Recommended CE courses

[BrentC]

Hey Group-
Curious as to what some of you would recommend for CE courses that you have attended in the past. I have been to too many in which I have left disappointed. The most recent being an EIM course on the lumbar spine.

Any personal experiences with NOI? Neurodynamic Solutions? etc?

I am more interested in courses on theory as opposed to courses where you learn a new bag of tricks to perform on patients.

Thanks for any advice-- and Barrett and Diane - If you are ever in the Midwest region let me know!

Brent Cordery, PT

[Diane]

Originally Posted by BrentC

Any personal experiences with NOI? Neurodynamic Solutions? etc?

I am more interested in courses on theory as opposed to courses where you learn a new bag of tricks to perform on patients.

Well, the bag o' tricks will be there, but so will theory, neurodynamic and pain. Both are very good. Pivotal even.

[Barrett Dorko]

Brent, Will do. I guess Milwaukee isn't quite "midwest" enough for the people of the corn.

And I mean "corn" in the nicest possible way.

[proud]

Originally Posted by BrentC

Hey Group-
The most recent being an EIM course on the lumbar spine.

What was it about that course that disappointed you?

[joebrence9]

I highly recommend the Maitland series, especially MT-0. All of their courses go through a rigorous process of making sure the data which makes them evidence-based is the best available.

I was at an MT-0 course this weekend, and it teaches us what we know and what we don't know as PTs. It takes on our special tests, procedures, etc and then takes the systematic reviews/ RCTs available on each of them and analyzes them through QUADAS, MDIC, etc. to determine their applicability to practice. Chad Cook and Chris Showalter wrote the course and they did a fantastic job (alot is based off of Cooks new edition of his book on special tests).

I also got to present an hour forum on pain classification (nociceptive, peripheral neuropathic, central sensitization) at the course and describe what the literature is telling us about classification of pain and how that can help us lead to better interventions.

Overall the Maitland group (www.ozpt.com) has adopted pain as being an output from the brain and their approach is the most supported of any of the "gurus".

[BrentC]

Originally Posted by Barrett Dorko

Brent, Will do. I guess Milwaukee isn't quite "midwest" enough for the people of the corn.

And I mean "corn" in the nicest possible way.

How could "corn" be construed in any other way than nice? Maybe if you make it to town for a class we can invite Hruska too

[BrentC]

Originally Posted by proud

What was it about that course that disappointed you?

Proud-
The biggest issue I had coming away from the EIM course was the fact while they were preaching the most current research and CPR's in the next breath they were teaching us palpation techniques and SI joint motion tests! I asked one of the teachers in the class why we were being taught something that had VERY poor reliability and validity and was told that some people at EIM are still set in their "old" ways and techniques. I would guess 2 hours of the course were spent on practicing these type of tests. Disappointing.

Brent

[zimney3pt]

Brent,

Adriaan Louw has a con ed group ISPI he and others from the group teach mobilization of the nervous system and explain pain from NOI along with their other courses. It does have the usual bag of tricks with mobilizations and manipulations but there is always pain science and explain pain info.

I do have to admit to my bias as I have come to know Adriaan personally and started to do a little bit of lecturing with them (ISPI), so my critique of the classes is biased so take it with a grain of salt. Some of the group that teaches are still pretty meso- in treatment, but all have had the explain pain info and understand it's basics. They just maybe haven't leaped the chasm completely yet.

[zimney3pt]

Originally Posted by BrentC

How could "corn" be construed in any other way than nice? Maybe if you make it to town for a class we can invite Hruska too

I would love to see you pull that off.

[BrentC]

Thanks Kory-
I was actually able to attend a short 2 hour lecture put on by Adriaan a couple years ago in Lincoln. I really enjoyed it but it was much to short to get into much detail.

Sounds like some of the ISPI teachers are similar to the teachers I had at the EIM course I attended last year. Just haven't fully crossed the chasm yet. Can't blame them since I have not yet fully crossed either.

[Barrett Dorko]

Brent says:

Maybe if you make it to town for a class we can invite Hruska too

I doubt he'd express any interest whatsoever. After all, what could possibly be in it for him?

He and his followers have had years to join us and discuss what it is they think and do, but they remain silent.

[John W]

Can't blame them since I have not yet fully crossed either.

You most certainly can. You're coming fresh off the indoctrination train from PT school whereas many of those you refer to have been treating real patients with real problems for decades. That is inexcusable.

[BrentC]

Good point John. That is were my disappointment from the EIM course arose from. Attending a course that touts evidence and then being instructed on SI joint mobility palpation exams was very upsetting. Thats why I posted this thread in the first place... I am looking for CE courses that don't contradict themselves.

Brent

[Diane]

Wow Brent, I'm glad to see people like you coming along.
Keep your seatbelt fastened at all times. Some of it might be rough going.

[John W]

Brent,
You should be upset. I'm still upset- that and the ongoing plight of my patients is what keeps me coming back here to discuss, learn and improve my skills.

Many of those you're talking about just want to teach material that they know is worthless at best and nocebo-inducing at worst, but they also know it entices paying customers to their courses. Perhaps they justify teaching this crap by sneaking in some of the good stuff, which allows them to shrug off the fact that there's no science to support, for example, motion palpation of the SI joint. In fact, there's science to support that it is worthless!

My take on it is that this behavior is confusing, dishonest, harmful to patients, a drag on the profession and a pitifully hypocritical excuse.

But, I'm just an old grump.

[mrupe82]

Brent,

I have attended all of the EIM courses as a resident in the orthopedic program. I can only speak on behalf of my instructors and say these were not taught. As a matter of fact, the evidence refuting them was presented and discussed in depth. Like my courses and most continuing education, the material is influenced by the instructor. i had this experience with the McKenzie A course talking about discs 'swishing and sloshing around' in the spine. I think a read of this blog will give a better perspective:

http://blog.myphysicaltherapyspace.c...ed-part-2.html

[ovpt]

''
Many of those you're talking about just want to teach material that they know is worthless at best and nocebo-inducing at worst, but they also know it entices paying customers to their courses. Perhaps they justify teaching this crap by sneaking in some of the good stuff, which allows them to shrug off the fact that there's no science to support, for example, motion palpation of the SI joint. In fact, there's science to support that it is worthless!

My take on it is that this behavior is confusing, dishonest, harmful to patients, a drag on the profession and a pitifully hypocritical excuse.''


I have taken 40 + con ed courses over the years and even though i may have not agreed with all the content, i never felt like the instructors where purposely misleading the class. At times, i would say they were be blinded by their passion or old habits. Since the evidence is fairly terrible for most of what we do, i think its easy pick and choose what evidence you want to use to support or sway your treatment rationales.

I am curious which courses you have taken that you thought were actively misleading?

[John W]

...i never felt like the instructors where purposely misleading the class.

Purposely misleading is not the same as dishonest, confusing and hypocritical. You're assigning malice of forethought, whereas I'm just assigning a lack of forethought- and rear-thought for that matter. Let's just call it a general lack of thought.

I'm tired of that.

Do you think experienced physical therapist clinicians and instructors with advanced clinical and academic credentials should be teaching motion palpation examination techniques for the SI joint as Brent identified in his OP? If so, how do justify it?

Not all the evidence is terrible. Ironically, often the good evidence is ignored. Now that's terrible.

[Diane]

I don't know what John is going to say in reply, but let me say that in Canada, you have to suck the last bit of Koolaid through a straw or you don't get your black belt in ortho. You not only have to "believe" you can feel, for example) specific facets through 4 inches of thick back blubber/fascia (but substitute in, if you wish, any bone or joint), you have to "believe" you know what grade of what you are doing and the instructor and model have to all agree. Then, maybe, if the instructor is in a good mood, you advance up the belt hierarchy. I'd call that indoctrination, misleading indoctrination.

[ovpt]

"Many of those you're talking about just want to teach material that they know is worthless"

that sounds like trying to mislead for financial gain. sorry if i took you wrong. also i dont believe in the palpation skills many of the courses teach. i was just surprised by your cynicism

[John W]

If they didn't want to teach it they wouldn't, and apparently, according to Matt, some of them don't. So kudos to them. However, many of them know the reliability literature on this stuff is dubious, but your guess is as good as mine why they choose to teach it anyway. I know there are financial incentives in play. I also know there's the tendency to teach it because of "tradition". I suspect some of them don't trust the most recent research and defer to their magic hands.

I think all of those reasons suck pretty bad, don't you?

i was just surprised by your cynicism

I'm incredulous of that. You don't read my stuff much do you?

[Diane]

There is this: Your Deceptive Mind: A Scientific Guide to Critical Thinking Skills with Steven Novella. I wonder if people can get CE credit for this?
Hey, even if you can't, it should be on the must-have list anyway. Maybe Bernard could figure out how to buy it for here.

[BrentC]

Originally Posted by mrupe82

Brent,

I have attended all of the EIM courses as a resident in the orthopedic program. I can only speak on behalf of my instructors and say these were not taught. As a matter of fact, the evidence refuting them was presented and discussed in depth. Like my courses and most continuing education, the material is influenced by the instructor. i had this experience with the McKenzie A course talking about discs 'swishing and sloshing around' in the spine. I think a read of this blog will give a better perspective:

http://blog.myphysicaltherapyspace.c...ed-part-2.html

Matthew-
I am not trying to paint all instructors at EIM in a bad light. All I know is from my own experience. I attended the course entitled "Evidence-based Examination and Interventions for Patients with Management of Lumbropelvic Disorders" in April 2011 taught by Kyle Adams. During this course we had lab portions where we spent WAY to much time on goniometry of the spine (why?), standing flexion SI palpation test, Stork test, and sitting flexion SI palpation test... I took took McKenzie A and had a similiar experience that you had. Which is why I never continued onto B. I am glad to hear that your experience with EIM was better than mine. Unfortunately one bad instructor or experience reflects poorly on the whole group.

Maybe my instructor needed some 'filler' for the class... I don't know. But if that was the case there are many different things that could have been done besides what was done.

Im just a PT with money to spend on CE that is looking for something that is consistent and fully up to date with all research. Still have yet to find it...

Brent

[Jason Silvernail]

SIJ palpatory assessments?
http://ptthinktank.com/2012/03/18/si...evance-please/

If you go by the evidence from RCTs the McKenzie and Maitland methods can probably show the most numbers of successful trials. Obviously the way individual instructors teach is somewhat variable. I think Barrett teaches more scientific and practical information in a couple hours of a one day workshop than you'll get in a full weekend at most other CME courses.


[From my iPhone, please excuse typing]

[Barrett Dorko]

Thanks Jason.

I abandoned palpatory examination for motion of that sort in about 1980.

[Jason Silvernail]

1980?
What's with our colleagues?

It's not the science, it's the culture of physical medicine and therapy that's the problem.


[From my iPhone, please excuse typing]

[amacs]

Thank you Jason for that piece. Is it worth placing in a separate thread particularly if there is more material to follow. I wonder if in being in this thread it risks being lost/missed under the CE thread title. I think it may deserve its own distinction.

Good piece,

Regards
ANdy

[Sheffphysio]

If anyone gets chance to go to Peter O'Sullivans SIJ course I would recommend it. It’s the most evidence based, clinically relevant, useful, lack of woo course I have done on this specific joint.

[Bas Asselbergs]

I am now curious, Dave.
I have attended more courses that I care to shake a stick at with DOs and PTs (Canadian Ortho, American Osteopathy) about spine and SI, and at this time, can not really come up with any plausible context in which doing a whole course on SI joint would make sense.
What is the course about?

[Bas Asselbergs]

I forgot I went through the Vleeming/Lee stuff about the SI as well....Add that to the list.

[ian s]

After a certain number of years practising what do people gain from going on CE courses??

I am just curious ?

I would go to connect up with like minded individuals , to network a little and to talk about clinical cases perhaps ....

Life changing courses were Dave Butlers and Louis Giffords ......that provoked reading , reading , reading , experimenting and learning to be a therapist . I see most courses as tending towards training technicians , not graduate level thinking 'interactors'.

Dave were you serious ?? I can't imagine anything more myopic myself .

[Sheffphysio]

Hi Bas,

Most of it is setting the scene. Presenting the evidence that the thing doesn't move, you can't test it, you certainly can't feel it. It does not "go out" in does not become "unstable" its a stiff joint but believe it or not does have a nerve supply so can be responsible for some pain conditions. He presents that the levels of relaxin release during pregnancy is not associated with pain in the SIJ or even increased movement. The woo around this joint is quite special and most of it not valid or even useful..... in fact it could even contribute to a lot of the presentation of "SIJ" pain we see by getting people to hold themselves and brace themselves in a way that make absolutely no common sense at all.

He very much looks at how much load the joint is under, and normally the thing is being over loaded NOT under loaded with protective bracing and splinting. He very much gives a practical way of moving people, there and then, under less load to change the pain response. He gives 3 patient demo's of "chronics" that he interviews then treats. It’s a very bio-psychosocial intervention, very clinically useful and in my opinion (which can happily be challenged) should be a must for all undergrad physio's.

p.s I am in no way on the marketing team for his courses. But I have done 3 of them now and have never failed to be impressed. We can all argue about the subtleties of the treatment and I’m sure we would all go about it in our own different ways but the principles are sound and really helped to clarify my thinking (keep me in the profession) when I was a newly qualified PT.

P.S, Yes Ian, am serious. Can we tempt you with a course by Diane?

[Bas Asselbergs]

Thanks for that, Dave.

The issue comes up: obviously he associates an SI joint "problem" with some pain complaints. Considering all he (and we ) know about the difficulty to pin-point a joint's role in the development of pain, why even go there?
Sorry if I am misunderstanding this but by focusing on the SI, is he not - despite his bio-psychosocial intervention - perpetuating a faulty premise? A biomechanical cause of a painful condition?

[Barrett Dorko]

Dave says:

...but believe it or not does have a nerve supply so can be responsible for some pain conditions...

I don't think anyone here denies that nerve support is a common feature of mesodrmal tissue. Our problem lies with the meaning of this and how changes in that tissue should then be understood and treated.

[ian s]

Dave , I understand the benefit now through your description of;

1.theoretical deconstruction
2.replacement of the widespread 'meme' of faulty mechanics with something more positive and practical in a way that makes sense and is clinically useful to many people . Again seems like graded exposure that others taught a while back?

I had a lady in the other who had been going to someone for 20 years for SI joint manipulation . There is no way anyone here would be successful in challenging the views that the problem was no longer around the pelvis .....

[Sheffphysio]

And who's done that to the poor lady, not that any one person is to "blame" but as a community we must improve our message.

I had a lady recently who had "SIJ pain" for 5 years after giving birth. She came with a letter from her last care provider telling me about all these problems she had, uplslip this and that and nutated this and unstable that. The poor lady would not weight bare on her right side in case it dislocated her SIJ. I'm am sure nobody actually said that to her but that is what she put together from the information she had been given by us, the medical community.

And this message of unstable SIJ's that "go out" is still being taught. This makes me sad and a little annoyed, as this is indefensible now from what we know. We can do better than this, not for ourselves but for out patients.

[Sheffphysio]

Originally Posted by Bas Asselbergs

Thanks for that, Dave.

The issue comes up: obviously he associates an SI joint "problem" with some pain complaints. Considering all he (and we ) know about the difficulty to pin-point a joint's role in the development of pain, why even go there?
Sorry if I am misunderstanding this but by focusing on the SI, is he not - despite his bio-psychosocial intervention - perpetuating a faulty premise? A biomechanical cause of a painful condition?

Bas, I think he calls it an SIJ course just to market it. As he does not really focus on the joint or the biomechanics of it but more on the behaviour of the nervous system around it (including the CNS).

Calling it "SIJ pain" only means pain around the buttock area that our profession, sadly, has labelled SIJ pain. If we want to change the profession we have to get people in which sadly does mean speaking language and advertising courses that appeal to the masses. But now, hopefully, there are changes a foot. The NOI conference is much bigger that previously, Butlers lecture here in the UK sold out with 100 at each. Peter O'Sullivan courses get booked up fast and getting bigger numbers.

[John W]

I have to admit that I'm a bit perplexed by O'Sullivan's approach of saving us all from the SIJ meme by presenting an entire course on deconstructing it, but then implying that some joint, because it's innervated, can be a "source" of pain. Too much having and eating of cake there for me, Dave.

I wouldn't bother with it. There are much more edifying and expeditious ways to overcome that meme by reading other stuff and going to other courses that simply ignore joints altogether. I'm having trouble understanding how spending an entire weekend focusing on a joint helps clinicians to stop emphasizing thinking about joints.

[Sheffphysio]

Originally Posted by Barrett Dorko

Dave says:



I don't think anyone here denies that nerve support is a common feature of mesodrmal tissue. Our problem lies with the meaning of this and how changes in that tissue should then be understood and treated.

I agree, what we can actually do to an SIJ in pratically nothing. What we can do with the nervous system around it (including the central) is slightly more.

[Sheffphysio]

Originally Posted by John W

I have to admit that I'm a bit perplexed by O'Sullivan's approach of saving us all from the SIJ meme by presenting an entire course on deconstructing it, but then implying that some joint, because it's innervated, can be a "source" of pain. Too much having and eating of cake there for me, Dave.

I wouldn't bother with it. There are much more edifying and expeditious ways to overcome that meme by reading other stuff and going to other courses that simply ignore joints altogether. I'm having trouble understanding how spending an entire weekend focusing on a joint helps clinicians to stop emphasizing thinking about joints.

The course does practically as you state. It ignors the SIJ and explorse how people use it and how most long term pain states are an overactive protective system, not a SIJ issue.

It was my comment about nerve supply to it, bad choice of words.

[John W]

Thank you Jason for that piece. Is it worth placing in a separate thread particularly if there is more material to follow. I wonder if in being in this thread it risks being lost/missed under the CE thread title. I think it may deserve its own distinction.

I agree with this. And, you know ANdy, I don't think Jason would mind if you started that thread.