Nigel,

refer to my comments to Dr. Siff in the other e-mail. Weak muscles are not 
neccessarily lengthened, they can also be tight. From my experience, I get a 
lot of success from stretching the iliopsoas muscles... which makes sense 
because patients with back pain who sit for a long time and try to stand up 
get a lot of pain because the psoas works maximally at 90 degrees hip 
flexion, and locks up when they try to stand up. This shows us that occ 
health and safety and many physio's have been teaching their patients the 
wrong way to sit down... the hips should really be at around 110 degrees to 
put the psoas off working, and to employ more the transversus and multifidus 
to work.

Henry***


>From: "Nigel Biggs" <[log in to unmask]>
>Reply-To: [log in to unmask]
>To: <[log in to unmask]>
>Subject: Re: chiropractors
>Date: Fri, 29 Sep 2000 21:43:15 +0100
>
>I seem to recall from a muscle imbalance course that iliopsoas was 
>described
>as a stabiliser,and will therefore tend to become long and weak.It will
>therefore need shortening by working it in inner range.So what's all this
>talk of stretching it.?!The more I read on this list,the more confused I
>get!I won't sleep tonight over this!Put me out of my misery someone!!!
>                                                   Nigel Biggs
>                                                   Physiotherapist,UK
>-----Original Message-----
>From: Henry Tsao <[log in to unmask]>
>To: [log in to unmask] <[log in to unmask]>
>Date: 29 September 2000 10:12
>Subject: RE: chiropractors
>
>
> >Yes, that would definitely stretch the iliacus muscle, but will also
>stretch
> >other muscles like the psoas.
> >
> >The best stretch I have found for the iliacus muscle is lying in supine,
> >right leg over the side of the bed. Gently adduct that leg into the bed,
> >elevate the right side of your pelvis and resisting with your right hand,
> >hence doing almost like a ipsilateral static contration. Obviously, do 
>the
> >same for the left leg.
> >
> >Another stretch is in a half kneeling position; externally rotate the leg
> >that is on the ground, and perform a iliopsoas stretch (ie, leaning 
>forward
> >and elevating the same arm toward the ceiling).
> >
> >Henry***
> >
> >>From: "Paul Sumner" <[log in to unmask]>
> >>Reply-To: [log in to unmask]
> >>To: <[log in to unmask]>
> >>Subject: RE: chiropractors
> >>Date: Thu, 28 Sep 2000 13:53:16 +0100
> >>
> >>Would a 2 joint hip flexor stretch stretch the iliacus muscle? That is
> >>lying with the legs at the end of the plinth, bending the good leg up to
> >>the chest and hanging the other over the edge, with or without knee
>flexion
> >>to take the strain off rec fem.
> >>
> >>Thanks Paul Sumner uk
> >>
> >> >>> "Henry Tsao" <[log in to unmask]> 09/28/00 10:57AM >>>
> >>Interesting case Simon, I have actually experienced the same with 2
> >>patients
> >>of mine. They basically had tight iliacus muscles and weak gluts, and if
> >>you
> >>have a look at the biomechanics of the iliacus muscle, it basically will
> >>compress the hip joint if tightened. Hence, if you can release the
>iliacus,
> >>you can avoid unneccessary surgery. But I agree with you, each 
>individual
> >>is
> >>different, and hence the treatments we give should also fit the
>individual.
> >>
> >>Henry***
> >>
> >>
> >> >From: "Mesner, Simon" <[log in to unmask]>
> >> >Reply-To: [log in to unmask]
> >> >To: "[log in to unmask]" <[log in to unmask]>
> >> >Subject: RE: chiropractors
> >> >Date: Wed, 27 Sep 2000 09:54:55 +0100
> >> >
> >> >To Stewart and Henry,
> >> >
> >> >Interesting conversation guys.  A case study I heard about recently 
>may
> >>be
> >> >of interest.  I have to say before I start that it was from a
> >> >Physiotherapist and is thus pro-physio but it is to hilight a point
> >>rather
> >> >than champion/malign a profession.
> >> >
> >> >A gentleman of 70 attended a clinic for pre-operative phsyiotherapy in
> >> >respect of an impending hip replacement.  The gentelman was very fit 
>and
> >> >still competed to a black belt in karate within his age group.  He had
> >> >experienced a very recent onset of hip pain and had seen a surgeon
>who,on
> >> >radiographic examination alone, which had shown some degeneration,
> >> >recommended a hip replacement.  The patient had requested the
> >>pre-operative
> >> >phyiotherapy.
> >> >
> >> >The phyiotherapist on assessment had thought that the pain did not 
>sound
> >> >like it was degenerative in origin although not disagreeing that
> >> >degenerative changes were present.  on further assessment muscle
> >>imbalance
> >> >around the hip was identified that tallied with the patient's sport 
>(the
> >> >kicks in medial hip rotation).  The patient had been active in this
>sport
> >> >for 50 years.
> >> >
> >> >Over three weeks of treatment with muscle imbalance correction the
> >>patient
> >> >was pain free and the operation was not required.
> >> >
> >> >Here an apparently clear case of OA hip seemed to be an impingement
> >> >syndrome.  The initial assessment lead the first practitioner down the
> >> >wrong
> >> >route as it was too simplistic and did not cater to the individual.
> >> >However
> >> >for another person with the same pain and X-rays an operation may be
> >> >indicated as the problem was from the degeneration.
> >> >
> >> >It matters not what technique is used but whether it is appropriate to
> >>the
> >> >situation.
> >> >
> >> >Thought provoking discussion guys.
> >> >
> >> >Simon
> >> >-----Original Message-----
> >> >From: [log in to unmask] [mailto:[log in to unmask]]
> >> >Sent: Saturday, September 23, 2000 1:21 PM
> >> >To: [log in to unmask]
> >> >Subject: Re: chiropractors
> >> >
> >> >
> >> >Thanks for the reply Henry,  good to hear you're having success.
> >> >
> >> >I was particularly interested in your comments regarding the 
>simplicity
> >>of
> >> >the treatments you use. There is a difference between viewing 
>something
> >> >simply and simplistically, the latter implying a lack of depth of
> >> >understanding while the former differentiates the relevant information
> >>from
> >> >the superfluous.  Your example of disc prolapse suggests the medics 
>are
> >> >viewing discogenic back pain simplistically.
> >> >
> >> >(As I understand it, nerve roots will only be painful when compressed 
>by
> >> >disc
> >> >material if they are already inflamed, this has been well researched I
> >> >believe (sorry but I can't provide references off the top off the top 
>of
> >>my
> >> >head), so the difference is not the muscles after all.  A disc 
>prolapse
> >>may
> >> >affect the function of a spinal segment however and produce pain which
> >>can
> >> >be
> >> >treated by manual techniqes.  In this case I believe the quality of 
>the
> >> >pain
> >> >
> >> >would be discernible from that of neurogenic origin.)
> >> >
> >> >I believe the interactions within the body are extremely complex and
>will
> >> >probably never be fully understood and so we will always be guilty of
> >> >simplisticity (I don't even know if this is a real word) in our
> >>treatments.
> >> >
> >> >This is not to say that treatment techniques and working theories need
>to
> >> >be
> >> >
> >> >overcomplicated.  Often simple things do work, but we should not
>convince
> >> >ourselves we know exactly what is going on.
> >> >
> >> >I made a refernence in an earlier discussion about the frustration of
> >> >trying
> >> >
> >> >to understand how the body works when we don't have any operating
> >> >instructions and are in effect trying to "backward engineer" the human
> >> >body.
> >> >
> >> >Someone commented how this may not be a helpful approach when treating
> >> >patients.
> >> >
> >> >Regarding your comments re. mobilising joints and the effect on
>overlying
> >> >tissue.  I agree with your comments to a degree but would suggest that
> >>the
> >> >mechanism of what is actually happening is poorly understood.
> >> >
> >> >I do not doubt your treatment techniques work Henry and have seen
>equally
> >> >remarkable effects using other methods suggesting other things are
> >>causing
> >> >the effects seen.  I think my concerns about your assertion that your
> >> >techniques will "revolutionise physio" are that I have had similar
> >> >revelations in the past, only to be disappointed at a later date that 
>I
> >> >haven't discovered the holy grail of physiotherapy.  Its been 
>suggested
> >>by
> >> >many people in the past that the problem with physiotherapy is that so
> >> >little
> >> >is really known and even less proven that we tend to latch onto things
> >>that
> >> >appear on the surface to answer all our prayers.  Then again, perhaps
>I'm
> >> >just a negative killjoy!  :o)
> >> >
> >> >You said you get frustrated when, 6 months after treating someone with
> >> >joint
> >> >
> >> >mobilisations, they return with the same pain.  You then say that you
> >>have
> >> >only been using your muscle techniques for 8 months.  Perhaps in time
>you
> >> >will find that both techniques will be equally effective in the long
> >>term.
> >> >
> >> >Its good to talk Henry, thanks for your comments, they help me 
>question
> >>my
> >> >own understanding and practise.
> >> >
> >> >Stewart Harrison
> >> >Physiotherapist
> >> >UK
> >>
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