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Rotexion/Latextion
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Rotexion/Latextion - June 22, 2005 4:29:00 PM
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MPT
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I have been to several manual therapy courses and in some of them they talk about rotexion/latextion in the upper cervicle and thoracic spine.
Does anyone use this concept with their treatments and has it changed your treatments?
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Re: Rotexion/Latextion - June 22, 2005 4:43:00 PM
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Synergy
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Without looking them up, I have no clue what they are! Feel free to explain. :)
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Re: Rotexion/Latextion - June 22, 2005 5:16:00 PM
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MPT
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The basic idea is coupled motion at the spine (rotation/sidebend) change dependind on which motion is initated first.
I always forget exatly what way it goes (it's late) but it would be something like this: If you rotate a thracic vert right you get right sidebending but if you right sidebend first you get left rotation.
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Re: Rotexion/Latextion - June 22, 2005 5:30:00 PM
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jbeneciuk
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Are you referring to functional vs.
non-functional motions ?
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Re: Rotexion/Latextion - June 22, 2005 5:36:00 PM
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srcase
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I've heard it defined as coupled and noncoupled movement...Kaltenborn uses it quite extensively, but frankly, I don't usually have a need for dissecting the movements of my patients so thoroughly (if that is even possible)
Sarah
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Re: Rotexion/Latextion - June 22, 2005 5:51:00 PM
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Synergy
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Thanks for the clarification. I am more familiar with coupled and noncoupled motion as Sarah stated. I believe we discussed this rather thouroughly in PT school...coupled motions referring to Type 2 mechanics and noncoupled motions referring to Type 1 mechanics.
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Re: Rotexion/Latextion - June 23, 2005 4:07:00 AM
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JLS_PT_OCS
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Sarah brings up a good point. I'm not sure knowledge of the esoteric spinal mechanics is helpful in taking care of people in pain.
If we acknowledge that "motion palpation" as a manual therapy approach is useless (see my thread Diagnosis and Palpation in Manual Tx), then one wonders if these detailed and tiny arthrokinematic motions that manual therapy gurus love to discuss even matter a whole lot. Certainly some people have even built an entire profession with this knowledge as a major part of their treatment paradigm, and yet the effects and outcomes are not commensurate with the effort and training involved in knowing this stuff. I think knowing those kinds of biomechanics better would help me with patients about as much as knowing how to rebuild a carburator on a car. Nice to know, but not applicable to daily practice. (especially since carburators are so rare)
It seems foolish to consider biomechanics without the other issues attendant in resolving painful problems.
I do remember such motions from school and subsequent courses, but at the last few manual therapy courses I was at (taught by leaders in our field, for what that's worth), the mechanics and diagnosis of these sorts of movement problems was de-emphasized in favor of classification based treatment and skill in basic techniques.
It all comes down to trying to select a manual therapy procedure based on your assessment, and while I do think there are some subgroups of people with specific arthrokinematic problems that can benefit by detailed diagnosis, these people are exceedingly rare, in my opinion. More general techniques can often resolve the problem.
All Rotexion/Latextion aside.
I think there is an element of Guru-ism at manual therapy seminars, as well, which may explain why they spend so much time with their power point presentation attempting to impress me with their esoteric rotexion knowledge.
Hands-on experience with patients has done more for my manual skills (which are admittedly in their infancy) than any reading of spinal mechanics or lectures by "experts" ever could. Maybe there's a reason for that...
:)
J
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"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
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Re: Rotexion/Latextion - June 23, 2005 5:00:00 AM
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OaksPT
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Jason,
Welcome to the dark side, I experienced a similar paradigm shift several years ago, occasionally go back to the arthokinematic level, just to see if it may be applicable to "this patient". Of course I usually wind up having to take a different approach. I have been to several manual courses as you describe, and while the knowledge of the mechanics is good to a point, (and I'm glad to know them), applicability issues are vague. Actually, I think knowing the details in an appproach whether it's mechanics, muscle recruitment or neurophysiology helps you to understand the limitations/value in a specific approach.
Scott
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Re: Rotexion/Latextion - June 23, 2005 5:50:00 AM
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JLS_PT_OCS
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Good point, scott. Knowledge for the purpose of understanding limitations is valuable.
However, it seems that many who have this knowledge do not seem to see it our way!
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Rotexion/Latextion - June 23, 2005 6:42:00 AM
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steve
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Just to add to Jason's comments regarding arthrokinematic movement in the thoracic spine, I almost feel like this thread could be put along side the upper cervical ligament thread. Evidence for what the thoracic spine does biomechanically is scarce. As far as I know, there are only two studies investigating biomechanics, one by Williams and another by Lee and neither study was particularly well done. Studies investigating our ability to reliably palpate movement in the thoracic spine are equally lacking with only 4 poorly done studies (Last time I checked) that suggested that we could not detect movement. If we cant reliably palpate the movement and we really have no idea what the actual biomechanics are, what type of information is any testing on this basis providing us with?
Sounds kind of like the upper cervical spine ligament thread...
Steve
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Re: Rotexion/Latextion - June 23, 2005 8:50:00 AM
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spfister
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Hi,
I have a clinical commentary published in Manual Thearpy (1998)3(2), 95-101 titled Muscle Energy Concepts and Coupled Motion of the Spine. I can't get it online, but the basic summary is
1. There is evidence to support sidebending and rotation coupling in the cervical spine (same direction)
2. Lumbar spine coupling is inconsistent and demonstrates no clear patterns that are comparable to Fryettes's law.
Does not talk about the thoracic spine.
Thanks
Steve
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Re: Rotexion/Latextion - June 23, 2005 12:30:00 PM
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FLAOrthoPT
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love that pfister guy...even though he never returns my calls or emails...I for one still think if it walks like a duck and quacks like a duck, then it may be a turkey disguised as a duck, but chances are it is a duck. If someone has sharp pain near the spine with rotation of head and you can assess and palpate some FRS or ERS of the upper T spine and do the specific mobs at that segement or manipulation and follow up with some good neuro re-ed motions then why not use these arthrokinematic laws. Now I do not approach every patient looking for FRS ERS etc, but there are definite times when it screams that it is the culprit. I think people poo poo manual ortho too much, and it does serve a purpose and is very logical to follow. I still find it exciting, maybe that is just me..anyway I just wanted to stand up for the other side, lots of manual canadian approach naysayers in here..need to say it works often for me.
Ben
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Re: Rotexion/Latextion - June 23, 2005 12:49:00 PM
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SJBird55
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Ben, does it work because of why you think it works or does it work because of some other reason that is not arthrokinematic in nature?
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Re: Rotexion/Latextion - June 23, 2005 2:22:00 PM
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FLAOrthoPT
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i think it works because of why i think it works...I do not buy into the mehcanical link theory, I do not think it is placebo b/c of I do the "Wrong" mob at the wrong level it does not work, so yes, I feel it works because of MET prncipals of autogenic and reciprocal inhibition as well as the "waking" up the joint again bringing nutrients into the capsule and possibly maybe allowing some nerve roots to "un kink" a bit.
But Yes, I do think that specific manual techniques directed at the spine that correllate to the dysfunction be it type or 1 or 2 that you find does work in the short term, and couple it with behavioral modification, proper postural or behavioral strengthening or re'ed if needed, and i tend to have very good results with the C-spine, T spine and L spine and all are paying me some serious cash so tey have no reason not to tell me it doesn't work...unless they are afraid of hurting my feelings or cash equals some placebo, or they just like me, but when I have a golfer who cannot follow through because of a "kink" in their neck (which is typically more like T2)and I find and I find a corresponding arthrokinematic dysfunction and treat appropriately and they tell me they are then able to play 18 holes without pain, I think it is working based on the principles that the osteopathic principals suggest.
I am aware of the research showing poor efficacy or validity of manual techniques (and by manual I am referring ignoranty only to mobs/met directed at the joint) but I feel these research methods are flawed with all sorts of problems from whom they picked to do the techniques and they repeated them on the same subjects so if they were working than the dysfunction would not be present later, etc. So until this technique no longer works for me, I will continue to take courses in perfeting the art, and continue to keep it in my tool box as one tool to use as is a tool such as neural fascial release techniques.
Tanks for listening-
Ben Galin, MPT, OCS
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Re: Rotexion/Latextion - June 23, 2005 3:16:00 PM
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Synergy
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[QUOTE]I think people poo poo manual ortho too much...[/QUOTE]Greatest line ever!
What Ben describes in his last post is exactly how I was taught in school. Getting slammed with literature telling you motion palpation is bunk kinda shoots my wheels off I suppose because I'm still a fairly new grad. However, I'll deal with it and continue to find new and interesting ways to treat.
Nice summation Ben! I couldn't have said it better. :)
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Re: Rotexion/Latextion - June 24, 2005 2:25:00 AM
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MPT
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I was studying for my level III NAIOMT test and I had to sit back and say how is friken latexion and rotexoin going to help me treat my patients. I really could not come up with a way so I stopped wasting my time studying it. I am glad that others feel the same way.
I do not feel that all the Canadian manual therapy stuff is worthless but they do put a lot of emphasis on seemly stupid stuff.
Steve the thread on upper cx lig stress tests is what made me think of this even more.
And the concept of rotextion/latextion is a little different than coupled motion (type 1/2). The point of the later is that the direction of the coupled motion at a given level can change depending on the motion that occurs first.
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Re: Rotexion/Latextion - June 24, 2005 3:16:00 AM
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JLS_PT_OCS
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Ben-
I am sure you are an excellent manual therapist, as well as an intelligent person. But I'm not sure it's your knowledge of biomechanics that provides your efficacy.
There are some fallacies in your arguments that we should discuss, some of which are also discussed in the Diagnosis and Palpation thread in Manual Therapy section.
1. It works for the reason I think it works. - How can we know this? Researchers have been studying the spine from a biomechanical perspective for years and years, and we cannot explain even how the most simple manipulative procedures work. If you say it works "in your hands" because if you do the "wrong" mob your patient doesn't improve, then I don't quite know how to approach that sort of anecdotal evidence.
2. It works because people feel better and/or they pay me money for my services. - People are laying out all sorts of money for all sorts of "treatments" that have no physiologic basis, a spurious physiologic basis, or no evidence to support them. Your treatments do have evidence and science behind them, but the mere fact you can make a living at it does not mean it's truly effective.
3. The research demonstrating the issues with the diagnostic methods is flawed. -So, your default reaction is belief in an unproven paradigm, and you require convincing proof to allow any doubt? How is that a useful approach? Shouldn't we be approaching things from a more skeptical point of view - that is being open to all possibilities, but requiring a standard of evidence beyond pure belief? I wonder if you believe in the FRS and ERS, how is that different from the subluxation of our Chiropractic friends?
I do think that some people truly have a biomechanical joint problem that can be addressed with manipulative therapy, and god knows I do that sort of thing every day. But I think it's important to separate the skill and/or effectiveness of technique from the diagnostic paradigm. I don't argue the effectiveness or utility of the technique, I have a problem with the paradigm used.
For us to progress, we need to isolate out from our conventions what the salient items of an effective intervention are. All interventions start out in their infancy with all sorts of baggage - you have to learn some history, maybe some famous guy/gal who invented it, some "background" on why it's the best and why it works, and some practical training and descriptions of techniques.
Think about it, this sort of basic setup is true in any intervention - from Ultrasound to Kinesiotaping to McKenzie to Lumbar Stabilization.
Any course or book you read about an intervention will cover all the above major points.
The issue for us as scientists is to sort out the wheat from the chaff. What's really important in the intervention, and what's not. I have seen McKenzie technique work for some of my patients. Do I need to get certified in the techniques (read: pay lots of money) and learn their theory of "why" it works in order to use it effectively? No. Can the McK folks prove that it works for the reason they say it does? I don't believe they can.
I don't want to turn this into a McKenzie thread, but it's a system most people can relate to and serves as a handy example.
The same is true of manipulative training. We should be spending our time on the important parts there, namely skill in techniques, and not waste so much time discussing and memorizing such an unproven diagnostic model. But I guess knowing all this complex biomechanics (or theorizing you know it, as it's uncertain) does allow some CEU course instructors to feel superior and show off their supposedly advanced practice. And take our money.
Is it the biomechanical "knowledge" we're lacking, or the technique experience and confidence? Which of those can we get at a CEU course?
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Rotexion/Latextion - June 24, 2005 5:48:00 AM
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Alex Brenner PT MPT OCS
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[QUOTE]...But I think it's important to separate the skill and/or effectiveness of technique from the diagnostic paradigm. I don't argue the effectiveness or utility of the technique, I have a problem with the paradigm used.[/QUOTE]I agree, this is exactly how I view it.
I feel the same way about McKenzie technique. Do McKenzie therapists truely believe that all back pain is caused by disc? I am not faulting the technique, it seems to work for certain subgroups of people with low back pain, but I do have a question with the paradigm.
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Re: Rotexion/Latextion - June 24, 2005 5:50:00 AM
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Alex Brenner PT MPT OCS
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[QUOTE]The same is true of manipulative training. We should be spending our time on the important parts there, namely skill in techniques, and not waste so much time discussing and memorizing such an unproven diagnostic model. But I guess knowing all this complex biomechanics (or theorizing you know it, as it's uncertain) does allow some CEU course instructors to feel superior and show off their supposedly advanced practice. And take our money.[/QUOTE]Right on.
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Re: Rotexion/Latextion - June 24, 2005 5:58:00 AM
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steve
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Well said Alex and Jason,
Our efforts should not be to take on a specific paradigm as the steadfast truth, but rather identifying those people who can benefit from a specific intervention and apply our treatments appropriately and effectively.
Steve
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