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  • #16
    Originally posted by proud View Post
    I do believe in deviating from the outcome lit for 3-4 sessions to see what happens.

    Proud,

    What makes you decide how and when to deviate from the outcome lit.?
    How do you choose your deviations?
    How do you evaluate "what happens"?


    Nick
    Nick Matheson, PT
    Strengthen Your Health

    Comment


    • #17
      You must have a very long patient or else very short arms, proud.
      You should see how short I am, and how short my arms are, but I can reach this span without difficulty on most people... It should be ok to lean on people, as long as there's something between you and them, like a sheet or blanket, or if you think they need to be informed first... "I'm going to try something for your mid back, for that crabby spot we found, that involves me needing to reach both your back and your foot on that side, at the same time. I may need to lean on you on this side, to be able to reach. Are you OK with that?" Something like that.

      For the elbow, you might try laying the patient prone and with his arm dangling down, grasp above and below the elbow, lightly, wait for something to happen kinesthetically that tells you his nervous system registers your presence in a comfortable way, then try taking just the skin layer in opposite directions. Usually the arm skin into medial rotation and the forearm skin into lateral rotation. Very slow. Stop for long rests. See what happens. Usually there will be some amount of upheaval in and around the elbow that the patient doesn't usually pick up on, although they might relax and say something like, "I just felt my arm lengthen by a couple inches." Usually you will have felt that happen before they say anything, but it doesn't really matter. Then you just hang out with your hands in exactly the same position, holding the same way, minutes and minutes if necessary, until it feels like nothing else is going to happen. Un"screw" the skin gently, slowly, and lift your hands off. They'll usually feel better by some, often by a lot.. you can throw some tape on again maybe, but not much.

      So, how does this get to the radial nerve? Several cutaneous branches come off the radial nerve, posterior cutaneous of the forearm, lateral lower cutaneous of the upper arm (two branches of that), so you are pulling on them some when you S-stretch the skin at the elbow. It's not in the book, but it's worth a try I guess, since you are swinging out this far, might as well go all the way into completely foreign perceptual territory.
      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


      • #18
        Hello Nick,

        1. Well I deviate if I am not getting the success with a patient using the available evidence. The time I expect will depend on what it is I am treating. usually 6-8 sessions I guess?

        2. How do I choose my deviations? Well there is alot of techniques out there that I have been exposed to( been through the EV system, CertMDT, Mulligan, Butler, APTEI courses, Sandy Burkhart, Shirley sahrman etc). Not all of it is indexed in pubmed. But I will reach back into those based on my clinical experience( consistent really with Sackett's definition of EBM). I just think it's rather ethical( and professional) to try to use treatments with the supportive data before deviating away.

        Don't you?

        3. Is a strange question is it not? I think it is Nick. I'll quote Barrett( at least how I recall the quote). "don't we all define success the same way?"

        Success is how I evlauate "what happens".

        Comment


        • #19
          Thanks Diane. I actually don't think it's much of a "stretch"(:clap2 for me.

          All the neuro anatomy is outlined quite nicely and I can link the theory to the treatment. I like that.

          BTW...I must get back to you on the other thread about my odd shoulder pain experience. I printed off the basic anatomy stuff and read it today. I still cannot answer (brain) and (why). The why part....I must admit....I am not even sure what you mean by the question.

          Thanks for the clarification on the techniques. Excellent.

          Comment


          • #20
            Diane -

            Thanks for the hard work of making this available to all. I have been learning more about the methods I currently practice and paying more attention to the CNS as an alternative explanation for how they work. Over the last few weeks, I've come to realize that I have intuitively been working as much with the CNS as with my (training and/or massage) client's other tissues.

            As I am just starting to learn about DNM, I won't ask many questions until I've had more time to read and digest the info. However, I am curious whether you (or anyone else) has used DNM to treat scoliosis. I've spent many hours seeking good published research on non-surgical, non-brace approaches to scoliosis treatment, but haven't found anything substantive other than some vague discussion of "exercise" administered by PTs as treatment. In your experience, has DNM successfully arrested or reversed the progression of scoliosis?
            Novice Woo Shoo Kung Foo practitioner. Experienced critic of Truthiness.
            "It used to be, everyone was entitled to their own opinion, but not their own facts. But that's not the case anymore. Facts matter not at all...Truthiness is 'What I say is right, and [nothing] anyone else says could possibly be true.' " - Stephen Colbert

            Comment


            • #21
              Jason,
              There are lots of things that look like scoliosis and aren't: if a side curvature is just postural or habitual, some sort of approach like this might help. If the curvature is because one half of the vertebrae didn't develop the same way the other half did, there will be no kind of manual treatment that will ever change that in a million years.
              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


              • #22
                Originally posted by Diane View Post
                You must have a very long patient or else very short arms, proud.
                You should see how short I am, and how short my arms are, but I can reach this span without difficulty on most people... It should be ok to lean on people, as long as there's something between you and them, like a sheet or blanket, or if you think they need to be informed first... "I'm going to try something for your mid back, for that crabby spot we found, that involves me needing to reach both your back and your foot on that side, at the same time. I may need to lean on you on this side, to be able to reach. Are you OK with that?" Something like that.

                Actually I also have big problems to visualize this technique for the back and at the same time pulling the foot. I tried it and my arms are killing me this way. And I am above 6 foot with long arms but I cannot do it.

                Comment


                • #23
                  Actually I also have big problems to visualize this technique for the back and at the same time pulling the foot. I tried it and my arms are killing me this way. And I am above 6 foot with long arms but I cannot do it.
                  Well, maybe you are trying too hard. You don't have to literally bend your patient, instead you can just pull the skin down the entire side of them, from the lateral malleolus. It helps if you put the other foot up over the pulled foot's ankle. And stick a wedge in under the hip closest you to make a pivot point. The foot might move a few inches or several, but it's not hard work.
                  (I'm a small female, sort of chunky, with no mechanical advantages, short arms, and pushing 60 - if I can do this fairly readily on almost any size person, people with longer wing-spans should be able to. )
                  I'll try to make a picture.
                  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


                  • #24
                    I'm fairly certain we took a picture of 'the headbutt technique' at the workshop last year Diane.
                    Eric Matheson, PT

                    Comment


                    • #25
                      Eric, you're right! I'll look for that.
                      That's a little extra thing one can do when both hands are engaged - press one's head into the patient's trocanter, to shove the pelvis a bit, add a bit more input into the system. Sometimes it gives that last bit of oomph necessary to side bend their nervous system enough to shut down the crankiness up at the back.
                      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


                      • #26
                        Diane,

                        Thought I would let you know that I proceeded with your techniques on my elbow patient on Thursday. I was hopeful but ever skeptical.

                        The patient presented today( Friday) and reported( in his words), perhaps 75% less pain and no "stiffness" that he had previously.

                        What can I say? I went ahead again today( to bad it's Friday....in a way). I'll see him again on Monday.

                        That's pretty impressive though....

                        Comment


                        • #27
                          Hey proud, way to dermoneuromodulate. :clap2:

                          And you did not have to spend big bucks learning how, from any guru.
                          All you had to do was check for woo, decide for yourself there wasn't any, check for "evidence", find out there wasn't much, but follow a train of logic based on nervous system principles, a few suggestions, et voilá - it's not rocket science, it's just good handling - let the patient's brain do all the heavy lifting.

                          75% for a first attempt is pretty good. You must have quite good hands on you, and an ability to be receptive to what another person's system is doing/trying to do.
                          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


                          • #28
                            What I did was first evaluate the ULTT( radial nerve) and sense how much elbow extension I could get before "tension".

                            I also simply palpated over the common extensor muscle group and admittedly it felt harder than the opposite side( I'm thinking you would call that cranky?)

                            Anyway, that was what I used for my baseline "objective" data as well. Before the treatment he could only get from 90 degress to 70 degrees. After treatment he could go to 30 degress extension. He maintained that today as well along with the reduction in pain and stiffness.

                            I am not sure if you measure that way?

                            Anyway, It's the science Diane that you and others have provided that is so convincing to me. Plus I took a pretty excellent course from Debbie Patterson( I think you know her?)

                            Anyway, my patient thanked me today. That's pretty good I think.

                            Comment


                            • #29
                              I am not sure if you measure that way?
                              Yup, pretty much. Crankiness (upregulation, mechanical allodynia, central sensitization, whatever) of some sore spot, get some idea of the crankiness level but not deliberately over-provoking it by being at all fixated on some mythical mesodermal mishap that may be buried within. Or if there is no sore spot, just the quality of the tissue, hard/ bouncy like off a drum, soft and yielding, whatever; basic quantity of movement, how it "feels" to the patient. I ask people to take mental snapshots of how a part feels to them, at rest, and trying to move it. Then we treat, then I ask again after. Then I tell them, "Move it to improve it."

                              I've met Deb once, and talked to her lots. I will be traveling to her place in Ont. in the fall for our first big Official Division Meeting.
                              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


                              • #30
                                Hi,

                                I like to get some feedback on LBP, often I find around the SIJ area a painful spot sometimes some bean like nodule over it. I tried DNM over it but the nodule doesn't seem to disappear. Pain is disappearing but if i reasses the same spot it seems to come back almost every time.

                                I saw this on a quite a few patients. Should I stay longer on the spot or just move on looking for other cranky parts? Sorry to bother all the time but I am a slow learner it seems.

                                Comment

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