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Crossing the Chasm - Meso to Ecto

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  • #46
    I realised as long as I keep visualising and reasoning I can't feel.
    Why not?
    You can learn to do it all at the same time. It's like a juggling act, as Barrett is fond of pointing out.
    Practice going back and forth until you don't have to anymore because your neurons have "learned" to do it seamlessly all on their own.
    Diane
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    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

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    • #47
      You're probably right, still being 'on' the bridge, trying to keep all balls in the air. There's still work to be done.
      i keep wondering.......................

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      • #48
        The importance is not to cross the bridge: It is the bridge itself. :lightbulb
        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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        • #49
          Bernard
          Could you explain that? By bridge you mean the SNS itself?

          Diane
          I realised as long as I keep visualising and reasoning I can't feel
          I meant: I can't feel properly, by visualising and reasoning - staying in the 'head' - it is
          difficult to sense the body properly.
          As long as I'm not aware that I don't sense properly it's hard to sense.
          Last edited by Line M; 29-01-2009, 06:13 PM.
          i keep wondering.......................

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          • #50
            • The two sides exist.
            • The two sides need a link.
            • The two sides are mandatory to construct a bridge.
            • The nervous system exists on the two sides, too.
            • But one side rules the other.
            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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            • #51
              I guess my bridge's construction is rather thin yet and needs more layers
              Last edited by Line M; 29-01-2009, 06:21 PM.
              i keep wondering.......................

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              • #52
                A spider silk is very thin but more resistant than steel...
                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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                • #53
                  Line,

                  Bernard is right about staying on the bridge. From there you can sense/feel/rationalise because you can 'see' both sides. Both sides alive and symbiotic, but most of the wildlife lives on the ectodermal side visiting the other constantly. PTs tend not to see this ecological fact.

                  Nari

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                  • #54
                    most of the wildlife lives on the ectodermal side
                    It used to be we lived on the _______ side of the tracks.
                    Guess learning is a lifestyle, not a passtime.
                    Those people who think they know everything are a great annoyance to those of us who do. ~ Isaac Asimov

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                    • #55
                      Meso to Ecto - The Prone Hang

                      So not only can generalized treatment processes be "Ectodermed", but individual therapeutic activities can also.

                      The Prone Hang is designed to increase the end range knee extension motion. It is performed with patient lying prone and the knee extended out past the edge of the treatment table. A rolled up towel is often placed above the patella for increased comfort. The patient assumes this position for anywhere from 5-15 minutes, and weights are sometimes placed on the lower leg at the ankle to increase the extension moment of force.

                      This is often prescribed for patients who have had knee surgery or a knee injury and who cannot regain the full extension of their knee through exercise or via other means.

                      I have observed other therapists placing ever-larger cuff weights on their patients ankles in an attempt to "stretch out the back of the knee" to allow more knee extension, often increasing the time spent in this position if it is deemed necessary.
                      I think approaching the prone hang like this is not only counterproductive, but often more than a little bit medieval.

                      I teach the prone hang much differently. I never use weights, and the patient actively lowers their leg into full extension, and may combine it with ankle dorsiflexion at various points to achieve a neurodynamic effect. The full tension position is never held for more than a few seconds.

                      How the treatment got ectodermed:
                      -I cannot provide the requisite force (50-250lbs/24-115kg) to create plastic deformation of connective tissue, so using small loads to try to accomplish this is futile, especially in the time frames required in a therapy environment. See here.
                      -Many, if not nearly all, of these cases are due to a protective guarding response in the hamstring and gastroc muscles. Trying to directly oppose this by forcing it often creates even more of a protective response - and I have seen this many times. I've met a few therapists who acknowledge this but then they say they need to "fatigue out" the hamstring to allow the knee to drop down into full extension. I'm wondering how they can possibly create a more coercive and threatening environment for the patient's brain, which is obviously trying to protect something in the first place. Throw rocks at them, perhaps?
                      - The limiting factor here is typically a protective muscular response and I don't believe that forcing it or providing such a stretch to attempt to accomplish this is defensible, given the properties of the materials we are dealing with.
                      Attached Files
                      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.

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                      • #56
                        How about working with the skin on the back of the hamstrings, knee?

                        Mary
                        Guess learning is a lifestyle, not a passtime.
                        Those people who think they know everything are a great annoyance to those of us who do. ~ Isaac Asimov

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                        • #57
                          Excellent idea, Mary.
                          I was just trying to put an Ecto spin on that exercise - and certainly supportive manual therapy would be a great idea as well.
                          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


                          • #58
                            Meso to Ecto- Glenohumeral distraction mobilization

                            This is fun, can I play?

                            Most of my shoulder patients at various stages of their recovery "love" getting their glenohumeral joint distracted while held close to the "loose-packed" or "resting" position of the joint.

                            Aside from the effects of skin stretch provided, which can augment this technique by performing a sort of "balloon" grip over the skin of the deltoid region, it's both plausible and probable that the neural structures of interest (e.g. axillary, suprascapular nn) achieve a considerable amount of gliding motion with this passive movement.

                            Since being "ectodermed" myself, I tend to perform any "joint mobilization" like this more slowly and gently and with more attention to my grip on the skin. Gently "ballooning" the deltoid is an added kinesthetic effect that I have found provides additional relaxation and pain modulating effects. I also wait to feel what the tissues are telling me, and then stop when the neuromodulatory effects are evident. I don't just keep yanking on their arm for 8 minutes so I can document Manual Therapy code 97140 in my note.

                            How the treatment got ectodermed:
                            -Attention is paid towards the movement of the neural tissues of interest, rather than stretching/deforming joint capsule (see Jason's reference to Threlkeld in post #55).
                            -You don't have to slavishly guess or fool yourself into thinking you are in the actual "resting" position as defined by the various joint mobilization gurus. One just finds a position of comfort somewhere in the neutral part of the ROM and starts moving the humerus laterally from the glenoid in a slow, rhythmic way in order to allow neural tissues to "breathe" better. It's perfectly ok to add different components/moments of IR/ER in order to adjust the treatment as needed. Creativity is allowed and encouraged, not denounced as heresy and poor technique.
                            -Waiting and feeling for subtle neurophysiological changes in the tissues will tell you when you've done enough, not some arbitrary rule based on a flawed reimbursement system or because some "authority" at a CE course on the shoulder said it takes 6-10 minutes. If your not sure, you can always ask the patient for feedback and then re-assess their motion.

                            Not all classic shoulder "joint mobs" move the neural tissues in this way, and so I have abandoned them.

                            So, there you go all you "joint mob'ers" out there. Don't throw the baby out with the bath water!
                            Last edited by John W; 04-02-2009, 03:14 AM. Reason: Because Jason said so...
                            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

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                            • #59
                              I had 2 patients today, 1 with numbness and 1 with pain in the ant thigh. Ballooning near the exit of the lat femoral cutaneous from under the inguinal ligament helped them both. And this they can do at home, too. Skin work really is fun.
                              Guess learning is a lifestyle, not a passtime.
                              Those people who think they know everything are a great annoyance to those of us who do. ~ Isaac Asimov

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                              • #60
                                John-
                                Ur doin it wrong.

                                You forgot how the treatment got ectodermed...
                                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.

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