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Re: Reason for back pains, ischias, foot pains, stiff back, disc problems, headaches,.

 
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Re: Reason for back pains, ischias, foot pains, stiff b... - March 30, 2007 8:31:00 AM   
Kongen

 

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Ginger,

On a little side note, I have asked you some questions about your cont.mobs in the past over on **********, and I wonder how you restore function to the SI joints. I have read you stand on your patients sacrum, but other than that, do you have any other methods up your sleeve?

Thanks a bunch!

Anders.

(in reply to tonska)
Post #: 21
Re: Reason for back pains, ischias, foot pains, stiff b... - March 30, 2007 2:10:00 PM   
tonska

 

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Dear ginger...

"malposition may arise because of malfunction"

So where that malfunction comes from???

"but is largely irrelevant. "

That is just shoking response. You can't mean that?

"One cannot tell , for instance , wether a pair of SIJ's is mobile or not, by their position."

Of course not! But if the position is wrong the pelvis can not function symmetrically! If single sij is in malposition the whole pelvis is not functioning as it should be. It doesen't matter if that misplaced sij is blocked or hypermobile...

(in reply to tonska)
Post #: 22
Re: Reason for back pains, ischias, foot pains, stiff b... - March 30, 2007 6:11:00 PM   
ginger

 

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SIJ malfunction/dysfunction or more plainly , immobile, most often occurs as a result of abnormal forces related to ankle foot pronation. The valgus forces arising by virtue of a single or pair of pronated feet will , in almost all cases, be associated with observations of SIJ immobility. Restoring SIJ mobility in these cases , will be temporary ( 3 to 6 months ) unless pronation is properly controlled with orthotics.
The second most likely cause is trauma. Thirdly , poor movement dynamics often seen in the elderly, following long periods of bed rest etc will ofetn lead to SIJ movement loss. The ligaments get tight without sufficient stretch and movement and reduce mobility .
Once again , movement, or lack thereof, can be easily tested with the so called 'stork'test.
There has been bad press about the reliability of this test , but I honestly cannot see what the fuss is about , the stork test is easily learned and I have found it very usefull . Indeed , the only usefull SIJ dynamic test.
POSITION of either inominate ,or sacrum, may be a function of anatomy unrelated to SIJ behaviour. Is unreliable as a feature of interest and may mislead the observer.

_____________________________

Geoff Fisher
Physiotherapist

(in reply to tonska)
Post #: 23
Re: Reason for back pains, ischias, foot pains, stiff b... - March 30, 2007 6:24:00 PM   
ginger

 

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Anders , yes you read correctly and if you had , you must want me to simply repeat what you have read ,is that it ?
I've been unwilling to be involved at the thomathimple thight because of the odd, other worldly culture that seems to thrive there. The blind leading the blind.

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Geoff Fisher
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Post #: 24
Re: Reason for back pains, ischias, foot pains, stiff b... - March 30, 2007 7:32:00 PM   
nari

 

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Ginger, if you are looking for a bite (and probably you're not) then best to fish somewhere else.
Just a nudge though; none so blind as those who cannot or will not see.

Cheers

Nari

(in reply to tonska)
Post #: 25
Re: Reason for back pains, ischias, foot pains, stiff b... - March 30, 2007 8:31:00 PM   
Jon Newman

 

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The Culture. It certainly does influence behavior. Is the blindness you refer to a trait of the people that post there?

As I pause to reflect on that, I completely agree. Thank you.

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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 #: 26
Re: Reason for back pains, ischias, foot pains, stiff b... - March 31, 2007 9:23:00 AM   
Kongen

 

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Ginger,

I also read you knew of a couple of other methods to restore the function of the SI joint other than standing on the sacrum, although not as effective in your mind. I would like to know what those are, as I'm not comfortable enough to stand on my patients yet, and besides, there's nothing in my office to grab on to for balance :)

I've tried PA grade 4 on the sacral sulcus with my hands and upper body weight, which seems to be effective in some.. Always interested in other options.

Anders.

(in reply to tonska)
Post #: 27
Re: Reason for back pains, ischias, foot pains, stiff b... - April 1, 2007 3:12:00 AM   
tonska

 

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"often occurs as a result of abnormal forces related to ankle foot pronation. "

But ofcourse. When innominate has rotated it twistes femur and the whole foot. It is well known that pronation occurs must often to shorter leg. I had overpronation on my short leg. I no longer have overpronation nor a short leg because the problem that caused short leg and overpronation is now corrected..

You think pronation problems are coming from nowhere? You think pronation errors can be corrected with compensative error like orthotics? Then the cause of pronation problem is again left undiagosed.

"Restoring SIJ mobility in these cases , will be temporary ( 3 to 6 months ) unless pronation is properly controlled with orthotics."

As I told most experts try to mobilize the wrong SIJ. Or they don't know how to do it well enough. That is why the relieve is only temporarily. That is why the doctors tell manipulation doesn't alter the position of inominates or SIJs.

Doctors told me to wear orthotisc. I never did because everybody knows that's a bad idea. I know many patients who have had orthotics. They have been using them years with no help. After they got pelvis balanced they threw those orthotics to garbage...

(in reply to tonska)
Post #: 28
Re: Reason for back pains, ischias, foot pains, stiff b... - April 1, 2007 4:50:00 AM   
ginger

 

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Ok Tonska , have it your way. How about you take a break soon from being right, and give a moments thought to gently extolling the virtues of breathing in and out , something you can rightly claim some expertise in.

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Geoff Fisher
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Post #: 29
Re: Reason for back pains, ischias, foot pains, stiff b... - April 1, 2007 12:12:00 PM   
tonska

 

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Too difficult english for me to understand...

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Post #: 30
Re: Reason for back pains, ischias, foot pains, stiff b... - April 1, 2007 7:23:00 PM   
ginger

 

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Anders, over the years I have had occasion to employ three different SIJ mobilising methods. The most immediately effective of which is bodyweight applied through one foot onto the prone patients sacrum, with mobilising effect gained by alternate flexion/extension of your knee. routinely about twenty seconds , up to three times is almost always successful in restoring significant SIJ movements. ( I am 85 kgs )
The other methods are less effective, but chosen on the basis of what patients will cope with.
method two. patient in side lying, upper leg in hip/knee flexion. therapist at the rear, with one hand forcing the illium ( of the upper side )to rotate rearwards, the other hand on the ischium assisting this pressure. Difficult in larger people, usually successful in the frail , tiny, young.
method Three. A manipulation of the inominate away from the sacrum . patient supine, therapist at foot of bench, grasps the foot and suggests relaxation after the briefest of descriptions, after a few 'dummy runs' where therapist pushes the leg into hip/knee flexion and back to straight , exerts a powerful yank into hip/knee extension ( pull the leg straight ), thus distracting the inominate away from the sacrum ( manipulating it ). Works well but usually only get one try at it. After first attempt most patients are too tense to allow sufficient ralaxation.
I've largely abandoned this method in favour of standing mobs.
Clearly some attention to the physiological/anatomical state of your patient must precede any of these methods. I have not had concerns, post treatment ,with any of these methods however.
Remember , restoring SIJ movements will be valuable in the long term for LBP sufferers, particularly the pronators. ( Pronation is a major cause of SIJ immobility ) But must be followed with appropriate orthotic anti pronation control to be lasting.
Cheers

_____________________________

Geoff Fisher
Physiotherapist

(in reply to tonska)
Post #: 31
Re: Reason for back pains, ischias, foot pains, stiff b... - April 2, 2007 10:36:00 AM   
tonska

 

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"( Pronation is a major cause of SIJ immobility ) But must be followed with appropriate orthotic anti pronation control to be lasting."

Yes, that is one theory. Other is that pronation is a symptom of sijd. As is sij immobility, but that comes to the other side than sijd is.

(in reply to tonska)
Post #: 32
Re: Reason for back pains, ischias, foot pains, stiff b... - April 2, 2007 5:40:00 PM   
ginger

 

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For the sake of clarity and perhaps more to benefit other readers than our erstwhile friend, pronation does certainly occur in cases of assymmetrical leg length. The pronated foot ankle is invariably on the long leg side. This is explained by the likelihhod of stance faze increases on the short side , setting up a valgus posture in the long side . This will then lead to SIJ immobility on the pronated( long ) side. I have had success without orthotics in some cases like this , by simply adding a heel lift to the short side, reducing ( though not equalising ) the difference in leg length. This can be successful in elimintaing the abnormal forces leading to SIJ dyfunction , provided the individual was young enough and had only marginal pronation. More severe pronation will require orthotics for a lasting effect on both pronation/sij dysfunction and the resultant increases in abnormal forces in the lumbar spine. While I have heard claims of podiatrists being able to "cure" pronation , by attention to exercise and postural control , I have yet to see any clinical or other evidence that this is possible. Results from orthotics are so good and lasting, I wonder wether , all things considered, it is worth the bother and likelihood of failure , to attempt to restore non pronated postures and gaits any other way.
Comments from those with successful alternatives welcomed.

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Geoff Fisher
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Re: Reason for back pains, ischias, foot pains, stiff b... - April 2, 2007 5:45:00 PM   
Sebastian Asselbergs

 

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"Results from orthotics are so good and lasting, I wonder wether , all things considered, it is worth the bother and likelihood of failure , to attempt to restore non pronated postures and gaits any other way."

Couldn't agree more, ginger.

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Mundi vult decipi

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Post #: 34
Re: Reason for back pains, ischias, foot pains, stiff b... - April 2, 2007 5:51:00 PM   
nari

 

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I agree with Ginger's statement on orthoses as well. Fix the primary issue and all else will sort itself out without our random interventions.

Nari

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Post #: 35
Re: Reason for back pains, ischias, foot pains, stiff b... - April 2, 2007 7:16:00 PM   
ginger

 

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Nari, appropos the comments I made about thomathimple, I hope you took no offence personally, I'm aware you take time to be as straighforward and non judgemental with the many irrational commentors there. I just find myself squirming in my seat wanting to offer comment, knowing there will be few to appreciate or understand them. As long as you are a regular here , I'd be pleased.

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Geoff Fisher
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Post #: 36
Re: Reason for back pains, ischias, foot pains, stiff b... - April 2, 2007 9:33:00 PM   
nari

 

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Ginger,

No, no offence at all taken. Sorry you feel that way about TT. There is a wealth of information there about big picture physiotherapy practice, but am well aware many are not ready or wish to take it in. Oh well, whatever.

Nari

(in reply to tonska)
Post #: 37
Re: Reason for back pains, ischias, foot pains, stiff b... - April 3, 2007 12:54:00 PM   
tonska

 

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"Results from orthotics are so good and lasting, I wonder wether , all things considered, it is worth the bother and likelihood of failure , to attempt to restore non pronated postures and gaits any other way."

That is funny when I have met tens of patients who have been using orthotics for years and after correcting the sijd they threw them into a garbage.

Ofcourse they give some help to most, but how do you explane that for some people they make things worse?

(in reply to tonska)
Post #: 38
Re: Reason for back pains, ischias, foot pains, stiff b... - April 3, 2007 3:19:00 PM   
Sebastian Asselbergs

 

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"but how do you explane that for some people they make things worse? "

Well, a few reasons: poor history, poor diagnosis, poor orthotics, poor practitioner, poor patient, (or their planet was not in the right house) or a combination of all of the above.

You see, that is why "patient-stories" are NOT good evidence. No matter what treatment or surgery or medication or technique you'll investigate, you WILL find many who will NOT be happy with their result.
It is when a scientific group collects data from a very large group of patients in a specific, controlled way, that one can start to make careful conclusions. Not with stories from individuals.....

Doesn't take away from the point that YES, there are a lot of bad apples out there who will sell orthotics to anyone walking through their door, for any condition. And that is sad for those patients who end up being abused for $$$.

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Mundi vult decipi

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Post #: 39
Re: Reason for back pains, ischias, foot pains, stiff b... - April 3, 2007 5:22:00 PM   
ginger

 

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Sebastians point is important. The variations on the theme of pronation control are legion. Best to have these made by an expert ,from lasting materials that are fit for the purpose. You are also somewhere near the money Tonska , by being alert to the role of the SIJ.
Orthotics alone will rarely return normal function to a pair of SIJs. One must first adress function, with methods such as I have described above. The full restoration of normal movement dynamics to a dysfunctional pelvis plays a useful role in the alleviation of spinal protective responses.

_____________________________

Geoff Fisher
Physiotherapist

(in reply to tonska)
Post #: 40
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