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  • I imagine they do their best.
    I wonder though if they achieved success.

    Please do continue posting cases.
    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
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    @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


    • Originally posted by Mikal Solstad View Post
      Can I help him with his tinnitus problems?
      I have had limited success with tinnitus of less than 3 months duration, although I would argue that it probably resolved spontaneously.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • The latest case in full:

        Male approx. 30 years old complains of a headache that is localized to the back of the head on both sides. Onset one week ago after being very drunk, gradually worsening the day after drinking. The pain is described as "icy" and is fairly constant. Some relief during physical activity such as chopping wood and taking a hot shower, and complete relief during sleeping hours. Can not provoke the headache with neck movements.
        The patient has been thoroughly examined by his physician. No red flags and no significant yellow flags.

        Exam:
        General findings: The patient is very mobile, no obvious posture deviations. The patient had a headache during the entire exam.
        Cervical AROM: ERP in extension, no loss of ROM. All other movements fine.
        Long-sitting slump: Negative.
        Palpation: The headache is worsened with palpation around the greater occipital nerves on both sides. Other areas of the neck are normal.

        Thoughts: Sounds like his greater occipital nerves are a bit cranky. Probably from sleeping in a weird position for several hours while being drunk.

        Treatment:
        DNM greater occipital nerves, around 20 minutes. During the treatment the patient moved slightly on his own accord with his feet and neck, while warming up immensely in the back of the head.

        Post-treatment:
        No headache, cervical extension did not produce any pain. Gave the patient chin tucks to mobilize his posterior nervous system to be done several times daily.
        Two days later:

        He came in today with no symptoms. However, he did mention some tinnitus that has been bothering him for about a week, which came after his presenting symptoms.

        Exam:
        Cervical spine AROM negative.
        The greater occipital nerve area was slightly tender on both sides. Sternocleidomastoids were hard and tender to touch (problem with superfiscial cervical plexus, perhaps?)

        Treated his occipital nerves and superfiscial cervical plexus with DNM. His sternocleidomastoids melted during the treatment. Told him to keep doing chin tucks for about 4-5 days.
        Present status (7 days after he first came in for treatment): Spoke to the patient via e-mail, has not had a headache since he last came to see me. We decided to cancel his appointment for today.
        Last edited by Mikal Solstad; 22-10-2014, 10:23 AM.

        Comment


        • My first question for anyone who complains of tinnitus is, "Have you had a hearing test?" Tinnitus most commonly results from damage to hair cells in the outer portion of the cochlea, which will show up as high frequency hearing loss. It's essentially a "phantom" sound syndrome. Interestingly, most people who have tinnitus aren't distressed by it. This suggests to me that those who are may be more likely to have a placebo response to just about anything.


          Sent from my iPhone using Tapatalk
          John Ware, PT
          Fellow of the American Academy of Orthopedic Manual Physical Therapists
          "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
          “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
          be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

          Comment


          • I had an episode of tinnitus for one day, nothing severe, just very annoying. I know plenty of people who have tinnitus permanently, eg for decades.

            So I thought: OK, I will totally ignore it and see what happens. I pretended that the noise was the brain having a whinge for a while. (yeah, silly?)

            It disappeared after thinking about this "cause" for a while. Coincidence? Likely. But who knows.

            Nari

            Comment


            • And yet another case:

              Male approx. 40 years old with shoulder pain on his right side. Came on insidiously 6-7 weeks ago. The pain is the same or a bit worse now. No previous trauma. The pain is located "deep" in the top/front of the shoulder and is worsened with activities overhead. No significant pain during rest. No neck/thoracic pain. He has not had any trouble with his shoulders or neck previously that he can remember. No red flags and no yellow flags.

              Exam:
              AROM neck: Generally a bit "restricted", but normal for him (he said).
              AROM shoulders: The pain is triggered during abduction around 90 degrees, it goes away when he abducts further. ROM: WNL.
              Other shoulder movements are WNL and pain free.
              Isometric tests: Shoulder external rotation and abduction causes pain.
              Palpation: Very cranky around the suprascapular notch on the right side.

              Thoughts: Sounds like mechanical deformation of some of the nerves around the shoulder. Probably not axillary nerve, may be suprascapular nerve.

              Treatment:
              DNM using Diane's pencil trick (without using a pencil, I have thin fingers) for 15 minutes and lateral glide mobilization of his neck toward his painful shoulder for 2-3 mins.

              Outcome: The patient reported significant worsening of his shoulder pain 1 day after treatment. 2 days after treatment the pain was all gone, and 1 month post-treatment it has not come back.

              Thoughts?

              Comment


              • Good job!
                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


                • I find it very hard to predict who will have an increase of pain and who will not after treatment, even when using such a gentle technique. Maybe it is just inexperience, or maybe it is just the fact that we are dealing with another person, complexities and all.

                  Comment


                  • Originally posted by Mikal Solstad View Post
                    I find it very hard to predict who will have an increase of pain and who will not after treatment, even when using such a gentle technique. Maybe it is just inexperience, or maybe it is just the fact that we are dealing with another person, complexities and all.
                    I am none the wiser in this respect after 36 years.
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • Mikal,

                      Say, "Anything that gets better I'm taking credit for. If it feels worse; It's the crisis of change."

                      I greater experience of pain shouldn't last more than a day. Personally, I've seen this as rare and have never been able to predict it.
                      Barrett L. Dorko

                      Comment


                      • One is wise to include the possibility this could happen and not to worry too much about it, in the pain ed before the patient leaves. I often forget.
                        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


                        • I have begun saying that they might experience some more pain a day or so after treatment, or they may experience complete relief and anything in-between. Either way, it is nothing to worry about.

                          Comment


                          • Originally posted by Mikal Solstad View Post
                            I have begun saying that they might experience some more pain a day or so after treatment, or they may experience complete relief and anything in-between. Either way, it is nothing to worry about.
                            I say something similar.

                            I am fairly sure that I have read critical opinion on this site, that warning of a possible treatment reaction could be nociceptive.
                            Jo Bowyer
                            Chartered Physiotherapist Registered Osteopath.
                            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                            Comment


                            • Warning of a possible adverse reaction to treatment sound very nociceptive to me. I used to say: You may feel more discomfort or less - either way it's OK. Or words to that effect.

                              Nari

                              Comment


                              • I am a bit torn whether I should say anything about the increased soreness of not.

                                On one hand, if the patient gets significantly more sore (rare, but it happens) and is not informed, he/she may decide to discontinue care, even though progress is being made later on.

                                On the other hand, if the patient gets significantly more sore simply because of the seed which I planted (left-sided input into his/her neuromatrix and all that), that is advantageous to no one.
                                Last edited by Mikal Solstad; 23-10-2014, 09:32 PM. Reason: Grammar.

                                Comment

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