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  • #16
    Diane-
    I believe I posted it in my previous entry, at the bottom there. Can everyone else see/download it?

    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


    • #17
      It's there now and it downloaded fine Jason.

      I think the term "adhesion" is thrown around as freely as the word "release" is. These terms ought to be defined outright so that communication between various professions is possible. Otherwise surgeons who have to go into someone's abdomen to lyse adhesions or ortho surgeons who have to worry about breaking bones in the attempt of manually lysing adhesions under anesthesia are going to think you aren't thinking straight about the holding power of actual adhesions.
      Last edited by Diane; 19-11-2006, 02:53 PM.
      "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

      Comment


      • #18
        Thanks for pointing that out. Got 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
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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


        • #19
          Originally posted by Jason Silvernail View Post
          We simply cannot change connective tissue this quickly. After reading the article, don't you agree?
          Sure I agree. What I'm saying is that I do not want to change the connective tissue. If you lung adheres to the chest wall post inflammation - this happens - you don't want to remodel any connective tissue - you want a surgeon who separates the one tissue from the other. To break up the adhesions so they will be reabsorbed and tissues will move freely.

          Originally posted by Jason Silvernail View Post
          BTW, I think this is entirely different from the effects of the treatment - I've hear both practitioners and patients rave about ART. So I'm sure it works sometimes for some people. But not for the reason we have been told it works, you know what I mean?
          And I agree! But I think there is something to the adhesions too. The techniques work on non-contractile tissues as well.
          Ole Reidar Johansen, Musculoskeletal Physiotherapist
          "And if you gaze for long into an abyss, the abyss gazes also into you." - Nietzsche

          Comment


          • #20
            Originally posted by Diane View Post
            So, Ole, you do not agree that the skin overlying the tissue you think you are directly affecting has anything to do with autonomics or their outflow, or fast sensing by the cortex, or changes in the stuff you think you are directly effecting through your contact? Do you regard the nervous system as being the change agent, or yourself and your probings? How about a combination of yourself and the sensory nervous system of the patient in the form of a kinesthetic conversation?

            Sounds like you regard skin as just a convenient passive holder in of tissue leakage.
            I hear you. I do regard the nervous system as being a change agent as well as my "probings". I'm not quite sure it's because I'm affecting the neural endings in the skin... I think it's the neural ending in the deeper tissues. If you consider a successful use of PA mobs on a facet joint - I think it's the pushing on the neural endings in the joint capsule that produces the result rather than the skin or the mobilisation of the joint.

            Originally posted by Diane View Post
            I would call the neural effects from skin a "confounding factor" to your theory; to disprove any effects deriving from skin is a necessary step, at least mentally, to help your hypothesis along, or it can't fly. If you were able to remove the skin from your patients, then treat them and get your results, then put the skin back on after, I would believe your theory without hesitation. But, in that this is impossible to do in living conscious outpatients, I assert that you must take skin/sensory input through it into account in any kind of manul therapy. Once your mind does take it into account, it becomes simpler/less complicated/more creative to get the effects you want just by handling the outer layer. Given a chance, the patient's system will paradoxically do much more with way less.
            Like I said earlier - I'm looking forward to hearing of the outcome of your research.

            Originally posted by Diane View Post
            Jason, "By this I'm talking about Threlkeld's 1992 article I've posted here." Would you please repost that? Or post a link to the post where you posted that? I tracked back but couldn't find where you had posted it. Thanks.
            Scanned through that one. Here is a quote from it:

            The mobility of CT is changed by breaking some of the links between adjacent CT bundles. Mobility might also be improved by restoring the interstitial fluid content of CT structures to normal levels, thereby reestablishing normal frictional resistance between the bundles and adjacent structures.
            This is of what I speak.
            Ole Reidar Johansen, Musculoskeletal Physiotherapist
            "And if you gaze for long into an abyss, the abyss gazes also into you." - Nietzsche

            Comment


            • #21
              Ole,

              You've chosen a quote indicating that we know how remodeling might occur if the proper forces were applied to the target tissue at just the right angle. The problem is that manual pressure is highly unlikely to do that unless the practitioner (and patient) are lucky. Threlkeld makes this clear.

              I don't know of any studies attempting to clearly define much less solve the issues surrounding force tranmission. That being the case, the theory behind the effect of ART and the rules regarding technique are largely wishful thinking.
              Barrett L. Dorko

              Comment


              • #22
                Ole, so far I have no particular diagreement with what you have posted so far.

                Clinically, ROM and the perception of pain can be changed for the better without any venturing into deeper tissues. A soft longitudinal ectodermal stretch which cannot affect CT fibres - it is far too soft - can clinically do this. A light contact over a moving structure within the available ROM can quickly increase the ROM. The movement doesn't change the status, it is the available movement when the patient presents.

                "Stickiness" is an unglamourous word, but probably describes the state of tissues better than adhesion.

                I think we are stuck again with the "why" question, not the "how"....

                Nari

                Comment


                • #23
                  Ole,

                  The mobility of CT is changed by breaking some of the links between adjacent CT bundles. Mobility might also be improved by restoring the interstitial fluid content of CT structures to normal levels, thereby reestablishing normal frictional resistance between the bundles and adjacent structures.
                  So, we are looking at 2 different mechanisms here. The first involves mechanically breaking, severing, a link. If this link is scar tissue, collagen fibers, I still don't see how you can break it without creating an inflammatory response.

                  The second mechanism, re-establishing normal friction between adjacent structures by changing the interstitial content, sounds like the "stickiness" that Nari describes. Mechanically speaking, this sounds more feasible to me.

                  What causes these interstitual fluid changes?
                  Cory Blickenstaff, PT, OCS

                  Pain Science and Sensibility Podcast
                  Leaps and Bounds Blog
                  My youtube channel

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                  • #24
                    What I'm saying is that I do not want to change the connective tissue. If you lung adheres to the chest wall post inflammation - this happens - you don't want to remodel any connective tissue - you want a surgeon who separates the one tissue from the other. To break up the adhesions so they will be reabsorbed and tissues will move freely.
                    I think this suggests that "adhesions" on the one hand is something qualitatively different from "connective tissue" on the other. Really, all of it is "CT". Scars are "CT". Fibroblasts make both "CT" and "scar" and "adhesion". I don't see that any point is served by trying to differentiate them "as if" one were more amenable to handling than another, especially through a force dissipator /spreader like skin is, especially living, functioning, nervous system charged skin.

                    About PAs, same thing. Still got to get through the skin and all its opinions to get to anything "neural" in the joint. Still have to account for any effects that might come your way via skin receptors first, since it is entirely in the way. Still have to then discount those same effects, or you don't have construct validity for your manual therapy hypothesis. Still have to go through all the unpleasant cognitive dissociation.

                    I'm sorry, but I can't help it that
                    1. skin is the external sensor array of the brain and that;
                    2. it is in the way of all mesodermal hypotheses and that;
                    3. no one else ever pointed this out before.

                    That's what we all have to cope with.
                    Attached Files
                    Last edited by Diane; 19-11-2006, 09:51 PM.
                    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


                    • #25
                      Hi Ole,

                      Are the manual forces used in ART graded similarly to other manual approaches (if there is more than one grade)?

                      What is the "Active" part of Active Release Technique?
                      Last edited by Jon Newman; 20-11-2006, 01:58 AM.
                      "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                      Comment


                      • #26
                        Clinically, ROM and the perception of pain can be changed for the better without any venturing into deeper tissues. A soft longitudinal ectodermal stretch which cannot affect CT fibres - it is far too soft - can clinically do this. A light contact over a moving structure within the available ROM can quickly increase the ROM. The movement doesn't change the status, it is the available movement when the patient presents.-Nari

                        This has been proven or just hypthesized?

                        Diane, it is simple to test your theory, you can apply light contact before doing ART and see if that resolves the problem. I bet if Ole does this he will find no change. So once again I have to point out that the burden is to prove that skin manipulation has the effects you claim before you use it to argue that it is the real answer to why other manual therapy approaches are effective.

                        Comment


                        • #27
                          Randy,

                          No studies done - just clinical experience. That's all. And, like all applied techniques, it doesn't "work" for all patients. Especially the clientele I have, who are all complex pain people.

                          Nari

                          Comment


                          • #28
                            Nari,

                            In Australia, it won't work anyway => skin is burnt by sun.
                            Simplicity is the ultimate sophistication. L VINCI
                            We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

                            Everything should be made as simple as possible, but not a bit simpler.
                            If you can't explain it simply, you don't understand it well enough. Albert Einstein
                            bernard

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                            • #29
                              Very funny, Bernard...

                              We are getting better at avoiding the sun - but have a long way to go yet.

                              Nari

                              Comment


                              • #30
                                "This has been proven or just hypthesized? "
                                Randy, hypothesize how to get around it. Skin I mean. I'm listening.
                                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

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