Muscular strains- not enough treatment techniques!!

[cleehaddock]

Hello all.

I am starting to see more and more muscle strains- rec fem and medial head of gastroc. Although this may sound silly, but am struggling to fill out a half an hour session. especially injuries in the acute/ sub acute stage. I feel the patient comes for treatment, not just to be given a load of exercises. Apart from stretches, ultrasound and active release I am struggling to come up with anymore treatments.

Many thanks

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[neuromuscular]

Truth is my approach is a bit more complex than just fascial release. I have found an underlying common denominator in most musculo-skeletal dysfunction and pain and that is the sympathetic nerve cell dysfunction. This dysfunction seems to be a starting point of the body's adaptation to overload or stress, and if this system fails it loses control of the blood flow rate to certain areas of the body resulting in fascial shrinkage, muscle weakness and pain. I usually treat this first to see the effects of restoring function to teh sympathetics, and in most cases (>95%) this restores muscle strength immediately. I then use myofascial release to restore the flexibility, thus giving muscles the 2 main things they need apart from an intact nerve supply, namely good blood flow rate and space in which to operate.

I find this restores muscle balance, pelvic balance and general function in the musculoskeletal system, and because of this pain is relieved. I find there are 2 main types of pain, that from fascial stress due to musculoskeletal dysfunction, and that from poor blood flow control (commonly pain at or after rest, or after too much activity). Pain with movement is more mechanical, thus related more to the myofascial component.

Before I started using myofascial release 16 yrs ago I used to do manual pelvic adjustments which showed similar changes in muscle strength, however it did not last very long, but myofascial release gives a more permanent change in the strength and posture.

In my view if we restore good blood flow rate and fascial integrity, there is very little reason why there should be any pain from a musculoskeletal origin.

Dear Physiomitch:

Thank you for your reply.


I have never used the manipulative approach as it would appear to me to create a feedback much like a strain or sprain where the area is at first inhibited and then the prprioceptive sense is fooled to accept an abnormal as normal.
The affect is temporary at best as you menrtion.

I am result driven. I do not use methods taht flatter me as the great healer. If I do not see a change I do not feel that a change has been made.

I have mentioed the assessment that I use as the four sided pelvic bone assessment with hip abduction. Pretherapy the angles are off the normal plane.
Post treatment the angles are in the anatomiclal neutral position. That is my criteria for success. in low back treatment. The other areas such as the ankle are harder to quantify by postural assessment.

I use postural asssessment first and foremost as it is the most objective. If i fool the proprioceptive sense, the muscle strength may appear to be normal until the patient returns to normal activity and then the muscle "strength" may not be so "normal".

I would be most interested in how your therapy corresponds to the comparison using the assessment of the four sided pelvic assessment pre therapy and posttherapy.

The OGI test in Nebraska USA is finding very positive affects of using the assessment. Patients who previously did not respond to any treatment by any discipline are responding to this assessment and the changed therapy resulting.

Thamks again.

My best to you,

Neuromuscular,

[physiomitch]

Hi again

I have never come across the 4 sided pelvic assessment, but I can understand the approach especially in this day and age and the need for objective measures. Personally I trust the muscles themselves for giving me an idea of where things are at physically/posturally. I too do not use manipulation, my treatment for the sympathetics is based on specific application of cold, not as we are taught, based on Frederick Erdman's approach.

I am of the belief that if the muscles are strong, the ROM is normal and equal side to side, and this is backed up by good circulation control, then the body should function pain-free. The great thing about using muscles as a test either through Kinesiology or basic strength tests is the patient is immediately involved and when strength returns or a Kinesiology indicator muscles changes from weak to strong, they can feel something is happening, even though there may not be any change in symptoms initially. I judge improvement by increased strength and flexibility, not symptoms, these will follow basic functional stability.

In essence, as an Acupuncturist/Kinesiology practitionar as well, I am able to improve strength in many ways, including one needle in Pericardium 9 for hip abduction (as an example only..usually 5 elements approach used here), or by stimulating neurovascular or neurolymphatic points for a minute or so. All these can show an improvement in strength, but need to be backed up by blood flow control and soft tissue flexibility. If the pull of muscles is balanced then pelvic posture will be restored, thus I am positive all the angles will be normal, otherwise strength and symptoms will not be restored. Posture follows fascial changes like a shadow, and as fascia is an adaptable tissue and able to shrink, it is the primary suspect in postural changes and thus bony positions.

Out of curiosity, how do you measure the angles of the pelvis?

Regards

[neuromuscular]

Dear physiomitch:

You are not alone in trying to find information on a four sided pelvic bone position test. There is little on this type of testing. The OGI is doing a research project on it and a paper should be forthcoming soon.

I use a landmark test with the following comparison referenees: ASIS to ASIS. PSIS to PSIS, ASIS to PSIS (R&L) with hip abduction directly lateral in the coronal plane from closed foot stance to the maximum obtainable by the patient using 30 cm increments..

Any deviations should be significant. Normal is all landmarks level or even in the horizontal plane.

You can use a goniometer or eye sight. The differences will be greater than 1 cm in the ASIS comparisons and less in the PSIS comparison. ASIS differences are often in the order of 2 cm plus. PSIS usually are less .5 cm or sligthly greater.

Do not look for mm differences. The differecnes must be significant.

See if your results pre therapy and posttherapy are significantly different.

Hope that this is helpful.
Best regards,


Neuromuscular.

[physiomitch]

I take it this is done in supported standing? Do you do actual manual muscle strength tests as well in your assessment?

[neuromuscular]

I take it this is done in supported standing? Do you do actual manual muscle strength tests as well in your assessment?

Dear physiomitch,

The test must be in full support against gravity. The patient must be free standing and have complete control at each progression. The idea is to see how the posture muscles hold against gravity. Each stance must be complete and with the patient in control to his ability.

Most patients will deviate much from anatomical neutral as the foot width stance progresses. Some will appear to come closer to anatomical neutral. However, each will tell you why the patient cannot hold close to anatomical neutral throughout the progression. It will take some time before it falls into place for the practitioner as this is a new direction for them, but it will make sense as it is used.

Unlike the Kendall manual on muscle testing, I have not found muscle testing to be objective. The role of reverse inhibition has not been explored. Although, I have taken seminars on "better" positioning to get the most objective results, I have not found that I can depend on these as an absolute test.

The postural test that I use gives me the most objective information on the patient.

We cannot say that the synergist, antagonist, joint, fascia, etc is not inhibiting the muscle in muscle testing no matter the position or care given. Using an instrument to measure the responses only rules out the practitioner's input, but does not rule out other factors such as reverse inhibition or eccentric contration problems interfering with the muscle testing.

I also do a supine and prone assessment to see if there is a difference in the gravity to non gravity action of the muscles. There often is.

The supine test is of ASIS to ASIS for superior or inferior placement and distance of ASIS to the bench or table or plinth.

The prone test is of the PSIS to PSIS for superior to inferior placement and the distance of the buttocks from the table left compared to right

Hope that this is of benefit to you.

Try these test against your therapy to assess your success in return to anatomical neutral.

My best to you,

Neuromuscular Ed