Entries by Bodine Ledden

Are you certain?

How certain are we about the causes we identify? Before labelling something as the cause, have we genuinely explored all possibilities? We often take the path of least resistance, seeking confirmation for our assumptions rather than challenging them. For example, if a patient presents with back pain and we examine them through a structural lens, […]

Everything was great until…

Some time ago, I was in a Vietnamese restaurant in Cabramatta NSW. Those who know the area will confirm that ‘Cabra’ is about as authentic as it gets outside of Vietnam, hence it’s nickname ‘Little Saigon’. I was there with some work colleagues after a dry needling course. One of my colleagues ordered a combination […]

Who is the better driver?

Do you feel more anxious when someone else is in control? Are you more worried or less confident? Are you more tense as a passenger? Does your emotion or behaviour influence the driver and make them more tense? Or perhaps you feel more nervous in the driver’s seat and prefer someone else to take control? […]

What if it gets worse?

Okay, but what if it doesn’t? Fear can be a significant barrier to improvement and contributor to increased pain, sensitivity and avoidance behaviours. Injuries occur, and our bodies heal. But the regression of pain is rarely linear. Is there a belief that a movement is harmful, a subconscious expectation of pain, a memory that is associated with […]

Zoom out and think deep

There is often so much focus on anatomy and structure in relation to pain, but let’s not forget about human physiology. Disruptions in homeostasis, may be the underlying mechanisms influencing a pain experience. We have 11 body systems and none of them can function independently.That’s right, muscles are not an independent system. Let’s go back to physiology […]

The best exercise..

We could spend hours searching the internet for the “Best exercise for (insert pathology)”. Well, I will save you the time and tell you right now! The best exercise is… the one your patient enjoys! The key to getting people moving is finding out what they enjoy doing. The more they enjoy it, the more likely they […]

Pain and performance

Let’s consider a high-performance athlete.For an athlete to perform at the highest level, they need to put in the work, they need to train, they need to eat well, they need to sleep, they need to ensure they are focused on a goal, and they need to minimise distractions that may stop them from achieving […]

That’s a fact…

Recently, I was told that course content and discussion should be solely factual, and that opinion should not be used as it may bias discussion…  The fact is… much of what we know about pain and manual therapy is not necessarily fact but rather evolving hypotheses. It is the discussion that allows us to question […]

Are you focusing on the wrong thing?

Do you ask questions like, how is your pain today? How has your pain been over the last week? What is the level of pain you are feeling at the moment? Tell me more about your pain… Directing attentional focus to the pain may not be helpful. Now don’t get me wrong, I know pain may […]

Feedback

A very important but overlooked skill… Feedback is what I am referring to. I believe that both giving and receiving feedback is a skill, and that skill takes practice. The word itself might increase anxiety levels when someone says  “let me give you some feedback”, it might automatically put you on the defensive. However, the implications […]

Case study time..

Let’s tickle your dendrites, fire up your axons because this case study will get you more excited than an action potential. What comes to mind for you? Does your mind go completely blank? Do you panic? Or do you get a rush of possible differential diagnosis rushing to your head?  It might be easy to point the […]

How much is enough?

I always get asked the question, “How much is enough?” What I mean by this is treatment dosage.How long should you mobilise a joint for? What grade mobilisation should I use? How long should I leave a needle in for? How much stimulation should I use? How many repetitions should I prescribe? How many times should I […]

Are you staying up to date?

As clinicians it is important that we are always staying up to date with evidence based practices and terminology. One very commonly used label is “Sciatica” This diagnostic label dates back to Hippocrates who was allegedly, the first physician to use the term ‘sciatica’, deriving from the Greek ischios, hip. Many years later Galen treated sciatica by blood letting, […]

Stop Blaming Me!

So often in clinicians and patients blame an individual muscle or structure as the cause of pain.  How often do you hear (or even say) that it’s the Piriformis, Supraspinatus or the QL… Yes, I am sure if someone presents with pain in the buttock, shoulder or low back, these muscles may be tender to press on. […]

Reconceptualising pain with a plastic brain

Can your brain change? Have you every changed your mind, or changed your opinion? Even when you believed something so strongly, but you were still able to change. What about that bad habit that you were able to shake? Have you ever tried to learn to play an instrument, learn a new language or take […]

Leadership – personal perspective

Firstly, let me start out by saying I am no expert in leadership, nor do I think I am a great leader. But over the years I have had some great leaders and some not-so-great leaders. I am lucky enough to currently be led by one of the best, so I am learning as I […]

You have a bad posture..

Does pointing out postural discrepancies help or harm? I, like many of you were taught to assess a patient’s posture, and was taught that if someone had an anterior pelvic tilt, then it must mean their hip flexors are short and tight and their glutes are long and weak, or if their shoulders were internally […]

I think, therefore I am

Often there is a lot of attention directed towards the ‘condition’ or the ‘pathology’ in chronic pain, and while this is a component, we need to zoom out and look at the whole person. It is common to think and believe that the pain is the cause of the negative impact on a patient’s life. What if we look at it […]

Stress, pain and resilience

We all talk about stress, But what is stress? The World Health Organisation defines stress as any type of change that causes physical, emotional or psychological strain. But is all stress bad? Stress is a common and normal physiological response. Stress that is applied appropriately can be positive – this is eustress, which can be beneficial effect […]

What kind of a plant is painful?

A faceplant.. Ok that’s enough jokes… But it does link in with today’s topic so I couldn’t resist. Our bodies and our aches, pains, injuries and overall wellbeing can be a bit like a garden. You put good stuff in, you get good stuff out. You plant nothing, then you get nothing out. Sometimes, a plant in […]

The Trigger Point

A trigger point is something that you will deal with in everyday clinical practice when treating patients with musculoskeletal pain presentations. Unfortunately, the myofascial trigger point is often an overlooked contributor to chronic myofascial pain and central sensitisation.  So what is a trigger point? As defined by Travel & Simons a trigger point is a “A […]

A perspective of change

Definitions in the world of science continuously change. Just as our skin ages and changes so do our brains. The ideas and beliefs that we held to be true when we first learned about manual therapy in our undergraduate studies should also change and evolve as the understanding improves. When our understanding fails to evolve, […]

6 Myths about sacroiliac joint pain

Myth #1 The SIJ can become unstable The SIJ functions to provide stability and the transmission and dissipation of load from the trunk to the lower extremities. (Thawrani, 2019) The SIJ is an inherently stable structure with only a small 6 degrees of movement available during normal activity.  (Palsson et al. 2019) During development the SIJ changes structure, it […]

Hip and Groin pain

Anterior hip and groin pain could be due to a number of different reasons. But let’s talk about intraarticular hip pain. ▶️ Intra-articular hip pathology refers to pain and pathology within the hip joint▶️ It typically presents as deep pain in the anterior hip and groin region and can also present as buttock pain▶️ Common […]

The importance of patient expectations

Patients’ beliefs and expectations need to be better understood by clinicians to improve management. Asking the question, What is your understanding of your pain? Do you believe that it is just a physical / mechanical problem? Spending the time to really hear your patient’s story and understand what they expect from this treatment regarding their pain and […]