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Clinical Reasoning Typical cases are discussed there. The cases are brought by practioners.

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Old 19-07-2004, 09:02 PM   #1
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Default Back Lateral Shift .

Hello all ;

In some cases of back pain there is lateral shift of the spine toward the nonaffected painful side , usually those cases have sciatica , disc ......

compressing nerves ....
Meckenze concept , is the only one who discussed that topic .

Could we open a discussion regarding that issue .

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Old 20-07-2004, 01:09 AM   #2
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Trauma reflex! Withdrawal response from where the pain is present.
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Old 20-07-2004, 03:13 AM   #3
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Hi Emad,

I have also seen a person with a lateral shift and back pain with no recent history of trauma. After further questioning he reported having a severe plantar fasciitis several years prior. He tended to stand with more weight on one leg than the other.

I hypothesized that he began to shift weight off of the painful foot, this became habitual (he kept putting more weight through that leg even after the foot felt better), and the lumbar shift was a result of the weight shift over time.

My treatment was to help him learn to stand evenly again.

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Old 20-07-2004, 03:44 AM   #4
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Hi emad

Quite a few conditions will produce this reaction, from corns and warts on the foot to the pelvis - in fact almost anything in the WB lower areas.

Trauma is the least common cause, I think - but the most recognised culprit is the severe. acute radicular pain from disc herniation (according to the experts).
Sometime after the pain is registered by the brain, the owner of the body forgets what is 'normal' and accepts the new posture as odd-looking but cannot see a way out of it. It is easy to retrain the brain - use a mirror, ask them what is wrong and ask them to change it. And if the pain returns suddenly, they can ask themselves: where are the hips -where is all the tension- etc. Basic Rehab (neurorehab) physio, when you think about it....
There is debate whether it is important tor quite unimportant to 'change' an 'abnormal' posture that has been designed by the brain anyway....but being physios, we tend to retrain to what is visually normalised to be optimal function.


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Old 20-07-2004, 09:15 AM   #5
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Cory and Nari,
I want you to understand what I mean by trauma.
Trauma reflex is a pattern of the somatic representations thru the physical body.
Trauma is not necessarily a big one time stress to us.
A small repetitive stress can be traumatic. Strong physical and emotional experience is also a trauma. Strong negative imagination (representation by the brain) can be that, too.

Also note what said after Trauma Reflex": Withdrawal response away from the pain. Cory, your example of the person with foot pain is the exactly what it is.
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Old 20-07-2004, 02:22 PM   #6
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Hi Somasimplers,

I moved that one on Clinical Reasoning Forum. It is the best place to find a consensus about this lateral back shift!

1/ lateral back shift is a muscular contraction of waist muscles.
2/ this contraction is not ever painful!
3/ patients feel that something goes wrong but are unable to change what is going wrong?
4/ it comes often with low back pain/sciaticas?
5/ it may be a consequence of long distance injury/trouble?
6/ it is sure that is a brain reaction. :wink:

Questions;
Why did this reaction occur?
What is the goal of this reaction?
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Old 20-07-2004, 09:55 PM   #7
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Hi all :
thanks for your discussions

Takao&Bernard

you considered the topic somatic education , no more than fear ,withdrawel and reflexes

Nari

you looked at the topic as manual therapist , and you gave brain consideration looking at the issue as rehabilitation .

Cory

The example you wrote ,slightly different however limb length change and foort problems could create the same shifts .

Friends
i set that discussion as i have a patient of that lateral back shift , extremely painful case ,he is 20 years

the patient can not even stand with extended knee ,he felexed the knee around 10 degrees to avoid pain from sciatica .

really i felt so sad after assessed that case in his second visit to me , i felt i do so bad , iam the cause of his over pain sensation , he was to some what have pain and back shift , after i tried to treat him using neural mobilisations and physiological mobilisations of lumbar ,and trying to correct his shift .

When i tried to correct his shift was so painful and referring numbness .

So

What we do in case of lateral shift?
usually that case is accompanied with numbness with in flex/ext .

Has any one studied Meckenzie concept ?

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Old 20-07-2004, 10:05 PM   #8
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Takao & Bernard:

I looked at the topic from tradational manual therapy point of view ,i mean Meckenzie concept .

But If somatic education seems more applicable practical with good outcome than Meckenzie concept ,that is Okay , however we can not have any evidence .

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Old 21-07-2004, 03:44 AM   #9
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emad

Correcting lateral shift can be intolerable for them, and also produce sensations of numbness, p & n (which usually reproduces their signs)
McKenzie would be the ususal way to proceed, but first of all, try to teach the patient to correct the shift actively in a mirror, to where it feels quite tolerable.
The shift should be corrected before EIL or EIS - but does not have to be 100% corrected, which is unlikely in one go.

Perhaps the Somatics PTs can suggest some strategies.

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Old 21-07-2004, 11:01 AM   #10
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Hi Nari:

When i tried to correct the shift very very gently :arrow: severe pain and numbness :idea: :!: :?:

By the way all perpheralisation occurs with extension .

Trunk flexion :arrow: no perpheralisation .


To Takao & bernard

If we use somatic education & relaxation actively :arrow: may relax surrounding musclature but not at all will correct if there is disc herination .

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Old 21-07-2004, 11:40 AM   #11
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emad

Flexion - no peripheralisation = do flexion+ in side/lying or sitting or standing
Extension -peripheralisation = avoid extension (eg supine) or supine in spaceman's position. (Supine, hips at 90, knees at 90, lower legs fully supported by an ottoman or similar)
Try to get him to shift in a position of flexion, eg spaceman's.
When he gets up from that position, -->sidelying-->all fours-->stand up slowly, 'uncurling'.

Are you sure he has no underlying spondylolisthesis?
Disc herniation, if causing symptoms, is unusual anteriorly in segment; but it could be antero-pateral - perhaps.

main thing is move SLOWLY - tell him.


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Old 21-07-2004, 12:17 PM   #12
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Emad and others,

Just try low back exercise I gave in the Try it section!
There is no risk, absolutely!

The only risk comes with you, you think it will hurt or you think they cannot do it.

Consequence => if root problem then it lets a sort of unplesant localized little zone around it.
other cases => the patient feels => nothing just the feeling that muscles worked.
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Old 21-07-2004, 04:37 PM   #13
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Hi Emad,
I would also be suspiscious of a spondylolisthesis, but regardless what tissue is involved, as Nari said, you know to avoid extension positiions.

From a recruitment standpoint, be suspiscious of illiopsoas. You will probably need to settle it down, as well as improve the recruitment of the lumbar stabilizers. Maybe try Nari's treatment in the try it section with several pillows under the hips or in sitting.

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Old 21-07-2004, 08:39 PM   #14
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Bernard :

I have to say sorry with somasimple , i have NOT seen any flash ,versions of what u had downloaded on the forum.

i can not say why , but here all computer specialists can not get me the answer .

i think i have read before the topib you put on TRY section , but the flash can not be downloaded here , so i can not do it properly


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Old 21-07-2004, 08:53 PM   #15
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Hi Nari:

you are absoultely right , i am thinking of what you have written.

Regardiny the issue of spondylositheis , he visited a spcealist in orthopedics before me , who performed all investigations , then referred him , so i will be so sure from the issue again , i will read all his investigations reports by myself .

I think , yes i will perform flexion from sitting /sidelying , but if i choosed to use sidelying which side i may use , i think i will ask him about the most relaxed with no referring sympotoms postion of sidelying , and i will tell you.

Cory
thnx for your advice regarding iliops and stabilizers , but now i search to subside his pain and numbness .


By the way the neural mobilisation ex i used was of ( very gentle sligt degree only one knee EXT + neck EXT and the opposite for 3 repitations only with great cauation )

And of course Ultrasound for just 2 minutes on the area of great tender on Gluetus center ( i will try to stop it )

I spend 60% of the session speak and educate the consumer.

i hope to do better in coming thrusday :?

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Old 23-07-2004, 09:52 AM   #16
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Emad,

I embodied the flash animations directly on the site. Normally you must see them If you get flash player installed on your computer.

For an example, if you click on the link below, you may see a little animation?
http://www.somasimple.com/flash_anims/rubber01.swf

If you see a blank page then you must update/download flash player, here =>
http://www.macromedia.com/shockwave/...nguage=english

If you continue to experience problems, let me know!
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If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 23-07-2004, 10:37 AM   #17
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Hi Bernard:

thank you very much i try to install , now , from the Micro media webste.

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Old 24-07-2004, 09:43 PM   #18
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hi all:

clear this consumer suffered more problem , he does not come back, of course i have not the chance to apply Meckenzie and Nari ,s suddesations.

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Old 25-07-2004, 11:03 AM   #19
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Emad,

What was exactly the content of the last session? Is it the one that you described before?
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We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

Everything should be made as simple as possible, but not a bit simpler.
If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 25-07-2004, 11:30 AM   #20
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Hi Bernard :

yes that what i have done at our last session .

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Old 25-07-2004, 12:52 PM   #21
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emad

I think you will find what you did was the exactly the right thing...very little of the appropriate method and lots of education.
Some patients expect a lot of hands- on and magic machines - but it is not necessary.
In the 1980s, people would roll up to physiotherapy, receive 5 minutes of Maitland passive mobilisation on a defined spinal segment. a few McKenzie movements and 20 minutes hot pack. They all did pretty well...but they were almost all in acute stages.


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Old 25-07-2004, 12:59 PM   #22
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Emad,

Could you download the files?
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We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

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If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 25-07-2004, 08:25 PM   #23
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Hi Bernard :

Which files you mean ,.

cjeers
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Old 25-07-2004, 08:28 PM   #24
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Hi Nari:

you r right , this of no evidence to be done in acute satge !

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Old 25-07-2004, 08:47 PM   #25
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Ok bernard ;

i will try then
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