Evidence Informed Physical Therapy with Dr. Jason Silvernail

Why is "conservative care" treated like the alternative, while surgery is the default setting? 🛑In this episode of Untold Physio Stories, Dr. Wells shares a case of a patient that highlights exactly what is broken in our healthcare system.The patient reached out with a simple, heartbreaking question: "Am I getting the right care?"Here is the patient's timeline before ever talking to a PT:The Scan: Went in for low back pain, immediately received a scan.The First Surgery: Based on the image (not the function), they operated. It failed.The Second Surgery: The surgeon’s solution to the failed surgery? Cut again.The patient eventually made his way to Dr. Wells, but asked him, what do you think of the recommendations I've been given so far?Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

When an acute ankle sprain hobbles into your clinic, do you treat them all the same? 🛑If you treat a high ankle sprain like a standard lateral inversion sprain, you are going to flare that patient up. Fast.In this episode of Untold Physio Stories, Dr. Sean Wells and I break down two very recent, very acute cases that walked through the door.Case 1: The Classic Lateral Sprain.Patient presented with immediate swelling and loss of ROM. We discuss why checking the distal fibula for positional faults immediately can restore movement before they even leave the table.Case 2: The "Combo" (Lateral + High Ankle).This one is tricky. The squeeze test was positive. Dorsiflexion was painful and limited. We break down why you have to stabilize the syndesmosis differently than you treat the ATFL.In this episode, we cover:💥 Manual Therapy in the Acute Phase: Yes, you can touch it! We share the safe MWMs to regain dorsiflexion. Plus bonus - e-stim combo for early WB💥 Taping Strategies: When to use a fibular repositioning tapeStop guessing with acute ankles. Assess the mechanics, classify the injury, and load them appropriately.Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Dr. E here with another asynchronous episode of Untold Physio Stories, featuring the great Dr. Wells!We're diving deep into the trenches of chronic elbow tendinopathies, specifically lateral epicondylalgia, and the surprising speed of response in a couple of recent patient cases.What We Cover in This Episode:The Power of Length and Load: We revisit the concept of using isometric contractions in a lengthened position (70-80% MVC) for superior tendon loading, inspired by Dr Michaud's excellent tendinopathy article.Dr. E shares a recent article on LinkedIn by Dr. Malliaras showing that this position creates significantly higher tensile force in the tendon compared to concentric/eccentric exercises, making it ideal for remodeling and managing inflammation.Case 1: The WFH Warrior (Lateral Epicondylalgia): A work-from-home patient with bilateral elbow pain from excessive arm raises found complete symptom resolution in just two weeks using the lengthened isometric contraction technique (wrist flexion, pronation, resisting extension). We discuss why this response was so much faster than typically expected for tendinopathy. Was it pain modulation, a true strength issue, or something else?Case 2: The Chronic Tennis Coach: A long-term case of lateral epicondylalgia that didn't respond to the initial lengthened isometric program or even repeated cervical retractions. We explore the eventual success with a Mulligan Mobilization with Movement (MWM) technique (lateral ulnar glide with gripping/wrist extension), highlighting the sometimes-necessary shift from exercise to pain-modulating manual therapy before resuming loading.The Big Question: Dr. Wells and Dr. E debate the varying patient responses, the balance between mid-range vs. lengthened loading, and why these tendinopathy cases can be so unpredictable. Dr. Wells also shares a cautionary tale about an athlete who didn't respond to conservative care, ultimately revealing a significant tear.🔑 Key Takeaways for Rehab Pros:Don't underestimate the loading capacity of isometrics in a lengthened position for tendinopathy—it's backed by science to create high tensile force!Always rule out or treat the cervical and thoracic spine, but recognize when a tendon needs direct, aggressive loading or a different form of pain modulation (like the Mulligan MWM).Be ready for the "Mulligan Miracle" and keep those MWMs in your toolbox for instant pain relief that allows for better, deeper loading later.The path to resolution is rarely linear—different athletes and presentations require different starting points.Listen to the full episode on your favorite podcast platform and let us know your experiences with lengthened isometrics and Mulligan MWMs for those tricky elbow cases!Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

You know I preach the Eclectic Approach and empowering patients with Self-Treatment Strategies... but this one was straight out of the McKenzie Method textbook, almost too good to be true.I recently saw a PT with a five-year history of chronic LBP. He initially felt better with extension (press-ups), but that eventually faded and his flexion became painful and limited.Then, he started noticing something crazy that you parents will understand: every time he'd bend over to put his 5-month-old in or out of the crib (a repeated flexion activity!), his back pain got better. Even more so when he had to lower the crib level! 🤯Could this be the Unicorn of LBP cases: a Flexion Rapid Responder? Or what McKenzie would call an Anterior Derangement? They're rare, but they exist! (I've only seen three in my career!)My co-host, Dr. Wells, and I dive deep into:🔄 Testing the Hypothesis: How repeated movements back and forth confirmed the directional preference and how extension blocked flexion in this case.🤸 Hypermobility & Over-Pressure: How the patient's extremely flexible hips required creative manual therapy to truly hit end-range lumbar flexion for effective treatment.📚 Dosage is Key: The critical difference between sporadic relief and a proper dose of 10x/hour to achieve lasting change.🚫 The Flexion-Extension Pitfall: Why so many patients (and even clinicians!) negate the positive effects of a directional preference by constantly trying to "even out" or "loosen up" their back with the opposite movement.Tune in for the full case breakdown! And hit the comments—what are your thoughts on this Flexion Rapid Responder? Have you seen a case like this?Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Is your e-stim unit just gathering dust? 🤔 Or are you still just using it as a passive modality?What if you could turn e-stim into a powerful active treatment to get even better outcomes?On the latest Untold Physio Stories podcast, I had an awesome chat with Dr. Sean Wells.We break down exactly how to stop just placing pads and start driving activation. ⚡️Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Why do some patients struggle with their home exercise programs, no matter how simple? It's a question every physical therapist faces. In this episode, we're joined by Dr. Sean Wells to unravel the complex issue of patient non-compliance.We explore the "5 Whys," a powerful yet simple technique borrowed from industrial problem-solving, and adapt it for the clinic. Learn how to peel back the layers of a patient's excuses to uncover the true, deep-seated barriers to their recovery. This isn't just about adherence; it's about fostering genuine, lasting motivation.In this episode, you'll learn:What the 5 Whys framework is and how it helps you look beyond surface-level answers.Practical tips and phrasing for asking "why" without making patients feel defensive.How to use the root cause you uncover to create a truly collaborative and effective plan of care.Real-world case study of how this technique transformed patient outcomes.Stop the cycle of frustration and start building stronger therapeutic alliances. Tune in to discover the questions that could change your practice.The article referenced by Dr. Wells is here.Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Dr Wells and Dr E talk about feet, toes, cases, exercises and more. Specifically we coverzero drop shoes, should everyone be in them?toe spacersThe Toe Pro Exercise deviceand more! Let us know what you think and if you have any questions/comments.

Dr Wells reviews a recent case of acute post op ACL repair. May be old hat for many, but neither he nor Dr. E sees post op in their practices. What was surprising to Sean was that the surgeon called for 1 week of complete NWB. Sean did research and was surprised at the amount of variability in many ACLR protocols. They also discuss lifestyle medicine and other rehab topics.What do you do when a post op protocol seems outdated?

In this episode, Dr. E is joined by Dr. Chance Unger. Chance discovered his passion for running in college and found as a DPT, he had a unique ability to help those that needed to keep their passion going. You can find Chance's amazing resource on running here or go to his websiteUntold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Dr. E is joined by Dr. Joe Simon. Joe talks about watching the PT profession change and grow over 20 years and how many of us are struggling. He wanted to use our unique contact points and relationship with patients to give PTs an opportunity to be paid for referring for second opinions. Sign up for early access to his platform which is going live soon here.Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com