Some soft tissue techniques with the nervous system in mind

[Diane]

I hope you can stand my crude sketch, and I hope it can get across the idea of skin stretching as therapy, both biomechanically (at the surface of the body and microscopically) and neurophysiologically (firing up the slow-adapting type IIs) for ultimate improvement of function through decrease of nocioception.

Please note that the drawings are so crude they give no idea whatever of the miniscule amount of force required to gain a big amount of leverage in the system. Go slow, and no pinching! :angel:

[Diane]

I'd like to add that I first was introduced to this idea by Loren Rex (DO, URSA Foundation), who used it to teach his version of cranial, even though he did not discuss it in terms of neuromodulation through skin.. he taught it as if the head really were a balloon, bones and all.

I've used it for heads and for everything else as well for years.

Lately I saw Michael Shacklock use it for carpal tunnel, pinching/gathering skin on the dorsal side of the hand to relieve symptoms/pain/tightness in the ventral side.

[BB]

Diane,
This is great! If you wouldn't mind, could you maybe talk about your balloon technique in relation to some specific areas/examples (for people like me who think better with context:o )

I think your drawing is just fine by the way. I hope you continue this thread with more diagrams of your other skin stretching methods. For example, what would make you decide to perform a rotation glide (like on the brachial plexus thread) versus the balloon technique?

I'm excited about this because I've been having quite a bit of luck with your skin stuff, without really knowing what I'm doing:o . I just slide the skin in different directions until the spot softens or becomes less tender to touch.

Unfortanately, I won't be able to check in for a bit, but I look forward to seeing this thread when I return!

cory

[EricM]

Diane, I too am rather interested in learning more about just what it is you, er, um...do. Thanks for the drawing.

eric

[Diane]

OK.. I'll write/draw a manual, and I promise the drawings will be less crude. At least the ones that eventually get published will be less crude. I hope. I will cover all parts of the human organism. How's that sound? I'll get busy and include you guys in the process.

[nari]

We're waiting!!:angel:

Nari

[Diane]

I've been having quite a bit of luck with your skin stuff, without really knowing what I'm doing . I just slide the skin in different directions until the spot softens or becomes less tender to touch. Cory, that's about all there is to it. Easy huh?
Nari, I'll get right on it. :)
Cory and Eric, would you like to come to a workshop someday?

[EricM]

I can be there in about 4 hours :D

[Baecker]

hi,

yes very nice get a manual out, that would be great! i would definetly buy one.

i am using this skin stretches also a lot, maybe a bit differently cause if i am reading your advices it is sometimes a bit difficult to perceive how you ment it. with drawings it is much easier to get what you mean.

[emad]

Diane ;

I bring here your words regarding the "Balloon" ( ) technique

B. "Balloon" ( ) technique:
Find a tight place, or a sore spot, to focus on. Do not press it, just find it. They can be anywhere, because cutaneous nerve twigs are everywhere, but usual places are medial side of knee, superior/anterior tibial aspect, and posterior aspect of knee, and all round the circumference of the patella. Once you've found something that feels (to palpation) either too hard to your fingers or else uncomfortable to the patient, address it the following indirect way:
1. keep a finger on the cranky spot and monitor
2. with your other hand, grasp skin on the opposite side of the knee and gently pinch it circumferentially, into a bunch. I call this the "balloon technique." (A visual: If the leg were a balloon, pulling the skin together on one side of the balloon would cause the air inside the balloon to displace over and thin out the skin on the other side. Make sense?)
3. You should be able to feel a response in the tissue you are monitering, a relaxation of tightness, and/or sudden disappearance of tenderness, confirmed by the patient.
4. stay there for as long as it takes (usually 90 seconds-two minutes) for the process to complete, the process being a motor outflow you'll sense as pulsing or lengthening of skin and underlying tissue. The patient will be able to feel this too, as a pleasant feeling of some kind, perhaps spreading around a little or a lot.
5. You can do this anywhere on the leg, but the knee will have more than one of these to treat likely.
6. if there is tenderness around the patella, you can affect it positively by loading (with one finger) some slight pressure onto the opposite side of the patella, in effect levering/lifting up the edge that feels tender. Usually the patellar tenderness willl vanish.

I am reading it with those comments related to images

Regards
Emad

[Diane]

Eric, you are a funny man.
Here's a picture of lateral skin stretch for dorsal cutaneous nerves. On the Netter picture, check out the dorsal cutaneous nerves. Anything cutaneous means it will ultimately be embedded in skin, therefore easy to neuromodulate mechanically, even physically glide, all the way to the nerve root. I like to aim for where I think the cutaneous portion bifurcates superficially, but usually I'll just go with where the tissue feels cranky. I'm pretty sure there's good overlap between the two concerns, perceptual and conceptual.

[emad]

Diane ;

Thanks ,here you are my whole comments regarding the Baloon :

The new idea for me was applying tension/stretch force from more than one direction ,but at distance from pain spots .

Usually , i apply tension like that you descirbed but at the pain spots from than one direction but too gently with my thumbs or indeces.

I like to raise one point here ,there are plenty of cases /patients complain of pain around the side of the trunk ,which are usually considered internal visceral complaint !

632:thumbs_up :teeth:

Regards
Emad

[Diane]

Ah. I see, Emad.
Yes, skin stretch works much better if the stretch is applied away from the pain site; at the same time, you need to moniter the painful spot somehow so you know when it has "shut off." On a limb even with small hands, the balloon technique is easy enough to do one-handedly while you moniter the sore spot with the other. As soon as it shuts off, there is no need to go further into a stretch... it is sufficient to just stay where you are and wait.

In a two hand stretch such as the one shown for the back, there is either nothing especially sore, or else a lot of things will be sore simultaneously, so, less chance to moniter than in a limb, and perhaps less need to anyway.

I'll try to draw a picture for treating the skin on the lateral ribcage. It's still balloon technique, but with a twist.

[Diane]

Here's the "balloon with a twist" for skin over the ribcage/lateral cutaneous nerves. (Review the huge sensory field for the lat. cutaneous roots in the above thumbnail from Netter.) It works best when done from the "mirror".. i.e. opposite side of the body, same level.
(Another crude drawing from yours truly.:cool: )

[emad]

Thank you for the drawing .

I think most of those patients are misdiagnosed , here they are treated by surgeons or internal medicine .

I believe i can not follow sound clinical reasoning process for those cases ,i can not rule out the pure internal viceral patient from that neural or muscloskeltal patient .

Regards
Emad

[Diane]

I think it's not always crystal clear either, Emad, but the history will usually say a lot. Generally, pain that goes away and stays away with simple measures like the ones we use; skin modulation, movement therapy, awareness, behavioral intervention/education (e.g., don't always sit with your right leg crossed over your left.. mix it up..), and pain education - generally speaking, pain that goes away and stays away was not visceral, it was somatic.

If it's visceral, a clue will be discomfort when recumbent, pain doesn't change in any position, comes on/ gets worse at night, wakes up the patient, is vague, diffuse, deep, dull, no "sore spots" to find, or if you find some and treat them, the pain doesn't change, referral pattern that is usually predictable, e.g., gall bladder to right side mid-back.