The Physiotherapy Blog

Discussion in 'Injuries and Prevention' started by Late for dinner, Apr 13, 2012.

  1. Late for dinner

    Late for dinner Valued Member

    The band is lower as it changes the angle that the tendon attaches to the bone and hopefully changes the loading on the tendon.

    Here is a mind blowing fact that throws people - pain is a liar!

    You have a heart attack and it hurts down your arm.. we don't treat the arm.

    You have a neck injury and your arm hurts or your fingers go numb.. we don't treat the arm...

    Personally I think it is important to link the symptoms to a set of signs/behaviours that are independent of pain... eg a ligament test isn't about pain as much as whether the ligament holds and keeps the joint together..

    Arthritis isn't boney damage.. that throws people too... it's inflammation of the joint. The can be inflammation and no degenerative changes... but the joint goes through a series of protective changes to try and limit damage (at the same time being possibly painful)...

    1- swelling... can't compress a fluid so it limits how far you can take the joint

    2- soft tissue thickening.. acts as a brake preventing you from pushing the joint too far

    3- boney changes.. spurs/osteophytes etc create boney blocks to protect the joint..

    When you get to 3 there has been joint inflammation for quite a period of time. There are variations but this is sort of a basic view.

    Don't get me wrong, pain can be local but it can also be projected as can swelling or tenderness which completely confuses the issue.

    LFD
     
  2. belltoller

    belltoller OffTopic MonstreOrdinaire Supporter

    Fascinating stuff - ja, the whole idea of "Inflammation" - whether one is speaking about inflammation of the joints in arthritis; the allergic response in tissues to toxins; the *possible* role of inflammation - a cycle of irritation, trauma, healing, re injury - if similarly occurring inside the arteries and blood vessels - might be a significant player in coronary artery disease and the role the immune system ( body's defence reacting in similar fashion as in the allergic response ) may well play in that, etc., etc.,.

    Can't help but wonder if maps to understanding one disease could be found in investigating the pathology of another. Significant keys to understanding underlying mechanisms in atherosclerosis lying hidden for all the ages inside the laboratory databooks compiled by countless researchers, doctors, statisticians and physiotherapists working in the field of rheumatology and the like.

    Unfortunately, my education in medicine ends right around Year 2 primary school (if I really stretch things ;)) but its still fun to speculate.

    ------

    Oh...remember now what I came on here for - :eek: - reading between the lines of some of your posts a bit with respects to not only referred pain but - what I find even more interesting in your post - the implication being that there may even be referred tissue response to damage; e.g. the primary injury in a local tissue setting up conditions that cause damage and swelling ( or some sort of visible response ) in a secondary, adjacent tissue which is felt/detected first due to its more easily accessible location or whatever makes it stand out and is erroneously thought to be the prime injury/disease point?

    The diagnosis of a seemingly straightforward condition such as tennis elbow, for example, might have more room for error than one would be inclined to think? Besides being doctors being in a great hurry these days, beleaguered by compliance mandates, insurance company requirements and the like.

    Apology in advance for what I'm sure will turn out to be a jumble of run-on sentences and dangling doorknob fragments but its late and I had to cobble the post together in pieces on and off as time's allowed.
     
  3. Late for dinner

    Late for dinner Valued Member

    FYI :' D

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1957126/ Tennis elbow and the cervical spine.

    http://windcitypt.com/files/2011/07/pain_in_cervical_and_thoracic_spine_with_lateral_elbow_pain.pdf Prevalence of pain and dysfunction in the cervical and thoracic spine
    in persons with and without lateral elbow pain

    Lee D 1986 Tennis Elbow: A Manual Therapist's Perspective. JOSPT 8:3

    http://rinardpt.com/pseudo-tennis-elbow-a-commonly-misdiagnosed-mechanical-problem/

    There are tons more things written.. some might be valid and some might be nonsense but there is a consensus that there can be things other than a direct injury causing a complaint.

    eg

    - adjacent parallel conditions eg elbow joint pain making muscle sore
    - serial conditions where stiffness in the elbow might make turning the palm over difficult and adds excess load onto the lateral elbow
    - referred conditions eg where pain in the dermatome from a tissue that is embryologically related - tissues in the lateral shoulder can be felt down the arm as far as the wrist.. really bad hip joints don't hurt but often cause the patient to feel severe knee pain
    - conditions that lead to hyperaesthesia, either central or peripheral, where the patient feels sensation much more intensively than it normally would be. Interestingly there is clear chemical changes, either in the peripheral tissues or in the brain, that reflect a far greater chemical response than what should normally happen. This hyperaesthesia is convincingly painful to the patient irrespective of how little damage is present.

    I could go on but I won't be so impolite... ;' D

    LFD
     
  4. Late for dinner

    Late for dinner Valued Member

    Hip FAI problems

    I've just been on a 2 day conference on the management of hip problems in the elite sportsperson and I have to say that the time's they are a changing. Interesting to see physicians/surgeons questioning their methods and reaching out to others (including physiotherapists regarding the best ways to manage patients with groin/buttock/hip pain and dysfunction.

    I think that most people would be surprised at just how critical the medical establishment has become of their past methods, their standard procedures and weaknesses in how they approach patient management. We had speakers from Spain, Denmark, Netherlands, France, England, America, Scotland and other places. It is always shocking how difficult it is to pin down what should be treated and what should be managed/left alone. It was great to see the approaches of such a broad range of professionals and even better to see them discuss and critique what was doing done all in the name of improving patient care.

    You people living in the UK, you are very lucky to have such a positive medical community in spite of some the circumstances that they find themselves in.

    Regards peeps!!

    LFD
     
  5. Late for dinner

    Late for dinner Valued Member

    Oh and I bet that many of you would have laughed at the Danish surgeon's jokes.... (who says that the Scandinavians don't have a sense of humour?).

    :' D

    LFD
     

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