218275 Bullies, 7552 online  
  • Register
Our Sponsors:

Results 31 to 38 of 38
Page 4 of 4 FirstFirst 1234
Sponsored Links Spacer Image
  1. TheRuss is offline
    TheRuss's Avatar

    is badder than you

    Join Date
    Jul 2008
    Location
    Not Canada
    Posts
    4,335

    Points
    7,664
    Achievements:
    Three Friends1 year registered10000 Experience Points

    Posted On:
    7/07/2013 1:05am

    Join us... or die
     Style: None

    --
    Hell yeah! Hell no!
    Is there any correlation between patellofemoral pain syndrome and actual knee damage?
    Quote Originally Posted by Emevas View Post
    Downstreet on the flip-flop, timepants.
  2. Gypsy Jazz is offline
    Gypsy Jazz's Avatar

    Senior Member

    Join Date
    Jul 2004
    Location
    Long Island, NY
    Posts
    959

    Points
    1,741
    Achievements:
    Veteran5000 Experience Points

    Posted On:
    7/07/2013 5:11pm


     Style: Does exercise count?

    3
    Hell yeah! Hell no!
    Sticking my nose in this one again, I absolutely appreciate that there is research being cited, but a whole lot it seems to be a bit backwards to me. It is now quite clearly understood that the presence of pain dramatically alters neuromuscular control regardless of if there is tissue damage present. It's settled science that painful injuries alter or "shut off" certain muscle groups under the reasonable assumption that this happens so that excessive movement does not interfere with the healing of involved tissues.

    Why are people assuming that in the presence of pain that suddenly the "weak" muscle groups are the cause rather than result of the pain? PT Barrett Dorko refers to this concept as "defense vs defect" and I think it's quite valuable to understand.

    This isn't to say that people don't see positive results from strengthening programs because of the nonspecific benefits, but this might explain why doing contradictory programs all sometimes work and sometimes don't. Find someone who treats and understands pain and then examines to see if weakness still persists.

    Tangentially related, Adriaan Louw discusses how pain will affect athletic performance here:
  3. sazahko is offline

    Registered Member

    Join Date
    Apr 2009
    Location
    SoCal
    Posts
    59

    Points
    162
    Achievements:
    1 year registered1000 Experience Points

    Posted On:
    7/07/2013 11:40pm


     Style: Headbutts

    --
    Hell yeah! Hell no!
    Quote Originally Posted by TheRuss View Post
    Is there any correlation between patellofemoral pain syndrome and actual knee damage?
    As far as I know, from the research I've read and the clinicians I've talked to, the two can go together, but there definitely is not a one-to-one relationship.

    Quote Originally Posted by Gypsy Jazz View Post
    Why are people assuming that in the presence of pain that suddenly the "weak" muscle groups are the cause rather than result of the pain? PT Barrett Dorko refers to this concept as "defense vs defect" and I think it's quite valuable to understand.
    Frankly, I don't think it's a good assumption that pain is necessarily caused by "weak" or inhibited or what-have-you muscles. To assume that would be to take an extremely narrow view of pain, which is itself a pretty complicated topic. And there are a multitude of instances in which biomechanical abnormalities don't create pain. So is it a necessary causal relationship? No. But I would also bring up the converse of your question: Why would one assume that the biomechanical abnormalities (weak/inhibited/whatever muscles) are always the result of the pain in question?

    I almost certainly don't know enough on the subject to speak cogently about it, but it seems possible to me that pain could create biomechanical abnormalities and vice-versa. All I was trying to argue in my last post is that abnormal movement, muscle tone, flexibility, etc. in the hip may be a factor in pain or other dysfunction at the knee. Is it the only factor? Is it safe to assume that it's the cause of said pain? Absolutely not.

    This isn't to say that people don't see positive results from strengthening programs because of the nonspecific benefits, but this might explain why doing contradictory programs all sometimes work and sometimes don't. Find someone who treats and understands pain and then examines to see if weakness still persists.
    This is an excellent perspecctive, and I don't think it's something clinicians talk about enough, so thank you for bringing it up. People tend to get locked down in using one particular approach or one set of interventions because they've seen them work or been told that they work. Subsequently, we get entrenched, we stop treating effectively, and/or we get bewildered when the same thing doesn't work for everyone. What other resources might you recommend for a (hopefully) future clinician who wants to understand pain better?

    As always, thanks for the input, guys. Keep it coming!

    -Sazzy
  4. ChenPengFi is online now
    ChenPengFi's Avatar

    Senior Member

    Join Date
    Aug 2005
    Location
    Hawai'i
    Posts
    3,246

    Points
    7,279
    Achievements:
    5000 Experience PointsVeteran

    Posted On:
    7/08/2013 4:52pm

    Join us... or die
     Style: Hung Gar, Choy Lay Fut

    1
    Hell yeah! Hell no!
    Mark Rippetoe touches on this subject a bit in his latest rant.
    And how about the classic "VMO that's not firing"? First, there is no such thing as the VMO as a separate muscle.

    Dissection studies on hundreds of cadavers have proven this conclusively. There are oblique fibers on both the vastus medialis and the vastus lateralis, but neither of these have their own fascial sheath or epimysium, their own innervation, action, or antagonist. All of the quad bellies are innervated by the femoral nerve, which arises from L2-4.

    In the words of a better-than-average DPT: "If they all have the same segmental innervation, and they all extend the knee, then how the **** is it possible to isolate out the function of the VMO?"

    And if this is the case, how's it possible that a weak VMO is responsible for "Patellar De-tracking Syndrome"? And how would it then be possible to fix this non-existent problem by teaching a muscle that doesn't exist how to fire with "corrective exercises"?

    Might weakness be confused with "not firing" either purposely or through ignorance? Why wouldn't squats done with correct symmetrical technique solve this problem?
    http://www.t-nation.com/free_online_...petoe_goes_off
  5. Gypsy Jazz is offline
    Gypsy Jazz's Avatar

    Senior Member

    Join Date
    Jul 2004
    Location
    Long Island, NY
    Posts
    959

    Points
    1,741
    Achievements:
    Veteran5000 Experience Points

    Posted On:
    7/08/2013 8:11pm


     Style: Does exercise count?

    1
    Hell yeah! Hell no!
    Quote Originally Posted by sazahko View Post
    Frankly, I don't think it's a good assumption that pain is necessarily caused by "weak" or inhibited or what-have-you muscles. To assume that would be to take an extremely narrow view of pain, which is itself a pretty complicated topic. And there are a multitude of instances in which biomechanical abnormalities don't create pain. So is it a necessary causal relationship? No. But I would also bring up the converse of your question: Why would one assume that the biomechanical abnormalities (weak/inhibited/whatever muscles) are always the result of the pain in question?

    I almost certainly don't know enough on the subject to speak cogently about it, but it seems possible to me that pain could create biomechanical abnormalities and vice-versa. All I was trying to argue in my last post is that abnormal movement, muscle tone, flexibility, etc. in the hip may be a factor in pain or other dysfunction at the knee. Is it the only factor? Is it safe to assume that it's the cause of said pain? Absolutely not.
    Pain is far too complicated to rule anything anything out a contributing factor. I wouldn't assume that "weakness" (or whatever term is most appropriate) is always the result of pain, but I would question its relevance if it's not. The extent weakness matters would seem entirely dependent on what the person values. A gymnast who can't do a hand stand may suffer emotional distress due to weakness, which is highly correlated to pain. For the average person, not being able to do a hand stand probably doesn't matter one bit. Biomechanical factors are still important for ambulation and meaningful activities, but their relevance to pain is otherwise unclear at best. Quoting Barrett Dorko, "If pain is the primary problem, treatment of pain should be primary"

    Quote Originally Posted by sazahko View Post
    This is an excellent perspecctive, and I don't think it's something clinicians talk about enough, so thank you for bringing it up. People tend to get locked down in using one particular approach or one set of interventions because they've seen them work or been told that they work. Subsequently, we get entrenched, we stop treating effectively, and/or we get bewildered when the same thing doesn't work for everyone. What other resources might you recommend for a (hopefully) future clinician who wants to understand pain better?

    As always, thanks for the input, guys. Keep it coming!

    -Sazzy
    I have suffered from, and to a small degree still do suffer from persistent pain that was managed a whole lot of ways with no real respect to actually understanding and treating pain itself. This is one area where even education alone can help, so I'm preaching the gospel of understanding a bit. Assuming things get processed well I hope to be heading back to school for massage therapy soon myself and I expect to be the one skeptic in the room at all times. I'm guessing my classmates and some teachers are going to hate me...

    As for resources I could easily flood this post with names and books, and it's entirely self-promotional, but I think I did a pretty decent job providing a good introduction to pain science when I wrote a guest post here: http://deansomerset.com/2013/06/10/a-primer-on-pain/

    The links and names toward the bottom are all highly recommended and I would strongly suggest registering at www.SomaSimple.com To avoid a total derail, if you'd like more info, I'd be happy to PM.
  6. sazahko is offline

    Registered Member

    Join Date
    Apr 2009
    Location
    SoCal
    Posts
    59

    Points
    162
    Achievements:
    1 year registered1000 Experience Points

    Posted On:
    7/20/2013 12:06pm


     Style: Headbutts

    --
    Hell yeah! Hell no!
    Quote Originally Posted by Gypsy Jazz View Post
    Pain is far too complicated to rule anything anything out a contributing factor. I wouldn't assume that "weakness" (or whatever term is most appropriate) is always the result of pain, but I would question its relevance if it's not. The extent weakness matters would seem entirely dependent on what the person values. A gymnast who can't do a hand stand may suffer emotional distress due to weakness, which is highly correlated to pain. For the average person, not being able to do a hand stand probably doesn't matter one bit. Biomechanical factors are still important for ambulation and meaningful activities, but their relevance to pain is otherwise unclear at best. Quoting Barrett Dorko, "If pain is the primary problem, treatment of pain should be primary"

    I have suffered from, and to a small degree still do suffer from persistent pain that was managed a whole lot of ways with no real respect to actually understanding and treating pain itself. This is one area where even education alone can help, so I'm preaching the gospel of understanding a bit. Assuming things get processed well I hope to be heading back to school for massage therapy soon myself and I expect to be the one skeptic in the room at all times. I'm guessing my classmates and some teachers are going to hate me...
    The first thing that comes to mind while reading your response is the fact that, for PT's in particular, pain is almost exclusively seen a symptom of an underlying problem. Perhaps therein lies the issue? I've actually heard a couple different PT's explicitly state that they only treat dysfunction, not pain. So would you argue that that attitude ought to be changed?

    To keep things in perspective, you mention that "biomechanical factors are still important for ambulation and meaningful activities", which really is the idea behind most physical therapy interventions. We want to return the patient to a prior level of function. Subsequently, in most cases, biomechanical factors are a big part of what we deal with - they may have been disrupted by an injury, or they may have been part of the cause of an injury. All the same, it's apparent to me from the points you've brought up and based from my own experience with patients with more chronic-type pain that fixing mechanics may not be the solution for every patient. Unfortunately, given the focus on mechanics, I can also see how easy it would be for a PT with this typical mindset to view the pain as secondary to the dysfunction.

    As for resources I could easily flood this post with names and books, and it's entirely self-promotional, but I think I did a pretty decent job providing a good introduction to pain science when I wrote a guest post here: http://deansomerset.com/2013/06/10/a-primer-on-pain/

    The links and names toward the bottom are all highly recommended and I would strongly suggest registering at www.SomaSimple.com To avoid a total derail, if you'd like more info, I'd be happy to PM.
    Awesome! I'll look into those and message you as well. Thanks a lot!

    -Sazzy
  7. Gypsy Jazz is offline
    Gypsy Jazz's Avatar

    Senior Member

    Join Date
    Jul 2004
    Location
    Long Island, NY
    Posts
    959

    Points
    1,741
    Achievements:
    Veteran5000 Experience Points

    Posted On:
    7/20/2013 5:26pm


     Style: Does exercise count?

    1
    Hell yeah! Hell no!
    Quote Originally Posted by sazahko View Post
    The first thing that comes to mind while reading your response is the fact that, for PT's in particular, pain is almost exclusively seen a symptom of an underlying problem. Perhaps therein lies the issue? I've actually heard a couple different PT's explicitly state that they only treat dysfunction, not pain. So would you argue that that attitude ought to be changed?
    To be perfectly blunt, I would argue that attitude is ass backwards. Are the people going to PT because their glute medius is weak or because their back hurts? Might their weak glute medius somehow relate to the back pain? Maybe, but I'd guess probably not. Does their back hurt? Yes.

    Hypothetically, if I went to a doctor because there was some sort of cancer detected and they spent the whole interaction discussing how important healthy lifestyle was in the prevention of high blood pressure, heart disease, diabetes, etc, then I would never return to that doctor. Fantasy doctor isn't wrong about any of this, but it's not what I went for and it's not the most pressing concern.

    Quote Originally Posted by sazahko View Post
    To keep things in perspective, you mention that "biomechanical factors are still important for ambulation and meaningful activities", which really is the idea behind most physical therapy interventions. We want to return the patient to a prior level of function. Subsequently, in most cases, biomechanical factors are a big part of what we deal with - they may have been disrupted by an injury, or they may have been part of the cause of an injury. All the same, it's apparent to me from the points you've brought up and based from my own experience with patients with more chronic-type pain that fixing mechanics may not be the solution for every patient. Unfortunately, given the focus on mechanics, I can also see how easy it would be for a PT with this typical mindset to view the pain as secondary to the dysfunction.
    I have heard arguments from Shirley Sahrmann, Diane and LJ Lee, and Gray Cook about dysfunctional movement. I absolutely used to buy every last bit of it too. If a person can perform meaningful movements pain free, but it doesn't look like a text or guru said it should, is it dysfunctional? If dysfunctional movement had any sort of linear causal relation toward pain, shouldn't everyone who moves in "non-ideal" ways be in pain? Isn't this the same story with posture which has be thoroughly disproven?

    I am not highly well versed in the research of predictive injury factors, but "dysfunctional movement" isn't anything I've seen as being anywhere near a slam dunk for prevention or prediction. There is very little good evidence on the whole beyond general fitness, strength, and neuromuscular control.

    This may be belaboring the point some, but even if function is the primary goal (which I contest it's not in most cases) then pain still needs to be addressed first. It is extremely well established that pain changes neuromuscular control. Chronic pain can even change the representation of the painful body part in the brain's cortical body matrix.

    This is a bit cut and dry, but check out this video of strength coach, Ben Bruno - he is a monster. Here is a picture of his leg 1 day after MCL reconstruction http://www.benbruno.com/wp/assets/day-1-post-op-003.jpg - It entirely evident that Mr. Bruno's rapid appearance of muscle loss is neurally modulated as a protective mechanism. Why would anything change if someone else had pain?

    Quote Originally Posted by sazahko View Post
    Awesome! I'll look into those and message you as well. Thanks a lot!

    -Sazzy
    Happy to help and I'll message you soon. For onlookers, please be aware that I'm harsh on the PT profession and indeed all health and wellness professions because I have tremendous respect for what they can do. If there were a thread about personal trainers, massage therapists, chiropractors, etc you could be sure I'd be there too.
  8. Gypsy Jazz is offline
    Gypsy Jazz's Avatar

    Senior Member

    Join Date
    Jul 2004
    Location
    Long Island, NY
    Posts
    959

    Points
    1,741
    Achievements:
    Veteran5000 Experience Points

    Posted On:
    7/23/2013 10:05pm


     Style: Does exercise count?

    --
    Hell yeah! Hell no!
    Apologies for the double post, but I just got done reading through this study (public access) and I thought it was particularly relevant.

    Pain induced by injection of hypertonic saline into the infrapatellar fat pad and effect on coordination of the quadriceps muscles: http://onlinelibrary.wiley.com/doi/1...art.24089/full
Page 4 of 4 FirstFirst 1234

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Powered by vBulletin™© contact@vbulletin.com vBulletin Solutions, Inc. 2011 All rights reserved.