Hi Murray,
Please can you expand on "The use of NSAID'S and the potential effect on
cartilage healing/health" ?
Regards,
Paul.
Paul Gurnett. MCSP. SRP.
Chartered and State Registered Physiotherapist.
----- Original Message -----
From: "Murray Maitland" <[log in to unmask]>
To: "Paul Gurnett" <[log in to unmask]>
Sent: Thursday, February 05, 2004 7:38 PM
Subject: Re: contradictions
> Will:
> We are not alone when it comes to apparent contradictions that need
> further understanding. The use of NSAID meds and the potential effect on
> cartilage healing/health is a good example. Antipyretics have also gone
> through some degree of controversy. Fever might be helpful in some
> cases. The analogies go on.
>
> The paradoxical relationships between exercise and energy, exercise and
> the reduction of pain in osteoarthritis, producing oxidants and having
> net anti-oxidants confuses many people including myself.
>
> Interesting stuff
>
> Murray
>
> Murray E. Maitland PhD PT
> University of South Florida
> School of Physical Therapy
> 12901 Bruce B. Downs Blvd
> MDC 077
> Tampa, Florida, USA
> 33612-4766
>
> Telephone (813) 974-1666
> Fax (813) 974-8915
>
> Email [log in to unmask]
>
>
> -----Original Message-----
> From: - for physiotherapists in education and practice
> [mailto:[log in to unmask]] On Behalf Of Will Remigio LLU
> Sent: Thursday, February 05, 2004 1:04 PM
> To: [log in to unmask]
> Subject: Re: contradictions
>
> It is funny sometimes how we selectively decide to set the permeability
> level
> of our belief membranes to accept or reject things because we feel we
> are all
> for good evidence. And we want so bad to be certain and to be on the
> Right
> side.
>
> Things in PT that are considered simple we tend to accept face value
> such as
> the application of RICE principle. Ice for instance, ( this has puzzled
> me
> for a while and maybe someone might have an explanation). We like to
> recomend
> and apply to people after trauma. People after trauma are usually seen
> by an
> MD who prescribes Anti inflamatory drugs. Then they come to PT. we apply
> ICE
> because we don't presecribe AIDrugs. We want ice to be effective so we
> really
> try to cool down the metabolism of the tissue involved and thereby block
>
> circulation there, maybe inhibiting sypathetic efference. Then we are
> doing a
> disservice to the Anti inflamatory drug because THE DRUG is not getting
> there
> since we have been periodically applying ice ( A vaso constrictor ) to
> the
> tissue .
> On what side are we?
> For us to be evidence based there is a pre requisite, as I see it : That
> we
> are sensible and use good common sense and intuitiveness AS WELL and
> don't
> discard things based only on someone elese's judgements or accepted
> stardards
> about THings but be willing to try, test to learn and unlearn as well.
>
> There is more to science than meets the eyes, specially medical science!
> That's what my experience tell me over and over. Being open to this is
> being
> vulnerable to and probably that's a safer place.
>
> Will
>
> > Well said, Blaise, and thanks for your thoughtful comments (and
> > support).
> >
> > Regards -
> >
> > Billi
> >
> > At 02:39 PM 1/22/2004, you wrote:
> > >Dear Contributors
> > >
> > >This has indeed been a fascinating thread to follow. At the risk of
> being
> > >burned by the list for adding my own comments...
> > >
> > >I am a great believer in the application of the best current
> evidence....to
> > >a point. Some elements have always troubled me about the models
> which
> > >have been hastily embraced from other disciplines (particularly
> > >the 'heirarchy of evidence' from EBM - systematic reviews of RCTs
> ++good,
> > >empirical evidence ++ungood) for they seem to reject elements of the
> > >evidence continuum that are in my own opinion, extremely important;
> namely
> > >qualitative research and clinical (empirical) evidence.
> > >
> > >I am heartened by some of the comments that much more esteemed and
> > >experienced professionals than I have contributed to the thread.
> Mainly
> > >because I agree with them. RCTs obviously work for drug trials, but
> I am
> > >less convinced when there are multiple variables - as there are in
> most PT
> > >treatments.
> > >
> > >After much reflection, my own way of rationalising this, which I hope
> is
> > >not just hokum but a way of balancing available evidence, goes like
> this:
> > >Looking at evidence as a constellation, with the patient at the
> > >centre...and evaluating the available quantitative and qualitative
> studies
> > >(in recommended ways) I can see what gravity they exert on the
> presenting
> > >problems of the person I'm treating. Presently, I rely heavily on
> studies
> > >that I read, but my anticipation is that once I build up a bank of
> > >clinical/experiential knowledge, this will come into play as an
> equally
> > >valid form of evidence.
> > >
> > >
> > >Practitioners like Billi, it appears to me, keep the curiosity of
> applied
> > >scientific practice alive by evaluating/developing new methods in
> > >practice. As a profession we still rely on things that do not
> respond
> > >well to being analysed by double blind RCTs, but that doesn't prove
> that
> > >it's quackery either. But, I also know it's also down to us to find
> > >methods that are robust to evaluate the merit of new methods
> > >
> > >Hmmm. Questions, questions...always questions...If I found the
> answers
> > >I'd probably pack it in.
> > >
> > >Once again, many thanks
> > >
> > >Blaise Doran
> > >Student Physiotherapist
> >
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> > See www.theratogs.com for details...
> > ===========================================
> > Providing top-quality education, tools, and resources
> > for practitioners in neuromotor rehabilitation.
> > ===========================================
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> > [log in to unmask] . http://www.gaitways.com
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