Does this stuff really work???

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Does this stuff really work??? - November 26, 2000 4:21:00 PM

JoePT

Posts: 0
Joined: November 20, 2002
From: Birmingham,AL
Status: offline

Hi group....my co-worker and I have gotten into a debate. He claims that nothing we do really works and tends to be a very jaded therapist. I don't feel that is the case. I do fairly well with low back patients. I have found that petrissage and stabilization really getss a lot of patients better.
However, I have had a lot of frustration with tendonitis patients, especially shoulder. I do the standard phono followed by deep friction massage. I am not sure this is working. Then the other day I was reading where Cyriax recommends 20 minutes of deep friction massage which is not even close to how long I do it. How long do others do it for??? At the factory where I work I usually see 2 patients within 20 minutes. Even if I had the time, I'd imagine it would get awfully tiring and boring for 20 minutes. What do others think???

Post #: 1

Re: Does this stuff really work??? - November 27, 2000 2:36:00 PM

Betty Smoot

Posts: 49
Joined: March 1, 2000
From: Sonoma CA
Status: offline

Joe,
If the patient can reach, you could teach them to do it themselves...
Cyriax has taught 20 minutes, but I think a more typical rx is 3-10 minutes or til the patient can't feel the pain anymore.
Contraindications to DTF are, among other things, acute inflammation where there's lots of swelling, and pain that is instigated because of exhausted adaptive potential of the tissue in question (like a tendon about to tear). Also DTF may not help if the pathology is secondary to a "facilitated segment", cervical spine dysfunction, or shoulder girdle problem. If you're treating the shoulder with the standard of care and there's no change you may wanna look harder at other structures. Old news, right?
Also, what's the rationale for DTF? Is it to temporarily knock out deep mechanoreceptors, central biasing to inhibit pain, mechanical distortion to collagen fibers to elongate them, or to create a localized hyperaemia? If with DTF we create tissue trauma and therefore inflammation to then stimulate healing, why do we do anti-inflamatory modalites in conjuction with the DTF? When I do DTF I do it without other modalities so I can more accurately determine patient response. Just some thoughts....
Betty

(in reply to JoePT)

Post #: 2

Re: Does this stuff really work??? - November 27, 2000 3:55:00 PM

bonmar

Posts: 137
Joined: August 15, 2000
From: Boston, MA
Status: offline

[QUOTE]Originally posted by JoePT:
Hi group....my co-worker and I have gotten into a debate. He claims that nothing we do really works and tends to be a very jaded therapist. I don't feel that is the case. I do fairly well with low back patients. I have found that petrissage and stabilization really getss a lot of patients better.
However, I have had a lot of frustration with tendonitis patients, especially shoulder. I do the standard phono followed by deep friction massage. I am not sure this is working. Then the other day I was reading where Cyriax recommends 20 minutes of deep friction massage which is not even close to how long I do it. How long do others do it for??? At the factory where I work I usually see 2 patients within 20 minutes. Even if I had the time, I'd imagine it would get awfully tiring and boring for 20 minutes. What do others think???[/QUOTE]

Re: no luck with shoulder tendinitis, I find checking the glenohumeral capsule for hypomobility (many times hypomobile post) as well as strengthening the scap retractors and performing light/painfree/high rep exercises of the biceps and subscapularis (initially) as well are effective. If the humerus is not downward rotating due to rot cuff/scap retractor weakness, the patient will continue to re-inflame structures with use of the involved UE (this is with "impingement syndrome"). Re: DFM , I have learned it is generally only effective when done for 15-20 mins. I also show the patient how it is done (making sure the UE is placed in the position for maximum exposure of the tendon eg. hand behind the back for the biceps).

(in reply to JoePT)

Post #: 3

Re: Does this stuff really work??? - November 27, 2000 5:11:00 PM

mcap

Posts: 652
Joined: February 8, 2000
Status: offline

Dear Joe:

2 patients every 20 minutes....that's six patients per hour. How could anyone give quality care in that kind of setting???

As for deep friction massage, I think it can help but make sure you are doing it for the correct reason. The patient must have non-inflammatory TENDINOSIS. If the patient has TENDONITIS, it will make things worse.

Second, once you have determined that DFM is appropriate, make sure that you have selected the appropriate tendon and that you are massaging the correct one.

There are many opinions about how long. I have heard that 10 minutes is the minimum.

I am not aware of any research on the subject but it has been shown to increase Rat fibroblast activity. Maybe other forum members know of more research.

Don't forget to check the strength of the cuff and scap muscles.

And, finally, PLEASE read a text on the subject. I recommend Donatell's book or Management of Common Musculoskeletal Disorders as good starting points.

mcap

(in reply to JoePT)

Post #: 4

Re: Does this stuff really work??? - November 27, 2000 5:16:00 PM

RookiePT

Posts: 11
Joined: November 21, 2000
Status: offline

hey joe,
i think we work with the same kind of people. there is one character who doubts everthing, he thinks nothing we do works, that PT is useless. i can't believe he says stuff like that when at the clinic you can see miracles happen. in the past week i have seen some myofascial mapping discover some embedded bone bruises, some mulligan techniques to relieve headaches(that guy said tylenol works the same), and some strain counter-strain relieved some trigger points. please hang in there.
as far as DFM is concerned i normally do it for the stated 15-20min. i know your hand gets tired but it does help.

(in reply to JoePT)

Post #: 5

Re: Does this stuff really work??? - November 27, 2000 5:27:00 PM

JoePT

Posts: 0
Joined: November 20, 2002
From: Birmingham,AL
Status: offline

Mcap, at my clinic we see minimum 4 patients per hour. And that is when we are light. Otherwise they encourage double booking so it is fair to say we treat 5-6 patients per houron average. I once saw 42 patients in a 6 hour span (my personal record). Same as MD's. It's great for the metabolism though, we really learn how to "boogie."
Rookie, it is good to hear of the various "miracles" you have observed. It keeps you motivated to stick with PT during these trying times. Since I am new, I still have not become in "tune" with my instincts and palpatory skills. I am told I focus too much on science and not the "art" of PT. I am also told that will come in time. I guess you pay you. Guess that comes with experience.

(in reply to JoePT)

Post #: 6

Re: Does this stuff really work??? - November 27, 2000 5:29:00 PM

JoePT

Posts: 0
Joined: November 20, 2002
From: Birmingham,AL
Status: offline

Mcap,

Please define tendonitis vs. tendinosis and how you would distinguish clinically?

(in reply to JoePT)

Post #: 7

Re: Does this stuff really work??? - November 28, 2000 5:38:00 AM

edilling

Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
Status: offline

Joe PT
Your co-worker should get out of a profession they have no respect for. If they they truely believe that PT has no effect they are committing fraud each time they bill for their services. (have they ever looked in PT, JOSPT, Spine, J of Sports Med.....?)

As for your patients--
The modalities may address the local symptoms but tissues involved require very low grade stresses and appropriate rest to reorganize and heal. Make sure to address changes in use of the arm to prevent continued impingement as well as very light, high rep exercises to encourage circulation and influence the collagen of the inflammed tissues. (repetitive low grade, painfree movement is far superior to passive modalities to encourage circulation). Also, has phonophoresis been shown to get a therapeutic dose to tissues as deep as the one's you are trying to treat?
Good Luck

(in reply to JoePT)

Post #: 8