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  • #31
    I agree, we found a way of communicating that would have fooled anybody else into thinking we'd done it all before. This is especially rare for me.

    Rapid and dramatic change as you describe is common. Today in Sioux Falls a woman changed similarly while I handled her and lectured simultaneously. She stated that her painless range improved to places she "hadn't been for years," and I could see no reason not to believe her.

    What's of greatest interest to me is the reaction of the therapists witnessing this. They seemed not especially impressed. If they were, their thoughts will turn elsewhere very soon and most work with others that not only won't believe them, they'll discourage their pursuing the method or thinking further. This will be done non-verbally for the most part. That makes it more effective.

    You may be the first actual "in-charge" therapist I've had understand things as you do. Perhaps that's what makes your experience so different than others.

    By the way, I never take the head off the end of the table in supine. If the patient unconsciously desires cervical extension I'll just let that happen in any one of a number of alternate positions.
    Barrett L. Dorko

    Comment


    • #32
      Jason,

      I'm interested in how you go with the costochondritis patient, since this condition is primarily inflammatory in nature (if the diagnosis is correct).

      If never heard of a sternal manip before, and I'm no stranger to HVLA. I image it to be quite harrowing. What does it attempt to cavitate?

      Luke
      Luke Rickards
      Osteopath

      Comment


      • #33
        If never heard of a sternal manip before, and I'm no stranger to HVLA.
        Is it called the 'manubrial whip'? ( )
        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


        • #34
          Luke-
          I look at costochondritis the same way Barrett says he looks at "adhesive capsulitis" - with suspicion. I think that "diagnosis" was the physicians way of saying "musculoskeletal chest wall pain at the sternocostal area".
          It does not have the hallmarks of chemical pain by history, and the anti-inflammatory drugs he's been prescribed don't work. So that throws the diagnosis into a bit of a question.
          I'll let you know when he comes in again and what i'll do to treat him, and how he's doing.

          Barrett-
          Perhaps you're right, my relative position of authority makes it easier for me to treat as I see fit without worrying about pressure from others. If that's the case, then so much the better.

          Bernard should be posting the short video clip of the 2nd rib manipulation I'm speaking of, as I couldn't get it to load. It's from a manual therapy CD by Flynn/Whitman/Magel, and is excellent for learning/reinforcing manipulation. So that's nice.

          J
          Last edited by bernard; 29-06-2006, 03:57 PM.
          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


          • #35
            Well, I added the movie but it doesn't work.
            I must change some settings on the board.

            You must save the file before read it. Just right click on the link and choose the right option.

            The server doesn't allow direct streaming.
            Attached Files
            Last edited by bernard; 29-06-2006, 04:04 PM.
            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


            • #36
              Bernard, it played just fine for me. You've gotta love the delayed sound effects!

              eric
              Eric Matheson, PT

              Comment


              • #37
                Eric,

                I got it! (those damned cache files!)
                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


                • #38
                  Well, in my outpatient Ortho/sports world, I am noticing a group of people who consistently do very well with SC....patients who are postop from shoulder surgeries. Sometimes their progress slows/stops, pain increases, and N&T complaints to hand.
                  Every patient like this i've tried it on ( 5 so far) has done wonderfully, with signficant improvements in their pain and neurodynamic exams.

                  I now don't say anything much before starting, just something like, let's see if I can help you find your way out of this pain you're in....and then I verbally encourage the ideomotion when it happens. I am now saving the explanation for, as Luke and Barrett suggest, after the treatment.
                  Hope that's helpful for those just starting to try this out...

                  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


                  • #39
                    Jason,

                    Great to hear. Have you seen any correlation with the ipsolateral hip resting posture? I'd predict it's there 80% of the time.

                    As you've discovered, these patients represent "an orthopedic problem gone bad" or, to put it more accurately, "an othopedic problem with a neurologic component/solution."

                    I'll be in Virginia in September. Sorry you'll be in Heidelberg. Send some staff instead.
                    Barrett L. Dorko

                    Comment


                    • #40
                      As you've discovered, these patients represent "an orthopedic problem gone bad" or, to put it more accurately, "an othopedic problem with a neurologic component/solution."
                      Or, a neurologic problem that got culturally stuffed into an orthopaedic category by fluke or by design.
                      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


                      • #41
                        Jason,

                        One more thing. It sounds like you've discovered how to "do nothing" and "understand enough." This is remarkably powerful in the right context.

                        This "doing nothing" is especially well-suited to the Army, of course (ha,ha). I've heard rumors.

                        Diane,

                        I've had to come up with my own definition of "orthopedic problem." It includes mesodermal structures that require healing or repair or strengthening for full recovery. All of this might happen of its own accord without therapeutic instruction or surgery but they, at times, are certainly necessary.

                        For some of these, an intricate and significant alteration in the neurology must take place as well, perhaps almost entirely. I think this "balance" may shift in either direction and would have difficulty saying where or when the tipping point from one to the next might occur. It's likely that the patient will indicate this in some way, probably through the expression of their autonomic state. We know that this can be difficult to measure and interpret.

                        No doubt cultural attitudes as expressed by the therapist play a role as well, both consciously and unconsciously.

                        Sarah Vowell's description of the Canadian Mountie as opposed to the American Cowboy fits perfectly here: "Canada got Mounties - Dudley Do-Right, not John Wayne. It's a mind-set of "Here I come to save the day" versus "Yipee-ki-yay, (insert powerful expletive here)."

                        I had a feeling you might like that.
                        Last edited by Barrett Dorko; 05-07-2006, 09:13 PM.
                        Barrett L. Dorko

                        Comment


                        • #42
                          I actually have noticed the hip thing - though right now I am having better luck in standing and sitting than supine so I don't have an opportunity to see everyone in that position.

                          But I have to agree with the orthopedic/neurologic difference you mentioned, I think that's exactly right.

                          I had a guy just the last few minutes who improved his Cx rotation from 10 degrees to nearly full in just a few minutes.

                          I now know I'm going to do my case study/review article for my DPT program on simple contact, I just need to find an appropriate patient to do a review of. Will keep everyone posted.

                          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


                          • #43
                            Wow Jason, that could turn you into not just Barrett's new best friend but you could help the whole profession redesign itself. OK.. Back up Diane. I'm being too ambitious for you.
                            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


                            • #44
                              Jason,

                              Sounds like good stuff. I know I am diving in at the deep end starting with very complex patients, but that is how I chose it. Call me a geek for uncertainty.

                              I think supine is the most challenging position for SC and have not gone there yet.

                              Do you use SC on yourself with success?

                              Good luck with the study.

                              Nari

                              Comment


                              • #45
                                Jason,

                                Think about doing an SSRD for your review instead of a case study. They are quite similar but an SSRD offers stronger evidence, and SC could do with more of this. I can send you some info on SSRDs if you like.

                                Luke
                                Luke Rickards
                                Osteopath

                                Comment

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