24/12/09 - Mental block when it comes to feet ... don't like them ... don't want to like them ... don't want to work on them ... don't want to learn about them ... this needs some serious attention from me !!!
06/03/10 - Having worked on feet during technique class I cant believe I still cant recall the joints of the foot and the direction of there planes quickly ... its always still a struggle for me ... this is so wrong for a fourth year osteopathy student.
29/04/10 - Now I should have realised that in Sports Clinic there would be people coming in with ankle and feet problems, so why on earth didn't I read up a bit before hand.
I saw one of the new patients in the sports clinic today. A 29 year old office worker who plays 7 a-side football at the weekend. 4 weeks ago his received a inversion strain of his left ankle. I was amazed at the swelling that remained after 4 weeks. It was at this point that I realised that despite an interest in wanting to work in a sports related field on qualifying I realised I know nothing about it !!!
When presenting my patient to the tutor I realised that I failed to ask lots of appropriate questions ... like was there bruising and where was there bruising.
The tutor thought that he had possible torn some of the cartilage in his ankle due to the severity of the swelling that remained, and a treatment plan was drawn up. It was at this point that I realised actually how important feet are and the implication for biomechanical changes throughout the body.
Thursday, 24 December 2009
Friday, 27 November 2009
Mock CCA Exam
Well did my mock CCA. Bit of a strange experience but I guess it was going to be.
My continuation patient was a 34 year old man who presented to me 6 weeks prior with Low Back Pain and I diagnosed an annular strain. After answering a few questions on his management plan and progression it was time to see my new patient.
New patient was a 35 year old women with generalised low and mid Tspine pain. She'd had a breast reduction 5 years earlier as her large breasts were giving her back ache. She'd put on weight recently and her back ache had returned.
I didn't get asked many questions about her apart from ergonomic type questions about sitting posture and chair wedges which I don't think I answered very well at all.
Note to self ... make sure I know more about this for the future.
My continuation patient was a 34 year old man who presented to me 6 weeks prior with Low Back Pain and I diagnosed an annular strain. After answering a few questions on his management plan and progression it was time to see my new patient.
New patient was a 35 year old women with generalised low and mid Tspine pain. She'd had a breast reduction 5 years earlier as her large breasts were giving her back ache. She'd put on weight recently and her back ache had returned.
I didn't get asked many questions about her apart from ergonomic type questions about sitting posture and chair wedges which I don't think I answered very well at all.
Note to self ... make sure I know more about this for the future.
Tuesday, 24 November 2009
S-CS: L5 Somatic
Well Ive just finished a session in Bethnal Green. I was working with a 72 year old gentleman with a history of chronic low back pain. Due to his age and marked OA changes on xray of his LSpine he isn't a candidate for HVT hence I tired to treat his back pain with S-CS.
The patient appeared to accept that it was a appropriate choice of treatment for his low back. I found it hard to locate his tender-point as I had to place couch roll over his boxers shorts as they were stained in urine, but I managed to make sure that everything was kept out of the way.
Unfortunately I wont be seeing this patient again to follow up (as its the end of my placement) to see how effective S-CS was for his back pain.
Tuesday, 17 November 2009
Technique - CT Junction
Ive never been able to thrust a CT. From observation in clinic prone seems to be the most popular technique chosen by other students and tutors, followed by a lift off. I cant get either :-(((
17/01/10 - Having identified in that I'm struggling with CT thrusts a clinic tutor talked me through how she does her CT thrusts supine. She adds lots of side shift of the cervical spine down to the CT before applying any other levers. She allowed me to try the technique on her (which I was surprised about) ... and thankfully it was the first CT thrust I managed to get ... and it was supine, not the easiest of techniques I hasten to add.
11/04/10 - I'm still moaning to everyone about not getting my CT thrusts when another of the fourth years offers to show me how he does his prone technique. Theres nothing new about the technique compared to what we have been shown in technique apart from the addition of placing the tips of the fingers onto the SP of T1 whilst applying the side bending to ensure that the side bending go down to the CT. Then carry on as normal. Penny lent here CT to me to try ... I cavitated both sides ... I returned to favour to her and she got both sides ... one side even cavitated without the thrust.
23/04/10 - After my success with the prone technique one of the senior clinic tutors showed me her side lying technique. It really got me thinking about the levers and feeling what is happening at the joint instead of practising rehearsed application of the levers ... I haven't been very successful with this technique but when it does work it is very effective and non-traumatic for the patient compared to some of the prone thrusts we do.
12/05/10 - I think Ive now got 12 CT thrusts in a row with my new revised prone technique ... Ive even been able to teach others how to do it ....
17/01/10 - Having identified in that I'm struggling with CT thrusts a clinic tutor talked me through how she does her CT thrusts supine. She adds lots of side shift of the cervical spine down to the CT before applying any other levers. She allowed me to try the technique on her (which I was surprised about) ... and thankfully it was the first CT thrust I managed to get ... and it was supine, not the easiest of techniques I hasten to add.
11/04/10 - I'm still moaning to everyone about not getting my CT thrusts when another of the fourth years offers to show me how he does his prone technique. Theres nothing new about the technique compared to what we have been shown in technique apart from the addition of placing the tips of the fingers onto the SP of T1 whilst applying the side bending to ensure that the side bending go down to the CT. Then carry on as normal. Penny lent here CT to me to try ... I cavitated both sides ... I returned to favour to her and she got both sides ... one side even cavitated without the thrust.
23/04/10 - After my success with the prone technique one of the senior clinic tutors showed me her side lying technique. It really got me thinking about the levers and feeling what is happening at the joint instead of practising rehearsed application of the levers ... I haven't been very successful with this technique but when it does work it is very effective and non-traumatic for the patient compared to some of the prone thrusts we do.
12/05/10 - I think Ive now got 12 CT thrusts in a row with my new revised prone technique ... Ive even been able to teach others how to do it ....
Tuesday, 10 November 2009
Technique - Thoracic Spine
24/11/09 - I don't know whats happened to my Dog but Ive lost it .... I think I'm over complicating things. Watching some clinic tutors Dog and they just appear to circle over the patient until they feel the tension then drop. Where I actively thing about side bending, flexion, extension and rotation etc
21/04/10 - Well it looks like its not just my rib TSpine thrusts that I'm struggling with its also my Ribs !!! Had a 34 year old man today with a rib lesion that needed manipulating. Once I managed to work out which side the left rib was when the patient was laying down (how embarrassing) I attempted to thrust his rib. All I managed to do was hurt him. Need to practice my rib thrusts before he comes back next week.
28/04/10 - My rib patient came back. Good news was he was feeling some improvement in the intensity of his pain and also the area of pain was more localised to that rib 4 lesion. I attempted it again, twice and failed to get a cavitation (I know its about quality of movement but still !!!). My tutor then attempted to mobilise the rib for me. He took two attempts. On discussion with my tutor after he said that the rib just didn't want to seem to move so he elected to thrust the TSpine to improve the movement in the segment as a whole. This made me feel better in my failed attempts.
05/05/10 - Rib patient is back ... symptoms are improving further as expected. Still I wanted to mobilise that rib. This time I had listened to the feedback that my tutor had given me on the previous weeks about rotating over the patient and pronating my fulcrum more and at last the rib mobilised. Im looking forward to seeing what improvement this will have made next week.
21/04/10 - Well it looks like its not just my rib TSpine thrusts that I'm struggling with its also my Ribs !!! Had a 34 year old man today with a rib lesion that needed manipulating. Once I managed to work out which side the left rib was when the patient was laying down (how embarrassing) I attempted to thrust his rib. All I managed to do was hurt him. Need to practice my rib thrusts before he comes back next week.
28/04/10 - My rib patient came back. Good news was he was feeling some improvement in the intensity of his pain and also the area of pain was more localised to that rib 4 lesion. I attempted it again, twice and failed to get a cavitation (I know its about quality of movement but still !!!). My tutor then attempted to mobilise the rib for me. He took two attempts. On discussion with my tutor after he said that the rib just didn't want to seem to move so he elected to thrust the TSpine to improve the movement in the segment as a whole. This made me feel better in my failed attempts.
05/05/10 - Rib patient is back ... symptoms are improving further as expected. Still I wanted to mobilise that rib. This time I had listened to the feedback that my tutor had given me on the previous weeks about rotating over the patient and pronating my fulcrum more and at last the rib mobilised. Im looking forward to seeing what improvement this will have made next week.
Tuesday, 3 November 2009
Technique - Glenohumeral and Shoulder Orthopedic Tests
03/11/09 - So many orthopedic tests for the GH ... Im really struggling to remember them all, especially by name and need to improve SLAP lesion examinations.
http://www.prohealthsys.com/
12/11/09 - Keira Kinch Tutorial - GH Examination
The tutors allowed us to select the topic of of tutorials this term so I suggested that it would be helpful to see how they performed a shoulder/GH examination.
Keira suggested that we do some further research on shoulder examinations and I came across this resource on the Internet.
http://www.prohealthsys.com/physical/shoulder_exam.php
Again Keira was great at showing us how to perform the tests accurately and how to interpret what we found.
Having never seen a patient with Adhesive Capsulitis through out the whole course I saw two in one week during the Easter vacation. Thankfully I had another student with me who was more familiar with them than myself. I vaguely remembered the capsule stretches that you need to do and to stretch the shoulder to the point before its painful for the patient. The other student gave the patient an exercise to do whereby they stretched their GH capsule in front of a mirror to ensure that they were not using side bending to assist (see video).
http://www.prohealthsys.com/
12/11/09 - Keira Kinch Tutorial - GH Examination
The tutors allowed us to select the topic of of tutorials this term so I suggested that it would be helpful to see how they performed a shoulder/GH examination.
Keira suggested that we do some further research on shoulder examinations and I came across this resource on the Internet.
http://www.prohealthsys.com/physical/shoulder_exam.php
Again Keira was great at showing us how to perform the tests accurately and how to interpret what we found.
Having never seen a patient with Adhesive Capsulitis through out the whole course I saw two in one week during the Easter vacation. Thankfully I had another student with me who was more familiar with them than myself. I vaguely remembered the capsule stretches that you need to do and to stretch the shoulder to the point before its painful for the patient. The other student gave the patient an exercise to do whereby they stretched their GH capsule in front of a mirror to ensure that they were not using side bending to assist (see video).
Friday, 30 October 2009
Cranial to Spinal ....
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.
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.
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
Monday, 28 September 2009
Strain Counterstrain - The Theory - Jo Holmden
The definition given by Jones describes a passive positional procedure that places the body in a position of greatest comfort, thereby relieving pain by the reduction of the inappropriate proprioceptor activity that is maintaining somatic dysfunction. It is an Indirect Technique where the action is away from the restricted barrier.
When an already shortened muscle is forcibly stretched the proprioceptors in the muscle spindle report strain before that muscle has reached its normal length. This situation has the effect of increasing the "gamma gain" (gamma impulses that are calling for a sudden contraction of the fibers to oppose the induced stretch). This opposes the return to normal by exaggerating the afferent firing from the muscle spindle. A good example of this is when a muscle is being overstretched at the same time as it is trying to contract, ie. the injury occurs faster than the body can react. Another example is when a muscle is unexpectedly shortened and slackened in an unguarded passive movement.
EXAMPLE
Assume the forearm is forcibly extended suddenly putting stretch on Biceps ---THIS IS THE STRAIN.
Triceps is then shortened and proprioceptive reflexes come into action to contract Biceps and counteract the sudden loading. Korr suggests that this action and the silencing of the spindles in Triceps (due to it's initial shortening) causes the gamma gain to be turned up (increased) causing Triceps to contract---THIS IS THE COUNTERSTRAIN.
The central nervous system regains the spindle information at the expense of the shortened Triceps because it is reporting to the CNS that it has been stretched before it had reached a neutral length.
Flexion is thus restricted by a tonically shortened Triceps caused by inappropriate high gamma gain.
Clinically the elbow will move easily into extension but would resist flexion.
All of this has taken place within the normal length of the muscles concerned and maintained by the increased gamma gain in Triceps effectively resetting the forearms neutral position towards extension.
The inappropriate response is reduced by applying a mild sustained strain for 90 seconds to its antagonists which then allows the malfunctioning muscle spindle to shorten.
Diagnosis is (1) by history, where if possible assessment of the type of injury, the position of the patient, and the direction of forces involved must be made.
(2) by the presence of tender points in muscle and fascial tissue. These ate usually found in the
or insertion the belly or the musculo-tendinous junction. Tender points tend to be more segmental in origin ---points along the vertebral column tend to indicate dysfunction at the corresponding level.
Jones emphasises the importance of tender points on the anterior aspect of the body, which may not appear to be related to local subjective pain especially on the posterior surface.
Tender points are often found in tissue where there is no complaint of pain by the patient.
There may also be oedema and tenseness at these points.
Treatment
The principle behind treatment is to passively position the joint or muscle in its position of original strain.
Treatment is directed at the dysfunction that causes the Tender Point.
In the example by approximating the ends of Triceps by placing the forearm into extension, thus recreating the direction of the original force.
Korr suggests this allows the "gamma gain" to be gradually reduced by the central nervous system, which in turn allows the muscle to return to its easy normal at its resting length.
This is achieved by:
( 1 ) Palpation of the tender point/s and assessing the degree of pain by asking patient to score the pain on a scale of 1-10 with 10 being most painful.
(2) Positioning the joint or muscle SLOWLY into its position of ease using flexion or extension as the prime movements, with sidebending and or rotation added as necessary until the patient reports a patn score of 3 or less. This position is maintained for 90 seconds. The effect of treatment may be enhanced by minutely exaggerating the combination of the movements at the position of ease. This is called fine tuning. Often the palpating/monitoring finger can detect a "give" or plasticity of the tissue. The patient needs to be as relaxed as possible during the entire procedure. A simple rule of thumb is that for Anterior tenderpoints we use Flexion with SB/ROT towards the tenderpoint side, and for Posterior ones, Extension with SB/ROT away from it.
(3) The pressure of the finger should remain constant throughout the procedure, and the return to the resting position should be SLOWLY carried out.
(4) The muscle/joint is then retested in the same manner noting the patient's pain evaluation.
(5) Jones has suggested that for tender points near the mid-line more flexion is needed for anterior points and extension for the posterior ones. As the points become more lateral mote sidebending and or rotation may need to be introduced.
It has been suggested that the 90 seconds allows the local circulation to improve due to the release from
chronic sympathetic stimulation.
Treating a tender point may resulting in;
(1) becoming softer and less tender.
(2) becoming warmer.
(3) Pulsating.
(4) Relaxing of the muscle and / or surrounding area (fascial unwinding).
The overall effects may be summarized as "Removing Restrictive Barriers of Movement" by:
[1] Reducing muscle hypertonicity.
[2] Normalising fascial tension.
[3] Increasing joint mobility.
[4] Increasing local circulation and reducing swelling.
[5] Decreasing pain.
[6] Increasing strength.
Although Jones maps out his tender points specifically, you will find others that do not correspond to his
charts, but can be treated in the same way using the basic principles.
APPLICATIONS
The most striking things about Strain and Counterstrain technique is that
(1) It is very patient friendly in that they are able to give constant feedback to the practitioner.
(2) It is minimally invasive and therefore suitable for:(
(a) Acute onset of musculo-skeletal symptoms
(b) Nervous patients
(c) Aged patients
(d) Bedridden patients, whether for acute conditions, or to help with musculo-skeletal pain in patients with metastases where conventional techniques would be contraindicated.
The technique of Strain and Counterstrain can be applied and adapted to suit the needs of a wide variety of patient types as well as the practitioner.
CONTRAINDICATIONS
Obvious contraindications are treating tender points where there ate open wounds, sutures, local skin lesions or infections, haematoma and hypersensitivity of the skin.
Care must be taken when treating the neck and skull tender points not to position the head or neck in a position which could possibly provoke any vertebrobasilar compromise.
Therefore it is of paramount importance, as with all patients, to take a full case history.
When an already shortened muscle is forcibly stretched the proprioceptors in the muscle spindle report strain before that muscle has reached its normal length. This situation has the effect of increasing the "gamma gain" (gamma impulses that are calling for a sudden contraction of the fibers to oppose the induced stretch). This opposes the return to normal by exaggerating the afferent firing from the muscle spindle. A good example of this is when a muscle is being overstretched at the same time as it is trying to contract, ie. the injury occurs faster than the body can react. Another example is when a muscle is unexpectedly shortened and slackened in an unguarded passive movement.
EXAMPLE
Assume the forearm is forcibly extended suddenly putting stretch on Biceps ---THIS IS THE STRAIN.
Triceps is then shortened and proprioceptive reflexes come into action to contract Biceps and counteract the sudden loading. Korr suggests that this action and the silencing of the spindles in Triceps (due to it's initial shortening) causes the gamma gain to be turned up (increased) causing Triceps to contract---THIS IS THE COUNTERSTRAIN.
The central nervous system regains the spindle information at the expense of the shortened Triceps because it is reporting to the CNS that it has been stretched before it had reached a neutral length.
Flexion is thus restricted by a tonically shortened Triceps caused by inappropriate high gamma gain.
Clinically the elbow will move easily into extension but would resist flexion.
All of this has taken place within the normal length of the muscles concerned and maintained by the increased gamma gain in Triceps effectively resetting the forearms neutral position towards extension.
The inappropriate response is reduced by applying a mild sustained strain for 90 seconds to its antagonists which then allows the malfunctioning muscle spindle to shorten.
Diagnosis is (1) by history, where if possible assessment of the type of injury, the position of the patient, and the direction of forces involved must be made.
(2) by the presence of tender points in muscle and fascial tissue. These ate usually found in the
or insertion the belly or the musculo-tendinous junction. Tender points tend to be more segmental in origin ---points along the vertebral column tend to indicate dysfunction at the corresponding level.
Jones emphasises the importance of tender points on the anterior aspect of the body, which may not appear to be related to local subjective pain especially on the posterior surface.
Tender points are often found in tissue where there is no complaint of pain by the patient.
There may also be oedema and tenseness at these points.
Treatment
The principle behind treatment is to passively position the joint or muscle in its position of original strain.
Treatment is directed at the dysfunction that causes the Tender Point.
In the example by approximating the ends of Triceps by placing the forearm into extension, thus recreating the direction of the original force.
Korr suggests this allows the "gamma gain" to be gradually reduced by the central nervous system, which in turn allows the muscle to return to its easy normal at its resting length.
This is achieved by:
( 1 ) Palpation of the tender point/s and assessing the degree of pain by asking patient to score the pain on a scale of 1-10 with 10 being most painful.
(2) Positioning the joint or muscle SLOWLY into its position of ease using flexion or extension as the prime movements, with sidebending and or rotation added as necessary until the patient reports a patn score of 3 or less. This position is maintained for 90 seconds. The effect of treatment may be enhanced by minutely exaggerating the combination of the movements at the position of ease. This is called fine tuning. Often the palpating/monitoring finger can detect a "give" or plasticity of the tissue. The patient needs to be as relaxed as possible during the entire procedure. A simple rule of thumb is that for Anterior tenderpoints we use Flexion with SB/ROT towards the tenderpoint side, and for Posterior ones, Extension with SB/ROT away from it.
(3) The pressure of the finger should remain constant throughout the procedure, and the return to the resting position should be SLOWLY carried out.
(4) The muscle/joint is then retested in the same manner noting the patient's pain evaluation.
(5) Jones has suggested that for tender points near the mid-line more flexion is needed for anterior points and extension for the posterior ones. As the points become more lateral mote sidebending and or rotation may need to be introduced.
It has been suggested that the 90 seconds allows the local circulation to improve due to the release from
chronic sympathetic stimulation.
Treating a tender point may resulting in;
(1) becoming softer and less tender.
(2) becoming warmer.
(3) Pulsating.
(4) Relaxing of the muscle and / or surrounding area (fascial unwinding).
The overall effects may be summarized as "Removing Restrictive Barriers of Movement" by:
[1] Reducing muscle hypertonicity.
[2] Normalising fascial tension.
[3] Increasing joint mobility.
[4] Increasing local circulation and reducing swelling.
[5] Decreasing pain.
[6] Increasing strength.
Although Jones maps out his tender points specifically, you will find others that do not correspond to his
charts, but can be treated in the same way using the basic principles.
APPLICATIONS
The most striking things about Strain and Counterstrain technique is that
(1) It is very patient friendly in that they are able to give constant feedback to the practitioner.
(2) It is minimally invasive and therefore suitable for:(
(a) Acute onset of musculo-skeletal symptoms
(b) Nervous patients
(c) Aged patients
(d) Bedridden patients, whether for acute conditions, or to help with musculo-skeletal pain in patients with metastases where conventional techniques would be contraindicated.
The technique of Strain and Counterstrain can be applied and adapted to suit the needs of a wide variety of patient types as well as the practitioner.
CONTRAINDICATIONS
Obvious contraindications are treating tender points where there ate open wounds, sutures, local skin lesions or infections, haematoma and hypersensitivity of the skin.
Care must be taken when treating the neck and skull tender points not to position the head or neck in a position which could possibly provoke any vertebrobasilar compromise.
Therefore it is of paramount importance, as with all patients, to take a full case history.
Tuesday, 22 September 2009
Technique - General Osteopathic Examination
During technique practice it became apparent that I need to do more active examinations as well as how important it is to perform a sitting examination as it can give lots of information about the pelvis and leg length as well as whether a patients scoliosis is functional or structural.
13/11/09 - Kiera Kinch Tutorial - Knee Examination
It wasn't until Keira Kinch gave us a tutorial that I really appreciated how observation is the first key step to assessment. When a fellow student was asked to perform a knee examination to the rest of the tutorial group. She did as I would ... stand the patient up and look at their knees etc and then get them straight onto the table to perform a passive examination.
When the tutor repeated the examination she look at the patient in greater detail and got the patient to do active movements. She asked the patient to engage their quads whilst standing to see how the patella tracks and she asked the patient to do squats to see how the different muscle groups engaged.
25/01/2009 - Anatomy Trains
Something that I don't feel the course at the BSO has given me is a very good understanding of fascia and how muscles are interconnected. Obviously I understand why we need to learn the individual muscles and there origins and insertions, however through clinical experience I have learnt to appreciate how important myofacial connections are. An example of this is whilst treating a patient with lateral knee pain. It wasn't until I started working more globally on the 'Superficial Back Line' that I really did make some functional changes to my patients pain whilst running.
13/11/09 - Kiera Kinch Tutorial - Knee Examination
It wasn't until Keira Kinch gave us a tutorial that I really appreciated how observation is the first key step to assessment. When a fellow student was asked to perform a knee examination to the rest of the tutorial group. She did as I would ... stand the patient up and look at their knees etc and then get them straight onto the table to perform a passive examination.
When the tutor repeated the examination she look at the patient in greater detail and got the patient to do active movements. She asked the patient to engage their quads whilst standing to see how the patella tracks and she asked the patient to do squats to see how the different muscle groups engaged.
25/01/2009 - Anatomy Trains
Something that I don't feel the course at the BSO has given me is a very good understanding of fascia and how muscles are interconnected. Obviously I understand why we need to learn the individual muscles and there origins and insertions, however through clinical experience I have learnt to appreciate how important myofacial connections are. An example of this is whilst treating a patient with lateral knee pain. It wasn't until I started working more globally on the 'Superficial Back Line' that I really did make some functional changes to my patients pain whilst running.
Monday, 21 September 2009
INTRODUCTION
Well this is the first of many entries to my Osteopathic Journal Blogg ..... not that this entry is going to have anything of osteopathic relevance to it as I just need to work out how this thing works hehehe .... but here goes ... I expect great things from myself ;-)