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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