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  • #16
    Nari,

    Good idea! I have printed out several of Barrett's essays since I first saw his website and have read them each a few times in hopes of 'getting it'. Needless to say, I have yet to reach that point. However, your idea may at least assist my presentation to my patients and I'm sure I'll learn more in the process. Thank you!

    Mike,

    I'm not sure if the following will be of any help to you, but I've approached my patients with the scenario mentioned in Barrett's essays regarding a child sitting in a classroom...wanting to move and stir about but is not allowed because he/she may get in trouble, i.e. creating a suppression of movement. I've tried to portray examples for my patients like the above as well as adding in some 'simple' and easy to understand physiology.

    Baecker,

    I'm not sure it matters if your patient, who is lying prone, suddenly assumes a quadruped position. I wouldn't consider this a failure, but rather your attempt at trying to predict their movement which may lead to a predetermined effect of your treatment [read: coercion].
    Chris Adams, PT, MPT

    Comment


    • #17
      Baeker,

      Why prone? Was it your choice or the patient's?

      The position doesn't matter; what counts more, by my reckoning, is that the patient is free to move. Perhaps sitting or standing, but ask them what they would prefer; after all, we do an awful lot of ordering patients around into positions - it makes a pleasant change that they can choose for themselves.

      Nari

      Comment


      • #18
        Well, even though Baecker's questions were my own at one time, I feel I shouldn't go into too much detail. I'm afraid that if I say doing X worked for me, then some will try only X and it may not work for them.

        But, here's a try: I explain to them that the body does three things in response to pain (withdrawal, protection, resolution- from Patrick Wall). I give them examples of stubbing their toe or me twisting their finger. Then I tell them that they are stuck in the "protection" phase, and I adopt a protected posture to emphasize - face grimacing, shoulders raised, hands in fists, etc. Then I tell them that their body needs to move to resolve the problem and I can help them with that. I have had best luck in standing, and just touch LIGHTLY at lateral shoulders, and they start to move in less than 3 seconds. After about 10 seconds, I ask about correction characteristics, and in every case they've said their involved part or another painful part has felt hot like blood rushing to it. Then I retest their neurodynamic exam and it is almost completely symmetric, and one patient was completely asymptomatic. They turn and usually give me this "How'd you do that?" look, and I explain that the motion is in their body, they need to trust it and practice several times a day. I talk a bit about abdominal breathing and hip abduction, and we're done.
        So this is really not much as far as setup goes. I may be doing/saying too much as it is.

        Barrett is right about not really needing to be taught any specific technique, but somehow it really helped to have him show me in person, not sure why. I'm sure all sorts of other positions and setups could work equally well, but I haven't tried that as yet.

        Not sure if that helps, but there it is...
        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


        • #19
          but somehow it really helped to have him show me in person, not sure why
          Two words: Mirror neurons.

          It's the same reason the patient will benefit more from seeing and talking to you. It is simply how we're wired and I think touch tends to drive it home even more efficiently than say a "video presentation" or something similar. Think about when your friend has something cool and you say "Let me see that" and reach out with your hands. Your friends holds it up and away from you and slyly says "See". You end up disappointed and not just at your belligerent friend.
          Last edited by Jon Newman; 28-06-2006, 02:45 PM.
          "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

          Comment


          • #20
            Jason,

            Yeah, that helped. How you approached the explanation of SC to the pt. was my main interest. I'm certain I have talked SC to death with pts. before I even touched them.

            Nari,

            I like your idea as well. Having something ready before hand would help me organize my thoughts and keep the discussion to what is important.

            By the way, I will be moving to a new clinic in the near future where I will be the lone PT. Should be quieter, calmer and a better enviornment to talk with and educate pts.

            mike t
            "Reality is that which, when you stop believing in it, doesn't go away"
            Phillip K. Dick

            Comment


            • #21
              Baeker, your post reminded me of something, when you said your patients were prone; that's how infants develop their spinal movement against gravity. If supine they learn to roll their head from side to side, but if they are prone they learn to lift them up and move them around. There's something interesting about that here, on this Jason/SC thread, but I'm not sure what. Any clues Barrett?

              My little postulate, for now, is that maybe patients are flushing out the pipes of their motor programs from the very oldest layer forward.
              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


              • #22
                Well, I've had two more successes, one yesterday and a big success again today, and I am slowly reducing the amount of "scene-setting" I'm doing.
                It continues to be in standing, and the results continue to be impressive, more so for the patient than me.
                It was all I could do to keep from laughing out loud when I saw an upper limb neurodynamic test change 180 degrees in 5 minutes of corrective movement.

                I see why Barrett is so guarded about speaking of clinical outcomes - while they are often impressive, the "testimonial" nature of them is problematic.

                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


                • #23
                  hi,

                  ooops i messed up prone and supine

                  i ment supine. but yes this helped me a great deal more than you can imagine. i will try this definetly out and yes i understood that the position is not important. still i guess for someone with low back pain it seems to be more logical to start standing or sitting or on all four? or is that incorrect?
                  what about patients falling asleep?

                  Comment


                  • #24
                    Baecker,

                    I suspected you meant supine. Please, I only speak English, and when others contribute here in something other than their native tongue I certainly admire the courage that takes.

                    In any case, I work with people while they are supine a great deal. It's a good idea for a number of reasons, and there are other good reasons for working in standing or sitting. Let the patient lead you from one to the next.

                    Diane,

                    I've heard many people comment about how the developmental sequence of posturing might be related to ideomotion but I've never, never seen the idea go anywhere. It seems to be a non-starter.
                    Barrett L. Dorko

                    Comment


                    • #25
                      Speaking of supine...

                      I Worked with a patient with complaint of "costochondritis" today.
                      Previously, he did not tolerate attempts at manipulation/mobilization.

                      After a few minutes of ideomotor movement in standing and then supine, he felt a strong warmth in his chest area, and his complaints improved.

                      I'm not sure how he'll do in the end, but it was my first experience with this in supine. I was holding his head off the surface and trying to allow movement as much as possible. I wonder if by holding up his head I was helping him or coercing him. Thoughts?

                      Anyway, it sure beats the supine sternocostal manipulation. Boy, that one is hard on both patient and therapist. I have a video of it from one of Flynn's manual therapy CDs, but can't post an mpeg here. Suffice to say the setup is difficult and predicting whether it will help is even more difficult...

                      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


                      • #26
                        Jason,

                        I added the mpeg type to the board.
                        You may normally be able to make an attachment.
                        Simplicity is the ultimate sophistication. L VINCI
                        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
                        bernard

                        Comment


                        • #27
                          I don't know about anyone else but I'm really tempted to go get some of Jason's first posts to Barrett on RE. He's almost gone full circle.

                          Well, I'd like to tease him about it but his ability to keep an open mind without abandoning skepticism is something I find admirable.

                          Comment


                          • #28
                            Jason,

                            I know exactly what you are experiencing - although I am not practising SC yet, I have achieved similar results with 2-3 minutes of neurodynamics on some four month old "frozen shoulders".

                            It makes one really understand and appreciate what pain is really all about.....and it's not to be found in the 'bibles' of PT practice. Sad.

                            Nari

                            Comment


                            • #29
                              What would "full circle" be in the reasoning lexicon? We have deductive, inductive, abductive.. maybe this would be "circumductive": Able to reason all the way around the equator of a problem.

                              This is my favorite (a kind I made up) "sphere-o-ductive": Inward or outward reasoning along any (of an infinite number of) vectors perpendicular to a problem.
                              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


                              • #30
                                Yeah, Randy, I do recall that Barrett and I didn't exactly hit it off right away.
                                Funny, when we met at APTA, I could have sworn we'd known each other for years.

                                Thanks for the compliment about the open mind. I think any EBP-minded therapist would approach SC the way I have, if they only take the time to REALLY investigate the approach. But that's the thing. You've really got to take the time and effort to examine what Barrett proposes in order to understand it, and make an argument. I suspect that that's what the problem is.

                                But it's really kind of impressive what the patients are reporting. I had a patient today with chronic neck and back pain, who was not improving on the previous treatment of occasional manipulation (gave temp relief only) and lumbar stabilization/motor control exercises. We did a little SC today, and she went from 5/10 pain to 0/10, with improved spinal ROM. It was impressive to see the parasympathetic shift, she said she felt warm and tired afterward.
                                It really makes a lot of what I was previously doing seem unnecessary.
                                I've definitely got the cautious optimism going so far...

                                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

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