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Re: Lingering problems with sitting
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Re: Lingering problems with sitting - October 14, 2005 2:48:00 AM
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Barrett
Posts: 967
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From: Cuyahoga Falls, Ohio
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Randy,
Erica said, "Interestingly, the people who complain about this sitting achiness are usually the ones who never exercised a day in their life before they came to PT." To me, this clearly implies a correlation between regular exercise and comfort in sitting-and regular exercise and fitness are, of course, related.
What I object to in your "taking it out" comment is the notion that compensation occurs at the joint without mention of anything else. All kinds of motion, primarily in the neural structures, will take place before the periarticular structures become significantly involved, and when it comes to sensitivity the nervous system is way out ahead. Think about it-when put in a hammerlock many tissues are mechanically deformed, which of these is most likely to complain first?
Is sitting essentially different than any other sort of mechanical deformation? I can do it painlessly for hours without attending to the "proper" nature of my posture and my connective tissue flexibility would be unacceptable in most PT departments. How is this so?
Sorry your wife didn't make the course. I was looking for her.
_____________________________
Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Lingering problems with sitting - October 14, 2005 3:58:00 AM
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SJBird55
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From: Michigan
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I'm a bit lost on the horse idea. A rider isn't just "sitting" in the saddle. There is a continual adduction force occurring in bilateral hips kind of sort of combined somewhat with an internal rotational force and at times an external rotational force too. The type of riding one does determines the posture of the rider. Also saddles are different based on how one is going to ride. You sit differently in an English saddle versus a Western saddle. I'm only familiar with gaited horses and Western saddles, but when riding them one needs to maintain more of a posterior pelvic tilt as opposed to say a non-gaited horse. Also, when riding English on a non-gaited horse, the rider is posting. Posting adds a bit more leg work. There really isn't anything static in regard to sitting on a horse. Riding bareback brings in even more work because you have to know where your center of gravity is and react appropriately to stay on the horse's back.
I've never sat on my saddle while not on my horse... so I don't know how it would be for just sitting purposes. I would imagine boring - it wouldn't be dynamic. Also, just a moving pseudo horse probably wouldn't cut it because when you are riding, you know what you want your horse to do and you communicate through you body and through your seat and a bit with your hands and legs what you want your horse to do. In other words, the majority of your movements are anticipatory (proactive) in nature. The only time you tend to react is more related if your horse spooks, or trips over something or another, or gets scared or tries to do something you aren't expecting it to do.
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Re: Lingering problems with sitting - October 14, 2005 10:52:00 AM
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nari
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From: Australia
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SJ
What you say is quite true - a horse's movements could never be imitated mechanically. Where I think the point of the pseudohorse was heading, was to just draw a comparison between sitting like a log and sitting while adjusting to a constant movement. Rather like standing and walking on a constantly rolling and pitching ship; one quickly adapts to the movement and when it stops, ordinary ambulation is off balance.
It was never a serious comment; just a bit of a play on the boredom of sitting, and the difficulty many people have in finding a comfortable neutral position, if they are obliged to sit 'still' for a long period of time.
Nari
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Re: Lingering problems with sitting - October 14, 2005 8:30:00 PM
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Randy Dixon
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Barrett,
I missed Erica's remark about those not exercising. I agree with you, I think, about concentrating only on the joint. I thought I clarified that when I said I wasn't concerned much with the structures, but joint position is important in isolating areas, this is true of sitting and hammerlocks.
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Re: Lingering problems with sitting - October 15, 2005 3:24:00 AM
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Barrett
Posts: 967
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From: Cuyahoga Falls, Ohio
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Randy,
I think we're very close in agreement as well. As far as joint position goes, I think that the most telling is what is chosen by the patient in the hip while they are supine, and this because it is more intimately connected to neural tension than anything else I've found.
A good deal of nervous irritation can be produced without any provocation of a joint though. When I was a kid a bully on the playground would hand out "Indian wrist burns," a painful (and, today, politically incorrect) twisting of the superficial structures of the forearm in opposite directions. It always made me wonder why they called it a "play" ground. But then, that's just the way my mind works.
_____________________________
Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Lingering problems with sitting - October 15, 2005 8:08:00 AM
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Jon Newman
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From: Amherst, WI
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I'm helping Barrett out with this link until he learns his way around UBB codes next week.
[URL=http://news.yahoo.com/s/nm/20051014/hl_nm/exercises_backpain_dc]Back exercises not the answer to low back pain[/URL]
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: Lingering problems with sitting - October 16, 2005 7:48:00 AM
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Geert Jeuring
Posts: 92
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From: Möhnesee, Germany
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Hello Barrett (posting as jon), that is parallel to my recommendations for Patients. I recommend every sort of sports as long as:
* they like it
* it ist done for more then half an hour at least 2-3 times a week
* It causes the pulse rate to be between 130 - 160 (according to age, gender and affliction.
darts, snooker and fishing are not allowed
Geert
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Re: Lingering problems with sitting - October 16, 2005 5:09:00 PM
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eam
Posts: 291
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From: New York, NY 10028
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Everyone-
Getting back to the original question- then the abnormal neurodynamics should be addressed 1st to alleviate the symptoms associated with a prolonged sitting posture? As sitting is prolonged flexion for most people as Sarah mentioned above, do we reduce the tension in the neural structures first? (I am not trying to be repetitive with this, I am just trying to comprehend the thought process here :) )
And the addition of neck flexion as most people are looking down to read or type on the computer, then we truly have increased tension.
I tend to approach things from a biased biomechanical view point and am enlightened by other's comments :)
Erica
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Re: Lingering problems with sitting - October 16, 2005 5:44:00 PM
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jma
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From: NY
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Interesting article posted.
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Re: Lingering problems with sitting - October 17, 2005 1:39:00 AM
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Barrett
Posts: 967
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From: Cuyahoga Falls, Ohio
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Erica,
Increased tension undoubtedly occurs in the psture you suggest. The issue is whether or not this produces symptoms. In those who acquire this position painlessly for prolonged periods, what is present that enhances tolerance and how can that be seen and promoted in therapy?
This is what I teach.
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Lingering problems with sitting - October 18, 2005 4:24:00 AM
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eam
Posts: 291
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From: New York, NY 10028
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Barrett-
I would imagine there are a number of things that enhance tolerance in sitting -from the nervous system to our muscular system. One can have a normally functioning nervous system and it can "break down" under an abnormal force like sitting because sitting for that person correlates to increased tension. And for some others they have no problem. The conundrum for me is how to identify that and promote tolerance as you mentioned in your post. Thanks for the comments. :)
Erica
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Re: Lingering problems with sitting - October 18, 2005 5:16:00 AM
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Barrett
Posts: 967
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From: Cuyahoga Falls, Ohio
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Erica,
You're welcome. What Shacklock points out that we've learned during the decades of study during the neurobiologic revolution is the following:
1. Normal nerves subjected to normal forces are less likely to produce symptoms.
2. Normal nerves under abnormal mechanical forces are more likely to produce symptoms.
3. Sensitized nerves subjected to normal forces can produce symptoms.
4. Sensitized nerves that are subjected to abnormal forces are likely to produce symptoms.
Not exactly rocket science, but clear statements that are easily defended.
I think you're talking about #3 when you say that sitting produces symptoms. Unless you're talking about extreme circumstances combined with severe restrictions in the ability to simply shift, sitting isn't that hard for a normal nervous system. Of course, I get on planes where this happens regularly.
What I see in my students who have plenty of room and opportunity to move and still hurt after ten minutes is what I must conclude is a sensitized nervous system.
I think you identify this by looking at the patient supine and listening to the nature of the symptoms. The signature of the abnormal neurodynamic has been well-documented.
_____________________________
Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Lingering problems with sitting - October 18, 2005 10:46:00 AM
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james097
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From: West Vancouver BC
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Hi Barrett, the four points mentioned above are reminiscent of the work done by Cannon and Rosenblueth in the 40s and their studies on supersensativity, are they not?
Jim McGregor
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Re: Lingering problems with sitting - October 18, 2005 10:50:00 AM
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Barrett
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From: Cuyahoga Falls, Ohio
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Jim,
I'm not familiar with that work and I don't have Shacklock's book in front of me. If you know more, please fill us in.
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: Lingering problems with sitting - October 18, 2005 3:30:00 PM
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james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
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Barrett, The paper, which I thought I had but can't find now is called,
Cannon WB, Rosenblueth A : The Supersensitivity
of Denervated Structures. New York, The MacMillan Company, 1949 pp 1-22,185
Cannon and Rosenblueths law states, if I can remember that, "When a unit is destroyed, in a series of efferent neurones, an increased irritability to chemical agents develops in the isolated structure or structures, the effect being maximal in the part directly denervated."
So when a nerve is not functioning properly as in a neuropathy it becomes supersensative. Striated muscle seems to be the structure that develops supersensativty more than any other. Although the original work relied on total nerve
denervation it seems that any physical interuption will be a cause.
I shall continue to root around my files and see if I can find the paper.
Jim McGregor
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Re: Lingering problems with sitting - October 20, 2005 8:31:00 PM
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FLAOrthoPT
Posts: 1011
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From: West Palm Beach
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ischial bursitis ruled out?
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Re: Lingering problems with sitting - October 20, 2005 10:19:00 PM
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avalon
Posts: 181
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Hi,
M Schacklock found that one of interest.
http://jn.physiology.org/cgi/content/abstract/90/3/1949
J Neurophysiol 90: 1949-1955, 2003. First published April 30, 2003; 10.1152/jn.00175.2003
0022-3077/03 $5.00
Inflammation Induces Ectopic Mechanical Sensitivity in Axons of Nociceptors Innervating Deep Tissues
Geoffrey M. Bove1, Bernard J. Ransil2, Hsi-Chiang Lin1 and Jeong-Gill Leem1
1 Department of Anesthesia and Critical Care Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215; 2 Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215
Submitted 25 February 2003; accepted in final form 30 April 2003
A variety of seemingly diverse pain syndromes are characterized by movement-induced pain radiating in the distribution of a peripheral nerve or nerve root. This could be explained by the induction of ectopic mechanical sensitivity in intact sensory axons. Here we show that inflammation led to mechanical sensitivity of the axons of a subset of mechanically sensitive primary sensory neurons. Dorsal root recordings were made from 194 mechanically sensitive neurons that innervated deep and cutaneous structures and had C, A alpha, and A delta conduction velocities. No axons of any category were mechanically sensitive in control experiments. However, the axons of neurons innervating deep structures and having C- or A delta -conduction velocities became mechanically sensitive during the neuritis, and also exhibited an increased incidence of spontaneous discharge. The incidence of mechanical sensitivity followed a distinct time course. In some cases, paw withdrawal thresholds were obtained after neuritis induction. The time course of the resultant hypersensitivity was not directly related to the time course of the axonal mechanical sensitivity. Ectopic axonal mechanical sensitivity could explain some types of radiating, nerve-related pain coexisting with diseases of seemingly diverse etiologies.
Address for reprint requests: G. M. Bove, Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Dana 721, Boston, MA 02215 (E-mail: gbove@bidmc.harvard.edu).
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