Author: Sue

A therapist asked me to name the five books that had brought me to be the therapist I am today……..thought of the five. However there are really six each in their own way shaped and guided my offering all kind of information to challenge, educate, create more question and promote at time deep reflection. The reflection was who I am as a therapist, my intent and compassion.

All equipping with differing skills to treat people with chronic long term pain and those sport injuries that have been persistent, as well as those acute condition we see each week.

Thomas Hendrickson, Massage and Manual Therapy for Orthopedic Conditions, Second Edition, (Lippincott Williams & Wilkins), 2009 and his accompanying DVD

Tom’s book came a long when as a massage therapist I was looking for a technique that would enable me to become increasingly precise, deep yet gentle and one that wasn’t going to create a secondary inflammatory response. I had also begun to notice a torsion in the fibres of injured muscle and had begun to develop my own strokes through my oil work to role muscle away from the mid-line of the body. THEN I found Tom’s book, decades ahead of me! His book was reassuring, it gave the precise movements I had been searching for,  that at last I was truly working with the body and not at the body. His explanation of Muscle Energy Technique was so much more accessible. So I study it, then had to go meet him. Through Tom’s patience and guidance, aided by his assistants I connected with his wave mobilisation, learning to trust my own body much more. Those who have trained in the Hendrickson Method say, ‘phew there are no more scary patient’ because the HM encourages you to be very proficient in your anatomy knowledge. This then creates a more refined understanding when addressing subjective and objective assessment.

Nicola J Petty, and Ann P Moore, Neuromusculoskeletal Examination and Assessment, Second Edition, (Harcourt Publishers Ltd.), 1999, 2001

This book helped me to understand assessment much clearer, I had a stronger grasp of how much deeper subjective assessment needed to be. To get that big picture of your patients history, clues that guide you down the most useful path for your patient. Especially those patients with long term chronic pain. Some of the objective movement are extreme but can be useful when you think you might have missed something.

Nancy C. Cutter, and C. George Kevorkian, Handbook of Manual Testing, (The McGraw-Hill Companies, Inc.), 1999

This book is so easy to access, each page gives you the open and closed chain action, nerve innervation, antagonist, synergist, and a little test for function. I have it on my desk even now, just to check up if I am wondering ‘have I remembered that ‘

It is also really useful to show the patient which muscles that I am working and why!!……..they really find it useful

Explain pain, course  Neuro Othopaedic Institute uk

http://www.noigroup.com

This book answered all sorts of question I was developing re my long term pain patients. That less is more, that patients need to find the right therapist at the right time with the right therapy, that the body only create pain when it feels under threat. Wonderful illustrations to help with explaining to patients and amazing workshops which may need visiting twice, for all the information to sink in.

Joseph O’Connor and Ian McDermott, Principles of NLP (Singing Dragon)

http://www.judithlowe.com

In 2003 I embarked on an NLP practitioner programme, I felt the way forward was to increase my communications skill. Having tried a few different methods but NLP seemed sensible, it had a process not unlike what I did each day in my treatment room. It was life changing, both for me and my patients. I was often caught up in trying to fix everything for my patients, mind body and soul, and exhausting myself.

PPD Learning lead by Judith Lowe, the process helped me to see my patterns of behaviour. What pay back I got from them and were they useful! After a period of soul searching, I developed a greater understanding. It was in brief giving people the space that is useful for them, for them to sort it out! Phew.

I would recommend training with Judith Lowe, she is a clear, clean, emphatic teacher with a cracking sense of humour and passion for subject

This little book above sums it all up very easily and accessible for someone new to NLP.

Erik Franklin, Dynamic Alignment Through Imagery 2^nd Edition (Human Kinetics)

This is my latest addition. I wanted a book that would explain movement, that would be meaning full for both myself and patients. He explains movement in a way that I can connect with as a visual learner. Also his little movements with visualisations to give to my patients really do work and they do get their homework done, and progression is made.

 

On the weekend of the 16^th and 17^th of May, Hendrickson Method Practitioners and those embarking on the work, all of whom have attend an Introduction to the Hendrickson Method gathered.

Led by myself, we spent the weekend investigating the psoas and reviewing past treatment protocols. The conclusion was that they often fell short. However we felt that the Hendrickson Method gives the precision that is needed, with depth and gentleness promoting the feeling that we are working with the patients rather than at the patient.

What we needed was to expand our knowledge. We spent time considering the relationship between biceps femoris and the gluteal group, and how it can influence psoas at its full range of function along with the role of the pelvic muscles and how we need balance within the pelvic floor in order to stand tall and walk. These muscle need to be in perfect balance for the body to make small subtle shift in weight. As Eric Franklin points out in ‘Dynamic Alignment Through Imagery 2^nd Edition (Human Kinetics) ‘The pelvic floor relates functionally to the thoracic diaphragm, iliopsoas, transverse abdominis, rectus abdominis, oblique abdominis, and lumber multifidus.’ As he explains I develop an increasing vivid picture of how the psoas feeds through the pelvic area on to the lesser trochanter. We also went on to examine how the adductors, piriformis, and the other deep lateral rotators could influence the function of the psoas if they were not long, strong, and operating at their full range.

Next we investigated the role of muscle in their role as prime mover, antagonist, synergist, enquiring what would occur if they are not fulfilling their role. The range of movement becomes restricted and if left unaddressed patterns of dysfunction can set in with the patient not even being aware.

It was also an opportunity for therapist to review their knowledge and experience of the Hendrickson Method soft tissue mobilisation, and wave mobilisation®. We took time to assess our precision, depth, gentleness, and checking in on our intent through the movement with ourselves. As a group we reflected on how there are no new strokes just the deepening of our knowledge and touch.

It was beneficial to spend some time reviewing the execution of Mets, looking at making the contraction very very small, to isolate out a ‘certain’ muscle to create a for the want of a better word ’purer’ ‘clearer’ reconnection neurologically . All the time checking in with our intention, exploring how we keep focus, sharing in an open and honest way what can get in the way, bringing in our humour, having a smile at ourselves. At the same time considering how can we re-engage our patients with their bodies. We practiced describing anatomy, creating pictures, imagine the pelvic floor as a ‘hammock’ with candy stripes, and some fun sharing feedback, all of which reflected how unique we all are.

Toward to end of the weekend we practiced some of the ‘Imagery’ movements based on Eric Franklin work to help patients reconnect with good function in the muscles, this also acts as ‘homework’ without it feeling like exercise. In my experience within my practice this is working much more successfully than standard rehab exercise.

At the start of the weekend I asked the group to notice how they were standing, noticing femurs, feet, lower back, knees. As the weekend drew to a close we took time, at the closing circle to note any change as we had all been working on each other. The feedback was good showing clear evidence based practice, as each therapist could identify change. The feedback was they felt taller, straighter, more grounded, more into their heels, being able to feel a ‘letting’ going in the hamstrings.

I shared that I believe I am on a great adventure, always discovering something new in how the body functions, moves, and the courageous part for me is my developing understanding of the neurological system/function which will aid me in enabling those patients in chronic pain.

This is a super quote from Theodore Rosevelt,

‘It is not the critic who counts; not the man who points out how the strong man stumbles, or where the door of deeds could have done them better.

The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and short-coming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause;

who at the best knows in the end of triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly……’

My last two blogs have been in relation to subjective & objective assessment. It feels right to have a closer look at the ‘planning’ stage of treatment plans.

Within the practice, we treat many patients with long term chronic pain, which some have been experiencing for anything between 10– 50 yrs. With these patients it can prove challenging to create meaningful, purposeful treatment plans.

In treating such people, their original problem can quickly become lost, as solving one area of pain will lead you to further areas of discomfort and pain in a completely different part of the body.

Once you have completed a subjective & objective assessment, you then begin to build a picture of what the issues are for your patient. Sometimes they have passed on so much information, gained through the subjective & objective information gathered, that clarity is needed as to what would be a good outcome for them from their perspective. This can often be different to the view the patient originally arrived with. It can be useful to revisit the aim/objective of the treatment regularly.

Treatment has to be flexible as the pain messages will change both in quality and areas of the body. Sometimes the plan is to increase mobility before the pain eases, as this, in our experience, often leads to calming down the autonomic nervous system.

Subsequently, we have to be open to short term plans, with space to revisit the objective assessment procedure, adapting your plan with the progression the patient makes. The ability to measure outcomes made within the treatments is important for both the patient to understand and recognise any progress made, and for you as the therapist to maintain focus on how to plan and move forward with treatments. Returning to objective assessment skills is a useful tool in enabling that process.

All the books below lay out clear protocols for objective assessment – active, passive, resistive. These are often full range movements, so the question that often comes up at the workshops is “How do we discover the cause, when people are too much in pain to move!”

Our anatomy has to be at its best understanding, piecing together the antagonist/agonist/synergist. Always keeping in mind, ‘Red Flags’, and the quality of their pain. We make a plan, outlining which techniques we are going to use, the depth of treatment and how much pain free passive movement might be useful.

Over the next 2-3 treatments, improvement may occur then we can re-assess with all our objective assessment skills and measure new ranges of movement (ROM), checking the ease that may have been brought about with the tissue. This may challenge what we first assessed, which is fine, and now we develop a new plan.

Objective assessment is such a great procedure as an initial assessment to create a plan. To re-assess, it gives the patient a picture of where they started and how far they have come, it gives us the ability to be clear, and it promotes reflection both for us as the therapist and the patient.

Books:

Thomas Hendrickson, Massage and Manual Therapy for Orthopedic Conditions, Second Edition, (Lippincott Williams & Wilkins), 2009

Nicola J Petty, and Ann P Moore, Neuromusculoskeletal Examination and Assessment, Second Edition, (Harcourt Publishers Ltd.), 1999, 2001

Nancy C. Cutter, and C. George Kevorkian, Handbook of Manual Testing, (The McGraw-Hill Companies, Inc.), 1999

Florence Peterson Kendall, et al. Muscles: Testing and function with posture and pain, Fifth Edition,(Lippincott Williams & Wilkins), 2005

Our Aims of the day:

• To be able to palpate nerves with new confidence
• To review the : Cervical Plexus, Brachial Plexus, Lumber Plexus, Sacral Plexus, Coccygeal Plexus
• A wider understanding of the Autonomic Nervous System
• Clearer goals and treatment modalities when treating people with acute and chronic pain

We had a really thought-provoking time investigating the plexus’s through the spine, starting with the cervical ending with the much un-addressed coccygeal, relating it the nerve implication with regards to chronic low back pain. I have found in some chronic LBP, the rectum and pelvic floor are holding on too tight, and feather light intended light strokes to the coccygeal plexus start to ease the tension in a way that is non-threatening to the neurological system.

I created space to re-visit the quality of our palpation skills, by as a group palpating ribs to enquire with our hands how the person was breathing. We discovered with a lighter touch you gained more information, also noticing how our own breath fell in-line with the person we were palpating. I believe most importantly it creates stillness within ourself, leaving a clearer mind for gathering assessment procedure.

John Olsson, Massage Therapist:

“Cheers Sue and Ros, already treated coccygeal plexus with profound result wow! Great day and takes the fear about palpating nerves. Loved seeing you all and can’t wait to tickle more nerves.”

Laura Frankin, Charted Physiotherapist:

“From a physio background it was an excellent to recap anatomy in a more holistic manner, taking into consideration the body system and the effect of our hands.”