In episode 123 we continue our conversation with Mr. Josef Andersen, instructor of Mulligan Concepts. We discuss more ideas on patient care, his philosophy of optimizing outcomes, resources, studies and even the comparison of scientific studies versus clinical experience.
Josef speaks about how taking a broader view is important within each patient encounter, as he is seeing patients mainly as a consultant.
Memorable Patient Encounter
Josef shares a story of a patient with pain and parasthesias in hand 20 years after compound fracture. He recognizes how his clinical reasoning at the time of this patient encounter was biased, and how this bias led him to make poor decisions.
He recalls another story of a friend who was in acute pain, and how utilizing one approach with this patient simply wasn’t enough. He reports that understanding one approach is important, but being competent in treating patients within a framework of several treatment approaches often helps patients improve even more.
Josef notes that when patients are not responding rapidly, or gradually, we must look at a broader spectrum of treatments to help them. Often times, it is more important to know when patients may need much more than a “hands on” approach (such as self care, modification of daily activities, psychological treatments, etc).
Josef speaks of the differences between treating high level athletes and treating the more common populations. He notes that often times the athletes that he sees are those who are not responding well to the normal course of sports physical therapy. He again notes that clinical reasoning is vital in these cases, and that his focus tends to be on movement patterns rather than tissue pathology.
Resources and Studies
Josef’s main resources are his colleagues, as well as internet databases and social media.
A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Jull et al. Spine (Phila Pa 1976). 2002 Sep 1;27(17):1835-43
Efficacy of manual therapy treatments for people with cervicogenic dizziness and pain: protocol of a randomised controlled trial. Reid et al. BMC Musculoskeletal Disorders 2012 13:201
Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. Bisset et al. BMJ. 2006 Nov 4;333(7575):939.
Josef explains while research in relation to clinical practice can often display major limitations, exposing the Mulligan Concepts to controlled trials has defined the value of controlled clinical trials and broadened the horizons for the future of these concepts. He speaks again about the video case series, and how this might help to bridge the gap between the RCT and a single patient case. He gives some specific examples of how these case series can be used.
Be open minded and innovative, don’t get stuck in cookbook type approaches, and if you learn a system… learn it well!
Contact Josef at firstname.lastname@example.org