Lee Schneider

Physiotherapist interested in pain. Navigating the space between disillusion and awe.

[Lee Schneider @LSchneiderPT]

Physiotherapy is becoming more psychologically-informed and this is a good thing.

However, the common overlap of pain, anxiety, depression and past-trauma often means that if we are to address the psychological-contributors without psych-input we are venturing beyond our scope.

[Lee Schneider @LSchneiderPT]

@Dr_OliverT_PhD @Retlouping @PeteOSullivanPT @NSaraceniPhysio @GregLehman That’s a great study. I hadn’t heard of roentgen stereophotogrammetric analysis but I have to agree bring it back! From 1989 but seems to suggest some movement (though very little) and no difference between symptomatic and asymptomatic side
https://t.co/l0HnVikOEP

[Lee Schneider @LSchneiderPT]

Does the SI joint move? If it does, is this movement clinically meaningful? My understanding was no to these questions though it has been challenged recently.

@PeteOSullivanPT @NSaraceniPhysio
@GregLehman

Recommended papers to read in this space?

[Lee Schneider @LSchneiderPT]

@Retlouping @PeteOSullivanPT @NSaraceniPhysio @GregLehman Thanks David looks like a lot of work went into this thread. Had a PD with senior physio at work regarding SIJ and honestly I could not feel what they were talking about. Tough situation.. threads like this are very validating!

[Lee Schneider @LSchneiderPT]

@GregLehman @PeteOSullivanPT @NSaraceniPhysio Appreciate that Greg, will have a read 👍

[Lee Schneider @LSchneiderPT]

@MervTravers @PeteOSullivanPT @NSaraceniPhysio @GregLehman Thanks Merv I know Valdi and the team have done great work in this space and has largely shaped my thinking around SIJ. Will come back to read this paper 👍

[Lee Schneider @LSchneiderPT]

@MervTravers @PeteOSullivanPT @NSaraceniPhysio @GregLehman Cheers Merv. I’d say that matters a lot.. if the best biomedical option we have does not outperform placebo what does it say about interventions that hope to stabilize this joint.

[Lee Schneider @LSchneiderPT]

@AdamMeakins @apaphysio Stay in your damned lane EPs!

[Lee Schneider @LSchneiderPT]

@JoeBarryPhysio True that’s a good point. I learnt a lot from this one too.. definitely makes me want to learn more about the mechanical cause of OA.. the points about repair were interesting to me. I wonder how much is reducing sheer force and how much is bolstering adaptation 🤔

[Lee Schneider @LSchneiderPT]

Monday bias challenge:

Shear force at the joint could be the ticket to osteoarthritis development and global contributors (smoking, weight etc) more likely impact repair mechanisms.

https://t.co/1tH28m4o5M

[Mark Kargela @MKargelaDPT]

Great clinicians do not care about loading the toolbox

They are masters of the patient relationship

Then add:
-Mastery of the basics
- Ability to identify red flags
- Understand complexity of pain
- Solid clinical reasoning

Losing toolbox mindset = path to clinical mastery

[Lee Schneider @LSchneiderPT]

@physiojack @MicahWong_DPT Thanks Jack,

Have you found that patients in this cohort (generally) are open to and respond well to active management strategies?

Also, have you come across any issues with funding for these patients either privately or publicly?

I’ve heard this can be hard..

[Lee Schneider @LSchneiderPT]

Calling all rheumatology physios!

Considering this as a specialty area as I’ve been seeing a number of patients in outpatient musc with dx AS and other rheum conditions. Find it very interesting.

What are some challenges/perks of working in this space that you’ve found?

[Lee Schneider @LSchneiderPT]

@arothschildpt “It’s my L3/L4” is a yellow flag imho

[Lee Schneider @LSchneiderPT]

@thomas_jesson It can take some time.. though here’s what we can do now to help you manage now.

[Dr. Scott Carlin @scottcarlinpt]

A secret:

Laying on the couch is just as effective as those fancy recovery tools.

And much cheaper.

[Lee Schneider @LSchneiderPT]

@paintoolkit2 classic 😂

[Lee Schneider @LSchneiderPT]

Perk 2 of public health (at least for me and where I'm working).

Multidisciplinary team, all located on the same ward, all vying for the same outcome.

[Lee Schneider @LSchneiderPT]

@DerekGriffin86 @JoeBarryPhysio I partially agree. Though if we take empiricism seriously we are all underwhelming. Everything we do is very underwhelming. Improvement of 1.5 on a VAS = statistically significant, though a very underwhelming change for the person in pain.

[Lee Schneider @LSchneiderPT]

@Roger_OToole Short I'd say.

[Lee Schneider @LSchneiderPT]

We learn more when we are breathing in versus out 😳

Some of our oldest systems phylogenetically are our olfactory. Breathing in meant sensing the world.

And now, it’s domain general (as far as we know). Can it help with sticky internal models? Pain?

https://t.co/KHCfnMih85

[Dr. Scott Carlin @scottcarlinpt]

The worst advice I ever received:

“Don’t run, it’s bad for your knees.”