Question about knowledge of trigger point and residency application

[pokerslut]

I'm still a few years out from applying to a residency program but the thread about interviews got me to thinking about my own resume.

It would seem that training and experience in "Trigger Point" or neuromuscular therapy would be a plus for an applicant, but I don't want to blindly make that assumption.

For example, what if the PD director doesn't have the same beliefs or preference for approach to treatment?

If anybody can share their opinion or perspective it would be appreciated.

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[dc2md]

It is important to the MSK side of PMR. But keep in mind that most program directors (it seems) are inpatient rehab oriented. So I personally wouldn't harp on it much. A great case where a TP was the source of someones long undiagnosed pain, and was treated successfully would be good to have in the personal statement.

 

[lobelsteve]

Trigger points are voodoo and do not provide effective long term relief.

You want no experience in them.

Let the program decide how they want to teach you their own voodoo as it will be different among different voodoo practitioners and they will poke fun at other voodoo doc's techniques.

 

[dc2md]

Sorry man, I was gonna mention that too. Some people don't just not believe treating them is effective, but they get angry at the mere thought of it. Travell and Simons are Steve's antichrist.

I happen to believe they are totally over-treated and more importantly, wrongly treated. Most docs with a needle and dollar signs in their eyes will inject ever TENDER point they find. I happen to find success with treating actual TRIGGER points for certain conditions (like headache, neck pain, vague shoulder pain). NOT low back pain or thoracic pain. And I've found that ischemic compression on those trigger points works just as long as lidocaine/steroid injections...but of course that takes way too much time and energy and doesn't reimburse nearly as much.

But most people are at least receptive to the idea of treating trigger points and having an anecdotal success stories in your personal statement won't hurt you at all.

 

[pokerslut]

Sorry man, I was gonna mention that too. Some people don't just not believe treating them is effective, but they get angry at the meer thought of it. Travell and Simons are Steve's antichrist.

I happen to believe they are totally over-treated and more importantly, wrongly treated. Most docs with a needle and dollar signs in their eyes will inject ever TENDER point they find. I happen to find success with treating actual TRIGGER points for certain conditions (like headache, neck pain, vague shoulder pain). NOT low back pain or thoracic pain. And I've found that ischemic compression on those trigger points works just as long as lidocaine/steroid injections...but of course that takes way too much time and energy and doesn't reimburse nearly as much.

But most people are at least receptive to the idea of treating trigger points and having an anecdotal success stories in your personal statement won't hurt you at all.

I used "Trigger Point" in quotations because they can mean so many different things to different people.

Personally, I think these "hypertonic" muscles are treated the wrong way.

If you are interested in learning a great non-invasive technique to get rid of these "knots" here is a link:

Do they allow links for products? [NO]

At the risk of sounding cliche, there are many people out there suffering needlessly in my opinion. I was one of them.

I will personally send you my backup one (----) to borrow if you are seriously interested in trying it out but don't want to risk the financial cost (assuming you are a physiatrist and open-minded to the approach).

I truly want the benefits of this approach to reach many people as possible. If you are in the DC metro area I will be more than happy to do a demonstration-- given that you are working in the rehab field preferably.

If I come off as a naive, wanting-to-save the world medical student so be it. The reality check comes and goes for me. lol.

The designer of the biopulser has a book called "What is really wrong with you-- a revolutionary look at how muscles affect your health"; Thomas Griner.

 

[rehab_sports_dr]

I think most interviewers appreciate when applicants bring their experiences and perspectives to the field, but also don't want someone who is overly dogmatic and feels like they don't need to be taught anything

Something that would be appreciated:
"One of the things that made interested in PM&R was my experience in such-and-such. I saw how there was significant overlap in rehab, and that a PM&R residency would help me broaden my perspectives and improve my ability to help patients."

An exaggerated version of what would probably annoy your interviewer:
"I have experience in such-and-such, and I think my skills will help revolutionize the field of PM&R. It's amazing to me how many PM&R docs just don't get it, and don't see the utility of such-and-such. You guys are such nincompoops."

I think that applies to anything, especially if it doesn't fit into the particular bias of the interviewer. This is not limited to trigger points.

For example, when I've interviewed applicants, they know that I do spine injections, so there are some applicants who won't talk about anything other than spine injections. Even though I believe spine injections are an important part of the field, I find it a turn-off when they don't care about the rest of the field.

As for trigger points specifically- my personal bias is that trigger point injections are over-used since they are a reimbursable procedure. I tend to think that trigger points usually reflect some other underlying problem that needs to be addressed. There are occasions, though, where a trigger point injection or some form of manual release can help the patient break through their pain cycle sufficiently to help address the underlying issue more effectively.

 

[dc2md]

I think rehab_sports_dr put it much better than i did. don't go to an interview with the intention to teach the interviewers something about PMR. be humble...even if you believe TP therapy is overlooked.

and rehab_sports_dr brings up another good point. it's cool to be really excited about spinal injection (for example), but don't bad talk or show disinterest in the other areas of PMR.

 

[pokerslut]

Thanks for the feedback.

Definetly won't be trying to sound like a fanatic during an interview; humble, yes.

Since I'm here can I throw out another thought about PM&R?

I've had great experiences with a form of manual therapy on these so-called trigger points. Manual Neurosoma with a percusser called a biopulser.

Should I just do family medicine and open up a "wellness clinic" that specializes in back pain, nutrition counseling, etc? What I am trying to get at is, if I don't plan on doing injections, etc wouldn't it be kind of counterproductive with the training.

But I really do want to join the Army again and work with my wounded brothers/soldiers as a physiatrist.

I guess I will find out more when I do electives a year from now. Still early in the game; and on that note let me go and do some more USMLE World questions.

Thanks for the comments.

 

[lobelsteve]

Thanks for the feedback.

Definetly won't be trying to sound like a fanatic during an interview; humble, yes.

Since I'm here can I throw out another thought about PM&R?

I've had great experiences with a form of manual therapy on these so-called trigger points. Manual Neurosoma with a percusser called a biopulser.

Should I just do family medicine and open up a "wellness clinic" that specializes in back pain, nutrition counseling, etc? What I am trying to get at is, if I don't plan on doing injections, etc wouldn't it be kind of counterproductive with the training.

But I really do want to join the Army again and work with my wounded brothers/soldiers as a physiatrist.

I guess I will find out more when I do electives a year from now. Still early in the game; and on that note let me go and do some more USMLE World questions.

Thanks for the comments.

You might want to go through medical school first. All of the crap you are talking about is not based in sound science. As a physician, you are first a scientist, so when you fully understand anatomy, physiology, and pathophysiology- you will reserve the above treatments to the ND and not the MD. But that aside, you'd be better off in FP. There are already enough nuts in PMR.

 

[rehab_sports_dr]

If you are interested in musculoskeletal medicine, I encourage you to strongly consider PM&R. I am biased because it is what I do, but I think PM&R training gives the most broad based perspective on MSK medicine of any field.

I find that the perspectives that you gain from EMG training, SCI (which forces you to understand myotomes and dermatomes), TBI/stroke (which forces you to understand the ascending/descending neuro pathways), amputee (which forces you to understand ground reaction forces and principles of biomechanics), etc. all help tremendously in making me a better MSK doc.

 

[pokerslut]

You might want to go through medical school first. All of the crap you are talking about is not based in sound science. As a physician, you are first a scientist, so when you fully understand anatomy, physiology, and pathophysiology- you will reserve the above treatments to the ND and not the MD. But that aside, you'd be better off in FP. There are already enough nuts in PMR.

Ouch. One of the things that attracted me to PM&R, at least according to the literature, is its approach in treating the body as a whole.

I'm pretty sure nutrition is important in helping your body recover faster. Sure, what you stuff down your face doesn't matter.

Are you telling me that monitoring a soldier's psychological health after PTSD is not important? Not to mention taking care of dealing with the loss of limb.

In my mind every piece of the puzzle is important. That is what I meant by wellness.

Thank you for the heads up/reminder of the narrowmindedness to come.

In poker, I'll take the NUTS everytime.

 

[dc2md]

You might want to go through medical school first. All of the crap you are talking about is not based in sound science. As a physician, you are first a scientist, so when you fully understand anatomy, physiology, and pathophysiology- you will reserve the above treatments to the ND and not the MD. But that aside, you'd be better off in FP. There are already enough nuts in PMR.

HAHAHAHA. Steve never bites his tongue. I like that. But something can be said for accepting therapies that work despite lack of good science to prove it. I personally don't care if injecting sterile witch hazel into a joint relieves a person's pain from 9/10 to 2/10 where other therapies have failed. If it works, it works. If my patients feel better and are more functional and productive in society, I'm happy.