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Wednesday, 25 January 2012

Weber's Fracture

I had a patient with a Weber's fracture (of the ankle) the other day: so I've been brushing up on my orthopaedic surgery rehabilitation skills.

Research driven clinical practice - neurodynamics

On my recent cervical spine (neck) course I was instructed by a lady who has been researching nerve pain and nerve movement.

This is an area I have been excited to be involved with.

In people with say non-specific arm pain: there is often a restriction on nerve gliding testing (neurodynamic testing ULTT1, 2, 3 etc.).

It was thought originally that sustained stretching the nerves would help but it was found that this was provocative and made things worse. Thus techniques were modified to be gentler and to glide or slide the nerve.

The most recent research of my lecturer showed little movement of the nerve on these tests certainly longitudinally. Thus it is now thought that the nerve does not become so much resistant to sliding in its tunnel, as irritated and this mechanosensitive.
This mechanosensitivity translates into muscle guarding on movement of the nerve. It is thought that the nerve often becomes irritated at its interfaces, or points where it touches neighbouring structures.

Thus, the most productive approach would be expected to be mobilising these interfaces with techniques such as myofascial release.

This ties in well with what I have been experiencing clinically. Certainly I have very rapidly relieved treatment resistant arm and elbow and shoulder pain with such work in a variety of patients.

It also ties in with my qualifying Masters research project which was never published. At the time (2005) there was concern among physiotherapists that the ULNT (Upler Limb Neurodynamic Tests) could themselves traumatise the upper limb nerves. Certainly they often provoked transitory symptoms. This my prow t was to sensitively measure and disruption in healthy volunteers following testing. This was done with vibration threshold testing. In conclusion no change in vibration threshold was found. But this was after me cautiously applying ULNT 1 to normal individuals.

This new research helps to explain my finding. If little longitudinal movement occurs in the upper arm nerves with ULNT 1 then it is not surprising that they are not much affected by it. The resistance felt us that if the muscles guarding an irritates nerve. Muscles are quite robust things and heal easily: compared with nerves.

All this is very interesting to me!

If you are a non Physio or anatomist reading this: the upshot is : if you get an arm pain and it ends up being to do with your arm nerves: I now more likely to be able to fix it : and most likely quicker than before!

Friday, 20 January 2012


After discussing Plantaris with a fellow Physio at a conference I've the weekend I have been looking up its exact anatomy. I see it's insertion is slightly medial to the calcaneus tendon. This may well be relevant to a client of mine.

Psoas stretch

A client showed me a great psoas stretch that he had learned from his rugby coach. Sometimes the best stretches seem to come from all sorts of sources. It's a stretch in standing good for Pitchside. Details to follow ...


On the weekend cervical course we looked at the subclavius muscle and how restrictions here can irritate the neural tissue into the arm. I will be examining this carefully where relevant from now on.

Thursday, 19 January 2012

Clinicalfocus Cervical spine course

This weekend I was I a 3 day course covering the cervical spine by Clinicalfocus. The course was excellent. Great content and great people. I learned skills I can put in to practice with my patients straight away

Wednesday, 18 January 2012

True manipulation by a physiotherapist

I have had several patients come to me wanting to have 'true' manipulation ( a rapid thrust technique often resulting in a click noise). Often having seen a chiropractor or osteopath or similar practitioner in the past: and having achieved good relief from such a technique.

In physiotherapy circles all mobilising of a joint comes under the heading manipulation with rapid manipulation past with a click often define as grade V manipulation.

As it happens this I am very interested in (grade V) manipulation. So I am happy to be of service!

Tuesday, 10 January 2012

New Golf challenge!!

I advised a client to help relieve his back pain by practicing his golf swing left handed in addition, for a while. I have started a new trend and his whole team now have a left handed golf competition and league! Plus he is fixed!

Vertebra laser!!

I have done it ! Perfected the vertebra laser! E-e-e-excellentttt!!

Red laser

The green laser was too strong for my multimedia Physio treatment sessions. So I now have a tiny red laser! I'm very excited!

Sunday, 8 January 2012

Wasted time

I just spent ten minutes reading a very official looking leaflet on a new healthcare' product that came through my door at home. It's aimed at physios and the like. How did they get my home address?!!

On reading to the end of the leaflet on this magic cure all device it has a disclaimer that says

"The "&& "££;)-@" is not a medical device and does not claim to diagnose, treat, prevent or cure disease.... (the above) claims have not been evaluated by any government agency or organisation"

Wow! Quite an admission.!!!

So what IS THE POINT!!??

Saturday, 7 January 2012

Clarke ' s test

The other day I spent the day observing one of London's leading musculoskeletal doctors in Kensington.

One test I was him do that I hadn't been using was Clarke's test. So I have just been looking up what it is for. My research informs me that It is one of several tests for chondromalacia patellae.

Multimedia multi sensory outpatient Physio sessions

I did it!!

I have made it so my iPhone projects onto the wall in the treatment room

So now using Muscle system II and ligament system II, I can project 10 foot high images of the skeleton complete with muscles and ligaments into the wall as I treat a patient. I can finally show them some of what I see in my mind as I treat them, with my decade of fascination with human anatomy!

06/01/2012 CPD diary

06/01/2012 19:20

Watched a 10mim clip on Toutube on knee assessment as I am keen to get better in this area.

I was most interested in Hoffa's test for fat pad irritation but it wa not covered.

It was interesting to see they perform the valgus and carus collateral ligament stress tests in 30 degrees knew flexion only and not in neutral : to remove the stabilising effect of the joint capsule. Something I had not considered.

The video was by a US DO osteopathic doctor. In the USA osteopaths are part of mainstream medicine much more.


Friday, 6 January 2012


I have worked out that I may be able to set up the projector to use in my room during sessions to display anatomy apps from my iPhone. I just ordered a cable to allow me to do this now!  I'm excited. This should add a new dimension to my sessions. 



I have been reading up and practicing my dermatomes and myotomes knowledge. I think I could pass a test on them now.

I also read up on the TRX body weight suspension system online: after seeing it used in the gym and talking to personal trainers who use it. Perhaps it might me of use in my work and in rehabilitation in general?