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Re: Upper Trap Spasm
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Re: Upper Trap Spasm - March 16, 2006 6:04:00 PM
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nari
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From: Australia
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In fact, I've yet to see anyone who has 'strained' anything.
Spasm is regarded as a defence; trying to get rid of it is usually ineffective until the underlying cause (usually neural) is identified. The knots and lumps and bumps, unless they are "pathological", vanish in minutes, once the neural misdynamics are approached in the way Diane suggests, or through glides. or what the heck, both if justified.
Ginger, stop grinding your teeth... I'll agree that mobilisation has a similar effect, but takes longer and the patient can't do it themselves.
Nari
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Re: Upper Trap Spasm - March 17, 2006 2:32:00 AM
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dosrinc
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From: Bonita Springs
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Nari,
youve never ever seen anyone strain anything?
I agree that neruodynamics are important but come on, never?
I personally have strained my HS, Adductors, pecs, abs multiple times, sure, neural tension may have precipitated things but muscle tissue damage is muscle tissue damage regardless.
Why can it only be one way or the other, why not a mix of both?
Rick
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Re: Upper Trap Spasm - March 17, 2006 3:13:00 AM
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SJBird55
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From: Michigan
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A biceps rupture is a major strain... oh, yeah, and sprinters often strain their hamstrings (never seen a sprinter just be running along all focused and then wham! on the ground?)... and hockey players and football players can get some nasty groin strains... It's kind of fun observing those strains that someone has yet to see - all the pretty color changes...
And, I'll disagree with Rick.. it probably isn't neural tension components that are the main variable in strains. I think more in the lines of forces, acceleration, deceleration...
I'm with Rick... having just neuro goggles on isn't always in the patient's best interest...
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Re: Upper Trap Spasm - March 17, 2006 4:56:00 AM
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Diane
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Having neuro goggles on, looking through them first, and eliminating whatever is going on that way will save time and aggravation, since most of the time the nervous system will protect the body before there is ever any tissue damage, especially if onset is slow. Of course other goggles are good to have as backup if the neuro ones don't chase down the problem properly. (Rare.)
(I didn't mention checking for/eliminating possible neural entrapment at elbow/forearm/wrist, easy enough to do with the arm hanging down as described. Of course, if your brain has been wired to seek and destroy booboos in just one anatomical location based on mesodermic and financial considerations, you won't think to check possible origins for pain all along the lengths of those pesky nerves that are so easy to ignore, or that branch so endlessly everywhere throughout the body. Let's pretend pain comes from (insert tissue of mesodermic origin of your choice) so that we can get paid, instead of the nervous system where it actually originates.)
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Re: Upper Trap Spasm - March 17, 2006 6:39:00 AM
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pt_davey
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Diane,
Thanks for the tip. Any ideas for similar golf balls in the rhomboids?
Joe
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Re: Upper Trap Spasm - March 17, 2006 7:35:00 AM
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dosrinc
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Diane, I dont understand how you equate ignoring the neural issues to just wanting to get paid, explain to me how one can have any effect on the other.
Rick
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Re: Upper Trap Spasm - March 17, 2006 9:24:00 AM
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nari
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From: Australia
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Thought that would get the muscle-folk upset; though I didn't set out to do so.
Groin strains are now being seen as neural "injuries", and treated as such; if there are colour changes that SJ is so keen on, then there is obvious muscle damage as well. It will heal itself, with a bit of palliative care. But the key issue is being ignored if ongoing management ignores the neural component, and of course, as a result, it recurs, for many athletes.
Hasn't anyone seen a "strain" where there is minimal colour, a lot of swelling and pain, loss of function? We're not talking sprains, as in ankle sprain, which is patent ligament damage.
It does not get away from the fact that the pain experienced is neural in origin and yet all the focus remains on the muscle or the ligament or something else..anything else but the nerve in the area affected.
Nari
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Re: Upper Trap Spasm - March 17, 2006 11:48:00 AM
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Diane
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Nari, ditto everything you said. Joe, yup, there are neurally oriented treatments for golf balls anywhere including rhomboids.
Rick, [QUOTE]Diane, I dont understand how you equate ignoring the neural issues to just wanting to get paid, explain to me how one can have any effect on the other.
Rick[/QUOTE]Well, here's where I'm coming from with that statement: I used to work for insurance. I don't know how it works where you live, but the standard of care (or rather lack of care) here, was/ is 4 patients/hour. To get paid one had to (literally) focus on some chunk of mesoderm somewhere, usually a joint. One got paid per joint, maximum four joints ("areas" that were called "elbow", "knee", etc.) per session. One couldn't bill for treating, say, two elbows. It had to be different joints. Drove me crazy. I couldn't live confined like that anymore, so I fired all the insurers and started just treating the nervous system, one person per hour. anywhere/everywhere where the nervous system has long axons, motor outflow or sensory input. Usually at the same time.
Believe it or not, the joint-based way of being paid was a step up from being paid per modality, the way payment was doled out in another province where I had lived before.
I don't think insurance will ever get around to paying PTs for treating non-locally, non-mesodermally, interconnectedly for so called ortho problems, pain that seems to be in the whatever, patients with an intact nervous system, intact but cranky. So we are doomed to be mesopractors or mesodermotherapists for a long time to come probably. Insurance companies like to slice the body up into little charts like those butchers use. That's what I meant. Make sense? If we aren't careful, we end up thinking along those lines ourselves, far too often. Then we end up thinking that way of thinking makes some sort of sense, imagining patterns and so on. And different groups of practitioners end up fighting over who has what right to treat which patch of mesoderm where. Ludicrous.
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Re: Upper Trap Spasm - March 17, 2006 1:03:00 PM
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SJBird55
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From: Michigan
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Well... I guess my brain works a whole lot more broadly than some of you who seme to have really narrowed your approaches down to the neuro rationale for all problems.
#1... a decent chunk of time evaluating and listening to the whole scenario that is the supposed reason for the complaint, considering medications (prescribed, over the counter and the alternative stuff), considering the medical systems review. First and foremost, I believe we first need to decide if we should treat or not treat or refer on.
#2... then consider the various reasons for the complaint - sure, the neuro system is part of it, but heck yeah, you have to consider the musculoskeletal too. It'd be kind of like eating peanut butter cups without the peanut butter. I really think that there needs to be balance in how we assess patients.
#3... things have changed in the insurance world... we have less visits, patients with higher copays, dollar limits... the LESS we can do to get the person where they need to be the BETTER off we are in the reimbursement world.
#4 There ARE patterns to recognition. If it walks like a duck, looks like a duck... well, it probably ain't a horse.
#5 Believe it or not, when we do treat bones or muscles, we are having an effect on the nervous system - the nervous system is continuous throughout the body, so there isn't getting past that we wouldn't have some sort of an effect on the nervous system. Also, the sights, smells and noises will have an effect too... and what we say and how we day it probably has a huge effect. There is that cognitive portion of the nervous system too - shouldn't be ignoring that portion either.
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Re: Upper Trap Spasm - March 17, 2006 3:08:00 PM
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nari
Posts: 1568
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From: Australia
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SJ
To respond to your points:
#1: Agree!
#2: Quite reasonable
#3: the key point here is:
"the LESS we can do to get the person where they need to be the BETTER off we are in the reimbursement world" (quote)
Absolutely!!
Choosing the most efficient and effective way to get someone better is a prime target. Therefore, why do so many PTs have people coming for weeks on end while they try out different tools? Seems to be endemic (in Oz as well, certainly).
#4: Of course there are patterns. Who said there weren't?
#5: At least you grant the CNS/PNS has a role, and possibly an important one. So why the general PT emphasis on stretches and strengthening and electro stuff? For *everybody*?? As if the CNS does not count? I agree that 'the cognitive portion' needs close attention...what about the rest of the brain?
Your definition of broad thinking is interpreted quite differently from some of us. When one deals with the CNS, it is as broad as it can possibly get. Dealing with muscle/joint systems (or fascia, or ligaments or whatever) is a narrower view. IMHO.
OK, results are probably good for both 'outlooks', but I wonder which outlook will serve the patient best in the long term?? Will they have to pop back for a manip or a mob or something else in a few months when the problem is actually chronic pain?
(Given that the definition for chronic *unchanging*pain is now considered to be between 6-10 weeks)(many sources)
Nari
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