Seth Peterson @DrSethPT Twitter profile

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Seth Peterson

@DrSethPT

2 years

Just out in @JOSPT The Blind Men, the Elephant, and the Continuing Education Course: Why Higher Standards Are Needed in Physical Therapist Professional Development @ShepDPT @CPRJoe @danrhon This demands a 🧵: (1/?)

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Seth Peterson

@DrSethPT

2 years

When I graduated #physicaltherapy school I wrote down my goals for 5 and 10 years later. I crushed them. In fact, I was thinking way too small. Here’s the advice I have for new PTs:

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Seth Peterson

@DrSethPT

2 years

⚡️I wish nerve root referral patterns were like a textbook, but of course, it’s not that easy. Probably all you can deduce from these is that S1 doesn’t refer into the anterior leg (at least very often). Anyone else?

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Seth Peterson

@DrSethPT

2 years

“Whilst RCTs are a fantastic idea for testing drugs, they are a catastrophically bad idea for testing loads of other things.” - @trishgreenhalgh Great listen on EBP, humanities, and value of SoMe today @cuttingforstone @EricTopol

‎Medicine and the Machine: How We Can Err if We Rely on Randomized Controlled Trials on Apple...

‎Show Medicine and the Machine, Ep How We Can Err if We Rely on Randomized Controlled Trials - Nov 23, 2022

podcasts.apple.com

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Seth Peterson

@DrSethPT

2 years

The SIJ rotates at maximum less than the thickness of a US nickel. If you think a lot about this, don’t.

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Seth Peterson

@DrSethPT

1 year

Many PTs want to be doing the newest thing. I get that. The problem is that the newest thing is very often BS. My advice is to get as good as possible at the basics before you start reaching for unusual things. And then, be skeptical.

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Seth Peterson

@DrSethPT

2 years

As a PT student, I really thought understanding divisions of the brachial plexus was going to be way more critical to clinical practice somehow

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Seth Peterson

@DrSethPT

3 years

You can’t do notes and be fully present with the patient at the same time. Our brains don’t work that way.

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Seth Peterson

@DrSethPT

4 months

“Good news. We got your last spot filled. Something called fibromyalgia. Said his back and neck and a few ‘pinched nerves’ were bothering him. He’s gonna show up about fifteen minutes late, but you should still have a good 30 minutes for the eval.”

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Seth Peterson

@DrSethPT

2 years

Bill to expressly permit physical therapists to refer for radiographs in AZ passes state Senate overwhelmingly! @AzPTA @APTAtweets

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Seth Peterson

@DrSethPT

2 years

We can’t rest as a profession until this is eliminated.

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Seth Peterson

@DrSethPT

3 years

Most PTs aren’t out there deciding between MT and exercise. This is a manufactured SoMe dichotomy. Exercise is a given. They’re deciding whether any MT would help and how much.

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Seth Peterson

@DrSethPT

3 years

Deciding whether or not something is cervicogenic based on whether movements of the neck or arm cause the pain is not enough. Even Spurling’s is can’t be used to r/o cervical referral and the arm is attached to the neck.

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Seth Peterson

@DrSethPT

2 years

Not rocket science, but it bears repeating: Limited mobility 1-2 weeks after joint replacement isn’t because of “excessive scar tissue” and cranking on it isn’t the most successful approach.

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Seth Peterson

@DrSethPT

3 years

What’s wrong with #physicaltherapy in one snapshot.

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Seth Peterson

@DrSethPT

2 years

WHAT ARE YOUR FAVORITE ALL-TIME PAPERS? I’m going to have to start a 🧵 for this ⬇️

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Seth Peterson

@DrSethPT

2 years

🦴 Put the nerve root referral maps next to this and you can begin to understand even better why looking can’t get you very far with LBP-related leg pain. 📝 Note: This is just the beginning of the story.

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Seth Peterson

@DrSethPT

1 year

I think doctors need some education about PT. Crazy since this has been a problem for 100 yrs. Most seem to either have no idea what we do or think we pound everyone into the ground with exercises.

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Seth Peterson

@DrSethPT

9 months

We graduate doctoral level PTs who try to treat neurological weakness by working on trigger points. On and on. If I see more ppl do this and declare themselves an “expert” I’m gonna lose it. We need more post professional training.

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Seth Peterson

@DrSethPT

3 years

I think the continued story of our spines “going out” and not “being aligned” has probably done more unnecessary damage to people’s self image than just about anything else in healthcare.

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Seth Peterson

@DrSethPT

3 years

😍 Just put an awesome cranial nerve guide together if you’re one of the people that needs to start implementing this in your practice. ➡️ Posted in our FB group but can email a PDF if anyone wants it.

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Seth Peterson

@DrSethPT

2 years

Past hx of cancer is the biggest predictor of future cancer. Pt with 7/10 scapular pain and no way to reproduce it mechanically other than poke an area but has had cancer x2. Referred for MRI and over the past few weeks found metastases everywhere. 😔

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Seth Peterson

@DrSethPT

2 years

The greatest threat to physical therapy will always be bad physical therapists.

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Seth Peterson

@DrSethPT

2 years

⭐️ My TOP 10 papers (and things they taught me) of 2022 🧵

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Seth Peterson

@DrSethPT

2 years

🔍 We looked at continuing education courses in #orthopt and #sportspt in the US ❌ >1/2 taught interventions not supported by CPGs or SRs Is this what we want for con Ed? What consequences might result? #physicaltherapy Link to article in @PTJournal :

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Seth Peterson

@DrSethPT

1 year

Areas I think research in PT would be smart to focus on: -lifestyle change -cost (amount and perceived value) -mechanisms -what can we help prevent? NOT intervention A vs B. Any others?

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Seth Peterson

@DrSethPT

2 years

I have published more case reports than most, and I get people asking me about how to do it all the time. Here’s how to get a high quality case report published for others to see: 🧵

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Seth Peterson

@DrSethPT

2 years

Patient today: I don’t know if PT is very beneficial since it’s just doing exercises by yourself while no one in clinic even watches you. At least a personal trainer watches you, that has been really beneficial. 😳

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Seth Peterson

@DrSethPT

2 years

“Overall, these randomized clinical trials typically demonstrated benefits of structured, supervised exercise programs and manual therapy for improving pain and functional status in persons with lumbar spinal stenosis.”

Diagnosis and Management of Lumbar Spinal Stenosis

This review summarizes current evidence regarding diagnosis and treatment of acquired, degenerative, lumbar spinal stenosis.

jamanetwork.com

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Seth Peterson

@DrSethPT

10 months

Communication: one of the most important skills for clinicians. Happy this paper’s finally up, with a stellar group, arguing maybe it all comes down to two things: mindfulness and reflection @MaxiMiciak @mjkleiner @JuanLoboPT @sunsopeningband

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Seth Peterson

@DrSethPT

2 years

One thing that is amazing to me to reflect on every time I gear up for this Primary Care PT course is how much metabolic/endocrine conditions influence the MSK system, but how rarely we talk about that in PT.

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Seth Peterson

@DrSethPT

2 years

Essentially all PTs use exercise as a treatment. The position that we should not do anything BUT exercise is kind of weird to me.

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Seth Peterson

@DrSethPT

2 years

🦎 From Idea Cults to Clinical Chameleons: Moving Physical Therapists' Professional Identity Beyond Interventions 👆🏼How can we embrace complexity in practice? Maybe the most fun I’ve had writing. Thanks coauthors Matt Erb, @sunsopeningband @JOSPT

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Seth Peterson

@DrSethPT

1 year

🔥JUST RELEASED: How Physical Therapists Became Diagnosticians: an American History -really excited for this to be out. It’s the first historical essay I’ve written and one of only a handful @PTJournal has published Recap: 👇🧵 Paper: 👇

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Seth Peterson

@DrSethPT

2 years

If your business model requires people doing stuff on their own, with little to no guidance, I beg you to change your business model. It’s hurting the reputation of the profession. @pps_apta

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Seth Peterson

@DrSethPT

2 years

Not doing joint mobilization because the joint doesn’t move much Not stretching because the muscle doesn’t physically lengthen Not doing resistance training because hypertrophy doesn’t occur Did the person come in asking for those things?

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Seth Peterson

@DrSethPT

3 months

If you’re going to do neck manipulation, this is how it’s done. Demo by Lauri Hartman from ⁦ @AAOMPT ⁩ two years ago clearly saying to keep amplitude small, mid-range.

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Seth Peterson

@DrSethPT

1 year

@DrJN_SportsMed Reflex irradiation. The vibration is what stimulates the muscle spindle so in ppl with spasticity you can see it spread more easily. So by definition it’s hyper reflexia and sounds like an UMN case. Maybe myelopathy based on the story. MS also.

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Seth Peterson

@DrSethPT

3 years

It’s really hard to be person-centered in your care while also listing off things you “don’t do.” Don’t be a “manual PT.” Don’t be a “weightlifting PT.” Don’t be a “pain science PT.” Don’t approach every pt the same way. Learn to become a clinical chameleon.

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Seth Peterson

@DrSethPT

2 years

As MT shamers have gone to the point of “rarely do people use clinical reasoning with MT” I’d like to remind everyone that: -Clinical reasoning as a concept in PT started w/MT -Arguably diagnostic reasoning by PTs was started by MTs -Best communication chapter still by an MT 🧵

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Seth Peterson

@DrSethPT

2 years

You can talk about utilization and necessity all you want, but an older adult coming in for an exercise plan just to keep moving and aging well is something that makes me happy - and something I would want for my own mom and dad.

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Seth Peterson

@DrSethPT

2 years

📣 JUST PUBLISHED in @MSKPhysioJnl : Who writes the MSK pages on the most popular health sites? What makes the quality of info bad? Is it really? ➡️ This was a long journey, I learned a lot, and it deserves a 🧵 (1/?)

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Seth Peterson

@DrSethPT

3 years

The Myth of Core Stability. An article that definitely changed how I practice. Similarity/context principle should also be in everyone’s mind in rehab

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Seth Peterson

@DrSethPT

3 years

Unpopular opinion?: If you treat people with respect, assuage their fears, empower them, and provide hope…you might never need to explain how action potentials work.

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Seth Peterson

@DrSethPT

2 years

Hypercholesterolemia=⬆️ risk of tendon pathology. Remember just b/c you learned about each system individually doesn’t mean it functions in isolation. ⬇️ Tendon pathology in hypercholesterolaemia patients: Epidemiology, pathogenesis and management

Tendon pathology in hypercholesterolaemia patients: Epidemiology, pathogenesis and management

Tendon pathology is a general term used to describe a group of musculoskeletal conditions related to tendons and surrounding structures. There is only limited evidence available regarding the exact...

www.ncbi.nlm.nih.gov

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Seth Peterson

@DrSethPT

3 years

Since @JAMANetworkOpen doesn’t take letters I’ll make a brief thread on this concerning article they recently published. 1.) “PT modalities” aren’t a thing. The @APTAtweets has made clear that PT is a prof. not an intervention. (1/?)

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Seth Peterson

@DrSethPT

1 year

It’s disturbingly common these days to see notes from other providers documenting that they did full physical exams and when I say “forgive me I’m probably the millionth person to do this” they say no one has done ANY physical exam at all

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Seth Peterson

@DrSethPT

4 months

This is an example of why we need to use our brains in tx. This person had B calcaneal fx and was given ONLY DN for 6 months by her PT. She couldn’t do a single heel raise and now had B Achilles tendinopathy as well. We’re better than this.

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Seth Peterson

@DrSethPT

9 months

I’ll never forget this early career experience: Pt: if I bend my knee (replaced) >90 deg, the patella will dislocate. Me: When was the last time this happened? Pt: A year ago. Me: (dubious, seeing he was fearful) Would you feel comfortable trying it? He does. It dislocates.

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Seth Peterson

@DrSethPT

2 years

Great podcast with clinically relevant information on neurological exam in PT ⁦ @JOSPT ⁩ ⁦ @AnninaBSchmid ⁩

‎JOSPT Insights: Ep 110: Nailing your neurological assessment, with Dr Annina Schmid on Apple...

‎Show JOSPT Insights, Ep Ep 110: Nailing your neurological assessment, with Dr Annina Schmid - Nov 21, 2022

podcasts.apple.com

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Seth Peterson

@DrSethPT

3 years

If you run out of hip motion you don’t “get that motion from the SIJ.” The SIJ moves 3 mm. You get motion from places that move.

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Seth Peterson

@DrSethPT

2 years

⁦More accurate headline: @UHC ⁩ once again develops a program solely to rob paying customers of their existing benefits while claiming it’s a cool new benefit

UnitedHealthcare rolls out new virtual physical therapy program

UnitedHealthcare has partnered with Kaia Health on a new virtual physical therapy program. | The program aims to offer 24/7, on-demand exercise feedback to eligible members with musculoskeletal...

www.fiercehealthcare.com

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Seth Peterson

@DrSethPT

2 years

My impression is that burnout in healthcare isn’t just because of the number of patients clinicians see, it’s the feeling that they have been commoditized and the impression that they are replaceable.

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Seth Peterson

@DrSethPT

2 years

One thing I always thought was over rated is telling patients not to have a pillow under their knee at night. You suffering in pain is not going to help improve your knee mobility. Let’s not throw you being sleep-deprived onto the top of that pile.

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Seth Peterson

@DrSethPT

8 months

This is one of my favorite all-time papers and I will die on the hill that people need better critical thinking and awareness in their practices, not less.

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Seth Peterson

@DrSethPT

2 years

I had a pt who initially wanted to do 0 exercises to self manage her pain b/c of past bad experiences with PTs. So we didn’t. 15 visits in, we finally have a visit where most of her tx was exercise she could eventually do at home. Sometimes the tortoise wins the race. 🐢

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Seth Peterson

@DrSethPT

1 year

I have to admit I’ve probably operated the past 4 years as if TOS and piriformis syndrome didn’t exist and don’t think it’s impacted my outcomes at all. I think they’re probably real but clinicians grossly overestimate how common they are.

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Seth Peterson

@DrSethPT

2 years

@BillingMartin Sorry but this is a horrible take. We can see people with symptoms of CV event (neck pain, headache, dizziness, scapular pain, arm pain, paresthesia.. even back pain) Exercise raises BP. It’s negligent to not assess BP in our role.

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Seth Peterson

@DrSethPT

3 years

This graph should be liberating. There are many ways to help each individual person we see. I also wonder if it explains why all tx effect modifiers come up empty for LBP. It’s a tangled interconnected web and we’re trying to pin it on one thing.

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Seth Peterson

@DrSethPT

2 years

Want to read a case that appeared to fit the “grumbling cauda equina” description? Just published in @JOSPT cases early: Let me break this one down: 🧵(1/8)

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Seth Peterson

@DrSethPT

3 years

@ZoieSheets There’s mistrust for sure, but does it even get to that point? The patients I see usually describe getting zero education from the doc, just a diagnostic label...which they then have to Google.

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Seth Peterson

@DrSethPT

9 months

It’s amazing how many PTs on SoMe that proclaim themselves to be on a mission to fix the profession’s wrongs spend their time just bickering about meaningless stuff and trolling people.

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Seth Peterson

@DrSethPT

2 years

Full article: A call to action: direct access to physical therapy is highly successful in the US military. When will professional bodies, legislatures, and payors provide the same advantages to all US civilian physical therapists?

A call to action: direct access to physical therapy is highly successful in the US military. When...

In 2000, the American PT Association (APTA) published its Vision statement advocating for DA (DA) to PT. This narrative review of the literature aims to identify the current state of DA in the Unit...

www.tandfonline.com

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Seth Peterson

@DrSethPT

2 years

It’s interesting how online PTs like to talk about philosophy and weird cases, but when you go to a course, you realize 90% of the time they don’t even do the basics well.

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Seth Peterson

@DrSethPT

3 years

I’ll say this again - if we are trying to convey the message to the public that we’re smart and skilled do we just think people don’t care/won’t notice they’re spending 75% of their time with techs you taught in a week?

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Seth Peterson

@DrSethPT

1 year

The physical activity paradox summed up in an image 👇

The physical activity paradox: six reasons why occupational physical activity (OPA) does not confer...

Physical activity (PA) is well documented to improve health. However, this documentation is restricted to leisure time physical activity (LTPA; eg, sports, recreation and transportation). Increasing...

bjsm.bmj.com

non aesthetic things

@PicturesFoIder

1 year

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Seth Peterson

@DrSethPT

11 months

News I forgot to share this year: Thanks to @AAOMPT and @JOSPT for the nods. I’ve always held them both in high esteem and hope to continue to contribute and provide what I hope is a valuable perspective as a full-time clinician

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Seth Peterson

@DrSethPT

2 years

A thread on evidence supporting PT being as effective as surgery for LSS: 🧵

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Seth Peterson

@DrSethPT

2 years

Baker’s cyst: not from baking and not a cyst. Spread the word.

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Seth Peterson

@DrSethPT

1 year

I don’t know who needs to hear this (apparently 85% of PTs) but finishing most or all of your notes while the patient is still there is not the ultimate goal

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Seth Peterson

@DrSethPT

3 months

I remember starting my career I wanted to be the best PT in my area and now idk what that even means I like to think I’m better at seeing my blind spots and referring to colleagues who love seeing things I do not Have a culture of referring to other PTs

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Seth Peterson

@DrSethPT

9 months

Congrats to @RGriffithDPT getting the Innovation Award at @AAOMPT for her work integrating manual therapy and top of scope practice in the ED

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Seth Peterson

@DrSethPT

2 years

Refer a person to a pain doctor for an irritable radicular presentation. Says “IDK what’s going on let’s get an MRI” and in the same breath “PT won’t help this.” It’s these interactions that make me just not want to refer to these guys again.

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Seth Peterson

@DrSethPT

2 years

One of the best papers in the last 50 years. Let’s keep in mind pain AND suffering as goals of healthcare and helping our patients with persistent pain, not one or the other.

The nature of suffering and the goals of medicine - PubMed

The question of suffering and its relation to organic illness has rarely been addressed in the medical literature. This article offers a description of the nature and causes of suffering in patients...

pubmed.ncbi.nlm.nih.gov

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Seth Peterson

@DrSethPT

2 years

For those in the back: Pain over the SIJ doesn’t mean the SIJ is causing that pain. If it is and they’re a young male, AS needs to be a top consideration.

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Seth Peterson

@DrSethPT

2 years

Mirroring patient language does something more. If a patient says they have a “walking through quicksand” feeling ask about their “walking through quicksand” feeling, don’t call it weakness or stiffness or something else. It helps immensely to use their words.

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Seth Peterson

@DrSethPT

7 months

Just remember, if you didn’t get what you want at Christmas, it’s probably because your iliopsoas is tight.

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Seth Peterson

@DrSethPT

2 years

Great to see! Stay tuned for a narrative of how a profession evolved from “aides” to diagnosticians.

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Seth Peterson

@DrSethPT

2 years

PTs are like “thankfully the guru era is over” but immediately adopt ideas from their favorite Twitter personalities

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Seth Peterson

@DrSethPT

2 years

What I’ve learned about being a clinician: Don’t try to control outcomes, you can’t fully do that. Just be - bring your best most engaged self to that moment, treat every person with compassion, and never give up on them.

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Seth Peterson

@DrSethPT

1 year

Referral Decision Making and Care Continuity in Physical Therapist Practice @PTJournal @APTAtweets @jheick1 2 concepts rarely discussed in PT. Let’s change that 👇🧵

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Seth Peterson

@DrSethPT

2 years

Any good broad papers on communication basics in PT practice? I keep referencing Maitland just wondering if there’s anything more modern. @Retlouping @MaxiMiciak @JuanLoboPT

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Seth Peterson

@DrSethPT

5 years

Spinal cord stimulators: 3rd most injuries caused by a medical device, over half of people end up having them removed. FDA has 500 reports of death. Why did 6 patients this week say it’s been recommended to them? #pain #OpioidCrisis

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Seth Peterson

@DrSethPT

10 months

This is what I think when PTs keep saying “we just need more evidence and then they’ll pay us more money.” I don’t think that’s how these companies work.

Dr. Glaucomflecken

@DGlaucomflecken

10 months

I spoke with a solo family physician at a conference recently who said he tried to negotiate with UHC for a higher reimbursement and in response, they simply dropped him from their network. @UHC actively works to limit patient access to primary care.

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@DrSethPT

2 years

Something every PT should recognize and be able to provide some education around, regardless of setting or problem

Journal of Brown Hospital Medicine

@BrownJHM

2 years

A patient was referred to the hospital for possible cellulitis. No fevers or chills. Inflammatory markers are normal. What is the likely diagnosis? (Image: Charlie Goldberg) #MedEd

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Seth Peterson

@DrSethPT

2 years

My primer for improving most clinical outcomes: -Focus on the relationship -Drive toward the patient’s goals -Do the basics well -Respond if things aren’t working -Manage the case efficiently What did I miss?

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Seth Peterson

@DrSethPT

2 years

Another paper supporting the idea that mentorship aimed at clinical reasoning actually improves patient outcomes @ShepDPT

Evaluation of the clinical effectiveness of a work-based mentoring programme to develop clinical...

This is the first study that we aware of that provides patient outcomes measurement of an established educational intervention in physiotherapy, providing evidence that this type of intervention...

pubmed.ncbi.nlm.nih.gov

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Seth Peterson

@DrSethPT

1 year

The challenge of #physicaltherapy today: Creating an alliance, performing an efficient exam/diagnosis, and starting a successful treatment approach… In 15 minutes.

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Seth Peterson

@DrSethPT

2 years

I see why some PTs think getting some prescribing authority might be good, but count me in the group that wants us to never have to do that. Calling meds in off hours, elevated risk ($$$), licenses ($), and more ppl in the system prescribing… Nah.

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Seth Peterson

@DrSethPT

3 years

It’s been 20 years and the ICF model is still probably the best model for clinical practice.

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Seth Peterson

@DrSethPT

3 years

We vastly overestimate our ability to change self efficacy, beliefs, and build trust in one visit. This person just met you. They’re testing you as much as you’re testing them.

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Seth Peterson

@DrSethPT

1 year

Lateral ‘hip’ pain? Don’t always blame the glutes…. - BJSM blog - social media's leading SEM voice ⁦ @DrJN_SportsMed ⁩ discussed this today on an online case…

Lateral ‘hip’ pain? Don’t always blame the glutes��. - BJSM blog - social media's leading SEM voice

Part of a new MSK-focused blog series Lateral hip pain is a common complaint in our active patient population. It has certainly become more prevalent during and after ‘lockdown’ as patients shift...

blogs.bmj.com

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Seth Peterson

@DrSethPT

3 months

We have to do the basics better as a profession and healthcare system. How can anything have a chance of working if you don’t even know what makes it worse? (It was gluteal tendinopathy)

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Seth Peterson

@DrSethPT

1 year

The fact that this gets posted every few months on physio twitter should tell us something. It’s one of the most common clinical syndromes and many haven’t even heard of it

Cameron Tudor

@camtudor

1 year

Your rib joints aren’t ‘out of place’. ➡️ Instead consider the Cloward’s referral pattern. Often overlooked. Always check out the neck in patients with thoracic pain.

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Seth Peterson

@DrSethPT

3 years

Part of continuing to improve as a clinician is learning to reflect on the times you failed while also forgiving yourself for the failure.

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Seth Peterson

@DrSethPT

1 year

The frustrating thing about healthcare in the states is that businesses, not patients or clinicians, get the special treatment. Meanwhile people get sicker, providers get burnt out, and our society gets worse. But glad @uhc had a good quarter 🙃

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Seth Peterson

@DrSethPT

2 years

3.) Find mentors and use them Mentorship is part of deliberate practice. We actually need someone else who is more advanced to point out weaknesses we don’t see ourselves. Being uncomfortable means you’re learning. I can’t overstate how important this is.

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Seth Peterson

@DrSethPT

2 years

So PT specialists need to demonstrate competence, including submitting case reflections having continued clinical contact or retesting - but regular PTs just need to show they sat in a classroom once? What’s the overall plan here

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Seth Peterson

@DrSethPT

2 years

My toddler had a tummy ache…so he put a band aid on it 🩹 Whether it’s ritual or expectations, the band aid was doing its magic. Sometimes it’s ok to put a hot pack on or wear a brace—or wear a band-aid—if it gives you some control and let’s you keep being you.

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Seth Peterson

@DrSethPT

1 year

How Stories Help Us See Ourselves: The Power of Storytelling by Physical Therapists 📖 New perspective in @PTJournal 👇

2

10

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