Entrevistas
David Thompson - Biomechanics (Inglês)
(PROMIND): In simple terms, what is biomechanics?
(Pt. DAVID THOMPSON): Simply stated biomechanics is the study of the human body and human movement using principles of physics and mechanics. It is a way of describing and evaluating the forces and motion of the various parts of the human body.
(PROMIND): How important is biomechanics in the process by wich the musculoskeletal physioterapist assesses the patient’s dysfunction?
(Pt. DAVID THOMPSON): It is critical to have an thorough understanding of biomechanics when assessing a patient with neuromusculoskeletal impairment. It is only once a physiotherapist has a knowledge of what is ‘normal’ can they then intervene to improve a patients movement dysfunction.
(PROMIND): How can biomechanics have a positive effect on patient’s treatment?
(Pt. DAVID THOMPSON): By restoring normal biomechanics in and around a joint or to a muscle or nerve or any other soft tissue for that matter, the patient can experience complete and permanent resolution of pain. The advantage of a biomechanical approach is that it seeks to treatment the cause of a problem rather than just symptoms. Often patients understand the principles of a biomehcanically approach more readily then say a biopsychosocial or neurophysiological management approach and as a consequence tend to be more compliance with self directed rehabilitation.
(PROMIND): Why did you choose lower limb as the subject of your course? Is the high incidence of lower limb injuries related to biomechanical dysfunctions?
(Pt. DAVID THOMPSON): I chose lower limb biomechanics because I have an interest in lower limb injuries. I have suffered various lower limb injuries myself and that started my interest in lower limb rehabilitation and then naturally to biomechanics. My clinical case load consists largely of lower injuries simply because that is what I am known for and patients are referred to me as a result. I think biomechanical principles are equally applicable to the upper limb and spine as they are to the lower limb. As for incidence, after cervical and lumbar pain, anterior knee pain is the most common condition people present with to a physiotherapy clinic. AKP almost always has a biomechanical basis. Obviously there are many other reasons for lower limb injuries but in my experience a large number of them have a biomechanical basis
(PROMIND): Based on your clinical experience what are the most recommended treatment approaches for the lower limb’s biomechanical dysfunctions?
(Pt. DAVID THOMPSON): The generally accepted treatment approach to manage biomechanical problems is to first correct any static biomechanical anomalies and reassess to gauge effect and if this does not total resolve a patients problem, the next approach is to correct any dynamic biomechanical dysfunction and reassess. Different pathology and different individuals will response better to one than the other, however it is not uncommon to use a combination of approaches to manage a client’s problems.
(PROMIND): Which manual therapy techniques are taught during the course?
(Pt. DAVID THOMPSON): On the course participants learn a large number of mobilisations for the foot and ankle, the knee and the hip. I have incorporated Mulligan’s, Maitland, Cyriax and Kalternborn techniques which I have fond to be of greatest use in my clinical practice. It is my hope that the people who attend my course will use the techniques I teach but also adapt them to create/invent some of their own techniques. There is nearly an infinite number of manual therapy techniques one can perform on the lower limb and with the sound clinical reasoning a skilled manual therapist/physiotherapist can alter any technique to make it very specific for a particular patient.
(PROMIND): We know you have a large experience in sports rehabilitation and that functional taping techniques are practiced widely in the treatment of sport injuries. How can taping techniques affect the treatment and when are they indicated?
(Pt. DAVID THOMPSON): This is difficult to answer in a few short lines and we cover this in great detail throough out the course, however I feel taping is a hugely useful supplement to all treatment and can be used in the management of all musculoskeletal problems, from acute traumatic injuries to chronic overuse injuries and everything in between
(PROMIND): How have you structured your course to blend clinical reasoning with evidence-based practice?
(Pt. DAVID THOMPSON): I have tried to cite the research which has been done regarding taping, manual therapy and exercise through out the course. However as with many aspects of physiotherapy there is much research that still needs to be done regarding lower limb biomechanics assessment and treatment. The course is largely clinically based simply because that is how the techniques of assessment and treatment have developed. I draw from my own clinical experience quite a lot throughout the course and use numerous examples of patients that I have actually treated using a biomechanical approach in order to make the course more relevant and interesting to participants.
(PROMIND): In general, what are the aims of your course? What do you expect to achieve in your course?
(Pt. DAVID THOMPSON): The aims of the course are to introduce biomechanics as a concept; demonstrate its application in physiotherapy practice; and to apply biomechanics in the use of manual therapy, taping and exercise for the treatment of musculoskeletal dysfunction. It is my hope that at end of the course participants will have learned the basic theory of biomechanics, and will also have learn a large number of manual therapy and taping techniques and when and why to use the techniques.
(PROMIND): Would you like to say something to Brazilian Physiotherapists?
(Pt. DAVID THOMPSON): To be a great physiotherapist should be every physiotherapists aim. It is my belief to that to be truly great as a physiotherapist you need to be constantly learning not just from research and teaching, but also from patients. It is important to keep an open mind about all treatment approaches, no single paradigm has all the answers.
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