|
|
What happened
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
What happened - September 24, 2006 5:19:00 AM
|
|
|
proud
Posts: 951
Joined: March 22, 2006
Status: offline
|
What happened to the reasons to test mechanically thread. It actually had clinical merit...
|
|
|
|
|
Re: What happened - September 24, 2006 5:40:00 AM
|
|
|
rv36116
Posts: 216
Joined: August 5, 2006
From: Texas
Status: offline
|
I didn't do anything.
|
|
|
|
|
Re: What happened - September 24, 2006 5:45:00 AM
|
|
|
dfjpt
Posts: 238
Joined: April 9, 2006
Status: offline
|
It looks like it turned to virtual powder.
|
|
|
|
|
Re: What happened - September 24, 2006 2:41:00 PM
|
|
|
David Adamczyk
Posts: 309
Joined: March 14, 1999
From: Cleveland
Status: offline
|
The Forum is a little glitchy today. We will have Thundertech check it out on Monday. Sorry for any inconvenience.
Dave
|
|
|
|
|
Re: What happened - September 24, 2006 4:07:00 PM
|
|
|
Jon Newman
Posts: 1713
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Hi Proud,
That might have been my bad. I tried posting a relevant link on discography and when I hit the reply button the thread crashed. I tried correcting it but failed. It could have been coincidence but I don't think I'll try it again to test that hypothesis. The link I intended to post is available to view on another discussion forum under the thread header "discography".
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: What happened - September 24, 2006 6:31:00 PM
|
|
|
Synergy
Posts: 596
Joined: March 11, 2004
From: Texas
Status: offline
|
Proud,
The discussion forum Jon referred to is s o m a s i m p l e. Obviously, exclude the spaces when you type it into the address bar. For some odd reason, one is not allowed to write those two words in this forum.
_____________________________
Chris Adams, PT, MPT
|
|
|
|
|
Re: What happened - September 25, 2006 10:06:00 AM
|
|
|
steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
|
**********
soma simple
just checking
|
|
|
|
|
Re: What happened - September 25, 2006 1:24:00 PM
|
|
|
proud
Posts: 951
Joined: March 22, 2006
Status: offline
|
Jon,
Thanks for the link. Excellent slide show.
One thing to remember about McKenzie( as I assume you posted it based on the original thread), is that McKenzie himself suggests that he does not know the reasons the techniques work( disc model was conceptual). It could be as dfjpt suggests...the point being that the techniques provide a reliable assesment tool to base future research. Also, centralization has been validated as a positive indicator for recovery.
I had responded to dfjpt about the article she posted. The problem with that article is that it lacks any real credibility. Here is a guy who clearly makes assumptions based on his poor use of the evaluation techniques.
I have been using McKenzie as "part" of my evaluations for 6 years now...not one adverse response. Virtually impossible if you are doing it correctly.
|
|
|
|
|
Re: What happened - September 25, 2006 2:27:00 PM
|
|
|
Jon Newman
Posts: 1713
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Hi Proud,
Louis Gifford seems like a pretty smart guy to me and his books (if you haven't read them) are very thought provoking. His debate is just that. He's offering an interpretation of what we are observing and allowing others to respond. We could use more like Gifford if you ask me. Regardless, I'm uncertain if you are dismissing the entire 7 pages of the debate or just certain points within it.
I don't understand why you reference the discography--McKenzie connection and, in virtually the same breath, suggest that it is just conceptual and not to be taken too seriously. I've been around long enough to know that patients and therapists (myself included) have taken the "concept" of HNP quite literally and likely induced some iatrogenic behavior. Just ask Annie O'Connor how many therapists are concerned (read fearful) about using her exercise approach and why.
I also find your last sentence a bit enthusiatic. Are you suggesting that if someone gets worse, the therapist is doing it wrong? Doesn't that smack of infallibility?
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: What happened - September 25, 2006 2:57:00 PM
|
|
|
proud
Posts: 951
Joined: March 22, 2006
Status: offline
|
Jon,
I also think louis Gifford is a smart guy. And yes, I am dismissing certain points, not the entire article. Fear avoidance is important, agreed. However, it is clear within the text that his reference point for how to perform the technique is slightly askew:
He states:
>>>>...but what if a back pain patient was told never to bend - like many so often are in the early stages of management. Fine to suggest care with some forms of bending to start out in the early stages perhaps, but surely bending confidence should be restored in a graded way at some stage? <<<<<
Wow, now that is misinformed...
He states:
>>>Long ago I gave up using a combination of asking about pain while getting the patient to repeat a movement - because it wasn't productive and often made matters worse, and quite often a lot worse (for me). Having to face patients who one moment have simple back pain and then later rapidly develop leg pain and a neuropathy is not nice and something I would preferred to avoid (fear avoidance- yes!).>>>>
If this happened, it is certain he was way out in left field. I only wish a DipMDT could comment on that. yikes.
Secondly, reference the discogenic connection, my point to dfjpt was that fissures within the annular fibers have been shown to be predictable in direction using the McKenzie assessment. Which is interesting to say the least. But was not intended to suggest that is proof of the conceptual model. Although many Mckenzie'ists feel strongly about this connection. Whatever, the techniques produce reliable information regardless of what is being influenced.
Thirdly, I maintain that if done correctly, it is just not possible to make someone worse. If you know anything about the assessment techniques, and I am not suggesting you do not, then you would know that it is based on progression of forces starting from the least provocative. On top of that, patients are brought back within 24 hours to ensure proper progression. And...patients are instructed to discontinue any directional preference exercise if the symtoms worsen.
So yes, if done correctly, it is virtually impossible to make someone "worse". I have never had someone get "worse" using McKenzie...literally hundreds of clients. Plenty that did not respond to Mckenzie, but none got worse...
|
|
|
|
|
Re: What happened - September 25, 2006 3:55:00 PM
|
|
|
dfjpt
Posts: 238
Joined: April 9, 2006
Status: offline
|
I hope proud that you took in the part of the debate that had to do with finding symptoms that are the exact opposite of what was dictated by the "method" by "leading" the patient's expectations. To me, that is the most relevant part of the whole thing.
This is a little off topic, but you might find another thread over there at SS intersting, one called "Myth of Core Stability." You'll have to use the little search engine there, but if you type in the title the thread will come up for you, and the attached slide show. Worth a look.
Fondly,
Diane
|
|
|
|
|
Re: What happened - September 25, 2006 4:14:00 PM
|
|
|
proud
Posts: 951
Joined: March 22, 2006
Status: offline
|
dfjpt,
Yes...but it really is a poor article. Afterall, the topic is in part ...does the McKenzie approach need a shift? Pretty hard to extract anything useful with such huge knowledge errors concerning the very topic of the article...
|
|
|
|
|
Re: What happened - September 25, 2006 4:47:00 PM
|
|
|
Jon Newman
Posts: 1713
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Proud, are you telling me you have never had anyone come back and say that they feel worse? Not ever? If not, then good for you, you'll like stand apart from your peers. I'm not suggesting that the McKenzie approach actually harms someone but sometimes peoples' subjective report is that they hurt more--the same thing can happen with any technique. I think the "come back in 24 hours" is, at least partly, to assess whether this might have happened.
Gifford's critical thoughts tend to be ahead of the research and who knows, it might even inspire some of it. I've actually posted that (Long, et. al.) article and commented on it someplace on this board (in 2004) but I can't seem to locate it. RE isn't known for it's fabulous search tool. Anyone know whether that specific piece of research has been validated as alluded to at the end of the abstract?
You won't find an argument from me that patients have a directional preference. In fact I think they'll figure it out given the opportunity. Actually, they probably already have and are presenting to the clinic with it. And I'll also agree that some guidance would be nice as it pertains whether a particular movement might be helpful because, as has been discussed elsewhere, pain is not the best indicator itself. McKenzie espouses centralization as the golden ticket. It may turn out that it is sufficient but I have my doubts about whether it is necessary.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: What happened - September 25, 2006 11:59:00 PM
|
|
|
proud
Posts: 951
Joined: March 22, 2006
Status: offline
|
jon,
of course, depends on the definition of worse. Mr. Gifford indicates worse to be pretty harsh.
Yes, I have had patients return to be more sore...occassionally not in the direction I wish. So I modify things. Over the course of say 5 sessions I have never had someone get worse, is what I mean.
|
|
|
|
|
Re: What happened - September 26, 2006 12:46:00 AM
|
|
|
Jon Newman
Posts: 1713
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
It would be interesting to hear comments from anyone who has taken a McKenzie course both long ago and recently to see if they have any impression of whether there has been a shift in what is presented. Any McKenzie anthropologists out there?
Hi Proud,
I imagine everyone would modify things, or at least they ought to. When you modify things are you thinking you're targeting the wrong part of the disk or do you use some other clinical reasoning to help you out?
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: What happened - September 26, 2006 1:22:00 AM
|
|
|
proud
Posts: 951
Joined: March 22, 2006
Status: offline
|
Jon,
If I suspect that directional preference type exercise should work day one, I will proceed for 4-5 sessions working within the conceptual model( if it is a derangment). I now never tell a patient that they have a "disc" out of place. No need, it adds to potential fear avoidance beliefs. When i took my first mcKenzie course in 1998, the instruction was to tell the patient about the disc( one actually used a tennis ball stuffed under a shirt to demonstrate to a patient..yikes).
If after 4-5 sessions this does not work, I assume more chemical then mechanical( which you can usually tell day one anyway). Then I switch to "calming" down things like neural taping and very low grade mobilizations.
My initial 4 years upon graduation, I was a hard "manual" therapist so developed some skill in passive intervertebral motion assessment. I might go to this on occassion. However, it is very unreliable and as I have stated, non specific. So I would be really reaching if I diped into this bag of tricks.
|
|
|
|
|
Re: What happened - September 26, 2006 6:19:00 AM
|
|
|
PainFree
Posts: 84
Joined: August 13, 2006
Status: offline
|
Proud,
I would like to hear your comments on how you tell if pain is of a chemical origin on visit one.
I actually look at all patients as if they had both occuring.....but have some thoughts as to distinguishing between the two (i.e. mechanical vs chemical) and would like to hear your thoughts.
|
|
|
|
|
Re: What happened - September 26, 2006 6:49:00 AM
|
|
|
Shill
Posts: 1107
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
Jon asked, "Any McKenzie anthropologists out there?"
Actually there is one, whom I refer to on occasion. His name is Angelo DiMaggio, PT , DipMDT, who teaches a series called "Strategic Orthopedics". (It is actually advertised on this site) He used to teach the McKenzie approach, specifically part C, the problem solving portion. He has taken the utility of the repeated movement evaluation and treatment, and expanded upon it with a tremendous amount of detail. He also expands upon some of what he considers to be the shortcomings of the McKenzie approach. For example, to name just a few, he is not insistent that the lateral shift be corrected first. Secondly, the McKenzie classification system is confusing, and also that they do not necessarily have clear guidelines as to when to start flexion on a patient using extension for centralization and pain relief.
His courses are great, make excellent use of available evidence. I have no monetary interest in his courses, I just found them very helpful.
Steve
_____________________________
Steve Hill PT
|
|
|
|
|
Re: What happened - September 26, 2006 9:38:00 AM
|
|
|
proud
Posts: 951
Joined: March 22, 2006
Status: offline
|
Painfree,
A few hints that I use for chemical:
1. Constant pain( can be mechanical but a hint towards chemical or combination).
2. Recent onset( traumatic or possibly insidious).
3. Cardinal signs may be present( swelling, redness,excessive tenderness, heat).
4. Lasting aggrevation of pain by all movements.
5. No movement found which abolishes or centrailzes.
Just a few concepts.
|
|
|
|
 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 |
|
0.078
|
Printable Version
