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  • Oh My God I Got It!

    Well, I finally got it.

    I met Barrett at the APTA conference last week, and he was nice enough to not only buy my wife and I breakfast, but also demonstrate handling and correction on both of us. Now I see why his workshop is not so popular. He must be a jerk.
    I really couldn't help but start to laugh when my ideomotor motion started, and was amazed that it truly was as he said it was. Not that I doubted, but I did have trouble getting it to work.

    Well, today, it worked on two patients of mine, with disparate areas of pain, who improved immediately in their autonomic state, pain complaints, and even findings on neurodynamic exam!
    In the interest of full disclosure, I did have two patients that sort of stood/sat there, clearling stopping their isometric activity and holding themselves in a certain posture, preventing correction. So not exactly 100%, buy surely better than I was doing before.

    I mention all this not to brag or take up forum space, but just to help make clear what I was NOT doing earlier, in the hopes I could help others.
    1. I was pushing too hard earlier. I was very surprised how light of a contact required, and clearly was resting too heavily on patients before, which might have inhibited their movement.
    2. I was doing a lot of explanation and "scene-setting" when I probably should just jump into it. I know Barrett doesn't like to tell us what to say or do exactly, but it helps to get me started sometimes, and after that my therapeutic metaphors develop. So my "lead-in" was quite short today.

    In one case, my patient had had a R shoulder Rotator Cuff repair in FEB06, and was now recently having more and more pain in the shoulder, which she couldn't understand. The shoulder mobilization and RC and periscapular strengthening I was doing wasn't working to make it better. A shocker, I know. Anyway, she had also had a carpal tunnel release on the same side, and complained of "trigger points" in her neck on that R side. Her ULNT median was short and painful. After about 10 minutes of correction, her ULNT was normalized and her shoulder ROM was immediately significantly improved.

    The other patient I had for first visit, and she had chronic buttock and leg pain. She had had multiple epidural steroid injections and an SIJ injection, which had helped and she said had "diagnosed" her problem as an SIJ problem. She had reported temporary relief with manipulation and massage before. There were 2/5 manipulation criteria (not a good candidate), no centralization with repeated motion, weakness of hip muscles in single leg stance, and TTP at her L SIJ area, and 3/6 SIJ provocative testing. Previously, I would call her a good candidate for lumbar stabilization exercise, and preliminary CPR for success with this made her a good candidate. But, I was fresh off my success with my patient with shoulder pain, so I tried SC first.
    This patient actually leaned forward and walked her hands out in front on all fours with knees bent before saying "ahh...that's the spot." She felt warmer immediately, had no pain with lumbar extension where previously there was some, and a negative slump test where previously she had about jumped off the table.

    I could get used to this...

    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.

  • #2
    Jason, consider yourself ruined for good!
    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


    • #3
      Jason,

      Did you feel as though all the complex things we do, ie : stretching/mobing/contracting/relaxing/analysing/evaluation was all rather unnecessary and vaguely nociceptive??

      I did.

      Nari

      Comment


      • #4
        Nice to hear Jason and I appreciate hearing what you felt was going wrong before. In other words I didn't mistake your contribution for bragging.

        Were the patients able to continue on their own?
        Last edited by Jon Newman; 27-06-2006, 12:41 AM.
        "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

        Comment


        • #5
          Jason,

          I'm not surprised. It should be noted however that buying breakfast for a couple of vegans isn't like buying for a steak and eggs guy like me. You're a cheap date. Please don't tell your wife I said that.

          I'm guessing that you gave the two patients who didn't move something to resist. Here's my advice for next time:

          Don't do that.
          Barrett L. Dorko

          Comment


          • #6
            Jon-
            I beleive they were, but to be honest, I didn't remove my hands while they were correcting, so I guess it's hard to say.

            I talked about autonomic balance and practicing, and said if they couldn't do as well without me in a week, they should call and I'll bring them back in. This sort of followup is common for my manual therapy patients.

            I guess we'll see...

            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


            • #7
              hi jason,

              thanks for sharing sounds interesting.

              i would like to know about the 2 patients you applied sc on. what was their initial starting position and where did you place the hands on? did they lay on their backs or standing or what?
              what did you tell your patients before?
              i must say i seem to have patients which don't start to move. sometimes they move if i let them lay down and hold their head, then some move but only the neck noting else.
              any tips? from what i understand sc is that the touch is light and no coercion is being done. i sometimes though exaggerate a position they are already in if they don't start to move.

              Comment


              • #8
                That's great to hear Jason. It sets your mind whizzing when you realise how easy it is, doesn't it?

                I also found very early on that a lot of explanation is not necessary to illicit the movement, although it may be useful later on.

                Luke
                Luke Rickards
                Osteopath

                Comment


                • #9
                  I agree with Luke that explanations later in the course of care are more useful than those given sooner. In fact, initially the patient might find them quite distracting. In my culture I think it's fair to say that pretty much everyone is touch-starved and thus will not need any special preparation for it. I'm pretty sure they aren't starved for coercive touch though.

                  I hope Baecker that you will one day understand that it isn't the starting position that's important. Every position has its advantages and disadvantages and I swear I don't work with my patients in any sort of sequence. It's also important to remember that the characteristics of correction take precedence over the movement you can easily see.

                  Baecker, I appreciate your curiosity but you're asking the wrong questions. I say that because the answers aren't going to help you understand this method. Having taught it for a couple of decades I feel I can say that with some confidence.
                  Last edited by Barrett Dorko; 12-04-2013, 01:56 AM.
                  Barrett L. Dorko

                  Comment


                  • #10
                    Jason,

                    What kind of explanation did you use? I have had the same problem talking too much and not just getting started. Each time I have tried to explain SC to a pt. I think of one of the quotes at the bottom of Diane's post about not understanding something until you can explain it to your Grandma.

                    I realize Baecker already asked about this, but I would like to hear how you approached the pt. (not physically approached, but verbally).

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

                    Comment


                    • #11
                      Jason

                      It helps to think that there should be some air between your touch and the patient's body surface. That keeps it light and in no way coercive.

                      I agree that explanations prior to actual SC should be minimal; too much information will rattle up anticipation and other cognitive processes. I would think about 1 minute or so, to begin with.

                      Nari

                      Comment


                      • #12
                        Jason, now that you've "got it" I expect you could become quite a maven or connector or whatever it is that is necessary to get to that tipping point some day. Meanwhile, I think we all need to lift our share of the canoe of abductive thinking during the long portage upstream along Mesoderm river to Ectoderm lake around the Grand Rapids of cultural indifference.
                        Last edited by Diane; 28-06-2006, 01:47 AM.
                        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


                        • #13
                          Jason,

                          Thanks for sharing your insight! Maybe I'm pressing a bit too hard on my patients as well, inhibiting their 'corrective' movement. From what Nari said regarding time spent discussing/informing the patient taking ~ 1 minute, I better change that as well. I have always over-explained things...brevity is something I need to learn I suppose.

                          Barrett,

                          Feel free to come down to Forney, TX (20-30 miles East of Dallas) and buy my wife and I breakfast. She's pregnant and I'm a steak and eggs guy myself. I promise you a more expensive ticket than the Veganator.
                          Chris Adams, PT, MPT

                          Comment


                          • #14
                            Chris,

                            I'm developing a basic 1 page document talking about the nonconscious vs the conscious mind; I found some years ago a "sheet for patients" helped me with the subtlety of clinical neurodynamics, during a period when many PTs abandoned neurodynamics because it "didn't work" or "caused too much pain", I decided that the CNS needs very little done to it, but it must be of the right nature and sequence.

                            Perhaps, typing out an explanation of ideomotion and SC in 1 page only, will help to make thinking effectively succinct. Then give it to a 12 year old to read - someone with no understanding of neuroscience - and see if it 'gels' with him/her. If it doesn't...you can blame the kid (or the information).
                            Then, take some crucial sentences from the text and this can be a starting point for the intro for a clinical session.

                            Just a suggestion.

                            Nari

                            Comment


                            • #15
                              hi,

                              even though I might ask the wrong questions but I still would like that Jason could answer if he has the time.
                              Reason that I am asking is because that I am experementing with SC and if a patient lays prone on the table and I am having my hands on their heads I never had one yet to get up on its four or turn around or whatever, all what I experienced so far it that they move their heads/necks in odd ways. Often they also fall asleep.
                              Since traveling to the US and taking a course will be a bit far for me as well expensive so I try to figure out as much I can here. I apologize for the wrong questions but they are important for me at this time.

                              Comment

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