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How do you explain joint mobs to pts?

 
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How do you explain joint mobs to pts? - June 7, 2011 10:09:15 PM   
Kidwell_PT

 

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Just curious what you tell pts when you are performing joint mobilizations. It seems when I explain to them what I am going to do they associate it with what chiropractors do. I try to follow that up by further explaining what I am trying to do using models, spines etc and typically say I am not sure what chiropractors do.
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RE: How do you explain joint mobs to pts? - June 7, 2011 10:50:52 PM   
Physiogenius

 

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Are you asking how to explain to a patient the difference between a joint mobilization and a joint manipulation?

If you are, just tell them they are the same, but the mobilizaton is done with a lot less pressure.

You can also tell them that a mobilization is a stretch and a manipulation is more of a thrust.

< Message edited by Physiogenius -- June 7, 2011 10:52:26 PM >

(in reply to Kidwell_PT)
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RE: How do you explain joint mobs to pts? - June 8, 2011 11:07:13 AM   
Kidwell_PT

 

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I guess I am talking more about the mechanics behind what I am trying to do, not just mobs vs manip. Maybe it is a case where I try to explain to much. I like to explain exactly what I am doing to patients to help them understand there is a reason for what I am doing.

(in reply to Physiogenius)
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RE: How do you explain joint mobs to pts? - June 8, 2011 12:58:11 PM   
Eric E Douglass, PT, DPT, OCS, FAAOMPT

 

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I usually start from the mechanoreceptor aspect, explain that my initial goal is to inhibit pain and guarding through stimulation of the type 1 and type 2 mechanorecptors in the facet joint capsules, I go in to a patient friendly explanation of what is happening at the dorsal horn of the spinal chord and how the mobilizations can effect the action of the neurotransmitters associated with pain perception and then I proceed to discuss ten second holds at the end range of collagen tension to improve plasticity in the facet joint capsule and restore motion around a physiological axis and then as we progress to muscle activation I talk about the importance of coordinating the muscles to control the newly gained range of motion. Finally I show them how, through exercise, self mobilizations and muscle energy techniques, they can, or will be able, to do this all themselves. Works for me and also answers the common question: How is this different than chiro? To which I answer, I am not a chiro nor have I ever been to one, so I can't tell you for sure but...

< Message edited by Eric E Douglass, PT, DPT, OCS, FAAOMPT -- June 8, 2011 12:59:23 PM >

(in reply to Kidwell_PT)
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RE: How do you explain joint mobs to pts? - June 8, 2011 3:15:31 PM   
bonez

 

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Well there is the old thrust into/past certain physiological barriers at end range vs the more rythmic osscilations within certain ranges too
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RE: How do you explain joint mobs to pts? - June 8, 2011 7:54:57 PM   
proud

 

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I REALLY like that answer Eric( aside from the whole ".... to improve plasticity in the facet joint capsule and restore motion around a physiological axis..." bit)

Other than that....nice and succinct.

I also liked how you handle the typical "how is this different than Chrio" question.

Thanks

< Message edited by proud -- June 8, 2011 7:58:52 PM >
Post #: 6
RE: How do you explain joint mobs to pts? - June 18, 2011 8:50:16 AM   
Long Tracts

 

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My reply is not specific to joint mobilizations, but...

quote:

...what you tell pts when you are performing joint mobilizations.


I literally don't tell them anything 'when' I'm adjusting them.

quote:

when I explain to them what I am going to do they associate it with what chiropractors do.


If you are providing spinal mobilization/manipulation for complaints of musculoskeletal pain, don't blame them for being confused.

quote:

I guess I am talking more about the mechanics behind what I am trying to do, not just mobs vs manip. Maybe it is a case where I try to explain to much. I like to explain exactly what I am doing to patients to help them understand there is a reason for what I am doing.


I don't get into mechanics at all. As far as mobs v. manipulations, the patient isn't going to understand (or care) about the difference, IMO. All they're aware of is no-cavitation v. cavitation.

You don't need to make them understand there is a 'reason for what you're doing'. They're already in your hands and under your care. They already know there is a reason.

FWIW, I really like Eric's explanation. However, I don't use terms like.....mechanoreceptor...dorsal horn....type Ia...etc etc. The description is very accurate, but just way over the heads of the patient. They'll nod their head in agreement, but later they are telling their spouse... I have horns in my back interfering with some type of mechanical reflector.

(in reply to proud)
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RE: How do you explain joint mobs to pts? - June 18, 2011 9:39:46 PM   
proud

 

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Long tracts,

Ever read the work of Lorimer Moseley? Read the book explain pain?

Why do you assume it's best to keep your patients in the dark about what is happening?

Do you assume all is fine so long as the patient "gets better" from the episode?

(in reply to Long Tracts)
Post #: 8
RE: How do you explain joint mobs to pts? - June 18, 2011 10:08:44 PM   
Sebastian Asselbergs

 

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From: Barrie, Canada
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+1 proud.

(in reply to proud)
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RE: How do you explain joint mobs to pts? - June 24, 2011 8:27:40 AM   
Long Tracts

 

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Joined: June 25, 2008
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quote:

Ever read the work of Lorimer Moseley?


Yes, I'm familiar with some of his work.

quote:

Read the book explain pain?


No, but it has several favorable reviews, maybe I'll buy a copy.

quote:

Why do you assume it's best to keep your patients in the dark about what is happening?


I don't. My obligations to the patient are:

1. Find out what is causing their problem (pain in this case).
2. Discuss the various treatment options.
3. Design a treatment plan that will resolve their complaint in a timely and cost efficient manner.
4. See that the patient has the knowledge and tools available to help prevent future episodes.

I don't feel it necessary to delve into cord anatomy, differences between Ia and Ib fiber types, or the finer nuances of various mechanoreceptors. IMO, this is not keeping the patient "in the dark".

quote:

Do you assume all is fine so long as the patient "gets better" from the episode?


I'm not sure what you mean. A patient presents with a chief complaint of X, and I (see #1-4 above) leading to resolution of X. How is that bad?

(in reply to Sebastian Asselbergs)
Post #: 10
RE: How do you explain joint mobs to pts? - June 24, 2011 8:33:56 PM   
Sblip

 

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Can we expand this a bit further in regards to how you discuss the source of pain in patients with lower back or neck pain? (aside from irrelevant MRI / X-ray findings)

(in reply to Long Tracts)
Post #: 11
RE: How do you explain joint mobs to pts? - June 25, 2011 10:44:45 AM   
Long Tracts

 

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quote:

Can we expand this a bit further in regards to how you discuss the source of pain in patients with lower back or neck pain? (aside from irrelevant MRI / X-ray findings)


I keep things simple and straightforward explaining that just about anything in the lower back (for example) has the potential to cause pain. If they flat-out ask me, "Is it a _____", I will offer my opinion, telling them to not get too hung up on a specific diagnosis, that it won't likely change the way we're going to treat it anyway. I like to put things in proper perspective, alleviate any fears/concerns they may have and assure them that we will do our best to take care of their problem, whatever it may be.

Could you elaborate on what you mean by irrelevant MRI/X-ray findings?

(in reply to Sblip)
Post #: 12
RE: How do you explain joint mobs to pts? - June 30, 2011 5:40:49 AM   
ginger

 

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Those of you familiar with my posts on the mobilisation method known as CM, will have become familiar also with my explanations about the nature of protective spinal behaviour. Which is what i describe to all patients who present with spinal pain, or spinal related pain/dsysfunction.
That is sumarised by the following.
Your spine is equipped with the means to offer a level of support and protection from perceived threat to itself.
This protective behaviour involves the recruitment of muscles grouped around and near to spinal structures and joints. By turning up the tone of these postural small muscles, a level of protective splinting is activated. This reduces movement and affords a increase in safety, while allowing certain movements to remain.
In many cases these responses proceed unabated and are increased over time. In some cases, this may give rise to pain. In other cases merely reduces movement and increases fatigue.
Sometimes the effect of this behaviour is to create sufficient irritation to nerves and nerve roots, that referred pain occurs in the head and limbs.
The way to restore a non protected state to the spine is with movement.
Active movements can be of great benefit( exercise), although the effects are non specific and often slow.
Passive intervertebral joint movements can greatly increase both the specificity of the response and the speed of the reduction of paravertebral muscle tone.
The effects of continuous movements through a short range, of facet joints ( in particular) is to restore a non protected range of movement to the spinal area treated. This reduces and may ultmately normalise both the state of irritation of nerves and the inflammatory events that involve joints, the result of a poverty of movement.
I follow with self help routines that encourage movement, complimentary to the complained of area as well as globally.
I offer that the two most important aspects of a normal healthy pain free spine are, strength ( fatigue resistance) and mobility. Also that flexibility , although sometimes compelling, as it is taught in yoga classes for instance, is only a small factor in the requirements that a healthy spine has.
I then make a strong recommendation that they shift their AFL allegiance to the Geelong Cats, or if they are already supporters, congratulate them for their good sense.
After that it is small talk.

_____________________________

Geoff Fisher
Physiotherapist

(in reply to Long Tracts)
Post #: 13
RE: How do you explain joint mobs to pts? - June 30, 2011 8:21:24 AM   
Shill

 

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From: Madison WI USA
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Good work Ginger. Your best elaboration to date, in my humble opinion.
Now, since this theory is based on spinal protective behavior, certainly there must be some evidence that this behavior does exist. If the proposed theory is based on muscular activation near the spinal segment in question, this would be detectable from a norm with EMG. Are there some salient studies you can direct us do on this?

BTW, I am headed to your great land in about a month, although I will be North of you by quite a ways, starting with Sydney and then going up to Cairns. Otherwise a pint or two might be in order.

_____________________________

Steve Hill PT

(in reply to ginger)
Post #: 14
RE: How do you explain joint mobs to pts? - June 30, 2011 8:43:12 AM   
ginger

 

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Steve, thanks for that, I may be the worst of all people to ask about recent or relevant research on matters to do with the spine. I do catch up with some reading from time to time, ofetn courtesy of posts on SS, but I'm not a good source for you. As to your visit to Oz, I can understand your reluctance to come to the wintry south, though if you did I would be very pleased to welcome you. Either way I'm sure you will enjoy your stay. By all means give me a call, if you PM me when you arrive I'll give you my private number,
Cheers

_____________________________

Geoff Fisher
Physiotherapist

(in reply to Shill)
Post #: 15
RE: How do you explain joint mobs to pts? - June 24, 2012 1:06:44 PM   
Niko

 

Posts: 137
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I'm going to press on the joint to stretch it out

(in reply to Kidwell_PT)
Post #: 16
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