Nick Allen
@snickalous
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Remains passionate about MSK but not too seriously. Raising boys. Outdoors and cricketer.
Buxton, England
Joined May 2014
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We are fucking mugs in health care.
We are smart and kind, capable and driven and do important work.
My brother has just employed a new girl from school to do menial work on a waste water site. £500 a day starting aged 19.
We are fucking mugs in health care.
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MSK 🦴 made easy
🕰️ Time is the healer
🥶 75 year olds don’t get frozen shoulder ( it’s OA)
🦓 It’s usually just OA
🧲 MRI are not evil
🙌 💊 don’t miss inflammatory conditions
🥱 and yes yes antibiotics can cause tendon pain.
Call me if you want a job
Pill
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@vicderbyshire
We did exactly this ... and we stayed at home and coped!! Two kids .... we were prepared. It was tough. Our parents live 3 miles away. We did not see them at all.
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@damekellyholmes
You do know that any force your therapist is applying there is far far less than you doing so with gravity. This is utter snake oil nonsense
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@ttvlifeoftiger
@PatrickN1502
@nytimes
Guess what happened in Australia after they banned guns. No school shootings there after. Very strict gun laws here in UK, not a massacre in decades.
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Wee case study. Asked to see a 73 M a few weeks ago as a favour from a friend on a Sunday afternoon. He had been very well with no health history and was very fit. He was being discharged from hospital - 1 night stay as off his feet- sent home with a Zimmer frame no less 🤦🏻♂️
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@mollygiles2015
Ian Austin is the sort of hypocritical scumbag who will happily sell shitloads of sophisticated weaponry to Saudi head-choppers so they can blow up buses full of Yemeni schoolchildren, then accuse Jeremy Corbyn of being a terrorist sympathiser because he talked to Sinn Féin.
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🚨 😡 Utterly Despondent 😡🚨
Pitch side today. Dangerous tackle on a 17 year m. Long story short. Posterior GHJ dislocation likely. Frank sensory loss bilateral arms, no motor loss. Spinal pain +++. Concussed +++. This chap was taken to hospital in a Ford KA by his mate because
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I’m banging this drum again.
Before you send your chronic pain, slightly auto immune patients into the forever of pain management, FMS, nothing we can do dungeon.
Check their b12 and then don’t believe any serum b12. Make sure folate is in the top 3/4 of its range.
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I received this email yesterday for some private work. What. Is. Wrong. With. People?
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@Mike_Fabricant
He’s on a soap box in Trafalgar Square you bloated Jaffa sponge. No secret here! Jog on
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@Gadzooooooks
@SimonJonesNews
Then don’t vote Tory! Because they are the reason for your health waits.
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My take home was simple. If it feels wrong it likely is. Be an advocate for your patients. Zimmer frames on discharge 🚨
His communication delays really had me concerned from the get go.
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How lucky to live in the
#peakdistrict
A return to running with
#AS
has defiantly made my pain far worse but my life far far better. 50 miles in Feb
#lunchruns
#lessonlearned
#ankyspond
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@damekellyholmes
Respect of course. The problem here is that this is totally unrealistic treatment for the general public. It’s base in science is none existent. I’d suggest that your hard work and natural history helped your gold medals not cupping and passive therapy.
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999 did not deem this bad enough for an ambulance. On a fucking spinal board. What fucked up algorithm goes here!??!. How does that stand up in court but more the point. Poor guy!!! I was incandescent with rage with the people in power who have led us to this. Not good enough
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7 months post TKR my dear old mum had returned to walking her regular 12 mile walks, 24 mile rides and has lost 3 stone. Knee replacements when truly needed can be life changing. Thanks
@manchesterknees
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45 year old with 3 years ‘none specific lower back pain’ seen in pain team after rehab had not helped. No clinical features of hip stiffness and mainly buttock and lower back pain. A specific problem there was.
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I’v said it before but... my clinic room is better than yours!
@DCHStrust
#physio
#msk
#wintersun
#peakdistrict
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@acweyand
Wooah! Used to treat these on burns ICU. CRAZY condition. What did you have a reaction to? Abx? Glad you're OK!
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Referral letter from a private physio today. Diagnosis: Tx impingement ... ya wha?
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I have been on a pseudo science autoimmune paleo diet for 4 months now and I’m symptom free from all AS pain. First time since my early twenties having tried everything, it’s quite extra ordinary.
#AS
#cuppingnext
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🌟 Interesting case/ scenario 🌟
20yr F presents to community physio via primary care ref with 5/52 h/o LBP intermittent mild incontinence and vague saddle anaesthesia. No other PMH or neuro but she is 28 weeks pregnant. What do you do?
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21 yr M with 5/12 h/o lateral knee pain atraumatic. No rehab no imaging no red flags.
Injected in first consult with private physio with HLA.
This feels very very wrong to me.
Now referral to MSK for MRI as no better. …
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Defiantly getting better
Having suffered a grave b12 deficiency and lasting peripheral neuropathy. I would usually be training for the coming cricket season. This year I’v taken to paining. It’s been a Tonic
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I can not stand profiteering in health care. Dear Orthopod, billing a lady at the end of the session without her knowing the cost prior. £950 for a SAS CSI that lasted 3 days is totally and utterly immoral. Bastard 🤬
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Thank you for your clearly well meaning referral and work up. But there really is no need to USS an 85 year olds shoulder with severe limited arom in case there’s “rotator cuff syndrome” sigh
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@Martin_Nekkolai
I once referred to a gentleman’s wife as his mother for the whole 30 minutes. They said nothing until they left holding hands. Fuck me i still wet my knickers about to at now.
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I’m very much with Evie here and I’ll share a personal tale that highlights her insights.
Last year I developed severe neurological symptoms. Left sided sensory changes, ataxia, awful cramping and a very ugly feeling of dread.
After a conversation with a GP who reassured me
"Against Reassurance" 😈
Seriously though I'm against physios "doing reassurance"
1. You don't know whether the patient should be worried
2. They're probably not concerned about the thing that YOU think they're concerned about.
(Spoiler alert: they already know it's not cancer)
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Weak shoulder ++ no neurological issues. Previous breast CA. Discuss X-ray
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Phone call to paramedic after I injected her wrist for CTS. +Durkans +Tinnels, 75% Betterand very happy. Work have sent to rehab physio (private) who said it’s not CTS but cervical. And that the injection would have settled the nerve root! FUCK. OFF!
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Iv been saying this for a while now. If you’ve not read this, do so. It’s the most incredible book on general health. I double dare you.
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My mum casually just announced at the dining table that her grandma was Sir Mat Busby’s house keeper and then.... pulls out a football signed by all the busby babes!!!! I mean I really don’t like football but that’s pretty cool!
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WHAT is the obsession in physio land around scanning. It baffled me 15 years ago. It baffles me now.
Stop debating it. Flaunting it. Discussing it and go get a life!
There is a big old world out there. Mostly full of cool people who don’t give a shit about MRI scans.
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@benedsmith
@consultantPT
And the evidence for the effectiveness of a hug, or a walk in the sunshine or a good piece of music. God physio has become sterile with black and white idealism. Who cares about tape... good work Uzo.
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I get asked why I travel so far for work. It’s so these guys don’t have to travel to get to these places.
#peakdistrict
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@pdkirwan
@physiojack
@drjrees
@TendonGlasgow
I had bilateral heal pain at 14 -
Back pain at 16- qualified physio aged 21 - severe symptoms on and off - put down to chronicity- no one listened to me- ESP physio in rheumatology and MSK for 10 years. Diagnosed AS aged 40! What hope to folk have!!!! Must do better
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Can clever folks explain this to me? WB X-ray. Just a nine radio graphic spacer?
@hjluks
@ShoulderLondon
@DickyShoulder
@OrthopodReg
am I being really daft?
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24 hours post op. 4 days from being admitted to HDU with Sepsis and 11 weeks post Webber a # time to squad (badly) treat thy self
@physio
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“Please fast track this pleasant gent whom I believe had pseudo cauda equine”
Good grief. I thought I’d seen everything.
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The meaning of life: your kids and being kind to others. It is really that simple. Everything else just slots into place there after.
#meaningoflife
#kids
#love
#family
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You can’t be a dad without kids. And mine are the best in the business. 🥰😇🥳😄😎🥸🤩 (emojis curtesy of the eldest)
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Isn’t
#physio
wonderful. I treat many fell runners. One particular one has been having Tib Post issues for 18/12 with confirmed tendinopathy on USS, clinically tendinopathy. 5 sessions in 18/12 education, load management, tendon rehab, gait stuff bla bla bla. Not one bit better!
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@afneil
Serious question Andrew, do you really believe JC is anything other than a principled peace activist?
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I had a french lady in today. Her interpreter didn’t show so we just parl’ d’frances. French is so much more descriptive of pain. It was wonderful to hear. Felt like we both understood more after the consult. She even taught me a new phrase. Ras -de- Bol “totally fed up”
#oolala
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I’m just back from a clinic in MSK land. It’s been a blast. We started the morning off with the usual Sherry snifter. 11venses brought about a new experience in a few Old fashions and a lovely chianti. Lunch came as went with a bottle of decent fizz. Post work gin and all is good
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@ethan_wusu1
@StatisticSingh
@tominfrance
@theresa_may
But that’s literally ridiculous “ I understand we are worse off but we voted out so out we must go ”
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68 m none traumatic medial knee pain. Severe++ sudden onset. Clinically OA flare. Stopped golf and struggled with rehab. Meniscectomy ‘90s. Spot anything unusual?
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Yesterday’s pt. F 47 with T2dm hypothyroid & PCO. Left Ulna palsy at hand. Things local quack didn’t consider. Compressive neuropathy - elbow, Wrist. Terminal plexus, cx radicular, UMND, metabolic. ( long list here) Things were considered ... trigger points. ...for 6 months 🤣
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Thanks team Notts
@Lauren_Turner6
@JoeWaldman3
@Linds200
@Neil_Marshall1
@grant25716784
@HenryWathen10
@physio_alec
@DaniBrailsford
y’all know me well. It’s been a blast. Best job I ever had!
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@doctor_oxford
@Retlouping
@Retlouping
have you read the article? It’s silliness.. xrays for LBP, mri for knee oa, arthroscopic knee surgery. All this stuff should NOT be happening. This is good clinical governance not money saving
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Kids used to love me playing nursery rhymes. Now they like Pokemon 😞
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Ongoing index finger pain. No known inflammatory disease. Historic b12 deficiency. Didn’t expect that!
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@Antco57
@YvetteCooperMP
It’s their right under uk law and Genova convention. Welcome to Brexit and taking our borders back. Government fault no one else’s.
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Your yearly reminder. DO NOT miss Bennetts fractures. They are life changing injuries when poorly managed. Axial load, pain severe and not improving and can look normal on xray. Listen listen listen, get three great views on xray and MRI if in doubt. BUT DON'T MISS UM!
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Happy weekend muckers. My littlly loved the windy and wet this afternoon
#peakdistrict
#roaches
#getoutside
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Honestly all the gym stuff, posh equipment, fancy exercises, perfect form... it’s so silly. Iv watched my 70 year old dad today (retired builder) lift 2x 25 kg bags of sand all morning with zero form and zero effort.
#gymsaredaft
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@DrLucyDouglas
@jackconran8
@FCPphysio
@DrJN_SportsMed
@SportDocBedford
@adamdobson123
P- regnancy
O- ral contraceptive pill
M- enapause
E-ndocrine. Acromegaly, HypOthyroid, DM
G-out
R-enal. Nephrotic syndrome, renal failure (overload), haemodyalisis, AV fistula (blood steal)
A-myloid. MM
N-europathy. pressure palsies
A-rthritis
T-rauma
E- xtras. TB, Sarcoid
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@dr_irfan_malik
Not rubbish at all. What In gods name do you need knee mri for in primary care? I’d say 80% of requests from primary care for mri are inappropriate.
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It was directed at me, it was put on me that “all was ok” when I really never thought I wasn’t, I just wanted help - not to rule out sinister but to help my symptoms.
Listen up folks. Evie is wise here.
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R/v a patient after6/52 in our gym classes. X-ray severe degen +sclerosis. Poor gait. A summer of gardening awaits and no TKR now! Result!
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Thanks to
@HelenRobson19
@Neil_Marshall1
and gang today. Clear, professional and well delivered transition session over to new clinical software.
@Connect_Health_
have some serious clinical clout in their midst.
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@AdamMeakins
Key is to just be a bloody human being and stop this power trip holier than thoust bollocks. Talk to people like they’re your family, like they’re youre son or daughter. Talk like a human and then you won’t have to worry you’re saying the wrong stuff.
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📝 Wee little case study 📝
Some system thinking in MSK🦴 💩
58y M presents after 9/12 hiatus with reoccurrence of right arm pain. Radiation from cervical source. Degenerative. Mx well with pregaband rehab. Was well other than arm pain in previous session. Kidney transplant
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We saw some of the Wakefield lot doing pistols and found out we have a beast in central team
@Connect_Health_
@DaniBrailsford
@stevenawoor
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We agree no more paid sessons as not getting anywhere. We remain friends. He’s tells me today. He payed for a session of instrument assisted massage on his tendon and he’s 100% fixed after one 1/2 consult and back running full pelt! 🤯🥳🤣🤦🏻♂️
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@DrLucyDouglas
100% .. it’s a vanity project gone south and it’s totally not working. Creating more work, longer pathways, and awful referrals into MSK services. Self referral into community msk services and hubs. Take MSK away from primary care.
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@consultantPT
@thecsp
💯 it’s not good enough to stay neutral on this matter. The right side of history will be judged. As humanitarians we must call an end to hostilities especially those that are tantamount to genocide.
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Jesus Christ. Why do we put up with it. How can anyone afford this!?
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@BillingMartin
Please call my receptionist to put you on the 7 week wait list or have you considered a steroid injection 😂😂🤣😇
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Occupational health showing how to be at work when still in a sling.
#practicewhatyoupreach
#clinicalcave
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