One of the difficult aspects of applying current research for treating various pathologies is that not everyone experiences an injury the same. Not only do we have to incorporate injury-based research, but we also should consider aspects of pain science research. Each component of the pillars of evidence-based practice should be incorporated in patient management.

Have you ever wondered why two patients with the exact same diagnosis can present completely differently? While one might retort that the severity of pathology (amount of arthritis or tendon degeneration), imaging studies regarding pain science have found that often presenting with a worse experience can easily present with minimal pathoanatomical findings. Pathology does not equal injury and hurt does not equal harm.

When an individual experiences pain, there are many different factors that go into it. Pain is actually that, an experience. Have you ever noticed how a baby looks to their parents to see how to react when hurt? Or how an individual might describe their pain differently based on the setting? Past experiences (their own or family members), social expectations, individual expectations, fear and much more can influence a patient's injury experience. Because of that, we cannot address every patient with "achilles tendinopathy" the same. We must incorporate their individual expectations, beliefs, and stressors into consideration when managing their care. While it can be upsetting that we aren't able to treat based on pathology alone or even regularly apply pathology-based research to our care, we are fortunate to understand WHY not all people experience an injury the same way. By further developing our understanding of pain science, we will hopefully be better able to treat our patients in the most efficient and successful way.

-Dr. Chris Fox, PT, DPT, OCS

As part Optim Manual Therapy's COMT Program, we have weekly case discussion sessions online. Below is a sample of a recent session on a patient with chronic low back pain. How would you have handled the case differently? While we include the typical didatic material, manual assessment/treatment techniques, OCS prep, online courses, and exercise prescription, regular mentoring is the essential component that sets us apart. It helps to develop clinical reasoning and decision making. Check out www.optimfellowship.com for more information or feel free to reach out to me.

-Dr. Chris Fox, PT, DPT, OCS

These are common comments I hear from patients when using Mirror Therapy in my Orthopedic practice. The beauty of using the mirror is that we are tricking the brain, and both the patient and I know it! I tell patients before we begin a session, "we both know your uninvolved leg is doing the movement, but it will feel look like your involved leg, and it will work!"

Mirror Therapy has been used in the neurological population for quite some time. Fortunately due to a deeper understanding of pain science, we have also been able to transfer this intervention into the chronic pain population. Through the use of a mirror, this rehabilitation technique creates illusory visual feedback of the involved extremity (Sathian et al 2000). From the cortical level, we are identifying and correcting any misinformation between our visual and proprioceptive systems. In other words, we are reorganizing how the brain perceives the movement! 

Mirror Therapy is not an isolated intervention. Other graded motor imagery exercises and graded exposure to sensitize stimuli is also important. When performing Mirror Therapy, be dynamic! Change the environment- sounds, clinic environment, light, etc... Additionally, be patient and progress slowly! Chronic pain does not develop overnight. Typically multiple sessions and hours of retraining is required to retrain the brain. 
​-Jim Heafner PT, DPT, OCS 

It has been long thought that elevated cholesterol served as an increased risk for heart attack or stroke. Frequently, doctors prescribe statins to lower cholesterol, and they have been shown to be effective in doing so. That being said, there are many side effects that must be considered: liver damage, hyperglycemia, neurological side effects, and muscle pain/damage. For this article, I want to highlight its effects on muscles.

About a month ago, I had a patient s/p partial meniscectomy. On one of the follow up sessions, he mentioned he started getting full contractile muscle spasms in his forearms. While I had been familiar with calf pain and spasms as side effects, the violent contractions this patient described was unusual, so I had him call his cardiologist, who had recently changed his statin medication dosage. The patient was instructed to go see his cardiologist and have some tests performed. When the patient returned a week later, he informed me that his doctor had hospitalized him, running many different tests. His symptoms had gotten so bad his entire body when into contractile spasms that would even force his spine into various motions. Eventually, it was determined that the statins were the cause of the muscle spasms and the medication was then adjusted, resulting in reduction in symptoms.

Now I recognize it is difficult to know every single side effect of every drug. The best option is to either know the general side effects of each class of medication and look up each drug as you scan a patient's medication list. Over time, you will become more familiar with each drug's possible interaction, but with how commonly statins can present as "muscle pain," I recommend recognizing when a patient may have related side effects.

-Dr. Chris Fox, PT, DPT, OCS