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  • Thanks Barrett and yes, that is pretty funny.

    I have noticed with a couple of patients, that when they first lie down and say "I'M relaxed" they are breathing apically and both feet are pointing straight up - as they are relaxing into more diaphragmatic ventilation, the legs slowly "sink" into lateral rotation. This sometimes takes minutes to fully develop, and only then can I determine any difference between left and right. It is funny how at times, no words are needed to start this sequence, while at other times, I had to go as far as asking the patient to really relax their legs and "let" their feet fall outwards - this also changed their breathing. I find it fascinating - it is such a simple event (and so long not appreciated by me), yet illustrates so profoundly for the patient the interrelation of systems in their body. It can often be an "Aha"-event for them on their way to awareness and connection with their soma.
    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


    • Bas,

      My experience precisely, thousands of times.

      Therapists often ask for the posture of the upper quarters that has a similar effect and are disappointed when I tell them there isn't one. This is just another example of our genetically driven desire for symmetry.
      Barrett L. Dorko

      Comment


      • Barrett

        This is a dopey question, but why isn't there an equivalent posturing in the upper quarters? Is it because we are primarily bipedal?

        Come to think of it...in the painful shoulder, the humerus tends to internally rotate and adduct. Often after treatment, it derotates towards neutral and I have not even touched a muscle; well, not with intention anyway. This is using neurodynamics as per Shacklock/Butler.....



        Nari

        Comment


        • Nari,

          I think you hit upon the answer in your mention of bipedalism. We need mobility in the upper quarters and relative stability below.

          It would follow that the nervous system isn't as sensitive to positioning in the shoulder.
          Barrett L. Dorko

          Comment


          • Hi!
            Been reading your topic with great interest and have some comments.
            Not to consider a patients emotional state of mind(cognition) regarding their pain and their way of living(psychososial)is for me more or less impossible due the fact that i personaly know how my "feelings" interact with my "body"(hypothalamus,amygdala,ANS etc)

            In my point of view its quite normal for people in"pain", due a mechanical ,emotional ,chemical etc etc "source"
            to have their left leg internaly rotated.
            An increased ANS/corticospinal activation increases the general muscular tone/tension espessialy on the left side(right handed)("here i go again")

            Where do YOU find the internal rotaed leg???

            If you "dear to touch" the patient(not SC this time)youll
            might find some sidedifferences in strenght and musclular tone/tension thats quite interesting!

            The longer iam in this "buissines"the more convinsed iam about the body/mind connetion!

            Iam not focused on a diagnose but the patient might be!!

            Iam letting many of my patients "treath them selvs" by giving the increased knolwledge in this connection but also focusing on, not beeing afraid to use their body dispaite their pain,as long as their pain dosent increase.(the back will not brake in to)

            They might have been told to be carefull by MD or physiotherapist labeling them with diagnoses.

            As soon as they is convinsed that they have to use their bodyit isent dangerous,but its "dangerous" not to use it,,and starts to do this by getting back to exercise groups etc the ANS-sympathicus/corticospinale activation
            "calms down" and the pain gradually decreases ,function increases ,muscular tone decreases,lateral leg rotaion is more sidelike,breathing is calmer and more in the abdominal area ,for many of them(not all of course).

            Still i havent done any classical physiotherapy or manuelltherapy modalities.

            Sorry ,got carried awy!
            SC might be got soultion for many patients but there are other ways to Rome !
            I have found one way which fuction for many but luckily not all!

            RIN

            Comment


            • Rin,

              What you describe sounds perfectly reasonable - educate, reduce fear, and get moving in a general way. Lots of PTs would support this method, even without manual therapy or other techniques. If you calm down the ANS, then it is a start to reduce dysfunction.
              I think the extra value of SC is its educational value; it is an instant insight for the patient that they "don't need this pain"; the consciously contrived chains placed there by some doctors and PTs with warnings of do this but don't do this, and so on, are artificial.
              There are a few ways to reduce this closed circuit of pain generation, and as long as these ways are based on sound neurophysiology, nobody is saying there is only one way. What needs to be kept on mind is to learn the most effective, the quickest, long-lasting and user-friendly way to meet the patient's needs.

              Nari

              Comment


              • Damn Randy...

                Randy you are one tough dude for running on a tibial fracture!
                It has been my clinical experience that the tissue in this area is very sensitive to mechanical stimuli, and have seen grown military men with tibial fractures break down and cry, even in front of others. Now that says a lot.
                J
                Jason Silvernail DPT, DSc, FAAOMPT
                Board-Certified in Orthopedic Physical Therapy
                Fellowship-Trained in Orthopedic Manual Therapy

                Certified Strength and Conditioning Specialist


                The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                Comment


                • But was it the fracture of the bone that hurt? Or was it the irritation of the free nerve endings in the periosteum, also presumably deranged (mechano nocioception)/bled into (chemo nocioception)/irritated by inflammation (thermo nocioception) (final one less likely, more likely to be more chemo-nocioception) by the fracture?
                  Diane
                  www.dermoneuromodulation.com
                  SensibleSolutionsPhysiotherapy
                  HumanAntiGravitySuit blog
                  Neurotonics PT Teamblog
                  Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                  Canadian Physiotherapy Association Pain Science Division Facebook page
                  @PainPhysiosCan
                  WCPT PhysiotherapyPainNetwork on Facebook
                  @WCPTPTPN
                  Neuroscience and Pain Science for Manual PTs Facebook page

                  @dfjpt
                  SomaSimple on Facebook
                  @somasimple

                  "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                  “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                  “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                  "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                  "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                  Comment


                  • Good questions, Diane, I guess I meant all of the above.
                    I think just because tibial fractures hurt, it doesn't mean it's the nerve endings in the bone.
                    Having banged my shin before, i know that it certainly can happen in the absence of fracture.
                    Many of my military patients with stress fractures can attest to this. Periosteum, surrounding tissue, cutaneous nerves...any of the above.
                    J
                    Jason Silvernail DPT, DSc, FAAOMPT
                    Board-Certified in Orthopedic Physical Therapy
                    Fellowship-Trained in Orthopedic Manual Therapy

                    Certified Strength and Conditioning Specialist


                    The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                    Comment


                    • Jason,

                      If you're going to say that "bone" hurts along with the rest of it you're going to have to explain the mechanism. Got one?
                      Barrett L. Dorko

                      Comment


                      • I guess what I was getting at was that the nerve endings in the bone were stimulated by mechanical deformation.

                        I'm not sure why it sometimes persists even with rest from the offending activity (usually running/jumping). I am beginning to feel that it is a lack of corrective movement, and after having significantly helped two patients today with simple contact, I can say that with somewhat more confidence.

                        By the way, this thread is awfully long and I got lost on where we are on our list of questions, can we fill in the list?

                        1. Can you change your pain with position or use?
                        2. What is your autonomic state and how is it related to breathing?
                        3.
                        4.
                        5.

                        J
                        Jason Silvernail DPT, DSc, FAAOMPT
                        Board-Certified in Orthopedic Physical Therapy
                        Fellowship-Trained in Orthopedic Manual Therapy

                        Certified Strength and Conditioning Specialist


                        The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                        Comment


                        • Jason,

                          It might help to think about the 'deep bony' pain that people with chronic pain often describe in the absence of any injury, and the extent of injury is not proportional to the degree of pain experience.

                          And...the 5 questions:

                          1. Post #1
                          2. Post #28
                          3. Post #42
                          4. Post #49
                          5. Post #132

                          Nari
                          Last edited by nari; 26-06-2006, 11:11 PM.

                          Comment


                          • Jason, Nari is right.. never underestimate the power of the patient's brain to concoct a perceptual pain fantasy that they will accept as absolutely real, and might even fool you into thinking might be real, like "I feel like there's a bone out of place"... there are so many of these;
                            1. It feels like I have a noose around my armpit/hip/wrist/knee/whatever
                            2. I feel like I have a nail stuck in my back/knee/hip/foot/whatever
                            3. There is this place right here (pointing to posterior pelvis/wherever) that if I grind my thumb into it for awhile it sort of feels better at least for awhile
                            4. etc etc..

                            They are all metaphors for kinesthetic disarray from motor output glitches..

                            If you scan through the posts the 5 original questions will reveal themselves.
                            Diane
                            www.dermoneuromodulation.com
                            SensibleSolutionsPhysiotherapy
                            HumanAntiGravitySuit blog
                            Neurotonics PT Teamblog
                            Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                            Canadian Physiotherapy Association Pain Science Division Facebook page
                            @PainPhysiosCan
                            WCPT PhysiotherapyPainNetwork on Facebook
                            @WCPTPTPN
                            Neuroscience and Pain Science for Manual PTs Facebook page

                            @dfjpt
                            SomaSimple on Facebook
                            @somasimple

                            "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                            “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                            “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                            "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                            "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                            Comment


                            • As another example, 2 weekends ago I did a half ironman triathlon, and suffered the expected aches and pains thereafter. 36 hours after the event a new annoying pain developed around my heel. If I didn't know any better I would I said it felt just like a "bone was out of place." In fact this is exactly what I told Diane, much to her delight. It was like walking with a large rock under my foot. Although not completely resolved, Diane, the ultimate professional social groomer, demonstrated how rapidly significant neuromodulation could occur just by twisting the skin around my heel and foot. No need to crack anything, or whip cuboids back into place. This was a real aha moment for this kinesthetic learner.

                              eric

                              ps. If anyone is wondering, I finished the race, and not in any spectacular sort of way. I have alot to work on for next year. pic(4006.jpg)
                              Last edited by EricM; 26-06-2006, 11:43 PM.
                              Eric Matheson, PT

                              Comment


                              • Nice job Eric. Did you happen to notice any pains leading up to the race? You know, things that called your attention and perhaps made you contemplate whether that particular ache is going to interfere with your race? I ask because it seems like that sort of thing is common and in fact I have experienced it in the past.
                                "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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