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Re: Restricted Shoulder Abduction
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Re: Restricted Shoulder Abduction - September 26, 2005 2:44:00 PM
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ginger
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From: Melbourne Victoria
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Jon and yogi, thanks for your messages, Jon I can't help thinking that we agree that exercise is of value, and yes I agree that it's use as a "treatment" involves the patient in a way that passive does not. The difference is the effectiveness of the treatment. No exercise related or AROM if you prefer, can match the speed and effect of well delivered mobs to tight inflamed and painfull facet joints. Moreover cannot match it as a method for relieving referred events. Not even in the same ball park. Why rely on the slow hit or miss of AROM when there is a speedy safe effective method within anyones reach. Exercise takes over when pain and dysfunction has been relieved.
I"m not sure that I'm offeriung the insights or scale of any "Hawking" revelations here, But your comment about rebooting the system matches my thoughts. We can find the off switch however. The joint itself is that switch.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Restricted Shoulder Abduction - September 26, 2005 4:12:00 PM
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Jon Newman
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Ginger, if you are going to proclaim faster results with one technique over another you really ought to provide evidence for that statement or not make the statement at all as it has nothing to stand on.
You ask, why choose a technique that might be slower than [your own]. In the event that my methods are statistically slower than your own, I would have to also consider that my patients would be able to self correct in the future (if circumstances were such) whereas yours would not. That has value to the patient and society and shouldn't be brushed aside in my opinion.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Restricted Shoulder Abduction - September 26, 2005 7:55:00 PM
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Synergy
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I'm going to have to agree with Jon "The Missing Link" Newman on this one. Ginger, perhaps you can provide us with your "missing link" of evidence that supports your statements. You may very well have something that's quite efficient, but we have yet to see anything in terms of evidence.
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Chris Adams, PT, MPT
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Re: Restricted Shoulder Abduction - September 26, 2005 9:06:00 PM
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ginger
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From: Melbourne Victoria
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No problem Chris, As it happens , my current undergrad student is in the process of making a retrospective study of outcomes with two seperate groups who had treatments by me over the past 6 months. A shoulder group and a knee (pfj) group. Numbers are not huge ,but ought to reveal the kind of relationships I describe here, in terms of referred events.
I know I ought to have used student help in the business of collating and publishing data , it's all too easy to fall into a rhythm of treatments and expected outcomes, without being attentive to the bigger picture .You are right to expect some sort of proof. I'm pleased that I've been able to alert the forum to the prospect of a reliable method that is valuable. I look forward to offering more as able.
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The Grand Pediculator
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Re: Restricted Shoulder Abduction - September 26, 2005 9:40:00 PM
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Lukey
Posts: 180
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From: Australia
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Ginger,
Is a "retrospective study of outcomes" an appropriate research design for such a question?
Luke
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Re: Restricted Shoulder Abduction - September 27, 2005 3:25:00 AM
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bburas
Posts: 54
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From: colorado springs, co, usa
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man, ginger, you aussies must have tremendous patience. i'm not sure i could keep posting if everything i said was followed with "SHOW ME THE EVIDENCE"! (said in a jerry mcguire kinda way).
mulligan's SNAGs have been around for years and the evidence isn't exactly overwhelming. but i'm most of us use it at some time or another. more and more people are becoming believers in Simple Contact and i haven't seen one RCT. why can't we simply take a theory and put it to the real test. does it work on our patients?
i've tried it out and it has help a few patients achieve greater movement or less pain in various conditions. is the final epiphany of PT? to be determined :)
brett
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Re: Restricted Shoulder Abduction - September 27, 2005 4:09:00 AM
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Jon Newman
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bburas,
If Ginger is making claims that his technique works better than another's, it is incumbent upon him to prove it. If, on the other hand, he is simply discussing why his theory is more compelling than another then the type of evidence he needs is of different sort. Regardless, I don't think he's succeded on either front.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Restricted Shoulder Abduction - September 27, 2005 2:47:00 PM
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ginger
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From: Melbourne Victoria
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to Luke, retrospective studies will give an indication for more research , but then doesn't all research do this?, Not many are satisfied unless they can make it work for themselves, and why not. The best method of introducing a concept or a treatment is in person. That may not be possible for the majority , but I've been hiving away at this now for a lot of years and taught hundreds. A few disbelievers on the internet is hardly a problem for me.
Success is a fine line between the rewards of effort and the sense of belonging that comes with giving. I'm happy to put my thoughts on the line along with my reputation, the end justifies the means in this case.
Cheers
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Restricted Shoulder Abduction - September 27, 2005 3:40:00 PM
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Jon Newman
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Ginger,
I don't doubt your success. At this point you don't need to prove it to anyone unless you point blank state that your techniques yields superior results than another specific technique. John Childs successfully did this with manip/AROM versus spinal stabilization.
If your theory is correct, that muscle guarding is the cause of the facet problem and subsequent inflammation, it doesn't answer what the muscle is guarding against in the first place. You do state:
[QUOTE] The spinal system has protective responses, as is true for other systems and organs. The first response to threat, perceived as threat to the spinal cord itself... [/QUOTE]However, I have never had anyone suggest to me that they felt their spinal cord was at risk and had subsequent back pain. I think I'm simply confused as to what is doing the perceiving. Additionally, you go on to describe the pain spasm pain cycle to describe what maintains pain and this model has been discredited. [URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9539669&query_hl=3]See Simons and Mense for example[/URL]
Regardless it doesn't seem to make sense that one could interrupt muscle guarding by treating something that the muscle is not guarding against. If the muscle is guarding against a threat to the spinal cord as postulated, then it is the removal of the threat that would seem appropriate, to me anyway.
I actually applaud your efforts as reflected by the poem (A Finch Sitting Out a Windstorm in a different thread of yours). Unfortunately, this is what "help" from me sometimes looks like.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Restricted Shoulder Abduction - September 27, 2005 8:01:00 PM
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ginger
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From: Melbourne Victoria
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I'm only too grateful Jon for your interest and help. I'd always prefer to preach as it were to the unconverted than waste effort where it does less good. I'm surrounded on occasions by the back patters and well wishers amongst my legion of converts, it is only proper that I supply the proofs and explanations .
The only trouble is there is rarely enough to satisfy those who would prefer to remain within their own safe ball park.
Threat relationships are a broad envelope of external and internal irritants that are seen to set off a spinal protective event.Perception can be at the level of feelings associated with movement, with the performance needs of synovial joints, with the expected outcomes of direct trauma, and indirect trauma, with the process of disease, with the all too common effects of fatigue, as well as with the effects of altered biomechanical stressors.
Many will describe the moment in the yard where lifting gave a twinge, thought later to be inconsequential. This is followed by severe pain and spasm the following morning. Something then took place , or began , at the time of the incident. This includes occasions where no structural or soft tissue damage has been done. The process leading to a painful back then took its course automatically. Arising from a moment of stress, ( threat ) commonly but not always felt as pain. I have postulated a mechanism to expain this automatic process.
This same response is seen to be able to be reversed. Continuous mobilisations in the manner previously described here does this quite well.
If one could accept for a moment that a protective response related to spinal function exists, then it would need a means to a. be turned on
b. be maintained.
c. be turned off.
My theoretical model addresses these requirements adequately I believe. As to Simons and Mense, it appears there has been no specific consideration of muscle tonus and the maintenace and elevation of this tonus in relation to the intimate spinal muscles, where a mitigating and irritating factor is the inflanmmatory events associated wqith hypomobility of the facet joints. This is a key message in my statements.
That is , that once the tone has reached a level where hypomobility takes place to synovial joints , then an inflammatory event occurs to the synovial membrane, in order to produce more synovium ( also a protective response) , which acts as a more lasting irritant .Thus we see chronic situations , ( quite reversable) with no apparent relationship to either disease or trauma.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Restricted Shoulder Abduction - September 27, 2005 8:07:00 PM
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ginger
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From: Melbourne Victoria
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Brett, I'm not sure what Mulligan's SNAGS are, would these be bacon and honey, or lamb and rosemary ?my favourite is beef , boiled first, cut up then and fried with a little chilli and onion. Didn't know mulligan ate snags, we all do here, very popular on the barbi.
Cheers
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Restricted Shoulder Abduction - September 28, 2005 2:23:00 AM
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Jon Newman
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Ginger,
You claim that reduction in muscle tone is caused by movement of facet joints, but the joints are apparently so restricted that AROM isn't helpful. Why do you think that gentle jiggling is able to move the joint? I would think that the muscle tone would have to reduce before you could mobilize the joint, not the other way around.
Also, in the presence of an inflamed joint, don't muscles typically reduce their ability to generate force as a protective response?
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Restricted Shoulder Abduction - September 28, 2005 3:37:00 AM
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Lukey
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Ginger,
You mentioned your current research efforts after Jon and Chris asked for evidence for the statement that your method works faster that other methods. Just wondering how the current retrospective study will satisfy this query, "No problem.."
Luke
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Re: Restricted Shoulder Abduction - September 28, 2005 2:08:00 PM
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ginger
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From: Melbourne Victoria
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Jon , "gentle jiggling "is not a fair description of a movement effort sustained over several minutes, applied as close to the joint as possible to attempt movements in a physiological manner, where the attendant resistance can be felt and monitored by the therapists thumb, in such a way as to allow the movement attempts to slowly reveal less and less resistance over these few minutes.It makes sense that attempts to move in this way, with pressures applied directly at the joint, would have far more likelihod of achieving discreet movement of facet joints than any AROM, no matter how carefully applied.
Yes it would seem an anomalous situation , or at least compared to that expected of the behaviour of Phasic muscles in the presence of pain and inflammation. These are not phasic muscles however, they act at the effect of postural and protective influence.So do other phasic muscles indeed when recruited in the event of ongoing irritation and threat. Can you deny that muscular activity is seen to increase exponentially in the presence of painfull spinal stimuli?. AS a group , each layer ( of three) muscles gives a level of protection, the ultimate being the recruitment of all three , usually seen in the presence of severe pain and debilitating spasm.
Luke,
The retrospective study will not satisfy in a complete way, any more than any study which does not have n=several thousand. RCT's are best but out of the question for my limited resources. While I have students to provide however I'll tackle what I can.
Cheers
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Restricted Shoulder Abduction - September 28, 2005 3:56:00 PM
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Jon Newman
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I thought gentle jiggling was more accurate than vigorous jiggling based on your posts. I don't mean any disrespect by calling it jiggling if that's the issue. Manipulators crack peoples backs and Barrett "does nothing" for example. It's just a simplified summary of what's going on but perhaps I'm mistaken about what it is you are doing.
[QUOTE] Can you deny that muscular activity is seen to increase exponentially in the presence of painfull spinal stimuli?. [/QUOTE]Yes.
[QUOTE] It makes sense that attempts to move in this way, with pressures applied directly at the joint, would have far more likelihod of achieving discreet movement of facet joints than any AROM, no matter how carefully applied. [/QUOTE]Since when does this have to be discreet? I thought the problem was getting the facet joint moving so that the reflexive muscle guarding could be released. It shouldn't matter if it is 10 facet joints or just one. If there is movement, that's good.
Still, I don't think your pain-spasm-pain concept if valid. Here are a couple more links pointing in that general direction.
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8880843&query_hl=1]link 1[/URL]
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11514246&query_hl=4]link 2[/URL]
Also, consider the atrophy demonstrated by multifidus/TA in the presence of low back pain. I would think constant tone would produce hypertrophy if anything.
Wouldn't it make more sense that if a muscle is 'active' that it is 'trying' to move a part. This is what muscles typically do right? Why not let them produce the movement they will?
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Restricted Shoulder Abduction - September 28, 2005 5:21:00 PM
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ginger
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From: Melbourne Victoria
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Jon , interesting links , both of these studies were to phasic muscles which were not spinal. Were studies done specifically to those I describe, I may have cause for any careful modification of my model ,or deductions in relation to the effct of facet joint movement. As these offer no discredit to my model I go back to my point that a spinal protective response is wired to provide a means to limit movements and reduce threats.
Thsi is not to deny that phasic muscles may have inhibitory effects from inflammatory states. Indeed it is part of the statement included by "altered sensations" , in my model. I commonly see muscles lose aspects of strength and recruitment at the effect of inflammatory neuralgic states. Such as VMO function with L3 stiffness to produce patello femoral dysfunction.
I don't disagree with the results you allude to here and in your links , I do maintain however that the hard wiring of the postural /intimate muscles in particular,of the spine, allows for the maintenance of tone, by a feedback loop intimate to itself. I'm not attempting to redraw the nervous system , so much as follow the path that the postural mechanisms already working suggest, which is that there is a second purpose to those same postural mechanisms.
Active muscles in the case of those closest to facet joints work just as the postural mechanisms would . In concert to supply enough holding power to maintain upright stance.The difference is that when irritated , these same muscles get tighter, leading to a stete of hypomobility which has another consequence, inflammatory events of joints and nerves.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Restricted Shoulder Abduction - September 28, 2005 6:14:00 PM
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Jon Newman
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Is your model based on existing physiology or are you proposing a physiological mechanism that has yet to be discovered? It seems to me that it is the latter, in which case I'm sure you're quite safe with your model but it also becomes uninteresting. You have a theory not based in known physiology AND no outcome studies. What is there to discuss? Perhaps I missed the references that make your proposed physiological mechanisms plausible in another thread.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Restricted Shoulder Abduction - September 28, 2005 6:54:00 PM
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ginger
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Interesting enough to keep you up late at night. Be that as it may, if you are out of questions Jon then I'm sure someone else will carry your torch for a while. I look forward to more useful questions, like yours. Keeps me honest with a proposal that deserves discussion and a better rendering than a non interactive book could ever give.
Talk again soon if you have further questions, or moot points to go over, I value your efforts so far.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Restricted Shoulder Abduction - September 29, 2005 12:49:00 AM
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OaksPT
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From: Va
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Jon,
Great point about the multifidus/TA after an episode of LBP, I have given an inservice on thisto some of the local surgeons, lots of blank looks. If injury causes inhibition/atrophy to the multifidus, without spontaneous recovery, I wonder if the effect of surgery is similar or accelerated( being that it would not be a "reflexive protection" injury)
Scott
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Scott Oaks PT,DPT
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Re: Restricted Shoulder Abduction - September 29, 2005 4:28:00 AM
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Yogi
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Jon, I can assure that constant hypertonus does not produce hypertrophy. Check the spastic cerebral palsy population.
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