Quote Originally Posted by ginger View Post
I'm sure I just said that, but, yes , that is exactly what I do . No need to reiterate the position I have already made clear. Were I not to do this , I would not know , and could not know, what contribution was made to pain and dysfunction from neuralgic means. Clearing tests are virtually useless, have always been so. One cannot percieve referred pain in a way that would identify it as such, tests for joint function routinely offer false postives when blurred by neural interference. The logic of spine first makes more sense of course once you have seen this approach work over and over again. With the experience of having reduced and eliminated pain and dysfunction hundreds and hundreds of times in the face of diagnoses including OA, tenosynovitis , frozen shoulder , PFS, migraine, achilles tendinosis, shin splints , tennis elbow, Ilio tibial band synd. etc etc etc . It is clear to those who approach MSK problems this way , that desigated pathology does not , by itself, exclude the possibility that these signs are less relevant , in the aetiology of pain , than neurology . One only has to treat a few people with so called iliotibial band syndrome by twenty minutes of L4 mobs to witness the elimination of this referred event to have a taste for this approach.

Do you ever use planning sheets during your subjective assesment to write down your thoughts on : 3 key diagnoses then what it could be and might be ?
I know this detracts from the original thread but I don't understand your reasoning for the majority of problems arising centrally rather than perif.

In particular your thoughts on OA.

Think about a footballer with early onset OA...
In particular a footballer with no preivous injuries who sustained medial meniscal damage and subsequently showed with OA on Xray a year or 2 after the injury.

Where is the neural component in this?
I think you're right, at this stage there would be a component- but I don't think your reasoning for why it is there is the same as mine.
I would think that there would be compensatory postural adjustments, ie decreased weight bearing on injured side, decreased strenth, having a 'knock on' effect at the back.
This in turn may 're-refer' (if you can put it like that!) as well.

I don't think always the neuro is the issue and i don't think it's appropriate to go in a treat this and only treat this.
Treat the cause of problem, in this case, weak quads, hams, glut med etc strengthen the knee, propriception, correct posture and you won't get secondary Lx problems and Lx neuro.
You may be reaching the stage where there is a combination, but perhaps not targeting the No. one problem on your planning sheet!

m