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Old 10-03-2004, 08:30 PM   #1
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Default Pain of Cortical origin!!

Hi all :

Soon i have read an article from the NZ physio journal ,discussing pain as
orginal from the cortex.
Any function has mapping organisation (synaptic connections) in the cortex ,when there is distortion /misorganisation of those mappings ,thus result in pain ,regardless there is inflammation in the soft tissues e.g.reptitive injuries .
when there is miscongruance between the motor intenetion and the sensory input ,thus result in misorganistion.

Also the visual,propriceptive ,hearing inputs also affect thus organistion.
So if you have a patient of those who work in computer typing a lot time , asking him to look ,and feel his fingers may have role in his ,mapping oragnisation ,thus may used as profelactive and a treatment !!

Have i understood the article right ?
i hopr your ideas !

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Old 11-03-2004, 12:32 AM   #2
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Emad,
Can you post the article?
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Old 11-03-2004, 03:17 AM   #3
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By the way, Emad.

I think that you are right on your comment and interpretation. At least your though makes sense to me!
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Old 11-03-2004, 12:22 PM   #4
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Hi Takao& Bernard :

Thank you for your attention .
there is a problem that the abstract contain no knowledge could be considered , however i will post you soon it .
i think that journal was 2000 ,which is not avilable on the web.

I like to mention here a simple trial i read in that article performed on monekeys, apples (i hope i can remember well) were put in a black box ,the monkeys go in different directions to reach the apple , after few days those monekeys stop to eat the apples from the boxes as they suffer reptitives injuries , hwever the period was few days , thus because they do not see the apples , no visual input !

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Old 11-03-2004, 12:36 PM   #5
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Hi all friends :
I have searched pubmed for the same issue of pain of cortical origin , i found a lot ;

J Rehabil Med. 2003 May;(41 Suppl):66-72
Cortical reorganisation and chronic pain: implications for rehabilitation.

Flor H.

Department of Clinical and Cognitive Neuroscience, University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany. flor@zi-mannheim.de

Recent neuroscientific evidence has revealed that the adult brain is capable of substantial plastic change in such areas as the primary somatosensory cortex that were formerly thought to be modifiable only during early experience. These findings have implications for our understanding of chronic pain. Functional reorganisation in both the somatosensory and the motor system was observed in neuropathic and musculoskeletal pain. In patients with chronic low back pain and fibromyalgia the amount of reorganisational change increases with chronicity; in phantom limb pain and other neuropathic pain syndromes cortical reorganisation is correlated with the amount of pain. These central alterations may be viewed as pain memories that influence the processing of both painful and nonpainful input to the somatosensory system as well as its effects on the motor system. Cortical plasticity related to chronic pain can be modified by behavioural interventions that provide feedback to the brain areas that were altered by somatosensory pain memories or by pharmacological agents that prevent or reverse maladaptive memory formation.

ANOTHER ABSTRACT
Appl Psychophysiol Biofeedback. 2002 Sep;27(3):215-27
The modification of cortical reorganization and chronic pain by sensory feedback.

Flor H.

Department of Clinical and Cognitive Neuroscience, University of Heidelberg, Central Institute of Mental Health, J5, 68159 Mannheim, Germany. flor@zi-mannheim.de

Recent neuroscientific evidence has revealed that the adult brain is capable of substantial plastic change in areas such as the primary somatosensory cortex that were formerly thought to be modifiable only during early experience. We discuss research on phantom limb pain as well as chronic back pain that revealed functional reorganization in both the somatosensory and the motor system in these chronic pain states. In phantom limb pain patients, cortical reorganization is correlated with the amount of phantom limb pain; in low back pain patients the amount of reorganizational change increases with chronicity. We present a model of the development of chronic pain that assumes an important role of somatosensory pain memories. In phantom limb pain, we propose that those patients who experienced intense pain prior to the amputation will later likely develop enhanced cortical reorganization and phantom limb pain. We show that cortical plasticity related to chronic pain can be reduced by behavioral interventions that provide feedback to the brain areas that were altered by somatosensory pain memories.


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Old 11-03-2004, 12:42 PM   #6
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Default The famous Herta FLOR!!!

I'll take a look at the pubmed references and put them in the scientific reference forum.

Herta FLOR is already known by many physiotherapists.
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Old 11-03-2004, 08:57 PM   #7
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Hi Bernard & Takao:

This abstract illustrate very well the article whichi have read here you are:

Lancet. 1999 Oct 23;354(9188):1464-6.

Cortical origin of pathological pain.

Harris AJ.

Department of Physiology, University of Otago Medical School, Dunedin, New Zealand. john.harris@stonebow.otago.ac.nz

Pain without accompanying tissue pathology poses a classic puzzle, presented in extreme form by phantom pain in a non-existent amputated limb. A clue to the origin of such pain is given by the recent discovery of a region of cortex active in response to incongruence between motor intention, awareness of movement, and visual feedback. Phantom-limb sensation, and repetitive strain injuries or focal hand dystonias in writers, musicians, or keyboard operators, are accompanied by plastic changes in sensorimotor cortex and by pathological pain. Disorganised or inappropriate cortical representation of proprioception may falsely signal incongruence between motor intention and movement, which results in pathological pain in the same way that incongruence between vestibular and visual sensation results in motion sickness.

PMID: 10543687 [PubMed - indexed for MEDLINE]

This excellent abstract

Comment

So ,when we treat a consumer with neck ,shoulder pain ,it is better to perform exe, in front of the mirror to increase visual input , so feedback will be strong , thus may reoragnise the mapping patterns in the cortex , so there will be balance between motor intention and the outcome , which is the congrance , so there will be skill movement without pain .

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Old 12-03-2004, 06:11 PM   #8
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Emad,
Thank you for your post of the articles/abstracts. The excellent articles, which show how the brain is involved in development of chronic pain.

I agree with you, Emad, on using the vision to help the motor function. The use of vision is a good start, but we need to graduate from that at some point of rehab. We can't have a mirror in front all the time and vision alone will not help us restore normal sensory-motor loop, where you need to feel body position, movement, and muscle action.
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Old 12-03-2004, 08:54 PM   #9
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Hi Takao & Bernard:

THank you very much for going on , really thus so excellent on that topic , at first i have read a lot of article about "Somatic education", but there was not any scientific /evidence to support the concept , NOW , it is avialble at least for me , During that topic of "pain of cortical origin"

I was searching Pubmed for more knowledge Here you are The ::

CONCLUSION
During any movement(function) of the body there will be changes in the cortex , In case of pain there is mapping changes/reorganisation/mispresentations /shaping /sculpt of the brain MAPS , which are in a dynamic status ( I think those are cortex areas ),those changes may increase with chronic pain .

MOTOR INTENTION:
thus the motor command of any fuction

OUTCOME :
which is monitored by
visual input
touch(feel)
proprioceptive
prevouis experince
attention

IF (compare )
miscongurance between the motor intention&outcome , thus result in misperesentaion /remapping leading to pain .

TREAT

visual input through watching /seeing the movement
feel while doing it
proprioceptve input through hands on e.g mobilistion ,motion .....
attention (somatic education)
previous experince ( i do not know )


THEN
I had read through those abstracts {BEHAVOIURAL INTERVENTION} could imrove /treat those mappings , and so chronic pain.

DO you know what are behavioural interventions???

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Old 13-03-2004, 04:03 AM   #10
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Emad,
I am with you on your point.

Here is my guess: Behavioral intervention is a part of posychological approach, ie, used by psychologist. Get clients to become more familiar with what is affecting their pain and to learn about themselves and their pain behavior. Learning allows more control over the pain. For example, they may be advised to keep journal/record of what they did and how the pain reacted --- in the lond run, they start seeing some patterns, or maybe not.
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Old 13-03-2004, 11:50 AM   #11
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Hi Takao & Bernard :

Actually when i asked about BEHAVIOURAL INTERVENTIONS , JUST i was asking what are those techniques which i do not know !!

Regarding "motion" It is no more than one of those parts of the feedback ,which give propriceptive input .
BUT
in our approach here we have many choices to improve the outcome through different inputs as :
visual
touch
attention
proprioceptive
previuos expereince

Using of all those wiil give strong input to
reorganise themaps/syanaptic connections .

I hope we can discuss each way of input to reach the optimamal for every one .

Let us discuss the visual input in our patients.
By the way ,there is a strange idea in my thinking , are blind peoples not easy to be treated .

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Old 13-03-2004, 12:00 PM   #12
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No problems with blinds persons, they have got a better sense of touch!
Behavioral treatments are interestings but a bit far of subject. I'll try to reply in a moment!
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Old 13-03-2004, 10:30 PM   #13
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The blind have much better acuity in the other senses than people with all the senses intact. In Japan, many blind become a massage therapist. When I was little, it was a blind person's occupation -- I did not see nobody but blind massage therapists. They have extraordinary senses in touch, proprioceptions/kinesthetics, hearing, and intuition in order to understand the world within them and outside them.

Sometimes, relying LESS on vision might be helping to develop the other senses. I think that we tend to use vision TOO dominantly in sacrifice for the other senses --- particularly our dominat eye seems to be working too much too hard. And particularly the central vision is used too much vs. peripheral vision. That might be interfering with the function of the rest of the body and sesnse.

A lot of eye strain is because of overuse syndrome of central vision and visual fixation (my hypothesis). Maybe, declining vision may be because of that.
I like to train people's eyes to use the full range of motions, especially periphrally. Since I have trained it for myself, I have less headache (and much less frequently) and tension in the jaw.
The use of visual feedback is good, but I would like to propose the training of eyes is also profound effect on our function.

Diane may know more about the eye, learning from Servaas.
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Old 14-03-2004, 12:59 AM   #14
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It is also interesting to note that, years ago, physiotherapy was considered the ideal occupation for partially sighted and blind people.
In my year there was an almost totally blind man (the only male) in his forties. He did well, until it came to remedial massage lessons, and we protested because for gluteal massage, many of us did not want to be 'exposed' to such intimate touch from a male, and he did not either!
So he went off to a hospital PT (Male) for the practicals.
He had just enough vision to read the dials on machines, and he knew who was who, just by sensing and hearing the voice.
His acute sense of touch was better than any of ours.


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Old 14-03-2004, 01:36 AM   #15
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Yes, about blind PTs...
The first PT job I had (age 20) was in a small prairie city, in the local 300 bed hospital with a little 5-person PT dept. A man came to work with us who was in his forties... his retinas had detached spontaneously not that many years prior.. he had worked in some other field before that, can't remember what. He trained in a special school in England, that taught only blind students to become PTs.
This guy was amazing; he assessed gait problems by listening to people walk! As well, he had the best pair of hands in the world. He lived alone, maintained his own apartment, used a white cane, negotiated traffic in a strange new place in a strange new country with strange new (very windy, icy footing, cold!) weather.. (his third, he was originally from India) and managed very well. About a year after his arrival one of his patients fell in love with him and they married.
I met another blind PT, this time blind from birth, just a few years ago in a workshop, who maintained his own private practice in the interior of the province. He and I were workshop partners, again, good hands..
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Old 15-03-2004, 08:22 AM   #16
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Hello SomaSimplers (a bit long?)

Thanks Emad for these excellent abstracts and fine conclusions.
Nari and Diane,
It is true that blind persons are in-sighted human beings. When I was a young student, I worked in a great clinic (700 beds) and 30 MDs, 75 PTs with two blind ones. A blind PT was able to recognize the persons and how they felt themselve!

I think that is not necessary to be a blind person to loose vision! An human being was last week at the office and I tried to awake his body/mind connections. I wanted that he lifts the shoulders => simple? No, impossible. I helped him and it worked once!!!
I put him face to mirror and he had seen but when he leaved the reflect, he lost the ability to move appropriately.

A blind, well seeing human being!

We have to make a new evolution and a shift in this forum! I propose that we contact (here we can), every time, the writers of abstracts! It is a good way to enhance the level of discussion. :?: :?:
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Old 15-03-2004, 11:28 AM   #17
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Hi all friends:

It is clear that Blind people have many alternative inputs , to replace their sight .

Here you are a sientific reference/evidence to support that visual cortex recieves /being activated from tactile ,and auditory inputs:

Nature. 1996 Apr 11;380(6574):526-8.
Activation of the primary visual cortex by Braille reading in blind subjects.

Sadato N, Pascual-Leone A, Grafman J, Ibanez V, Deiber MP, Dold G, Hallett M.

Human Motor Control Section, Medical Neurology Branch,National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1428, USA.

Primary visual cortex receives visual input from the eyes through the lateral geniculate nuclei, but is not known to receive input from other sensory modalities. Its level of activity, both at rest and during auditory or tactile tasks, is higher in blind subjects than in normal controls, suggesting that it can subserve nonvisual functions; however, a direct effect of non-visual tasks on activation has not been demonstrated. To determine whether the visual cortex receives input from the somatosensory system we used positron emission tomography (PET) to measure activation during tactile discrimination tasks in normal subjects and in Braille readers blinded in early life. Blind subjects showed activation of primary and secondary visual cortical areas during tactile tasks, whereas normal controls showed deactivation. A simple tactile stimulus that did not require discrimination produced no activation of visual areas in either group. Thus in blind subjects, cortical areas normally reserved for vision may be activated by other sensory modalities.

PMID: 8606771 [PubMed - indexed for MEDLINE]

VISUAL INPUT

What I meant here is the using of the visual input to reshape/organise the changes which take place in case of pain .
Here i am going to present you an evidence that changes do( already ) occur through visual input :

Proc R Soc Lond B Biol Sci. 1996 Apr 22;263(1369):377-86

Synaesthesia in phantom limbs induced with mirrors.

Ramachandran VS, Rogers-Ramachandran D.

Brain and Perception Laboratory, University of California, San Diego, La Jolla 92093, USA.

Although there is a vast clinical literature on phantom limbs, there have been no experimental studies on the effects of visual input on phantom sensations. We introduce an inexpensive new device--a 'virtual reality box'--to resurrect the phantom visually to study inter-sensory effects. A mirror is placed vertically on the table so that the mirror reflection of the patient's intact had is 'superimposed' on the felt position of the phantom. We used this procedure on ten patients and found the following results. 1. In six patients, when the normal hand was moved, so that the phantom was perceived to move in the mirror, it was also felt to move; i.e. kinesthetic sensations emerged in the phantom. In D.S. this effect occurred even though he had never experienced any movements in the phantom for ten years before we tested him. He found the return of sensations very enjoyable. 2. Repeated practice led to a permanent 'disappearance' of the phantom arm in patient D.S. and the hand became telescoped into the stump near the shoulder. 3. Using an optical trick, impossible postures--e.g. extreme hyperextension of the fingers--could be induced visually in the phantom. In one case this was felt as a transient 'painful tug' in the phantom. 4. Five patients experienced involuntary painful 'clenching spasms' in the phantom hand and in four of them the spasms were relieved when the mirror was used to facilitate 'opening' of the phantom hand; opening was not possible without the mirror. 5. In three patients, touching the normal hand evoked precisely localized touch sensations in the phantom. Interestingly, the referral was especially pronounced when the patients actually 'saw' their phantom being touched in the mirror. Indeed, in a fourth patient (R.L.) the referral occurred only if he saw his phantom being touched: a curious form of synaesthesia. These experiments lend themselves readily to imaging studies using PET and fMRI. Taken collectively, they suggest that there is a considerable amount of latent plasticity even in the adult human brain. For example, precisely organized new pathways, bridging the two cerebral hemispheres, can emerge in less than three weeks. Furthermore, there must be a great deal of back and forth interaction between vision and touch, so that the strictly modular, hierarchical model of the brain that is currently in vogue needs to be replaced with a more dynamic, interactive model, in which inverted question markre-entrant' signalling plays the main role.

Publication Types:
Case Reports

PMID: 8637922 [PubMed - indexed for MEDLINE]
--------------------------------------------------------------------------------------

Ok, my friends so we can use visual input to re-change the brain maps(patterns).

Now ,how do you say we can use visual input cosidering it a technique
How we could use visual input ?
Are we going to use it habahazerly?
With acute pain like chronic pain ?
e.g. wrist pain , we will ask the patient to look to his hand during movements, we will advise him to look to his hand for all the day /half an hour /an hour....?
Are we going to use it gently in acute pains to avoid making the neuromatrix that there is danger ???????

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Old 15-03-2004, 01:51 PM   #18
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Emad,

Visual inputs can be important and intended in one goal => the patient sees the movement and controls it by vision!
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Old 15-03-2004, 06:40 PM   #19
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The visual input for movement education:
1) look yourself moving in a mirror.
2) look directly at yourself moving.
3) Close your eyes to sharpen the other seses.

When visual input is too dominating the other sesnse for motor control, closing eyes may be a good way to feel our movements. We can often feel us better, when we are not using our vision.
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Old 16-03-2004, 12:03 PM   #20
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Hi all friends , excellent input Takao:
Thus means that we can use one input , more than one , we can replace one input using another one .
Of course if there is one input more dominant , we can strengthen another one .
The mean way we can take through any input will be stimulating in a gentle,gradual,easy,simple,relaxed manner .

we can also making a process of refreshement of the cortex through changing our way of input .

Let us discuss another way of input :

Touch (feel) Input

thus means asking the patient to allow him/herself to feel the paiful area , where is the tension .

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Old 16-03-2004, 04:39 PM   #21
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Hi Emad,
Then the NEXT step might be hands-on,
1. to search out tender (as opposed to painful, felt by the patient without touch) areas. And the step after THAT..
2. gently land on the tender areas, not hard enough to hurt them but hard enough to feel with your fingers the tissue quality...usually turgid and not very mobile... what I usually describe to patients as "gnarly" (I'll write what is meant in the definitions section.. )

Some other next steps, considerations:
3. with the other hand, broad contact, pull skin somewhere else, away from the site, feel the tissue over the tender area or the tissue that IS the tender area melt into normalcy, and be suddenly painfree to pressure.
4. Achieving painfree-ness in tender spots might require placing an entire limb into a strange and unachievable- by- self position.
5. Any pain relieving manouvers by therapist must be entered into slowly enough for all proprioception to be able to stay on task, held for sufficiently long enough (a few minutes) for physiologic processes (blood flow etc,) to shift and adapt to the 'new normal', and returned to neutral position slowly, again to permit proprioceptive function to stay on track so the condition of the tender point remains "turned off" (tissue feel is homogenous, point not tender, patient's range of motion increased, pain decreased)

Hope I haven't taken the discussion off track. It's my daily observation. Perhaps Bernard might be able to make an image of how this happens in the nerrvous system...
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Old 17-03-2004, 04:23 PM   #22
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Hi Diane:

you have forward us to the :

proproceptive input OK:

yes ,we are going to use only gentle ,gradual,fine ,slow,simple input in low degree and number , this is what i feel every day ,The body feels there is an attack/danger ,so may respond inversly.

Diane :
I think the concept you used as(tender areas): Is not it like trigger point therapy?


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Old 17-03-2004, 05:20 PM   #23
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No Trigger point Therapy is suffered by patient.

We have to bring the patient to conscious movement. It is a better way to augment the painfree inputs whashing the painfull ones.
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Old 17-03-2004, 06:03 PM   #24
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The hands-on treatment as described by me above is not direct pressure to the tender points, therefore is not painful. It is like 'judo' in that it deflects their pain right out of them by moving the tissue from a distance ( very easy to do because all tissue is linked together in various planes). No increased experience of pain is being added to the system while pain is taken out of the system. The monitering fingers simply moniter at a level that is not painful. They do not poke into the tissue except to check that it has in fact become painfree. The other hand is doing all the work some distance away.

Meanwhile, the brain learns that 'movement', (or at least proprioceptive input) passive at first, reinforced by active directly after, is painfree.

I agree that active movement is a necessary component. Perhaps Servaas' class will show that prior hands-on treatment will be unnecessary altogether... but in my 35 year experience, getting the pain removed from tissues FIRST greatly facilitates painfree movement after: Normal range, strength, tissue 'tone', muscle balance right and left, balanced gait, greater access to easy upright posture, etc.

It is "treatment simple" for the "somasimple."
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Old 17-03-2004, 09:12 PM   #25
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HI Diane :
Thank you for clarifing your view ,you mean just pulling the skin /ST a distance away from the tender area could be condier propri input ,the other finger over the tender area used for assessing , thus if the dysfunction is soft tissue , ,how about if it is joint ?

Then very gentle glides , and physiological mobilisation is not it proprio input !

You are right in your view regarding just gentle tractioning of the skin ,today i have case of knee osteoarthritis i think your view could be good for /
But our proprio input will depend on the stage ,degree of pulling force ,the distance we use (Am i still using biomechanical basics /rules).

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Old 18-03-2004, 01:06 AM   #26
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Hi Emad, I wonder if you could clarify "could be condier propri input" from your post above?

As for, 'what if the pain is from joint' :
I stepped back a long time ago from worrying too much about joints, changed the 'focal length' with which I treat. Consider the following: (Call me a heretic, I don't mind.)

1. What is a joint? It's a place where two bones come together and provide movment.
2. A lot of soft tissue attaches to joints.
3. At joints, the nerve tunnels are narrow and/or bony. Nerves are vulnerable (David Butler)
4. I think therefore that most "joint" pain is "nerve" pain.

Furthermore.... from a treament perspective...

1. Joint surfaces are somewhere between 5 times (Deane Juhan) and 15 times (a MD I saw on TV discussing joints) slipperier than ice.
2. Soft tissue has a tensile force of something in the neighbourhood of 2000 (two thousand) pounds per square inch surface area. (Deane Juhan, "Job's Body")
3. In any sort of contest between joints and soft tissue, who is going to win, everytime? Soft tissue.
4. To help a body function better, where should one put one's energy? Soft tissue (loaded with nerves, adjustable by the brain) is my choice.
5. Even if one treats what one assumes to be 'the joint'..one is still touching skin (skin is the outside of the brain. Brain, nerves, and skin all come from ectoderm), and all the assorted soft tissue attachments and ligaments around a joint and their innervation, and affecting all the proprioceptors at that joint. So one is still treating nerves anyway.
6. So if we have a 'joint problem', what is that? Really? It's usually a joint that won't line up quite right (soft tissue is pulling it off somehow) or, it is a joint that won't/can't move through full range, again, usually because some voluntarily contractile 'bungee cord' ( soft tissue again) is out of synch in the sequence. Either way, the system has to reset before the joint will function optimally.
7. What is joint 'pain'? Pain is a nervous system function. Not enough oxygen getting to a nerve, or an abnormal force going onto a nerve, or something irritating a nerve, including the brain. (output from cortex)
8. So...we're back to soft tissue again.
9. Someone can have quite advanced xray changes, eg: degeneration, cartilage gone etc, but have little or no pain resulting.

So I think..
1. Joints have been given a bad rap, pain is not their fault.
2. Joints have been given way too much attention from most PTs and all chiros.
3. Because joints are easy to study and measure they tend to attract the science heads, because soft tissue is so variable and fluid and mysterious and alive, it has tended to attract the alternative types.
4. With all the new neuro research blossoming forth, it's time soft tissue of the body, (including skin, muscle, connective tissue, vasculature and nerves, ALL of which contain nervous representation) was considered worthy of really good careful science based treatment, not ignored, not poked, not prodded. Touched as if it were alive and capable of change, which it certainly is.
5. And once soft tissue changes in the desired manner, joints stop being pulled on abnormally and function much better and more painlessly. Instantly, with no coercion.

Off my soap box now,
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Old 18-03-2004, 12:05 PM   #27
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Hi Diane & Bernard:

Diane:
Regarding the sentence you have sked me about . I was concluding that pulling gentlly a skin a distance from the tender area could be cosidered a proprioceptive input, which i also support.
---------------------------------------
Concerning the Joint/soft tissue
I am not against the hypothesis of the soft tissue is more responsible in a high percent of compaints which we deal with daily, yes soft tissue (ST) could be resposbile for compressing nerves ,arteries,viens and entering the closed cycle soft tissue affect the nerve and nerve affects the soft tissue and so on .
Yes ,Diane
The joint could be arthreted ,degenerated since long time in the conumer ,and why pain appeared those days exactly,however thsoe joint changes are already excit since long time .
I beleive in the biomechanical relation the limb lenght may creat problem if there is difference , but i meet a lot of persons daily withvery clear limb difference in length , without any pain/complaint.

BUT
If we have a case of joint pain ( or call it ,surrounding ST problem),we apply physiological passive mobilisation IS not considered proprio input ???

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Old 18-03-2004, 04:22 PM   #28
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Hi Emad,
Thanks for clarifying your other sentence

"BUT
If we have a case of joint pain ( or call it ,surrounding ST problem),we apply physiological passive mobilisation IS not considered proprio input ???"
Yes, absolutely. That's probably why it helps. (I will extend myself out on a metaphoric tree limb and say that's probably the ONLY reason it helps..)
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Old 18-03-2004, 10:10 PM   #29
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Hi Diane &Bernard:

Diane

Please could you clarify the meaning of :
(I will extend myself out on a metaphoric tree limb and say that's probably the ONLY reason it helps..)

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Old 18-03-2004, 10:54 PM   #30
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Sorry Emad, for using poor or unclear English. Lots of metaphors aren't explicable but I'll try to explain this one.

In English, there's an idiom, "out on a limb".... I'm not sure of the origin, but the concrete meaning is, that if you go too far out on a tree limb (branch) it will break and you will fall down. The idiom (metaphoric meaning) is, if you take an idea too far it will support you maybe a little way, but if you go "out on a limb" with the idea, it might break the way a tree branch would... the farther an idea moves away from a central position, the less strength it has. I said I was toying with danger by thinking in perhaps too adventuresome a manner.

So I said I was deliberately extending myself 'out on a metaphoric tree limb' ... (not a commonly thought of idea in our theraputic culture, but an idea that I think is true) about the effect of treatment of joints being mediated through soft tissue/nerves that supply the joint and the tissues, and that I don't regard the joint itself as anything particularly treatable in and of itself, by us, through skin and soft tissue. That was all..

Hope that helps..
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Old 18-03-2004, 11:13 PM   #31
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Bernard and Diane

I will go out on a limb with you, Diane. Proprioception may well be the only reason movement and pain improves after passive mobilisation. If we take the case of headache, where we treat with impossibly light (Gr 1) techniques around the occipital ridge and OC1C2, how could it be anything else?
The other aspect is massage - why does it help? Increase circulation? Maybe. Proprioception? I reckon...

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Old 19-03-2004, 03:37 AM   #32
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It's a strong limb then Nari if it can hold both of us!
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Old 19-03-2004, 08:15 AM   #33
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Bernard, I'm thinking of proprioceptors as little mechanical sensors, capable of detecting relative motion. How about "motion detectors"? Or "tension detectors"? Correct me if I am wrong, but it is my understanding that such endings are strewn everywhere, not just in joints.
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Old 19-03-2004, 08:22 AM   #34
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You are correct. Sensors inform us from everywhere. It's true that, even, passive motion can change our brain behaviors since all things change it!

But there is no certitude that something is listened by patient if he is not listening to his feelings (inputs).
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Old 19-03-2004, 01:34 PM   #35
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Hi diane ,nari& Bernard;

Diane

Thank you very much for explaing that nice explanation of the idea behined the Tree & Branch( Cetral & perpherial)

I Think if the weight increased on the branch it will fail to go with weight ,yes ever branch will only go as he can , as he designed to go with.

BUT
There are recptors in the muscle and the joint ,why NOT we use both to improve propriocept input .

Bernard
Ok , iam with you we will listen very well to things when we use our feeling ,attention to listen ,but alsi at the same time we hear a lot of thing which are not important for us ,e.g. noise , when we feel boring of that noise we close doors and widows !!!

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Old 22-03-2004, 11:19 AM   #36
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Hi Bernard & all friends:

Yes attention is another important way of input/feedback to our cortex to re-change the maps of the cortex.

you have differenate between :

Awarness & attention
you have concluded that awarness is a listening skill with all intention to what happens ,
good to say we can listen to sun heat through our skin ,listen to the flower through ear and eye , it seems that all concepts of somatic education have mind words .
This method depends extremly on the therapist ability to communicate /speak/choose appropriate words/ with the patient .

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Old 22-03-2004, 09:17 PM   #37
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Ok Bernard:

yes , practising ,living is more important than scienific knowledge!

Let us discuss what is previous experince to improve plasticity

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Old 23-03-2004, 07:31 AM   #38
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Emad,

Please, explain => "previous experience to improve plasticity".
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Old 23-03-2004, 12:04 PM   #39
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Hi Bernard:

we can use previous experenice as a way of cortical input to re -map the cortical changes , to increase the feedback.

i think ,but i am not sure ,for example while you are trying to reach with the patient to relaxation status , you tell the consumer :

If there is pain in your house ,try(allow) yourself to re-live/re-feel /remember what you feel now .

thus is previous experince .

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Old 23-03-2004, 12:33 PM   #40
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Yes,

they have to feel that now, the same movement is painfree but the goal must be achieved with attention on the movement.
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Old 23-03-2004, 09:13 PM   #41
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Somasimplers

thank you very much for that excellent discussion ,we have more knowledge regarding the role of the brain in treating pain, seems the issue more and more central .

thank you ;

Bernard
Takao
diane
Nari

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Old 24-03-2004, 08:51 PM   #42
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Emad, you are welcome! You are one of my best discussion buddies. I am learning from you, too.
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