Re: Lateral Epicondylalgia
Can't help but wonder which outdated text book this was lifted from james.
Re: Lateral Epicondylalgia
Hi Ginger,
Not lifted my dear but referenced.
I hadn't put the thorax or cervical assessment on there as there isn't a research base for it. This protocol can be used with confidence knowing there is research to back it up. In this environment where insurance companies don't understand that Level 3/4/5 evidence is still evidence based practice, it is helpful.
In reality, you would assess the articular, myofascial, neural, visceral and emotional systems of the patient for each region (Lee and Lee 2007).
However, knowing that you live in the articular system, you will still get neurophysiological effects and inhibition of the myofascial system from your mobilisations to the cervical spine. Kind of like a shotgun.
Still, as you know, i still would prefer your manual therapy to electrotherapy any day ;)
Cheers
Re: Lateral Epicondylalgia
not sure with whom I'm responding to here , it is either a james in pakastan who has lifted a piece from a text book , or an aussie who responds as if he had done so. I'm sure all will be revealed. I had trouble reading the last post after the piece from alophysio where he claims to pay attention to " visceral and emotional systems ". haven't had a bigger laugh all day.
Re: Lateral Epicondylalgia
Thanks Ginger, glad to help you add some humour to your day.
To clarify, the original post listed a protocol i had posted upon request in a different thread. If you had properly read the original post (just scroll higher and you can see it clearly), my name is there and i listed the sources where i got my information from.
In context, the protocol is a practical summary of information provided by people who research in the field of lateral epicondylitis.
Next, just because you lack the skill of knowing how to assess someone's viscera doesn't mean that everyone else who does is a joke...
Also, if you don't pay attention to your patient's pyschosocial issues, you would be a very cold physio indeed - and ignoring the biopsychosocial model that has been thrust upon us. Actually i am sure that you do since you claim such high rates of success for your CM.
If the information is outdated (the paper was from 2003 by the way so it can be considered a little outdated), then what is your "up-to-date" information to contribute to the discussion? What are your intelligent remarks (smirks not required...) and arguments as to why the above is not valid?
Derision is not an attractive look for you. I appreciate that not all people think/believe that everything can be cured by your "continuous mobilisations" to the spine for all problems. The fact that you have devotees out there should counter your claim that research is impossible because you lack the time or the energy (perhaps sore from so many thumb breaking mobilisations?). Sometimes physiotherapy is an art - which i am sure you appreciate - so what is the harm in finding out how other therapists are helping people?? Are you that arrogant that other ways actually exist?
Lastly, your way is not the only way otherwise someone earlier in life would have discovered it. In fact, your continuous mobilisations are simply Maitland mobilisations practiced by thousands around the world. It doesn't actually sound hard.
In fact, i could probably sum up most of your posts - "use CMs".
Respect is somethinig i have always paid to you. You claim to be happy to answer questions about CMs but then when i do, you direct me sites where other physios also question you and you don't reply to the questions.
Still, i suppose we need all types of people out there. It is truly a shame that your method of communication is one of arrogance, lack of research-informed comments, single-minded in nature (CMs fix everything), and just plain abrasive.
I haven't felt so sorry for someone in ages...i pity you. :(
Re: Lateral Epicondylalgia
Quote:
Originally Posted by
ginger
not sure with whom I'm responding to here , it is either a james in pakastan who has lifted a piece from a text book , or an aussie who responds as if he had done so. I'm sure all will be revealed. I had trouble reading the last post after the piece from alophysio where he claims to pay attention to " visceral and emotional systems ". haven't had a bigger laugh all day.
I think that the first post was in relation to something published by alophysio, who is a regular and widely read contributor to this forum. I think the first poster lifted it just for some reference material on which others could comment. Perhaps specific discussion of what should/should not/could be included etc. in this list would be more constructive than personal bickering.
Everyone likes to "have a good laugh" but it would be great for those who do to put their words where their comments are.
Re: Lateral Epicondylalgia
Apologies for the rant...i should be more respectful.
Re: Lateral Epicondylalgia
alophysio , you deserve my apology for seeming abrasive derisive and unwilling to prop my responses with further considered details. I find myself more and more disillusioned with the general state of the physiotherapy community, at least those represented by the majority of posters on MSK matters. The real possibilities that may lie in improving the understanding of MSK problems by physios , are at the undergrad level. It seems those whose reference points and methods are derived from outdated models , find a paradigm shift just too hard. I do find it difficult though to lurk and not respond where seemingly rational discussion occurs with the blinkers still on about referred events. AS to your comments , I take responsibility for your umbrage and will refrain from offering comment without sufficient detail to fill in the blanks.
Re: Lateral Epicondylalgia
Hi Ginger,
Thank you - no hard feelings. I too share your frustration.
I am a little cynical at the undergrad level though because students are focused on passing, not healing at that stage - they haven't had the experience of actually helping someone significantly change their life due to manual therapy.
But hopefully by putting credible alternatives out there will help others consider the possibilities, maybe even feel the difference!
Cheers
Re: Lateral Epicondylalgia
To Jamesmayur and those who have stated that there is no inflammation in lateral epicndy"litis":
I am aware of the research that says that there are no inflammatory cells, but some patients seem to respond well (although temporarily) to NSAIDS and injections. Do you agree? If so, how would you explain this?Thanks!
Re: Lateral Epicondylalgia
Hi Marty10,
NSAIDs and injections...
...well, if there are signs of inflammation, treat them - heat, swelling, pain, redness, loss of function...
As for injections, i am fairly confident there is research that suggests a short term benefit in terms of pain but longer term results in the same group leading to decreased improvement overall.
If you were treating someone who strained their elbow on the weekend, you are probably looking at some form of inflammation. If you are treating someone with a 6 month history of elbow pain, you are probably treating something that is not inflammation.
In the end, we are trying to break a cycle and gradually expose the injury to load to assist in repair - i am fairly pragmatic about such things...especially having suffered from LE myself...i only ask that the patients know about WHY they are getting a treatment etc.
Cheers
Re: Lateral Epicondylalgia
bill vicenzino missed one thing in his assessment; the myofascial assessment developed from physiotherapist luigi stecco and his wife carla stecco who is an orthopaedic surgeon. the technique is called myofascial manipulation and is based on the meridain channels of traditional chinese medicine. luigi refers to painful sites and centres of perception; arease that your are aware of pain and states the lesions of the myofascial meridian; meridian channel, usually are juxtapositioned near the centre of perception (CP), the lesion site is called the centre of coodination (CC) and usuallu is found where the monarticular and polyarticular muscles converge there line of tension along the myofascial plane.
for example;
lateral epicondylagia is the centre of perception of the elbow. to identify the centre of coordination look at the muscles attached to the lateral epicondyle.
the monoarticular muscles is the aconeus and supinator and brachialus
polyarticular muscles are the wrist extensors/ thumb extensors abductors and the muscles that attach onto the lateral intermuscular septum such as triceps and biceps brachii
the centre of coodination will be the area of convergence of the tension of monarticular and polyarticular muscles either proximally or distally from the area.
the distal site of supinator over the interosseous membrane and the origin of thumb extensor / abductor. also beneath the wirst extensors.
or
the distal site of aconeus and the interface between brachioradialus
or the origin of brachialus and the interface between triceps or biceps brachii
the CC wil be tender on palpation and refer pain like a active trigger point.
i also quickly run along the path of the affected myofascial meridian to identify lesions; active and latent trigger points then treat the active trigger point and re asssess. if there is still residual weakness i then will treat the latent trigger pint as well if still there after the release of the active trigger point. 90 percent of the time the latent trigger point will resolve with active trigger point trreatment
for example
the large intestine meridian is made up of the soft tissue that passes over the lateral epicondyle. i will palpate over the length of the large intestine and its opposite the heart meridian to identify lesions to treat in the segments juxta positioned to the painful site; active trigger points, if there are no active trigger points i will then assess the next segment above or below until i find the active trigger point along the length of the myofascial meridians; large intestine and heart
Re: Lateral Epicondylalgia
Hi Mulberry,
very interesting.
Can you give us some references to read about this technique you speak of?
You might know I have spoken about the meridians in relation to musculoskeletal problems and epicondylitis before (from the bindegewebs/meridian corner) and am always interested in knowing more, especially regarding the science behind any given method or technique.
Thanking you in advance.
Esther
Tennis Elbow” problems are treatable using physiotherapy.
