Clear the Joints First

[Nick]

I have a part-time therapist working with me who also works part-time at a clinic owned by a manipulative therapist. Interestingly, it is the same clinic where I worked several years ago when I practiced in a much different manner. The owner of the clinic is very biomechanically-oriented and thinks manipulation is the be-all, end-all. I have, of course, tried to introduce the therapist working with me to all the intricacies of pain science (at least those I know) and the wonder of corrective movement. The other owner teaches her all the biomechanicl stuff that I chucked long ago. It is a bit frustrating. Recently, the therapist employed by each of us was discussing what I had taught her with the other owner. She was told that I was wrong and it HAD to be the joints treated first before anything else could be successful. Sounds like and orthopedic hangover (I hear they're wicked). I think this is nonsense and have seen many joints that seemed stiff miraculously move better after a little bit of ideomotor movement. No dangerous neck cranking required. This "joint out of place" meme is getting very tiresome. Not even the good manipulative therapists believe it any more. I excuse it daily in my patients (well, not without doing my best to educate them) because they have fallen victim to the manipuloid meme factories. I am quickly losing patience for those in our profession.

Desperately seeking the tipping point,

Nick

[nari]

Nick,

I am quickly losing patience for those in our profession.

Glad to hear that from someone else; sometimes I feel I am a lone bugler bugling from the hills and only the sheep listen, and not very well at that.

"Joints clear" with neurodynamics as well as ideomotion, though I suspect not as effectively. Maybe skeletons should be banned from PT rooms.

I think a tipping point will come, but not in my lifetime.

Nari

[Diane]

I completely agree Nari, but I still want to keep my skeleton in my treatment room. No one minds it, and it's handy to show people where their nerves have to get around the big ballooning joints. :D

[Barrett Dorko]

To say, "I cleared the joints" just sounds so good there's no point in even trying to get people to stop saying it. No matter that they can't actually do this without imaging, or need to in any case.

Most therapists saying this speak the phrase with authority and finality and all the therapists around them nod and flatten out their lips with that expression that says, "Ah yes, cleared the joints. I know what that means. I often do that myself." No other announcement from a therapist will generate as much solemnity, community, comfort and assurance.

In other words, I don't think it will ever, ever disappear. The most we can hope for is that more and more ectodermalists are created, and that when this phrase is once again grandly evoked - they roll their eyes.

[gary s]

Barrett,
Mentioning the word solemnity brought on a flashback to my first course with Ola. Now there's a salesman! We sat mesmerized as he challenged us to find/feel Washington's nose on a quarter--with eyes closed. That was supposed to be the epitome of palpatory skills. Those were the days my friend.......

[BB]

Gary,
We had to do that in PT school for extra credit in our manual therapy course. We had to tell the instructor which direction Washington's head was pointing in our hand before we brought it out of the bag. The nose was definately the key!

[gary s]

Cory,
I guess you could say that the nose knows.

[Jon Newman]

Was the rate of success 50%?

[BB]

Well, I don't like to brag, but I was 4 for 4. Anyone who needs their quarters palpated can contact me anytime.:D

[Diane]

Hey Cory, your skills on noses on quarters have translated into feeling differentials in tissue layers, so the kinesthetic skill set isn't entirely wasted.:D

[EricM]

Has anyone ever tried to find out through how many pages of a phone book you can feel a single human hair?

eric

[Diane]

Eric, did you have to do that in NZ?
All the palpation that is required to do decent handling is the same amount of tactile sense that it takes to read Braille and make sense out of tiny bimps and bumps. Defintely easier to do with the eyes closed. Lucky for us the finger tips have such enormous sensory representation. To do Barrett's work one has to use proprioception a little bit differently, but only for three seconds, and one needn't study Braille at all..

[Luke Rickards]

Eric,
Yeh, we had to do that one.

[Barrett Dorko]

Well, when a quarter is palpated the teacher needs to ask questions aside from the location of the nose. Questions such as:

What's this thing actually worth?

What is its meaning?

Why did they bleed George Washington to death?

Stuff like that.

Diane,

I'm familiar with differentiating tissues with palpation and attention but I've never been able to figure out why I would want to do that, doing what I (don't) do. At Butler's course we spent a lot of time trying to trace a nerve in the lower leg but no one could tell me why were doing this.

[nari]

I spent hours in David's 1990 class tracing the sural, occipital and half a dozen others.
I think it was done so we knew where they were, and in order to roll one when we found it. I've rolled a few nerves since then, but am not sure if it worked.

Interestingly, I never learned to palpate and 'feel' joints and stuff - it had not been invented when I was at Uni. After a couple of inservices, it seemed impossible to distinguish a facet (ZPJ) from the hyperactive muscle around it, so I never figured it out. Didn't seem to matter - as long as one was roughly over the area, it usually helped.

We never had to distinguish Queen Liz's nose on a 10c coin.....

Nari

[Diane]

Barrett, I expect our brains have organized themselves differently, is all.
I think the fingertip palpation is very primate, comes from feeling for nits etc. I feel for the nerve 'nits' under the skin, and can "see" them better with my eyes closed. The whole topography jumps into exaggerated relief then, and sensation through the fingertips leaps into my visual cortex and stage lights go on in there, flooding the scene. Like successful improv, the scene moves itself forward based on cues that come from the "audience" and from interacting with it.

Without these fingertips, I'd be "blind." Helpless for awhile. I'd have to learn a whole other way to "feel" my patients - maybe the way you do, with your whole mind and kinesthesis. That would take a huge amount of interior boundary reorganizing however, which I don't think my psyche could handle at this advanced age. So I use your SC mostly for homework assignment after the nitpicking. I like this combination best.

About the palpation training, in the classes I took at URSA, we used onion skin sheets over human hairs. How many sheets could one feel through successfully? was the goal of the exercise. But since I was a baby I've developed this fingertip sensitivity I currently make a living with - I was an expert label peeler by the age of two, I'm told. No one ever knew what the tin can contained, as all paper had to be peeled off all outsides of all groceries soon after entering the house, so for a long time all meals were pot luck. Babyhood can be so boring..

[Diane]

A random thought I had about how this "clearing of joints first" business makes no sense, is how it isn't just a mesodermal train of thought but also fundamentally a chiropractic one. It seems so in tune with the whole "subluxation" or "dysfunctional segment" (osteopathic version of the same thing) thing they seem to stick to like glue, to help them organize their thoughts and pass along their skill sets.