Well after an email with Bex Morrison (head of technique) she suggested that I contacted Heather in registry to see if I could swap from IMS (cranial) to Advanced Spinal Manipulation ....
Got confirmation with Heather that I can do the swap. I'm really pleased as I think that getting my manipulation skills under my belt first will benefit me much more than trying to learn learn the basics of cranial when my palpation still needs some fine tuning.
Friday 30 October 2009
Tuesday 27 October 2009
S-CS: Glutei were just to tight !!
Tried to do strain-counterstrain on Piriformis on a young chap (34 yoa). Having previously struggled with the side-lying technique I thought I would have another go at it .... well it didn't work with this specific patient either ....
The reason for this is that it wasn't only piriformis that was shortened but also the glutei ... as a result I wasn't able to flex the patients knees into a high enough position of flexion to produce a decrease in the level of tenderness of the Tender Point.
Hopefully it will be third time lucky.
The reason for this is that it wasn't only piriformis that was shortened but also the glutei ... as a result I wasn't able to flex the patients knees into a high enough position of flexion to produce a decrease in the level of tenderness of the Tender Point.
Hopefully it will be third time lucky.
I think Ive made a mistake !!!
Think Ive made a mistake .... I should have done Advanced Spinal
Manipulation (ASM) ....
Been having problems with my neck, it's been responding to treatments
from students, however this weekend it's moved up a joint or two to my
Occipital Atlas (OA) Joint with a headache in the area as well. Tried
to get the best student of my year to manipulate it, four attempts
later we got a click, pretty confident it was my OA but I still had
the neck pain and the headache.
Been to see a qualified Osteopath ... WOW hope I'm that good one day.
As soon as he picked my head up it clicked, didn't even feel like he
wound the joint up !!!!
So obviously I asked him to talk me through what he did, to be told
"minimal leverage is that way to go" .... starting to think that I
should be doing the ASM course, such as shame I can't do four of the
electives instead of just the three, but I know everyone is thinking
that shame .... need to explore my options here I feel.
Manipulation (ASM) ....
Been having problems with my neck, it's been responding to treatments
from students, however this weekend it's moved up a joint or two to my
Occipital Atlas (OA) Joint with a headache in the area as well. Tried
to get the best student of my year to manipulate it, four attempts
later we got a click, pretty confident it was my OA but I still had
the neck pain and the headache.
Been to see a qualified Osteopath ... WOW hope I'm that good one day.
As soon as he picked my head up it clicked, didn't even feel like he
wound the joint up !!!!
So obviously I asked him to talk me through what he did, to be told
"minimal leverage is that way to go" .... starting to think that I
should be doing the ASM course, such as shame I can't do four of the
electives instead of just the three, but I know everyone is thinking
that shame .... need to explore my options here I feel.
FUNCTIONAL TECHNIQUE
27/10/09 - Well back at Bethnal Green and just met the ideal candidate for my first attempt of a Functional approach.
The patient was a 81 years of age lady with spondylotic and spondylotic degeneration of her spine. During my examination of her spinal function I identified two levels of decreased quality of movement (T3/4 & C3/4).
I proceeded to ascertain the position of ease for the thoracic spine firstly. The joint I was palpating was tender to touch .... after putting the joint into a position of easy and working with the patients breathing she reported that the joint felt less tender, I'm not 100% sure the quality if the movement was any better, but then I know my palpation in terms of Functional Technique requires a considerable amount of practice. As for the patient stating that if felt less tender, I hope sure meant it and wasn't just being the sweet old lady she appeared and was saying what she thought I wanted to hear lol
I continued onto doing the same for her CSpine ... however I am 100% confident this time ... however I'm confident that I didn't make a difference to quality of movement of her C3/4 .... oh well I'm sure my touch must have had a therapeutic effect on her at least.
I'm looking forward to next week to palpating those joints to see what their function is like.
24/03/10 - Spontaneous Cavitation
Having been struggling with my TSpine HVT techniques I decided to give functional another go ... totally for the wrong reasons yes I know ... but none the less I tired lol. I sat the patient on the table and asked him to take the pose and started to assess the position of ease of his T4 segment. After a few moments of 'playing' around with the technique I returned him to a neutral position and on return a spontaneous cavitation was heard ... don't know who was more surprised me or the patient.
02/05/10 - Valeria showed us a functional technique to work on releasing the sternum. What the operator does is stand in front of the patient who is sat on the plinth. The patient slumps forward and rests there head on the operators shoulder. The operator then palpates the sternum with one hand and then assist by balancing the patients with their other hand on their spine.
I struggled with the technique .... as always ... but I think this is because my palpation isn't fine-tuned enough ... or that I don't trust my palpation skills enough.
Receiving the technique was really nice and comforting actually.
The patient was a 81 years of age lady with spondylotic and spondylotic degeneration of her spine. During my examination of her spinal function I identified two levels of decreased quality of movement (T3/4 & C3/4).
I proceeded to ascertain the position of ease for the thoracic spine firstly. The joint I was palpating was tender to touch .... after putting the joint into a position of easy and working with the patients breathing she reported that the joint felt less tender, I'm not 100% sure the quality if the movement was any better, but then I know my palpation in terms of Functional Technique requires a considerable amount of practice. As for the patient stating that if felt less tender, I hope sure meant it and wasn't just being the sweet old lady she appeared and was saying what she thought I wanted to hear lol
I continued onto doing the same for her CSpine ... however I am 100% confident this time ... however I'm confident that I didn't make a difference to quality of movement of her C3/4 .... oh well I'm sure my touch must have had a therapeutic effect on her at least.
I'm looking forward to next week to palpating those joints to see what their function is like.
24/03/10 - Spontaneous Cavitation
Having been struggling with my TSpine HVT techniques I decided to give functional another go ... totally for the wrong reasons yes I know ... but none the less I tired lol. I sat the patient on the table and asked him to take the pose and started to assess the position of ease of his T4 segment. After a few moments of 'playing' around with the technique I returned him to a neutral position and on return a spontaneous cavitation was heard ... don't know who was more surprised me or the patient.
02/05/10 - Valeria showed us a functional technique to work on releasing the sternum. What the operator does is stand in front of the patient who is sat on the plinth. The patient slumps forward and rests there head on the operators shoulder. The operator then palpates the sternum with one hand and then assist by balancing the patients with their other hand on their spine.
I struggled with the technique .... as always ... but I think this is because my palpation isn't fine-tuned enough ... or that I don't trust my palpation skills enough.
Receiving the technique was really nice and comforting actually.
Tuesday 20 October 2009
Technique - Cervical Spine
20/10/09 - Whilst working with Nandeep today it became apparent that she was loosing first lever whilst applying the others which was making the wind up in effective. Also it became a little tender at times when she didn't stay on the articular pillars.
25/11/09 - During a technique tutorial in clinic today I was shown another approach to manipulating the OA. The technique is basically the same as we are shown in technique class but with full rotation, then you take off half, then you put on full side-bending, test your levers, add on side bending and shift if required and then thrusts. Ive tried it a few time now when practising, but I'm not sure its C1-2 that's cavitating.
24/03/10 - Doing well with my upper CSpine thrusts ... not many I'm missing ... however my lower CSpine is still hit or miss (so to speak). On reflection I feel that Im loosing it whilst adding the other components (i.e. taking off the last lever) and that I'm struggling to support the weight of the head as I'm trying to wind up the joint. Having discussed this with tutors I feel that I need to apply side-shift before the rest of the levers to lockout the neck to stabilise it before the weight of the head affects my thrust.
11/04/10 - Today I had a patient that I needed to thrust their OA joint. I don't know why but the thought of doing this panicked me as I haven't had the opportunity to practise my thrust as the students that I practice technique with dont want to practice OA thrusts hence I didn't feel confident. The tutor thrust the patients OA for me. He used a different technique which was a combination of a cradle and a chin hold. The technique worked for him. It heiglightened to me how techniques can be adapted to suit the individual practitioner as long as good anatomical knowledge and a clear idea of what your trying to achieve is used.
13/05/2010 - Whilst performing a HVT to a mid CSpine today I had the wind up but then when I went to thrust it was very weak and feeble. I was really embarrassed. I tried again and it was still feeble. By this stage I was really hot and sweaty and uncomfortable. Miss Gooddard was excellent as ever and put me at ease for when I had to try to manipulate the same joint on the other side. This time I had success. Its strange as its always been my left hand that has been my stronger hand at CSpine thrusts ... but not this time.
Me performing a CSpine HVT on a fellow student during a clinical tutorial.
25/11/09 - During a technique tutorial in clinic today I was shown another approach to manipulating the OA. The technique is basically the same as we are shown in technique class but with full rotation, then you take off half, then you put on full side-bending, test your levers, add on side bending and shift if required and then thrusts. Ive tried it a few time now when practising, but I'm not sure its C1-2 that's cavitating.
24/03/10 - Doing well with my upper CSpine thrusts ... not many I'm missing ... however my lower CSpine is still hit or miss (so to speak). On reflection I feel that Im loosing it whilst adding the other components (i.e. taking off the last lever) and that I'm struggling to support the weight of the head as I'm trying to wind up the joint. Having discussed this with tutors I feel that I need to apply side-shift before the rest of the levers to lockout the neck to stabilise it before the weight of the head affects my thrust.
11/04/10 - Today I had a patient that I needed to thrust their OA joint. I don't know why but the thought of doing this panicked me as I haven't had the opportunity to practise my thrust as the students that I practice technique with dont want to practice OA thrusts hence I didn't feel confident. The tutor thrust the patients OA for me. He used a different technique which was a combination of a cradle and a chin hold. The technique worked for him. It heiglightened to me how techniques can be adapted to suit the individual practitioner as long as good anatomical knowledge and a clear idea of what your trying to achieve is used.
13/05/2010 - Whilst performing a HVT to a mid CSpine today I had the wind up but then when I went to thrust it was very weak and feeble. I was really embarrassed. I tried again and it was still feeble. By this stage I was really hot and sweaty and uncomfortable. Miss Gooddard was excellent as ever and put me at ease for when I had to try to manipulate the same joint on the other side. This time I had success. Its strange as its always been my left hand that has been my stronger hand at CSpine thrusts ... but not this time.
Me performing a CSpine HVT on a fellow student during a clinical tutorial.
Thursday 15 October 2009
IMS: IMS ... It helped!
Spoke to my friend today about her cranial treatment yesterday. After the treatment she took herself off home and off to bed ... after an hours sleep she woke, however felt like she could have slept the whole day. She tells me that for the rest of that evening she felt emotional.
Today she woke feel fresh and light headed. The congestion that had previously plagued her had cleared, however the cold she had still remained (I still hope for miracles lol). I so wish I understood IMS ... guess I will have a better understanding once I've done the elective. I do wounder if my palpation will ever be good enough to feel it ... guess the only way is to put my hands on lots of bodies and have a go. Perhaps I should start now as part of my usual Osteopathic assessment ... the only problem is I never have enough time as it us to do the usual structural stuff I'm more familiar with.
Today she woke feel fresh and light headed. The congestion that had previously plagued her had cleared, however the cold she had still remained (I still hope for miracles lol). I so wish I understood IMS ... guess I will have a better understanding once I've done the elective. I do wounder if my palpation will ever be good enough to feel it ... guess the only way is to put my hands on lots of bodies and have a go. Perhaps I should start now as part of my usual Osteopathic assessment ... the only problem is I never have enough time as it us to do the usual structural stuff I'm more familiar with.
Wednesday 14 October 2009
S-CS:Tender Points ... theres so many !!!
Just been sorting through some paperwork (not really productive but makes me feel like I'm doing some college work) and have come across some Tender Point diagrams ... there are so many of them, how am I meant to remember !!!
S-CS: Gastrocnemius Video
Having been taught lots of S-CS techniques I thought I would have a go at filming myself performing one. Not sure the vest looks very professional but it was only a practice run lol
IMS: ENERGY
In clinic today at Bethnal Green the practice nurse spoke to our tutor as she was due to go on holiday tomorrow, however after a Sports Massage she had for shoulder pain she was now getting 'nerve' pain as well. During a free slot I agreed to treat her. During the assessment the tutor pressed hard into a Trigger Point on her supraspinatus. After the tutor left she told me that even that short time with him touching that spot she had felt a relief.
During the rest of the treatment she asked me if I would be able to treat her again as she instantly knew as soon as I started to palpate that I had a healing nature. The conversation soon progressed to my background as a nurse and my believes in positive energy etc and how disappointed I was with my Reiki One attunement as U didn't feel a euphoric rush of positive healing.
She turns out to be a Reiki Master and offered another attunement for me. Now I know this isn't part of Osteopathy and so maybe a tad irrelevant for the purpose of this blog .... but there has to be something in my thoughts of being able to feel/be aware of other peoples energy and IMS ... don't know what the link could be but I'm sure there is one!
During the rest of the treatment she asked me if I would be able to treat her again as she instantly knew as soon as I started to palpate that I had a healing nature. The conversation soon progressed to my background as a nurse and my believes in positive energy etc and how disappointed I was with my Reiki One attunement as U didn't feel a euphoric rush of positive healing.
She turns out to be a Reiki Master and offered another attunement for me. Now I know this isn't part of Osteopathy and so maybe a tad irrelevant for the purpose of this blog .... but there has to be something in my thoughts of being able to feel/be aware of other peoples energy and IMS ... don't know what the link could be but I'm sure there is one!
S-CS: Strain-Counterstrain of Piriformis with a Lumbar Disc Bulge - does it work ?!?!
Well I'm here in Bethnal Green clinic. Just seen a returning patient with a suspected Disc Bulge of her Lumbar Spine who is receiving treatment whilst awaiting an assessment for a MRI scan. During the treatment I decided that I would try my new technique of S-CS to piriformis side-lying.
No sure I'll be doing this technique again with a patient that is in as much acute pain as this lady was with her low back.
With her side-lying I found the Tender Point so took the leg into Flexion, this wasn't a problem however when I tried to add either int/ext rotation to relive the Tender Point ... this wasn't happening, as in order for her me to support the weight of her lower limb and get her in a position of ease meant I was was putting movement through her pelvis and ultimately her lumbar spine.
Not sure whether this technique wasn't suitable or whether it was more to do with operator error ... I need to do some work on this !!!!
IMS - I so don't get it !!!!
Well I don't start the IMS course till next term, which is a shame as I think for me to get my head round it (almost a joke there) I need as much time and practice as I can get. One of the girls who's had the same cold as me went and asked one of the tutors to do some cranial work on her as she has been complaining that due to her cold she is all congested which is not just stopping the way she feels her sinuses are working but also preventing her from studying ....
The tutor did his cranial work as well as some work on her sacrum and pelvis .... after the treatment she said she felt her head and thoughts were already clearer ... she looked however worse than before the treatment, all tired and drained .... the tutor suggested she went and had a sleep for an hour (which she did) ...
I'm looking forward to tomorrow to asking her how she feels ... shame she needed the sleep as we were ment to be practising Functional Technique together, never mind as it ment I could pop up to The Royal Free Hospital to see how dissertation questionnaires were going ....
Tuesday 13 October 2009
Technique - Lumbar Spine
13/10/09 - During technique practise we found that we were placing our elbows in the wrong place on the innominate and it was painful to perform the thrust.
29/11/09 - Discussion with Chris Thomas - we don't need to apply so much pressure with the caudal hand during the thrust.
26/12/09 - Discussion with Simon Browning - During LSpine thrust it is more important to make good contact with our ASIS than the pressure that we apply with our caudal applicator. In theory we should be able to thrust with only applying the caudal forearm to stabilise the patient.
04/02/10 - Clinic - Whilst treating a 22 year old female rower with a Rib 12, QL and LS strain I tried to manipulate her LS without success. I found it so difficult to wind up the joint as she was so mobile ... I felt that I had her in so much rotation that her lower extremity was almost 180 degrees from her trunk !!! Need to practise LSpine thrusts with hypermobile patients.
18/02/10 - Side bending thrust Mr Barker - During a clinic tutoral with Mr Barker we were shown how to perform a side bending LSpine thrust. The hand hold was very much like a SI with the caudal hand on the patient pelvis to perform the drop. This technique was very much like the Anterior SI thrust where it feels like I put a lot of strain in my caudal arm. However the technique was very effective and we revised the type of patients that a side bending thrust may be a good technique to use.
14/03/10 - Haven't thrust many LSpines lately ... must find time to practise them as I'm concerned that I wont be able to thrust them like my TSpine thrusts !!!
16/04/10 - Had some positive feed-back from Mr Harding today concerning my LSpine thrusts ... he said that they looked very comfortable for the patient and that the wind-up was very joint specific.
20/04/10 - On watching one of the smaller girls in clinic today attempting to thrust a 6'4" muscular male it was obvious that she didn't have the table low enough as she wasn't able to put her PSIS onto the patients inomminate ... I had to resist offering advice during the technique in front of the patient ... which was hard as I wanted to have a go myself lol.
29/11/09 - Discussion with Chris Thomas - we don't need to apply so much pressure with the caudal hand during the thrust.
26/12/09 - Discussion with Simon Browning - During LSpine thrust it is more important to make good contact with our ASIS than the pressure that we apply with our caudal applicator. In theory we should be able to thrust with only applying the caudal forearm to stabilise the patient.
04/02/10 - Clinic - Whilst treating a 22 year old female rower with a Rib 12, QL and LS strain I tried to manipulate her LS without success. I found it so difficult to wind up the joint as she was so mobile ... I felt that I had her in so much rotation that her lower extremity was almost 180 degrees from her trunk !!! Need to practise LSpine thrusts with hypermobile patients.
18/02/10 - Side bending thrust Mr Barker - During a clinic tutoral with Mr Barker we were shown how to perform a side bending LSpine thrust. The hand hold was very much like a SI with the caudal hand on the patient pelvis to perform the drop. This technique was very much like the Anterior SI thrust where it feels like I put a lot of strain in my caudal arm. However the technique was very effective and we revised the type of patients that a side bending thrust may be a good technique to use.
14/03/10 - Haven't thrust many LSpines lately ... must find time to practise them as I'm concerned that I wont be able to thrust them like my TSpine thrusts !!!
16/04/10 - Had some positive feed-back from Mr Harding today concerning my LSpine thrusts ... he said that they looked very comfortable for the patient and that the wind-up was very joint specific.
20/04/10 - On watching one of the smaller girls in clinic today attempting to thrust a 6'4" muscular male it was obvious that she didn't have the table low enough as she wasn't able to put her PSIS onto the patients inomminate ... I had to resist offering advice during the technique in front of the patient ... which was hard as I wanted to have a go myself lol.
Monday 5 October 2009
Advanced Spinal Manipulation Lecture Notes
Tutor: Daryl Herbert DO
Functional Tech Pt 1 Scanning and Thorax
Functional Tech Pt 2 Cervical & Lumbar. Theory
Functional Tech Pt 3 Pelvis
Functional Tech Section 4 Thorax and Ribs
Functional Tech Pt 1 Scanning and Thorax
Functional Tech Pt 2 Cervical & Lumbar. Theory
Functional Tech Pt 3 Pelvis
Functional Tech Section 4 Thorax and Ribs
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