Diane
17-08-2008, 08:25 PM
NateM started a new thread, Dr. Pavel Kolar (http://www.somasimple.com/forums/showthread.php?t=6002). I see Karel Lewit is involved in this organization, and out of curiosity dug up an old text I have (which formerly belonged to a DC who wrote his name in ink inside the front cover) by Karel Lewit (http://www.rehabps.com/REHABILITATION/LEWIT.html) called Manipulative Therapy in Rehabilitation of the Motor System. (http://www.amazon.com/Manipulative-Therapy-Rehabilitation-Locomotor-System/dp/0750629649)
The book is dense, encyclopedic, and most of it appears to be looking at the nervous system mainly as a motor output system rather than as equally a sensing system, which of course leads to all sorts of garden paths...
But I took it out, and because I have nothing better to do at the moment, checked out all the bits that have to do with skin stretching - selective attention, I realize, but the Occam's Chainsaw application in my prefrontals says to me, "Don't waste any time wading through any other treatment concepts in there." So, here are the selected bits.
QUOTES re: SKIN STRETCHING:
1. P. 3: There is certainly a great variety of methods available to us if we want to act on a hyperalgesic skin zone, as skin receptors may be reached by most types of physical therapy (massage, electrotherapy, needling or even simple skin stretching.)
2. P. 137: Recently I have developed a method that is proving diagnostically more reliable, is completely painless, and therapeutically very effective; this is the method of skin stretching. Any area of skin, large or small, can be stretched by the operator either with his fingertips or with his hands placed flat on the skin. The technique is simple: I first stretch the skin with the minimum of force, so as to take up the slack, and then feel springing in the end position. This is compared in several directions over the tested area, which is also compared with the corresponding area on the healthy side. In a HSZ (hyperalgesic skin zone) there is a very stiff resistance after taking up the slack; after stretching in the end position has been held for about 10 seconds this resistance can be felt to weaken and normal springing is restored. This can be measured if we mark the area with a pencil before taking up the slack, after doing so, and then after about 10 sec stretching (see Fig 6.128 p. 303). By this method it is possible to diagnose (and treat) even such small HSZ as can form between toes, over painful bone areas (spinous processes, xiphoid processes, and over and around scars.
3. P. 172: It is also possible to test reflex changes: muscle spasm, trigger points, hyperalgesic zones, the skin fold or skin stretching may all be influenced immediately by manipulation, local anesthetic, or needling, or simply by skin stretching or post-isometric muscle relaxation. Instrumental methods such as the measurement of skin temperature, conductivity, plethysmography etc. may also show reflex changes affected by any type of therapy.
4. P. 183: Skin Stretching
This method is as specific in hyperalgesic skin zones as is PR (post-isometric muscle relaxation) where there is increased muscle tension. It has of course an effect similar to that of some massage techniques applied to the skin, like rolling a fold of skin (the 'pince roulé' described by Kibler (1958)), or the technique of Leube and Dicke (1951) but unlike these techniques it is completely painless, much less time consuming, and again can and should be used by the patient himself. Skin stretching should only be indicated for increased tension in the skin, more more precisely, for increased resistance to stretching in a specific area of the skin. It can be applied even to a very small area of the skin, such as the hyperalgesic fold between the toes in a radicular syndrome, or the skin over a periosteal pain point, with very good effect. Being entirely painless, it can be used even in hyperalgesic skin in causalgia.
5. P. 185: On closer examination it seems that many acupuncture points can be tender on palpation, that increased tension can be palpated on the site and that the skin over them may show increased resistance to stretching. In other words, if clinical examination of acupuncture points were to become a routine, a more rational application of treatment would ensue. This is borne out, too, by the results of electrical measurement of skin resistance at the sites of acupuncture points.
6. P 185: Any scars found should be examined for tender points on deep palpation, with increased resistance ('adhesions'); there may also be a hyperalgesic skin zone round the scar, best detected by skin stretching, To produce the Huneke phenomenon we may first stretch the skin, and if the result is not satisfactory we may then infiltrate or apply the needle to the pain spot within the scar. If treatment is successful both the resistance and the pain spot within the scar should disappear, and the lesion for which the patient is being treated (headache, radicular pain, etc.) should then markedly improve, and with lasting effect.
7. P 302: Skin Stretching
A method of reflex therapy that seems particularly useful yet is little known is skin stretching. In effect it is comparable with some forms of connective-tissue massage, but has the advantage of being more accurate as diagnosis, and entirely painless as therapy (unlike connective-tissue massage).
As explained in Chapter 4 (p. 138), an area of skin may be held between the fingertips or with the ulnar aspect of the crossed hands, from the little finger to the wrist (according to the size of the area) and stretched with the minimum of force so as to take up the slack. On further stretching a springing resistance can be felt. If there is a hyperalgesic zone the slack is taken up sooner and there is much less springing. If the therapist then holds the stretched skin in end-position, resistance weakens until normal springing is restored. The hyperalgesic zone can then as a rule no longer be detected. If pain is due to this hyperalgesic zone, this method is quite as effective as needling, electrostimulation and other similar methods. Moreover, it is entirely painless and can be applied by the patient himself. If we mark the area on the skin, the effect can be measured, and Berger (personal communication 1982) has constructed and electrical instrument that stretches the skin rhythmically with a constant force that can be recorded (Fig 6.128)
8. P. 324: A tender temporalis muscle can be treated by PR (together with the masseter) or by local anesthetic. The hyperalgesic zones on the forehead, temples and round the nose respond very well to skin stretching (see p. 303).
9. P. 333, Root Syndromes: ...hyperalgesic zones by skin stretching or by other methods of 'reflex massage'; the same methods may be applied to scars, which react very well to skin stretching.
The book is dense, encyclopedic, and most of it appears to be looking at the nervous system mainly as a motor output system rather than as equally a sensing system, which of course leads to all sorts of garden paths...
But I took it out, and because I have nothing better to do at the moment, checked out all the bits that have to do with skin stretching - selective attention, I realize, but the Occam's Chainsaw application in my prefrontals says to me, "Don't waste any time wading through any other treatment concepts in there." So, here are the selected bits.
QUOTES re: SKIN STRETCHING:
1. P. 3: There is certainly a great variety of methods available to us if we want to act on a hyperalgesic skin zone, as skin receptors may be reached by most types of physical therapy (massage, electrotherapy, needling or even simple skin stretching.)
2. P. 137: Recently I have developed a method that is proving diagnostically more reliable, is completely painless, and therapeutically very effective; this is the method of skin stretching. Any area of skin, large or small, can be stretched by the operator either with his fingertips or with his hands placed flat on the skin. The technique is simple: I first stretch the skin with the minimum of force, so as to take up the slack, and then feel springing in the end position. This is compared in several directions over the tested area, which is also compared with the corresponding area on the healthy side. In a HSZ (hyperalgesic skin zone) there is a very stiff resistance after taking up the slack; after stretching in the end position has been held for about 10 seconds this resistance can be felt to weaken and normal springing is restored. This can be measured if we mark the area with a pencil before taking up the slack, after doing so, and then after about 10 sec stretching (see Fig 6.128 p. 303). By this method it is possible to diagnose (and treat) even such small HSZ as can form between toes, over painful bone areas (spinous processes, xiphoid processes, and over and around scars.
3. P. 172: It is also possible to test reflex changes: muscle spasm, trigger points, hyperalgesic zones, the skin fold or skin stretching may all be influenced immediately by manipulation, local anesthetic, or needling, or simply by skin stretching or post-isometric muscle relaxation. Instrumental methods such as the measurement of skin temperature, conductivity, plethysmography etc. may also show reflex changes affected by any type of therapy.
4. P. 183: Skin Stretching
This method is as specific in hyperalgesic skin zones as is PR (post-isometric muscle relaxation) where there is increased muscle tension. It has of course an effect similar to that of some massage techniques applied to the skin, like rolling a fold of skin (the 'pince roulé' described by Kibler (1958)), or the technique of Leube and Dicke (1951) but unlike these techniques it is completely painless, much less time consuming, and again can and should be used by the patient himself. Skin stretching should only be indicated for increased tension in the skin, more more precisely, for increased resistance to stretching in a specific area of the skin. It can be applied even to a very small area of the skin, such as the hyperalgesic fold between the toes in a radicular syndrome, or the skin over a periosteal pain point, with very good effect. Being entirely painless, it can be used even in hyperalgesic skin in causalgia.
5. P. 185: On closer examination it seems that many acupuncture points can be tender on palpation, that increased tension can be palpated on the site and that the skin over them may show increased resistance to stretching. In other words, if clinical examination of acupuncture points were to become a routine, a more rational application of treatment would ensue. This is borne out, too, by the results of electrical measurement of skin resistance at the sites of acupuncture points.
6. P 185: Any scars found should be examined for tender points on deep palpation, with increased resistance ('adhesions'); there may also be a hyperalgesic skin zone round the scar, best detected by skin stretching, To produce the Huneke phenomenon we may first stretch the skin, and if the result is not satisfactory we may then infiltrate or apply the needle to the pain spot within the scar. If treatment is successful both the resistance and the pain spot within the scar should disappear, and the lesion for which the patient is being treated (headache, radicular pain, etc.) should then markedly improve, and with lasting effect.
7. P 302: Skin Stretching
A method of reflex therapy that seems particularly useful yet is little known is skin stretching. In effect it is comparable with some forms of connective-tissue massage, but has the advantage of being more accurate as diagnosis, and entirely painless as therapy (unlike connective-tissue massage).
As explained in Chapter 4 (p. 138), an area of skin may be held between the fingertips or with the ulnar aspect of the crossed hands, from the little finger to the wrist (according to the size of the area) and stretched with the minimum of force so as to take up the slack. On further stretching a springing resistance can be felt. If there is a hyperalgesic zone the slack is taken up sooner and there is much less springing. If the therapist then holds the stretched skin in end-position, resistance weakens until normal springing is restored. The hyperalgesic zone can then as a rule no longer be detected. If pain is due to this hyperalgesic zone, this method is quite as effective as needling, electrostimulation and other similar methods. Moreover, it is entirely painless and can be applied by the patient himself. If we mark the area on the skin, the effect can be measured, and Berger (personal communication 1982) has constructed and electrical instrument that stretches the skin rhythmically with a constant force that can be recorded (Fig 6.128)
8. P. 324: A tender temporalis muscle can be treated by PR (together with the masseter) or by local anesthetic. The hyperalgesic zones on the forehead, temples and round the nose respond very well to skin stretching (see p. 303).
9. P. 333, Root Syndromes: ...hyperalgesic zones by skin stretching or by other methods of 'reflex massage'; the same methods may be applied to scars, which react very well to skin stretching.