At , you wrote:
>At 12:57 PM 4/23/99 -0300, you wrote:
>>Herb Silver wrote:
>>
>>> At 07:17 AM 4/22/99 -0700, you wrote:
>>> >"Mr. Yves Savaria" wrote:
>>> >a series of assumptions and reports of individual case experience which
>>> >"supports" his assertion that mobilization of the upper cervical spine is
>>> >effective in the treatment of plantar faciitis.  There is no evidence
in the
>>> >medical literature to support this assertion and in no way does this
>>> >approach represent the commonly accepted standard of practice in the
>>> >physical therapy profession.
>>> >--
>>> >Dean Farwood, P.T.
>>> >Precision Spine Training
>>> >San Rafael, CA, USA
>>> >http://www.sirius.com/~farwood/
>>>
>>> I would like to second Dean's opinion on this "novel" approach to plantar
>>> fasciitis.  Since when has every pathology become "nerve tension"?  I have
>>> successfully instructed many patient's on how to treat their plantar
>>> fasciitis.  The approach emphasizes a lot of independent home achilles
>>> tendon stretching and protecting the plantar fascia from injury--it really
>>> is not rocket science and it makes a lot of sense anatomically.  How in
the
>>> world could it be that this is a problem eminating from the cervical
>>> spine--maybe in some odd case, but not in the majority of cases
especially!
>>>  I have taken courses in nerve tension testing--I find it very usefull
when
>>> a nerve root is involved.  But I am confused at how some therapists are
>>> finding nerve tension problems in every pathology.  This is totally
>>> confusing to me.  I find it is very important to differentiate between
>>> nerves, muscles, connective tissue, ect., and identify the problem(s). If
>>> everything is now nerve tension, I think we are going to see the same
>>> problems that come when some falls into the camp of believing that all
>>> pathology is cranio sacral rhythm, or fascia, sublux vertebra.
>>
>>
>>
>>    I agree with Yves and Dorko here. If you think the nervous
>>system is just another structure, you may be right about thinking
>>that it's envolvement in several pathologies are a consideration
>>based more of a comercial momentary tendency than scientific facts.
>>But if you think that every structure in our body are somehow
>>innervated and this innervation is not just a convey of information
>>to and from the structure, we may think about a deeper relationship
>>which probably it's envolved in most of the dysfunctions.
>>        I believe this approach came in time for us (physical therapists)
>>do something that we should have done long ago: stop looking
>>locally and start seeing our patient and his pathology from a global
>>perspective.
>>
>>PT Sergio Marinzeck

I was just wondering when we will get past what we "think" is correct and
when we will actually look at research.  Or we might get to the point where
we base our practice on a quote from Timothy Leary--"Anything we truly
believe is either true or in the process of becoming true."   There is a
certain validity to this statement.  And there are also certain
applications to science and medical treatment.  But, until we can identify
causal links, we risk being mislead by our beliefs.  When I started
practicing PT I wanted to believe that I could treat anything and that none
of my patients would ever need surgery.  That didn't hold up.   In
Tradidtional Chinese medicine, the order of intervention goes: prayer and
fasting, herbs, diet, acupuncture, massage, surgery with the final efforts
being "medicine".  There is a places for different interventions.  So I
question whether neural tension is at the base of all disease.  I think
this is dangerous thinking and here is my rational.

  The only studies where there was any attempt at blinding the subjects
have found no treatment effects for craniosacral techniques.  Neural
tension has been shown to be effective at identifying a spinal lesion with
specific neural tension tests--I am hard pressed to understand how a
cervical lesion would be identified wtih tension tests involving the
plantar fascia.  It is much the same as the spine surgeon believing the MRI
when there are no clinical tests to confirm that what is seen on the MRI is
indeed symptomatic/causative.  Now, before I get too much criticism about
the difficulties involved in double blinding and being to stuck on
"scientific method", let me be the first to say these are difficult issues
to overcome.  On the other hand, we need to agree on something.  I know
that the nervous system connects all parts of the body.  I know that my
computer is connected to the internet via phone lines--sometimes those
phone lines and the information coming over them cause problems for my
computer but sometimes they don't.  I know that in the past when I have
assumed that I downloaded a virus as the problem, I have been wrong many
more times than not.  

So, why don't we try this as an approach to seeing what works in PT.  Don't
blind the patient, or the practitioner, only the evaluator/MD--send 20
patients each to different practitioners and blind the physician who
reevaluates them to determine what approaches get better results.  I am
sure that we will find that sometimes neurotension techniqes work,
sometimes joint mobilization works, sometimes just a simple home exercise
program works.  At that point we can start determining what techniques work
for what pathologies. 

 I started out my PT carrier using craniosacral techniques, acupuncture,
acupressure, massage, soft tissue mobilization, etc, etc.  I don't doubt
they have their benefits.  I do think that treating every plantar fascia
patient as a neural tension problem borders on being very difficult to
understand (not to go back to an earlier point, I do understand that the
plantar fascia is innervated).  I have seen so many patients respond with a
very simple but specific exercise routine with very little intervention on
my part or the doctor's that I am at a loss to explain how they did so well
without involving the neural tension if neural tension is a primary
cause--I have followed up on quite a few of these people and their relief
lasted.  And, the results of the protocol I use have been researched and
published (though I don't have the reference available).  I would also
agree that we should avoid looking too locally.  At the same time, there
are things that happen locally, so I would argue against missing the tree
for the forest.



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