I made an error in my last e-mail, it should have read 'It is not a slight
on our profession that we use techniques we can NOT completely justify but
that we keep using them with little or no thought'. I am not sure if that
correction makes any difference to your answer. However what I noticed from
your most recent e-mail is that you do clinically reason. Presumably you
assess the length of gastrocnemius in shin splint patients and lengthen
those which are tight. Surely this is clinical reasoning as you have made
the connection between shin splints and altered biomchanics and muscle
function. If however one routinely lengthens all gastrocnemii in shin
splint patients regardless of their length because some bloke said it worked
on the internet, then one is doing the profession and one's own standards an
enormous disvervice. I conceed that in my assessments, I asked the same
questions alot but I ask different questions depending on the type and
nature of the complaint. My objective assessment if thus guided by my
subjective questioning. My treatment is based on the objective findings.
The techniques I use are based on research, common sense and experience.
However there isn't a treatment or adjunct to treatment/assessment I haven't
read up on or wondered how it works.
I have to say, where as I have seen the same conditions over and over again,
I have never met a patient you was exactly like another. Surely this
precludes your management from becoming routine. Tiredness, inexperience or
boredom may lead to routine but how can one advocate a technique for a
condition solely on the premise 'because it works'. You have already stated
that you are not a 'recipe physiotherapist' and that everyone is different,
so how can you argue against clincial reasoning and a move towards evidence
based practice?
As for physiotherapy being an art form, I agree. I am not with out some
artistic qualities. However it depends how one defines 'art'.
Art is subjective but it is also about skill and technique. Surely
physiotherapy should not be a subjective art form but a skiled one.
> -----Original Message-----
> From: sophie dhenin [SMTP:[log in to unmask]]
> Sent: 01 September 1999 16:27
> To: [log in to unmask]
> Subject: RE: FW: Clinical reasoning
>
>
>
>
>
> >Dear Simon
> >
>
> > It is not a slight on our profession that we use
> >techniques we can completely justify but that we keep using them with
> >little or no thought.
>
> Maybe I'm being a bit picky about semantics......but I really don't have
> any
> problem with using techniques with little thought if I've used them a
> hundred times before for similar musculoskeletal lesions when I know they
> work. I cannot believe that having made your diagnosis of say shin splints
>
> and having decided that one of several elements leading to this problem is
>
> tight gastrocs that you don't go right ahead and do some soft tissue work
>
> to the offending musculature and teach the patient to stretch. I do it
> every
> week and don't think about it....
> OK that's a pretty basic example but let's face it, a lot of our work (or
> mine anyway) is fairly routine. I suppose I must adjust three or four
> L5/S1
> 's daily: again, having made my diagnosis I go right ahead and do it.
> Sophie
>
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