One particular group asked a lot of great questions, this was very refreshing as often, when I ask if anyone has any questions, no one has any, so my response invariably is "Great, so you know everything!"
I get it that it is hard to let go of "acute discogenic pain with radiculopathy," "post surgical anything" "fusion of whatever" but that was almost every question I received today in Houston.
Here are some specific questions
Would you use this approach on....
- post surgical cases
- someone with a C5-6 fusion
- a patient coming in with acute pain
- stenosis
Eventually, the answer after several of these was, the answer to all of your questions is YES! It is liberating to move away from treating a diagnosis, and use a system that directs your evaluation and treatment. Regardless of how the patient is feeling. I told the therapist who asked about patients in acute pain (meaning high level of intensity) - the more acute the better! Rapid onset of pain in the absence of true trauma often equals rapid resolution of symptoms!
One thing I learned, end range is a simple concept not easily attained. You've all heard me preach it over and over. Even several blog readers in attendance were at the courses. Almost every therapist was afraid to push their colleagues or even themselves as far as was needed.
Houston Case Example, a patient with right sided arm, neck, and upper trap pain/tightness. She often stretches to the left to try and relieve this. She has been doing this for years. Chances are, if that was the strategy that would enable her to self treat, that would be all she needs, correct?
Objectively, she could not tolerate end range loading and sustained cervical retraction, this increased her complaints and radiated to her thoracic spine and worsened her scapular symptoms. Then I assessed cervical sidebending left, which was full and sidebending right which had pain during motion, and moderate loss to the right. Repeated retraction to the right, was at first PDM, which rapidly changed to ERP. She gained motion rapidly, and it felt more comfortable. I had her place her left hand on her ribs to do "I'm a little teapot" to slack the left upper trap, enabling her to get to end range. After 50-60 reps, she went from about 10 degrees of SB to touching her ear to her scapula. Almost all her pain went away, and sidebending to the left no longer reproduced her complaints. She kept up with repeated retraction with SB to the right hourly the rest of the class and her chronic pain of years in duration, was pretty much gone! Some work on her IASTM patterns by her partner improved her SFMA tests of MRE and LRF on the involved side as well.
This patient and others who just witnessed this rapid change also had trouble pushing their partners to end range. The ultimate message is farther not harder. If you cannot do it on yourself, or do it to a clinician with little to no complaints, it is very tough to have the same rapid response in a real patient caseload.
Another recurring pattern and theme of the weekend. I coined a new term "Stupid Easy." Moving someone to end range in a loading pattern that was contrary to what the patient/therapist was already doing ad nauseum, and working on soft tissue patterns to make rapid changes in SFMA, MDT, and Neurodynamic movements is so easy, it's stupid. Less is more.
Another case, patient with decades of left radiating arm pain. Loss of left cervical sidebending, full right cervical sidebending - she normally stretches to the right, shocker, huh? Instead of end range loading the cervical spine, I tested neurodynamics, severe limits with painful paraesthesia in the median and ulnar nerves, reproducing her left UE complaints. Less than 2 minutes of basic skin scraping (re: light as possible) in medial upper arm and anterior forearm patterns. She has nearly full motion in both neurodynamic movements and almost full resolution of complaints. Yes... it works this way on patients too.
There is nothing magical about rapid changes, unless by magic you mean neurophysiologic. One participant who owns a private practice that sees 70% outpatient neuro, 30% ortho, asked, "So, you're really just using neurosci to explain everything?" YES!!! The take home message is, none of these approaches, PNF, IASTM, MDT, education, prevention, education, skin stimulation, should be compartmentalized as they are in school. Indications for rapid response, interaction, intact skin, end range, and a nervous system.
Objectively, she could not tolerate end range loading and sustained cervical retraction, this increased her complaints and radiated to her thoracic spine and worsened her scapular symptoms. Then I assessed cervical sidebending left, which was full and sidebending right which had pain during motion, and moderate loss to the right. Repeated retraction to the right, was at first PDM, which rapidly changed to ERP. She gained motion rapidly, and it felt more comfortable. I had her place her left hand on her ribs to do "I'm a little teapot" to slack the left upper trap, enabling her to get to end range. After 50-60 reps, she went from about 10 degrees of SB to touching her ear to her scapula. Almost all her pain went away, and sidebending to the left no longer reproduced her complaints. She kept up with repeated retraction with SB to the right hourly the rest of the class and her chronic pain of years in duration, was pretty much gone! Some work on her IASTM patterns by her partner improved her SFMA tests of MRE and LRF on the involved side as well.
This patient and others who just witnessed this rapid change also had trouble pushing their partners to end range. The ultimate message is farther not harder. If you cannot do it on yourself, or do it to a clinician with little to no complaints, it is very tough to have the same rapid response in a real patient caseload.
Another recurring pattern and theme of the weekend. I coined a new term "Stupid Easy." Moving someone to end range in a loading pattern that was contrary to what the patient/therapist was already doing ad nauseum, and working on soft tissue patterns to make rapid changes in SFMA, MDT, and Neurodynamic movements is so easy, it's stupid. Less is more.
Another case, patient with decades of left radiating arm pain. Loss of left cervical sidebending, full right cervical sidebending - she normally stretches to the right, shocker, huh? Instead of end range loading the cervical spine, I tested neurodynamics, severe limits with painful paraesthesia in the median and ulnar nerves, reproducing her left UE complaints. Less than 2 minutes of basic skin scraping (re: light as possible) in medial upper arm and anterior forearm patterns. She has nearly full motion in both neurodynamic movements and almost full resolution of complaints. Yes... it works this way on patients too.
There is nothing magical about rapid changes, unless by magic you mean neurophysiologic. One participant who owns a private practice that sees 70% outpatient neuro, 30% ortho, asked, "So, you're really just using neurosci to explain everything?" YES!!! The take home message is, none of these approaches, PNF, IASTM, MDT, education, prevention, education, skin stimulation, should be compartmentalized as they are in school. Indications for rapid response, interaction, intact skin, end range, and a nervous system.
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| Having a well deserved beer with Carlos Reta |
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| How not to sit, like a pro! |
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