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  • A simple case

    Consider the legs pictured below. What questions would you like answered? How would you ask them? What would you ask them and why?

    More pictures to come.
    Attached Files
    Last edited by Barrett Dorko; 16-01-2017, 01:53 PM.
    Barrett L. Dorko

  • #2
    I really just like to jump in so my first question is why is he so close to the edge of the bed? It looks as though he is about to fall off.

    Is he supposed to get some kind of feedback from the laptop?

    I know this is a very rudementary bit but like I said I like contributing.:teeth:
    Byron Selorme -SomaSimpleton and Science Based Yoga Educator
    Shavasana Yoga Center

    "The first principle is that you must not fool yourself - and you are the easiest person to fool" Richard Feynman

    Comment


    • #3
      Are the pillows under the knees providing some sort of relief for LE or back pain? Is the left hip more comfortable in external rotation? (It appears to be situated that way in this picture)
      Lauren Clark

      'Tis a poor craftsman who blames his tools.

      Comment


      • #4
        Don't worry about how close to the edge he appears. No one's in danger here.

        Forget the computer and the pillow. Clark's onto something.

        What does the hip position result in?
        Barrett L. Dorko

        Comment


        • #5
          Originally posted by Barrett Dorko View Post
          What does the hip position result in?
          Postural Restoration says that this patient presents with a typical L anterior interior chain from poor zone of apposition in the L thoracic cage...but I doubt that is what you are looking for...so...I offer you a more serious answer:

          ER and Abd of the L hip would reduce neural (sciatic) tension, no?

          (Cannot tell clearly if the R hip is in "neutral" or is IR'd b/c of the pillows).

          Thanks for this thread.

          Respectfully,
          Keith
          Blog: Keith's Korner
          Twitter: @18mmPT

          Comment


          • #6
            My first question would be, does the patient have a painful problem on the (R) side of the body somewhere? What's causing the observed asymmetry in the lower limb position.

            Comment


            • #7
              Well,

              1. My first Q: what was this guy's main complaint??
              2. It seems to me:
              a. R side in neutral (does this guy have any deformity in R tibia??)
              b. L side in ER: unload the lateral cutaneous N tension+ in hip sl. F further unloading whole Femoral N tension
              3. Barett, di you really think that a pillow did not make any positional change???
              And why you put him in this position??

              Thank you,

              Weni

              Comment


              • #8
                Compensatory (L) hip ER for the apparently kinky (R) tibia?
                Plus some dodgy neurodynamics.

                Nari

                Comment


                • #9
                  The pillow's there because the patient's knees won't extend fully. It doesn't affect the most important issue: Where do the legs rest when the patient lies supine? This is the position he chose. And my interest is in the hip's affect upon the foot position.

                  Of course I want to know whether the patient can alter their pain with position or use. Otherwise, how can I determine anything about the origin of their pain?

                  Forget the tibia. As you can see in the picture below, taken ten minutes later, treatment has already resulted in an alteration of position that couldn't have come from any change there.

                  How might I have tested him manually prior to employing Simple Contact?

                  P.S. The picture's blurry because I'm not Ansel Adams
                  Attached Files
                  Last edited by Barrett Dorko; 14-10-2011, 12:06 PM.
                  Barrett L. Dorko

                  Comment


                  • #10
                    His initial position appears to be tense and protective compared to his post-treatment position - both hips have rotated more externally. Apparent reduction of defense/neural stress.

                    Pre-treatment manual testing may have been neurodynamic testing of femoral and sciatic complexes (with, for me, a strong suspicion of both left sciatic tension and right femoral tension - but just vissual clues can be deceiving. He may simply be asymmetrical).
                    We don't see things as they are, we see things as WE are - Anais Nin

                    I suppose it's easier to believe something than it is to understand it.
                    Cmdr. Chris Hadfield on rise of poor / pseudo science

                    Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                    We don't need a body to feel a body. Ronald Melzack

                    Comment


                    • #11
                      Originally posted by Barrett Dorko View Post
                      How might I have tested him manually prior to employing Simple Contact
                      Originally posted by Bas Asselbergs View Post
                      Pre-treatment manual testing may have been neurodynamic testing of femoral and sciatic complexes
                      This is what I was thinking as well.

                      Originally posted by Bas Asselbergs View Post
                      with, for me, a strong suspicion of both left sciatic tension and right femoral tension
                      Before the second pic, I was thinking about how the sciatic n. is sensitized with SLR/Slump testing via IR/Add and that the patient might be displaying defense (rather than defect, as I have read mentioned before) via ER/Abd the L hip to reduce tension. But there appears to be less "defense" in the later pic, and we are to assume that the pics are presented chronologically, right?

                      If so, even if my thought had been correct (sciatic n. tension) my logic had been poor, or else the patient would NOT have been "guarding" by positioning himself in a position of increased neural tension (IR/Add on the L) in the first pic compared to the second.

                      Again, thanks for this learning opportunity.

                      Respectfully,
                      Keith
                      Blog: Keith's Korner
                      Twitter: @18mmPT

                      Comment


                      • #12
                        Personally, I wouldn't do any neurodynamic testing. Heresy, I know.

                        I would have already determined that use of the right leg increased his pain so the origin is obviously mechanical deformation. At least, the origin I can most readily deal with given what I do for a living.

                        The obvious choice of internal rotation and adduction of the right hip is something I want to see given the patient's history. It means I have something obvious to treat. I need to help him find a path toward external rotation and abduction. In this position that's where gravity would take him and that's where the left leg can go easily. That, I assume, is why it doesn't hurt.

                        My test? "Lie on your back. Here's a pillow for your knees." Now I observe - takes about 3 seconds. Then I see how the limbs respond to passive movement toward the position I'd prefer - the one the left leg is already in external rotation.

                        I don't handle the limb as if I'm trying to start a lawnmower.

                        Twenty minutes later you see what is depicted below.

                        How did we get there?
                        Attached Files
                        Last edited by Barrett Dorko; 24-02-2013, 02:49 PM.
                        Barrett L. Dorko

                        Comment


                        • #13
                          Pre-treatment manual testing may have been neurodynamic testing of femoral and sciatic complexes
                          I did not mean to imply that you actually did. By now, I know that you observe these and appreciate them as effect of mechanical deformation somewhere. It has only been in the past 5 years that I have really started to appreciate this phenomenon of rotated leg positions.

                          Heresy? In many circles: yes. Not in my eyes.


                          "start a lawnmower" - I now have that image stuck in my head......Funny (and it should be sad)
                          We don't see things as they are, we see things as WE are - Anais Nin

                          I suppose it's easier to believe something than it is to understand it.
                          Cmdr. Chris Hadfield on rise of poor / pseudo science

                          Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                          We don't need a body to feel a body. Ronald Melzack

                          Comment


                          • #14
                            Thanks Bas. I appreciate how neurodynamic testing is required to satisfy those who insist upon such things. I don't. and I doubt they're as telling as we hope they'd be. The nervous system is too complex.

                            Still, I love that they've been invented.

                            I like that "starting a lawnmower" thing too. Elaine told Kramer that this is the way she intended to "pull the plug" if he ever needed that (Seinfeld).

                            I tap gently. This tells me what I need to know.
                            Barrett L. Dorko

                            Comment


                            • #15
                              Originally posted by Barrett Dorko View Post
                              I like that "starting a lawnmower" thing too.
                              It does resonate...similar to when I (if I remember correctly) you told a student that she wasn't "sweating to the oldies" in one of the "Diamonds" vids.

                              Originally posted by Barrett Dorko View Post
                              I tap gently.
                              I am picturing you gently tapping the foot, to determine how readily/easily the lower limb moves into rotation, but I am uncertain if I am taking from this what you intend.

                              Originally posted by Barrett Dorko View Post
                              This tells me what I need to know.
                              The operator in me is frustrated by this and needs more information than a "tap" will provide. The interactor in me is still learning that all that extra information can just be window dressing, anyway.

                              Respectfully,
                              Keith
                              Blog: Keith's Korner
                              Twitter: @18mmPT

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