The Bigger Picture

@Jonathan Edwards

This is a little off-topic but I have been trying to figure out something my neurologist said to me at my last appointment. For some years now I have been experiencing pain and muscle weakness in my left leg (theweakness becomes very apparent on inclines & stairs) and after tons of testing we have concluded that it is most likely sciatica caused by tightness and/or inflammation of muscles in my buttock (piriformis syndrome?). When I asked my neurologist how the sciatica could cause muscle weakness in my leg he said that it was probably the pain causing the weakness. Would this be the same mechanism your talking about? I've tried researching it online and haven't been able to find anything. How does pain do this exactly and is the weakness reversible?

 

I have never been sure if performs syndrome is a real thing or a physio's invention but never mind. Pain from pinching the sciatic nerve can certainly cause a functional weakness. It is reversible in that the muscle is OK and will work once the inhibition by pain settles.

Pain inhibits muscle action all the time. If you have a sore thumb joint you will find you cannot grip with it. If you try and walk on a sprained ankle it will give way. What is less obvious is that the nervous system blocks the muscle action at the reflex level in the spinal cord even before the pain has reached the brain, so it is involuntary. In some cases you can overcome it a bit by bearing the pain but it is pretty impossible to produce a normal muscle contraction.

 

Interesting that this conference was courtesy of the Novartis Foundation. That ten must be considered to be broadly the same organisation as the CIBA Foundation, and we know what we have to thank them for.

 

CIBA renamed itself Novartis some time around 1985-2000 - I forget exactly when.

 

There is a strange congruence to this. 1993 was the year of the damaging CIBA conference and also the year when plans must have been put in place to employ LoCascio as an advisor, and lo and behold, here he is, cent,re stage in the photo of the Novartis conference, designed to further the political objectives even further.

I do wish MPs could call for evidence from Peter Lilley and Mansell Aylward about what really went on.

 

I just read this thread @Jonathan Edwards and I would like to comment on your initial post about GP being gatekeepers but not helpful in advancing science or even giving care for that matter other than giving vaccines, performing physical exams and prescribing meds that relate to general health (anti-depressants, sleeping pills, simle course antibiotics, blood pressure, etc...

Our health care system here in Canada is moving towards team based primary care where the GP will work with para medical professionals (physio, social workers, dieticians) more closely with the goal of preventing patients from accessing further more specialized and costly) care. They simply want to insert further hurdles for patients to access appropriate care. I can see them forcing patients into chronic disease management as part of treatments but veering away from the science and understanding the disease as a single entity and instead calling everything ’chronic illness’.

Also in the news in Canada there was discussions surrounding the ‘1 problem per visit’ rule that many GP adhere to and which is quite detrimental to so many living with several problems that require attention. There are ethical issues surrounding that. Eyedropper approach to health care if you will...

 

Exactly as in the UK. What they do not seem to understand is that this is not just bad care, but it is almost certainly much more expensive because it involves employing a lotto unneeded professionals and the delays in referral will make treatment more expensive when it actually comes to being provided.

Unfortunately all political parties have got sold on the idea that focusing on primary care is good practice. The good news is that in the provinces in the UK the primary care system is so obviously collapsing that it is rapidly being replaced by generalists working in hospitals, providing a hospital based primary service. So reality is overtaking the politics. Hopefully one day the administrators will realise that their emergency stopgap clinics are actually the answer to both the care and the cost problems.

 

I think the value of physiotherapy depends on context and medical history. Some people enjoy a placebo effect, some need and benefit from it. I have another huge concern. Low barriers to entry. Too many para-medical, physiotherapists, psychs, etc. are of a very poor standard, IMHO. Secondary care gets replaced by low qualification care, low effort care, all to often.

If you compare these professions to nurses, you can see the difference. Nurses have a very high bar to entry, are almost doctors in many cases and have extremely high standards to uphold. They can become almost professionally on par with medics in some situations, such as GPs and Nurse Practitioners in the UK. It will vary by country and decade, I'm sure. But it's much easier to become and remain a half-baked therapist of some sort.

My spouse and child have all needed physios on different occasions, ranging from after accidents, for back weakness issues to dealing with muscle strengthening for hypermobility. And the majority of them were clearly in the wrong profession. I believe that many viewed it as a low qualification, but qualifiable, respectable profession to enter, with useful barriers to entry. Private physios in particular treat their profession as easy money. They know there is very little damage they can do when not caring, usually (I know of ignorant physios putting people in hospital, within a session, who arrived with minor complaints). Many private physios have a culture of doing almost nothing for their patients, because they spend most of their time as administrators of insurance evidentiary trails. And rousing themselves to be proactive in other contexts sounds like too much work.

There were only two physios my family have encountered that inspired any confidence. And neither of them detained themselves at the lowest common denominator. One was a PhD in their field and the other clearly medically inclined.

 

...also applies to psychologists. Some are gifted and valuable, but many are not exactly the smartest or most able. In a profession where raw intuition combined with knowledge is key, that is worrying.