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  • VIS Sarah's hip

    For a change I do not have to create a alias for this individual. This pic is all over twitter and facebook now. It was taken by Sandy Hilton, and is of her colleague Sarah Haag, who hosted a DNM class in their Chicago PT clinic this past weekend.

    Sarah's issue was not pain. The woman is a very bendy woman who moves all the time, does yoga, studies burlesque dancing for fun.
    Her issue was that although she could do splits on one side, she couldn't on the other.
    Her issue was lack of ROM, interoceptive asymmetry, and a feeling as though there was a block in her body that wouldn't resolve no matter what she did.

    Many years earlier she had been on a cycling tour. During that tour she had developed low back pain and left sciatic radiculopathy. She tells me she can vouch for Michael Shacklock's new paper, Normal multiplanar movement of the spinal cord during unilateral and bilateral straight leg raise: Quantification, mechanisms and overview - she had loss of straight leg raise with pain felt in the left side, no matter which leg she tried to raise.

    She dealt with it by doing back extensions, and eventually the pain on movement resolved. She was left, however, with these residual effects. It wasn't a painful bother, but it was a bother nonetheless.

    It makes sense to me that the spinal cord would hijack all input from that side to create an endless positive feedback loop of withdrawal reflex in anything it was able to commandeer.
    It makes sense to me that her spinal cord got so good at maintaining its protective loop that it prevented movement with very little to no nociceptive input anymore.
    It makes sense to me that all that was required was some nice sensory rehabilitation directed toward more rostral parts of her brain, i.e., somatosensory cortex (which maps skin surface) and insular cortex (which maps pleasurable input from skin, and from anywhere else too).
    It makes sense to me that feeding (changing blood flow around and through) a few small cutaneous nerves, setting them up so their input would change, in a completely innocuous way, would suffice to help those brain parts mount an all-clear signal to send down through all the evolutionarily older parts of her NS, including the dorsal horn. With descending modulation. To tell the spinal cord to stop being so protective by high-jacking the ability of contractile elements to lengthen.

    So, with just 15 minutes or so of attention to putative cutaneous neural tunnel syndromes of iliohypogastric and anterior inguinal nerves, and me not having to work very hard at all, her ROM improved quite dramatically and her interoception changed from a blocked experience to a yes-ciceptive one of block having been removed. A perceptual block-ectomy. All accomplished through changing of perception, via cutaneous nerve sliding, and deliberate exploitation of ruffini ending while lying relaxed in a quadruped position (legs in flexion over a bolster). Well, OK, the treatment of ilohypogastric neural structure by dragging it through neural tunnel required a bit more strategic positioning and handling and sweat. But we gotter done.

    Now Sarah's ROM for splits is a lot more bilateral, with much easier trunk and hip extension available to her on the left. This was just the day before yesterday. There is another day of receptor turnover to go before Day 4 reassessment, figuring out if more treatment would even be necessary. She's doing all the motion-is-lotion business meanwhile, and maintaining her improvement.

    Why makes complex things like the NS, and some holding pattern it's in, complicated by tissue-based nonsense when you can make things simple by affecting it directly, through skin?
    Attached Files
    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

  • #2
    Requests to look at range of movement issues are extremely common for those who work with sports science teams treating world class athletes. Very gentle (effective) treatment poses least risk for adverse effects which might affect training and performance.

    The same goes for those who work in the performing arts.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

    Comment


    • #3
      Thanks for posting this Diane. Very nice example. Any chance someone can get a copy of the full paper by Shacklock?
      Thanks

      Comment


      • #4
        Certainly Simon. Here is a link.
        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


        • #5
          Here is Sarah, yesterday.
          Attached Files
          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


          • #6
            I looked at this carefully.

            Her initial complaint was of pain. When does pain begin and end? I don't think we can know.

            At least, I can't know.
            Barrett L. Dorko

            Comment


            • #7
              Her hip issue was not pain.
              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


              • #8
                From Diane in post #1:

                Many years earlier she had been on a cycling tour. During that tour she had developed low back pain and left sciatic radiculopathy.
                Might she have not learned something then? I can't do the splits on my lef...sorry, couldn't say that with a straight face.

                I'm concerned with the issues of challenge, pain and injury. I guess function might take a back seat.

                You certainly helped this woman with DNM.
                Barrett L. Dorko

                Comment


                • #9
                  Barrett,

                  Beware of post hoc ergo propter hoc.

                  Diane,

                  How is this any different from the numerous showcases that other people use to support their method online?

                  Comment


                  • #10
                    Originally posted by Barrett Dorko View Post
                    From Diane in post #1:

                    Might she have not learned something then? I can't do the splits on my lef...sorry, couldn't say that with a straight face.

                    I'm concerned with the issues of challenge, pain and injury. I guess function might take a back seat.

                    You certainly helped this woman with DNM.
                    The pain in her back and leg was long gone.
                    As I recall she had been able to do splits just fine on both sides prior, but not after.
                    For years.
                    It seems like DNM helped her, well and handily and with no fuss or nociception, but as Mikal points out, there is no escape from post hoc ergo propter hoc.
                    And Mikal, there is no difference.
                    Alas, I'm just as stuck behind the looking glass as everyone else is.
                    I happen to think I'm less wrong than everyone else by thinking more and doing less than everyone else, but I certainly can't prove it.
                    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


                    • #11
                      I appreciate that, Diane.

                      Comment


                      • #12
                        I appreciate your appreciation.
                        I also don't make wild claims about being able to bend tissue to my will.
                        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
                          Diane says:

                          As I recall she had been able to do splits just fine on both sides prior, but not after.
                          I wondering, "after" what?

                          It doesn't matter really. None of this is known for sure, but you are certainly "less wrong." This, according to me, is because you've begun by offering a defensible premise. That's a rare thing.
                          Barrett L. Dorko

                          Comment


                          • #14
                            After her low back episode. Which resolved, years earlier, along with the radiculopathy.
                            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


                            • #15
                              To me, resolution implies more than pain relief.
                              Barrett L. Dorko

                              Comment

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