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RE: Does reading my posts make you stupid?

 
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RE: Does reading my posts make you stupid? - August 1, 2008 3:56:07 PM   
proud

 

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watch those knickers people. I see Diane's(Hpsg) response sort of funny actually. Afterall, Diane was banned so...

And I think her "cults and kissing a..." was a bit tongue in cheek?

Good points by everyone and far better articulated than I could ever be. Thus I'm remaining on the sidelines. But I do hope to see Doug, Cory, Diane, Rod, Jon etc continue to bring their thoughts here.

It's certainly helping me understand a great deal.

Okay. Now I have a question for Hpsg(). If a patient arrives with a remote Hx of a significant left ankle sprain and ongoing pain9 say 2 years). And they have have a significant asymmetry in knee to wall( lets say 2 cm on left and 10 cm on right). Would not mobilizations or manipulation that increase that range of motion alleviate some of that superficial peroneal nerve problem you speak of? I recently had a patient like this and I did manage to improve the knee to wall measurment on the left to 8cm. But the pain is still present....

Or are you okay with that sort of asymmetry and feel that so long as the pain is eliminated( via dermoneuromodulation....), then ignore the limited DF?

Just curious.

< Message edited by proud -- August 1, 2008 4:22:01 PM >

(in reply to TexasOrtho)
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RE: Does reading my posts make you stupid? - August 1, 2008 4:04:29 PM   
Jon Newman

 

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quote:

It's certainly helping me understand a great deal. Much harder to do on SS as one does tend to feel impending banishment.


Nice.

(in reply to proud)
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RE: Does reading my posts make you stupid? - August 1, 2008 4:11:58 PM   
Jon Newman

 

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quote:

Why doesn't Luke just come and talk for himself. --sj


He talks for himself all the time.  He just doesn't talk directly to you all the time.  I understand that.  Is it wrong? 

Some points have been forwarded.  Try dealing with those instead of the person who made them.  Isn't that what matters?

< Message edited by Jon Newman -- August 1, 2008 4:16:14 PM >

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RE: Does reading my posts make you stupid? - August 1, 2008 4:13:00 PM   
proud

 

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Jon,

I'll edit that out. The intention of my post was to highlight the fact that if everyone keeps things professional and acknowledges the various expertise of each individual poster....then the discussion can be quite fruitful.

It's nice to see everyone here. I'll send you a PM Jon. I just think RE provides a lot of leeway which really should be okay given that we are all professionals. I like the leeway.

Edit: Jon, I note that you do not have a PM icon in your settings?

< Message edited by proud -- August 1, 2008 4:26:48 PM >

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Post #: 124
RE: Does reading my posts make you stupid? - August 1, 2008 4:23:33 PM   
Jon Newman

 

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From: Amherst, WI
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quote:

The intention of my post was to highlight the fact that if everyone keeps things professional and acknowledges the various expertise of each individual poster....then the discussion can be quite fruitful. --proud


Yes, and doing so will not result in someone being banned from SomaSimple.  That's the whole point despite frequent mischaracterizations.

(in reply to proud)
Post #: 125
RE: Does reading my posts make you stupid? - August 1, 2008 4:26:02 PM   
Hpsg

 

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Proud asked a direct question:
quote:

Okay. Now I have a question for Hpsg(). If a patient arrives with a remote Hx of a significant left ankle sprain and ongoing pain9 say 2 years). And they have have a significant asymmetry in knee to wall( lets say 2 cm on left and 10 cm on right). Would not mobilizations or manipulation that increase that range of motion alleviate some of that superficial peroneal nerve problem you speak of?


Diane says:
quote:

Hi Proud, I don't know. I don't "perform" manipulation, and rarely use mobes anymore.


Proud:
quote:

I recently had a patient like this and I did manage to improve the knee to wall measurment on the left to 8cm. But the pain is still present....

Diane says:
quote:

Why not help the system deal with the pain first, and see what happens with the range after? I'll bet the pain bothers the patient more than the lack of range bothers "us."
Most of the time the range comes back all by itself anyway, once the pain is gone.


Proud:
quote:

Or are you okay with that sort of asymmetry and feel that so long as the pain is eliminated( via dermoneuromodulation....), then ignore the limited DF?


Diane replies:
quote:

I'm more ok with asymmetry in the absence of pain than I am with pain in the absence of symmetry. However, usually symmetry improves on its own anyway, once pain (and attendant mechanical allodynia) is no longer a problem.

(in reply to proud)
Post #: 126
RE: Does reading my posts make you stupid? - August 1, 2008 4:44:59 PM   
BB

 

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from post #79, Rod,
quote:

I'm tired and need a beer...good discussion Cory.  Hope to catch up later with it. 


..which made me think you had more to say on the topic.  I was looking forward to hearing it is all.

Might it be possible that you've misread me, now?  I'm sure that I can be more clear, but why the spike in hostility?  What nerve did I strike, sheesh.

An intervention's impact on outcome is not altered by the presence nor absence of an RCT.  Manipulation would have worked on people who met the CPR criteria even before described in an RCT.  RCTs provide descriptions of phenomena, not the phenomena themselves.  That was my point.  And to quote Luke:  "This doesn't mean I think stasis of this situation is satisfactory."

And, SJ apparently gets headaches from white boxes.

SJ,
Wow!

Cory

(in reply to Hpsg)
Post #: 127
RE: Does reading my posts make you stupid? - August 1, 2008 4:51:33 PM   
proud

 

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Jon,

I prefer to say this via PM...but I was directly threatened with banishment at one point. And I really never attacked anyone. I did (I guess )make the mistake of engaging the "outcome versus theory" discussion once again. I never felt I got that squared away in my mind in previous posts on other sites. So I thought I might attempt to do so on SS( straight from the horses mouth so to speak). It was not well recieved at all.

I will not disclose the subsequent personal attacks I recieved (from Barrett)....it was uncalled for and yes....I felt banishment was close by. Either that or another diatribe. Likely a bi-product of some of my comments on sites from the past. I get that. And I am willing to move along....

Regardless. This is a great discussion. And this is a side bar that is not required.

Diane,

Yes it was afterall the pain that brought the patient to me. He never even knew he had that asymmetry. I will say this....he also started getting shin splints when running. When thinking about the mechanics of things....lack of DF is going to have a variety of consequences on running mechanics...which in turn could aggrevate all those nerves you speak of( up the kinetic chain).

I wonder...have you ever had a patient that presented like this? And via addressing the pain only.....the ROM returned after perhaps 1-2 years of ROM loss?

< Message edited by proud -- August 1, 2008 5:02:04 PM >

(in reply to Hpsg)
Post #: 128
RE: Does reading my posts make you stupid? - August 1, 2008 5:18:08 PM   
Hpsg

 

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Proud, see Diane's reply below.
quote:

quote:

Diane,

Yes it was afterall the pain that brought the patient to me. He never even knew he had that asymmetry. I will say this....he also started getting shin splints when running. When thinking about the mechanics of things....lack of DF is going to have a variety of consequences on running mechanics...which in turn could aggrevate all those nerves you speak of( up the kinetic chain).

I wonder...have you ever had a patient that presented like this? And via addressing the pain only.....the ROM returned after perhaps 1-2 years of ROM loss?


Sure. Many times.

(in reply to proud)
Post #: 129
RE: Does reading my posts make you stupid? - August 1, 2008 6:13:52 PM   
TexasOrtho


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quote:

ORIGINAL: BB

from post #79, Rod,
quote:

I'm tired and need a beer...good discussion Cory.  Hope to catch up later with it. 


..which made me think you had more to say on the topic.  I was looking forward to hearing it is all.

Might it be possible that you've misread me, now?  I'm sure that I can be more clear, but why the spike in hostility?  What nerve did I strike, sheesh.

An intervention's impact on outcome is not altered by the presence nor absence of an RCT.  Manipulation would have worked on people who met the CPR criteria even before described in an RCT.  RCTs provide descriptions of phenomena, not the phenomena themselves.  That was my point.  And to quote Luke:  "This doesn't mean I think stasis of this situation is satisfactory."

And, SJ apparently gets headaches from white boxes.

SJ,
Wow!

Cory


Yeah...I actually think I did misread your post Cory.  Sorry for the tone of that last post toward you.  Let me go back and review what we were discussing that night and I'll post up.  Your comments on the RCT have been echoed on this thread and the other and I think frames the argument (most) of us agree upon.  We have to have a balanced approach to clinical issues that encorporates the spectrum of evidence-based resources.

It's once you've "decided" you are correct, and by extension filter out other reasonable possibilities, that I think you stop learning.  I think folks tend to do this at times.  We get too caught up in the latest CPR (forrest for the trees) or too bogged down in theory (analysis paralysis).  I don't claim to be the arbiter of where the fulcrum lies between evidence and theory, I just think the acknowledgement of it's existence seems to be missing from otherwise very good discussions.

< Message edited by TexasOrtho -- August 1, 2008 6:19:32 PM >


_____________________________

Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
Movement Science Podcast and Blog

(in reply to BB)
Post #: 130
RE: Does reading my posts make you stupid? - August 1, 2008 6:54:25 PM   
Tom Reeves DPT ATC

 

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quote:

It's once you've "decided" you are correct, and by extension filter out other reasonable possibilities, that I think you stop learning.  I think folks tend to do this at times.  We get too caught up in the latest CPR (forrest for the trees) or too bogged down in theory (analysis paralysis).  I don't claim to be the arbiter of where the fulcrum lies between evidence and theory, I just think the acknowledgement of it's existence seems to be missing from otherwise very good discussions.


Absolutely spot on Rod.  I couldn't have said it better.

(in reply to TexasOrtho)
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RE: Does reading my posts make you stupid? - August 1, 2008 9:35:27 PM   
Hpsg

 

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Sidebar:
Steve, I would like to reply to your message, but your PM is disabled. You can go into your profile and reset it to enable it, if you would like a reply.

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RE: Does reading my posts make you stupid? - August 6, 2008 1:56:19 AM   
bonez

 

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So Diane how would you approach the medial knee pain patient with a 2 year duration of symptoms but with very early OA on film studies and a very mild loss of terminal flexion.

Thanks

(in reply to Hpsg)
Post #: 133
RE: Does reading my posts make you stupid? - August 6, 2008 4:33:28 AM   
Hpsg

 

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quote:

Diane how would you approach the medial knee pain patient with a 2 year duration of symptoms but with very early OA on film studies and a very mild loss of terminal flexion.


Answer:
quote:

I'd assess the knee, assess it with the rest of the person's physicality, make a plan. I'd treat the both the nociception and the pain as perceived. At the same time. Through the nerves, bearing in mind that they are continuous from back to toe.
If there were still any movement deficit after pain relief (usually there isn't), and it bothered the patient by interfering with some desired activity or other, then and only then would I bother dealing with the joint as some kind of specific treatment target.

(in reply to bonez)
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RE: Does reading my posts make you stupid? - August 6, 2008 12:58:56 PM   
torques

 

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Hi all,
    Here is my view on this pain topic. I seldom put emphasis on pain in my practice unless in an acute condition (treatment of the inflammatory process than pain itself). Pain in itself is a symptom. It is not all physiological. There is  psychological component to it especially in chronic cases. I always treat dysfunctions (presence of aberrant motion-Paris SV)which are signs. In most part, pain is caused by dysfunction and not the other way around.
   
    Peace.

Julius Quezon, PT MTC CPed
   

(in reply to Hpsg)
Post #: 135
RE: Does reading my posts make you stupid? - August 6, 2008 3:20:52 PM   
Hpsg

 

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Julius:
quote:

In most part, pain is caused by dysfunction and not the other way around.


Diane:
quote:

Julius,
1. how long a time would have to go by after tissue healing before you would consider the patient to have a persistent pain condition and that there was no longer a "dysfunction"?
2. In other words, at what time, in your experience, does pain itself become the "dysfunction"?
3. At that time, do you assume the patient has psychological problems and is therefore outside your scope?
4. Or do you consider central sensitization mechanisms and treat them with that in mind?

I would have to say that much of the (persistent) "pain" people have is not because they are "crazy," but because their nervous systems have been sensitized physiologically. They now have something that is more than merely a "symptom." They are still treatable, but you have to look at them with slightly more developed and recategorized goggles.


< Message edited by Hpsg -- August 6, 2008 3:25:02 PM >

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RE: Does reading my posts make you stupid? - August 6, 2008 5:09:57 PM   
torques

 

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From: Marion, IN
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Hi Hpsg,
   I am not denying that pain is real for all patients. ("crazy" is a harsh worse, I reserve that term for psychotic patients) I just downplay it because it is subjective and hardly/ accurately measureable. It can't be purely assessed without considering other mechanics of pain.  I think more of function which I can objectively quantify. I consider pain only if the tissue is obviously inflamed (cardinal signs are present, not just pain) and affecting patient's participation in treatment. But then again, I believe that early mobilization (gentle ROM) is key to improve even acute tissue condition unless there is presence of contraindication (e.g. fracture, infection et al). Chronicity of condition for me is not so much just based on the physiological process of healing. I also consider patient level of reactivity (pain at rest, or during activity or after activity) and disability.  
  I am not generalizing the entire PT case population. I have patient who have autonomic type of pain which is a challenge to treat. My result is mixed. Some respond to general low grade conditioning/flexibility exercise and desensitization but some of my patient don't respond at all. Maybe I should read more research or go to seminars for this.
 
Julius Quezon, PT MTC CPed

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RE: Does reading my posts make you stupid? - August 7, 2008 1:17:38 AM   
TexasOrtho


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quote:


I'd assess the knee, assess it with the rest of the person's physicality, make a plan. I'd treat the both the nociception and the pain as perceived. At the same time. Through the nerves, bearing in mind that they are continuous from back to toe.


I'm not even exaggerating when I say this. The chiropractor who spawned this thread said almost the exact same thing to me.  He practices applied kinesiology.  I'm not comparing you or your methods to the chiropractor Diane, but your statement leaves a lot to the imagination.

What would you actually do with this patient?  Can you walk us through a treatment session? 

_____________________________

Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
Movement Science Podcast and Blog

(in reply to Hpsg)
Post #: 138
RE: Does reading my posts make you stupid? - August 7, 2008 6:28:29 AM   
bonez

 

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Yes I too am a little lost as to how you actually manage this problem. As such i would like to hear an example driven work through.

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RE: Does reading my posts make you stupid? - August 7, 2008 2:37:46 PM   
Hpsg

 

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TO asked:
quote:

I'm not even exaggerating when I say this. The chiropractor who spawned this thread said almost the exact same thing to me. He practices applied kinesiology. I'm not comparing you or your methods to the chiropractor Diane, but your statement leaves a lot to the imagination.

What would you actually do with this patient? Can you walk us through a treatment session?


Bonez asked:
quote:

Yes I too am a little lost as to how you actually manage this problem. As such i would like to hear an example driven work through.



Diane says:
quote:

TO, you had better not get confused between the two...

Management? OK... here is an example of a session (<= link) with a patient, which, from a PHYSICAL therapy (manual treatment) point of view was not so successful, in that she had large yellow flags, but which from physical THERAPY "management" point of view was a success.

For this case of knee pain? It sounds quite straightforward. If it were, I would assess (no, not with applied kinesiology whatever that is), the ordinary PT way, look at the patient, and at his knee, as he was doing things, moving around, standing, from all sides, ROM etc., see if he can squat and come back up. Just usual stuff, before I'd even touch it. I'd look to see how his back, feet and pelvis zones helped or conflicted with his efforts. I'd like to find out which leg he's most comfortable standing through, and why, and how it feels to him. I'd like to find what he does with his body at work and at rest (relaxation positions). Maybe the guy is a compulsive knee crosser, always the same leg, never the other.

I would not, however, be looking through bone and joint and muscle (mesoderm) conceptual goggles. I would be using behavioural goggles, neural goggles, visualizing neural trunks and branches, especially the more superficial ones, mentally overlapping zones of apparent lack of movement to neural structures and what distress they may be in, deciding to interpret the lack of ROM (if any) to a defense by the nervous system against its "environment" (i.e., the rest of the body through which it weaves) rather than a defect somehow in the actual body parts (usually innocent).

Depending on what I found I would proceed to treatment directed toward downregulating perceived pain. The list would include checking/treating all the nerves to be found at the knee, front and back: obturator, saphenous, tibial, fibular, all the cutaneous branches that drape down over the front and sides of the knee and anastomose at the patella. Treatment would involve palpation and skin stretching, maybe in some different positions. That's about it. Then reassess. Probably a longish strip of kinesiotape along the medial side of the knee, applied while the knee is at about 90 degrees of flexion, foot up on a stool.

If there were obvious foot contributions (e.g., feet that looked like they belonged to two different people - e.g., one with pronation and the other not) I would treat the nerves in the lower leg, heel and foot as well. If there were back/hip/pelvis glitches in movement, I would include neural structures at the inguinal area and side, top, back of the pelvis. Maybe on the opposite side of the body. All depends. Sometimes up the trunk all the way up to/including shoulder girdle (lateral cutaneous nerves of trunk).

Any more questions?
The easiest thing would be to just look up "knee" in the treatment manual, TO. I know I gave you a copy, long before things devolved into "cult" and "kissing of ---es." You must have not bothered looking at it.


< Message edited by Hpsg -- August 9, 2008 2:13:10 PM >

(in reply to bonez)
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