Clinically I focus on manual therapy, sports medicine and ultrasound-guided intervention. These are my own rehabilitation medicine study notes, and how I use evidence-based methods to read papers, do research and teach. Credibility grows from here.
Clinical & Evidence
Collapsing After the Finish Line: Most Post-Exercise Fainting is Harmless
The most crucial question when someone faints after exercise (finish-line collapse) isn't whether they're dehydrated, but when they collapsed. Collapsing during the race should be treated as cardiac arrest; collapsing after crossing the finish line is overwhelmingly benign postural hypotension, which resolves after lying down with legs elevated for 20 to 30 minutes. This post explains why the two are so different, which three conditions must be ruled out on-site, and why routine IV fluids are actually unnecessary.
Heat stroke isn't just being overheated: cool first, transport second
When a kid collapses on the field in summer, most people's instinct is to rush them to the hospital. But the key to surviving exertional heat stroke is bringing their temperature down right there on the sidelines—every minute delayed adds to organ damage. This post explains how to tell heat stroke from just being uncomfortably hot, why tympanic and forehead thermometers are completely useless, and why Taiwan's heat warning lights can't be used to manage training volume.
That Painful Bump Below the Knee: Osgood-Schlatter Is Not Growing Pains
When a teen's knee has a painful bump below it, it's often endured as growing pains. This post explains how Osgood-Schlatter is diagnosed, whether they need to stop sports, the quantitative red lines for training volume, and how a Danish national tracking found 70% still have residual discomfort in adulthood—it doesn't "heal on its own" as much as people assume.
Sarcopenia: AWGS 2025 Made the Diagnosis Simpler
AWGS 2025 simplified the diagnosis of sarcopenia to just low muscle mass and low muscle strength. Physical performance is now an outcome measure for tracking, and the "severe sarcopenia" grading was cancelled. This post summarizes the differences between the old and new cutoffs, why you should start testing at age fifty, and why exercise plus protein is currently the only effective prescription.
Milwaukee Shoulder: The Shoulder With Recurrent Massive Effusions
Milwaukee shoulder syndrome — when older folks repeatedly have 30 to 40 milliliters of fluid aspirated from their shoulder, it's mostly not just simple osteoarthritis. It's often a destructive arthropathy caused by rotator cuff tears and crystal deposition. This post covers the keys to diagnosis, how to send the synovial fluid for testing, and whether seniors with poor kidney function can get steroid injections.
Do you still need to exercise at 80? An older adult stumped me, so I actually checked the textbooks
After being stumped when talking about exercise with an 80-year-old adult, I broke the answer into five layers and checked textbooks and papers: walking isn't enough, multicomponent exercise is needed; telling people to exercise doesn't work because it uses the wrong stage of behavior change; motivational interviewing is the right tool; older adults have the right not to exercise; and gerotranscendence reminds us that living comfortably is sometimes more important than living long.
"Neurodynamic Solutions: Turns out my nerve exams have never been standard enough"
"After taking Michael Shacklock's two-level Neurodynamic Solutions course in Taiwan, I've put on a new pair of glasses for looking at nerve pain: standardizing nerve exams, reasoning from mechanics and anatomy, and putting evidence-based home exercises back into the hands of patients."
Completing PM&R Residency
I finished the board examination last weekend and officially became a PM&R attending physician. Looking back at my four years of training at Hualien Tzu Chi Hospital, from Prof. Cifu's reminder to "not be limited", to getting exposure to pediatric rehab, neuro, orthopedics, musculoskeletal ultrasound, and manual therapy, and then jumping into vibe coding with Claude Code this February to redesign my study methods. Documenting this milestone, and previewing the AI learning tools I want to share next.
A Physiatrist's Learning of the DAI Osteopathy Course
DAI Osteopathy is a manual therapy system developed by Dr. Kerry D'Ambrogio, integrating osteopathy, physical therapy, and acupuncture. Centered on systemic evaluation, gentle techniques, and "repeated reassessment," it's completely different from typical courses that only teach maneuvers. After six days of class, I actually helped a friend resolve their long-standing finger stiffness. The takeaways far exceeded my expectations.
First Time in the US, First International PM&R Conference at AAP Physiatry '23
My first time in the US and my first AAP Physiatry '23. The biggest shock wasn't the academic content, but the energetic, complimentary culture of American physicians, alongside the diverse developments in PM&R like pelvic rehabilitation, AI gait analysis, and lifestyle medicine. The bar for a resident to submit a poster is much lower than you'd think. I highly recommend taking the plunge and attending.
[EBM] Should I calculate study power when results are not significant? Misleading post-hoc power
Calculating post-hoc power when statistics are non-significant is actually a misleading practice: it's inherently tied to the p-value. When p > 0.05, post-hoc power will inevitably be low—the two are basically circular reasoning. A more practical alternative is to interpret the 95% confidence interval alongside MCID, which aligns with the latest 2022 Cochrane GRADE guidelines.
ACSM-CPT Prep (Part 1): Introduction
I passed the ACSM-CPT, a personal trainer certification with only a 53% pass rate in the US. As a PM&R resident, I took this exam to build a solid foundation in sports medicine and to force myself to study. There's not much shared online about this exam, so I hope this series can serve as a reference for anyone interested.
ACSM-CPT Prep (2): Resources
The core resources for preparing for the ACSM-CPT are the three-day course by Dr. Chia-Chih Lin, along with the CPT textbook and GETP 11th edition. For practice questions, the case studies in the official Certification Review are enough; Pocket Prep and commercially available practice exams each have their trade-offs. This post summarizes the pros, cons, and my recommendations for each resource.
ACSM-CPT Prep (Part 3): Question Trends
The 135 questions on the ACSM-CPT involve almost no rote memorization. They are nearly all flexible "best answer" questions. The exam covers four domains, ranging from the details of exercise prescription to US laws like negligence and HIPAA. Being off by a single number means picking the wrong answer. In this post, I break down the question trends and things to watch out for, domain by domain, based on what I encountered.
ACSM-CPT Prep (Part 4): The Prep Process and Test Day
It took me just 25 days from the course to the exam, with about 10 days of actual studying. This post shares a 9-step recommended prep sequence, plus the test day check-in process, whiteboard tricks, and time management, so you know exactly what to expect before you walk into the ACSM-CPT exam.
Technology Helping People with Disabilities Bridge the Gap to the World
A patient with a high-level spinal cord injury used an eye-tracking computer to open the door to connecting with the world, all while staying humorous and cheerful. In Taiwan, we have the Icebreaker Association and MUVE using technology to help people with disabilities bridge the gap to the world, showing that disability doesn't mean losing out on life.
<Systematic Review Workshop> Takeaway 1: Do we use PICO for diagnostic, prognostic, and harmfulness studies?
PICO is actually only suitable for therapeutic studies. For diagnostic studies, change it to PIGO (adding Gold standard); for harmfulness studies, use PEO (random assignment is impossible due to ethical concerns); for prognostic studies, just PO is needed. This was the most rewarding lesson from Prof. Edwin Chan of Cochrane Singapore's workshop. You need to figure out the study type before setting your keywords so your search can be precise.
Systematic Review Workshop Takeaway 2: Are Few Search Results a Sign of a Good Search Strategy?
Getting only 5 papers in your search results doesn't mean your search was highly accurate—you might have missed a lot of important articles instead. When you get too many results, use title search, filter, and NOT to narrow things down; when there are too few, use MeSH terms, similar articles, or free text to broaden your criteria. Mastering the trade-off between sensitivity and specificity is the only way to find the literature you actually need.