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Wednesday, 24 July 2013

Manual mobilisation of the coccyx

I just watched a video on YouTube, in Spanish, of a therapist, doing coccyx manipulation through the clothes. 

I am interested in coccyx manipulation. Mainly as, because it is a process that is not very appealing for a therapist, and it is not great to have done as a patient: probably often gets missed. This leaves an unfortunate sub group of patients who have a mechanical dysfunction of the coccyx: but are unable to find a therapist who deals with this area. 

Don't get me wrong: it is my least favourite body part to treat. It's ethically difficult ground.

But : it seems wrong to leave people in pain for years, when we are experts in manipulation of the rest if the body, to eliminate pain,  simply because its am awkward and undesirable area of the body to treat. 


Back to the SIJ?

I watched a YouTube video today by an orthopaedic surgeon on how 25% of back and hip pain may be from the SIJ. 

He noted that clinical and radiological tests are not reliable. 

The only reliable test is an anaesthetic injection to the SIJ. If the pain is gone then it was the source. 

He suggested manipulation and noted stabilisation belts as treatments. Also RF ablation and true fixation with a screw!  

It was good to do some independent CPD. The idea that some could have a true SIJ problem and do years of treatment with the wrong diagnosis is concerning. 

It will help me to think about the patients who do not get better and what could be going on for them. 

Thinking about it : I was in a similar place : treated for years for a facet or disc problem. When it was in fact stenosis. Something not diagnosable clinically. Needing an MRI and an advanced interpreter.

 Sacroiliac Joint pain, animation - Everything You Need To Know - Dr. Nabil Ebraheim, M.D.


Saturday, 29 June 2013

Manipulation and proprioception in the lumbar spine: HE Seminars Course

I went to  the HE Seminars course yesterday. A day on Evidence Based Practice for Physical Therapy. 

There were some really great talks and this included  a really good talk on lumbar spine manipulation, and proprioception, from Dr Neil Landeridge. 

This will certainly influence my practice. The idea of Manips affecting muscle spindle activity, and normalising it, then backing this up with bespoke proprioceptive functional training is exciting and feels intuitively sound. 

I really like cutting edge manual therapy and rehabilitation. 

I'm inspired to do my masters and PHd again. And MACP !

This is the mental challenge and excitement I 'jointed up as a physiotherapist' for. 

Sunday, 20 January 2013

New supplies to optimise my functional rehabilitation of clients

I have been looking into supplies

To optimise my work.

Theraband is available in the colours we have plus black silver and gold strengths.

Silver and gold are only available in the latex containing variety I think.

I can't order micro hurdles in the Physio med website. I must use the catalogue.

Friday, 18 January 2013

Anatomical models and sacral nerve exits

Here are some of our sacral models.

It turns out that only one is correct.

Guess which one!!

Sacral nerves: anterior or posterior ?

I just spent some time reading up on sacral anatomy. I was wondering: since anatomical models vary which is right? Do sacral nerve roots exit through the anterior or posterior sacral foremen ?

It turns out that the anterior divisions of sacral nerves and blood vessels exit through the the anterior sacral foraminae (aka the pelvic sacral foraminae). The posterior sacral nerves and blood vessels exit the four posterior sacral foraminae.

So both models are correct, but incomplete.

Ref: www.ceessentials.net/article47


I've noticed that at work I'm starting to see families. People send me their husbands wives neighbours. A lovely compliment. Thank you all!