The Rheumatology Physio
@physiojack
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Jack March Rheumatology Clinical Lead - Chews Health & @TPMPodcast Operations Director
Joined February 2014
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Pinned Tweet
I am going to record a Bone Health course
go to to register interest
Covering:
- Factors affecting bone health
- Osteoporosis
- Maintaining bone health
- interventions
- screening/investigation
- other pathologies affecting bone health
- suspecting
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NICE nice summary of the Management of Osteoarthritis Guidelines by
@bmj_latest
I find it hard to disagree with any of it...
A thread of comments 👇👇👇
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386
"What is Primary Raynaud's?"
Lets take a look! 👇👇👇
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What to expect from your Physiotherapy appointment
Sound on
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I have decided this is a hill for me, unpopularity looms in some quarters.
STOP SAYING WEAR AND TEAR FOR OSTEOARTHRITIS.
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I have totally slept on
#WorldPTDay
focussing on
#osteoarthritis
So here is a thread of resources about
#OA
some from me, some from actual legends
🧵 1/
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I would back the average MSK Physio over the average GP for undifferentiated back pain.
Come at me.
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ALERT!
My new look website is up and running thanks to
@HMDigitalGroup
To celebrate, I am giving away my new Rheumatology Clinical Scenarios eBook for FREE for a limited time
Head to click on shop and enter the coupon - free - at checkout and download!
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I am down an osteoarthritis rabbit hole.
"Adipose tissue is an endocrine organ that produces a host of proinflammatory mediators and then releases them into the bloodstream"
Fat cells it seems, are gits.
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So the HCPC will effectively allow, aid and endorse someone being bullied out of the profession.
Good to know.
Who is next?
Right then here goes!!!
So I’ve just received this evening notification of another 3 complaints sent to the HCPC about more so called unprofessional behaviour online that they are ‘investigating’ yet again!
These complaints were all sent during the first week of my hearing in
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1K
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Its
#WorldArthritisDay2021
Here are some Arthritis concepts in the form of bullet points and threads.
Get more detail on my website
1. you don't need imaging to diagnose OA, it's a clinical diagnosis not a radiological one (1)
#WorldArthritisDay
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"Tell the difference between Rheumatoid Arthritis and Osteoarthritis in the hand"
Possibly THE MOST common question I get from all angles...
Normally I palm it off BUT NOT THIS TIME... 👇👇👇
🧵/
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"What are the types of Spondyloarthritis?"
A question asked by email last week.
Principally there are 2 presentations:
- Predominantly Axial
- Predominantly Peripheral
Read on for more detail...
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It is
#WorldArthritisDay
and here is a list of resources to help manage these conditions.
Thread 🧵 1/
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NEW BLOG - Rheumatology Bloods
What are the useful tests when you suspect a Rheumatology condition?
Legend of the blog this week is
@GussieGrips
and music from
@paramore
Plus this graphic for blood result profiles 👇👇👇
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#TherapyLive
COMPETITION
3 Winners getting everything in the image!
Follow and retweet for 1 entry. Find the Instagram post for 1 entry.
Simply visit my Therapy live stand for 3 extra entries!
Up to 20% off Shop:
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Its
#RheumatoidArthritis
awareness week.
Here is a list of resources from me on the topic.
Thread 🧵 1/
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Thank you to
@NICEComms
for reading my tweets and publishing guidance re Osteoarthritis
Again
Diagnose OA if:
- over 45
- activity related joint pain AND
- no or under 30 mins joint stiffness
You DO NOT need to routinely x-ray to diagnose
🧵1/
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This EBook was downloaded for the 1500th time yesterday 🤯
60 pages: 14 clinical scenarios, a self assessment quiz, referrals letter examples...
Name your price: £0+
Grab yours here!
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Said it before and I will say it again...
BMI reduction (in those who are overweight) is easily the biggest bang for buck treatment for OA.
Followed by topical NSAIDs
Weight Loss Slows Knee OA Progression
Declines in body mass index (BMI) were linked with slower worsening of knee osteoarthritis (OA), according to data from three large longitudinal cohort studies.
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THE BEST EXERCISE FOR OSTEOARTHRITIS!
I found it, I looked through them all.
- Backwards walking
- Yellow Theraband Knee Extensions
- The others
Read on to the end of the thread to make sure you get the information
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"How do I differentiate Osteoarthritis and Rheumatoid Arthritis?"
The most common question I get.
It is not a good question.
So what is a better question?
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As promised!!
My RA and Joint Dysfunction article is now FREE to download here:
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I have received a few emails asking about tools to help with Rheumatology, so here they are in a thread.
And a picture of the Belgian Waffles I ate yesterday for attention
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It's
#WorldPTDay
all about inflammatory arthritis
Why not check out some of the work I have been doing for the last 7 years (ish) about these conditions!
Find everything here:
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Hey podcast fans.
Me and
@MRheumy
thought the market wasn't saturated enough so we recorded talking about the complexities of Spondyloarthritis.
Oh it's got a solid name too. Find it by searching in Spotify, Google podcasts (and soon iTunes)
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OSTEOARTHRITIS COMMUNICATION
This comes up so much
How do we discuss Osteoarthritis mechanisms, risk factors, treatments and so on?
I wrote a bit about it to explain how I go about it with examples
Link in image
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Spondyloarthritis Nomenclature!
I have had a few questions through my site in the last week about types of Spondyloarthritis so I thought I would repost this blog along with a new "Spondyloarthritis Symptom Profiles" Graphic
Read the full blog here:
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Turns out...
I passed!!!
I think I am now a diplomat?
Kudos to
@rob_chiro
who scored better than I did... I think I have to give up my HCPC reg now
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The suspense is over!
Here it is!
A clinical tool for suspecting Rheumatoid Arthritis!
(Free) download here:
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#TheBigRs
WOAH WOAH.
@AnninaBSchmid
just said that it is prognostically better in Sciatica to have muscle strength DEFICIT.
MIND BLOWN.
I don't know who I am anymore
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Delays in diagnosis of AxSpA is average 8.5 years.
Here are some of the delays that occur in my experience
None exhaustive list, in a roughly chronological order and won't occur in all
No blame! Just listing them out! 1/5
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The MSK Playbook: Chondrocalcinosis Pathway
The forgotten crystal arthropathy; Metabolically driven or just an incidental finding?
Was delighted to be asked to be a part of this
@BJSM_BMJ
blog
Read here:
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The Arthritic Hand
Here is a graphic I made for a presentation slide deck. It's a simplified view of course but had some nice feedback about it.
Thoughts?
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OUT NOW - Axial Spondyloarthritis In Sport and Exercise Medicine with
@DrJN_SportsMed
The title says it all really!
Listen:
Watch:
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Prognostic Factors of Axial Spondyloarthritis (AxSpA)
Thanks to
@DerekGriffin86
@pdkirwan
and
@DrJN_SportsMed
for pushing for this thread.
Remember AxSpA can vary greatly from person to person, and several factors can influence outcomes
Read on for details!
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NEW BLOG ALERT
Osteoporosis - An Introduction for Physio's
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I was in
@Telegraph
today with an article on Physio for arthritis...
Thanks to
@MediaplanetUK
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Draft NICE guidelines for managing osteoarthritis (paraphrased)
- if using opiods use them short term
- use topical NSAIDs preferably over oral
- paracetamol doesn't do much
Media: NICE SAY NO PAINKILLERS, EVER, FOR ANYTHING
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We are always quick to point out iffy practice so in the interest of fairness...
I triaged a referral today that contained a B6 physio's clinical notes. They were exemplary with concise, sensible clinical reasoning and a clear request.
Made my job easy.
Thanks anon B6 PT 👏👏
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VISCOSUPPLEMENTATION for
#osteoarthritis
Hyaluronic Acid (HA)
Just listened to
@jointactionorg
👏👏👏 discussing this systematic review
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Can I deadlift 2x my bodyweight
No
Yeah but can I run 10k in under 60 mins
Also no
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Due to Social Media pressure I am running a FREE webinar on Connective Tissue Disease for MSK Therapists 24/05/2023 @ 20:00
Register (its the top link):
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Dear
@KMiddletonCSP
@thecsp
I think the whole of
#TheBigRs
conference would join me in asking.
Please give
@OngwenMartin
a free ticket into
#PhysioUK
If anyone in the world deserves a leg up it is him.
@AdamMeakins
@JackAChew
@ShoulderGeek1
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I had a lapse of judgement and mentioned fibromyalgia on tiktok. A selection of comments:
- it doesn't exist
- it's always caused by magnesium deficiency
- it's always caused by tight pecs
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Ask and you shall receive...
"Polymyalgia Rheumatica" on my blog, a guide on recognising and managing for Physio's (and other AHPs)
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EXCITING NEWS
The proof copy has arrived, a couple of small formatting changes and removal of a couple of rogue full stops and it will be ready to dispatch next week!
Get yours here:
Preorder discount PRE1 ends 04/05/20 17:00 BST.
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NEW BLOG ALERT!
"An Introduction to Rheumatoid Arthritis for Therapists"
The start of a much longer series, looking at all aspects of RA for Therapists, feedback very much appreciated, also topic suggestions or reading materials!
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Feel like I have been hit by a bus but the outpouring of support for our team during yesterday and continuing today is absolutely incredible and reminds me why we put ourselves through it to try and help MSK professionals.
Thank you ♥️
@TPMPodcast
@JackAChew
@felicitythow
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"Manual Therapy For Ankylosing Spondylitis?"
There are different types, let's discuss them:
Read on for more 👇👇👇
#ankylosingspondylitis
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I have FINALLY gotten around to redesigning my "Suspecting Rheumatoid Arthritis" doc!
It no longer looks like a fruit cocktail from an all inclusive resort.
I will sort it as a downloadable PDF next week but for now...
👇👇👇👇🧵
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ANNOUNCEMENT!
New At A Glance Booklet is available for pre-order!
Lumbar Radicular Syndromes - By
@adamdobson123
10% off on pre-orders until 08/03/22 so take advantage!
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Exercise and AutoImmune Diseases
I will get into this in detail so watch this space.
- Regular Exercise IS anti-inflammatory
- Acute effects of exercise are NOT anti-inflammatory
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You don't *need* an X-ray to diagnose Osteoarthritis
It's also a clinical diagnosis not a radiological one
Radiological findings support your clinical diagnosis and there are false positives and false negatives
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- Weight loss seems to help people with Osteoarthritis
- Weight loss is difficult for various reasons and a challenge to maintain
- Fat shaming is not a good idea
All of these things can be independently true AND interact with each other
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Hope to see people at my talk on Rheumatology at 0915 on Friday :)
Also exciting news...
My stand will have exclusive discount to my entire shop AND first access to...
The Hand At A Glance! Content by
@handphysiodebs
&
Rheumatology ONLINE Course
Grab one at
#TherapyLive
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Recording of my Fibromyalgia Webinar from last night is now up on YouTube.
About 400 registered for this one 😎 need to decide on next months topic
Recording will stay up for about a week
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NEW BLOG! OAvsRA...?
How do we distinguish or should we just put this question to bed? (Spoiler, ask better Questions)
Legend of the blog -
@erikMeira
Music from
@BillyTalentBand
Text here:
Podcast here:
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Not sure what's gone on with NSAIDs and fractures but short courses are fine.
Fractures hurt, non-union is complex relating to bio and social factors
Consider NSAIDs in acute fractures please.
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Perceived/measured "hypermobility" is not automatically problematic and is sometimes advantageous.
Generalisations based on assumptions are problematic.
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"Can
#Osteoarthritis
flare up?"
If you think
#OA
is a simple condition then please come out from whatever rock you are hiding under...
Read on for more 👇👇👇
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"Why do we need MRI STIR images for Axial Spondyloarthritis?" (And what on earth are they)
Cards on the table I had to look up some of this 😆 I am not an MRI Physicist.
Let's have a look! 👇👇👇
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Metformin might prevent Osteoarthritis!?
Stick that in your wear and tear pipe and bin it
(Loads more research needed)
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"What are shiny corners on MRI?"
This keeps coming up so let's have a look... 👇👇👇
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Modelling my new t-shirt courtesy of
@DrJN_SportsMed
In the words of Gimli son of Gloin "It's a little tight across the chest"
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NEW BLOG : Hypermobility, Instability Misconceptions
Have seen a number of misunderstandings across social media recently and hope this clarifies some of them.
You can also see me do pushups on my very hyperextended MCPJs...
Video and text here
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NEW MINI BLOG "Diagnosing Fibromyalgia"
The slides from a recent seminar I gave outlining the diagnostic criteria for this condition. Hope you find it helpful!
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X-rays for Osteoarthritis
Never ❌
Always ❌
Sometimes ✔️
Clinical Reasoning ✅
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"Should I xray for gout?"
Reminder: Gout is caused by the accumulation of urate crystals in the joint(s)
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I found these around the house and I have been told to "get rid of them" so...
Retweet this to be in with a chance of being sent one! There are 11 items here so 10 winners will get something!
Find Facebook post and Instagram for extra entries.
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Sometimes I use the phrases
- you have the back of a 283 year old
- that is the worst knee in the history of knees
And
- discs are like a tasty ravioli that's cooked aldente
Because they save time and it's easy.
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You can call me names and stuff, offensively sub-tweet or DM me whatever.
But do not. I repeat DO NOT.
Say Osteoarthritis is "Wear and Tear"
It's disgusting behavior.
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"What Are Adipokines?"
These Cytokines are secreted by fat cells and play a role in regulating various bodily functions.
My niche interest in them is their influence on the inflammatory system and driving Osteoarthritis
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"Is it
#osteoarthritis
flare or
#gout
of the 1st MTP joint?"
A common question, let's explore the answer 👇👇👇
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"What is Secondary Raynaud's?"
Yesterday's thread on Primary Raynaud's rather went off.
Well, I assume it's different to Primary but let's check... 👇👇👇
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"What is Rheumatoid Factor?"
Other than pretty much a question certainty on my courses...
Rheumatoid factor (RF) is an antibody that is produced by the immune system. It is typically present in the blood of people with
#rheumatoid
#arthritis
(
#RA
)
Read on for more...
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Osteoarthritis as more than "joints wearing out" seems to be popping up so I am riding this wave having been promoting that approach for a while
An Osteoarthritis resources thread 🧵 (containing me obvs)
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NEW BLOG: Polymyalgia Rheumatica - Update
Thank you so much to
@profbdasgupta
for his excellent webinar, he has more to come so follow him!
This blog looks at recognising this challenging condition for us MSK therapists
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NEW PODCAST - Axial Spondyloarthritis in Primary Care with Dr Louise Warburton
Everything you need to know in Primary Care! Bloods, imaging onward referral and more...
Thank you to
@NovartisUK
for sponsoring this series
Audio and video links:
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For those asking, yes there is a picture of me from 2005 when I started my physio degree.
And yes, I was asked to cut my hair before going on placement in the name of professionalism
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Sorry but weight-loss is looking more and more like first line treatment for OA...
(In overweight individuals before anyone starts 😬)
(And exercise would help that goal...)
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Oh wow, the hardcopies of "Rheumatology Clinical Scenarios" just arrived and they are:
1. Gorgeous
2. HEAVY
eBook and wiro book (pic) here:
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BACK BY POPULAR DEMAND
Introduction to Rheumatology Red Flags - for students/new grads and anyone who wants a start in recognising Rheumatology
29/09/22 - 20:00-21:00
From £0.00
Tickets:
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My Rheumatoid Arthritis lecture is now live on
@TrustmePhysio
There is a trailer and you can sign up on this link
There are tons of other lectures on there too!!!
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Polymyalgia Rheumatica
Really misunderstood symptom presentation leads to it being both over and under diagnosed...
Watch here:
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Me when someone diagnoses Osteoarthritis with only an xray
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HAEMACHROMATOSIS
Maybe up to 10% of people carry the gene that cause it but we are only interested in the few that develop Iron Overload...
👇👇👇
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Does anyone else's day job get in the way of their CPD desires?
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