chondromalacia VS PFJ problem

[alophysio]

Thanks for your reply Ginger.

Some replies to your comments above...

Not complicated at all , for the most part the "damage " you refer to is irrelevant . In much the same way as the kinds of degenerative changes seen on x-ray etc in and around spinal joints and adjacenet structures is largely irrelevant. Once normal patterns of recruitment and referred pain and the galaxy of other altered ( referred ) neural events have been turned off , these identified features of the likely interaction of inflammatory chemistry on soft tissues remain , but are rarely the cause of pain. What you are noting are the consequences of dysfunction , rather than cause. A mistake often made by those whose notions of diagnosis are still rooted in the pathology model of MSK diagnosis ( doctors of medicine ).

I would have to disagree with you here. Yes i am noting the consequences of dysfunction however there are signficant changes that can occur which DO alter biomechanics physically as well as being possibly pain producing.

For example, you mention that a lot of degenerative findings on XRay are irrelevant and i agree with you to a certain extent. However if someone has a large bumper osteophyte on their facet joint as a result of poor local control, then that degenerative finding - though not necessarily painful - WILL be significant because it will physically stop the motion at that joint (essentially self fusing). The goes for a degenerated facet joint that is bone on bone. If we had gotten there earlier, then maybe something could have been done but now it is bone on bone what can you do?

The same for cartilage problems in the knee. Grade III problems can have flaps and tears and all sorts of pathology that can mechanically alter function and induce pain.

I used to be more single-minded in my approach similar to you - restore normal spinal joint motion and nerve function and things will settle but i have seen far too many physical problems - we need to get them earlier...

The purpose and result in dealing with spinal joints is to do what must always be first on the list, restore normal neurology. By doing so it becomes clear , what was local and what was not. In most cases this is all that is required as most MSK conditions not related to trauma ( along with many that are ) are simply referred events . By eliminating these events a lasting restoration to pain free normal function can be achieved in the majority of cases.

I agree with you here to a certain extent. I am not sure i am as bold as saying the majority of cases but maybe it is a caseload thing?

I used to , but I had a year off and now keep a lower profile. There are more things in a balanced life than treating patients . Unfortunately , now that I have returned to private practice , I find the numbers are increasing rapidly again and I have trouble saying no. I don't advertise or accept referrals from doctors, don't see workcover or other compensables. Just cash paying people from all walks of life who manage to hear about me. Many from interstate , some from overseas. My interests vary widely and I do my best to balance them out. There is a lot of joy however , as you would know , in being the person who can fix what others could not.

Any good physio worth their salt will have the same patterns. I have no doubt that you are a good physio. In fact, I have been told that there aren't many good manual therapists in the mould of you and i in Melbourne (apparently - Melbourne physios seem to have a good rep for sports but not musculoskeletal / manip physio) so perhaps your patients are just getting good manual therapy!!

Having said that, i have not heard of you before nor have i heard of CM until you posted on this forum. Whereabouts are you (don't mind if you PM me on that ). I have had a lot of trouble finding good physios in melbourne - i only have a couple of names. How are people finding out about you?

Lastly, I would appreciate some comments from you about the some of my other comments earlier posted...
1. Why no research - if it is as fantastic as you claim, then there should be plenty of confidence in the findings and it wouldn't be hard to do - so many existing models we could use. You have plenty of patients to draw on and apparently students who no doubt would be willing to help.
2. Mobilisation - is it hitting the level you want?
3. Spinal innervation - are the levels you believe are the problem REALLY the levels.

Thanks Ginger, always a pleasure to hear your comments

BTW - comments from others welcome too!