|
|
Mobilisation of facet joints, the continuous method
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Mobilisation of facet joints, the continuous method - July 2, 2006 7:34:00 PM
|
|
|
ginger
Posts: 647
Joined: February 26, 2005
From: Melbourne Victoria
Status: offline
|
After many requests for detail on the continuous method, I offer here a short examination of the method I call Continuous Mobilisation. Applied to spinal zygo apophyseal facet joints with care, this method provides the means to restore normal pain free function to hypomobile facets joints.
As this is a brief consideration of the method and reliable results considerably influenced by application, I urge the reader to practice on live humans to bridge the skills gap should there be one.
I will skip any further introduction and mention of physiological detail and examination protocals , these will be/have been dealt with elsewhere.
METHOD.part one
unilateral passive mobilisation of facet joints requires therapists hands to be a connection to the ongoing protective state implicit in the activity associated with spinal joint pain. As such it is necessary to be sensitive to changes in the state of tone of intrinsic muscles intimate to facet joints. Any attempt to move a facet joint which has a protective hypertonic load ( of muscle) will be met with resistance and pain. Pain can be of differing intensities, feel and irritability. ( by irritability I refer to the prospect that any attempt to move joints in a highly irritated state may be followed by pain not associated with passive or active movements, initiated by that attempt to mobilise)
By this sensitivity it will be noted that as passive movements are attempted and continued, a changing picture of pain and resistance emerges.
Movement is applied in a natural direction predicted by the angles of therapists hand and arm, where he/she stands at the side of the patient nearest to the joint being mobilised.
Pressure is sufficient only to acknowledge both pain and resistance at the joint. Continuous movements then at a rate of 2 per second are provided such that both these variables are able to be monitored. At or around 30 seconds of continuous mobs there will be noted the first level of alteration to both variables. That is , pain will be felt to reduce at the same time as muscular tension providing resistance reduces. Further attention to the same joint will produce still more reductions till A. either no further improvements are noted, or B. a full pain free resistance free condition is established.
The effect of successful mobilisation will be noted in several ways.
Active and passive facet ROM will be improved. This will be associated with improvements to comfort locally as well as distaly. It will be noted that as these local improvements are appreciated , so will the prospect of a reduction in distal pain and dysfunction associated with the spinal segmental innervation of those related structures.
The improvements to facet mobility are essentially permanent. That is, provided that there are no severe local irritations given by pathology or injury, protective responses leading to facet hypomobility and inflammatory events of joint and nerves are restored to normal. Inflammatory events associated with these states of hypomobility are usually dissipated over a 24 hour post treatment period. Some liklihood of a post treatment painfull facet joint period exists. This can be viewed as an unfortunate feature of this form of treatment , but not a contraindication for it's use. In my experience about 20 percent of individuals will experiece a post Rx period of tenderness, which last pproximately 24 hrs. Usually noted is a highly irritated facet joint, or group of joints prior to Rx, in this group.
Summary
Continuous facet joint mobs is NOT
forcefull
difficult
contraindicated by the presence of age or disease related arthropathies, "instability", or previous injury .
Continuous facet joint mobs DOES NOT require
Your attention to detail in the placement of your thumbs- at or over the lateral mass , as near as able to the facet joint will be fine. Provided that , the two basic criteria are met, that is resistance and pain.
Periods of five minutes of continuous mobs are commonly associated with continued improvements to some facet joints as above, longer periods are usefull also , though strain the limits of the thumb comfort of those new to the method. Practice will lengthen considerably the time able to comfortably mobilise. A lot of pressure is rarely more useful than less, pain and resistance is the key.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - July 5, 2006 2:48:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Hi ginger :
Are you going to complete any knowledge regarding that technique of Facet joints mobilization ??
Any way ,how could you be sure that the background of the pain is the facet joint ?
Best Wishes
Emad
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - July 13, 2006 6:02:00 AM
|
|
|
MPT
Posts: 161
Joined: April 4, 2004
From: Syracuse, New York
Status: offline
|
Has anyone tired Gingers technique?
_____________________________
Where am I
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - July 13, 2006 11:08:00 AM
|
|
|
steve
Posts: 454
Joined: May 14, 2003
From: victoria, bc Canada
Status: offline
|
Yes Ar15, we have all grown tired of hearing about ginger's techniques.
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - July 13, 2006 12:45:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Why?
Nari
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - July 13, 2006 2:40:00 PM
|
|
|
steve
Posts: 454
Joined: May 14, 2003
From: victoria, bc Canada
Status: offline
|
Nari,
Just a little joke based on AR15's typo and Ginger's standard approach to treating all distal problems with a central pathology based mobilizations.
Steve
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - July 13, 2006 4:21:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Steve,
Duh, I missed AR15's typo.
AR15,
i have been mobilising the spine for distal problems for years; not ALL problems, but spinal movement does make a very significant difference for many conditions. We in Oz would always exclude referred pain from the spine by extended evaluation for 80-90% of pain sites in the lower limbs and SIJs; it is the way we were brung up (sic) since the early 80s: never trust that a pain or swelling or atrophy in or near a joint is anything to do with the joint. It occasionally is...
As an example of the above, we once organised a Maitland Peripheral course, and were hunting down painful shoulders - about three - for presentation. On the patient lists, there were ten 'shoulders' being seen by our staff, all with varying common 'shoulder' diagnoses from doctors.
Not a single one was suitable - all of the presenting signs and symptoms were referred from the thoracic/cervical spine, and all were resolving nicely...
Nari
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - July 14, 2006 11:52:00 AM
|
|
|
MPT
Posts: 161
Joined: April 4, 2004
From: Syracuse, New York
Status: offline
|
oops, sorry about the type OOO. The new baby has not been sleeping the greatest and I think "tired" is on my mind.
_____________________________
Where am I
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - July 14, 2006 3:01:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Ar15
Congratulations on your new baby!
Nari
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - July 15, 2006 8:57:00 AM
|
|
|
MPT
Posts: 161
Joined: April 4, 2004
From: Syracuse, New York
Status: offline
|
thanks
_____________________________
Where am I
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - August 16, 2006 11:13:00 PM
|
|
|
rv36116
Posts: 211
Joined: August 5, 2006
From: Texas
Status: offline
|
In this theory, is it taken into account the research of Kuslich SD, et al. "The Tissue Origin of Low Back Pain and Sciatica: A report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia." Orthop Clinics North Am 1991 ;22 (2):181-187
This was the first thing that jumped into my head when I hear a treatment including a facet.
I'd be interested to see what conflicting instances and outcomes you could find between this research and your own?
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - August 17, 2006 12:19:00 AM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Rob
That is a very old study; I don't know if that makes a difference other than it was not well known then that all pain has its origin in the brain, not in tissue. It is the use of the word 'origin' that is part of the problem when investigating pain.
Nari
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - August 17, 2006 9:06:00 AM
|
|
|
rv36116
Posts: 211
Joined: August 5, 2006
From: Texas
Status: offline
|
Hi Nari,
Old and results in a study where an MD is pushing on structures and finding pain patterns still provides information, regardless of the age. The human body has not changed in the way structures react as far as I know. I can still stub my toe and it will hurt similar to how it hurt someone 100 years ago. But, I can pinch the skin on the end of my elbow and it will not hurt, similar to folks 100 years ago. I believe that is the importance of the study, wording aside...
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - August 17, 2006 10:35:00 AM
|
|
|
dfjpt
Posts: 238
Joined: April 9, 2006
Status: offline
|
[QUOTE]I can pinch the skin on the end of my elbow and it will not hurt, similar to folks 100 years ago[/QUOTE]... unless your brain decides in its own infinite wisdom based on some prior experience that pinch happening to the elbow constitutes some sort of threat to its own survival, or an hypoxic threat to the sensory nerves in the elbow, then watch pain response come into the picture.
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - August 17, 2006 1:15:00 PM
|
|
|
rv36116
Posts: 211
Joined: August 5, 2006
From: Texas
Status: offline
|
ok then.
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - August 17, 2006 1:38:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Rob
The human body has not changed in 100 years. But our understanding of its complexity and total dependency on how the brain interprets input and delivers output has skyrocketed and is still going on.
That is the difference.
Nari
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - August 17, 2006 6:14:00 PM
|
|
|
rv36116
Posts: 211
Joined: August 5, 2006
From: Texas
Status: offline
|
wait, have you read the study and results that I had pointed out?
There is something pretty blunt that I think you're missing.
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - August 18, 2006 12:47:00 AM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
NO, have never heard of this journal.I don't think that I would have access to it, actually.
Explain further what is blunt that I am missing?
Nari
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - August 19, 2006 6:10:00 AM
|
|
|
garv3
Posts: 6
Joined: August 7, 2006
Status: offline
|
can anyone recommend some good studies or texts to bring me up to speed on the neurophysiology of pain, and pain referral patterns? or some starting points on this mode of treatment? this is somewhat unfamiliar territory to me?
thanks
|
|
|
|
|
Re: Mobilisation of facet joints, the continuous method - August 19, 2006 6:35:00 AM
|
|
|
rv36116
Posts: 211
Joined: August 5, 2006
From: Texas
Status: offline
|
OK, makes sense now. Here's a quick summary. Not all quoted...
Between 1987 and 1990, 193 consecutive patients were prospectively studied. All of these patients were operated upon for complaints of intractable lower back and/or lower limb pain (sciatica). In stead of the use of general anesthesia, only a "progressive" local anesthesia was used, leaving the patients fully awake and responsive.
During the operation the surgeon randomly "stimulated" various tissues in and around the exposed disc and spinal nerve/nerves by means of 'mechanical force', i.e., the 'smashing of the tissue with a blunt surgical instrument, or the electric shocking of the tissue with low volt electricity.
The patients were then asked to describe and rate any associated sensations of pain, numbness, or burning on an analog scale of 0 to 5, where 5 was severe pain that was exactly like their usual and customary pain.
Facet Joints: If took great 'experimenter force' to elicit pain from this structure and when the pain came, it was localized an did not cause their typical deep lower back pain. Sometimes the facet capsule was painful but it referred pain into the back and "very rarely" into the butt, and "never" down the lower limb. Upon piercing the facet capsule they found that the facet synovium and articular cartilage was "never" tender.
Look in your PM box in the next few days when I get a chance to obtain the full text for you.
[QUOTE]nari posted:
NO, have never heard of this journal.I don't think that I would have access to it, actually.
Explain further what is blunt that I am missing?
Nari[/QUOTE]
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.109
|
Printable Version
