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meatmachine · 5 years ago

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THNXGVNG the quotes episode

The strength of a mind might be measured by the amount of truth it could endure. Nietzsche

There is no fate, that scorn cannot negate. -Camus

Philosophy is the battle against the bewitchment of language on our intellect. -Wittgenstein

Desire makes slaves out of kings and patience makes kings out of slaves. Imam Al-ghazali

Blessed are the hearts that can bend; they shall never be broken. Camus

We are what we pretend to be, so we must be careful about what we pretend to be. -Kurt Vonnegut

Giving what you have is a party, not love. Lacan

Sweat more in peace time, bleed less during war. -Lao Tzu

It’s not about the harvest you receive, its about the seeds you plant. RLStevenson

To be independent of public opinion is the first formal condition of acheiving anything great. HEgel

Man is the only creature who refuses to be what he is. Camus

The need to be right is the sign of a vulgar mind. Camus

Selfishness is not living you life as you wish to live it. Selfishness is wanting others to live their lives as you wished them to. Oscar Wilde

In human intercourse the tragedy begins, not when there is a misunderstanding about words, but when silence is not understood. _Thoreau

The point, as Marx saw it, is that dreams never come true. Hanna Arendt

Maybe the target nowadays is not to discover what we are but to refuse what we are. Michel Foucault

A man sees in the world what he carries in his heart. Goethe

He who knows when he can fight and when he cannot will be victorious. Sun Tzu

Every day is a new life to a wise man. Dale Carnegie

Morality is the best of all devices for leading mankind by the nose. Nietsche

Whether we fall by ambition, blood or lust, Like diamonds, we are cut with our own dust. John WEbster

A truth told with bad intent. Best all the lies you can invent. William Blake

Most people are far too much occupied with themselves to be malicious. Nietasche

From a hundred rabbits you cant make a horse, a hundred suspicions dont make proof. Dostoevsky

We must be free not because we claim freedom, but because we practice it. William Faulkner

Happiness is not an ideal of reason but of imagination. Kant

Well done is better than well said. - Benjamin Franklin.

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meatmachine · 5 years ago

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Perspective on treatment

What is more incredible than the endless varieties and ways in which food is prepared around the world is the fact that they all serve one purpose. Which leads me to wonder why doctors argue about which way to prepare food for their patients.

When the preparation becomes more important than the purpose the end result will suffer.

Some people imagine that there are generally two types of doctors, but I would like to propose a hybrid. For simplicity sake let’s just pretend there are doctors that feed their patients directly and doctors who teach their patients to feed themselves. I think it takes some serious perspective for a doctor to be able to do both, but there are certainly areas in which the patient cannot do for themselves what the doctor can. The most extreme example of this is what we call surgeons. Now, I know in the early days of medicine there are doctors who did operate on themselves, but there are exceptions for every rule. At the other end of the spectrum lives a mythical Guru doctor who creates a situation where the patient will discover themselves and will have gotten better because the doctor has lead them their naturally.

So that the patient will have become their own cause. They seem to realize that the patient is really only being attacked by their future self and they need to help them come to be where foreign forces once dominated.

So what does it look like to do a little bit of both? I imagine some testing and history taking would be a great place to start. Where can you intervene? and where should you illicit the patient in helping themselves? Is there a world in which both can exist?

What can you do for the patient that they cannot do for themselves? What can the patient do for themselves that you cannot do for them?

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meatmachine · 5 years ago

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Ideas for Kinesiotape

A good clinician can discover a seemingly unlimited number of ways to tape their patients if they just consider this one thing...

Youve seen it on pro athletes in the NBA/NFL/PGA/MLS olympics and beyond, but what is actually going on with all this Ktape? What is kinesiotape!? How does Ktape work? Who is Ktape for? Is it only athletes? What if Ktape doesnt work? Is there a brand that is better? There seems to be a lot of different ways people use Ktape... is there a right way? is there a wrong way? Whats the best way to use ktape?! First, let’s clear the air on some of the Ktape basics, then ill try to explain how I think the absolute best use of Ktape is to think about treating or an intervention of the skin AROUND the area you’ve taped (NOT the area under the tape, but around it that is most impacted)... but more on why this little secret actually works later... first...

WELCOME! to the anatomy of therapy, im doctor john cybulski and let’s get right into the ktape craze sweeping the therapeutic nation.

The Kinesio Taping® technique and Kinesio Tex tape was developed by Dr. Kenzo Kase in Japan more than 25 yrs ago. In the 1970's Dr. Kase began searching for a sports taping method which could assist in the healing of traumatised tissue and muscles. He found that standard taping techniques, such as athletic taping and strapping, provided muscle and joint support, however, they reduced range of motion, and inhibited the actual healing process of traumatised tissue. In 1973, Dr Kase's objective was to create a therapeutic tape and taping technique which could support joints and muscles, without restricting range of motion.

This is the first new and fresh perspective Ktape gave us in the therapuetic setting.... NOT decreasing range of motion. This fundamental idea that healing happens when you do NOT decrease range of motion is absolutely pivotal and i believe somehow overlooked by many clinicians today. Obviously, most clinicians will state that one of their goals is of course to increase range of motion, but sticking strictly to this principle almost immediately excludes those who are hypermobile and can cause confusion. but we will discuss more about hypermobility and ktape later.

So this is the answer to our first question: WHAT IS KTAPE? It’s a stretchy tape design to NOT decrease range of motion and help in the healing process. Sticking closely with the idea proper movement is indeed therapeutic.

Which leads us nicely into our second question: HOW DOES KTAPE work then? If we are taping someone and NOT decreasing range of motion, how is ktape helping? And this is where i start to go more off script because some bigger ktape brands often list that.... There are five main physiological effects of Kinesio tape: skin, circulatory/lymphatic, fascia, muscle, and joint. Now they stay safe in their wording by saying “effects” but Ive seen a number of different brands promote their ktape as beneficial to treating the: skin, lymph, fascia, muscle and joint. So ill have to edit to my own personal views, but the idea and standard line of ktape brands is to say that the tape lifts the skin and allows for easier circulation of lymph (and in turn inflammation) which then allows the muscle, fascia and joint to heal properly. I mean, okay. Sounds nice, but for me there might be a couple logical leaps in there. As i said in the intro, the skin not taped, nearest the tape may be out best way to intervene, but I have a hard time really understanding exactly how the fascia muscles and joints are effected. Perhaps its obliquely and indirectly through 6 degrees of separation from kevin bacon, but it’s going to be very challenging for your client/patient to actually be able to experience or sense some sort of change on that deeper level. Which is only really building my case as to why and how the superficial approach to thinking about the skin as you tape is actually the most efficient way to tape.

but the larger how is still in line with other ways of taping. Support through a certain joint in a certain direction will not decrease range of motion but can limit possibly damaging movement patterns. So let’s imagine that lateral abduction of the arm is painful at the AC joint. Placing the tape (with minimal tension) over the lateral aspect of the deltoid and shoulder while the arm is adducted should in THEORY help make the patient aware of that lateral abduction and limit an overuse of that specific movement. The idea that you need to stop picking the scabs and allow yourself to heal is obvious here. Although this CAN have an effect on the muscles and joint the intervention is really directed at taping the skin over said muscles and joint with the opposing tension (here adduction is helpful while abduction is painful) to illicit a sense of balance to the joint.

This is the standard approach. However, (with the same situation in mind) you can actually achieve some pretty interesting outcomes if you move the affected joint passively into or even past the point of pain and tape in that position.

So in taping the shoulder while in adduction, the deltoid, shoulder skin is stretches tight and then secured as tense underneath the tape. While if you passively raise the shoulder into abduction the skin and muscles around the shoulder would have some slack, or be looser than the first scenario. So when you are laying down your tape you’ll need to consider is you want the area underneath the tape to be slack or tense.

This is the most clinically consistent way I have been able to use Ktape to help my patients. Otherwise it’s simply that i slap some tape down, make it look nice and hope the patient tells me that it felt good. Using an solid skin stretch or taking the tension off of the skin and then taping is the best way to allow my patients to actually sense what I am trying to accomplish with the tape. They can feel via their skin that something is being pulled or something is relaxing.

So who is this tape for? The main problem here is that it’s mostly seen on high level athletes and your average joe doesnt think they can also find some benefit in taping. This is untrue. One of the most obvious differences between a pro athlete and us mere mortals is that we are often no as conditioned as the pro and the more deconditioned the patient the more effective a passive intervention will be to their system. It’s wildly important to explain where Ktape falls in terms of interventions and in returning your patient to their normal ADLs.

The tape will not heal you. Within the context of treatment it is merely stopping you from reverting to your old movement patterns. This is just another way of describing my first use of skin tension or slack to limit or encourage certain movements.

The tape is not the treatment. It is one piece of the puzzle. A good clinician can discover a seemingly unlimited number of ways to tape when considering what the provocative movement might be.

To limit lumbar flexion you tape them in lumbar extension

To encourage hip extension you place and tape in hip extension.

To limit cervical flexion you tape in cervical and thoracic extension

To encourage thoracic extension.... you tape in thoracic extension. and so on

It’s far less about the direction of the tape than it is what is happening to what the tape is being used on.

My basic rule would first be to over set the posture you’d like to encourage. Really exaggerate shoulder external rotation before laying the tape down. If you combine movements like left external rotation, left forearm supination, wrist extension... and so on, you can create more torque to trap underneath the tape.

There are a number of other fun techniques to use with the ktape but the last one ill talk about is in reference to when a patient has a very localized trigger point or area of pain. Let’s use the common upper trap, levator trigger point, or knot that patients often describe. If say this point is triggered by cervical rotation away from the side of pain. LEt’s says the pain is in the right upper trap and is triggered when the patient looks over their left shoulder. Then we know we need to turn the cervical spine to the right as far as we can and then and only then lay the tape down. The one different piece here is that we wont take over the “trigger point”... we tape just below the trigger point, or next to the trigger so as to create a new point of tension when turning to the left.

That’s the main point with the ktape as with the rest of your therapeutic interventions. Creating situations where tension is either relieved or tension is created naturally by the patient. That’s the definition of an exercise really. Ktape may be frowned upon by those who use it or see it’s use as something besides that, but if you do realize where you need to create tension with your patients and where it’s best to relieve tension then ktape can be a major ally in helping your patients

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