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Zachary Grin, PT, DPT

@zacharygrin.bsky.social

760 followers 470 following 60 posts

Doctor of Physical Therapy | 🏳️‍🌈 he/him Owner of Rethink Physical Therapy, PLLC | NYC I help people living with FND take back control. www.fnd.physio

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Nov 16

It’s a relief to start fresh on Bluesky!

I’m intending to share my knowledge and passion for functional neurological disorders and functional somatic syndromes.

Let’s start with an FND treatment thread! 🧵👇

#physiosky #medsky #neurosky #fndsky

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Reposted by Zachary Grin, PT, DPT

Jon Stone @jonstoneneuro.bsky.social · Feb 21

New review article on health anxiety for neurologists with Huw Green in Practical Neurology

❌Health anxiety is NOT FND.
✅Can occur in any neurological condition,
✅Reassurance usually makes it worse
✅Specific treatment.
pn.bmj.com/content/earl...

Free link - tinyurl.com/5n7shutv

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Reposted by Zachary Grin, PT, DPT

Matthew Hodson @matthewhodson.bsky.social · Feb 16

Keith Haring died of AIDS aged 31 on 16 Feb 1990.
One of his last works, Unfinished Painting, was deliberately incomplete, reflecting the devastating, unquantifiable loss to the arts due to AIDS.
#LGBTplusHistoryMonth

A square canvas. Only the top corner is filled with Harings distinctive figures, rendered in Lavender, the rest is blank.

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Feb 15

“Current evidence did not show an association between patients with MCADs #MCAS and those with #POTS and/or #EDS.”

www.jacionline.org/article/S009...

Prevalence Of Mast Cell Activation Disorders Amongst POTS And EDS Patients: A Scoping Review

Our aim was to determine the prevalence mast cell activation disorders (MCADs) in patients diagnosed with Ehlers-Danlos Syndrome (EDS) and/or Postural Orthostatic Tachycardia Syndrome (POTS).

www.jacionline.org

Reposted by Zachary Grin, PT, DPT

FND Poltergeist 👻 @fndportal.bsky.social · Jan 31

If you’re a clinician looking for resources to share with patients with FND, neurosymptoms.org should be your go-to!

Lots of great info on FND diagnosis, subtypes, treatment, and formulation - presented in wonderfully clear language.

By expert neurologist @jonstoneneuro.bsky.social

Functional Neurological Disorder (FND) – A Patient's Guide to FND

neurosymptoms.org

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Jan 30

I’m glad you found this helpful!

You can learn more about FCD here: neurosymptoms.org/en/symptoms/...

Yes starting a new med can be tricky. Anti-anxiety meds can sometimes be very helpful but you are right, it’s a new thing for your body to adjust to & that can sometimes cause problems w/ FND.

Functional Cognitive Symptoms – Functional Neurological Disorder (FND)

neurosymptoms.org

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Reposted by Zachary Grin, PT, DPT

ME/CFS research @cfsresearch.bsky.social · Jan 26

The mind/body revolution: how the division between ‘mental’ and ‘physical’ illness fails us all www.theguardian.com/society/2025...

The mind/body revolution: how the division between ‘mental’ and ‘physical’ illness fails us all

New research shows western medicine’s traditional split between brain and body is, in fact, far from clear cut – and could provide a breakthrough for many complex conditions

www.theguardian.com

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Reposted by Zachary Grin, PT, DPT

Dr. Mark Cheng @drmarkcheng.bsky.social · Jan 16

What @mcuban.bsky.social said!!!!!

As a medical professional, the things I could tell you about how foul it is dealing with #insurance would blow your damn mind.

Mark Cuban @mcuban.bsky.social · Jan 16

The facts are, the ACA saved millions with pre-existing conditions and set standards for care.

But now, more than a decade later, with what we now know, it’s time to take the insurance companies out of the mix.
The subsidies they get are enormous. We don’t need them as middlemen.

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 24

I’m concerned you get many patients with FND who are being misdiagnosed & mismanaged.
It doesn’t have to be that way though!

FND is real, reliability diagnosed with validated clinical signs on exam, and treatable.

Please learn 🙏🏼

www.bmj.com/content/376/...

www.nature.com/articles/s41...

Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 24

The FND misinformation in this video is very concerning. They discuss a number of FND symptoms but wrongly believe FND means feigning. They admit they don’t know the cause of the symptoms but they are open to learning more to figure it out.

Dr. Ruhoy, please consider learning about FND ⬇️

#FNDaware

Ilene Ruhoy MD PhD @ruhoy.bsky.social · Dec 16

EYE ROLLING SYMPTOMS youtu.be/wrbPty-1aIM?... via @YouTube

@kaufmanmd.bsky.social

EYE ROLLING SYMPTOMS

YouTube video by Unraveled: Understanding Complex Illness

youtu.be

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 24

Any data to back up what you’re saying? I do and it says you’re wrong 🤷🏻‍♂️

“There are a small number of very specific circumstances where life expectancy is reduced as a result of having ME/CFS - suicide and malnutrition being 2 important examples”

meassociation.org.uk/wp-content/u...

Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 24

Hi. That is not true at all. It is not a diagnosis of exclusion. It is diagnosed in the exact same way as migraines, Parkinson’s Disease, and other conditions. All diseases do not need to be ruled out.

Here’s a table of positive clinical signs to help rule-in: practicalneurology.com/articles/202...

The Diagnosis of Functional Movement Disorder - Practical Neurology

Functional movement disorder is diagnosed using positive signs, allowing a clinician to “rule-in” the diagnosis.

practicalneurology.com

Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 24

No. This is not true. Most deaths in people with ME/CFS are sadly due to suicide and starvation. The people with Long Covid who die of heart attacks and strokes are typically not the patients who present similar to ME/CFS. The patients in the above study seem to have the ME/CFS subtype.

Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 23

That is 100% not true. Organs don’t shut down in ME/CFS or the long COVID subtype that presents similar to ME/CFS after mild infection. This would happen if someone is unable to eat but that is due to lack of nutrition, not disease. The symptoms are not consistent with basic anatomy & physiology.

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 23

I disagree. There’s nothing unsafe about them. The only time they could be considered problematic is when the person believes they are unsafe and cannot update that belief. The threat value of energy expenditure and symptoms + excessive self-monitoring will continue to perpetuate the cycle.

Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 23

…these mechanisms may be accompanied by more frequent cognitive problems and greater perceived effort in task performance, which creates a vicious cycle that results in over-attention on these cognitive symptoms.”

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 23

…excessive self-monitoring, attentional bias, negative beliefs about the disease or ageing, health anxiety, perseverative cognition (rumination, obsession, worry), and abnormal emotional processing…

Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 23

“…global metacognition errors (i.e., errors in the way in which an individual assesses their own cognitive performance) and perfectionism in memory assessment, which ultimately results in low tolerance to memory lapses that may be considered normal in everyday life…

Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 23

We need to consider the neuropsychological & behavioral consequences of an infection too.

The study’s results seem consistent with functional cognitive disorder.

Good overview: www.elsevier.es/es-revista-n...

#LongCovid

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 23

The problem is the perception of energy expenditure required by an activity, not the actual energy expenditure. Engaging in meaningful activities can help reduce the threat of energy expenditure. Treatment aims to reduce excessive attention & threat value of symptoms, not ignore them.

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 23

There’s plenty of evidence showing no disease or meaningful tissue damage to explain the condition. People w/ mitochondrial diseases have clear evidence of disease and do not present similarly to people with ME/CFS or Long Covid. This doesn’t make the symptoms, limitations, suffering any less real.

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 23

I reject the narrative that there is a clinically meaningful reduction in energy production that is incapable of adapting to controlled increases in physiological demands.

The best evidence shows dysfunction of stress systems and any energy production issues are downstream effects.

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Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 23

I disagree. Sure you can say there’s an assumption of how it works based on the rationale for providing the intervention, but the study was not meant to confirm how it works. It could be the actual CBT elements, therapeutic alliance, something else. Regardless, it was still better than usual care.

Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 21

As clinicians we look at the body of evidence, not one study. The best available evidence says active rehabilitation. That may or may not change in the future.

Also, medication and surgeries are very different. They tend to come with higher costs and much higher risks including death.

Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 21

I understand, but the study is still comparing two choices a clinician would recommend to a patient. Based on this study, a clinician should refer to CBT-based rehabilitation. Even if the benefit is mostly due to contextual factors, it did better than usual care with very low risk.

Zachary Grin, PT, DPT @zacharygrin.bsky.social · Dec 21

It was a pragmatic study. They weren’t looking at how it worked. They wanted to know if CBT intervention was more effective than usual care. The study results say yes. Rehabilitative treatment always consists of contextual factors & can be considered part of the intervention (therapeutic alliance).

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