A break though....

[BB]

I just wanted to pass on, what was for me, an exciting although boring (because I wasn't doing anything) moment.

New patient today. Back pain with constant left LE pain of 1 month duration. Very fidgetty. No comfortable position. Very reactive, ie. I reach for her hand, her breathing changes, she visibly tenses up. Pain with flexion, and rotation especially.

After failed attempts at getting her to let go of her hip rotators, then showing her a helpful sidelying lumbar opener technique, I decided to let her lay in the comfortable position while I played at the leg.

I started with a broad medial skin glide at mid thigh and the same at mid calf. This provided some relief and vague warmth in the upper thigh. After spending some time there, I changed my hand position to the skin of the lateral knee and over the greater trochanter and immediately she says "that feels great! My whole leg just warmed up." We stayed in this position until I had to move on to my next patient.

Lots of luck in the past 2 weeks with the skin gliding (one was a chronic lateral epicondylitis with recent tendon perforation, multiple steroid injections, pain for 2 years, virtually full pain free motion after about 5 minutes of skin work) but this is the best example yet for me of a parasympathetic response.

Thanks for the brachial plexus taping and treatment discussion. My patients appreciate what I am learning.

Cory

[Diane]

Congratulations! Now you're treating something real (pain representations in the nervous system), and are interacting with the hard drive (the CNS) not just chasing imaginary mesodermal failures. :D
Great fun isn't it?

[emad]

Hi Cory :

Good ,nice to hear from you this imperssion !

Personally , i do not use skin gliding as diane and you perscribed , but i use some so so gentle perssure and passive stretch with my index and thumbs ,something like trigger point therapy which i used since 4 years .

As well ,sometimes i use whole muscle glide accompanied by nerve ,skin and fascia .

I will try to report regarding tapping through that thread of brachial plexus.

Regards

Emad

[nari]

Cory

Looks like an entirely different way of treating dysfunction/pain is right in your hands!
And the nice thing about it all - it can be logically explained, with the backup of known neuroscience, and not by a maybe-it's-this-muscle-ligament-joint problem.....

Nari

[Barrett Dorko]

Cory,

Playing gently with the pressure you employ without seeking to manipulate or coerce the body part into a position that you imagine might help both allows the patient's unconsciously directed corrective ability to take over and their sense of their own systems to grow via Weber-Fechner's law. Various pressures recruit stretch-activated ion channels at different layers, thus leading to different reflexive reactions - all of them unpredictable but open to interpretation once reported.

The warmth you rightfully describe as a parasympathetic response can only result from a movement that reduces mechanical irritation in the nervous tissue - that being the tissue producing a sympathetic response when irritated. In short, twisting and untwisting look the same, but one makes the system cold and the other warm.

My question: Should we wait for a chronic and/or severely involved patient to show up before we approach the body manually in this way? Shouldn't this be at the forefront of manual care and not used as a last resort?

[Diane]

Barrett, I appreciate your synposis of the neurologic effects of skin stretching.

Should we wait for a chronic and/or severely involved patient to show up before we approach the body manually in this way? Shouldn't this be at the forefront of manual care and not used as a last resort? In an ideal world.. but as was pointed out on another thread, by the time PT gets to see anyone the patient's in trouble. We will have to cajole other sorts of hands-oners to learn about the nervous system, entice them away from mesomatrix toward neuromatrix.