Mesodermal movement III - Tressel's new friend

[Barrett Dorko]

Tressel is the gentlest German Shepherd I’ve ever met, also the largest. My friend with the irritated nervous system (now resolving) bought a bunny for his grandson recently and normally it’s kept in a hutch in the garage, but occasionally they’ll bring it inside so that Tressel can play with it like he does everything else.

The long discussion about what methodology would best be used on “trigger points” has generated over 8500 views at this point so I’m sure a few of you have seen it.

Whatever else it may have accomplished, it made it clear that lateral movement of the skin rather than direct perpendicular pressure made a lot more sense when it came to manual methodology. The receptors dictate this.

Tressel doesn’t have any hands and he can’t control his paws nearly so well as he can his tongue. He knows better than to bite (read direct pressure), so he licks.

This is one lucky bunny.

[caro]

http://www.cs.ubc.ca/~vlev/docs/Luk-CHI06.pdf

A paper written by people who research mechanoreceptors for a living, in order to apply their findings to the creation of fancy technology, the stuff we see in sci-fi movies. The stuff that's in our future. In this context, lateral skin stretch is not a stretch...

A device based on this technology, called the Virtual Braille Display (VBD) [9], has been used to render legible Braille dots using only lateral stretching of the skin.
Similar sensations can be achieved using technologies that push into the skin [20], but the lateral skin-stretch configu-ration is mechanically simpler and makes the most efficient use of the range of motion of commercially available piezoelectric bending motors [4], resulting in favorable power, size, and weight profiles. Such a configuration also provides internal mechanical grounding, as forces are generated between adjacent piezo elements.
We thus chose lateral skin-stretch as the most promising configuration for our next stage of design.

[Barrett Dorko]

This TED video is perfectly relevant here.

Regarding Carol Lynn's contribution: I'm reminded of the fact that we don't see with our eyes, but our brain. There's something more about the way Braille changes that organ somewhere I'm sure.

[Tom Bear]

Well, I am the orthopaedic surgeon with the herniated disc that Barrett writes about. Barrett's understanding of the how the receptors in the skin arising from the ectoderm have such a profound effect on the entire nervous system is so simple that even Tressel my German Shepherd (No I haven't changed his name because OSU changed coaches, but that is for another web site.) and many other animals instinctively understand it. I am constantlly amazed that many of my colleagues in the physical thereapy and medical professions do not or will not buy into somethig that is so scientificaly sound. Despite the fact that my L4-L5 disc is one of the largest extrusions I have seen, Barrett is able to quiet my severe neuroclaudication each time he sees me. Each Wednesday night for the past two months I limp out to greet him, and when we are finished I walk painlessly to his car with Tressel tagging along. I am certain he will keep me practicing until my back surgery on the 27th of this month. And then he will quiet my post-operative pain with his touch. Tom

[Diane]

You are pretty sure you really need that surgery, are you Tom?
All the best.

[Barrett Dorko]

I have the distinct impression that movement of the mesoderm is necessary for lasting relief. As helpful as I've been, it seems obvious to me that changing the physicality of the problem will require things be done that I cannot do.

Sure, pre and post op care is essential and justifiable, but it will never replace what else needs done in this instance.

[gollygosh]

Barrett,
Does "movement of the mesoderm" mean removal of the disc?
Is the disc preventing the movement that would allow corrective movement. At first I was surprised to hear you describe surgery as part of the cure. But at the same time I realize you are always specific that ideomotion/Simple Contact is about relieving mechanic pain. So in case like this, surgery, followed by Simple Contact makes sense to you.

Geralyn

[Barrett Dorko]

Isn't it possible that the disc is interfereing with the restoration of adequate blood flow to the nerve? The surgical intervention makes sense to me.

When this is the case it's unlikely that ideomotion will always suffice. That doesn't mean that it won't help at all. I help create a context that Tom needs help with, but it's not enough.

I have NEVER said that ideomotion was always enough.

[Barrett Dorko]

There's also this short thread.

[Barrett Dorko]

It occurs to me that I never really thanked Tom for taking the time to write that. It's true that he's watched me struggle with his colleagues and the local therapy community since 1979 and not seen one bit of change in response to my efforts.

But his friendship and appreciation for my care keeps me going. Without it I may have left long ago.

[gollygosh]

"Isn't it possible that the disc is interfereing with the restoration of adequate blood flow to the nerve? The surgical intervention makes sense to me."

It makes sense to me too. I guess I'm at this point that I tend to more suspicious of any intervention that will leave behind scar tissue. When the pendulum of idea swings, I have a tendency to over-correct, and so your posts here are what it takes to help me center.

Geralyn

[Bas Asselbergs]

Barrett, I will try to remember this thread to link to when people decide to accuse us (you especially) of ignoring or diminishing the issue of tissue pathology.
I wish Tom a successful procedure with no complications; I know his aftercare will be just fine.

[Barrett Dorko]

I have the sense that scar tissue is often just conveniently blamed for problems that would be helped with the right movement if the therapist knew how to catalyze that.

Thanks Bas. I think that surgeons have an attitude toward therapy that only makes sense given what they've learned about what so many in the profession thoughtlessly do.

Yea, I said it.

[Diane]

I'm sure Tom will select the very best.

[Barrett Dorko]

Perhaps he will, but I see his pregression toward pain relief from many angles, all of them informed by his many years of practice.

He has colleagues that think I'm an idiot, just like other PTs they've never spoken to and wouldn't bother giving the time of day. Our profession's own fortress has come to rest against theirs and some of us are trapped between them, unable to enter either one.

Not a bad image - depressing, but not bad.

[Diane]

Fortresses shaped like silos, and not many willing to escape by reading.

[Barrett Dorko]

Diane, I've been working on the silo analogy.

So far, nothin'.

[Diane]

Here's something, don't know if it fits... I think each silo imagines itself to be a lighthouse. But when you look closer, mostly the lightbulbs are burned out, and it's... just a silo. Full of clutter. Stairwell blocked.

[zimney3pt]

Originally Posted by Diane

You are pretty sure you really need that surgery, are you Tom?
All the best.

Diane, this thought has been sticking with me since you wrote it. I'm wondering with some people if the actually do need the surgery.


I'm thinking of this optical illusion. I know why square A looks darker then square B (history of pattern recognition with checkerboard and shadows, etc). But even after looking at this and using it with many patients and knowing the square A and B are exactly the same shade of gray. Square A still always looks darker then square B. I can't get over the illusion because my brain has been wired for too long on pattern recognition and shadows I can't over come it. I wonder with some people if this isn't the case as well with their pain, and that surgery might be the only way to overcome. Kind of like using the mirror box. Trade one illusion for another.

Don't anyone jump over me, I understand the disc is giving mechanical pressure to the nerve and that danger signals are being sent. So no the surgery would not be a total illusion or is the disc only an illusion.

[Diane]

Good question Kory.
I was thinking of Butler and Moseley's book, Explain Pain, in which they refer to discs as "lafts", or "Living Adaptable Force Transducers", and the one between L5 and S1 as "the last laft."

I remember in lectures their saying that people with no back pain can have extruded discs that are found accidentally/incidentally; other people with a lot of back pain have no visualized disc issue; i.e., (yet again) there isn't necessarily a one-to-one correlation, or even any clearcut relationship, between discs and back pain.

[zimney3pt]

Yes, those last LAFTs are a bad one for many people.

There have been a few studies from normal populations and around 40-60% of us are walking around with some form of disc lesion. One of the studies then followed these over time and those with them are at no greater risk for any future problems (7 year follow up study) then those without disc issues. Also disc protrusions have shown to shrink about half their size in an 8 week follow up study and completely gone in all those they looked at within a year.

I always make sure I point these studies out to patients. Because inevitably when their pain doesn't go away in couple weeks they are going to want an MRI. I try to make sure they know this stuff before they get the results that with a flip of a coin will probably show some disc lesion. It has helped a few times as patients have made the choice to not have surgery and wait it out while the body heals itself.

[Diane]

If you have them handy, we should put links to them in this thread.

[Ref in Rehab]

Not specifically a study along the lines Kory spoke of, but interesting nonetheless....

World Neurosurg. 2012 Jan;77(1):146-52. Epub 2011 Nov 17.
Spontaneous resorption of sequestrated intervertebral disc herniation.
Orief T, Orz Y, Attia W, Almusrea K.
Source
Department of Spine surgery, Neurosciences center, King Fahad Medical City, Riyadh, Saudi Arabia.
Abstract
OBJECTIVE:
The aim of this study is to describe six cases with spontaneous resorption of sequestrated intervertebral disc herniation observed using magnetic resonance imaging. In addition, the possible mechanisms, predictive factors of spontaneous disappearance of the sequestrated disc herniation, and the proper surgical timing were discussed and reviewed in literature.
METHODS:
All the studied cases experienced acute radicular pain due to sequestrated intervertebral disc herniation; they refused surgery and were treated conservatively, and they were followed up neurologically and radiologically in the outpatient clinic in regular visits.
RESULTS:
The studied cases included five cases with lumbar disc herniation (three at level L4-5 and two at level L5-S1) and one case with cervical disc herniation at level C5-6. All patients recovered from their radicular pain within 3 to 6 weeks, and it was correlated with resorption of their sequestrated intervertebral disc herniation as documented in their follow-up magnetic resonance imaging at 4 to 9 months.
CONCLUSIONS:
We found that sequestrated disc herniation has potential for regression, which can be clearly demonstrated by magnetic resonance imaging, because of having higher water content, and therefore, may regress through both dehydration and inflammation-mediated resorption. We suggest conservative treatment in the initial course of the sequestrated type of disc herniation for at least 2 months before recommending surgical intervention unless severe neurologic deterioration takes place.
Copyright © 2012 Elsevier Inc. All rights reserved.

[Ref in Rehab]

On the older side, but here are a few studies about the natural history of disc herniations:

Radiology. 1992 Oct;185(1):135-41.
Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery.
Bozzao A, Gallucci M, Masciocchi C, Aprile I, Barile A, Passariello R.
Source
Department of Radiology, University of Rome La Sapienza, Policlinico Umberto, Italy.
Abstract
The aim of this study was to evaluate the evolution of lumbar disk herniation in patients treated without surgery. Sixty-nine patients with a lumbar disk herniation proved at magnetic resonance (MR) imaging underwent a follow-up MR imaging study. The disk herniations evaluated during both MR imaging examinations were measured and classified into four categories according to the change in size that occurred. The patients were also divided into three clinical classes on the basis of the clinical outcome. Sixty-three percent of the patients showed a reduction of disk herniation of more than 30% (48% had a reduction of more than 70%), while only 8% demonstrated worsening of the clinical picture. These findings suggest that lumbar disk herniation may be primarily a medical (nonsurgical) disease and that MR imaging could play an important role in management of and research into the disorder.

Spine (Phila Pa 1976). 1992 Aug;17(8):927-33.
Lumbar disc herniation. Computed tomography scan changes after conservative treatment of nerve root compression.
Delauche-Cavallier MC, Budet C, Laredo JD, Debie B, Wybier M, Dorfmann H, Ballner I.
Source
Department of Rheumatology, Hospital Robert Ballanger, Aulnay-sous-Bois, France.
Abstract
In 21 patients with computed tomography-diagnosed lumbar herniated nucleus pulposus, nerve root pain resolved after conservative treatment. A subsequent computed tomography scan was performed 6 months or more after presentation. This follow-up computed tomography scan was compared with the initial one. A definite decrease in size of the herniated nucleus pulposus was observed in 14 patients: disappearance in 5, obvious decrease in 5, and moderate decrease in 4. No definite change was observed in seven patients. Major computed tomography scan changes occurred significantly more frequently in large herniated nucleus pulposus than in small ones (p. less than 0.05). This study suggests that large lumbar herniated nucleus pulposus can decrease and even disappear in some patients treated successfully with conservative care.
PMID: 1387974 [PubMed - indexed for MEDLINE

[Barrett Dorko]

What a great thread.

I think the optical illusion is especially relevant, and, as Kory said, impossible to overcome.

[Diane]

Originally Posted by Barrett Dorko

I think the optical illusion is especially relevant, and, as Kory said, impossible to overcome.

I would agree, unfortunately.

[Barrett Dorko]

I don't know Diane, a world without illusion would not be livable.

Check out the last line of Row, row, row your boat.

I think this is the last line of Alice in Wonderland as well.

Then there's this:

All that we see or seem is but a dream within a dream.

Edgar Allen Poe

I don't think we want, need or could tolerate anything else.

[Bas Asselbergs]

Just a quick note: I have a herniated disc at C6-7 encroaching and compressing C7 root and a broad-based L3 disc bulge that encroaches on my spinal cord (imaging done with MRI). I had the imaging done because of persistent symptoms with my left arm - pain and unchanging weakness - and unrelenting left thigh numbness and weakness.

In the same week as the results became available, the six month-long symptoms started to clear and I have not had any problems - golfing and doing big choreography is just fine. For a while I was considering I might have to have something "done".
Glad I didn't.

PS: my doctor was also much in favour of waiting it out. I like him.

[PatrickL]

There have been a few studies from normal populations and around 40-60% of us are walking around with some form of disc lesion. One of the studies then followed these over time and those with them are at no greater risk for any future problems (7 year follow up study) then those without disc issues. Also disc protrusions have shown to shrink about half their size in an 8 week follow up study and completely gone in all those they looked at within a year.

Kory, can you post these articles? I'd love to be able to show these to patients

[thrill96]

Originally Posted by Barrett Dorko

What a great thread.

I think the optical illusion is especially relevant, and, as Kory said, impossible to overcome.

I haven't posted in a while, but I'm going to get back to it. I just want to say how grateful I am to folks like Barrett, Diane, Bas, Jason, Kory, etc who make comments like the ones above. It refocuses me and puts things back into perspective.

Grazie tutti!

Will

[zimney3pt]

Here is a starting list of some studies.

[Diane]

Here are a few of the papers that Kory kindly stashed for us, ones that are open access.
Definitely worth a close look.

1. Jensen 1994 Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain

2. Boden 1990 Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation

3. Jost 2004 MRI Findings in Throwing Shoulders

4. Matsumoto 1997 MRI of cervical intervertebral discs in asymptomatic subjects

5. Takada 2001 Natural history of lumbar disc hernia with radicular leg pain: Spontaneous MRI changes of the herniated mass and correlation with clinical outcome

[Barrett Dorko]

These wonderful references (well, wonderful unless you make money on the testing) are setting the stage for a series I'll begin this week titled Becoming minimal.

Watch for it.

[Jess Brown]

Originally Posted by Barrett Dorko

I don't know Diane, a world without illusion would not be livable.

Check out the last line of Row, row, row your boat.

I think this is the last line of Alice in Wonderland as well.

Then there's this:



I don't think we want, need or could tolerate anything else.

Illusions and dreams help us cope with....pain....stress...life...

Barrett, Chicago agrees with you: http://www.huffingtonpost.com/2012/0...n_1342564.html

[John W]

Barrett,

Latecomer to this thread, but I must ask: Are you sure that's not one of those rare Slavic Shepherds?

[Barrett Dorko]

Wikipedia tells me there is such a thing, so now I believe you and don't think you're making some obscure joke. Thanks Wikipedia!

Slavic or not, today's blog post refers to many animals with the same inclination.

Ironically, it also depicts a Slovak working on a Slavic.

[John W]

Obscure joke? Moi??

[Barrett Dorko]

Jess, Thanks.

I think this massive response exemplifies the fact that, unleashed, the desire inherent to life, movement and creative activity will surprise many.

It's even news. Why doesn't my therapy community use it?