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Re: adherent nerve root, who knows how to treat it?
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Re: adherent nerve root, who knows how to treat it? - September 27, 2006 5:06:00 PM
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dfjpt
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[QUOTE]what are you doing to determine "HOW THE NERVOUS SYSTEM IS RESPONDING"[/QUOTE]Oh proud, (roll eyes), a bit of this and a little of that. Handling, lots of handling. Skin stretching, lots of that. Lots of slow handling and close observation. Lots of sitting the patient back up to have them move their 'whatever' again, to see if it moves better yet, with less pain.
By now there is nothing "purely" anything about how I treat. I use no one's "system" but my own. I call it dermoneuromodulation. (If you must have a name.)(It's not anything that anyone else isn't also doing along with whatever the he** else they think they're doing, all their mesodermal perceptual fantasies.)
It is targeted to cutaneous nerves; since they are the most sensitive, it makes sense to me that they will offer the biggest nervous system change for the smallest amount of input. The fact that they're so handy, right under the skin and embedded into it, is a happy side benefit of evolution, which makes my life as a therapist more convenient. I just don't worry about mesoderm anymore. Free at last. Just interacting with nervous systems, staying one step ahead of them, helping them find a new way to be. Helping people be in a body better, from the hind brain (kinesthetic only) to the cortex (lots of kinesthesis but can be verbally accessed as well.)
The whole point is to help that brain, or those nested brains, shift out of putting out pain and into putting out easier movement. The nice thing is it only takes a few visits usually; the patient goes away with a couple moves they can do to stay out of trouble.
How do I "determine" how the nervous system is responding? I can observe better movement, and the patient tells me they have less or else no pain. I believe them, since it's their nervous system, not mine.
Hope that clears it up.
Fondly,
Diane
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Re: adherent nerve root, who knows how to treat it? - September 27, 2006 5:19:00 PM
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Jon Newman
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From: Amherst, WI
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Hi Proud,
I ask questions, listen to responses, watch what they're willing to do, determine if there might be some tissue that needs protection, determine goals, come up with a plan with the patient. If that fails I mobilize L5/S1 and yell at my wife when I get home.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: adherent nerve root, who knows how to treat it? - September 27, 2006 6:09:00 PM
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rwillcott
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dfjpt:
"I just don't worry about mesoderm anymore. Free at last. Just interacting with nervous systems, staying one step ahead of them, helping them find a new way to be. Helping people be in a body better, from the hind brain (kinesthetic only) to the cortex (lots of kinesthesis but can be verbally accessed as well.)"
I find this very confusing and quite frankly strange. Who's free at last? Are you confused with Martin Luther King Jr.
I hope you don't send notes back to the doctor explaining that you've treated their hind brain and cortex.
If you are treating the cutaneous nerves then why not simply send the patient to massage or place a hot pack on them. Are you a PT? None of what you are explaining sounds remotely close to any form of treatment I've ever read or have been taught.
Rob
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Re: adherent nerve root, who knows how to treat it? - September 27, 2006 6:50:00 PM
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nari
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Rob,
The statement about "treating" cutaneous nerves with massage and hot packs is totally confusing, to me. Who would do this in all seriousness??
And why would they do it? Haven't we emerged from the mid 20th century..?
It almost sounds as though you see the nervous system and brain as a neurotic, irrelevant structure....
Nari
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Re: adherent nerve root, who knows how to treat it? - September 27, 2006 7:17:00 PM
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dfjpt
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Rob, what's your idea of PT? That's what I am and do... Didn't you study any neuro in school? Any anatomy? If you did, under the skin you might have noticed nerves, those long thready white things. Attached to more white stuff, inside the spine. Attached to a largish blobby white thing at the top, called the brain.
I work with live conscious people, i.e., ones whose nervous systems are fully alive and awake, and generally intact, and in pain of one sort or another. What sort of PT do you do?
Fondly,
Diane
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Re: adherent nerve root, who knows how to treat it? - September 27, 2006 7:46:00 PM
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rv36116
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From: Texas
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Ok, great discussion.
The answer I have so far is:
- there is no such diagnosis as this, so there's no reason to treat something that isn't real.
Glad I treat imaginary people with imaginary diagnosis'
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 1:40:00 AM
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Jon Newman
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From: Amherst, WI
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Hi Rob,
Can you point out where someone stated that the diagnosis does not exist? Because I don't think that is true at all.
What has been presented is whether we are any good at detecting it, followed by whether a simple movement therapy is likely to unadhere the root. The "concept" you're using to treat people a certain way may very well be a myth. It does not mean that you aren't getting your patients better.
In my opinion, and anyone practicing using evidence as a guide, it is probably best to get used to it. Each time some significant new information comes out that contains unexpected revelations, a shift is required. Note the reluctance of some people to let go of the "bone out of place" thinking or those that literally think they are stabilizing the spine with spinal stabilization. Or that being too weak or too tight are the likely culprits to painful conditions.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 2:17:00 AM
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proud
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rwillcott,
You stirred the hornets nest...run man run!. I agree with you so I just put my running shoes on to run with you.
dfjpt, Thank you for your input. But your response of >>> a bit of this and a bit of that<<<<< It is just so "fluffy" for me...Frankly, it sounds like something Pheobe from that "friends" show might be into.
Not saying it does not work for you, but it is rather strange and I would hate to see that progress report ...roll eyes.
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 2:21:00 AM
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Sebastian Asselbergs
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Rob, your last post and this quote: ""tethering or adherence that now inhibits full movement of the nerve root/dural complex
Flexion is limited" show me that you believe we can, with relative certainty, diagnose an adhered nerve root. Limited motion is caused by pain defense mechanisms - a subjective event. So, NO test is clear and conclusive for "signs" of nerveroot adherence.
I don't say it doesn't exist, but A) how do we test it with any level of certainty?, and B) what then do we do about it, since - as Kathy so eloquently posted - the adherence is likely not going to be "released" by nerve mobilisation of any kind.
Just because we can't change some anatomical feature, doesn't mean we can't assist the person reducing their pain experience.
It does require getting away from the "style" of PT many schools provided - recipe book style. The schools focus on pathology, treatment types and techniques, and modalities, yet does NOT spend enpough time focusing on the process of being human with pain. Not enough cognitive neurophysiology, not enough peripheral neuroanatomy, not enough pain sciences.
But that's my take.
_____________________________
Mundi vult decipi
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 2:37:00 AM
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Jon Newman
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Diane,
How dare you. And what do your patients think they're doing getting better like they do. You need to perform painful procedures, 5-6 times, you need to control their core, you need to restrict what movements are allowable, you must seize control of their well being. You must be like Monica, from Friends. Fluffiness, whatever that means, has no place in the serious clinic or within the serious evidence based practitioner's arsenal.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 4:07:00 AM
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dfjpt
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Proud, my progress notes are simple. Unless you can't read my writing you'd have no problem with them - they're in plain English. I write down the CC, Hx, past Hx, OE, what I did, what happened after compared to OE, including (rarely because they're rare) any funny results, what I assigned for homework, a little plan for what I want to address in the next visit... same as I've always done.
Jon, maybe you're right. Maybe I'm way too lenient a PT, being satisfied with such meager results, like freedom from pain and freedom to move. It's because I'm lazy you know, never really liked exerting myself over-much, so I just zero in on the essential things that I hope will get the patient out of my hair as soon as humanly possible, meanwhile "pleasing" them so that they keep sending me new patients without being asked/told. (Did I mention that I run a strictly cash practice? I found working for insurance companies much too laborious, what with all that annoying paperwork and chasing them down to get paid.)
Yeah, I guess I don't belong in PT anymore. Someone should really investigate and rip my license - I'm probably a disgrace to the profession with all my incomprehensible fluffy ways, no modalities, and putting pain relief first. Imagine!
Fondly,
Diane
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 5:36:00 AM
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dfjpt
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PT Serenity prayer:
May my bank of knowledge acquire interest and capital sufficient to meet my daily needs. May I learn enough to always distinguish between that which I can change, (i.e. ectoderm and its output), from that which I cannot change, (i.e. mesoderm and any of its multiple anatomical variations), the wisdom to know the difference and when to quit/refer on.
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 6:53:00 AM
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steve
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From: victoria, bc Canada
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This is a great thread!
I think Rob, you are using adherent nerve root as a classification category that does have some evidence to support its use as there has been some research to substantiate the McKenzie classification system as being reliable. Unfortunately, this does not allow us to extrapolate and assume that patients that fall into this classification scheme actually have an adherent nerve root that is causing their symptoms. This subgroup of patients may respond more favourably to one intervention than another.
Diane, actually your description of what you do and your statement that "It doesn't really matter what we do, it is the interaction with the or nervous system" sheds more light on your actual treatment process than I have seen before. If I am interpreting you correctly, I dont disagree with you in that are words and body language are likely the most important component of treatment with patients and this is why reassurance repeatedly works as a treatment intervention irrespective of sub grouping patients. I would suggest that this combined with treatments that are established as efficacious by the literature creates even stronger results.
Jon, I like your comment about shifting our thinking, we get way to focussed on theoretical models and take personal ownership of a model, preventing us from altering our practice to meet emerging changes in research.
Steve
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 9:09:00 AM
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Shill
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From: Madison WI USA
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Diane,
Reading your description of your treatment could lead one to ask, "Isnt that just like massage?"
Nari mentioned "a sticky sort of neural tunnel". What is sticky in there? Is that where the honey we eat goes? Mmmmm.....honey.....
Gee, I cant see why anyone would have trouble understanding all of this talk. I agree with proud, in regards to the actual descriptions of how these "deeper model" techniques are performed, as they are often vague to a point where even vague is too vague of a term.
And Ive been to the courses.......
_____________________________
Steve Hill PT
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 9:38:00 AM
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proud
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dfjpt and jon,
>>>>A bit of this and a little of that>>>>>
I am not saying that your theories are wrong. I agree with Steve in an above post. Essentially we need to be receptive to new ideas and emerging research. The very reason I do not exclusivley use McKenzie. I use it as one part of an overall evaluation.
But that quote above is "fluffy". All I am doing is looking for the "how" invloved here. Ginger goes out on a limb and posts the procedure for continous mobs...But I just have not been provided with any clear understanding of what you "think" you are doing.
I recommend that instead of being defensive when someone requests clarification, that you proceed with a clear discription of what you might be doing. My first post requested that information in a respectful manner, to which you rolled your eyes and gave me >>>>a bit of this and a little of that>>>hmmmmm.
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 9:49:00 AM
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dfjpt
Posts: 238
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[QUOTE]Reading your description of your treatment could lead one to ask, "Isnt that just like massage?"[/QUOTE]Seems to me I've said I do "skin stretching" about a hundred million times. How is it that people still think this is anything like massage? There is no kneading or rolling or poking or worry of any sort about "muscle", or the coercion thereof into becoming more "pliable."
[QUOTE]Gee, I cant see why anyone would have trouble understanding all of this talk. I agree with proud, in regards to the actual descriptions of how these "deeper model" techniques are performed, as they are often vague to a point where even vague is too vague of a term.[/QUOTE]There's nothing vague about tracking a nervous system in operation, seeing new behaviors both conscious and non-conscious emerge, feeling pulses and stirrings under the fingertips, feeling the whole body soften and allow its bones to move more. I'd say the only "vagueness" that exists is in those who think a recipe should be provided and an outcome study done first because they still don't know how to be a PT and think they have to emulate chiropractors to get paid out there in the big bad world. Just relax, it's nature we're working with. There's lots of time to get it right, to allow it time so it can get itself right.
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 9:58:00 AM
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steve
Posts: 451
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From: victoria, bc Canada
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Diane,
How is using evidence and reproducible techniques to guide our practice anything like chiropractors?
Steve
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 10:05:00 AM
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dfjpt
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[QUOTE]How is using evidence and reproducible techniques to guide our practice anything like chiropractors?[/QUOTE]It isn't.
I meant in the sense of putting mesoderm, especially the bony sort, specifically the spinal sort, into the centre of PT cognitive existance, and adapting everything else therapeutic to fit around it.
Fondly,
Diane
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 10:34:00 AM
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steve
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From: victoria, bc Canada
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I agree Diane, fitting everyone into one theoretical grouping will lead to poor outcomes and the lack of significant findings on previous research studies that have treated low back pain as heterogeneous groups is a great example of this. I would question if you are doing the same thing by placing everyone in the ectodermal/neural group - how is this any different?
Steve
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 11:23:00 AM
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nari
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Not understanding a concept just means a person has not taken time to read up on the basics of the concept. There is a ton of work out there done on the nervous system and pain; and more is on the way, including work from USA researchers.
This is not a debate where anyone is saying that traditional mesodermal-based therapy is wrong. No-one has ever suggested it should cease, I don't think. Doing joint stuff and sending patients home with exercises (which some tend to avoid because they hurt or are boring) - has always been done and will continue to be done. Patients do get better, and some recover completely; no argument.
Many continue with pain, despite stronger muscles and improved function.
These patients are the ones who deserve a different focus - a focus on pain management, rather than motor control, strength and function at the expense of the CNS.
But it would appear that these chronic pain people (including health professionals!) do not rate well in the stakes.....somehow it seems a meme that PTs do not "treat pain".
Nari
PS It's difficult putting to paper a recipe for pain Rx, because there are no recipes. Every patient is treated differently, different strokes, different focus, different CNS responses.
Ther are no recipes - one works from a foundation of neurophysiology. And that neurophysiology is the patient's own, not ours.
So we are not hiding secret "methods"; there is a lot of knowledge out there, and on this very board, but one has to put effort into learning it.
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