This newsletter is a work in progress - I think the first iteration awaits your input! Placebo I recently read some information that coalesced with previous research stored in my memory. It's a bit like the opposite of when white light is refracted into spectrum colours, this time in reverse. Different areas around a common topic—placebo/power of the mind all come together. 1. Belief That Caffeine Ingestion Improves Performance in a 6-minute Time Trial Test without Affecting Pacing Strategy - Valero et al., 2024. Nutrients. https://www.mdpi.com/2072-6643/16/2/327 This study analysed the placebo effect of caffeine ingestion on running performance. Results: Placebo ingestion improved running p...

If you were allowed to do only one test per 'joint' area, what would it be, and why is this test so helpful for you? To start the ball rolling, here are my key lower limb tests. Foot & Ankle Yes, the F & A does involve 28 bones (+/—some sesamoids), so more than one joint, but taken as a functional unit, my go-to test is the knee-to-wall (KTW) test to measure dorsiflexion. The KTW test has great inter- and intra-rater reliability, meaning it is good for between therapists and comparing treatments. Technically the majority of dorsiflexion will be achieved at the talocrural joint, but substitution can come from the subtalar joint (plus the associated 1:1 ratio of pro...

"Time and tide wait for no man"  Geoffrey Chaucer. How long have therapists been treating spinal pain? Over 10 years ago, I realised there was no evidence-based guide to advise clients on the best sleep postures for those experiencing waking spinal pain. This surprised me. We know we spend 30% of our life sleeping, we know that sleep quality and quantity affect our longevity, and short sleeping causes MSK pain onset and flares. Surely, we already know the relationship between sleep posture and waking pain. Nope! There was plenty of anecdotal advice about what postures we should advise, but nothing had been tested. And so began my sojourn into research. With the help of researchers Kathy...

Here are some resources you might find of interest if you use dry needling as part of your clinical practice. The first is broad-brush dry needling science presented by a researcher with a strong focus on the cervical spine. The second is a systematic review of the lumbar spine, and the final is an adverse events review specific to dry needling (so not including TCM events). Exploring the Science Behind Dry Needling: A Comprehensive Overview The interview discusses dry needling as a technique used primarily by physiotherapists to treat myofascial pain. It distinguishes dry needling from acupuncture, highlighting its basis in Western medicine and its focus on muscle trigger points rather than...

On reviewing a client recently, I was struck by the difficulty of changing a habit, even when they knew it meant they would be better off, in this case experiencing less pain. On reflection, a lot of long-term outcomes revolve around our ability to affect +ve changes in our clients' lives. From my clinical perspective, the question was "Why would someone knowingly choose an action that causes them pain?" We could take smoking as a litmus test for this question. Smoking is strongly associated with every nasty health condition, the action is considered socially inappropriate, millions of $ are spent on education and each durry costs a small fortune. So you would think stopping would be a piece...

Potentially this may affect you in two ways. Firstly, as a business owner (WC insurance is compulsory with a $15000 fine) and secondly, as a clinician interacting with injured employees. The enactment of the Workers Compensation and Injury Management Act 2023 in October 2023 marks a new era in workers' compensation in Western Australia. The WCIMA23 is a complete rewrite of the prior legislation, the Workers' Compensation and Injury Management Act 1981 and will come into effect on 1 July 2024. Disclaimer: The following is a synthesis of information from various sources for your benefit. However, as every person's situation varies, do your research and don't rely solely on this before making i...

I have just been stung to the tune of nearly $400 for using a low-resolution picture in 2015 on a blog post by an organisation called PictRights. Nearly 10 years ago I wasn't thinking of ownership rights of such low-quality pictures, but beware. These companies trawl websites looking for any pictures used without a licence and bingo you are in their crosshairs! Anyway, I went through my blog posts for the past 15 years and have hopefully culled out any pictures used without a licence. Some have over 150K views and I thought others were of interest to review. What do you call a group of Physios? In English, collective nouns referring to groups of animals are often colourful and unusual; for e...

Shining a light into the world of sleep.... Being onto stuff, you will have known that March included World Sleep Day! On such an important occasion, I thought it was worth throwing out a 30% discount on our Sleep Mastery Course to celebrate this important annual milestone. Looking forward to receiving feedback from the many many clinicians who took up the snap sale offer and finding out how they are integrating this new knowledge into their clinical practice. Hot on the heels of this, I was sitting in the Perth T2 airport lounge waiting to return home and my lovely wife while browsing the bookstore noticed and purchased for me Dr Michael Mosley's book Fast Asleep. Needing no introducti...

As many of you will know, my specialisation and clinical background are focused on MSK and sleep. Along these lines, I have taught dry needling (DN), functional foot, anatomy and clinical reasoning courses for the past 30 years. During the DN courses, one of the most 'off-topic' questions I receive relates to the effectiveness of DN for spasticity. Even though I have a rural and remote practice and treat a wide range of conditions, neuro/post-stroke is just not one of them. My answer in the past has been that I don't have any clinical experience and have directed people to Val Hopwood's book Acupuncture in Neurological Conditions, 2010. A confluence of inquiries and emails following my last ...

I have been reviewing recent clinical sleep research with an eye to how it can be incorporated into clinical practice. I hope that you find some of these summaries also of practical use.  Gestational Diabetes Mellitus Diabetes mellitus complicates 6–7% of all pregnancies with 90% representing gestational diabetes mellitus [1]. Gestational diabetes mellitus is associated with an increased risk of preeclampsia, fetal macrosomia, birth trauma (e.g., shoulder dystocia), and neonatal metabolic complications [2] Women who are objectively assessed as short sleepers have poorer glucose regulation [3] and self-reported short sleepers (i.e., < 6 hours) have a 2-10% increased risk of gestationa...

If you aren't a parent, you may consider skipping this email. However, the sleep mechanisms/science underlying these protocols are still relevant to those of other age groups. Also, you might find you can lend some helpful advice to your next adult client presenting with headaches relating to their lack of sleep, secondary to their children's sleeping habits!  Children (3-12 years) What time should I put my child to bed? This depends on their age (3 - 5yo = 10 - 13 hours, 6- 13 yo 9 - 11 hours), sleep quality and wakefulness during the day. In other words, there are guidelines, but you need to see how well your child is coping with the amount and quality of sleep they are receiving. If ...

For most of us going to bed signals the end of a busy day and the chance to slip into a blissful period of rest and recovery. For some, however, it signals a period of frustration, pain and intense discomfort because they experience restless legs syndrome.  What is it? Restless legs syndrome (RLS) is a neurological and sleep disorder characterised by uncomfortable leg sensations and an irresistible urge to move the legs. Symptoms typically occur in the evening and at night, resulting in sleep disturbances but can also happen during quiet periods during the day. It mostly occurs in the legs, but can also affect the arms. Not only is it disruptive of nighttime sleep, but results in increa...

It would be hard to miss the increasing awareness of the importance of good sleep, which is fantastic. Within a few days, I had a client email me thanking me for providing sleep treatment advice that she hadn't received from her prior 3 health practitioners, a company requested me to provide a customised 1-day workshop on how to include sleep in clinical treatments and I saw the results of the HIF WA health survey on sleep. Are you riding this new health wave for your benefit and the benefit of your clients? The HIF survey focused on three domains, Environment (where and how we sleep), Priority (knowledge and value of sleep) and Impact (personal and community). There are many nuggets to dig ...

As we head towards hibernation and the shortest day of the year, I thought to share some of the great books I have been reading over the past couple of months and some of the takeaways that struck me as interesting. Will post this as a blog. Please add your own favourite texts and why.  The Good Partner (Karen Nimmo 2022) Communication is a key driver for our profession; the better our ability to listen/communicate/educate, the more successful I think we can be. And while this book is built around improving relationships, the content I believe is very relevant to our interactions with clients. Karen is a Kiwi clinical psychologist, with an interesting sense of humour, and she drills dir...

With a shortage of health professionals trained to provide F2F assistance in the insomnia space, there has been an explosion in the provision of such services over the 'net'. What is being treated and how effective are these services? Digital CBTi to prevent mental health disorders Epidemiological estimates suggest that 10% of adults meet the diagnostic criteria for insomnia disorder, about 33 million insomnia sufferers in the US (2020) or 2.6 million in Australia (2023). Despite being the gold standard treatment for insomnia, CBTi is often unavailable to patients seeking treatment. In the past few years, two studies have reported that the provision of CBTi via telemedicine is an effective a...

Does this sounds a bit like the chicken and egg story with a medical twist?   Background A growing hot topic in the past 20 years is the association between sleep and pain; one way, bi-directional, one-way dominant? While some researchers have suggested a reciprocal relationship, others have proposed that pain could be worsened by sleep disturbance [1,2]. Recently, growing evidence has suggested that sleep disturbance predicts the onset or aggravation of pain [1,3], even in healthy individuals, regardless of age (teenager, young adult and adult). Researchers conducting a 2021 systematic review found that self-reported poor sleep quality on the prior night predicted increased lumbar...

When I completed my full-time year of postgraduate in musculoskeletal Physiotherapy at Curtin University the BioPsychoSocial (BSP) model looked like this. The year was 1992. I am not exactly sure when the changes started to occur (given I live in small remote coastal time and we only get the mail on a monthly basis), but by the mid 2000's, when I was prepping for my specialisation examination, it was definitely on my radar and informing how I approached clients with persistent pain conditions. I guess that intuitively I was aware some clients had out-of-proportion pain given their injury, listed their ailments like a French cuisine menu and described their history as clearly as if reading it...

Have you noticed on those nights of poor sleep, you are less likely to put in a good effort at training or at work the next day. Just can't seem to find top gear or put it all together? You may recall a couple of months ago I drew your attention to a couple of articles examining the relationships between poor sleep and migraine and poor sleep and LBP. If not you can catch it here. Today's article titled 'Chronic Lack of Sleep is Associated With Increased Sports Injuries in Adolescent Athletes' examines another aspect of short sleeping, that is, increased injury rates. As health professionals, we are familiar with considerations of overall training loads, rates of increased training loads and...

Sleep & Migraine Background Being a clinician I am always keen to see what the researching body is producing that I can incorporate into my clinical practice. You may also find the following information of interest. There is now a longstanding evidence-base demonstrating that headaches can be triggered by various sleep disorders, including obstructive sleep apnea [1], narcolepsy [2], insomnia [3], circadian rhythm disorders [4], and restless legs syndrome [5], as well as poor quality [6] and insufficient sleep [7] in general. Management A recent study by Vgontzas et al 2022 prospectively examined participant's sleep and migraine experiences over a 6 week period. The researchers found tha...

In these unsettling days and months, AAP Education would like to assure our members and partners that we are monitoring the COVID-19 (Coronavirus) information and advice closely. As you will be aware the situation is constantly evolving all around the world and the health and wellbeing of the AAP Education tribe is paramount and will be at the forefront of any decisions made. We had to cancel the Level 1 and Level 2 Fascial Manipulation courses due to travel departure bans in northern Italy preventing Julie from leaving. Julie is fine and was keen to come if she could have left Italy. We are tentatively planning rescheduled courses later in 2020. You can reply email to me if you are keen to ...