|
|
Re: adherent nerve root, who knows how to treat it?
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: adherent nerve root, who knows how to treat it? - September 29, 2006 12:49:00 PM
|
|
|
SJBird55
Posts: 2362
Joined: May 10, 2004
From: Michigan
Status: offline
|
Cory, you are doing a nice job in presenting information. Thank you for your time and effort.
I liked that somewhere in that thread you did mention psychosomatic factors that have the potential of a higher risk of poorer outcomes - and knowing when to refer (you didn't say it that way, but did allude to variables that therapists cannot control). I also very much appreciate a simple fact that you are refusing to go down a path of mesoderm vs ectoderm or mobilization vs stabilization or whatever. I can almost get a glimpse of why subcategories of patients respond to the various approaches out there. I appreciate that you are encompassing the brain and the processes within the brain. I appreciate seeing some substantiation of the "environment" in which we work being a variable in our treatment approach. I like the clinical examples that you use to help understand some of the concepts. I can also easily reach into my brain and substantiate my own experiences and reflect on literature I have read that also jives with your presenting thoughts. Some of my questions of years past are actually being answered.
I know you mentioned that the "why" is an important question to you. Sometimes I don't know if we can always completely address the specific "why" in various approaches. Maybe a specific "why" isn't necessary but instead a general "why." Right now, there seems to be a lot more political pressure in our field to either prove that our outcomes are reasonable or to prove that an approach provides results and in which situations. There is just a feel of more importance on the outcome side than the why side because here in the States reimbursement will be changing. We do need the "why" though because if we also understand the "why" we just might be able to tweak approaches even more to improve outcomes.
Thanks for the time you are taking to reduce a divide between therapists. I'll continue reading your stuff over at the other site to understand and learn what it is that I do do or don't do and maybe alter some aspects to be more successful.
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - September 29, 2006 1:01:00 PM
|
|
|
SJBird55
Posts: 2362
Joined: May 10, 2004
From: Michigan
Status: offline
|
Cory... if you are reading here, I can't post at the other site.
Could you explain how you know the below quote from one of your posts at the other site to be true? I followed along with the example you had of the guy getting into bed naked, but I don't follow the example of pain. How is this known?
[QUOTE]That is an example of a useful inhibitory context provided by the autobiographical self. For those in pain however, it is this inhibition of the expression of the appropriate motor response through ideomotion that frustrates the progression through the action sequence.[/QUOTE]
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - September 29, 2006 1:29:00 PM
|
|
|
proud
Posts: 921
Joined: March 22, 2006
Status: offline
|
Sounds like Cory is on the sub grouping train. Excellent. We all have something to contribute. Let's let the research move us forward.
I just happen to believe that we must expose ourselves to the rigours of research into concepts that we propose. Otherwise we are using patients as lab rats. That is unprofessional and lowers the standard to the many many many self proclaimed magical cures. This is a "profession" first. In my opinion.
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - September 29, 2006 2:22:00 PM
|
|
|
yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
Status: offline
|
proud:
I agree. Seems to me like what you and Cory are both discussing is at the center of where we are going with our profession. We know that there are alot of people using a lot of different techniques on a lot of patients with a variety of conditions. And.... We get a lot of peolple better. This is why we must continue to look for the WHY. WHY do treatments work? This is why I hate the fall back to "placebo effect". This is often given as the reason for success because we fail to know the WHY.
Our assessments are key, I agree. Call it subgrouping or something else. There is no way the public or other health professionals will recognize and respect doctors of physical therapy if a LBP patient can get 10 different diagnoses and treatment plans from 10 different therapists.
Those who practice "alternative manual therapies" often revert to the notion that there is no recipe for what they do. They develop some sort of mind body connection with the patient and lay hands upon them until they are better. They scoff at those who use exercise or do mobilizations, etc.
"I just happen to believe that we most expose ourselves to the rigours of research into concepts that we propose. Otherwise we are using patients as lab rats. That is unprofessional and lowers the standard to the many many many self proclaimed magical cures. This is a "profession" first. In my opinion."
Well said.
_____________________________
Eric Yarrington, PT, MPT, OCS
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - September 29, 2006 3:40:00 PM
|
|
|
coryblick
Posts: 25
Joined: November 16, 2005
Status: offline
|
SJBird,
I'm going to respond to your question a bit later, when I have time to answer it adequately.
Proud and Eric,
I think that our differences have been described and fought over for quite some time. My intention in this thread is the opposite. How are we similar. The very things you all are describing are the reasons I started writing.
I'll go ahead and copy my posts in a new thread. That way everyone will be up to speed on what we are discussing. Attending to this thread on two different sites will demand some attention and more time, so be patient with me. It will be worth the effort I believe.
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - September 29, 2006 9:41:00 PM
|
|
|
coryblick
Posts: 25
Joined: November 16, 2005
Status: offline
|
SJBird,
Here is a quote from Patrick Wall's Pain: The Science of Suffering. Wall along with Ronald Melzack came up with the gate control theory of pain. He remained arguably the top pain researcher until his death in 2001. From p. 150:
"What are the appropriate motor responses to the arrival of injury signals? They attempt: first, to remove the stimulus; second, to adopt a posture to limit further injury and optimize recovery; and third, to seek safety, relief, and cure. The youngest, most inexperienced animal may attempt a series of these responses triggered by built-in mechanisms. As the animal grows in experience, the reactions will become more subtle, elaborate, and sophisticated. If the sequence is fustrated at any stage, the sensation and posture remain."
So, we know that pain, since it is a percieved sensation, is comprised of a motor plan (post 14 on SS).
We know that, in order for pain to be resolved an actual action sequence must be carried out (see above and post 32). I hope to expand on this "need" concept this coming week.
We know that our actions are carried out non-conscioulsy and are called ideomotion (post 61).
We know that our ideomotor behaviour is context driven (also post 61).
If the ideomotor expression of the needed action sequence is inhibited by the activation of another, based on a context provided by the autobiographical self, then it is not carried out. As pain is a "need state" such as hunger, the inhibition of the action sequence does not allow for the resolution of the pain.
Hope that makes sense.
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - September 29, 2006 9:49:00 PM
|
|
|
coryblick
Posts: 25
Joined: November 16, 2005
Status: offline
|
Actually, my most recent post (74) on SS, approaches this issue of inhibition of the needed action from another angle, based on a non-congruent explanation.
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - September 30, 2006 1:49:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Cory,
I will follow this thread here ,because i have not followed it there on SS .you have payed my attention toward that meaning need state on SS , good to see it here to because i can not remember it .
Cheers
Emad
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - September 30, 2006 2:17:00 AM
|
|
|
SJBird55
Posts: 2362
Joined: May 10, 2004
From: Michigan
Status: offline
|
I will post my questions up in the open forum so that there won't be two threads going on and creating confusion. It might be better to have this thread locked because it will be a "pain" to check two threads at one site.... LOL I'm such a comedian. :)
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - September 30, 2006 3:25:00 AM
|
|
|
emad/emad
Posts: 42
Joined: July 4, 2006
Status: offline
|
Oh SJ bird,
Correct you meant that thread on open forum called Unifying theory .
You are more than Comedian ,,,,hahaha
Cheers
Emad
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - September 30, 2006 11:35:00 AM
|
|
|
Bournephysio
Posts: 579
Joined: April 25, 2002
From: Calgary
Status: offline
|
[QUOTE] 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 [/QUOTE]Jon, what if you could actually detect the tissue damage with certainty but couldn't do a darn thing about it? Lets say the person has 3 or 4 "leaky discs" (ala Tapio Videman). How would that change your approach?
Doug
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - October 1, 2006 3:38:00 AM
|
|
|
Jon Newman
Posts: 1697
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Hi Doug,
Thanks for "Videman" as a reference. I'll have to print some of his articles for my "toolbox". It's interesting work and while I didn't find the "leaky disc" reference I did review some of the numerous published articles and remembered reading the PT Journal article once I saw it again. I found that his work supports the approach I'm currently taking. Perhaps it's confirmation bias. What's your take?
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - October 1, 2006 12:23:00 PM
|
|
|
srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
Status: offline
|
I'm glad I caught up on this intriguing thread.
First, back to the original question about how to treat (and perhaps a better question -- to diagnose) adherent nerve roots, I would like to refer you to the work of Michael Shacklock, PT in his book "Clinical Neurodynamics" in which he develops classifications for neurodynamic disorders. Broadly, three types of dysfunction can be found, which include mechanical interface dysfunctions, neural dysfunctions and interface tissue dysfunctions. Shacklock further classifies the neural dysfunctions into subcategories such as sliding dysfunctions, tension dysfunctions, etc. He notes that adhesions fit into the reduced sliding dysfunction and can be a "potential source of symptoms". Basically, one does not want to tension these nerves, but slide them through the adjacent tissues in a manner that reduces symptoms and does not risk damaging, sensitizing, or creating a physiologically harmful environment around the nerve (inflammation). Every point above has research studies to back it up. I highly recommend this resource for a deeper understanding of the nature of neuropathodynamics and very detailed procedures for treating them.
Second, I agree with Cory that we should be looking for the commonalities in our treatments instead of dividing into camps and throwing stones at one another over walls made of incomplete and insufficient theories.
I have taken DiMaggio's courses, and Barrett's among many others, and I completely understand where proud and Diane both are coming from. Jon and Doug always bring up excellent questions to steer us away from our need to find the ONE right path. The human body is a COMPLEX system and I for one think it is incredibly exciting being where we are in our profession, making some head way into understanding it.
These types of discussions are necessary and cathartic toward reaching that goal.
Sarah
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - October 1, 2006 1:31:00 PM
|
|
|
proud
Posts: 921
Joined: March 22, 2006
Status: offline
|
Sarah,
Nice synopsis. I agree the human body is complex and we are advancing our ability to understand how best to treat. But let me ask you this:
Do you think that we should "throw" treatments at patients before first having a few outcome studies with variables controlled to determine the benefit of a treatment? I imagine much of the "treatment effect" incapsulated within some of these "theories"( over at SS for example), are just that...a treatment effect called placebo. And yes, I may be wrong in that assumption, all I am asking is to prove me wrong.
It is my opinion that as a professional responsible to the public, then we should hold off on an enthusiastic feeling that you have found a valuable treatment tool until you expose it to well designed research. Most other health care professions do this. Does that not make sense?
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - October 1, 2006 2:30:00 PM
|
|
|
dfjpt
Posts: 238
Joined: April 9, 2006
Status: offline
|
Proud, I'm back.
[QUOTE]I imagine much of the "treatment effect" incapsulated within some of these "theories"( over at SS for example), are just that...a treatment effect called placebo. And yes, I may be wrong in that assumption, all I am asking is to prove me wrong.[/QUOTE]I would like to ask you, how do you define "placebo"?
Fondly,
Diane
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - October 2, 2006 2:09:00 AM
|
|
|
Sebastian Asselbergs
Posts: 1153
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
"placebo" ....ahhh, that lovely word. Means that somehow the brain has been engaged in the effect of the treatment (in the case of placebo - unintentionally). "Somehow" - through manual contact with skin, through patient perception of the therapeutic environment, as well as expectations of the patient. All aspects that have an effect in the brain - and an effect on the pain experience. Occurs in MANY pt-PT encounters - to greater or lesser extents.
So, rather than pooh-poohing the effect , how about trying to trigger it as the core effect of treatment of persistent and chronic pain? And to stop calling it "placebo" in that case - because it is a direct, open attempt at engaging the effect - not a hidden "control" in a study.
_____________________________
Mundi vult decipi
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - October 2, 2006 5:38:00 AM
|
|
|
proud
Posts: 921
Joined: March 22, 2006
Status: offline
|
Sebastian,
Sounds good. And Dfjpt, I understand all the concepts of central pain mechanisms( michael Shacklock etc). I gather that is where you were heading?
People who perform acupuncture refer to placebo as a "non specific component". The argument being that this has a potential to help many patients and therefore has greater clinical value than an intervention with a higher degree of specificity.
My question is if this is the mechanism being utilzed, then where is the division between a reikki master who has a non specific effect on central pain mechanisims and a PT?
Some would argue that treatments need to be safe and effectice and that the "why" can come later. Well, as a regulated profession, I would argue that the "why" must be known, or at least have a known effect through RCT's in order to obtain informed consent. Making your own form of treatment and claiming it works therefore it is justified seems a little outside the realm of what I percieve professionalism is all about.
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - October 2, 2006 5:43:00 AM
|
|
|
srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
Status: offline
|
proud,
I will address your question to me more specifically, but I was just reading this and thought it shed some light on your question about the need for outcome studies:
http://blog.evidenceinmotion.com/evidence/2006/10/good_outcomes_v.html
Sarah
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - October 2, 2006 6:40:00 AM
|
|
|
proud
Posts: 921
Joined: March 22, 2006
Status: offline
|
Sarah,
Thank you. I think my use of the term "outcome studies" was meant to be in tune with what the article by Hebert was indicating:
>>>>This is why the proponents of Evidence-based Physiotherapy, including ourseleves( Hebert et al 2005), argue it is necessary to look to randomised trials to determine, with any degree of certainty, the effects of an intervention. It is illogical, on the one hand to look to randomised clinical trials for evidence of effectivness of intervention while, on the other hand, seeking justification for the effectiveness of clinical practice with uncontrolled measurements of clinical outcomes...>>>>
So RCT's into specific interventions is where I am coming from.
|
|
|
|
|
Re: adherent nerve root, who knows how to treat it? - October 2, 2006 7:57:00 AM
|
|
|
dfjpt
Posts: 238
Joined: April 9, 2006
Status: offline
|
Proud, [QUOTE]My question is if this is the mechanism being utilzed, then where is the division between a reikki master who has a non specific effect on central pain mechanisims and a PT? [/QUOTE]I agree we've reached the nexus of the discussion, or the point at which we either must 'go outside' to continue our discussion, or else agree to disagree.
1. First of all, about placebo, you accurately predicted where I was heading. Patrick Wall defines placebo as central downregulation - of anything in any system pretty much.
About pain mechanisms (which is what he and Melzack researched together) he said "placebo is not something that is ADMINISTERED TO a patient, it is something that is ELICITED FROM a patient."
A science-based analysis of treatment effects of anything, any sort of kinesthetic input, should consider neuromodulation as the mechanism. Since we're talking manual therapy, that would be "dermo" neuro modulation. As opposed to say, psycho- or pharmo-.
2. The division between a Reiki practitioner and a PT, at least where I would draw one, is that a Reiki practitioner would have no knowledge whatever of the nervous system, and would rely on a belief system, whereas a knowledgeble PT would would know all about the nervous system and would not base therapeutic interaction on any belief system. At least one would hope.
Let me ask you the same question, only let's replace the term "Reiki master" with "chiropractor." Let's replace the term "non-specific" with the term "specific." That seems fair to me, because mesodermalists actually believe they can discount nervous system controls over pain output/reduction thereof, in favor of introducing some sort of byzantine/complicated/expensive-to-learn push or prod into the tissues that will do the job instead.
So the question I have for you is, "My question is if this is the mechanism being utilzed, then where is the division between a chiropractor who (believes he or she) has a specific effect on central pain mechanisims and a PT?"
3. [QUOTE]Some would argue that treatments need to be safe and effectice and that the "why" can come later. Well, as a regulated profession, I would argue that the "why" must be known, or at least have a known effect through RCT's in order to obtain informed consent. Making your own form of treatment and claiming it works therefore it is justified seems a little outside the realm of what I percieve professionalism is all about.[/QUOTE]I am concerned that if this trend continues, if "professionalism" continues to be defined as you state, PT will be forced to "prove" it shouldn't do anything, never has, and never will. It will have its head so far up it's *** it will disappear completely.
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.094
|
Printable Version
