Sounds as if it could be a shoulder instability problem Have you checked
that out. Jenny bartley
-----Original Message-----
From: [log in to unmask] <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Sunday, 5 March 2000 13:31
Subject: Digest of physio - volume 1 #598
Subjects of messages in this digest:
Re: body vibes
Re: Baseball pitcher
Re: Reaction to metal implants
Re: Sympathetic Dominance
RE: is anybody out there?
Sympathetic Dominance
Congenital radial dislocation
Re: is anybody out there?
Re: Types of physiotherapy
Re: Types of physiotherapy
Re: Baseball pitcher
RE: spinal psychology
Tendonitis Prevention
RE: Congenital radial dislocation
Re: spinal psychology
Manual Lymphatic Drainage
Re: Osgood Schlatters
Re: spinal psychology
Re: spinal psychology
Re: Osgood Schlatters
----------------------------------------------------------------------
Date: Sat, 04 Mar 2000 18:04:04 +1100
From: acthydro1 <[log in to unmask]>
To: [log in to unmask]
Subject: Re: body vibes
Message-Id: <[log in to unmask]>
I haven't seen the item that you are talking about. We do have infomercials
here
in Australia (lucky us!!!) but I don't get time to see them..(lucky
me!!!)...my
patients do though!! There are a few concerns that come immediately to mind
with
this type of thing for people with back pain, who think that improving their
abdominal tome will improve and reduce their back pain and possibly
"overuse" it.
Firsly I must say that I am a proponent of the lumbar stabilisation
techniques
which are being highly researched and utilised more and more in physio
clinics
throughout the world. (Research is continuing). These focus on getting the
patient to activate the transvesus abdominis and multifidis, which provide
the
major postural stabilisation to the lumbar spine. Proponents also say that
if the
other abdominal muscles are hyper activated or dominant (ie obliques /
rectus
abdominis) that they will work at the expense of the multifidis and TA which
are
the postural muscles which have a direct insertion into the lower lumbar
levels.
I believe that this object is likely to have the effect of Hyper-activation
of
the dominant prime movers, which would then fatigue over time and cause
compensatory recruitment of other muscles such as the upper traps/ scalenes;
levator scap etc possibly eventually leading to increased aggravation to the
neck
and cervical spine and also changing breathing patterns.
I hope that we as a profession can see the potential for "harm" in these
types of
products and that our patients can be reassured that they can receive the
right
type of exercises to assist them, without the use of another "gadget".
On that subject and I hate to bring this up again but about a year ago on
the
mail lists there was a lot of discussion about the use of magnets. Our
market is
currently being inundated with claims and hard sell about these. Magnablock
being
marketed by Amway. Be interested in other peoples experiences anecdotal or
otherwise.
(I should have paid more attention when this was an issue before!)
Di Howell
(Physio; Canberra; Australia)
[log in to unmask] wrote:
> I have just seen one of those "info-mercials" advertising a product called
> the Body Vibes. It appears to be a vibrating box, much like a pager,
which
> attaches to a belt which you then strap around your waist. The idea seems
to
> be that if you relax your abdominals while wearing this device it will
> deliver a vibrating prompt to tighten up. Apart from the usual "lose
weight
> and inches without any effort" claims there were several physical / sports
> therapists stating they used it in their clinics to encourage abdominal
tone.
> Does anyone out there have any experience of this, or similar, devices?
------------------------------
Date: Sat, 4 Mar 2000 03:54:14 EST
From: [log in to unmask]
To: [log in to unmask]
Subject: Re: Baseball pitcher
Message-Id: <[log in to unmask]>
It would seem necessary to get X-rays, scans done of this shoulder.
How long has he had pain?
How is his elbow?
My feeling about the referal is that you need the information on what
exactly
is going on in this shoulder? If not totally clear in your diagnosis then
thats maybe the time. Unfortunately we cannot arrange for our own scans
etc.
Until we do then we have to refer on.
Mike
------------------------------
Date: Sat, 4 Mar 2000 08:53:07 -0000
From: "kevin reese" <[log in to unmask]>
To: <[log in to unmask]>
Subject: Re: Reaction to metal implants
Message-Id: <002101bf85b9$4c78eaa0$423ca8c2@kevinree>
Dear Anna
I agree. I was recently reading an assessment sheet for a psychological
spinal approach. Many of the questions which would seem to imply a
significant psychological overlay seemed to suggest an autonomic type
disturbance to me.
I also very briefly looked at some of Gordon Waddells tests which are meant
to imply a patient has more psychological problems than musculoskeletal.
These included compression of head on neck, would irritate profoundly any
cervical intra-articular problems and Tx rotation with Cx static. I would
say every member of our discussion list knows the wierdo presentations of
the thoracic spine.
One of us is getting it wrong, I am not a proud man and with the appropriate
evidence would be happy to say it is me, if it is. Regards Kevin
Reese PT UK
-----Original Message-----
From: Anna Lee, Principal <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 03 March 2000 08:04
Subject: Re: Reaction to metal implants
>
>Why is it that when a female has these problems, the immediate cause is
>emotional?
>
>Cheers,
>
>Anna.
>
>
>
>
>
>Anna Lee
>Principal,
>Work Ready - Industrial Athlete Centre
>Physiotherapist and Occupational Health Consultant
>
>Write to me at [log in to unmask]
>Visit me at www.workready.com.au
>
>Snail mail:
>Suite 3, 82 Enmore Road,
>Newtown NSW 2042
>Australia
>
>Tel: (02) 9519 7436
>Mob: 0412 33 43 98
>Fax: (02) 9519 7439
>----- Original Message -----
>From: "Barrett Dorko" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Thursday, 2 March 2000 22:17
>Subject: Re: Reaction to metal implants
>
>
>> Di,
>>
>> I can't imagine that metal could possibly cause this reaction. It is far
>> more likely that the patient still resides in the midst of her
sympathetic
>> response to the original trauma. This would account for her over-all
>> symptoms, including the tearfullness.
>>
>> The best resource for understanding this is Levine's book, "Waking the
>> Tiger." Its' been the resource for several essays on my web site and I
>> reviewed the book on "Rehab Edge" <http://www.rehabedge.com>
>>
>> Barrett L. Dorko P.T.
>> <http://qin.com/dorko>
>> Also at <http://prorehab.com>
>>
>>
>>
>>
>> At 09:37 PM 3/2/00 +1100, you wrote:
>>
>>
>> >I have a woman (50ish)who fractured her tib / fib, middle of last year.
>> >It was fixated with pins and plate. She has been complaining of
>> >increasing generalised ache throughout her body; feelings of nausea and
>> >tearfulness. Have any of you seen these symptoms possibly as a reaction
>> >to the metal implants. If this is possible do you think that this will
>> >resolve if she has these removed?
>> >
>> >Many years ago, i saw a woman with a similar injury who had a severe
>> >respiratory reaction to the implants with onset of asthma- like
>> >symptoms, which she never previously had and once the metal was
>> >removed, the symptoms resolved totally. Any comments appreciated.
>> >
>> >Di Howell
>> >(Physio; Canberra; Australia)
>>
>>
>
>
------------------------------
Date: Sat, 4 Mar 2000 09:13:01 -0000
From: "kevin reese" <[log in to unmask]>
To: <[log in to unmask]>
Subject: Re: Sympathetic Dominance
Message-Id: <003b01bf85ba$c7be1e00$423ca8c2@kevinree>
Mel
Never stop contributing to our list ! You are a highly intelligent
scallywag. Regards Kevin
-----Original Message-----
From: [log in to unmask] <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 03 March 2000 23:38
Subject: Sympathetic Dominance
>Anna wrote:
>
><<Why is it that when a female has these problems, the immediate cause is
>emotional? >>
>
>Barrett Dorko responded:
>
>< Anna Since when is sympathetic dominance an emotional problem? >
>
>Siff ruminated:
>
>***Ever since males displayed unsympathetic dominance ?
>
>Dr Mel C Siff
>Denver, USA
>[log in to unmask]
>
------------------------------
Date: Sat, 4 Mar 2000 03:31:22 -0800 (PST)
From: nick bent <[log in to unmask]>
To: [log in to unmask]
Subject: RE: is anybody out there?
Message-Id: <[log in to unmask]>
Firstly, thanks to everyone who responded to my
question about muscle imbalance books. Secondly, after
2 days with no messages getting through, I checked my
email this morning to find 50 new messages in my inbox
- they must have all got stuck somehwhere in my phone
line! So please ignore my request to forward messages
to me. I would apologise for sending a message to the
list that has no interest or relevance to
physiotherapy, but then i would have to apologise for
all my previous contributions too.
Nick
__________________________________________________
Do You Yahoo!?
Talk to your friends online with Yahoo! Messenger.
http://im.yahoo.com
------------------------------
Date: Sat, 4 Mar 2000 07:16:14 EST
From: [log in to unmask]
To: [log in to unmask]
Subject: Sympathetic Dominance
Message-Id: <[log in to unmask]>
On 3/4/00, [log in to unmask] wrote:
<< Mel Never stop contributing to our list ! You are a highly intelligent
scallywag. >>
***Thanks awfully, old chap! It's absolutely smashing being here with all
of
you!
This little chinwag has suggested something to me. Let us create yet
another
one of those endless evaluative tools that litter the erudite corridors of
physical and psychological therapy. Since the McKenzie, Maitland, Bobath,
McConnell, Pavlovian, Harrington and other names already have been attached
to something or other, let us call this the "McNemo Psychotherapeutic Matrix
" or whatever you wish (after "nemo", meaning "nothing").
Now peruse what follows. This 2x2 matrix may be used to categorise any of
the physios or physical therapists in their dealings with one another and
with clients. The two rows and two columns allow us to recognise those who
are "unsympathetic submissive", "unsympathetic dominant", "sympathetic
dominant" or "sympathetic submissive".
............................................................................
..
...........................
: SUBMISSIVE : DOMINANT
:
.....................................:.................................:....
..
..........................:.
: :
:
UNSYMPATHETIC : :
:
: :
:
......................................:.................................:...
..
..........................:.
: :
:
SYMPATHETIC : :
:
: :
:
......................................:..................................:..
..
..........................:..
TUTORIAL: Without relying on biopsy, Babinsky or palpation tests, use the
above matrix to classify Anna and Barrett. On this basis, suggest what you
would consider to be an appropriate therapeutic protocol to facilitate
effective rehabilitation in each case.
Mel
Dr Mel C Siff
Denver, USA
[log in to unmask]
------------------------------
Date: 4 Mar 00 05:26:26 MST
From: -- <[log in to unmask]>
To: [log in to unmask]
Cc: [log in to unmask]
Subject: Congenital radial dislocation
Message-Id: <[log in to unmask]>
Hi list-members,
I'm trying to get info on Congenital Radial Dislocation in babies. I've
pretty much exhausted all avenues with very limited success.
I would appreciate it if anyone could direct me to any web sites where I can
get some more info on this topic.
Your help would be appreciated.
Thanking you,
Sibyl
____________________________________________________________________
Get free email and a permanent address at http://www.netaddress.com/?N=1
------------------------------
Date: Sat, 4 Mar 2000 11:27:55 -0000
From: "mdne adams" <[log in to unmask]>
To: <[log in to unmask]>
Subject: Re: is anybody out there?
Message-Id: <01bf85cc$af5885a0$LocalHost@default>
Yes, this seems to happen to me too. I think another explanation for some of
these surprising conversations that suddenly crop up out of the ether is
that some list members may occasionally copy to and or from other lists too.
Nikki Adams [log in to unmask]
-----Original Message-----
From: Trew Marion <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Friday, March 03, 2000 6:05 PM
Subject: RE: is anybody out there?
>I don't have the answer, though I am sure Heather will know, but I find it
>interesting because on several occassions I have had the impression that I
>may have missed some messages. Sometimes a discussion which interests me
>seems to refer to a response which I have not read. I have always presumed
>that I might have inadvertently deleted a relevant message before reading
>it, or someone might have replied directly to an individual member rather
>than to the list. However now I wonder if perhaps some messages don't
always
>get throught to all members. I know they ought to and I can't work out a
>rational explanation for why the system might not always be perfect - a
>computer properly programmed ought to repeat the same action every time. I
>would be interested to know if anyone else has had a similar problem.
>
>Marion Trew
>University of Brighton
>
>> ----------
>> From: nick bent[SMTP:[log in to unmask]]
>> Reply To: [log in to unmask]
>> Sent: 03 March 2000 17:14
>> To: [log in to unmask]
>> Subject: is anybody out there?
>>
>> Dear list members,
>> I seem to have a problem to add to my existing and
>> obvious ones. Although mailbase is distributing my
>> messages to other users (or so I have been told), I
>> have not received anything from the list for a couple
>> of days. This is a bit annoying as I think I may have
>> missed emails regarding ultrasound over growth plates
>> (which I am very interested to learn more about) and
>> any answers to my own question about books on muscle
>> imbalance. Would anyone be so kind as to forward any
>> of these to my email address? I will be eternally
>> grateful if you could and will send u a card every
>> xmas.
>> Also, does anyone have any suggestions as to why
>> mailbase is accepting my emails but not sending me any
>> back?
>>
>> Many thanks in advance,
>>
>> Nick
>>
>> __________________________________________________
>> Do You Yahoo!?
>> Talk to your friends online with Yahoo! Messenger.
>> http://im.yahoo.com
>>
>
------------------------------
Date: Sat, 04 Mar 2000 23:31:44 +1000
From: Daniel Belavy <[log in to unmask]>
To: [log in to unmask]
Subject: Re: Types of physiotherapy
Message-Id: <[log in to unmask]>
Jenny,
I can't say I have had years of experience with OPD vs. community physio
(I graduated last year). However, some of the things I have noticed are:
community -ves: physio sits in a car for a lot of time (ie. no patient
treatment + it is a pain when there is no aircon [in hot weather] + it can
get boring), physio may not be able to have ready access to equipment (like
traction), community physio is less cost effective when compared to OPD.
Community +ves: patients can get treated at home. OPD +ves: equipment,
time, probably bit more interesting than driving.
I hope this has been of some help.
Daniel
------------------------------
Date: Sat, 04 Mar 2000 06:18:01 PST
From: "John Willenbruch" <[log in to unmask]>
To: [log in to unmask]
Subject: Re: Types of physiotherapy
Message-Id: <[log in to unmask]>
I also do not have years of experience but I definitely remember an article
about +ve perception by patients of treatment within their own home and
therefore better outcomes. The government over here were thinking about
caring for most now hospital/rehab center type patients with community
physios and district nurses to eliminate "hotel" costs, until someone said
it would actually cost more!!!!
Cheers
John
P.S. I will try and find a reference for you.
>Jenny,
>
> I can't say I have had years of experience with OPD vs. community physio
>(I graduated last year). However, some of the things I have noticed are:
>community -ves: physio sits in a car for a lot of time (ie. no patient
>treatment + it is a pain when there is no aircon [in hot weather] + it can
>get boring), physio may not be able to have ready access to equipment (like
>traction), community physio is less cost effective when compared to OPD.
>Community +ves: patients can get treated at home. OPD +ves: equipment,
>time, probably bit more interesting than driving.
> I hope this has been of some help.
>
>Daniel
>
>
______________________________________________________
Get Your Private, Free Email at http://www.hotmail.com
------------------------------
Date: Sat, 4 Mar 2000 10:02:14 EST
From: [log in to unmask]
To: [log in to unmask]
Subject: Re: Baseball pitcher
Message-Id: <[log in to unmask]>
In a message dated 03/04/2000 3:56:26 AM Eastern Standard Time,
[log in to unmask] writes:
<<
How long has he had pain?
How is his elbow?
>>
Pain for about 6 months, no problem with elbow. Point tender along
supraspinatus. Has been pitching since he was 8 years old.
Steve
------------------------------
Date: Sat, 4 Mar 2000 10:05:21 -0600
From: JILL H KISON <[log in to unmask]>
To: "[log in to unmask]" <[log in to unmask]>
Subject: RE: spinal psychology
Message-Id: <[log in to unmask]>
Dear Kevin,
I agree completely! Why is it only for the spine that chronic pain or
patients that don't seem to improve immediately as a result of our treatment
that we automatically assume that it must be psychological? We know very
little about the spine, so instead of trying other treatment methods or
referring the patient to another practitioner who may try another approach,
we automatically lay the blame to the patient, i.e. not compliant, is under
too much stress, isn't following PT's advice, or has some underlying
psychological issues that must be addressed. Could it be (dare I say it)
that we tend to say anything to our patients except the truth- maybe we
don't exactly know what's going on, why they're not responding to our
treatment, that maybe we just don't know?
How does it help the patients when we dump all the blame on them? (When it
may or may not be an issue). As physiotherapists (speaking from my
perspective), we are not pop psychologists and should not let psychological
issues be in the forefront of our minds every time we evaluate a new back
patient just because they're back patients. For example, one of Wadell's
signs is tenderness in more than multiple locations or more tenderness than
would normally be expected. If your patient has multiple level disc lesions
along with sacroiliac malalignments, is it that odd for a patient to be
tender along most of the paraspinal musculature in addition to sacrum,
spinal processess, gluts, and piriformis in addition to having radicular Sxs
elsewhere (or perhaps aggravating the pain in some of the same already
muscle tender locations)? If we're so fast to jump to non-mechanical
conclusions, we could easily miss many of these problems (I know firsthand
that this happens).
How many patients with other pathologies at other joints do we treat,
knowing the patient is fairly non-compliant & has other issues, etc, and yet
our patient still gets better? This should tell us something.
Jill Kison, ATC, SPT
------------------------------
Date: Sat, 04 Mar 2000 17:20:30 +0100
From: "Luis M. Barbado Mellado" <[log in to unmask]>
To: [log in to unmask]
Subject: Tendonitis Prevention
Message-Id: <[log in to unmask]>
Hello:
I´m trying to do an exercises program in order to prevent
tendonitis based in eccentrics exercises. And then I would like to
include in the prevention of groin pain (when it´s caused by tendonitis
in pubic area).
What do you think?
Thank you everybody out there.
--
=========================
Luis M. Barbado Mellado
Physiotherapist (Spain)
Málaga C.F. S.A.D.
LMBM'00
=========================
------------------------------
Date: Sat, 4 Mar 2000 11:30:30 -0500
From: "Dave Pugh" <[log in to unmask]>
To: <[log in to unmask]>
Subject: RE: Congenital radial dislocation
Message-Id: <[log in to unmask]>
You may find the information you need at http://www.medmedia.com/o2/184.htm
Keep in mind that radiographs in the newborn will likely appear normal due
to lack of ossification.
Dave
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]On
Behalf Of --
Sent: March 4, 2000 7:26 AM
To: [log in to unmask]
Cc: [log in to unmask]
Subject: Congenital radial dislocation
Hi list-members,
I'm trying to get info on Congenital Radial Dislocation in babies. I've
pretty much exhausted all avenues with very limited success.
I would appreciate it if anyone could direct me to any web sites where I can
get some more info on this topic.
Your help would be appreciated.
Thanking you,
Sibyl
____________________________________________________________________
Get free email and a permanent address at http://www.netaddress.com/?N=1
------------------------------
Date: Sat, 4 Mar 2000 17:43:05 -0000
From: "kevin reese" <[log in to unmask]>
To: <[log in to unmask]>
Subject: Re: spinal psychology
Message-Id: <001c01bf8601$56af94e0$12eba8c2@kevinree>
Dear Jill
Yes!. In its most scurrelous form the reasoning goes
1 I am a diagnostic god, have all the answers and I am never wrong
2 The eight tests I do for this part of the body have all come back negative
3 Therefore you are bonkers in the head (pyschogenic pain)
Of course nothing happens in isolation. If musculoskeletal presentations go
unchecked they will have multiple level/tissue presentations and be
tenacious to shift. Of course pain is centrally mediated and produces
behavioural reactions.
As I have warned previously pyschology is a new science looking for
practical applications. Working with GPs we all see; 'This patient is
depressed and complains of all sorts of pains'. More often than not I feel
it is ' This patient has all sorts of pains and is depressed because of
this'.
Once again if I am missing the point please tell me, and I am happy to
concede my limited intellegence. If not this could be yet another example of
the Emperors new clothes.
I am sure there is a case for psychological assessment in some pain states.
Is it formally necessary in every one/. If not in which
percentage/presentation? and why?.
Warmest Regards and if this does not stir some reaction (yes I am thinking
of you Ian) I'll eat my shorts. Kevin
-----Original Message-----
From: JILL H KISON <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 04 March 2000 16:08
Subject: RE: spinal psychology
>Dear Kevin,
>
>I agree completely! Why is it only for the spine that chronic pain or
>patients that don't seem to improve immediately as a result of our
treatment
>that we automatically assume that it must be psychological? We know very
>little about the spine, so instead of trying other treatment methods or
>referring the patient to another practitioner who may try another approach,
>we automatically lay the blame to the patient, i.e. not compliant, is under
>too much stress, isn't following PT's advice, or has some underlying
>psychological issues that must be addressed. Could it be (dare I say it)
>that we tend to say anything to our patients except the truth- maybe we
>don't exactly know what's going on, why they're not responding to our
>treatment, that maybe we just don't know?
>
>How does it help the patients when we dump all the blame on them? (When it
>may or may not be an issue). As physiotherapists (speaking from my
>perspective), we are not pop psychologists and should not let psychological
>issues be in the forefront of our minds every time we evaluate a new back
>patient just because they're back patients. For example, one of Wadell's
>signs is tenderness in more than multiple locations or more tenderness than
>would normally be expected. If your patient has multiple level disc
lesions
>along with sacroiliac malalignments, is it that odd for a patient to be
>tender along most of the paraspinal musculature in addition to sacrum,
>spinal processess, gluts, and piriformis in addition to having radicular
Sxs
>elsewhere (or perhaps aggravating the pain in some of the same already
>muscle tender locations)? If we're so fast to jump to non-mechanical
>conclusions, we could easily miss many of these problems (I know firsthand
>that this happens).
>
>How many patients with other pathologies at other joints do we treat,
>knowing the patient is fairly non-compliant & has other issues, etc, and
yet
>our patient still gets better? This should tell us something.
>
>Jill Kison, ATC, SPT
>
------------------------------
Date: Sat, 4 Mar 2000 21:45:10 +0100
From: "Suana und Viktor Sadil" <[log in to unmask]>
To: "Physio" <[log in to unmask]>
Subject: Manual Lymphatic Drainage
Message-Id: <[log in to unmask]>
Dear listers,
I need urgently a physiotherapist for manual lymphatic drainage in
Cairo/Egypt. Anyone on the list who knows somebody?
Please reply to [log in to unmask]
Thanks in advance
Greetings from Austria
Viktor
Viktor Sadil, MD
************************************************************
Institut f. Physikalische Medizin / Akademie f. Physiotherapie
(Department of Physical Medicine & Rehabilitation / School of Physiotherapy)
A.ö. Krankenhaus der Barmherzigen Schwestern vom Hl. Kreuz
(General Hospital of the Sisters of Mercy of the Holy Cross)
Grieskirchner Strasse 42, A - 4600 Wels, Austria
(+43) 7242 415 2771 (voice)
(+43) 7242 415 3971 (fax)
(+43) 676 3409966 (mobile)
[log in to unmask] / [log in to unmask] / [log in to unmask]
urgent e-mails (max. 160 char. forwarded to mobile phone):
[log in to unmask]
2396530 (ICQ-#)
http://www.geocities.com/HotSprings/5786/aptwels.html
************************************************************
------------------------------
Date: Sat, 04 Mar 2000 23:32:56 +0100
From: Erik Goossens <[log in to unmask]>
To: [log in to unmask]
Subject: Re: Osgood Schlatters
Message-Id: <[log in to unmask]>
Dies ist eine mehrteilige Nachricht im MIME-Format.
--------------47E06DA2831BBD297C44F4ED
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boundary="------------D0A14A638D50B0D1BFCD3C19"
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Hi Alison,
you wouldn't mind telling me what PSWD stands for... (silly non-english
trained European PTs...)
EGO
Switzerland (see below)
Alison Dakin schrieb:
> In my experience Osgood Schlatters is a very painful, but self
> limiting condition and that the only treatment we can offer is advice
> & reassurance (to child AND parents) on stretches and activity
> adaptation if necessary. Ultrasound, PSWD etc only offer tempoarary
> releif if anything and I too would be concerned about applying these
> techniques over growth plates.
--
Erik Goossens
Dipl. PT SRK - PT Educator Akad. TvdL Landquart / CH
Physiotherapie Erik Goossens GmbH / MediFIT Medical Reconditioning
CH-4102 Binningen - Switzerland
VISIT US AT : http://www.medi-fit.ch
--------------D0A14A638D50B0D1BFCD3C19
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Content-Transfer-Encoding: 7bit
<!doctype html public "-//w3c//dtd html 4.0 transitional//en">
<html>
<body bgcolor="#FFFFFF">
Hi Alison,
<p>you wouldn't mind telling me what PSWD stands for... (silly non-english
trained European PTs...)
<p>EGO
<br>Switzerland (see below)
<p>Alison Dakin schrieb:
<blockquote TYPE=CITE><style></style>
<font face="Arial">In my experience
Osgood Schlatters is a very painful, but self limiting condition and that
the only treatment we can offer is advice & reassurance (to child AND
parents) on stretches and activity adaptation if necessary. Ultrasound,
PSWD etc only offer tempoarary releif if anything and I too would be
concerned
about applying these techniques over growth
plates.</font> </blockquote>
<p>--
<br>Erik Goossens
<br>Dipl. PT SRK - PT Educator Akad. TvdL Landquart / CH
<br>Physiotherapie Erik Goossens GmbH / MediFIT Medical Reconditioning
<br>CH-4102 Binningen - Switzerland
<br>VISIT US AT : <A
HREF="http://www.medi-fit.ch">http://www.medi-fit.ch</A>
<br>
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Date: Sun, 05 Mar 2000 10:09:13 +1000
From: acthydro1 <[log in to unmask]>
To: [log in to unmask]
Subject: Re: spinal psychology
Message-Id: <[log in to unmask]>
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> Jill & Kevin
>
> I agree completely! Why is it only for the spine that chronic pain or
> patients that don't seem to improve immediately as a result of our
treatment
> that we automatically assume that it must be psychological?
>> Jill, I think that you've missed the boat here. It is widely accepted
that
approximately 90% of people presenting with spinal pain will improve within
2 -
6 weeks. The types of patients that do not improve (ie have chronic spinal
pain), I think can basically be divided into two groups.
1. The group who over time have increasing difficulty "coping" with the
constant pain and as a result of this pyscho-social factors play an
important
part in pain management and learning to deal with the condition ie:
problems due to a change of roles in the relationship; feelings of reduced
self-esteem due to not being able to carry out their normal role in family
life
whether that be caring for the family or as primary income earner; societal
pressures or perceived pressures. These feelings of anger; depression and
withdrawal can have a very real effect on central processing areas (Central
sensitisation refer D. Butler) and pain perception.
2. The group who have had psychosocial factors pre-existing in their
lives eg
past history of depression; problems with teenage children; hate their jobs;
financial pressures; unhappy marriages ...and the list goes on...
I thinK that if you look carefully at those patients of yours presenting
with
chronic pain (of any desription ie spinal or otherwise)..you will find that
these issues are either there or becoming increasingly prevalent. I do not
think
that anyone is saying that they have a "psychological" problem meaning that
it
is all in their heads and yes they do require our skills as Physiotherapists
but
we also have the opportunity to talk to them about how other things affect
pain
perception and how it is important that if there are other issues that they
think may be affecting their ability to cope that they would be better to
talk
to someone who is qualified in this area.
This is an important part of taking control and "ownership" of their
condition
and moving to an acceptance that there are things that they can do to assist
making their lives more manageable.
> We know very
> little about the spine, so instead of trying other treatment methods or
> referring the patient to another practitioner who may try another
approach,
> we automatically lay the blame to the patient, i.e. not compliant, is
under
> too much stress, isn't following PT's advice, or has some underlying
> psychological issues that must be addressed. Could it be (dare I say it)
> that we tend to say anything to our patients except the truth- maybe we
> don't exactly know what's going on, why they're not responding to our
> treatment, that maybe we just don't know?
It is important not to blame the patient and I do not think that the
majority of
physios that truly understand and work with chronic pain patients would ever
do
that!
>
> As physiotherapists (speaking from my perspective), we are not pop
> psychologists and should not let psychological issues be in the forefront
of
> our minds every time we evaluate a new back
> patient just because they're back patients.
No we are not psychologists but we are often in a position where we can
identify
if there are other issues going on that may be affecting these patients
coping
mechanisms because we spend a lot more time with them than their doctors and
we
have an important role in assisting with this by referring on if necessary
or
bringing it to the attention of the patient and their GP. (It is very
important
when discussing issues like this that the patient understands the link
between
extrinsic factors (ie psychosocial) and intrinsic factors (their injury and
processing areas)
> ? If we're so fast to jump to non-mechanical
> conclusions, we could easily miss many of these problems (I know firsthand
> that this happens).
This is a tricky one...the nature of spinal pain is so complicated that
often a
"mechanical cause" cannot be found and even if it can eg bulges on MRI, may
not
necessarily be related to injury. I know that the majority of patients that
I
see are of the Non-specifc variety. It is likewise in these situations to
ensure
that we use our skills to assist the patients to understand that back pain
is
very complicated and can involve many strucures and just because a "cause"
cannot be found that it does not necessarily exist.
>
> How many patients with other pathologies at other joints do we treat,
> knowing the patient is fairly non-compliant & has other issues, etc, and
yet
> our patient still gets better? This should tell us something.
Yes it tells us that they probably would have got better anyway ie part of
the
large percentage that do with our intervention and there probably wasn't a
large
neurogenic component to their problem.
Please have a read of David Butlers; MOBILISATION OF THE NERVOUS SYSTEM if
you
want more technical info. Research is continuing and physios are at the
cutting
edge. How about getting on board!
All the best
Di Howell
Physiotherapist
Canberra
Australia
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<br>
<blockquote TYPE=CITE>Jill & Kevin
<p><i>I agree completely! Why is it only for the spine that chronic
pain or</i>
<br><i>patients that don't seem to improve immediately as a result of our
treatment</i>
<br><i>that we automatically assume that it must be
psychological?</i></blockquote>
>> Jill, I think that you've missed the boat here. It is widely accepted
that approximately 90% of people presenting with spinal pain will improve
within 2 - 6 weeks. The types of patients that do not improve (ie have
chronic spinal pain), I think can basically be divided into two groups.
<p>1. The group who over time have increasing difficulty
"coping" with the constant pain and as a result of this pyscho-social
factors
play an important part in pain management and learning to deal with the
condition ie:
<br> problems due to a change of roles in the relationship; feelings
of reduced self-esteem due to not being able to carry out their normal
role in family life whether that be caring for the family or as primary
income earner; societal pressures or perceived pressures. These feelings
of anger; depression and withdrawal can have a very real effect on central
processing areas (Central sensitisation refer D. Butler) and pain
perception.
<p>2. The group who have had psychosocial factors
pre-existing
in their lives eg past history of depression; problems with teenage
children;
hate their jobs; financial pressures; unhappy marriages ...and the list
goes on...
<p>I thinK that if you look carefully at those patients of yours presenting
with chronic pain (of any desription ie spinal or otherwise)..you will
find that these issues are either there or becoming increasingly prevalent.
I do not think that anyone is saying that they have a "psychological"
problem
meaning that it is all in their heads and yes they do require our skills
as Physiotherapists but we also have the opportunity to talk to them about
how other things affect pain perception and how it is important that if
there are other issues that they think may be affecting their ability to
cope that they would be better to talk to someone who is qualified in this
area.
<p>This is an important part of taking control and "ownership" of their
condition and moving to an acceptance that there are things that they can
do to assist making their lives more manageable.
<br>
<blockquote TYPE=CITE><i>We know ver</i>y
<br><i>little about the spine, so instead of trying other treatment methods
or</i>
<br><i>referring the patient to another practitioner who may try another
approach,</i>
<br><i>we automatically lay the blame to the patient, i.e. not compliant,
is under</i>
<br><i>too much stress, isn't following PT's advice, or has some
underlying</i>
<br><i>psychological issues that must be addressed. Could it be (dare
I say it)</i>
<br><i>that we tend to say anything to our patients except the truth- maybe
we</i>
<br><i>don't exactly know what's going on, why they're not responding to
our</i>
<br><i>treatment, that maybe we just don't know?</i></blockquote>
It is important not to blame the patient and I do not think that the
majority
of physios that truly understand and work with chronic pain patients would
ever do that!
<blockquote TYPE=CITE>
<br> <i>As physiotherapists (speaking from my perspective), we are
not pop psychologists and should not let psychological issues be in the
forefront of our minds every time we evaluate a new back</i>
<br><i>patient just because they're back patients.</i></blockquote>
No we are not psychologists but we are often in a position where we can
identify if there are other issues going on that may be affecting these
patients coping mechanisms because we spend a lot more time with them than
their doctors and we have an important role in assisting with this by
referring
on if necessary or bringing it to the attention of the patient and their
GP. (It is very important when discussing issues like this that the patient
understands the link between extrinsic factors (ie psychosocial) and
intrinsic
factors (their injury and processing areas)
<blockquote TYPE=CITE><i>? If we're so fast to jump to
non-mechanical</i>
<br><i>conclusions, we could easily miss many of these problems (I know
firsthand</i>
<br><i>that this happens).</i></blockquote>
This is a tricky one...the nature of spinal pain is so complicated that
often a "mechanical cause" cannot be found and even if it can eg bulges
on MRI, may not necessarily be related to injury. I know that the majority
of patients that I see are of the Non-specifc variety. It is likewise in
these situations to ensure that we use our skills to assist the patients
to understand that back pain is very complicated and can involve many
strucures
and just because a "cause" cannot be found that it does not necessarily
exist.
<blockquote TYPE=CITE>
<br><i>How many patients with other pathologies at other joints do we
treat,</i>
<br><i>knowing the patient is fairly non-compliant & has other issues,
etc, and yet</i>
<br><i>our patient still gets better? This should tell us
something.</i></blockquote>
Yes it tells us that they probably would have got better anyway ie part
of the large percentage that do with our intervention and there probably
wasn't a large neurogenic component to their problem.
<p>Please have a read of David Butlers; MOBILISATION OF THE NERVOUS SYSTEM
if you want more technical info. Research is continuing and physios are
at the cutting edge. How about getting on board!
<p>All the best
<p>Di Howell
<br>Physiotherapist
<br>Canberra
<br>Australia</html>
--------------DB24C004F7FAD1101206ADD2--
------------------------------
Date: Sun, 05 Mar 2000 10:18:56 +1000
From: acthydro1 <[log in to unmask]>
To: [log in to unmask]
Subject: Re: spinal psychology
Message-Id: <[log in to unmask]>
--------------C30A1868A8AC8AC18411F535
Content-Type: text/plain; charset=us-ascii
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Kevin,
Sorry, but I do think that you are missing the point, please see my post to
Jill. From my experience and estimation, Physios should be looking at these
other issues including how the patient is coping after about 3 weeks (if
they
are not showing any signs of recovery) and start discussing how "extrinsic"
factors may be influencing their ability to cope. Be very wary of those that
come in each time and say that they felt better for a couple of hours after
treatment but the pain is the same again now. This needs prompt and
immediate
action ie change of treatment technique or change tack to a purely active
treatment. These patients have an incredible ability to lull some
Physiotherapists into a sense that they are truly helping. In this
situation, I
believe, that these patients should be very quickly identified and shown
how
they can help themselves!!
Di Howell
Physio
Canberra, Australia
kevin reese wrote:
> Dear Jill
>
> Yes!. In its most scurrelous form the reasoning goes
> 1 I am a diagnostic god, have all the answers and I am never wrong
> 2 The eight tests I do for this part of the body have all come back
negative
> 3 Therefore you are bonkers in the head (pyschogenic pain)
>
> Of course nothing happens in isolation. If musculoskeletal presentations
go
> unchecked they will have multiple level/tissue presentations and be
> tenacious to shift. Of course pain is centrally mediated and produces
> behavioural reactions.
>
> As I have warned previously pyschology is a new science looking for
> practical applications. Working with GPs we all see; 'This patient is
> depressed and complains of all sorts of pains'. More often than not I feel
> it is ' This patient has all sorts of pains and is depressed because of
> this'.
>
> Once again if I am missing the point please tell me, and I am happy to
> concede my limited intellegence. If not this could be yet another example
of
> the Emperors new clothes.
>
> I am sure there is a case for psychological assessment in some pain
states.
> Is it formally necessary in every one/. If not in which
> percentage/presentation? and why?.
>
> Warmest Regards and if this does not stir some reaction (yes I am thinking
> of you Ian) I'll eat my shorts. Kevin
> -----Original Message-----
> From: JILL H KISON <[log in to unmask]>
> To: [log in to unmask] <[log in to unmask]>
> Date: 04 March 2000 16:08
> Subject: RE: spinal psychology
>
> >Dear Kevin,
> >
> >I agree completely! Why is it only for the spine that chronic pain or
> >patients that don't seem to improve immediately as a result of our
> treatment
> >that we automatically assume that it must be psychological? We know very
> >little about the spine, so instead of trying other treatment methods or
> >referring the patient to another practitioner who may try another
approach,
> >we automatically lay the blame to the patient, i.e. not compliant, is
under
> >too much stress, isn't following PT's advice, or has some underlying
> >psychological issues that must be addressed. Could it be (dare I say it)
> >that we tend to say anything to our patients except the truth- maybe we
> >don't exactly know what's going on, why they're not responding to our
> >treatment, that maybe we just don't know?
> >
> >How does it help the patients when we dump all the blame on them? (When
it
> >may or may not be an issue). As physiotherapists (speaking from my
> >perspective), we are not pop psychologists and should not let
psychological
> >issues be in the forefront of our minds every time we evaluate a new back
> >patient just because they're back patients. For example, one of Wadell's
> >signs is tenderness in more than multiple locations or more tenderness
than
> >would normally be expected. If your patient has multiple level disc
> lesions
> >along with sacroiliac malalignments, is it that odd for a patient to be
> >tender along most of the paraspinal musculature in addition to sacrum,
> >spinal processess, gluts, and piriformis in addition to having radicular
> Sxs
> >elsewhere (or perhaps aggravating the pain in some of the same already
> >muscle tender locations)? If we're so fast to jump to non-mechanical
> >conclusions, we could easily miss many of these problems (I know
firsthand
> >that this happens).
> >
> >How many patients with other pathologies at other joints do we treat,
> >knowing the patient is fairly non-compliant & has other issues, etc, and
> yet
> >our patient still gets better? This should tell us something.
> >
> >Jill Kison, ATC, SPT
> >
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<i>Kevin,</i><i></i>
<p><i>Sorry, but I do think that you are missing the point, please see
my post to Jill. From my experience and estimation, Physios should be
looking
at these other issues including how the patient is coping after about 3
weeks (if they are not showing any signs of recovery) and start discussing
how "extrinsic" factors may be influencing their ability to cope. Be very
wary of those that come in each time and say that they felt better for
a couple of hours after treatment but the pain is the same again now. This
needs prompt and immediate action ie change of treatment technique or change
tack to a purely active treatment. These patients have an incredible ability
to lull some Physiotherapists into a sense that they are truly helping.
In this situation, I believe, that these patients should be very
quickly
identified and shown how they can help themselves!!</i><i></i>
<p><i>Di Howell</i>
<br><i>Physio</i>
<br><i>Canberra, Australia</i>
<p>kevin reese wrote:
<blockquote TYPE=CITE>Dear Jill
<p>Yes!. In its most scurrelous form the reasoning goes
<br>1 I am a diagnostic god, have all the answers and I am never wrong
<br>2 The eight tests I do for this part of the body have all come back
negative
<br>3 Therefore you are bonkers in the head (pyschogenic pain)
<p>Of course nothing happens in isolation. If musculoskeletal presentations
go
<br>unchecked they will have multiple level/tissue presentations and be
<br>tenacious to shift. Of course pain is centrally mediated and produces
<br>behavioural reactions.
<p>As I have warned previously pyschology is a new science looking for
<br>practical applications. Working with GPs we all see; 'This patient
is
<br>depressed and complains of all sorts of pains'. More often than not
I feel
<br>it is ' This patient has all sorts of pains and is depressed because
of
<br>this'.
<p>Once again if I am missing the point please tell me, and I am happy
to
<br>concede my limited intellegence. If not this could be yet another
example
of
<br>the Emperors new clothes.
<p>I am sure there is a case for psychological assessment in some pain
states.
<br>Is it formally necessary in every one/. If not in which
<br>percentage/presentation? and why?.
<p>Warmest Regards and if this does not stir some reaction (yes I am
thinking
<br>of you Ian) I'll eat my shorts. Kevin
<br>-----Original Message-----
<br>From: JILL H KISON <[log in to unmask]>
<br>To: [log in to unmask] <[log in to unmask]>
<br>Date: 04 March 2000 16:08
<br>Subject: RE: spinal psychology
<p>>Dear Kevin,
<br>>
<br>>I agree completely! Why is it only for the spine that chronic
pain or
<br>>patients that don't seem to improve immediately as a result of our
<br>treatment
<br>>that we automatically assume that it must be psychological?
We know very
<br>>little about the spine, so instead of trying other treatment methods
or
<br>>referring the patient to another practitioner who may try another
approach,
<br>>we automatically lay the blame to the patient, i.e. not compliant,
is under
<br>>too much stress, isn't following PT's advice, or has some underlying
<br>>psychological issues that must be addressed. Could it be (dare
I say it)
<br>>that we tend to say anything to our patients except the truth- maybe
we
<br>>don't exactly know what's going on, why they're not responding to
our
<br>>treatment, that maybe we just don't know?
<br>>
<br>>How does it help the patients when we dump all the blame on them?
(When it
<br>>may or may not be an issue). As physiotherapists (speaking from
my
<br>>perspective), we are not pop psychologists and should not let
psychological
<br>>issues be in the forefront of our minds every time we evaluate a new
back
<br>>patient just because they're back patients. For example, one
of Wadell's
<br>>signs is tenderness in more than multiple locations or more tenderness
than
<br>>would normally be expected. If your patient has multiple level
disc
<br>lesions
<br>>along with sacroiliac malalignments, is it that odd for a patient
to be
<br>>tender along most of the paraspinal musculature in addition to sacrum,
<br>>spinal processess, gluts, and piriformis in addition to having
radicular
<br>Sxs
<br>>elsewhere (or perhaps aggravating the pain in some of the same already
<br>>muscle tender locations)? If we're so fast to jump to
non-mechanical
<br>>conclusions, we could easily miss many of these problems (I know
firsthand
<br>>that this happens).
<br>>
<br>>How many patients with other pathologies at other joints do we treat,
<br>>knowing the patient is fairly non-compliant & has other issues,
etc, and
<br>yet
<br>>our patient still gets better? This should tell us something.
<br>>
<br>>Jill Kison, ATC, SPT
<br>></blockquote>
</html>
--------------C30A1868A8AC8AC18411F535--
------------------------------
Date: Sat, 4 Mar 2000 19:28:45 EST
From: [log in to unmask]
To: [log in to unmask]
Subject: Re: Osgood Schlatters
Message-Id: <[log in to unmask]>
PSWD stands for, as I understand it, Pulsed Short Wave Diathermy. There is
an argument that if you pulse short wave treatments there is no appreciable
thermal effect therefore PSWD is a contradiction in terms, but thats another
issue. Hope this helps.
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