Asymmetrical tonic neck reflex???

[Thomas]

I stumbled onto this useful tip in the clinic while working with an elderly fellow who had atraumatic stiff shoulder, and have used it to good effect with some other patients. :D

When your client is using the pulleys to limber up the shoulders, have him rotate his head to the opposite side of shoulder flexion.

Ex- client pulls his right shoulder into flexion whilst rotating his neck to the left in a smooth and relaxed manner, as if the act of flexion is helping to turn the neck.


Try this without pulleys and there is a greater ease of motion.

Here in America we have to keep on eye on these kind of movements as the patients competitively speed up and force the motion,which shoud be SLOW and SMOOTH and absolutely PAIN FREE. No forcing of the neck or the shoulder.

Shoulder flexion improves more rapidly while easing neck stiffness. Is this due to asymmetrical tonic neck reflex , or perhaps exploring nonthreatening / non painful movement ?

Cheers.........Thomas

[nari]

Hi Thomas

This is an interesting post, and I think to your final question, it may be both.

I never use pulleys- can see no useful purpose in them, but very rarely I might suggest to someone that some block and tackle and a rope be set up in the home to use occasionally.

There is another way - when you ask someone to do the usual neck rotation exercise, ask them to elevate the contralateral shoulder; it increases rotation by a significant degree, as it relaxes the nerve roots.
Then, they are able to perform the same degree of rotation without shoulder elevation.
I also ask certain patients who need some good scapular motion, to retract scapulae while elevating the shoulders. Depressing shoulders while retracting increases nerve root tension and from a physiological view, may enhance an ischaemic state - just a surmise.

Your idea should work well, I think. Composite movements in physiological directions usually work better than isolated movement.
And, controlled calm breathing during the movements helps as well!

Keep posting!


Nari

[Thomas]

Hello Nari, Cheers down under !

Thank you for your reply. Your idea regarding contralateral shoulder elevation with neck rotation is a good one. Ditto to the scapular setting with shoulder elevation. :idea:

I would certainly be open to your ideas regarding "pulleys are useless". What sorts of clever techniques do you use to facilitate ROM
(other than strictly hands on or wand and traditional approaches)?

Was schooled in the traditional model of PT, ( very limited ) and would appreciate any insights you can offer. Will keep reading and learning.

Always find your posts insightful. ( Loved "thats when the penny dropped')

Thomas

[nari]

I was very much trained in traditional physiotherapy many years ago, and kept trying to crawl out of the stagnancy all the time.

Being something of a rebel, it helped my brain focus away from what seemed fairly useless, and adopt new things in the hope we can offer more.

Re ROM - it depends, I think on the reason for the loss of ROM.
If it is stiffness only, lots of hands on and PNF and active mobilisation.
Don't see many cases of stiffness only, mostly pain. I treat the pain with neural dynamics/mobilisation and sliders/tensioners and lots of education so they understand where the pain is coming from (eg, not the 'degenerative disease' as the MDs elegantly put it), but most likely the brain's temporary reaction to a change in a touchy segment.

I make up quite a few movements for UL based on the three UL nerves, and whether they are going to be free wheeling movements, or specific to wrist/elbow/shoulder tension points.

It is quite surprising sometimes how effective non-specific movements can be, or contralateral movements. eg, with a painful stiff shoulder that someone has unkindly labelled "frozen", you can pick up some ROM by getting the neck and other shoulder moving regularly on easy, rhythmical and thoughtful actions.


Enough rave - this forum is a very generous one as people can happily rave away on what is important to them and someone will always respond!!

Have a roam around Google or PubMed with the keywords Moseley GL, or Gifford L, Watkins L., or any of the references in this forum - there are heaps of them...
Enjoy!


Nari

PS What part of the USA are you from?

[bernard]

Welcome on Somasimple Thomas,

Here is an interesting picture that shows and confirms your finding!

http://www.somasimple.com/images/rope_pull.jpg

The normal functioning (here in limit contitions) shows the head rotation! It may be explained easily, using the controlateral side to help the weak one?

[Thomas]

Thank you for your replies Nari,

Boy, do I have a hell of a lot to learn. Where can I get my refund for 3 years of Physiotherapy so called "Education"?

Bernard,

Great PIC ! Were you referring to the rope pulling strictly in the photo of the "tug of war" ? In my limited example , I was thinking more along the lines of a subtle subconcious process that produced reflexive relaxation. John Iams has a technique where he recommends someone to turn their head to the right when they are feeling/starting to fell angry,
perhaps something like :evil: Maybe his technique works because it turns off the predator in us (eyes fixed forward/ canine teeth/ veggies be damned!) Just some musings.........................Cheers........Thomas

[Thomas]

Missed your last question Nari,

Got some serious reading to do , especially Butler's Sensitive etc..
Now that you've convinced me of Placebo I am no longer looking forward to the muscle energy course!


I live in small town in Maryland (East Coast) partway between Baltimore
and Washington D.C. . Envy your Winter !...................Thomas

[nari]

Thomas

When I look back on my three years' education in Physiotherapy, almost none of it applies today - or yesterday. This was at a topnotch University as well; and it was in the days of diplomas, where you had to have referrals and you had to follow orders. Straight technicians; that all ended in 1976, fortunately.
I became so bored with a technician's life doing recipe Rx, I threw it all in and went off for three years doing research (as a technician) in Zoology and Biochemistry -best thing I ever did. Caring for African lungfish, African clawed frogs, rare frogs, extracting DNA from rat livers by the armful, and so on. I can assure you, it is MOST exciting to stare at a 1 litre beaker chock full of stringy, sputum-like DNA in the raw - starting with a 20 mg sliver of liver....

But I came back to physio...for better or for worse.
If you learn something new each week - it is amazing what you will amass at the end of a year.

Keep going!


Bernard, a great piccy (Oz for photo) - very relevant!


Nari

[Diane]

Hi Thomas,
I'd say, don't stop being excited about muscle energy. I think it's a great technique. I also think it's name needs to be changed to something less weird sounding, and more descriptive, like "segmental contract relax exercise", but I'm not Fred Mitchell, DO, and I'm sure he would object if I changed the name of his great technique...

Anyway, good techniques are good techniques, and the great ones like muscle energy could take a lot of the steam out of the big blustery ones like highvelocity lowamplitude manips, if anyone ever cared to do a comparison study, I'm sure... Both of them probably work at least partly by placebo, but so what? Go for it, you can't learn enough, have enough tools to pick from, or too many ways to see the body and coax better behavior from it.
$.02,
Diane
PS: Welcome to the board!