Tristan Barrera

Doctor of Physical Therapy | Joint Based Manual Therapist | CSCS | Cert. DN | Certified Orthopaedic Manipulative Therapist | Regis University Residency

[Tristan Barrera @Traw_26]

“Don’t you see the plants, the birds, and bees going about their individual tasks, putting the world in order, as best they can?

And you’re not willing to do your job as a human being? Why aren’t you running to do what your nature demands?”

[JOSPT Community @JOSPT]

#LetterToTheEditor

Reexamining the Evidence and Clinical Relevance of HVLAT for Radiculopathy ➡️ https://t.co/MGmkq6n4jg

and the response ➡️ https://t.co/CWZAazKCcM

#yourJOSPT

[Greg Lehman @GregLehman]

Let me translate what this dude says:

"Wishing her the best now let me tell you why it's her fault. Hey, who wants to buy some BS injections?"

[Greg Lehman @GregLehman]

More nonsense about breathing.

[JOSPT Community @JOSPT]

Would you like to best understand how to prescribe neuromuscular exercises to your patients with hip and/or knee #Osteoarthritis 🤔

Here is your guide, including the 9-themes 'most asked about' by patients ➡️ https://t.co/xZg9tgvkr9

#HipOA #KneeOA #Arthritis #yourJOSPT

[sikandar adwani @SikandarAdwani]

If the patient has come to you with Foot drop?

Do the Inversion Test.

Ankle inversion = tibialis posterior (L5 via tibial n.)

Weak inversion → L5 radiculopathy

Inversion preserved + weak DF/eversion → Peroneal neuropathy (fibular neck)

Quick confirm: EHL power + dorsum-foot sensation.

Bookmark for busy OPD.

#Neurotwitter #Medtwitter #NeuroPearl #Neurology #OPD

[Ben Cormack @CorKinetic]

Pain likely has an effect on the way we move, potentially even after it resolves!

Does this matter?

For some, I reckon it can contribute to the ongoing issue! 😢

For others, not so much! 😀

How can we tell who is who? Not sure 🤷‍♂️

https://t.co/C3wb1TeR5S

[Spinnin Backfist @SpinninBackfist]

That’s really it huh Dustin?
#UFC318

[Makhachev Islam @MAKHACHEVMMA]

Congratulations, Dustin. You’re truly one of the greatest to ever step into the cage. It was an honor and a privilege to share it with you

[𝙉𝙖𝙩𝙝𝙖𝙣 𝙃𝙪𝙩𝙩𝙞𝙣𝙜 @NathanHutting]

Agree with @RogerKerry1 that it's impossible to draw firm conclusions from this sample. See also an extensive review from @RikKranenburg et al., 2017 (https://t.co/nLmArkmb21).

From the @IFOMPT Cervical Framework: The current hypothesis is, that patients presenting with neck pain and headache who go on to develop a serious adverse event, such as a dissection, have an underlying pathology which is subsequently aggravated by treatment (https://t.co/CcVDrSlY2C). I do agree that, based on the limited available evidence, that it's unlikely that a healthly vessel will be dissected by treatment of the cervical spine.

Re the conclusion that practitioners should exclude cervical spine pathology before performing cervical spine manipulation I largey agree. See also @AussieLouie et al, 2012 (https://t.co/HXrAUkcGwX). So this is important, however, difficult. Moreover we need to take into account the incidence arterial dissections is 1.0–3.0 per 100,000 people). Also, it's not feasible nor appropriate to use X-ray examination or other diagnostic tests in all patients.

Even more important, we need to acknowledge that a recent trauma and vascular anomalies are the most important risk factors for dissection vascular events. So, clinicians should pay attention to a previous trauma in the patient interview. However, anomalies are not identifiable in the patient interview and are largely unknown in the patients treated by clinicians.

It's also very important to pay attention to (early) clinical features (signs and sympotoms) of an underlying dissection (or more broadly: vascular flow limitation).

Re the case: in all my workshops I mention that we can't rule out the possibility that cervical spine manipulation itself, in extremely rare cases, may cause a dissection. Case 10 presented in the article might be such a case in which a vascular serious adverse event occured, potentially cause by a transdiscal fracture at C5-C6, resulting in critical stenosis and compressive myelopathy.

We don't know of the manipulation in this case was performed appropriately (I have some doubt about that), however, detailed information is lacking. Moreover, during her last session of spinal manipulation, she mentioned new-onset paresthesia beginning on the upper limbs and progressing to the lower limbs. Her complaint was disregarded, and the session continued, at the end of which she was unable to stand. Retrospectively (which is always easy), for me this emphasizes the importance of proper clinical reasoning and decision making, not only in the first session but also in follow-up treatments. Moreover, it endorses the hypothesis that the treating clinician might have been insufficiently aware and might have had insufficient contemporary knowledge about the potential incidence of serious adverse events.

Further reading (biased as I'm involved in these @MSKPhysioJnl @JOSPT @BrazJPhysTher publications):

Vascular flow limitations affecting the cervico-cranial region: Understanding ischaemia: https://t.co/sxwQbhUYEx

What to Look Out for, What to Do, and When: 3 Key Messages for Safely Treating Neck Pain, Headache, and/or Orofacial Symptoms in Musculoskeletal Rehabilitation Settings: https://t.co/sunWcw8SdZ

A guide to cranial nerve testing for musculoskeletal clinicians: https://t.co/Qg5AnXEXrA

Assessing Vascular Function in Patients With Neck Pain, Headache, and/or Orofacial Pain: Part of the Job Description of All Physical Therapists: https://t.co/ahOToADqhc

Yes, we should abandon pre-treatment positional testing of the cervical spine: https://t.co/vxQNcuY4ab

Effects of Head and Neck Positions on Blood Flow in the Vertebral, Internal Carotid, and Intracranial Arteries: A Systematic Review: https://t.co/31ZFzLGsOt

Considerations to improve the safety of cervical spine manual therapy: https://t.co/lqs9V2OldX

[Tristan Barrera @Traw_26]

#UTGRAD25 #cockrellgrad

[JOSPT Community @JOSPT]

Always among our most popular articles ... now we've got an update

The #ClinicalPracticeGuideline on managing midportion #Achilles tendon pain and muscle power deficits is here 💥

Take a look at the updated recommendations ➡️ https://t.co/J1a9Uh9fbT

#yourJOSPT #Guidelines

[Brian Sutterer MD @BrianSuttererMD]

Yea this is insanity

[Jake Paul @jakepaul]

@jakeshieldsajj You are right because you are even more irrelevant than Nate Diaz

[Abdullah Sulieman Terkawi, MD, MS(Epi) @asterkawi]

Modic changes can indicate vertebrogenic pain especially if the patient pain increases within bending forward. #BackPain YouTube education: https://t.co/2cDe8NQAwm

[André Martin Mansoor @AndreMansoor]

1/9
A man presents with weakness.

Let’s walk through an approach to this problem.

[Tristan Barrera @Traw_26]

Thank God we are out of the Stone Age

[James Dunning PhD, DPT, MSc @DrDunning]

Heading out to #AAOMPT2024 Orlando. Hard to believe I “failed” the Fellowship exam 16 years ago at AAOMPT2008 Seattle (after completing a 2-year MSc in Advanced Manipulative Therapy in the UK). During appeal “they” stated my manipulations had multiple cavitations so “not safe….

[Abdulwahed AL zaher @MSKUS_PT_KSA]

calcific tendinopathy of the infraspinatous = snake swallowing the egg.

[@CEMMT @DukeCEMMT]

Neurophysiological mechanisms of spinal manipulation. https://t.co/XTwXDCrjXJ

[JOSPT Community @JOSPT]

NEW #ClinicalGuideline Alert 🚨

What is the best evidence telling us about how to rehabilitate people following a Distal Radius Fracture

Find out ➡️https://t.co/ml2BByp9DM

#yourJOSPT

[Tristan Barrera @Traw_26]

@DerekGriffin86 @GregLehman Thanks Derek!