Joined: November 15, 2003
Rob, thank you for this.
From what you have posted, it would seem that: Facet joints do not refer pain (which I have known before) BUT nearby/adjacent nerves down to the nervi nervorum, etc do. Joints can't refer pain - it's not in their duty statement. BUT referral of pain to a more distal structure is well known....and treated in a number of ways, including ginger's methods. Look forward to the full text.
Joined: February 27, 2005
Rob and Nari , I haven't checked this thread for a while. To your question about the research Rob, I have many things in common with Nari's approach and understanding of the effects of spinal movement therapies. It is clear to me that the brain plays a significant role in the immediate effcts of Mobs. I contend there to be a local one , a reflexive effect also, where by local tissues provide feedback such that immediate change to muscle behaviour and sensation is mediated by both the flow of synovium to cartilage under oxygen debt. Also that nerves adjacent to these joints and intimate to the muscles themselves are localy at the effect of the tightness and irritations associated with hypertonicity. An immediate pain relieving effect is reliably produced with continuous mobs, further pain relief may occur over twenty four hours , suggestive of a metabolic change consistant with the dissipation of substrates associated with inflammation. As Nari points out , it is nerves that feel not joints. It is the activity associated with both an inflammatory event and muscle hypertonicity that explains the commonly experienced distal pain and behaviour changes. These are interpreted by the brain of course and a picture of pain emerges. The introduction of chemicals into joints and immediate spaces will induce pain or relief to only those structures it comes into contact with . It could be that the complex nature of a spondyl and its interactions with nerves in the circumstances of hypertonic muscles and irritated nerves defines a nervous relationship that is not well mimiced by the introduction of chemistry. I can only assume so , as the every day benefits of mobs in my experience goes well beyond those proposed and or refuted by this study.
Joined: August 6, 2006
I have the full text of the article, but I'm not sure how to PM it to you guys, as that choice seems to be limited currently.... if you add the following the the website in my signature, you'll find the text
Joined: March 21, 2006
Great article! I had heard of this article before but never had an opportunity to read it. Dr. Kuslich forces us to question the tissues we are treating in patients with back pain. Spending time on assessing a hypomoblie z-joint seems futile.
In the last paragraph he states that it is important to decompress the disc and nerve and stabilize the motion segment. I think this is a very important comment on his part. This fits into the McKenzie model as well as the Australian model of stabilization. He also comments on the comprssed nerve with scar tissue can increase the sensitivity due to compression and tension of the nerve root an outer annulus. This goes along with neural mobilization techniques and the concept of an adherent nerve root.
Thank you for posting this article. This strengthens my beliefs in both the assessment and treatment approach I take with my patients.
All Bogduk did a study looking at % pain primarily from facet, SIJ and discogenic origin. As I recall, discogenic pain ( provoked by discography) was the majority finding, facet and SIJ around 25% each, not provoked surgically. Don't have the article right at hand, will try to find reference. Did have a copy of article cited above, lost it somewhere. Our library only goes back to 1997 for this journal,"Orthopedic Clinics of North America", online. Pity
Proud Inner 1/3 of annulus not innervated, middle 1/3 MAY be, outer 1/3 is innervated. If nucleus material reaches innervated portion of disc but does not travel outside of annulus, poorly localized back and referred pain can be produced. Can only be confirmed by discography, as will not produce frank radicular pain or motor/neuro changes normally seen and used for dx. Don't recall article either.
As well as: Fukui S, Ohseto K, Shiotani M, Ohno K, Karasawa H, Naganuma Y. Distribution of referred pain from the lumbar zygapophyseal joints and dorsal rami. The clinical journal of Pain. 1997;13:303-307.
Ginger- some more questions of the CM method: 1) Do you not recommend doing CM in a weight bearing position such as Mulligans “NAGs” 2) Do you only perform CM if the spine segment is indeed tender or hypomobile- for instance with lateral epicondylitis and C5/6 not being tender to palp would you trial CM 30 seconds and then retest? And with re-testing are your performing neuro-tension tests or just functional movements that caused pain? It seems from what you have posted in the past that persons with peripheral problems are 90% of the time going to have a tender or hypomobile facet correlating with that level… 3) Do you treat just central low back pain in the same manner- CM to the tender facets- and why do you suppose the same protective state of the musculature and inflammatory responses in the foramen are causing -for some -local pain and for others distal referred pain to the structures those nerve roots innervate? 4) you said that for 20% of the patients they will have residual facet pain- how do you judge if the technique worked if it is based on decrease of their pain/protective response, would these pts ideally have temporarily more facet level pain though their elbow pain (for instance) now greatly decreased?
I would like to start experimenting with this more, though 5 minutes per level, and if sometimes adding up to 20 minutes of pushing- not sure if the thumbs could handle.
Joined: February 27, 2005
Hello Tal, quick answers first 1. Only if they can't lie down. 2.Yes, the first few attempts at moving any joint will usually tell the tale. What i'm looking for first is the answer to the question, 'could this problem be spinal?'and if so, where is the logical origin/level(s) CM is mostly done unilateraly. 2a. functional , active mostly , passive if necessary. 3.Yes. sometimes adding central PA's , provided PA mobs give rise to pain. 3a, this needs a longer answer, however variability in severity, locus and tone will account for differences in the nociceptive stimulus emerging, along with variability in the fashion in which the brain provides and maintains the pain picture. 4.a, obs of the initial ( during treatment) phase of change gives a reliable picture of effect, reducing tone/resistance to passive mvts is the first goal. 4b no. not at time of or immediately post treatment, this irritation becomes clear the following day in most cases and would best be described as "tenderness" Thumbs will get stronger, baby steps first, attempts at incorporating CM bit by bit will satisfy , more as you toughen up. I use Cm almost exclusively, have done for decades, I feel no thumb distress at all, though I did for the early years somewhat. My next video will demonstrate ideal thumb and upper limb "posture", more clearly. cheers