Simon,
Studies have shown that when a lumbar disc prolaps, it does not returns to
its normal position, therefore I don't believe it is possible to "force" the
disc back in place. It would be great to know what happens to the discs when
a patient undergoes treatment such as Mckenzie extensions.
**Does anyone know of any studies whereby someone has prolapsed a disc
(shown on CT/MRI), and after treatment has had another CT/MRI to check
whether that disc has been "put back in"??**
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: cold spray
>Date: Tue, 3 Oct 2000 08:19:56 +0100
>
>Dear Henry,
>
>Is it really possible to 'force' a lumbar disc back into place?
>
>Simon
>
>-----Original Message-----
>From: Henry Tsao [mailto:[log in to unmask]]
>Sent: Tuesday, October 03, 2000 4:54 AM
>To: [log in to unmask]
>Subject: Re: cold spray
>
>
>Sarah,
>
>Interesting that you had the same theory re: atrophied muscles not able to
>be stretched. This was what I found to be very unreasonable from my studies
>at university. However, an atrophied muscle is simply a muscle that has
>wasted and has less muscle fibres, whereas a tight muscle is a muscle which
>has shortened its resting length. These two things are separate entities,
>and hence as I suggested to Dr Siff, you can have a tight but atrophied
>muscle.
>
>As Philip Greenman said in one of his papers, the emphasis should be more
>on
>
>muscle length rather than muscle strength, and that if a muscle is both
>tight and weak, one should stretch the muscle first before strengthening
>it.
>
>This is what I do for the psoas muscle, stretch it and isometrically
>strengthen to increase the number of fibres and hence re-hypertrophy the
>muscle.
>
>I actually palpate, and stretch and spray the psoas muscle from the
>abdomine, hence I do not affect the multifidus muscle. Therefore this
>answers your question re: affecting the multif and psoas. Interestingly,
>the
>
>multifidus muscle is another muscle that can be tight and weak (and as we
>all should know, the multifidus muscle is very important in lumbar
>stability
>
>from Dr Hodges and Richardson's studies).
>
>I do use Mckenzie techniques of lateral correction, but if you have a look
>at the attachments of the psoas muscle, it is actually attached to the
>discs
>
>themselves. Therefore, if the psoas is tight, it may be a cause of disc
>prolapse in some patients, and could be what we need to treat; otherwise
>you
>
>will simply force the disc back into place, relieve that patient of pain,
>but when the psoas spasms again, it will pull the disc out of place again.
>
>Thank you for your questions, as it has made me think a lot more laterally
>and forced me to really reason with the work that I have been taught.
>
>Henry***
>
> >From: Sarah Fern Striffler <[log in to unmask]>
> >Reply-To: [log in to unmask]
> >To: [log in to unmask]
> >Subject: Re: cold spray
> >Date: Mon, 02 Oct 2000 09:18:48 -0400
> >
> >Dear Henry,
> >
> >I think the world of Dr Travell's work, & have used it for a long time
> >in my massage practice before becoming a PT & still use it a lot.
> >However, I really question the effect of coolant spray on the iliopsoas
> >because of the depth of other tissue between the skin & those mm.
> >And I agree w/ Dr Siff's point that atrophied m is seldom helped by
> >stretching. In the case you mentioned w/ atrophied psoas being helped
> >by your method, I find the McKenzie approach gives a much more
> >reasonable explanation for the mechanism: your stretching position
> >forced a bulging disc(s) back into its rightful place between vertebrae &
> >off nerve. The freed nerve(s) then correctly innervated the psoas which
> >recovered from its state of partial atrophy, or at least inhibition. Same
> >reason the multifidi were helped. Surely you can't argue that your spray
> >& stretch of psoas also was a spray & stretch of multifidi????
> >
> >Sarah Fern Striffler, PT
> >
> >
> >Henry Tsao wrote:
> >
> > > To Stewart and Dr Siff,
> > >
> > > I agree with you guys... sometimes what you perceive is happening
>could
> > > perhaps be something else. However, I guess this applies for almost
>all
> >the
> > > techniques that we use as physiotherapists; whether you are affecting
> >the
> > > structure involved is always difficult to say. As I said, I have only
> >been
> > > learning this for the past 9 months and I am still looking up research
> > > articles for more evidence, because I want to convince myself that
>what
> >I am
> > > doing is evidence based. I will be getting the research articles that
>I
> >lent
> > > to a few colleagues of mine back, so once I get them, I will pass them
> >on to
> > > you. With your questions, I will call Aileen Jeffirees, who has had 30
> >years
> > > experience with trigger points (and this is all she use - she does not
> >do
> > > any joint mobilisations at all), and I will tell you what she says.
> > >
> > > To Anna,
> > >
> > > there is actually 10 times more cold receptors on the skin than heat
> > > receptors, and this is why I favour the use of cold. However, I
> >sometimes
> > > still would use heat and DTM, especially on those who have injured
>other
> > > structure rather than muscles. U/S I use on muscle trigger points, but
> >only
> > > on pulsed and low intensity (0.5W/cm2).
> > >
> > > Henry***
> > >
> >_________________________________________________________________________
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> >
>
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