthusiastic talking about upper quadrnat clinical conditions and how to incorporate dry needling into current clinical experience. Love the sharing that happens between experienced practitioners.       We found the medial pterygoids of the year - see picture and while no photo credits were requested, thanks to Liz for sharing her inner secrets :)   Following on from participants suggestions some changes have been made for the 2016 course, thanks for everyone's input. Some course comments; "Safe needling through the thorax especially through not so obvious muscles like serratus posterior superior and better ways to needle through paravertebrals. Very good experience drawing out the rib cage + knowing where...

Just completed the Introductory Course in Perth. This would have to have been the most diverse group for a long time, and such fun. We had great mix of; rural and metro practitioners,a diversity across professions; physios, osteopath and OTage and experience; recent grads and old handsplus internationals (Sweden, UK and Canada) and locals I was using a different format of presentation this time and apart from some teething issues related to manuals found that the flow was much better and feedback was overall positive. Some great suggestions were made from participants and these will be taken on board for the next course. "Interaction wit Doug was fantastic. No question was silly so I felt very comfortable to ask every question...

You may have noticed or read that the ATO is currently in the process of writing to a number of taxpayers who are providing personal services, to clarify if provided as a business or individual. A bit confused about the difference then read on.. Employee or Independent Contractor - What's Your Status? In talking with lots of physios over the past 18/12, there is some degree of confusion in regards to the status of individuals either as employees or contractors. As a result of this  I have asked Workforce Advisors Group to help provide some clarity in this area. Due to the volume of the information I have divided this into 2 parts. The first part will provide background information and...

'MoMENts In Time' - Men's Health Week June 15-21 2015 Looking at men’s health across age groups there are several challenges, important to identify, that we can choose to become involved in.     Younger Males Suicide accounts for slightly more than one-quarter of all male deaths in the 20-24 year old age group. Action: As participants in society, we all need to remain alert to the challenges facing our younger males and help them develop the necessary skills to manage a changing and complex environment.   Research shows that fathers as role models have a particularly strong influence on encouraging healthy eating patterns in children. This is the same for exercising, reading, communication and manners. Action: Develop and encourage positive...

If you live in rural Australia and practice acupuncture or dry needling it won’t be long before you have someone present with ‘unusual’ symptoms asking for a magical cure. It probably happens in metropolitan environs also, but talking with colleagues it seems more common in a rural situation. Presentation In this situation it was a lady in her mid 50s and her left eye was completely closed. She proceeded to explain that in addition to her eye closing, she had developed increasing frequency and severity of headaches on the L side - frontal and temporal. This had occurred over a period of a couple of months. It culminated in a GP visit while traveling in N.S.W. and was admitted to hospital....

As you may know I have been interested in heart rate variability (HRV) for several years and first presented some concepts in relation to using acupuncture to positively influence the autonomic nervous system at the 2013 APA Conference in Melbourne. At that stage to purchase a monitor enabling HRV measurement, meant spending $10,000+; outside the range of most physiotherapy practices! Fast-forward a few years and with an appropriate Bluetooth transmitter plus smartphone app, you are setup for under $100. So what is HRV? Fluctuations in time between heartbeats, specifically the 'R' part of the QRS complex, is called heart rate variability or (HRV). Previous monitors averaged your heart rate - so it would say 60 beats per minute (bpm) and then...

Just completed an awesome course in Perth with a great group of physiotherapists. Really appreciated their insight and some great questions in regards to dry needling and acupuncture. One of the aside discussions that took place centered around employment and employment conditions. One of the features of these courses is the chance for the sharing of ideas around both clinical and non clinical topics. From this discussion and other recent ones, it would seem that many physios are being still being employed under the old system of a % fee for service arrangement. In association with this %, they receive no employee entitlements like holiday pay (or leave loading) or sick pay. Some are even being told this % includes their...

  Perception, Perspective, Passion and Paradise - How do they relate? This thought started after assessing a client who had just moved to Esperance, three months post an ACL reconstruction, toe walking, having had no rehab and with a grand total of 20 - 60 degrees ROM. Being in her early 20s, unemployed and in constant pain this wasn’t turning out how she had imagined. She was bitter with the surgeon and annoyed with the system. = Perception. After examination and scoring her Hospital Anxiety and Depression (both > 11), Orebro MSK Questionnaire (> unlikely to return to work) and explaining where at 12 weeks the average person is functionally at (lots of tears), I summarized she was young, graft intact...

  Infraspinatus is one of the more common muscles needled around the shoulder blade and a good one to start on because of the relative safety of solid bone as a depth stop. But wait you say, about 8% of the normal population have defective fossa floors (see 3D CTS picture). Clinically I would also add that a defect is probably more common in those over 60 years of age, due to osteoporosis and a general deconditioning in the upper limb with resultant bone loss in the scapular floor. Remember those undergraduate boxes of bones and how many had translucent scapular fossa floors? The concern in this situation is the potential of a pneumothorax or haemopneumothorax. Yes we have to be...

Hi Here is the second article on 'Trigger Points' exploring a previously unmentioned idea that not all trigger points are the same. You can review article 1 here. Novel Classification of Trigger Points (hypothesis) Rather than considering all trigger points the same, I am exploring the idea that trigger points present similarly, but potentially with different underlying mechanisms. I have divided trigger point presentations into 2 groups; Non traumatic and Traumatic. Non Traumatic In my opinion this is the much bigger of the two groups and I have divided it into 3 subgroups. These trigger points occur without any notable force, incident or direct injury and as a result I wouldn’t expect stimulation of the bradykinine/histamine system. Clinically these situations don’t...

I am not sure about your situation, but in our practice and small rural community, we are occasionally faced with the situation of providing professional advice on the management of acute achilles injuries, including ruptures. I have previously blogged on managing tendonopathy, you can review these; Clinical-kit-30-9-2013-Achilles Tendinopathy Clinical-kit-5-11-2012-Achilles Tendonopathy Clinical Kit 26-2-2014 - Achilles Tendinopathy while this Clinical Kit will be focusing on acute achilles rupture. Achilles Rupture Background: To date, studies directly comparing the rerupture rate in patients with an Achilles tendon rupture who are treated with surgical repair with the rate in patients treated nonoperatively have been inconclusive but the pooled relative risk of rerupture favored surgical repair. In most studies the ankle is immobilized for six to...

    Fascial Manipulation Level 1 & 2 Courses Now in Australia    With textbooks printed in 6 languages and courses conducted around the world, this comprehensive system of fascial examination and treatment pioneered by Luigi Stecco, an Italian Physiotherapist, is ideally suited for physiotherapists, osteopaths, medical doctors & chiropractors. These day courses are intensive, where theory lessons, demonstrations, and practice between participants alternate throughout the day. I personally have not yet attended these courses, so I asked a previous course participant to write about their experience attending the Level 1 Course and subsequently the effect on their clients. "I completed the first Australian course in March 2013 when it was taught by Julie Ann Day, who has helped translate Luigi Stecco's...

    Following the huge success of VideoXs on the apple platform and after repeated requests we are in the final stages of making this stand alone exercise prescription app available to android users. PLUS With this new android build, we have incorporated many user requests but kept the app simple and streamline.   *** KEY FEATURES INCLUDE *** A Stand Alone App - No database, No cloud, No hacking, No Setup, Contract or Monthly fees Only requires the clinician to have a smart phone (tax deductible) Client can receive exercises as email or printed copy Ultimate Clinician customization of Problems, Goals, & Solution Modules Solutions options include Aerobic, Strength, Flexibility & Customised (Vestibular, Cardio) Use in camera function for stills...

Hi With only a short time till the main Christmas break I trust that you have booked off some serious time quality time with family and friends. Also sometime with yourself to reflect on the year that has passed and what you have achieved, plus light some candles to represent your goals for next year. Clinical Grooves Professional development for me personally is the lifeblood of our profession. With time pressures it is too easy to continue repeating what was done yesterday, without reflection that there maybe a better way. This is not to say that years of treating experience are not as important as the new paradigm or in vogue technique. Not at all. Learning in our profession is very...

Hi Too Fit To Fracture: Exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Based upon guidelines available HERE Defining Activity and Exercise Not sure about you, but I find I regularly explain to clients the important difference between activity and exercise. Physical activity refers to “… any bodily movement produced by skeletal muscles that results in energy expenditure,” whereas exercise is defined as “… physical activity that is planned, structured, repetitive and purposive in the sense that improvement or maintenance of one or more components of physical fitness is an objective”. When looking at improving physical fitness components, the focus maybe strength, aerobic capacity, balance, flexibility or several at once. Guideline Recommendations For individuals with osteoporosis: Strongly recommend that...

Hi Study identifies best way to treat neck pain Johns Hopkins Medicine, 24/1/2014 (based on the study – Cohen et al. Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain - A Multicenter, Randomized, Comparative-effectiveness Study. Anesthesiology (2014); 121:1045-55 Clinicians need to be able to see through the sensationalism of research! Commentary by Dr. Shaun O’Leary FACP APAM It’s always useful to read a bit more in depth when claims are made in the media regarding new “best ways” of managing health conditions . If one was to quickly scan the title and content of this article summary in MDLinx Orthopaedics, they could be mistaken that a new best approach has been developed for the management of neck...

Hi Course Updates Adelaide Course It is a great pleasure to be offering colleagues in Adelaide the chance to attend Jeremy Lewis's The Shoulder: Theory & Practice. Conducted around Australia and internationally this is a very popular course. Places are limited and the course is now listed on our website for enrolment. Professional Development Special Offers - Students + Rural & Remote Practitioners We at AAP Education believe strongly in the ongoing commitment to professional development, as a means of individuals progressing their clinical skills and as a profession being able to offer high quality, effective services. Both of the following courses have available generous options for recent or financially challenged graduates to encourage their participation in professional development. The Mulligan...

The Shoulder: Theory & Practice Great news for SA physios as Dr.Jeremy Lewis is now going to be presenting this course in Adelaide for the first time in 2015. Certainly a 'must do course' for MSK and Sports inclined physiotherapists, be you in private or public practice. Full details can be found here 

Hi, As previously discussed I recently had the pleasure of learning from Jeremy Lewis about the management of rotator cuff conditions using exercise prescription. Importantly, how the evidence is strongly in favor of this approach in comparison to other interventions available; including medications and surgery. Being a ‘move well, stay well’ proponent, living and breathing exercise prescription everyday can make it seem passé. However when you see a client who has been given a downloaded exercise sheet and oral instructions of “do this twice a day,” it flies in the face of the skill required when correctly prescribing exercises. Whether assessing and determining a movement dysfunction in the shoulder or lumbar spine, the assessment findings, combined with an understanding of tissue...

I am really excited to let you know about some new courses that we have been able to arrange for early 2015 - actually these courses have all been requested from AAP Education membership. Mark Oliver's TMJ Course Presented by Mr. Mark Oliver (certified Mulligan concepts teacher), this 2 day practical workshop provides participants with new examination and treatment skills for TMJ disorders (utilising Mulligan's principals). Appropriately trained manual therapists can assist greatly in management of temporomandibular joint disorders (TMD). The manual therapist must have a sound knowledge of TMJ and orofacial anatomy, the role of postural disorders and spinal dysfunction on TMD, the ability to perform and evaluate an eclectic physical examination and the ability to carry out appropriate physical...

Hi Just returned from Perth and attending Jeremy Lewis's course, The Shoulder: Theory & Practice. The course reminded me of playing with LEGO as a kid. Block by block, I would construct the next Taj Mahal. In the same way Jeremy has put together this course, using blocks of research over a period of time. An evolving work, it provides clinicians with a structured protocol, going from assessment to treatment, backed by research, at a time when there is greater awareness of the lack of sensitivity or specificity of orthopaedic tests and inappropriateness of early surgical intervention. The first LEGO block looked at the epidemiology of shoulder pain. In the field of MSK pain the frequency of shoulder pain is less...

Hi You may have noticed (or may not), that in the August edition of InMotion there is on page 8 a heading "How well would your patient records stand up in court?" A fair question in today's environment. It is not enough to be aiming to do the right thing for your clients, but you must also be able to demonstrate this to an inquiring external body. One area highlighted in the article relates to your exercise programs. Often a key part of our treatment is the identification of strength, flexibility or motor performance deficits in relation to a client's problem. Once you identified these key factors and determined the best exercise(s) to address the problems, how do you ensure that...

Hi In the Advanced Lower Quadrant Course we look in detail at the involvement of the abdominal musclesand their contribution to back and pelvic pain, plus the associated viscerosomatic reflex. This article demonstrates in young women, the potential contribution of abdominal muscle trigger points to dysmenorrhoea. Titled “Wet needling of myofascial trigger points in abdominal muscles for treatment of primary dysmenorrhoea”by authors Qiang-Min Huang, Lin Liu. Reference is “Huang Q-M, et al. Acupunct Med 2014;32:346–349. doi:10.1136/acupmed-2013-010509” The authors recruited 65 participants with primary dysmenorrhoea, average age of subjects was 22 ± 2.5 years and mean VAS pain scores 7.49 ± 1.16, over a 6 year period. Patients with other diseases and conditions of the reproductive and urinary systems, as well as...

Hi This all started when someone sent me a link to a YouTube animation in an email. You will need to click on pic and have a look to understand the following discussion and I would welcome your thoughts and comments on the related blog post. See details at the end on where to put your comments. mmmm. To get involved or not…. Do you respond when poked or rise above…. Will it improve the situation or muddy the waters……. There are good physios that are also trained acupuncturists, and my thought is that they would caution against a reaction. So rather this is a clarification of some points as they rolled off my keyboard. My thoughts are they (the cartoon...

Free Online Learning Hand Hygiene Australia is providing free online learning packages on hand hygiene for a range of professional groups. The packages cover all aspects of hand hygiene including the importance of practicing excellent hand hygiene and best practice. An online test and the ability to print a certificate of completion is included. On completion of the HHA Online Learning Package, the participant will be able to: Explain what hand hygiene is and why it is importantDescribe when they should perform hand hygieneList the 5 Moments for Hand HygieneList the common products which are available for hand hygieneDescribe how to perform hand hygieneExplain the consequences of failing to perform adequate hand hygieneExplain the importance of cleaning shared equipment The HHA...

Hi We have just completed 3 dry needling courses in Perth and 2 Living Anatomy Workshops at the University of Australia. I had just driven down with family after a couple of weeks outback holiday and was really looking forward to mixing it up with some great physios, chiros and osteopaths for the week. Not disappointed, this week of courses brought out a range of great new ideas. Introductory Course The first amazing thing about this course was participants age. Apart from 2, all participants had been out for 6 months or less. Dry needling as a skill in both private practice and hospital environments is becoming a 'must have' skill as evidenced from participants comments. Quite the change around from...

Hi Frozen shoulder/Idiopathic Adhesive Capsulitis (IAC) is one of the clinical areas that has long held a fascination for me, largely because of the paradox between pain and range of motion. Whenever it is mentioned I prick up my ears, hoping for a silver bullet to use to assist my clients. While no single Lone Ranger moments have occurred, I have picked up some interesting clinical pearls that I discuss below. This recent case report is a good starting point for discussion. Abstract Available Trigger Point Dry Needling as an Adjunct Treatment for a Patient With Adhesive Capsulitis of the Shoulder My Classical Presentation Female > male, presenting with increasing degrees of shoulder pain and stiffness over several months. Can’t recall...

Hi - Introductory Dry Needling Boy did we have some fun! Just an awesome group of practitioners came together for the May/June Introductory Dry Needling Course. Some courses just flow and this was one. Here are a couple of pics of the happy tribe hard at work.  Feed back from this course was very positive; How interesting was this course? Interesting 18% Very Interesting: 82%As a physiotherapist how relevant was this course to your work? Interesting 18% Very Interesting: 82%The education level of the information presented was: Interesting 12% Very Interesting: 88%Would you recommend this course to other therapists? Yes 100% Physio and Pharming Reason for getting to this post a bit later than usual, is that my 'spare time' has...

  Titled “Electroacupuncture treatment of acute low back pain: unlikely to be a placebo response” and written by Dr. Kwan Leung Chia, from the School of Medicine at Flinders University in SA, you could be forgiven for passing over the abstract if you weren’t interested in or currently using electroacupuncture, however this case report leads to broader discussion. You can read the full case report here My Comment As others treating this age group and gender will agree, this type of history and presentation is not uncommon when the pain is in the buttock or lateral thigh. Often the onset is an unremarkable single legged, sudden overload situation; like a miss step, trip or hop. Pain is initially mild and builds...

  For this fortnights Clinical News I am providing links to several clinical resources for you to have a look at. The first three links relate to a series of blogs on different tumors presentations that I have encountered in the past few years. Less than 5% of primary care physicians routinely examine for red flags during their initial screen (Bishop PB, Wing PC. Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomized control trial. Spine J. 2006;6:282–288) and in 160 cases, 96% physical therapists examined 64% of 11 red flag questions, but routinely didn’t ask about weight loss (Leeraret, PJ et al. Documentation of Red Flags by Physical Therapists for Patients with Low Back...

Hi In preparation for the upcoming range of vestibular workshops and courses, I have been looking around and collating information that I have found useful and perhaps you will also. I am sure this list amounts to only a feather on the chook's back in regards to what is out there, so I would really appreciate you adding additional resource links at the end of this blog post. Much appreciated. Upcoming courses that are available include; Vestibular Introductory WorkshopVestibular Basic 5 day CourseVestibular Advanced 3 day Course and while some of these might seem awhile away, people are already enrolling such is the popularity. Currently the first Introductory Workshop in December, is 50% full. Vestibular Resources Videos Anatomy Eye Movement and...

I had a client present with Horner’s syndrome that made me think it appropriate to check all their cranial nerves. That made me realise I didn’t have a good recall of each cranial nerve function and appropriate test. So back to the books and I thought that I would share with you what I have learnt. Firstly yes, there are still 12 paired cranial nerves and here are some ways to clinically test. I was looking for quick tests that could be performed in the clinic, and I may well have missed a couple of easier ones. Please let the group know of your best/easiest test for each CN via the blog. Thanks. I Olfactory Sense of smell, but don’t use...

  Faulty Needles & Clinical Relevance You maybe aware of the current discussion about needle quality and based upon some of the high resolution needle tip pictures , wondered how far we have advanced forward from stone needles, in this area of technology. The discussion has picked up after publication of research in the current edition of Acupuncture in Medicine, titled “Examination of surface conditions and other physical properties of commonly used stainless steel acupuncture needles” by Xie YM, Xu S, Zhang CS, et al. (Acupunct Med Published Online First: doi:10.1136/acupmed- 2013-010472). You can see the abstract here and because it is open access you can see full paper here. In this paper, needles from 2 of the ‘most commercially available’...

Hi Do you enjoy a treasure hunt? I recently found this 'treasure map' and had quite a bit of fun looking up family and friends names, to see how much money was sitting in a bank waiting for them to claim. Finding Unpaid Monies – Little Pots of Gold Did you know there maybe stashes of cash, that for one reason or another, you don’t know about and are waiting for you to claim? There are different government organisations that hold this information. At a federal level it is organised by ASIC (Australian Securities and Investment Commission) and it seems at a state level it is organised by the relevant Treasury department (State or Territory). At a federal level, go to...

Hi Past readers of my blog 'Creating Clinical Success' will know about my past incursions into the realm of achilles tendinopathy. If you missed out here are the blog links; clinical-kit-30-9-2013-achilles-tendinopathyclinical-kit-5-11-2012-achilles-tendonopathy Researchers MARC STEVENS and CHEE-WEE TAN have just published a paper in Journal of Orthopaedic & Sports Physical Therapy titled "Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial". The research comparison taken in this paper looked at the standard protocol of 180 eccentric heel drops cf. a Do-As-Tolerated protocol for 6 weeks. The short time frame is a bit of a weakness, as 12 weeks is standard. They used the The Victorian Institute of Sport Assessment-Achilles (VISA-A) as the...

  Possibly my first presentation of Quadratus Femoris apart from the other ones that I have missed …… Clinical Presentation 51 year old male commercial painter with 2/7 Hx of pain. Not sure about cause of onset but had been painting a residential home (ladders, squatting, awkward positions) , plus moving around furniture day prior. Went to bed okay, slight sore in AM that increased as day progressed. Pain developed slowly and was described as a strong ache in R lumbar, lateral buttock with radiation to lateral thigh and hadn’t gone in the past 2/7. No PNN sensations. Over 24 Hr supine was fine, sidelying either side increased pain, walking was fine, but sit to stand or sitting increased painHad tried...

Hi Webinar cf. Course With the increasing profusion of information online plus greater demands on personal time, consideration is made about whether to attend a course or in some way gain the information via an online format. I certainly seek out a lot of information for my research online, not much shopping for IR cameras, access to research articles or experts in Esperance. When it comes to clinical education there are many reasons why I prefer to attend a course in person. The main one is that I am seeking to learn and therefore integrate or change a current clinical behavior. It maybe that I have recognized a skill set I need to develop – say occupational health or neurological treatment...

Hi Miracle Muscles and Neuropraxia When a client presents with noticeable weakness or other ‘hard’ neurological findings; abnormal sensation (temperature, light touch, pinprick), not just altered sensation or absent reflex, often I find clinicians jump to implicate a central nerve root involvement (dermatonal) without considering peripheral nerve compression or a somatic source. I think this just reflects the strong emphasis of our undergraduate training. This case report looks at the cubital tunnel and flexor carpi ulnaris as a source of peripheral nerve compression. No mention in this report is made of the anatomical variation anconeus epitrochularis, that would cause the same situation and as no MRI was conducted we are none the wiser as to which muscle was actually involved. You...

Hi I recently received this email from Tenielle Henson (with thanks), which coincided with a systematic review of the related literature, that I thought would be relevant, and of interest to a wider audience. “ I enjoy getting your news & research updates and having a read through. But I wonder if you have any info on the use of dry needling in pregnant women. As far as I was aware, all was okay as long as the patient had blood pressure managed & wasn't anywhere near the foetus & in general was asymptomatic for any vascular or neural related illness. However, I have a friend who is in the very early stages of pregnancy & who has an Achilles issue...

Hi Happy New Year and Welcome to 2014 Interesting Lower Quadrant Research Article Li J, Zhang J-H, Yi T, Tang W-J, Wang S-W, and Dong J-C. Acupuncture treatment of chronic low back pain reverses an abnormal brain default mode network in correlation with clinical pain relief. Acupuncture in Medicine 2013. URL: http://aim.bmj.com/content/early/2013/12/02/acupmed-2013-010423.abstract Abstract Summary Background Acupuncture is gaining in popularity as a treatment for chronic low back pain (cLBP); however, its therapeutic mechanisms remain controversial, partly because of a similar improvement in sham acupuncture control groups (but both sham and verum improve significantly more than 'usual care'). Resting-state functional MRI (rsfMRI) has demonstrated aberrant default mode network (DMN) connectivity in patients with chronic pain, and also shown that acupuncture increases DMN...

My first rant I have been using PC Tools Internet software for many years on all computers and been really happy. It turns out that recently it was 'purchased/morphed' by Symantec (the dark lord :<). Somewhere in the transition Symantec has decided to roll Nortons and PC Tools into one and cancelled my subscription with PC Tools so now it doesn't work. I contact PC Tools by live chat and they say I need to deactivate my license with Nortons before they can activate the PC Tools one again (even though I have never paid Nortons money nor subscribed to any of their programs). I phoned Nortons and after being transferred and then waiting 25 mins I hung up and start...

Infection Control Report Version 2.0 Following the recent release of the 2013 Immunisation Handbook Guidelines and the new AHPRA Chinese Medicine Board guidelines I have updated my "Infection Control in Dry Needling and Acupuncture Report" to include this latest information. Expanded to 20 pages, it contains new sections on managing needle stick injuries, necessity or not of swabbing and correct swab disposal. New members will receive the full report when first joining - see here Existing Bronze Members can download it from Member > Resources > Resources Gateway > Documents > AAP Education documents >2103 Infection Control in Dry Needling & Acupuncture Report_LR. Remember to log in first! If you have any questions regarding the content, please let me know. All...

   In researching information for my presentation Masqueraders (see All Has Not Been Quiet On The Western Shore!) at this years APA Conference in Melbourne, I noticed the exceptionally poor prognosis when diagnosed with pancreatic cancer.   Sure more people die from lung cancer, but if you are diagnosed with pancreatic cancer, your 5 year survival rate is basically less than 5% and this figure has hardly changed in the past 30 years. The poor survival rate relates back to the method of diagnosis that is poorly specific, expensive and only detects cancer late in the disease process - too late really for effective therapy.   That may all be about to change as the result of some ingenuity and heavy...

Hi All Has Not Been Quiet On The Western Shore! Apologies, no Clinical Kit as spare time in the past few weeks have been tied up with preparation for presentations at the APA conference. Kinda newbie at this stuff, and it seems to take a fair chunk of time pulling together all required information. If you are also going to be there in October, would love to catch up. Masqueraders The hidden aspects of tumors presenting as musculoskeletal presentations has been one of my most popular blogs series (30,000 total + hits) series. I was fortunate enough to be studying Manips in Perth, 1992 at Curtin, when Mr Gregory Grieve visited. He presented a talk of the same name and raised...

Hi Background Last month the American Medical Association sparked headlines when it voted to officially classifyobesity as a disease. The question of whether obesity is a disease or not to me is pointless, there is no universally agreed definition of what constitutes a disease and solutions are way more positive. However, it importantly turns up the public discourse around the subject, especially as obesity recently overtook smoking as the leading cause of preventable death in the world. Obesity is a growing problem (excuse the pun), with an estimated 10,000 deaths per annum in Australia attributed to excess weight. “Obesity and overweight are widely prevalent in the Australian population, and this prevalence is quickly increasing.1 In 2004-05, more than half of Australian...

Strong research evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, breast and colon cancers, and shortens life expectancy. You may have heard this music as it is often repeated and has become somewhat like elevator music, heard but not understood. So how about we crank up the bass a bit; “more people die from inactivity in the world compared to those dying from cigarette smoking”. What! Sitting on the couch is more deadly than sucking a cig? Yup. A series of papers published in the medical journal The Lancet, details the deadly impact on health of being inactive. In fact, the papers suggest that...

Knee osteoarthritis (OA) affects more than 250 million people around the world and is an important factor contributing to a loss of early lifestyle and later independence. In 2013, arthritis and musculoskeletal conditions are one of the national health priority areas in Australia. In association with knee OA, meniscal tears are very prevalent, with the medial compartment most commonly affected. Arthroscopic knee procedures are common in Australia with over 100,000 performed annually. These are predominately to address meniscal and arthritic problems. Katz et al 2013 (1) examined 351 symptomatic patients, 45 years of age or older with a meniscal tear and imaging evidence of mild-to-moderate knee osteoarthritis. The primary outcome measure was the physical-function scale of the Western Ontario and McMaster...

  The Sham Challenge This Clinical Kit looks at issues surrounding acupuncture and dry-needling research from the perspective of sham interventions to create an effective control group. Medical researchers need a control group as a basis for experimental comparison. Typically as participants are enrolled in a trial, they are randomly allocated to experimental and control groups. The control or placebo group mimics all the intervention group's metrics (gender, age, background), thereby controlling for intervention bias or placebo effect. The control group either receives no treatment or sham treatment. In pharmaceutical trials, it is very easy to create a reliable control group intervention; have two pills, both the same size, colour and scour marks, with only one containing the active ingredient being tested. It...

Hi Visitor This is the first of two eZines, that focus on assisting clients presenting with complex neck complaints, by using a system of integrated solutions recommended by our guest presenter Dr.Shaun O'Leary. Here is the first part of Shaun's, 10 Handy Hints when Managing Chronic Mechanical Neck Pain When your patient complains of a 'heavy head', it is important to remember that without muscles, the cervical spine can buckle, under a mass of less than 1/5 the weight of their head. Bearing this in mind it is important to understand the anatomy of the cervical spine. During our training we are introduced to a wide variety of muscles and yet with the cervical spine, it seems there is always another...

Comparing PRP, Saline and Steroid injection Reference Link Am J Sports Med. 2013 Jan 17. Treatment of Lateral Epicondylitis With Platelet-Rich Plasma, Glucocorticoid, or Saline: A Randomized, Double-Blind, Placebo-Controlled Trial. Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark. BACKGROUND:Lateral epicondylitis (LE) is a common musculoskeletal disorder for which an effective treatment strategy remains unknown. PURPOSE:To examine whether a single injection of platelet-rich plasma (PRP) is more effective than placebo (saline) or glucocorticoid in reducing pain in adults with LE after 3 months. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:A total of 60 patients with chronic LE were randomized (1:1:1) to receive either a blinded injection of PRP, saline,...

I am currently enjoying the gentle sound of rain falling onto our tin roof. Awesome. For the farm it means new grown grass in 2-3 weeks and that means happy cows. Actually, the cows are calving and that is how I happen to be lying down writing this blog. About 4 years ago a cow gave me a happy handshake to my right knee. After the initial phase of pain and swelling, it settled down to a grumbling meniscal issue that flaredup whenever I enjoyed my passion - running. It took a good 6 months of grieving until my acceptance arose, phoenix like with the sun and I started to seriously consider swimming for cross training. Now I regarded swimming as...

An example of using acupuncture to treat central nerve sensitisation using a contra lateral limb approach. Acupuncture treatment of phantom limb pain and phantom limb sensation in a primary care setting Acupunct Med. 2012 Dec 6. [Epub ahead of print]http://www.ncbi.nlm.nih.gov/pubmed/23220713 AbstractA 45-year-old man presented with phantom limb pain and phantom limb sensation 12 weeks after an above-elbow amputation of his right arm. He underwent seven sessions of acupuncture at weekly intervals carried out by his general practitioner on his intact left arm, with complete relief of the phantom limb pain and considerable improvement of the phantom limb sensation of his right arm. This case demonstrates the possible benefits from the use of short acupuncture sessions for a potentially chronic condition undertaken within...

In English, collective nouns referring to groups of animals are often colourful and unusual; for example, a school of whales, hover of trout, murder of crows, or, my favourite, a parliament of owls.

A catch up on some of the new changes and opportunities available for you in 2013

Hi We have just completed an Advanced Upper Quadrant Course in Perth and an interesting piece of information surfaced, that I felt was worth sharing with the wider clinical group. It is in relation to compression of the ulna nerve in the cubital tunnel. One of the course attendees, Ray Jongs from Sydney, works exclusively in the upper limb trauma and rehab arena and pointed out that there is a muscle present as an anomaly in approximately 20% of the population, that can cause compression to the ulna nerve (in addition to the FCU). Its called anconeus epitrochlearis. I have attached a link to a good 20 page review paper that looks at a wide variety of such anomalies in the...

Here is the third in this series of Red Flags - Tumor articles. The previous ones can be accessed via links;

• Red Flag Number 2 - Meningioma
• Red Flag Number 1 - Pancoast

One challenging aspect of being a primary contact practitioner, is being aware of red flags; fractures, infections, inflammatory conditions and tumors, which may enter your clinical door unknowingly.

Following some recent questions about trigger point treatment and associated documentation, I have developed these themes for others interested in dry needling and acupuncture.

Have you ever felt constrained by your drawing skills or the proforma program available in your clinic when prescribing a home exercises program?

Have you had clients come back, demonstrating 'one of your exercises', but you had never taught it!

A difficulty expressed by newly qualified clinicians when conducting their examination, is knowing what to do next. What do I mean? Well, we are told that we live in the "Information Age", but I think that we have well and truly roared through it. Basically every test, procedure or disease - our body of knowledge, can be found on the internet. All the information is out there in a variety of forms. In the same way a client is the internet - they have all the information. We are now in the "Synthesis Age." As clinicians, we need to type in the correct search parameters (know the correct questions) and be doing this in a logical sequence, thereby adding or subtracting...

I just recently completed a great 6 days in Perth teaching 2 Introductory/Refresher courses and one Advanced Lower Quadrant Course.

for those interested in the upcoming AAP Education Advanced Lower Quadrant, Adelaide and Perth courses,

I have just posted a couple of links to  videos for upper-quadrant course techniques;

1. Subscapularis 

2. Upper Trapezius

I have added some extra dry-needling resources for Bronze members under the AAP Education section.

Here are a couple of iliopsoas trigger point case studies that you may find interesting that were treated with dry needling. Places are available in both Advanced Lower Quadrant Courses in Perth and Adelaide. Case 1 A 35-year-old woman presented with LBP in the midline low lumbar area, with pain radiating to both posterior thighs, not below knees. Previous chiropractic + massage treatments and three months of bed rest had resulted in no improvement. A prior LS CT revealed left L4 to SI herniated discs, which had been surgically treated 12 months before presentation. Pain was reduced by 50%, but ADLs were limited and she was unable to return to work. Repeat LS CT revealed no additional changes. Physical examination revealed...