Range Of Motion !

[emad]

Hi all ;

On somasimple ,there is great attention to pain ,but there is quite negligance to Range of motion ( If i am wrong correct me ),the argument behind my topic is the Orthopedic theory .

To avoid the Orthopedic theory to give the thread life , i will take the Example of Frozen Shoulder ,which most of us encounter in private practice .

We have lots of techniques to address the patient,s pain .

How are we going to improve the joint motion ??Techniques?


Regards
Emad

[Diane]

Emad, in "frozen shoulder", pain IS the big problem.. decrease the pain and range inproves. Right? Pain relief and improved range seem to go together.

I guess the ortho mindset would have us think that range could be improved by pressing and pushing up and down on joints, with the goal of increasing range, rather than decreasing pain, and that improving range would decrease pain. The concept seems to exclude neuro effects from the actual contact with skin and with waggling/stimulating mechanoreceptors. I think they think they are actually stretching capsule tissue, etc., physically; instead of pain relief being the first thing to seek in order for greater excursion to happen, they think getting greater excursion will result in less pain. They have the cart in front of the horse IMO. MFR is a spin off of this, and highlights the logical absurdity of the concept.

[nari]

emad

If I recall, the traditional views for 'frozen shoulder' are these:
Stage 1: Pain, limiting ext rotation and abduction in particular.
Stage 2: Pain recedes and loss of ROM continues
Stage 3: Resolution, pain not a problem unless forced movement occurs.
This whole process takes up to 2 years and usually disappears completely.

Stage 1 we should deal with the pain, by whatever means we know about. At this point, if pain can be reduced to quite tolerable discomfort, or less, further loss of ROM can be prevented and movement becomes much easier. This has happened several times to my patients with painful restrictions in the shoulder. BUT there must be no force/pressure, repetitive exercises, etc etc. This is where neurodynamics is very helpful. So would Simple Contact...

There have been some studies done that suggest "physiotherapy" (whatever that means) increases pain and loss of ROM, compared with no intervention at all. I'll believe this.

Don't worry about increasing ROM. Deal with the pain, carefully, carefully, with the ULNTTs as a treatment. When the patient feels the pain slowly decreasing; stop, wait for ten minutes and do the movement/s again. Three reps. That's all.
And stay well away from pulleys and that silly stretchy elastic stuff. We are not interested in strengthening muscles at this point..far too aggressive.
People claim all sorts of successes with modalities. Maybe, but there are more efficient and active ways to achieve a response.

It is a difficult condition, and success for the patient is not guaranteed.

Think of the condition as being an extreme case of nerve sensitivity, not loss of physical ROM. There is a world of difference.

Nari

[emad]

Hi:

Nari ,You are so correct some physio are not considered effective ,for me ,but further more they may evoke /detirorate the patient,s complaints.I believe the pain you are speaking about is associated with protective reflex which results in motion limitation.Of course , the nervous system and cortex particularly for me is cosidered central regulator and governor in case of pain .

Diane ,yes the main point considering first pain or motion ,this is like a joke here in my culture when a dilemma of discussion we say (Which comes first the bird or the egg??)

Did not any one see/encounter a patient with motion loss without pain ??

Personally , i encounter but in ortho sets .

Regards
Emad

[Diane]

In English the same thing is said about the chicken or the egg, which comes first. Must be a version of this observation on dilemma in every language, every culture.. :teeth:

[nari]

emad

Yes, there are plenty of cases of stiffness without any pain - usually due to iatrogenic causes - surgery, medications, advice to rest, don't move, bandage, splint......
Hand therapy is largely needed to offset the effects of immobilisation and surgery, and stiffness is the primary problem, not pain.
I think most of our job involves working with effects of immobilisation in some form or the other.
One reason I was tired of physiotherapy: we spend most of out time fixing up the effects of doctors' interventions.

Nari

[emad]

Nari ;

Correct i meet plenty of elbow and hand stiffness ,knee .......post-operative and cast /immobilization ,which make me crazy to address motion .

I think when the Doctor immobilize the limb ,they think they immobilize bones only ,however the truth is they immobilize soft tissue ,nerve ,bone ,artery and alll all all ,i think thus could mask the cortex feedback from those perpherial areas ,a type of extnication .

I have read in an article that the neural blood supply within the nerve begin to be affected after only 2 days of immobilization .

The point of this thread is that motion techniques in stiffness in physiotherapy or manual therapy are not effective at all .

Could you suggest me a technique to improve range in case of no pain ?

Regards
Emad