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Re: sij dysfunction/ achilles tendinosis

 
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Re: sij dysfunction/ achilles tendinosis - December 13, 2005 6:49:00 PM   
nari

 

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Ginger
I don't get invitations to unsheath claws- this must be a first. Seriously, I don't make a habit of it, especially in cyberspace.

Do pedipulators develop more mechanoreceptors than manipulators? ;)

Nari

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Re: sij dysfunction/ achilles tendinosis - December 13, 2005 7:20:00 PM   
ginger

 

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Shill, the picture on why orthotics are usefull can be made a little clearer for you I'm sure.
When examining someone with spinal pain ( and its corrollory referred pain ) I always check for pronated feet postures. When seen , these individuals invariably have compromised SIJ function. While there is almost always a quick and easy solution to the hypomobility of lumbar ( and other ) spinal facet joints, leading to loss of pain and restored ROM, I prefer to achieve redundancy.
SIJ function is important as a force dissipator for torques and other forces arriving from the legs. Without normal rearward rotation ability of the os on the sacrum, these forces arrive at the lumbar spine and initiate and or continue protective responses there. Once restored to normal ROM these pronators will see a return of sij dysfunction , unlesss pronation is controlled.
I usually send them to a local orthotist who I've known for 15 years.He does very good work with one piece moulded devices, these last about 10 years or so.( cost $240)
Follow up with these people after one , three and five years indicates a trend (without further treatment) for considerably less spinal trouble.
The pediculator

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Geoff Fisher
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Post #: 42
Re: sij dysfunction/ achilles tendinosis - December 13, 2005 7:25:00 PM   
ginger

 

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Nari, yes they do , but if you don't mind I prefer Pediculator, after the ceremony here at the christmas party I intend to be known as the Grand Pediculator, a general posture of indifferent tolerance to others will then be effected. Your unsheathed claws can then not hurt me.

Dashing through the bloody snowwwwww.

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Geoff Fisher
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Post #: 43
Re: sij dysfunction/ achilles tendinosis - December 13, 2005 7:29:00 PM   
Jon Newman

 

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Hey!

I think I'm starting to figure out why your thumbs don't hurt.

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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]

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Post #: 44
Re: sij dysfunction/ achilles tendinosis - December 14, 2005 12:19:00 PM   
Shill

 

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Ginger,
Surely you must have some references showing the efficacy of said orthoses for LBP? Not to mention the incidence of flat feet leading to greater likelihood of LBP.

Again, a fanciful theory, but still edentulous.

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Steve Hill PT

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Post #: 45
Re: sij dysfunction/ achilles tendinosis - December 14, 2005 4:54:00 PM   
ginger

 

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Shill, to say nothing of gobs of verissimilitude

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Geoff Fisher
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Post #: 46
Re: sij dysfunction/ achilles tendinosis - December 14, 2005 5:02:00 PM   
FLAOrthoPT

 

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isn't verisimilitude the process of having realistic historical or actual references be it georgraphical or famous people within the text of a fictional work to make it seem more realistic?
wow mrs.miller would be proud 9th grade english class

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Post #: 47
Re: sij dysfunction/ achilles tendinosis - December 15, 2005 2:19:00 AM   
Randy Dixon

 

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Ginger,

Why when treating patients with pronated feet and SIJ dysfunction do you believe that you can treat from the ground up, using orthoses, when you're whole approach is that the dysfunction works top down. That is, if the SIJ is causing the problem, wouldn't it also be the likely cause of the dysfunctional foot mechanics? If you use orthotics then wouldn't you only be reinforcing/reestablishing the problems that caused the SIJ dysfunction in the first place?


I have to admit, this is a bit like arguing the Bible for me, the internal logic is fun to play with, even if the external logic gets pretty fuzzy.

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Post #: 48
Re: sij dysfunction/ achilles tendinosis - December 15, 2005 4:20:00 AM   
nari

 

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ginger

The only problem is - we don't get snow at Christmas....better to change the lyrics to:
"..dashing through the bush
with a sixpack in the kit.."
or similar.

I guess one could say that you treat proximally and distally...?

I figured out about your thumbs a little way back, but jon stole the line.. ;)


Nari

(in reply to ginger)
Post #: 49
Re: sij dysfunction/ achilles tendinosis - December 19, 2005 7:25:00 PM   
ginger

 

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Randy, sorry old son but I didn't check this thread till today, now where were we.
SIJ dysfunction is not the direct means to achilles tendinosis, that is an effect brought about by inflammatory events of L5Si in particular, leading to altered neural activity. Protective responses around L5Si see to that and are able to be turned off with little drama in most cases with continuous mobs to that joint. This leaves the patient in a state where the contributing factors need to be adressed. That is those biomechanical factors that contribute to the lumbar protective event. Without dealing with pronation , even where full SIJ mobility has been regained, Dysfunction of that pair of pelvic joints will arise within three to six months.
Pronation control , worn regularly for 90 percent of the shoe wearing time, will prevent loss of SIJ function.
You want a permanent good result, deal with all three contributing factors, the low back , the SIJ and pronation .
Happy holidays

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Geoff Fisher
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Post #: 50
Re: sij dysfunction/ achilles tendinosis - December 20, 2005 7:03:00 AM   
Jon Newman

 

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The SI pie sure seems popular no matter how you personally slice it.

[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16356154&query_hl=2]link[/URL]

It should be interesting to see tendinosis responds to this treatment.

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Post #: 51
Re: sij dysfunction/ achilles tendinosis - December 20, 2005 6:59:00 PM   
ginger

 

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Jon , reminds me of the zeal with which surgeons approach the shoulder in cases of so called frozen shoulder. To state there were no complications after surgery is a little bizarre, but that's another matter.
When referred conditions arise, as is very common from lumbar structures, pain at the site of that pain can easily be altered by effects to that site. ie an injection of corticosteroid , use of modalities, ice etc. The referred pain may be relieved , providing a period of sensory "rest" as it were , allowing other factors, ie movement, recovery on a broader sense, to take place.

The results from this study suggest that the intervention at the SiJ was the relevent effect bringing about change to the pain picture( though no details on how and when this was measured are shown). The difficulty I have with using this study as an establishment for perceptiion about SIJ , from a pathophysiological view, or a treatment intervention view, is that sometimes even the wrong treatment works.
If corticosteroid is injected into a joint where referred events produce pain, pain releif happens, the effect is temporary in most cases. This is seen where steroid is improperly injected for those complaining of 'tennis 'elbow. In this clinic, three treatments to the relevant upper spine is the norm for elimination of this problem, without any attention to the elbow itself.
The same goes for shoulder pain of referred origin. Sure , an injection will dull the receptors and reduce inflammation , so will acupuncture, ice, modalities. No doubt the effect of even inapropriate sugery will provide relief from some referred pain.
I have not seen any individual with discrete SIJ pain in many years. many complain of pain in the sacral area, with palpable tenderness to SIJ's, In every case under my supervision or direct attention , this is eliminated with mobs to upper lumbar facet joints, along with some dural stretching. I am not convinced there is such a thing as discrete SIJ pain, which is not referred, unless injury has been the cause.

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Post #: 52
Re: sij dysfunction/ achilles tendinosis - February 9, 2006 2:40:00 PM   
Bagel Physio

 

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hi i am new,

ginger could you just tell me in what way you perform dural stretching?

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Post #: 53
Re: sij dysfunction/ achilles tendinosis - March 19, 2006 8:15:00 PM   
PJM

 

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Ginger,

That SIJ mobe works like a charm

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Post #: 54
Re: sij dysfunction/ achilles tendinosis - March 27, 2006 11:27:00 PM   
ginger

 

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Ballistic stretches work quickest and I believe have the most viability in most cases where dura is tight. For instance the sciatic dura can be stretched in supine where therapist holds the patients leg in hip flexion with knee locked into extension, foot held by therapist into plantargrade or perhaps into some dorsiflexion, to engage the dural length.
Test by patient acknowledging the position where tighness and perhaps pain is felt.
Proceed by raising the leg into hip flexion quickly and forcefully such that a sharp stretch pain is felt ( usually pop fossa area) , repeat 6-8 times. repeat test. repeat this proceedure up to patient tolerance or 5 times. retest.
Ensure that when a sharp movement is made that it really is sharp and forcefull. wild manoevres where proper contact is not made with the limb is to be avoided, while good preparation , counselling about therapists expectations etc set the scene to increase patient compliance.
Rapid change can be expected which is essentially permanent. Most "tight hammies " are really dural tightness untested.

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Geoff Fisher
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Post #: 55
Re: sij dysfunction/ achilles tendinosis - March 28, 2006 6:23:00 AM   
Sebastian Asselbergs

 

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Dura stretches? It does? How'd you know? Is it malleable to sustained or ballistic stretches? With your description, are you not just messing with neural system - feedback changes, inhibitory responses etc? Is that not more reasonable and logical than to assume you are actually "stretching" the dura? After all, we do know that any tissue deformation, esp. manually, has an effect on the nervous system....and we have little to NO evidence that dura actually stretches....

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Re: sij dysfunction/ achilles tendinosis - March 28, 2006 7:23:00 AM   
Tom Reeves DPT ATC

 

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Ginger, what you described above, I would consider dangerous. Do you do this with all of your patients with posterior thigh pain? What do you do with your patients with a positive SLR test? Would you do that on an Olympic hurdler one week before the Olympics? or would you try something different? It sounds like a recipe for a big hamstring injury. Brachial plexopathy results from too rapid stretching of the nerves of the bracial plexus. What do you think you will be doing to the lumbo-sacral plexus?

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Post #: 57
Re: sij dysfunction/ achilles tendinosis - March 28, 2006 11:39:00 AM   
JLS_PT_OCS

 

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With what we know about the mechanical sensitivity of the neural tissue, I would think fast and hard is the last approach to take, and more likely to make things worse than better.
I would think that response to ginger's technique would depend on the level of sensitivity of the neural tissue.
J

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Post #: 58
Re: sij dysfunction/ achilles tendinosis - March 28, 2006 3:00:00 PM   
nari

 

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Ballistic movements as ginger describes might work where sensitivity is low and localised. It is true that in many cases, the socalled tight hams are not 'short', just sensitive to stretch.

Ginger, can you describe the degree of sensitivity your patient with a tight dura might have? How do they present and describe their pain?

It's just that what you describe does not fit in with neurophysiology responses as I understand the process...

Nari

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Post #: 59
Re: sij dysfunction/ achilles tendinosis - March 28, 2006 5:15:00 PM   
ginger

 

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Sebastian
Yes, yes, results are excellent and permanent,sometimes, yes, maybe, No.
Tom
It is not. After a positive slump test,
Yes, no, no it is not, stretching it, reeasing fibrous and other attachments.
Jason
No, it works best, no it does not.
Nari
Any patient presenting with referred pain , such as the majority of hamstring pain where clear evidence of local injury is absent, may be a candidate for restoration of normal dural length.
A positive slump is a usefull guide, though I often stretch even where this is negative, if , for instance a 'hamstring' tightness is percieved.
This applies to those with ankle /foot/calf etc referred pain also.
Cheers, sorry I can't reply in more detail this morning folks .
I think a new thread on dural stretching is in order.Who'd like to start it off?

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Geoff Fisher
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