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  • #61
    Mostly, I just sit there and let the nervous system respond to me being there. I've learned to feel it doing this, through my hands. It feels awfully active to me.

    When people ask me how I can feel all this stuff, even just basic areas that need treating because of the tissue texture being way off normal, and me interpreting that as a choked neural tunnel, .. I reply that if humans can learn to read braille they can learn to read tissue, and I'm human, so it's not that big a stretch to learn to do sensitive manual therapy.

    You can take whatever regular manual therapy you already "know", and finess it way down so that you are just hinting to the body at skin level what you would like to invite it to do; if the brain is in favor of the idea (after running it past all its processes for a few seconds) it will permit action to begin. It will come racing up to the skin to meet you. You will eventually be able to feel it correcting its own self. Suddenly you aren't capable (in your heart) of being coercive anymore. You've become interactive with this living creature buried inside human mesoderm, the 2% that is the nervous system.
    Last edited by Diane; 07-07-2006, 03:55 PM.
    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

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    • #62
      You HAVE to write Diane. More. Wonderfully tactile and living description!
      This is prose with a scientific flavour.
      Wow
      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


      • #63
        Hi!
        Thanks for your answears but the hole SC approach seems to be alittle like "healing" to me.I dont say that this approach might be of some help but how is the patient gooing to be participant iin his/her own "healing" prosess.
        Arent you interested in prevented therapy?what the patient can do by her own,without our "healing" technics?
        As you describe SC it seems to me to be an passive approch.Sorry Bas but im just a simple soul!

        RIN

        Comment


        • #64
          RIN-
          All movement comes from the patient, the patient's "home exercise" program is simply to find a place and time to practice ideomotion. There is no more active process than this.

          We don't heal anything, the body does. We can only set the stage to let human physiology run it's course.

          It is preventive in that it helps attune the patient to their body and to recognize the mechanical deformation of sensitive tissue before it reaches the critical [painful]threshold.

          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


          • #65
            RIN,

            I'm currently of the opinion that this concept of preventive therapy for pain is a bit of an exercise in wishful thinking. I think we can, with some confidence, decrease the risk of a number of pathological processes and slow the normal degenerative changes life presents us but this is a bit different than "preventing pain the next time". It is at this point that I find myself departing from many PTs. On a variety of discussion forums I'll read the idea that the PT will help the patient (correct their alignment, manipulate them, use ultrasound, etc) this time and teach them (specific exercises usually) how to prevent it (pain) from happening again. I think this portrays an unrealistic predictive ability as well as a naivety on our part. At least to the extent that any specific exercises we prescribe are going to have some significant pain preventative powers. What is realistic, in my opinion, is to try to teach people how to manage pain once they get it (through education in pain physiology and movement strategies) regardless of how they end up where they are. With those skills one can move on--living life without trying to avoid all those things that someone told them cause pain or feeling obligated to a set of specific exercises to avoid future pain.

            Simple Contact teaches people pain relieving strategies this time, right now and for their possible futures that neither we nor they can predict in a meaningful way.

            Jason, how about this for a (feel good) quote of the week?
            "We all labor against our own cure, for death is the cure of all diseases"--Sir Thomas Browne (I think)
            Last edited by Jon Newman; 08-07-2006, 12:12 AM.
            "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

            Comment


            • #66
              RIN,

              SC is not easy to "get" by reading about it. I agree, it sounds like "healing" on the first glance - or twentieth..

              Remember: The therapist does nothing. The patient does it all. We simply enable a way for the brain to get on with its evolutionary process of resolving a threat to its systems. It's pretty good at doing that...

              We, as PTs, are so attuned to telling a patient what to do and how to do it and it's-not-the therapist's-fault-if-the patient-doesn't-do-it type of thinking.
              This is a move away from controlling the patient and allowing instinctive resolution to occur. I think the patient's brain knows how to correct a dysfunction much better than any of us; we are not the patient's brain.

              Movement is the key. Repetitive, specific exercise is not. A patient can go off and practise Tai Chi, swim, dance ,whatever...and still get better. But not every patient, as you well know, is going to do that.

              SC is also a great way of enlightening a patient that this ongoing pain is not necessary, nor needed; and they can use it at home, whenever they wish to.
              Sure, you can still do preventative physiotherapy for fitness and decreasing obesity, and so on. That does not disappear if SC is employed. Nothing else changes, if you don't want it to. SC can make our clinical life much simpler and attends to pain issues without any complex protocols.

              Nari

              Comment


              • #67
                HI !
                Learning people the way our minds(thinking-emotions)interacts with our body becomes more and more important for me than my tradiditional physiotherapy/manuellterapy approch.Its not about either or but the traditional MT technicks(manipulation,mobilisation,stabilization etc)dosent seem nesecerry any more.
                The pain is interesting but the "man" behind the pain is even more intersting.
                Its much more fullfilling to day working as an MT than 10 years ago.
                Patients are much more intersting in this way of looking at their "painproblems" than just aiming at their pianfull area!To learn how thwi feelings interact with their body!
                It might not be SC but it gives the patients and me A GOOD CONTACT.

                PS!Have you dared to test the strenght on the left side?

                RIN

                Comment


                • #68
                  Hello Rin,

                  I agree that the person behind the pain/dysfunction is important, and whatever intervention we choose, this cannot be forgotten. It is undeniable that emotions have a crucial role in pain management (after all, it is thought pain IS an emotion) - I think the juries are out on its causing a pain state to arise.

                  In the end, we choose what we feel comfortable with; hopefully, as effectively as possible.

                  Re your left side hypothesis: no, I have not noticed what you have recommended for a long time. It doesn't mean it is not true.

                  Nari

                  Comment


                  • #69
                    Chris,

                    Just read the info sheet for your patients and I thought it was great! I also found it helpful and the analogies you used were easily understood. Thanks!
                    Chris Adams, PT, MPT

                    Comment


                    • #70
                      Wanted to share a good success with ideomotion and also put it in the context of "EBP"...

                      One of my partners is leaving the clinic, so many patients on her schedule were moved to me (and our chief, since I'm leaving as well in about 4 wks). This particular lady, 51 y/o female military officer, had neck and L upper trap area pain since JAN06, when a commuter train she was on derailed, and she was jerked about. She used her arms to stabilize herself, but says she felt the pain in the neck area shortly after the accident. No rollover or any trauma. She had the requisite Xrays and NSAIDs from primary care, and was sent to us. My partner treated her with what could be considered the best in EBP, and she simply was not improving.
                      Her findings on exam were cervical stiffness and hypomobility, especially "closing" L lower Cx facets and L rotation at the AA joint. Diffuse tenderness and "trigger points" in the cervical paraspinals on the left and the upper trapezius.
                      My partner had treated her with Thoracic manipulation, Cx joint mobilizations, AROM, and trapezius stretching, along with the deep neck flexor exercise. She was not improving, and my partner had moved her toward a general exercise regimen, with upper body stretch/strengthening and self trigger point massage.
                      She was mildly frustrated with her lack of improvement when I saw her, and my exam revealed loss of ROM of the Cx spine mildly in all planes, esp to L rotation, with only 45 degrees available. Her previously noted "joint" restrictions were also present, esp at the AA joint. Her ULNT was limited to about 60 degrees of elbow flexion before she had pain on her involved L side, and was mildly painful to her ULNT median on the R side also.
                      In supine, her L hip was internally rotated relative to her R.

                      We did about 5-10 minutes of ideomotion in standing and in supine, and she stated she felt better than she had in months. Her ULNT had improved to 15 degrees of elbow flexion on the L, no longer painful on the R, and her Cx ROM had improved to 65deg L rotation. Her "AA joint restriction" was no longer present. Her lower cervical "joint restrictions" were markedly improved. Many of her "trigger points" had disappeared. She reported all the characteristics of correction, especially a warming in her upper trap area.

                      I will see her back this week or next week (my last week in this clinic before my move) for a reeval.
                      I think I will be writing this up as a case report in the fall.

                      THoughts? Especially on improvement in the "trigger points" and "joint restrictions"??


                      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


                      • #71
                        Jason,

                        I am always fascinated by the general direction people choose to move when they have obvious restrictions in a certain direction. You said your patient had an obvious closing dysfunction in the lower Cx. I am wondering if she chose more flexion or extension during movement.

                        I had a patient today with Cx pain and stiffness, only 40' R rotation, positive Spurling's to the right and pain on full flexion, with bilateral pins and needles in the ULs. In the seated position the head went into gentle extension which increased his pain considerably and reproduced the pins and needles and pain into his arms. I assured him he was in control and he stayed there for 10 mins, slowly increasing extension, which also slowly increased his pain. When he could take no more he told me and I asked him what he wanted to do about it. He then slowly moved into full flexion, which was now painless, for a couple of mins and when he came back up the pain was gone and R rotation was restored. So much for centralisation, hey!?

                        Luke
                        Luke Rickards
                        Osteopath

                        Comment


                        • #72
                          Great result Jason. In your post you describe the findings of a rather extensive assessment. Given so many findings changed post treatment, would you agree that many assessment procedures could be dropped from your evaluation? Which ones would you consider important to leave?

                          Eric
                          Eric Matheson, PT

                          Comment


                          • #73
                            Just a quick interjection.. I would suspect that both Luke and Jason would need to keep their assessment procedures (and bother to do them faithfully) as long as they are planning to do writeups. Documenting in that sort of language will be best understood by all the mesodermalists out there who will need to be slowly herded toward neuroscience; therefore it will be necessary to maintain one's familiarity with this modern day dead language and ritual behavior.
                            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


                            • #74
                              Eric-
                              Good question.
                              I think ROM, ULNTs, and any neuro examination (reflexes, strength, sensation) are really the important aspects of the examination.
                              However, as Diane points out, I need to continue to document the pre/post changes in these other findings to illustrate the concepts since that is a universal language among PTs and manual therapists.

                              Luke-
                              Though she had a "closing" dysfunction, she did choose to L rotate several times, but only after she had extended multiple times (without pain of course). Interesting in the context of our mechanistic manual therapy education, right?

                              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


                              • #75
                                Perhaps you guys can appreciate how I feel about this recent exchange. I agree with each comment and have seen similar changes thousands of times. As Luke suggests, "centralization" ala McKenzie proved meaningless to me many years ago, as did many of the supposedly essential subjective and objective aspects of virtually every other form of manual care I'd learned in my long and passionate career in this field. Ideomotion (not Simple Contact) changed all of that.

                                Keep doing the documentation. Diane and Jason are certainly right about that.

                                I also presume that those of you who make any effort to predict or interpret the direction of the patient's ideomotion will find that this becomes useless. I also presume that Jason has discovered in this latest patient that the resting posture of the hips while supine is also extremely important to assess and assist toward appropriate change.

                                Am I right Jason?
                                Barrett L. Dorko

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