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Old 01-05-2009, 01:18 PM   #51
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So all he does is a two second stretch? no repetitions?
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Old 01-05-2009, 02:21 PM   #52
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I guess i'm just saying- that's it's easy to poke holes in their theories about what they do. Because their theories aren't very good.
But what about the reality of what they do? Could this be something worth playing with?
At some point, probably around the time in the U.S. when Medicare finally reaches financial insolvency, PTs will be compelled to use rational treatment interventions. Eventually, the "well it works" excuse won't fly. Payers will demand more. The system will require efficiency and expediency, not just "effectiveness."

We've gotten so spoiled, at least in the U.S., with getting paid for the most ludicrous and non-sensicial methods of treating movement disorders, that we have for all intents and purposes abandoned the concept of efficiency.

Why should I treat someone for half as much time in the clinic with DNM and ideomotion for a half or a third as many visits when I can keep them coming back for 15-20 visits until I've reached their Medicare cap?

So, to answer your question, Jono: I'm tired of "playing" around with the latest slickly advertised, treatment du jour. Give me something I can wrap my intellect around and embrace as meaningful.

Put up or shut up.
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Old 01-05-2009, 02:48 PM   #53
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Default Not helping Larry

Then there's this:

Larry is a sweet man and wonderfully cooperative with therapy. However, he no longer “gets’ how to use his legs once he stands with minimal assistance and every transfer is an adventure, to put it mildly. Formerly employed in the aerospace industry, he asked me yesterday if I worked for Boeing. I’ve been seeing him daily in the therapy department for two weeks.

What I’ll do today is sit him on the NuStep machine where he rows like Ben Hur (early in the movie) and then he’ll sit at the side of an exercise mat and lift his legs repeatedly in various ways, weights attached.

All of this will be billed for appropriately and everybody assumes I’m doing my job. I know it’s a charade and that breaking through to the part of Larry’s brain that has forgotten how to move his legs while standing simply cannot be done.

I find the described technique vaguely interesting but not much. I’d like the originator to talk publicly about what he thinks he’s doing. Is that too much to ask? He gets paid, but so do I.

In the meantime, I’m perfectly happy to admit that I know what I’m not doing – helping Larry.
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Old 01-05-2009, 03:35 PM   #54
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Thank you, Barrett.

I was feeling charitable today.
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Old 02-05-2009, 01:18 AM   #55
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Quote:
Originally Posted by Barrett Dorko View Post
In the meantime, I’m perfectly happy to admit that I know what I’m not doing – helping Larry.
This is exactly how I feel at the SNF I "work" in. The computer says I am productive, but the unfortunate Larry's in attendence remain stagnant. Healthcare?

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Old 04-05-2009, 04:27 AM   #56
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So, to answer your question, Jono: I'm tired of "playing" around with the latest slickly advertised, treatment du jour. Give me something I can wrap my intellect around and embrace as meaningful.

Put up or shut up.

I think my question was more along the lines of: If we assume this is a valid treatment- how might it be working?

I think we can safely assume that it doesn't work by "releasing the myofascia".

So what do you think?- proprioceptive regulation? peripheral nerve mob? spinal reflex? supraspinal? expectancy effect?

Just trying to steer this thread towards a more constructive deconstruction.
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Old 04-05-2009, 04:49 AM   #57
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How about all of those? The proprioceptive part will already include spinal and supraspinal aspects; nerve mobs - of course they move when the limb moves, so that's in. Expectancy effect? Sure, especially if stretch administered by the boss himself.

See, Jason. This is not rocket science. If Aaron spent one week of those 40 years checking some of this stuff.......

And Jono - how do we deconstruct this? Any further? Since quite a few times here, we have seemd to come to agreement that ANY handling will have neurological ramifications..... What else is there to talk about? Again?
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Old 04-05-2009, 04:52 AM   #58
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Jono,

Perhaps I'm oversimplifying things, but when something relieves pain it's ALWAYS because it reduces the origin(s). Just go there and you'll speculate with a much greater chance of being right, or relatively so.
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Old 04-05-2009, 08:20 AM   #59
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Sorry I have this terrible habit of making things more complex than they need to be.
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Old 04-05-2009, 08:37 AM   #60
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Jono,
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Sorry I have this terrible habit of making things more complex than they need to be.
Pain can be a complex issue but remembering that all pain originates in the brain via the nervous system makes it easier.
And there are many ways PTs adopt to ease/resolve pain, but in the end, the neurophysiology is the same whether it is a -myalgia or an -osis or an -itis plus several more.

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Old 06-05-2009, 09:13 AM   #61
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I appreciate the change of direction in this conversation. Your speculations on how Active Isolated Stretching (AIS) may actually be a form of neuro-based work are very helpful. I know this isn't rocket science, but it is neural science... at least one or two steps up from what most massage therapists are generally exposed to... So I've acquired Kandel's Principles of Neural Science. It should give me a better grasp of the basics.

For purposes of this discussion, here is part of the text from page 19 of Active Isolated Stretching: The Mattes Method; this text presents the basic protocol of the method:
Quote:
Active Isolated Stretching: The Mattes Method follows a simple physiological protocol:

1. Identification of the muscles and supportive connective tissues.
2. Isolate the muscle in the most relaxed state.
3. Continue gradual gentle stretch with less than 1 lb. of pressure towards the end point of range providing a controlled return back to the starting position.
4. The entire duration of gradual, gentle stretch should be no greater than 2.0 seconds.
5. Continue repeating this same isolated muscle stretch up to 10 times, with each subsequent stretch to achieve incremental gain of a few degrees of motion without eliciting a contraction of the opposing muscle.
6. Always return the area being stretched to the starting position before continuing the prescribed repetitions. This ensures a continuous supply of blood, oxygen, lymph and nutrition, while stimulating waste removal and enforcing the neural process.
7. Exhale during the stretching phase and inhale during the recovery phase (during the return to the starting position). Oxygen is an important fuel for muscle action.
8. Monitor the stretch reflex carefully as the tissue is stretched to the point of "light irritation" then release the tension to prevent reversal contraction of the muscles-fascia being stretched.
Much of the remainder of the basic method is learning how to position the yourself/the client properly to effectively isolate the tissues you wish to stretch. There are also many modifications appropriate to the needs of special populations and various health conditions.
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Old 06-05-2009, 04:04 PM   #62
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Thanks for posting that, Jason.
It still brings me more questions than answers about this (and that does not really surprise me).

Why 2 seconds.
What is #7 about? He talks about "muscle action" needing "oxygen", yet it is a passive stretch?

I can go on and on, but this really just illustrates a "method" with details of handling without any basis. Lots of minutae, but no explanation as to WHY. Or HOW.

Is it really that strange to say: "all his good results (if there are) can be directly related to: a) it is hands-on, b) it is on the skin, c) it is motion, and d) it engages the whole neurological system of the patient". All the details are just herbs and spice on the same steak.
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Old 06-05-2009, 04:24 PM   #63
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#2 strikes me as especially troublesome. How is isolation achieved? Don't we know that this is extremely difficult? How is "most relaxed state" determined?
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Old 06-05-2009, 05:22 PM   #64
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#1 seems the most problematic to me. Add "consider the nerves present" and "understand their connection to the entire nervous system and its function" and you have a nice description of neurodynamics and gentle handling.
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Old 06-05-2009, 05:48 PM   #65
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I can go on and on, but this really just illustrates a "method" with details of handling without any basis. Lots of minutae, but no explanation as to WHY. Or HOW.
And, this is a big problem in the physical therapy profession and in general conservative pain treatment. Too much minutiae, too much "method," too much focus on "nouns," as Diane continuously reminds us, and not enough emphasis on physiological mechanisms based on sound, plausible theories.

This method is just more of the same, and the apparent unwillingness of its developer to engage in rigorous scientific debate or scrutiny of it only reinforces my assessment that it's more part of the problem than the solution for patients with pain problems.
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Old 06-05-2009, 06:54 PM   #66
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We're watching a merry-go-round, and on the wooden horses are members of our own profession. Every once in a while one of them is brave enough to dismount, but they only walk over to the swan and take a seat, pretending that they've done something quite brave. Those of us watching know better, but those on the horses, well, you know what they're like; easily impressed, timid beyond our imagining, focused on hanging on for dear life.

Anyone care to list the methods we've examined here on Soma Simple? Which and how many have been deemed acceptable from the science-based viewpoint?
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Old 06-05-2009, 07:17 PM   #67
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Great analogy Barrett. It's the illusion of movement without ever going anywhere. A scientific backwater.
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Old 06-05-2009, 10:45 PM   #68
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thank you for the breakdown Jason

can you, or does Aaron Mattes elaborate on any of the why's?


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Old 06-05-2009, 11:07 PM   #69
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Anyone care to list the methods we've examined here on Soma Simple? Which and how many have been deemed acceptable from the science-based viewpoint?
Are you saying they're all worthless?
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Old 06-05-2009, 11:21 PM   #70
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Are you saying they're all worthless?
Seems to me he was just asking the question, but I'll let Barrett reply.
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Old 06-05-2009, 11:53 PM   #71
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Worthless? Where did you get that?

I don't think ANY of the methods are worthless. I think they are difficult if not impossible to defend, as I said. Without defense they would not be acceptable in MY practice. That doesn't make them worthless by any means.

Please be careful not to characterize my words about less-than science based practice in such a way. It does not help.
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Old 07-05-2009, 12:34 AM   #72
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There must be a powerful analogy here that can help bridge the disconnect that some are struggling with between a treatment having "worth" and a treatment having a solid, reasonable scientific rationale.

I recall Barrett's thread about Nikola Tesla, the brilliant though very strange electrical engineer, who invented alternating current. Despite Tesla's obviously better, more efficient and safer method of delivering electricity, it took many explosions, fires and mayhem before Edison was finally able to admit that Tesla's idea made more sense. Of course, Tesla's idea devolved from a deeper and perhaps more imaginative understanding of how electricity works.

Now, I don't know of any interventions that will cause a patient to catch fire or explode, but I know of a few that can cause serious harm and many more still that are probably a waste of time, effort and money.

As I've said before, at some point modern health care systems are going to collapse under the weight of their own inefficiencies. We cannot continue to see health care spending eat huge chunks out of developed countries' GDPs without dire consequences. Particularly while medical mistakes, substandard care for common ailments and dubious surgical procedures continue to increase in frequency.

Aside from all that, if I merely went from patient to patient all day doing stuff just because it "works," I think I would eventually go insane because a) it would invariably NOT work on many patients and b) my brain would turn to mush and c) I would have to don a leather vest and start wearing turquoise bling as I attempted to invoke the "Ancient Warrior."

Definitely not my style.
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Old 07-05-2009, 12:59 AM   #73
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John, you are a funny man.
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Old 07-05-2009, 01:34 AM   #74
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I think my brain did turn to partial mush if I thought too much about all the silly clinical things I used to do (and are still being done) with patients and which worked on a temporary basis, and therefore were "worthwhile" in the eyes of others.

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Old 07-05-2009, 08:40 AM   #75
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Thanks for posting that, Jason.
It still brings me more questions than answers about this (and that does not really surprise me).

Why 2 seconds.
What is #7 about? He talks about "muscle action" needing "oxygen", yet it is a passive stretch?

I can go on and on, but this really just illustrates a "method" with details of handling without any basis. Lots of minutae, but no explanation as to WHY. Or HOW.

Is it really that strange to say: "all his good results (if there are) can be directly related to: a) it is hands-on, b) it is on the skin, c) it is motion, and d) it engages the whole neurological system of the patient". All the details are just herbs and spice on the same steak.
Good questions Bas. The book's Foreword explains much more of the why, but it's heavy on the mesodermal perspective. Essentially the stretch is held for 2 seconds because such a short hold is less likely to trigger the myotatic stretch reflex.

It is not a passive stretch. Once positioned, the client actively moves into the stretch. The agonists do the work, theoretically improving innervation of those tissues, and the antagonists are reciprocally inhibited as they are stretched.

The method's minutiae are largely concerned with proper positioning and action for each stretch. Sequencing also makes a difference, as some stretches are much easier to perform if others have been done prior. Some muscles simply can't be stretched until others have been stretched prior. These details are critical to successful application of the method regardless of client expectations.
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Old 07-05-2009, 08:46 AM   #76
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thank you for the breakdown Jason

can you, or does Aaron Mattes elaborate on any of the why's?


ANdy
I can not. That's why I brought up the topic: to get some insight into the whys.

I can't speak for what Aaron Mattes may or may not know. I have not known him to discuss the neurodynamics of AIS, and most of the explanations I have heard him give are mesodermal in nature. I am trying to go beyond what he has already taught me so I can better understand how to get the best results with this work.
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Old 07-05-2009, 09:17 AM   #77
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There must be a powerful analogy here that can help bridge the disconnect that some are struggling with between a treatment having "worth" and a treatment having a solid, reasonable scientific rationale.

Aside from all that, if I merely went from patient to patient all day doing stuff just because it "works," I think I would eventually go insane because a) it would invariably NOT work on many patients and b) my brain would turn to mush and c) I would have to don a leather vest and start wearing turquoise bling as I attempted to invoke the "Ancient Warrior."

Definitely not my style.
I can relate to this John.

I don't want this to sound like i'm sticking up for AIS- i'm not. I've never heard of it until this thread and there's nothing about it that i've read so far that really grabs me. Certainly I don't believe any of the mesodermal explanations for it's (apparent) efficacy.

But I do think that if we're honest we all do stuff just because if works. Being good evidence based practitioners we can always find reasons for what we do (and no doubt some reasons are better than others). But you can find reasons for anything!

One of Barretts assessments relates to rotation in the hips in lying. (This is not a dig at Barrett- i'm just using a convenient example). I know that Barrett has reasons for using this as an assessment tool and I know that he can justify it to his satisfaction in scientific terms. But just because there is a reason for it doesn't make it a gold standard test. No doubt someone could think of some perfectly good scientifically backed reasons why NOT to assess this. But Barrett knows that it works for him and his patients- and that's why he does it.

And in my book that's fine!

I think we all do this to some extent. I have simular foibles in my own practice which i'm happy to admit to. I am completely ectodermal in my view of therapy. However I can't stop assessing 1st rib mobility in my neck pain patients. This isn't due to any ignorance on my part- I know perfectly well that you could argue from scientific literature both for and against such an approach and I honestly don't know what statistical validity my assessments have- but I just find that it works. And that's why I do it.

Please note that here i'm not advocating any therapies that are not scientifically sound. And as stated earlier this isn't supporting AIS or any of it's rational.

I'm just putting it on record that i'm a big fan of scientifically based therapies that work. And sometimes just the fact that they work is good enough.

So saying if you're going to teach stuff like AIS you'd better have some hard data on results and a solid rational
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Old 07-05-2009, 02:12 PM   #78
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Jason, thanks for that detail about some activity on the patient's side.

Quote:
Some muscles simply can't be stretched until others have been stretched prior. These details are critical to successful application of the method regardless of client expectations
There are three strong statements here: a) the assumption that muscles are being stretched, b) that somehow a sequence is essential, and d) that client expectations have been shown to NOT influence the successful application.
Those are strong statements, and dare I say: assumptions without basis.

First of all, the stretching of muscle is not really stretching muscle - it is reducing muscular resting tension through inhibition of neural paths (both peripheral and central).

Second, the sequencing: "first these muscles and then those" is something that has NO basis - logically or neurophysiologically (don't you love it that "neurophysiological" contains the word "logical"?).

Third, the patient expectations exclusion. It will require a very complex, big study to PROVE that patient expectations do NOT play a role in manual handling of ANY kind. At this time, all research points towards the idea that it ALWAYS plays some role in outcomes of therapy.

And lastly, a comment on this
Quote:
Once positioned, the client actively moves into the stretch. The agonists do the work, theoretically improving innervation of those tissues, and the antagonists are reciprocally inhibited as they are stretched.
PNF anyone? How does it improve the innervation? Because the muscle is used? Why is this better than, say, tossing pizza dough? The reciprocal inhibition is very old hat, and this method has nothing specific for this. It occurs in many ways and forms.

IOW, no need for spending the money for the learning of the "techniques" - applying the neurophysiology and other sciences, studies and researches will lead to a much simplified handling and enhanced education of the patient. The patient corrects.

And Jono - I disagree. "It works is" NOT good enough for me.
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Old 07-05-2009, 02:20 PM   #79
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Jono says:

Quote:
But Barrett knows that it works for him and his patients- and that's why he does it.
Jono, you're wrong here. I do this because it makes sense for several reasons, and I have never claimed that "it works."

By the way, if you know of anyone that can reasonably make the case that this finding is unimportant I'd really, really like to hear from them. Perhaps they have a case to make and I can learn something.

I'm nice to people, I listen to them, I dress carefully, I do not threaten them with my manner or handling. All of this seems to "work" but that's not the reason I do it. My reasons are based in the vast literature regarding human interaction and it can all be defended there.
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Old 07-05-2009, 03:54 PM   #80
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Once positioned, the client actively moves into the stretch. The agonists do the work, theoretically improving innervation of those tissues, and the antagonists are reciprocally inhibited as they are stretched.
How is this any different from eccentric lengthening? Sounds like it to me.
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Old 07-05-2009, 04:55 PM   #81
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I do this because it makes sense for several reasons, and I have never claimed that "it works."
I just got back from teaching last weekend and heard myself saying over and over, "it's about what makes sense to the body." Not to digress in this thread, but what I get from Barrett's quote above is the possible important difference between "it's what makes sense for the body" and "it's what works for the therapist." A neurodynamic change for the body is not therapist-directed and therefore leaves the therapist in unfamiliar, and probably uncomfortable territory of holding edges and not being in charge of the result.

Over the years I have found more and more students willing to let go and get more familiar with the neurodynamic approach. Over time, it becomes what makes sense to both patient and therapist.

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Old 07-05-2009, 05:22 PM   #82
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And sometimes just the fact that they work is good enough.
Based on what you've written prior to this statement, Jono, it doesn't sound like you actually do this.

For me, the effectiveness argument is NEVER enough. Furthermore, subscribing to such a thoughtless approach to treatment is not the behavior of a professional and is ruining the PT profession.
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Old 07-05-2009, 08:00 PM   #83
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Jason, thanks for that detail about some activity on the patient's side.

There are three strong statements here: a) the assumption that muscles are being stretched, b) that somehow a sequence is essential, and d) that client expectations have been shown to NOT influence the successful application.
Those are strong statements, and dare I say: assumptions without basis.

First of all, the stretching of muscle is not really stretching muscle - it is reducing muscular resting tension through inhibition of neural paths (both peripheral and central).
I agree; we aren't pulling taffy here. I could type it as "stretching", but that's ridiculous.

Quote:
Second, the sequencing: "first these muscles and then those" is something that has NO basis - logically or neurophysiologically (don't you love it that "neurophysiological" contains the word "logical"?).
In my experience, when a client has extremely tight gastrocs, it is much more difficult to effectively stretch the hamstrings or soleus. In my experience, if the client's pec minor(s) are very tight, it is more difficult to effectively stretch their biceps brachii. As you'll recall from Anatomy 101, muscles are arranged in layers, with fibers arranged in various directions. From a mesodermal perspective, it is logical to stretch superficial muscles before deep muscles. I have found this to be a useful approach in practical application of the method.

I can't speak to the neurophysiology aspect of your argument. I would love to know how to spend less time on the hardware approach by working more directly with the software.

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Third, the patient expectations exclusion. It will require a very complex, big study to PROVE that patient expectations do NOT play a role in manual handling of ANY kind. At this time, all research points towards the idea that it ALWAYS plays some role in outcomes of therapy.
I didn't say that client expectations have no impact. However, most of my clients know little-to-nothing about AIS before experiencing it. Many have been skeptical since they've previously "done stretches" without success. So, despite apparent negative or neutral expectations, I get better results when practicing the method in accord with the points iterated above. Interestingly, I haven't noticed better results with clients that have very positive expectations.

Quote:
And lastly, a comment on this

PNF anyone? How does it improve the innervation? Because the muscle is used? Why is this better than, say, tossing pizza dough? The reciprocal inhibition is very old hat, and this method has nothing specific for this. It occurs in many ways and forms.
Are you saying that reciprocal inhibition is no longer relevant? Is using a muscle no longer relevant to improving its function? Or are you just not dazzled by basic non-neuro physiological concepts? Tossing pizza dough is a fun exercise that requires efficient, coordinated innervation and inhibition - but it's not very practical in a therapeutic setting, and therefore an inferior method when compared to AIS or PNF.

Quote:
IOW, no need for spending the money for the learning of the "techniques" - applying the neurophysiology and other sciences, studies and researches will lead to a much simplified handling and enhanced education of the patient. The patient corrects.

And Jono - I disagree. "It works is" NOT good enough for me.
If you want to learn something, sometimes you've gotta pay someone. When knowledge of "much simplified handling and enhanced education of the patient" isn't readily available, I must settle for learning "techniques" instead.

Sometimes "it works" is a good place to start.
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Old 07-05-2009, 08:04 PM   #84
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How is this any different from eccentric lengthening? Sounds like it to me.
Client positioning is used to minimize eccentric lengthening.
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Old 07-05-2009, 08:27 PM   #85
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I didn't say that client expectations have no impact. However, most of my clients know little-to-nothing about AIS before experiencing it. Many have been skeptical since they've previously "done stretches" without success. So, despite apparent negative or neutral expectations, I get better results when practicing the method in accord with the points iterated above. Interestingly, I haven't noticed better results with clients that have very positive expectations.
Jason, you're now going beyond the "well it works" argument into the realm of it's superior based purely on anecdotal evidence.

This is a scientifically untenable position, and I doubt will be taken seriously here.
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Old 07-05-2009, 08:30 PM   #86
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Here's a question:

Last night one of my training clients mentioned a problem she's had for years: a painful "popping" in her right elbow on eccentric contractions (extending elbow), with somewhat less pain and no popping on concentric contractions (flexing elbow). The pain was minimal with no load, and progressively more painful as the load increased. As an avid juggler and musician, the issue had plagued her favorite hobbies.

We started with some biceps stretches, and noticed that she had tight pec minors. We stretched her pec minors, and the rest of the biceps stretches were more effective. Afterwards, she could easily eccentrically and concentrically curl a 10# dumbell without pain or popping.

What do you think happened neurophysiologically to enable this functional improvement?
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Old 07-05-2009, 08:33 PM   #87
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Jason,

What is it about "you can't "stretch" a muscle" that isn't getting through to your descriptions of what you think you're doing?
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Old 07-05-2009, 09:23 PM   #88
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Worthless? Where did you get that?

I don't think ANY of the methods are worthless. I think they are difficult if not impossible to defend, as I said. Without defense they would not be acceptable in MY practice. That doesn't make them worthless by any means.

Please be careful not to characterize my words about less-than science based practice in such a way. It does not help.
Did not try to characterize anything - just asked for the sake of clarification.
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Old 07-05-2009, 09:32 PM   #89
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Jason,

What is it about "you can't "stretch" a muscle" that isn't getting through to your descriptions of what you think you're doing?
Barrett -

Bas's description "it is reducing muscular resting tension through inhibition of neural paths (both peripheral and central)" is pretty good, but overly long and impractical for efficient communication. If you can give me verbal equivalents for it that are as short and efficient as "stretch" and "stretching", please do.

Until I have better terminology to work with, you'll just have to put up with me using those terms until better alternatives come along. If no better alternatives exist, perhaps SS could create them.
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Old 07-05-2009, 09:58 PM   #90
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But Jason - patients' expectations are NOT restricted to a technique: they are involved with the way the practitioner presents him or herself, the explanation given about what is about to happen, etc etc. So this WILL always play a role when you handle someone.

And I never said that reciprocal inhibition is not useful - just that you do not need a special course or technique to utilize it. And it is certainly not unique - a cheap PNF book does fine if you want to use reciprocal inhibition as a tool for muscle lengthening. Waste of time, but there you go. Cheaper than a course.

Start at the beginning - what are you looking for when picking through the field of muscles? Tight? Loose? Sore? By whose standards, and compared to what? And why? What is the reason to look for this? Your example is fine, but what explanation do YOU have for the results?

"it works" is strictly a perception on the part of the patient and/or the practitioner. That is why there is so much cr*p out there that "works" - and this goes back to bloodletting, snakeoil, sweating out "humours", etc etc.
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Old 07-05-2009, 11:19 PM   #91
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Until I have better terminology to work with, you'll just have to put up with me using those terms until better alternatives come along.
Better than the terms that actually make sense compared to terms that mislead, mischaracterize and oversimplify?

This conversation is becoming Orwellian.

"Give me word, any word will do."

How about this word from Archie Bunker: Mattes approach is a bunch of crapola.
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Old 07-05-2009, 11:48 PM   #92
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John,
Perhaps you can complete his sentence in a more acceptable , to this ectoderm belief system, manner so we all can use the correct nonmisleading terminology. Bas' response was helpful in its criticism might you try to be more constructive in yours.
You did say in your response to my introduction you had a sharp tongue. I would like to know what to use instead of "stretching". I have orders to stretch plantar flexors all day at the SNF. I would love to have some words to put in its place as well as more productive techniques.
thanks
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Old 07-05-2009, 11:51 PM   #93
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Deb,
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I would like to know what to use instead of "stretching". I have orders to stretch plantar flexors all day at the SNF. I would love to have some words to put in its place as well as more productive techniques.
Try "neurodynamics."
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Old 07-05-2009, 11:59 PM   #94
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Doesn't "lengthening" work? It implies what you seek and suggests the desired outcome will ensue.

I'm still wondering what Mattes thinks the origin of the pain is, or if he understands the concept.
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Old 08-05-2009, 12:03 AM   #95
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"Neurodynamics" suggests technique, but it's on the right track at least.

Neuromobilisation/neuromobility? Anything with a neuro context to get away from the notion that stretching plantarflexors addresses muscle and nothing else.

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Old 08-05-2009, 12:13 AM   #96
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I really LIKE "lengthening" as an alternate for "stretching". Really like it.

And with regards to your last example Jason: the clicking may be OA starting, with compression and load increasing pain perceptions, defensive neuromuscular reflexes, further increasing the joint compression, and so forth. Your handling allowed the neuromuscular hyperactivity to downregulate - "relax" - and reduce the joint compression.

Or, in short: it felt good and the patient's brain relaxed the joint/muscles and reduced the pain output.

How's that?
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Old 08-05-2009, 12:15 AM   #97
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To me neurodynamics doesn't suggest technique. To me it suggests the normal motion of the nervous system throughout the body, relationship of nerve to container. I refuse any more to conflate a word that represents a movement nerves do in the body and forces that operate on nerves naturally, with an exteroceptive force such as a therapist executing a certain style of treatment.

Yes, there are neurodynamic friendly treatment techniques, and neurodynamic friendly exercises, and yes, some have decided to name their treatment styles to include the word, but I think it's important to hold a space for what nerves do naturally.
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Old 08-05-2009, 12:18 AM   #98
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Thank you Nari. I like this statement and will write it tomorrow. "Utilized manual neuromobilization to the leg in order to lengthen the plantar flexors and aid in the prevention of contracture due to prolonged bedrest." The powers that be may want to add a new computer keyed charge for this procedure. I wonder if it will be tolerated by the supervising therapist since in this state I am not allowed to "mobilize" but I am allowed to stretch things!
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Old 08-05-2009, 01:06 AM   #99
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Deb, not being allowed to moblise but it's OK to stretch sounds very pigeonholed thinking. Can't touch joints despite the fact they will 'mobilise' when stretching occurs?? That must be frustrating for you.

I like 'lengthening' too. Less clumsy than 'elongating'.

Diane, I agree with your interpretation of neurodynamics but I'm thinking about its interpretation by others...many many others. It possibly need to evolve more gradually into minds set on muscle memes.
Though it has been long enough, I guess.

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Old 08-05-2009, 01:23 AM   #100
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Deb,

If you had asked the question, I may have responded differently.

I assumed that Jason was already aware of the terms "neuromobility" and "neurodynamics" (I prefer the latter) since he has used the terms himself several times here and elsewhere on this board. So I don't understand why he's having trouble finding an appropriate and more meaningful term than "stretching" when these terms are all over this board, indeed all over this thread, and certainly not new to him.

There seems to be a disconnect somewhere, but I can't for the life of me identify it, but I think it has something to do with a "chasm."

I don't think spoon-feeding folks with terms to describe their treatments is helpful. My evolution has been towards interactively empowering my patients and students rather than spoon-feeding them easy answers. I've never found that the latter results in an enduring change in behavior nor provided lasting benefit to anyone.
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