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FLAOrthoPT -> Re: sij dysfunction/ achilles tendinosis (December 12, 2005 3:04:00 PM)
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ok, Ginger, i will bite. During your eval, did you find any resisted isometrics painful in any part of the range, in an active or passive disadvantage position, at mid range, was it more painful with more contraction force, was it painful throughout, was it painful only with eccentric loading? What I am getting at is was there anything to actually rule out muscular pathology before jumping to the spine?
Like I said, you may be winning by mistake here. For example, I may think that pink water balloons thrown at fires help put them out, and be convinced it's because the balloons are pink, but not even realize it is because of the water inside.
To be more apropos, you admittingly are ignoring neural testing, that is, the possibility that neural impingement/irritation somewhere along the path, not necessarily at the spinal foramen, could be the underlying factor here. And that by you in your head mobilizing her SI joint is helping, you may really be helping by reducing neuralfascial impingement and improving longitudinal neural mobility and thereby reducing her nerve irritation symptoms. That is, your pink ballon of the SI joint was coincidentally there when the sacral plexus got some relief with the water of the neural mobs. Your treatment is not so much in question, which it is to some, but so much your rationale for her pain and the corresponding rationale for what and why you did what you did.
I am sure you are an amazing clinician, but I feel like you exude this aura of unwillingness to adapt and change to new ideas. I shutter to think how I used to treat patients back in the day, and am sure I will chuckle about how I treat patients now compared to my beliefs five years from now. Maybe your treatments are effective, but if they are working for a reason other than you think, wouldn't you want someone to open your eyes to that? I think that is one thing that rubs some people the wrong way, just that you seem to think you are on a plane of no more to learn. I think this is a dangerous pedastal to be on.
The world of neural dynamics is not responsible for every painful dysfunction, but wow does it play a major role in a good majority. I think that by simply ignoring this you may still get patients better, but not on purpose. Shouler pulley's for a painful shoulder may help to break up scar adhesions, improve muscle tensibility, but maybe it is helping because it is reducing neural impingement in the brachial plexus and for the fleeting moments the patient has their arm abducted over shoulder height they are reducing the strain on the nerve. Similar to the person who naturally holds their hand behind their head with their elbow and arm in the air, probably a body's known protection or relief for the neural stretch.
I think I making sense here, but I am sure this is erudite and long winded. I just want to try to open your eyes to the world of neurodynamics. While I do not post on Barrett;s forum nor do I even understand what he or Nari or some of the others talk about sometimes, I know that it is not to be dismissed and I know that it is as real a treatment option as a bike may be for knee problems. To simply be ignorantly blissful is not what will push our ptofession forward, to be confident in what you know is very nice, but to acknowledge what you do not know is even better.
Just be open to the ideas that your treatment techniques may be working for reasons other than you believe, and be open to the ideas that many of our treatments may work for reasons beyond what we think. Have a wonderful day, I still look forward to your approach and techniques, just want to try to let you see it from another perspective. Love these fierce conversations-
Ben Galin, MPT, OCS
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