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Modifying the length of the system when pain seems to be the primary impediment may be done in a number of ways, but it seems to me that special attention needs to be paid to the neural element. In order to do this with the least amount of potentially injurious stress we need to understand the central processes that accompany pain. This is more possible than it's ever been before. Melzack's neuromatrix and Wall's movement toward pain relief as a "consummatory act" demonstrate in their most recent writing that both of these giants in pain management (Wall passed away last year) have moved well "beyond the gate" and have a lot more to teach us about dealing with painful movement. It DOES matter how this stuff "works," and a thorough explanation of possible mechanisms is deserved by those we are treating. First we should explain it to our colleagues. Consider joining the discussion about these issues at http://www.rehabedge.com/cgi-bin/forums/forumdisplay.cgi?action=topics&forum=Barrett|APO|s+Bullypit++-++The+Deep+Model+of+Neurogenic+Pain&number=15&DaysPrune=365&LastLogin= We could use a few fresh voices. Barrett L. Dorko, P.T. <http://barrettdorko.com> And <http://rehabedge.com> At 02:07 PM 4/20/2004, you wrote: >Hi Anne-Marie > >I take your point. However, and I don't know the correct way to clinically >describe the physiology behind it, but I havecertainly come across >individuals, often unfortunately young, under twenty year olds, that are >unable to sit on the floor or treatment couch, with their knees flat on the >supporting suface i.e. long sitting. They often complain of anterior knee >pain and some had also had the misfortune of undergoing arthroscopic >examination of thier knees to try and explain their pain only for the >surgeon to see normal joint surfaces with normal tracking. Having advised >them to "stretch" their hamstrings, often using good old PNF hold relax >methods they are able to come back with reduced pain and able to long sit >and even reach further in this position. Whether we are "stretching" tissues >such as the muscle sheath I don't know, we may just be facilitating muscle >inhibition therefore allowing more extensibility. It seems to work though! > >Alison >----- Original Message ----- >From: <[log in to unmask]> >To: "Alison Dakin" <[log in to unmask]> >Sent: Tuesday, April 20, 2004 5:30 PM >Subject: Re: Knee & Hip pain? > > > > Dear colleague, > > I like your note about hamstrings. By the way, hamstrings do not need to >be stretched. They are short by nature, they are supposed to act like ropes >. They do not need to be highly reinforced and again certainely not >stretched. Have you ever seen an EMG recording on hamstrings function? in >a normal subject having a normal function ; during ambulation, they show >bursts of contraction . Here I do not intervene in your discussion but I >wish to open an exchange with PTs who spend their time stretching >hamstrings. Have a great day. Anne-Marie V. Newman