Note from Zac: This is my first guest post, and to start things up is the one and only Trevor Rappa. Trevor was my intern for the past 9 weeks and he absolutely killed it. Here is his story. It’s very exciting for me to get to write a guest post for Zac’s blog that I have read so many times and learned so much from. The experience I have had with him over these past 9 weeks has been incredible and I hope to share some of it with all of you that read this. He challenged me to think critically in every aspect of patient interaction: how I first greet them, which side of them I sit on, the words I use, and how I explain to the patient why I chose the exercises they’ll go home with. All of this was to create a non-threatening environment to help to patient achieve the best results they can. He also taught me how to educate patients with a TNE approach, incorporate other interventions such as mirror therapy into a PRI based treatment model, and deepened my understanding of the neurologic concepts behind performance. Therapeutic Neuroscience Education Perception of threat can lead to a painful experience which will cause a change in behavior. It’s the PT’s role to introduce a salient stimulus to attenuate the perception of threat in order to cause a positive change in experience and behavior (Zac and I came up with that, I really like it). Pain
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Post 100: Sexifying Upper Quadrant Post-Op
I Wrote a Lot It’s interesting to think how much this blog has changed since I started writing in February 2013. We’ve gone from cliff notes of books, to cliff notes of courses, to the occasional self-musing. While I still plan on reviewing and assimilating courses I take, my hope is to expand and reflect upon whatever is in my brain a smidge more. It makes sense to start this trend with post 100. And today, postoperative care is piquing my interest. Yes, post-op intervention is a guilty pleasure of mine. And it’s not because it’s easy. Far from easy. Post op treatment gives you a license to create under various constraints. Meaning you have to dig a little deeper to achieve desired goals. I think it can be way sexier, and effective, than your typical post-op protocol BS. So let’s create some successful post-op fun. The First Constraint Before we even talk about specific patients, we have to first look at the largest constraint yet: available tools. At my current digs, I don’t have much of anything in terms of heavyweights. So here is what I have at my disposal that I can implement: 1-on-1 care for 60 minutes Kettlebells: 10, 15, 25 pounds Therabands and theratubes of various sizes Cook bands of various resistances PRI trial orthotics (mouth splints, arch supports, reading glasses, yada) Steps Tape IPAD 3D stretch cage (aka very expensive equipment to tie therabands to) Access to higher level brain centers Heart of gold
Read MoreThe Post Wonderful Time of the Year: 2014 Edition
And That’s a Wrap It’s that time of the year that we get to look back and reflect and what posts killed it (and which bombed). It seems as though my fine fans be on a pain science kick this year, and rightfully so. It’s some of the best stuff on the PT market right now. It’s definitely a topic I hope to write about more in the coming year, and one I will be speaking on at this year’s PRC conference. But without further ado, here are the top 10 posts of 2014. 10. Treatment at the Hruska Clinic: PRI Dentistry and Vision Going through the treatment process as a patient has really upped my game in terms of knowing when to integrate with my patients. It has also been a life-changing experience for my health and well-being. Learn how they did it for me. 9. Course Notes: THE Jen Poulin’s Myokinematic Restoration So much fine tuning occured the second time around. I love how Jen acknowledged the primitive reflex origin of the patterns, as well as fine tuning both lift tests. She’s an excellent instructor (and fun to party with)! 8. Treatment at the Hruska Clinic: Initial Evaluation The start of my alternating and reciprocal saga. Made for one of the most fascinating evaluations I have ever experienced. Ron Hruska is otherworldly. 7. Course Notes: PRI Postural Respiration I love a good foundational course taught by the Ronimal. You always get a few easter eggs that allude to
Read MoreCourse Notes: Dermoneuromodulation
What? You Mean You Have to Touch Someone???!!?!? My gluttony for punishment continues. This time, I had the pleasure of learning Diane Jacobs’ manual therapy approach called Dermoneuromodulation (DNM). My travels took me to Entropy Physiotherapy and Wellness in the Windy City. These folks were arguably the best course hosts I have ever had. We had lunch!!!! Both days!!!!! That is unheard of, so a big thanks to Sandy and Sarah for putting the course together. I took DNM out of curiosity. I have been lurking around Somasimple on and off for the past couple years, and wanted to learn more about the methods championed there. Believe it or not, I have yet to take a pure manual therapy course, DNM seemed like a great way to get my hands dirty. That darn PRI has lessened the hand representation in my somatosensory homunculus! One reason I haven’t taken a manual course is due to the explanatory models many classes are presenting. It seems as though few are approaching things with a neurological mindset, but I was pleased to hear Diane’s model. It is the best explanation I have heard yet. I know that I usually list my favorite quotes at the end of the blog, but I wanted to share the best quote of the weekend right off the bat: “I don’t know why.” I heard this phrase so much throughout the course and it was quite refreshing. Diane made few claims about her technique, admitted who she “stole” from,
Read MoreCourse Notes: Therapeutic Neuroscience Education
How’s Your Pain How’s Your Pain How’s Your Pain How’s Your Pain? To purge onward with developing some semblance of chronic pain mastery (ha), my employer had the pleasure of hosting a mentor and good friend Adriaan Louw. I first heard Adriaan speak in 2010 when I was in PT school. I was amazed at his speaking prowess and the subject matter. Unfortunately, my class could only stay for a little while in his course, and onward life went. I went on with my career focusing on structure and biomechanics and forgetting about pain. It wasn’t until I ran into Adriaan again two years later. He was teaching me Explain Pain (EP), and forever changed how I approached patient care. It’s funny how things have come full circle. Here we are, Adriaan teaching Therapeutic Neuroscience Education (TNE) through The International Spine and Pain Institute (ISPI), and me promoting his work to my colleagues. A lot has changed in two years. EP and TNE are quite different courses, and I learned so much this weekend that I continue to become more engrossed with what I do. So thank you, Adriaan, for playing a huge role shaping me into who I am today. I have now become very much more interested in what ISPI has to offer, and I think you should too. And no worries Adriaan, I will stay hungry 🙂 So without further ado, here is what I learned. The Power of Words It’s getting worse. One person out of
Read MoreCourse Notes: Explain Pain
A Whirlwind I finally had the opportunity to meet my personal Jesus, David Butler, and learn the way that he explains the pain experience to patients. It was an interesting weekend to say the least. The course started off with a smash…literally. We had the unfortunate experience of someone breaking into our car to start the trip off. Then once we arrived to the course, we were informed that Dave was going to be 2 hours late. He was staying in Philly (where I also experienced flight troubles last week) and a snowstorm with a name no one cares about stopped his flight. So Dave drives all the way from Philadelphia, “tilting his head back to rest” for 1 hour, and then what happens? He, along with the other instructors, drive to the wrong campus. So after all these crazy things happen, Dave finally makes it to the course, sets up his presentation, plays a little Bob Marley, and……………… Kills it. I mean, absolutely kills it. To see Dave present this topic under the above circumstances and be on the entire time is a testament to the type of speaker and professional he is. David Butler is one of, if not the best speaker I have ever heard. So I’d like to thank you, Dave, for making an otherwise stressful weekend memorable and exciting. I look forward to applying what I have learned. If you haven’t taken a course from the NOI Group, please do so yesterday! So what did
Read MorePRI and Pain Science: Yes You Can Do It
Questions You may have noticed that my blogging frequency has been a little slower than the usual, and I would like to apologize for that. I am in the midst of creating my first course that I am presenting to my coworkers. It has been a very exciting yet time-consuming process. It makes me excited and more motivated to someday start teaching more on the reg. Ever since I started blogging people started asking me questions. These range from many topics regarding physical therapy, career advice, and the like. Some of the more frequent ones include: What courses should I look at? Any advice for a new grad? Seriously, Bane. What’s the deal? But the one I get asked more often then not is as follows: “Zac, how do you integrate PRI into a pain science model?” A great question indeed, especially to those who are relatively unfamiliar with PRI. With all the HG, GH, AF, FA, and FU’s, it’s easy to get lost in the anatomical explanations. Hell, the company even has the word (gasp) “posture” in the title. Surely they cannot think that posture and pain are correlated. I think there is a lot of misinformation regarding PRI’s methodology and framework. What needs to be understood is that PRI is a systematic, biopsychosocial approach that predominately (though not exclusively) deals with the autonomic nervous system. The ANS is very much linked into pain states, though not a causative factor. But of course, that may not be enough. Perhaps
Read MoreThe Post Wonderful Time of the Year: Top Posts of 2013
The Best…Around Time is fun when you are having flies. It seems like just yesterday that I started up this blog, and I am excited and humbled by the response I have gotten. Hearing praise from my audience keeps me hungry to learn and educate more. I am always curious to see which pages you enjoyed, and which were not so enjoyable; as it helps me tailor my writing a little bit more. And I’d have to say, I have a bunch of readers who like the nervous system 🙂 I am not sure what the next year will bring in terms of content, as I think the first year anyone starts a blog it is more about the writing process and finding your voice. Regardless of what is written, I hope to spread information that I think will benefit those of you who read my stuff. The more I can help you, the better off all our patients and clients will be. So without further ado, let’s review which posts were the top dogs for this year (and some of my favorite pics of course). 10. Lessons from a Student: The Interaction This was probably one of my favorite posts to write this year, as I think this area is sooooooo under-discussed. Expect to be hearing more on patient interaction from me in the future. 9) Clinical Neurodynamics Chapter 1: General Neurodynamics Shacklock was an excellent technical read. In this post we lay out some nervous system basics, and
Read MoreChapter 7: Standard Neurodynamic Testing
This is a Chapter 7 summary of “Clinical Neurodynamics” by Michael Shacklock. Passive Neck Flexion With this test, the upper cervical tissues slide caudad, and the lower cephalid. The thoracic spine moves in a cephalid direction as well. Normal responses ought to be upper thoracic pulling at end-range. Abnormal symptoms would include low back pain, headache, or lower limb symptoms. Median Neurodynamic Test 1 (MNT1) This test, also known as the base test, moves almost all nerves between the neck and hand. Normal responses include symptoms distributed along the median nerve; to include anterior elbow pulling that extends to the first three digits. These symptoms change with contralateral lateral flexion and less often ipsilateral lateral flexion. Anterior shoulder stretching can also occur. Ulnar Neurodynamic Test (UNT) This test biases the ulnar nerve, brachial plexus, and potentially the lower cervical nerve roots. Normal responses include stretching sensations along the entire limb, but most often in the ulnar nerve’s field. Median Neurodynamic Test 2 (MNT2) This version biases the lower cervical nerve roots, spinal nerves, brachial plexus, and median nerve. Normal responses would be similar to MNT1. Radial Neurodynamic Test (RNT) This test looks predominately at radial nerve, as well as the nerve roots. It is uncertain if this test biases any particular nerve root. Normal responses include lateral elbow/forearm pulling, stretch in the dorsal wrist. Axillary Neurodynamic Test (ANT) This test tenses the axillary nerve, though may not be specific. Normal responses include posterolateral shoulder pulling with about 45-90 degrees of
Read MoreChapter 5: Diagnosis with Neurodynamic Tests
This is a Chapter 5 summary of “Clinical Neurodynamics” by Michael Shacklock. Neurodynamic Tests In neurodynamic tests, there are two movement types: 1) Sensitizing: Increase force on neural structures. 2) Differentiating: Emphasizing nervous system by moving the neural structure as opposed to musculoskeletal tissue. The reason why sensitizers are not considered differentiating structures is because they also move musculoskeletal structures. Examples of sensitizing movements include: Cervical or lumbar spine contralateral lateral flexion. Scapular depression Humeroglenoid (HG) horizontal extension HG external rotation Hip internal rotation Hip adduction Interpreting The ability to interpret neurodynamic findings is crucial when determining the nervous system’s involvement. Findings such as asymmetry, symptoms, and increased sensitivity are all important. But to implicate neurodynamics, structural differentiation ought to be performed. Just because there is a positive test does not mean that it is relevant to the patient’s complaints. There are several ways to classify findings: Negative structural differentiation: Implicates musculoskeletal response. Positive structural differentiation: Implicates neurodynamic response. Neurodynamic responses can have different interpretations: Normal: Fits normal responses per literature. Abnormal: Differ from normal responses. Can be broken down further into… Overt abnormal responses: Symptoms reproduction. Covert abnormal response: No symptoms, but may have other subtle findings such as asymmetry, abnormal location, and/or different resistance. From here, one must determine if the findings are relevant or irrelevant to the condition in question. You may also come across subclinical findings, in which the neurodynamic test is related to a minor problem that may become major at some point.
Read MoreThe Year of the Nervous System: 2014 Preview
It’s All Part of the Plan And if you see my course schedule this year, the plan is indeed horrifying. I wanted to write a post today to somewhat compose my thoughts and plans for this year, as well as what I am hoping to achieve from the below listed courses. Because of the course load and some of my goals for the year, I am not sure what my blogging frequency will look like. I have begun to pick up some extra work so I am able to attend as much con ed as I do. The Amazon affiliate links that I don’t get money for because I live in Illinois simply cannot pay for classes :). I am just putting these links up here because I want to encourage you to read these books on your own. Use my site as a guide through them. Big Goals My biggest goal for this year is to successfully become Postural Restoration Certified (PRC), and my course schedule below supports this goal. The amount that I use this material and the successes that have come along with it simply compel me to become a PRI Jedi. I see the PRC as a means to achieving this goal. The application thus far has been quite time-consuming. There are a total of 3 case studies, 5 journal article reviews, and tons of other writing that has to be done. Couple that with studying the material, and I have had a very busy
Read MoreChapter 1: General Neurodynamics
This is a Chapter 1 summary of “Clinical Neurodynamics” by Michael Shacklock. Concepts When we first started working with the nervous system, oftentimes we called pathological processes adverse neural tension. The problem with this name was that it left out nervous system physiology; it was mere mechanical concepts. Hence, we call the movement and physiology of the nervous system neurodynamics. General neurodynamics account for whole body fundamental mechanisms, regardless of region. Specific neurodynamics, on the other hand, applies to particular body regions to account for local anatomical and biomechanical idiosyncrasies. The System There are three parts to the neurodynamic structure: 1) The mechanical interface 2) The neural structures 3) The innervated tissues The mechanical interface is that which is near the nervous system. It consists of materials such as tendon, muscle, bone, intervertebral discs, ligaments, fascia, and blood vessels. The neural structures are those which make up the nervous system. These structures include the connective tissues that forms the meninges (pia, arachnoid, and dura mater) and peripheral nervous system (mesoneurium, epineurium, epineurium, and endoneurium). The nervous system has mechanical functions of tension, movement, and compression. It also has physiological functions to include intraneural blood flow, impulse conduction, axonal transport, inflammation, and mechanosensitivity. The innervated tissues are simply any tissues that are innervated by the nervous system. They provide causal mechanisms for patient complaints, and are able to create nerve motion. When we have neural problems, sometimes the best treatment is to these structures. You must treat everything affected. Mechanical Functions
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