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  • Client with ankylosing spondylitis that actually started in the hips and cervical spine (both hips replaced and c2-c6 is fused, at 38 years young) has had anterior shoulder pain/limited ROM from a car wreck that we've been trying to help for what feels like the last 2 years. Treatments from myself (pre-DNM) and chiro had been very mesodermal. Had done some DNM on the shoulder in the past, but today I thought "what about his hip replacements/scars?" Contralateral hip treatment (lateral skin stretch above iliac crest and at the lateral malleolus with the leg adducted across midline) freed up the L shoulder ROM and made the shoulder pain go away except when the arm was abducted beyond its capacity (which would hurt anyone). His eyes lit up because the client was so used to Graston, ART, and deep tissue massage with temporary relief (and lots of discomfort), yet gentle work on the opposite hip provided the most relief. Really interesting experience.

    Comment


    • Very interesting Jeromie. Nice work.

      About apparent worsening, I try to remember to let people know about the 3-day window where receptors are being turned over after a treatment and the importance of moving their nerves small amounts frequently meanwhile, of symmetricalizing their default resting positions, and not worrying over the pain coming and going until it settles down by day four.
      I emphasize that if the treatment has done them any good they won't know for sure until day 4 arrives. Then they can stake stock. Also, if they do their homework and by day 4 they feel better, that will be the new level they'll be at, and we won't have to start at square 1 - they'll stay at least that much better (provided all they have is persisting mechanically changing 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


      • Feeling cold

        I saw a 74 year old woman today with swollen and painful left knee. She's been through 3 operations. First a TKA, then a new operation for scar tissue removal, and then a third to change the size of her new knee. The last one she had about 2 years ago.

        We worked on her knee, thigh and hip with DNM. I felt softening of tissue and observed some movement below the knee, she felt pain relief and.... she felt cold, at all the places we worked on, not warm. She told me it wasn't uncomfortable, so we kept on going. And to me her knee and thigh felt warm, so it may be her perception?? It's been "itching my mind", and I'm excited to hear if anyone else have had the same experience?
        Last edited by mortene; 06-11-2014, 10:36 PM.
        Morten

        Comment


        • A sympathetic outpouring, which would include the sense of cooling brought on by an increase in sweat gland activity, is not all that unusual. It probably won't happen again.

          Why not handle her head as well and treat the nervous system, not only specific nerves?
          Barrett L. Dorko

          Comment


          • Good question Barrett! My answer will be that I don't feel confident enough. I've been reading alot of threads in your forum, and I'm eager to try, but I think I'm nervous of failure... Got to get myself some guts!
            Morten

            Comment


            • Well, I suppose, "guts" would help, but I'd prefer some simple understanding.

              Not having attended a workshop, you wouldn't know what Bobath said and, not being me, you wouldn't have heard several thousand patients promote the method through defensible change.

              I can't recall a patient objecting but that has to do with the descriptions I offer and stories I tell.

              I guess.
              Last edited by Barrett Dorko; 06-11-2014, 11:28 PM.
              Barrett L. Dorko

              Comment


              • And look at how her legs lie on supine? Toes firing up to the ceiling? I suspect her TKA side would be. Try some lateral touch along the outer side of that leg.

                Three lots of surgery is one heck of an assault. It will take time.

                Nari

                Comment


                • I don't have very much info to put in here because honestly i don't understand everything as good as you guys do. But i have to cases.

                  Case 1: Ypung guy with pain in the right scapula area, sometimes feels like a stabbing and when not that, he has a feeling of constant buzzing and pain at low levels. Talked to him a little about pain and the brain, the basis for DNM and what i'm trying to help him with. Did some DNM along the right scapulae pulling the skin laterally. I have no idea how my technique is but i asked about the feeling he got which he said was pleasant. Lying on his stomach. After a couple of minutes his breathing was more relaxed and he was calmer. When he got up it had settled at the level of the scapulae but still hurt when he rotated his neck to the left so i put him in that position and treated from there. Pain gone in a couple of minutes.

                  Unrestricted ROM after that in the neck and no buzzing pain or sharp pain.



                  Case 2: woman in her 50s, pain in the right side of the back since monday after hurting her big toe. treated her on wednesday with passive hip movements, contractions and unloading the back while resting. came in today with much less pain but had a feeling of muscle stiffness and it felt like a big package and tension in the gluteal area. Treated her with DNM and at the same time talked about DNM and the brain. After 10-15 minutes the feeling was much less and in a much smaller area. She was amazed and moved much better and felt a feeling of warmth in the area.

                  What do i think happened in these cases?

                  I calmed them down, explained about the brain, nerves and pain and touching. Listened to their feed back of what felt good and where and just improvised and their nervous systems calmed down.

                  Comment


                  • I have a case I could use some help with.

                    Subjective:
                    64 year old woman complains of a stabbing, electric shock-like pain about 2 cm lateral to the spinous process of T4 the size of a quarter. The pain came on several years ago for no particular reason. Her pain has gotten worse over the years. No particular movements or positions provoke the pain, it comes and goes on its own accord, it seems, however, if she lies on her right side with her shoulder in a neutral position she can relieve some of the pain.

                    She is socially disabled by her pain, afraid to travel and to attend social gatherings because of it. She rates it at 10/10.

                    No pain in the neck, no neuro symptoms in the upper extremity, no red flags.

                    Objective:

                    AROM cervical spine is normal.
                    AROM thoracic and lumbar spine is normal.
                    AROM shoulders is normal.
                    Long-sitting slump: Negative.

                    Palpation: Dysesthesia and allodynia left side T4-T8, particularly prominent at T4.

                    Working diagnosis: Mechanical deformation of a dorsal cuteneous thoracic nerve, most likely around T4. AIGS formation is likely given her spontaneous pain.

                    Treatment 1:
                    DNM for 20 minutes on her intercostal nerves and dorsal cutaneous ramii T4-T10.
                    Her pain goes down to 7/10 after the treatment.

                    Treatment 2:
                    She came in today again, feeling better. The pain has not been as intense and has not come on as often.

                    We did some DNM again, this time for 30 minutes. We also applied some tape to the skin in the area of pain and tried to drag it towards the mid-line.

                    After the treatment she reported significant relief. I did not ask about a pain rating.

                    Any tips?

                    Comment


                    • Sounds like notalgia paresthetica.
                      Nope, no tips for the treatment aspect - looks like you're making progress. :angel:

                      I would however inquire about her default resting positions.
                      Which arm is dominant, does she put all her weight through one leg more than the other, how does she sit to watch TV, does she lean on one arm or the other, does she have to turn her head to one side or the other, does she cross one leg habitually and not the other, carry a heavy bag over one shoulder and never the other, has she slept only on one side for decades.. etc.etc. All those kinds of things take a toll as the years roll by.
                      If you notice any of these as habits, or if she mentions them upon questioning, I'd explain why it's so important to feed all the 72 km of nerve in the body from all sides, evenly, by breaking up old habits, learning how to lean on the other elbow at least half the time, etc.
                      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


                      • Thank you, Diane.

                        I agree, it sounds like notalgia paresthetica.

                        Would membrane stabilizing medication such as Gabapentin/Lyrica be of benefit considering the likely ectopic discharge?

                        Comment


                        • Mikal,

                          I never chime in on these (that I can recall, anyway) but in addition to what Diane has suggested I'm wondering if you've found the patient's authenticity, that is, their tendency to move without plan or willful intent, helpful at all. The bit of history indicating her ability to alter her pain with certain positioning is helpful in understanding at least one of the origins her painful output may have.

                          I've gotta ask: Where are her legs when she lies supine and do the characteristics of correction emerge from her when she moves ideomotorically?
                          Barrett L. Dorko

                          Comment


                          • Originally posted by Mikal Solstad View Post
                            Thank you, Diane.

                            I agree, it sounds like notalgia paresthetica.

                            Would membrane stabilizing medication such as Gabapentin/Lyrica be of benefit considering the likely ectopic discharge?
                            I don't know.

                            I do know this: I treated a young girl once, with ankle pain, dxed as CRPS, four years post #. She was in a cheerleading squad as I recall. She had been on gabapentin and it wasn't working for her anymore. She came in on crutches wearing a blow-up ankle brace she'd been wearing for 6 weeks prior.

                            She did very well with pain ed, skin stretching, deep breathing, some support for maintaining and using an internal locus of control in those instances where she was expected to haul equipment with all the others after she was spent from practice, when right then, what she needed to do was sit for a minute, focus and deep breathe to manage pain as it started to be noticeable, instead of buckling to social pressure and authority and putting off dealing with it until later, because of social context and expectations. I told her I had her back and if her teacher wanted to contact me I'd be more than happy to discuss the matter.

                            I think I saw her three times, widely spaced. She was off the crutches and out of the brace after the first visit.
                            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


                            • Originally posted by Diane View Post
                              She was off the crutches and out of the brace after the first visit.
                              Not because I'm so great. Because she'd been misdiagnosed.
                              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've not yet watched her lie supine. During the treatment the characteristics of correction did not emerge. However, I noticed increased blood flow to the area of symptoms by increased redness of the skin during the application of DNM to her thorax.

                                I will try to construct an environment where she can express her own ideomotor activity at our next appointment next week.

                                Thanks for the tips and comments, they are greatly appreciated.
                                Last edited by Mikal Solstad; 06-12-2014, 06:06 PM.

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