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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 28, 2006 1:37:00 PM
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Jon Newman
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From: Amherst, WI
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Steve, I'm all for a reduction in theories, especially those used in the vernacular. Which set of sciences do you think is better equipped to explain pain, biomechanics or neurobiology? To avoid an either/or limitation feel free to come up with your own. This question is open to anyone.
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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: adherent nerve root, who knows how to treat it? - September 28, 2006 1:38:00 PM
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proud
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Dfjpt,
Actually, do you want to know what the problem is? It's the poor research that has been compiled in the past.
Gone are the days were we take 100 LBP patients and ask, does stabilization work?
Or 100 LBP patients and have them do extensions to determine if "McKenzie extensions" work.
or 100 lateral epicondilitis patients and asking, does the mills manip work?
That would be akin to taking 100 chest pain patients( with numerous potential causes) and asking, does nitro work?
The research has learned that recognizing sub groups who are likely to benefit from a certain TX is important.
DfJPT, I honestly feel that those who practice outside the research paradigm, have done so due to frustration with where the reserach has lead. That will all soon change.
And the funny thing is that I think you and I will find that in some clientele, your ectoderm/neural ideas are correct, but in some patients, the mesoderm group are correct.
Dfjpt, by the way, I still have no idea what you do. How about a patient scenario?
33 YO male reports to you with insideous onset of right sided pain in fortin's finger point area( 2cm inferiomedial to PSIS). Red flags ruled out. How do you arrive at your clinical interpretation and then what exactly would you do for treatment?
This is just an honest attempt to understand. Can you assist?
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 1:53:00 PM
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dfjpt
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Tell me more about this patient. I've got the age and gender designation.. I've got a chief complaint but I've got no history, no past history, no mechanism, no assessment of ROM, or tenderness. I want to know his general health, his way of presenting himself, his manner, if he's had any illnesses, fractures or surgeries, other treatment from other practitioners, what kind. Telling me he has no red flags tells me he doesn't have cancer, that's about all. I want to know his archeology a bit. I want to know what he does with this nervous system on a daily basis. Every clue is important. Call me Columbo.
By the way, Nari is right when she says there's no recipe. Once you've learned to cook you rarely need to use one.
Fondly,
Diane
PS: BTW I think we already went through this on some other thread, me telling you what I'd do, no one getting it. Me presenting a typical pain patient profile, you saying it was too complicated or something.
Also, I'll be away for a few days.
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 2:03:00 PM
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proud
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Uh huh. Yes, things are often way to complicated for me...
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 2:12:00 PM
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steve
Posts: 452
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From: victoria, bc Canada
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Jon,
I am anything but a biomechanist and definately believe in the neurobiology model suggested by Butler and others for specific patients. Those who attend with soft tissue pain > 6 weeks, high DRAM/Fear avoidance beliefs scores etc benefit from this reassurance, challenging kinesiophobia through exercise and some "Ideomotor" hands on therapy etc. I would suggest that those in acute pain with observable signs of muscle gaurding etc benefit from the use of manipulation/manual therapy combined with restorative exercise for altered motor patterns.
I think the problem is that these theories are developed and then taken as fact by those who wish to have an explanation for what we are yet to fully understand - which is probably about 80%+ of our patient caseloads. Unfortunately, the theories become increasingly complex as they attempt to capture all the patients who do not fit in to the model.
just my 2 cents worth.
Steve
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Re: adherent nerve root, who knows how to treat it? - September 28, 2006 4:55:00 PM
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Jon Newman
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Hi Steve,
I'm not sure of your point. I think if someone wants to describe a change in pain they are best off describing it in terms of neurobiology regardless of the techniques they use (manipulation/mobilization, etc).
PT, being wide ranging, also has a role for biomechanics and the mesoderm. One of many examples include decision making as it pertains to what tissues need to be protected. For example, use of an ACL brace following a tear or surgery has its best explanation in biomechanics and wound healing. The main purpose of putting on an ACL brace however is not pain management or even pain management although pain relief may result (in which case one could switch to a neurobiological account).
Now it makes some sense to me that if someone cannot actually detect tissue damage with certainty and/or come to a reasonable conclusion that movement should be restricted to protect something, then a "neurological" clinical reasoning approach would be more informative than biomechanics as for what to do next. I'm assuming here a person whose chief complaint is pain that prevents them from doing what they want.
_____________________________
[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 7:23:00 PM
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steve
Posts: 452
Joined: May 14, 2003
From: victoria, bc Canada
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Sorry Jon,
My fault, my limited attention span prevented me from reading the question properly. I was answering from the prospective of neurobiology as a treatment paradigm as would be discussed on S-o-m-a rather than as an explanation on pain.
Sorry for the confusion....
Steve
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 4:57:00 AM
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Shill
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Joined: February 13, 2003
From: Madison WI USA
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Diane,
Look. You must know that I respect your opinion, wisdom, experience, etc. However, you must understand that there are people who are analytical by nature. I am one of these. I take what people say (write) and try to figure out what they might mean. Sometimes, people have a way of saying things that makes this very easy. Other times, not so much. When I have asked those who adhere to the deeper model to elaborate, they often are unable to satisfy my need for detail, and specific detail at that. This is my problem, but I am not alone in this.
Sure, you have mentioned skin stretching a hundred zillion times, but as you are aware, the body has a lot of skin. You could reply as to the area and direction of your skin stretching(s). Think of describing it as if you had to explain to a payor exactly what you were doing. I realize that you do not have to do this in your practice, but this is another reason that there are those of us who need this detail.
"feeling pulses and stirrings" is something you noted as well. The way that my mind works, I cant see myself documenting "During the treatment, I felt pulses and stirrings in the patient's arm." To me, (and again, note that I am taking ownership of MY problem of understanding) this is non-descript.
Nari Noted "These (chronic pain) 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"."
I fully agree, and I sometimes lose sight of the fact that the deeper model truly attempts to address THESE patients, not all patients. However, the general recipe, and even the specific ingredients need to be established if these theories and techniques are going to become accepted. There needs to be the ability to reproduce what is done.
However, Nari also noted "Not understanding a concept just means a person has not taken time to read up on the basics of the concept."
With this, I do not agree. The basics of the concept are easy to understand. It is the carrying out of the theory, and the putting it to consistent clinical practice that can not be explained to me in a way that meets my needs.
So, with that note, Have a nice weekend.
Steve (the other steve)
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Steve Hill PT
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 5:17:00 AM
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dfjpt
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Steve Shill, if you want hand placements, directions of pull, all the techie little recipe things, there are more of those over on SS, in files that are member access only.
I've got a project going over there, called Seeing the Light at the End of the Tunnel Syndrome, where I'm using a book on Tunnel Syndromes to get the basic medical info onto threads, a separate thread for each syndrome, then plan to group them into folders for "upper limb", "lower limb" etc. Once I've got all the threads up (still a few more to go) I'll be writing out all the usual skin stretch treatments I routinely do. You'll have to be patient, because I plan to take my time with this all winter and do it right. But it will be there, and free, for any who wants to try on using an ectodermalist approach.
(Also, I'm planning to take advantage of some possible access to an anatomy lab to take a look at dissemination of peripheral nerves into skin, if it can work with Dr. Ford's schedule. I'll do a little write-up on that. This will all be pre-publishing publishing.)
Anything that is already been developed, with pictures of taping suggestions, etc., is linked to an appropriate thread, e.g., axillary nerve or suprascapular nerve. (Those are more developed because of interaction on site, not because of any previously decided strategy.) For an example of a recipe, how all the threads will eventually look, including treatment details, check out the thread for pudendal nerve tunnel syndrome.
I won't be writing it all out again for here, or copying/pasting.
(Off for a wild weekend to a 35th year PT class reunion at Whistler. I hear hot tubs will figure in big time. :) )
Fondly,
Diane
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 5:24:00 AM
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SJBird55
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From: Michigan
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Steve (the other Steve),
You bring up valid questions and points. My thought processes are along the same lines as yours. I don't understand the style of written communication of Diane - and I know she is passionate and I know she has a vast amount of knowledge. At the same time though, it is very irritating to see lines drawn between therapists with regard to how the therapists treat... in particular the ectodermists versus mesodermists or manipulators versus non-manipulators. The first divide is ridiculous because the mesodermists are obviously touching the skin... I do see a lot of hope though. I am absolutely excited about the style of writing of a particular person over at the S-O-M-A site... #1 the goal of this person's writing isn't to divide therapists, the goal is to assist in figuring out what seems to be common between our various approaches. It has never made any sense to me that I can work with patients and have a style that dominates in education, some manual and mainly exercise with my patients (and I've assessed my outcomes and I like what I see). But then to read some of the vague stuff that Diane may write and know in my heart that she believes that she is having positive outcomes in a reasonable amount of time (and then I make the mental step to assume that she is accurate in what she believes because there is no proof)... then it is very confusing. How can such two different styles have positive outcomes? We all have to be "right" in some way, shape or form, but I can just never see how it is that results occur or why.
I'm definitely not allowed at that S-O-M-A site. I can lurk though and there is one post there that is highly exciting, insightful, non-political, not creating a divide by ignoring comments that can divide, definitely not labeling therapists and practice styles, seems to make logical sense and for the most part is written in a style that has more definition and less vagueness to it than anything I have read in the past. Look at a LONG post by BB - can't remember the name of it, but it has a lot of views and the post is always signed by a Cory B in Vancouver. Cory's thoughts, logic and writing style are much more conducive for those of us that a wired differently than the majority of the posters at S-O-M-A. I just peeked in on that site today and my thoughts are "finally!" There is finally someone who can communicate in a style that is easily understandable.
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 5:34:00 AM
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dfjpt
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I agree SJ that BB is writing a very good thread.
About this:
[QUOTE]The first divide is ridiculous because the mesodermists are obviously touching the skin... [/QUOTE]The whole point of the differentiation is to make mesodermalists face the fact that they completely bypass the nervous system in their thinking, conflate it into nothing, refuse to acknowledge it, allow it no consideration as they continue to try to create rituals and magical pokes and prods to systematize, then study/sell to others. They seem to want power and control over it, rather than learn to work with it. That's the big difference between mesos and ectos. All ectos want is to understand, develop our minds, get away from the hoopla. We're mostly done with being insecure about our skillsets, ready to enjoy doing good therapy instead, working WITH our patients instead of ON them.
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 7:08:00 AM
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Shill
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From: Madison WI USA
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Diane,
Excellent post, and very helpful as well. I do appreciate it, as I do think there is a whole lot of merit to the theories.
Thank you.
Thanks SJ, I will check out BB's post as well.
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Steve Hill PT
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 7:33:00 AM
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emad/emad
Posts: 42
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SJbird,
Why are NOT you allowed to post on SS ?Have you been banned there ?
Cheers
Emad
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 7:38:00 AM
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SJBird55
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From: Michigan
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I don't understand Barrett Dorko's written communication and he doesn't understand mine. He historically takes things personally and then it just becomes an aggressive/defensive attack with both of us being at fault. Hence, I am not welcomed at that site - it is his safe haven in which no Harpy's are allowed. :) I believe that is what I was called. LOL
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 7:51:00 AM
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proud
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SjBird55,
I think you have it right:
>>>>>>then it is very confusing. How can such two different styles have positive outcomes? We all have to be "right" in some way, shape or form, but I can just never see how it is that results occur or why.>>>>>
Just as we had the mobilizers versus the stabilizers for a while, a little of both is correct. Every patient is unique and requires sub grouping to determine what tx mode will work best. I can only assume that the "skin" approach discussed by dfjpt may one day prove effective for a certain clientele.
Dfjpt,
In your enthusiasm, I fear that you have fallen prey to "cultism". Just like there are "McKenzie" practitioners who have put the blinders on.
I gaurantee you that many of those who see mechanically do not completely bypass the nervous system...as you say.
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 8:30:00 AM
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dfjpt
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Proud, if it's a cult, then it's a cult of one, just me. :) Also, anyone who takes up dermoneuromodulating doesn't have to get certified or pay any money or join a special organization. It's all free, as is most of the pain science backing it, so I'll never be a guru. No one has to become a follower. They can just quietly add it to their list of things to do TO people, check it out that way. None of us should ever follow anyone or anyhing except a patient's nervous system, IMO.
It's easy to learn, but complex to understand, in contrast to mesodermal therapeutic approaches which are relatively more difficult to learn to do (byzantine some of them, especially the chiro ones, signify mostly nothing other than trying to seem impressive), but awfully simplistic as no real understanding is required.
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 8:43:00 AM
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proud
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Byzantine...nice. Scary that you would know and use that word, but nice.
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 9:28:00 AM
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dfjpt
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I meant the word strictly in this useage/sense: [URL=http://en.wikipedia.org/wiki/Byzantine_complexity]Byzantine complexity[/URL]
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 11:20:00 AM
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coryblick
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I'm BB from soma, and I'm very glad that you are finding my thread useful SJ.
Here is a copy of my first post which got me started posting:
On the Cusp of a Unified Field Theory
I think that our profession is a nation divided. We are many different therapists, using many different methods, to approach similar patients. A person practicing in method A, may work in a very different manner than a person working with method B. Both have success with their methods and therefore assume that it is the best. However, if A is right and B is wrong, then why do both work? And what do you do when neither A nor B work? Many often feel they have to throw out one method if they want to use another, or collect of bag of tricks, a toolbox, to run through until you find the "right one for that particular patient."
I'm not proposing that variation between therapists should not exist. However, a patient might get completely opposing explanations of mechanism of correction between therapists A and B.
We need to start looking for similarities between our treatments. The goal of this process would not be to find best practice, but instead to be able to explain WHY multiple methods work. What is the common ground, the generality between methods that allows both to have success? When this question can be answered then the concept of better practice can begin to be approached.
Inevitably, the answer to this question leads one to the nervous system. One must begin to consider the advances of neuroscience to find a broad enough framework to encompass the answer to the above question. The quest to achieve this understanding can lead one to the ability to answer that question from multiple perspectives. Outside-in and inside-out perspectives that are able to withstand scrutiny from what is known about the nervous system and the advances of neuroscience.
Einstein sought to create a unified fields theory. He reasoned that an explanation existed that would explain the divisions created in physics by his relativity theory. He was unable to find his unified field. However, his findings and his theory have allowed modern neuroscience to flourish. Our own unified theory may be within reach as a result.
The thread on the site is titled "A Unified Theory for Physical Therapy and the Treatment of Pain"
It is a large thread and still growing. I'd be willing to bring the thread here to RE as well if there is interest.
Cory
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Re: adherent nerve root, who knows how to treat it? - September 29, 2006 12:05:00 PM
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nari
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From: Australia
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Steve (Shill)
I would think that for many PTs, the basics of neurophysiology are not simple to understand; every time one reads a paper or article on the subject, it gets deeper and more complex.
But knowing some of the deep model means you don't need to learn lots of separate techniques; it simply is not necessary.
If your practice consists purely of acute conditions - such as acute spinal pain, sprained ankles,post-op TKAs - the focus may be different. Nevertheless, these are folk who have the potential to develop chronic pain; and an awareness of pain physiology and education of same might help prevent the transition to sensitisation.
Pain is pain - the chemistry changes, the concept doesn't. That's what I was attempting to say.
Nari
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