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Barrett's Forums This discussion is devoted to the latest advances in neuroscience and the clinical phenomena it explains.

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Old 26-06-2006, 10:55 PM   #1
Jason Silvernail
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Default Oh My God I Got It!

Well, I finally got it.

I met Barrett at the APTA conference last week, and he was nice enough to not only buy my wife and I breakfast, but also demonstrate handling and correction on both of us. Now I see why his workshop is not so popular. He must be a jerk.
I really couldn't help but start to laugh when my ideomotor motion started, and was amazed that it truly was as he said it was. Not that I doubted, but I did have trouble getting it to work.

Well, today, it worked on two patients of mine, with disparate areas of pain, who improved immediately in their autonomic state, pain complaints, and even findings on neurodynamic exam!
In the interest of full disclosure, I did have two patients that sort of stood/sat there, clearling stopping their isometric activity and holding themselves in a certain posture, preventing correction. So not exactly 100%, buy surely better than I was doing before.

I mention all this not to brag or take up forum space, but just to help make clear what I was NOT doing earlier, in the hopes I could help others.
1. I was pushing too hard earlier. I was very surprised how light of a contact required, and clearly was resting too heavily on patients before, which might have inhibited their movement.
2. I was doing a lot of explanation and "scene-setting" when I probably should just jump into it. I know Barrett doesn't like to tell us what to say or do exactly, but it helps to get me started sometimes, and after that my therapeutic metaphors develop. So my "lead-in" was quite short today.

In one case, my patient had had a R shoulder Rotator Cuff repair in FEB06, and was now recently having more and more pain in the shoulder, which she couldn't understand. The shoulder mobilization and RC and periscapular strengthening I was doing wasn't working to make it better. A shocker, I know. Anyway, she had also had a carpal tunnel release on the same side, and complained of "trigger points" in her neck on that R side. Her ULNT median was short and painful. After about 10 minutes of correction, her ULNT was normalized and her shoulder ROM was immediately significantly improved.

The other patient I had for first visit, and she had chronic buttock and leg pain. She had had multiple epidural steroid injections and an SIJ injection, which had helped and she said had "diagnosed" her problem as an SIJ problem. She had reported temporary relief with manipulation and massage before. There were 2/5 manipulation criteria (not a good candidate), no centralization with repeated motion, weakness of hip muscles in single leg stance, and TTP at her L SIJ area, and 3/6 SIJ provocative testing. Previously, I would call her a good candidate for lumbar stabilization exercise, and preliminary CPR for success with this made her a good candidate. But, I was fresh off my success with my patient with shoulder pain, so I tried SC first.
This patient actually leaned forward and walked her hands out in front on all fours with knees bent before saying "ahh...that's the spot." She felt warmer immediately, had no pain with lumbar extension where previously there was some, and a negative slump test where previously she had about jumped off the table.

I could get used to this...

J
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Old 26-06-2006, 11:03 PM   #2
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Jason, consider yourself ruined for good! :teeth:
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Old 26-06-2006, 11:43 PM   #3
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Jason,

Did you feel as though all the complex things we do, ie : stretching/mobing/contracting/relaxing/analysing/evaluation was all rather unnecessary and vaguely nociceptive??

I did.

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Old 27-06-2006, 12:29 AM   #4
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Nice to hear Jason and I appreciate hearing what you felt was going wrong before. In other words I didn't mistake your contribution for bragging.

Were the patients able to continue on their own?

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Old 27-06-2006, 12:56 AM   #5
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Jason,

I'm not surprised. It should be noted however that buying breakfast for a couple of vegans isn't like buying for a steak and eggs guy like me. You're a cheap date. Please don't tell your wife I said that.

I'm guessing that you gave the two patients who didn't move something to resist. Here's my advice for next time:

Don't do that.
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Old 27-06-2006, 12:58 AM   #6
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Jon-
I beleive they were, but to be honest, I didn't remove my hands while they were correcting, so I guess it's hard to say.

I talked about autonomic balance and practicing, and said if they couldn't do as well without me in a week, they should call and I'll bring them back in. This sort of followup is common for my manual therapy patients.

I guess we'll see...

J
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Old 27-06-2006, 06:33 AM   #7
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hi jason,

thanks for sharing sounds interesting.

i would like to know about the 2 patients you applied sc on. what was their initial starting position and where did you place the hands on? did they lay on their backs or standing or what?
what did you tell your patients before?
i must say i seem to have patients which don't start to move. sometimes they move if i let them lay down and hold their head, then some move but only the neck noting else.
any tips? from what i understand sc is that the touch is light and no coercion is being done. i sometimes though exaggerate a position they are already in if they don't start to move.
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Old 27-06-2006, 01:04 PM   #8
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That's great to hear Jason. It sets your mind whizzing when you realise how easy it is, doesn't it?

I also found very early on that a lot of explanation is not necessary to illicit the movement, although it may be useful later on.

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Old 27-06-2006, 01:25 PM   #9
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I agree with Luke that explanations later in the course of care are more useful than those given sooner. In fact, initially the patient might find them quite distracting. In my culture I think it's fair to say that pretty much everyone is touch-starved and thus will not need any special preparation for it. I'm pretty sure they aren't starved for coercive touch though.

I hope Baecker that you will one day understand that it isn't the starting position that's important. Every position has its advantages and disadvantages and I swear I don't work with my patients in any sort of sequence. It's also important to remember that the characteristics of correction take precedence over the movement you can easily see.

Baecker, I appreciate your curiosity but you're asking the wrong questions. I say that because the answers aren't going to help you understand this method. Having taught it for a couple of decades I feel I can say that with some confidence.
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Old 27-06-2006, 09:18 PM   #10
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Jason,

What kind of explanation did you use? I have had the same problem talking too much and not just getting started. Each time I have tried to explain SC to a pt. I think of one of the quotes at the bottom of Diane's post about not understanding something until you can explain it to your Grandma.

I realize Baecker already asked about this, but I would like to hear how you approached the pt. (not physically approached, but verbally).

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Old 28-06-2006, 12:10 AM   #11
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Jason

It helps to think that there should be some air between your touch and the patient's body surface. That keeps it light and in no way coercive.

I agree that explanations prior to actual SC should be minimal; too much information will rattle up anticipation and other cognitive processes. I would think about 1 minute or so, to begin with.

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Old 28-06-2006, 01:43 AM   #12
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Jason, now that you've "got it" I expect you could become quite a maven or connector or whatever it is that is necessary to get to that tipping point some day. Meanwhile, I think we all need to lift our share of the canoe of abductive thinking during the long portage upstream along Mesoderm river to Ectoderm lake around the Grand Rapids of cultural indifference.
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Old 28-06-2006, 05:33 AM   #13
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Jason,

Thanks for sharing your insight! Maybe I'm pressing a bit too hard on my patients as well, inhibiting their 'corrective' movement. From what Nari said regarding time spent discussing/informing the patient taking ~ 1 minute, I better change that as well. I have always over-explained things...brevity is something I need to learn I suppose.

Barrett,

Feel free to come down to Forney, TX (20-30 miles East of Dallas) and buy my wife and I breakfast. She's pregnant and I'm a steak and eggs guy myself. I promise you a more expensive ticket than the Veganator.
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Old 28-06-2006, 06:35 AM   #14
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Chris,

I'm developing a basic 1 page document talking about the nonconscious vs the conscious mind; I found some years ago a "sheet for patients" helped me with the subtlety of clinical neurodynamics, during a period when many PTs abandoned neurodynamics because it "didn't work" or "caused too much pain", I decided that the CNS needs very little done to it, but it must be of the right nature and sequence.

Perhaps, typing out an explanation of ideomotion and SC in 1 page only, will help to make thinking effectively succinct. Then give it to a 12 year old to read - someone with no understanding of neuroscience - and see if it 'gels' with him/her. If it doesn't...you can blame the kid (or the information).
Then, take some crucial sentences from the text and this can be a starting point for the intro for a clinical session.

Just a suggestion.

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Old 28-06-2006, 06:46 AM   #15
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hi,

even though I might ask the wrong questions but I still would like that Jason could answer if he has the time.
Reason that I am asking is because that I am experementing with SC and if a patient lays prone on the table and I am having my hands on their heads I never had one yet to get up on its four or turn around or whatever, all what I experienced so far it that they move their heads/necks in odd ways. Often they also fall asleep.
Since traveling to the US and taking a course will be a bit far for me as well expensive so I try to figure out as much I can here. I apologize for the wrong questions but they are important for me at this time.
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Old 28-06-2006, 07:04 AM   #16
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Nari,

Good idea! I have printed out several of Barrett's essays since I first saw his website and have read them each a few times in hopes of 'getting it'. Needless to say, I have yet to reach that point. However, your idea may at least assist my presentation to my patients and I'm sure I'll learn more in the process. Thank you!

Mike,

I'm not sure if the following will be of any help to you, but I've approached my patients with the scenario mentioned in Barrett's essays regarding a child sitting in a classroom...wanting to move and stir about but is not allowed because he/she may get in trouble, i.e. creating a suppression of movement. I've tried to portray examples for my patients like the above as well as adding in some 'simple' and easy to understand physiology.

Baecker,

I'm not sure it matters if your patient, who is lying prone, suddenly assumes a quadruped position. I wouldn't consider this a failure, but rather your attempt at trying to predict their movement which may lead to a predetermined effect of your treatment [read: coercion].
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Old 28-06-2006, 07:57 AM   #17
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Baeker,

Why prone? Was it your choice or the patient's?

The position doesn't matter; what counts more, by my reckoning, is that the patient is free to move. Perhaps sitting or standing, but ask them what they would prefer; after all, we do an awful lot of ordering patients around into positions - it makes a pleasant change that they can choose for themselves.

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Old 28-06-2006, 01:09 PM   #18
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Well, even though Baecker's questions were my own at one time, I feel I shouldn't go into too much detail. I'm afraid that if I say doing X worked for me, then some will try only X and it may not work for them.

But, here's a try: I explain to them that the body does three things in response to pain (withdrawal, protection, resolution- from Patrick Wall). I give them examples of stubbing their toe or me twisting their finger. Then I tell them that they are stuck in the "protection" phase, and I adopt a protected posture to emphasize - face grimacing, shoulders raised, hands in fists, etc. Then I tell them that their body needs to move to resolve the problem and I can help them with that. I have had best luck in standing, and just touch LIGHTLY at lateral shoulders, and they start to move in less than 3 seconds. After about 10 seconds, I ask about correction characteristics, and in every case they've said their involved part or another painful part has felt hot like blood rushing to it. Then I retest their neurodynamic exam and it is almost completely symmetric, and one patient was completely asymptomatic. They turn and usually give me this "How'd you do that?" look, and I explain that the motion is in their body, they need to trust it and practice several times a day. I talk a bit about abdominal breathing and hip abduction, and we're done.
So this is really not much as far as setup goes. I may be doing/saying too much as it is.

Barrett is right about not really needing to be taught any specific technique, but somehow it really helped to have him show me in person, not sure why. I'm sure all sorts of other positions and setups could work equally well, but I haven't tried that as yet.

Not sure if that helps, but there it is...
J
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Old 28-06-2006, 01:42 PM   #19
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Quote:
but somehow it really helped to have him show me in person, not sure why
Two words: Mirror neurons.

It's the same reason the patient will benefit more from seeing and talking to you. It is simply how we're wired and I think touch tends to drive it home even more efficiently than say a "video presentation" or something similar. Think about when your friend has something cool and you say "Let me see that" and reach out with your hands. Your friends holds it up and away from you and slyly says "See". You end up disappointed and not just at your belligerent friend.

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Old 28-06-2006, 01:47 PM   #20
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Jason,

Yeah, that helped. How you approached the explanation of SC to the pt. was my main interest. I'm certain I have talked SC to death with pts. before I even touched them.

Nari,

I like your idea as well. Having something ready before hand would help me organize my thoughts and keep the discussion to what is important.

By the way, I will be moving to a new clinic in the near future where I will be the lone PT. Should be quieter, calmer and a better enviornment to talk with and educate pts.

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Old 28-06-2006, 03:02 PM   #21
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Baeker, your post reminded me of something, when you said your patients were prone; that's how infants develop their spinal movement against gravity. If supine they learn to roll their head from side to side, but if they are prone they learn to lift them up and move them around. There's something interesting about that here, on this Jason/SC thread, but I'm not sure what. Any clues Barrett?

My little postulate, for now, is that maybe patients are flushing out the pipes of their motor programs from the very oldest layer forward.
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Old 28-06-2006, 03:38 PM   #22
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Well, I've had two more successes, one yesterday and a big success again today, and I am slowly reducing the amount of "scene-setting" I'm doing.
It continues to be in standing, and the results continue to be impressive, more so for the patient than me.
It was all I could do to keep from laughing out loud when I saw an upper limb neurodynamic test change 180 degrees in 5 minutes of corrective movement.

I see why Barrett is so guarded about speaking of clinical outcomes - while they are often impressive, the "testimonial" nature of them is problematic.

J
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Old 28-06-2006, 06:53 PM   #23
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hi,

ooops i messed up prone and supine

i ment supine. but yes this helped me a great deal more than you can imagine. i will try this definetly out and yes i understood that the position is not important. still i guess for someone with low back pain it seems to be more logical to start standing or sitting or on all four? or is that incorrect?
what about patients falling asleep?
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Old 28-06-2006, 07:02 PM   #24
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Baecker,

I suspected you meant supine. Please, I only speak English, and when others contribute here in something other than their native tongue I certainly admire the courage that takes.

In any case, I work with people while they are supine a great deal. It's a good idea for a number of reasons, and there are other good reasons for working in standing or sitting. Let the patient lead you from one to the next.

Diane,

I've heard many people comment about how the developmental sequence of posturing might be related to ideomotion but I've never, never seen the idea go anywhere. It seems to be a non-starter.
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Old 28-06-2006, 08:43 PM   #25
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Default Speaking of supine...

I Worked with a patient with complaint of "costochondritis" today.
Previously, he did not tolerate attempts at manipulation/mobilization.

After a few minutes of ideomotor movement in standing and then supine, he felt a strong warmth in his chest area, and his complaints improved.

I'm not sure how he'll do in the end, but it was my first experience with this in supine. I was holding his head off the surface and trying to allow movement as much as possible. I wonder if by holding up his head I was helping him or coercing him. Thoughts?

Anyway, it sure beats the supine sternocostal manipulation. Boy, that one is hard on both patient and therapist. I have a video of it from one of Flynn's manual therapy CDs, but can't post an mpeg here. Suffice to say the setup is difficult and predicting whether it will help is even more difficult...

J
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Old 28-06-2006, 09:41 PM   #26
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Jason,

I added the mpeg type to the board.
You may normally be able to make an attachment.
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Old 28-06-2006, 10:35 PM   #27
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I don't know about anyone else but I'm really tempted to go get some of Jason's first posts to Barrett on RE. He's almost gone full circle.

Well, I'd like to tease him about it but his ability to keep an open mind without abandoning skepticism is something I find admirable.
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Old 28-06-2006, 10:40 PM   #28
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Jason,

I know exactly what you are experiencing - although I am not practising SC yet, I have achieved similar results with 2-3 minutes of neurodynamics on some four month old "frozen shoulders".

It makes one really understand and appreciate what pain is really all about.....and it's not to be found in the 'bibles' of PT practice. Sad.

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Old 28-06-2006, 11:23 PM   #29
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What would "full circle" be in the reasoning lexicon? We have deductive, inductive, abductive.. maybe this would be "circumductive": Able to reason all the way around the equator of a problem.

This is my favorite (a kind I made up) "sphere-o-ductive": Inward or outward reasoning along any (of an infinite number of) vectors perpendicular to a problem.
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Old 29-06-2006, 02:55 AM   #30
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Yeah, Randy, I do recall that Barrett and I didn't exactly hit it off right away.
Funny, when we met at APTA, I could have sworn we'd known each other for years.

Thanks for the compliment about the open mind. I think any EBP-minded therapist would approach SC the way I have, if they only take the time to REALLY investigate the approach. But that's the thing. You've really got to take the time and effort to examine what Barrett proposes in order to understand it, and make an argument. I suspect that that's what the problem is.

But it's really kind of impressive what the patients are reporting. I had a patient today with chronic neck and back pain, who was not improving on the previous treatment of occasional manipulation (gave temp relief only) and lumbar stabilization/motor control exercises. We did a little SC today, and she went from 5/10 pain to 0/10, with improved spinal ROM. It was impressive to see the parasympathetic shift, she said she felt warm and tired afterward.
It really makes a lot of what I was previously doing seem unnecessary.
I've definitely got the cautious optimism going so far...

J
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Old 29-06-2006, 04:03 AM   #31
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I agree, we found a way of communicating that would have fooled anybody else into thinking we'd done it all before. This is especially rare for me.

Rapid and dramatic change as you describe is common. Today in Sioux Falls a woman changed similarly while I handled her and lectured simultaneously. She stated that her painless range improved to places she "hadn't been for years," and I could see no reason not to believe her.

What's of greatest interest to me is the reaction of the therapists witnessing this. They seemed not especially impressed. If they were, their thoughts will turn elsewhere very soon and most work with others that not only won't believe them, they'll discourage their pursuing the method or thinking further. This will be done non-verbally for the most part. That makes it more effective.

You may be the first actual "in-charge" therapist I've had understand things as you do. Perhaps that's what makes your experience so different than others.

By the way, I never take the head off the end of the table in supine. If the patient unconsciously desires cervical extension I'll just let that happen in any one of a number of alternate positions.
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Old 29-06-2006, 12:25 PM   #32
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Jason,

I'm interested in how you go with the costochondritis patient, since this condition is primarily inflammatory in nature (if the diagnosis is correct).

If never heard of a sternal manip before, and I'm no stranger to HVLA. I image it to be quite harrowing. What does it attempt to cavitate?

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Old 29-06-2006, 02:37 PM   #33
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Quote:
If never heard of a sternal manip before, and I'm no stranger to HVLA.
Is it called the 'manubrial whip'? ( )
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Old 29-06-2006, 03:45 PM   #34
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Luke-
I look at costochondritis the same way Barrett says he looks at "adhesive capsulitis" - with suspicion. I think that "diagnosis" was the physicians way of saying "musculoskeletal chest wall pain at the sternocostal area".
It does not have the hallmarks of chemical pain by history, and the anti-inflammatory drugs he's been prescribed don't work. So that throws the diagnosis into a bit of a question.
I'll let you know when he comes in again and what i'll do to treat him, and how he's doing.

Barrett-
Perhaps you're right, my relative position of authority makes it easier for me to treat as I see fit without worrying about pressure from others. If that's the case, then so much the better.

Bernard should be posting the short video clip of the 2nd rib manipulation I'm speaking of, as I couldn't get it to load. It's from a manual therapy CD by Flynn/Whitman/Magel, and is excellent for learning/reinforcing manipulation. So that's nice.

J
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Old 29-06-2006, 03:55 PM   #35
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Well, I added the movie but it doesn't work.
I must change some settings on the board.

You must save the file before read it. Just right click on the link and choose the right option.

The server doesn't allow direct streaming.
Attached Files
File Type: mpg TxHVT2ndRibSit.mpg (466.8 KB, 206 views)
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Old 29-06-2006, 04:18 PM   #36
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Bernard, it played just fine for me. You've gotta love the delayed sound effects!

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Old 29-06-2006, 04:41 PM   #37
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Eric,

I got it! (those damned cache files!)
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If you can't explain it simply, you don't understand it well enough. Albert Einstein
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Old 05-07-2006, 06:47 PM   #38
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Well, in my outpatient Ortho/sports world, I am noticing a group of people who consistently do very well with SC....patients who are postop from shoulder surgeries. Sometimes their progress slows/stops, pain increases, and N&T complaints to hand.
Every patient like this i've tried it on ( 5 so far) has done wonderfully, with signficant improvements in their pain and neurodynamic exams.

I now don't say anything much before starting, just something like, let's see if I can help you find your way out of this pain you're in....and then I verbally encourage the ideomotion when it happens. I am now saving the explanation for, as Luke and Barrett suggest, after the treatment.
Hope that's helpful for those just starting to try this out...

J
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Old 05-07-2006, 06:59 PM   #39
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Jason,

Great to hear. Have you seen any correlation with the ipsolateral hip resting posture? I'd predict it's there 80% of the time.

As you've discovered, these patients represent "an orthopedic problem gone bad" or, to put it more accurately, "an othopedic problem with a neurologic component/solution."

I'll be in Virginia in September. Sorry you'll be in Heidelberg. Send some staff instead.
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Old 05-07-2006, 07:23 PM   #40
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Quote:
As you've discovered, these patients represent "an orthopedic problem gone bad" or, to put it more accurately, "an othopedic problem with a neurologic component/solution."
Or, a neurologic problem that got culturally stuffed into an orthopaedic category by fluke or by design.
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“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

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Old 05-07-2006, 08:20 PM   #41
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Jason,

One more thing. It sounds like you've discovered how to "do nothing" and "understand enough." This is remarkably powerful in the right context.

This "doing nothing" is especially well-suited to the Army, of course (ha,ha). I've heard rumors.

Diane,

I've had to come up with my own definition of "orthopedic problem." It includes mesodermal structures that require healing or repair or strengthening for full recovery. All of this might happen of its own accord without therapeutic instruction or surgery but they, at times, are certainly necessary.

For some of these, an intricate and significant alteration in the neurology must take place as well, perhaps almost entirely. I think this "balance" may shift in either direction and would have difficulty saying where or when the tipping point from one to the next might occur. It's likely that the patient will indicate this in some way, probably through the expression of their autonomic state. We know that this can be difficult to measure and interpret.

No doubt cultural attitudes as expressed by the therapist play a role as well, both consciously and unconsciously.

Sarah Vowell's description of the Canadian Mountie as opposed to the American Cowboy fits perfectly here: "Canada got Mounties - Dudley Do-Right, not John Wayne. It's a mind-set of "Here I come to save the day" versus "Yipee-ki-yay, (insert powerful expletive here)."

I had a feeling you might like that.
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Old 05-07-2006, 08:35 PM   #42
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I actually have noticed the hip thing - though right now I am having better luck in standing and sitting than supine so I don't have an opportunity to see everyone in that position.

But I have to agree with the orthopedic/neurologic difference you mentioned, I think that's exactly right.

I had a guy just the last few minutes who improved his Cx rotation from 10 degrees to nearly full in just a few minutes.

I now know I'm going to do my case study/review article for my DPT program on simple contact, I just need to find an appropriate patient to do a review of. Will keep everyone posted.

J
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Old 05-07-2006, 11:17 PM   #43
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Wow Jason, that could turn you into not just Barrett's new best friend but you could help the whole profession redesign itself. OK.. Back up Diane. I'm being too ambitious for you.
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“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

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Old 05-07-2006, 11:17 PM   #44
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Jason,

Sounds like good stuff. I know I am diving in at the deep end starting with very complex patients, but that is how I chose it. Call me a geek for uncertainty.

I think supine is the most challenging position for SC and have not gone there yet.

Do you use SC on yourself with success?

Good luck with the study.

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Old 06-07-2006, 12:49 AM   #45
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Jason,

Think about doing an SSRD for your review instead of a case study. They are quite similar but an SSRD offers stronger evidence, and SC could do with more of this. I can send you some info on SSRDs if you like.

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Old 06-07-2006, 01:08 AM   #46
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Over the years I've found that for some reason people will choose a "favorite" position to allow their patients to get into before they employ Simple Contact.

Personally, I don't have one, though I often find myself sitting quietly at the patient's head while they're supine, the characteristics of correction popping up all over the place but relatively little motion to see.
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Old 06-07-2006, 09:11 AM   #47
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I have not yet developed a favourite position either, and will often use 3-4 in one session in no pre-chosen order.

In the beginning I felt more comfortable in the standing and sitting postions, only because the movement was more dramatic and thus appeared more impressive and effective. Now I work in supine more often. I am finding that the finger tips of one hand on the lumbar SPs or PSIS and the other at the medial malleolus and/or 1st MTP is an extremely effective contact for encourgaing external rotation at the hip.

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Old 06-07-2006, 12:37 PM   #48
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I love sitting and feeling my head go all over "heaven's" half acre. More successful on myself at the moment - am not always quiet enough inside for my patients yet. getting better. I love the pauses in my head/neck's motion, as if the system says: "Wait here for a bit, this needs to soften for a moment"....Funny, the mention of "orthopaedic/neuro": I also noticed when I let my own head/neck gently correct, I get some very smooth, but noticable joint "pops" on occasion. It is of course, a gentle action, moving into a soft but audible pop and followed by warmth. No HVLA needed ....
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Old 06-07-2006, 01:26 PM   #49
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Luke - I'll PM you about details. Thanks.

Bas -
It's so funny you posted that. I spent yesterday in the afternoon trying to correct my chronic but now subacute and painful Lx radiculopathy in my R leg. I just now finished setting up my workstation so I can stand all day now.
I figured out last night that it was chemical pain, and felt better after a blast of NSAIDs.
Much better today, but most frustrating for me is that now that I can elicit this motion in my patients, I'm having the most difficulty with it myself. Ironic, huh?

I'm hoping to have a few attempts at it tonight, since it seems more mechanical today, with my wife to help, since I can't seem to get it going without touch to set it off. While certainly annoying, it sure does make everything in the "Touch and Sensation" essay make personal sense.

J
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Old 06-07-2006, 04:11 PM   #50
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Jason,
I know exactly what you mean, it seems much harder for me to treat myself, when I have the rare flare-up of scapular pain from too much computer time.
As Barrett mentioned, I have a favorite position for my patients(standing), as the results seem more dramatic, but I am slowly gaining confidence and trying the patients in different positions.
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