After the amazing response I had to Part 1 about Pain, here is a continuation. Again, these are not in my own words....i think it's best the content comes in it's original condition taken directly from the RM website. Once again there is a lot of information but I figure if you are in pain and haven't been able to find someone to help you then you are probably happy to have a read and see if any of this applies to you. If you have any questions about any of this please feel free to give me a call. So what is going on for the brain to create pain? The response may be a protective mechanism of PAIN We know that nerves carry impulses, or signals, from the body’s tissues that tell the brain about the state of the tissues. Information such as excessive stretch, excessive strain, over-compression, tearing, bleeding, swelling etc. (both physical and chemical noxious signals) are transmitted to the brain indicating a ‘less-than-optimal' state, or an 'unhappy' state. This all happens in our subconscious - we aren't aware of it. This newest, and RM, way of thinking is that once the brain receives these signals then the subconscious brain decides on best approach to protect the body. If the brain perceives these signals beyond a threshold and ‘bad enough’, then one of the brain’s protective reactions is to create the experience of pain and/or symptoms and make us conscious of needing to avoid damage. Without this protective response we would be much more likely to do more severe damage to ourselves, and for this reason pain is a very successful protective mechanism. This protective response can be very different in different people, even with the same unhappy (noxious) signals. Experience and research tells us that our individual brains are so different they can choose to produce a protective reaction, such as the type and location of the pain, that is individual to each of us. On the other hand, if the brain perceives these signals are under the threshold and ‘not bad enough’ then we remain completely unaware of any problem. This whole process occurs at a subconscious level – and this happens every day to all tissues in our body as a natural process.
The PAIN can be created to be experienced anywhere in the body Let’s go back to the example of the faulty car and the dashboard warning light. How good would it be for all the parts of the car, which might relate to thedysfunctioning engine, to be tested to see which ones are faulty? How good would it be to fix the faulty part, and know how to check this for yourself at regular intervals in the future? What might happen to the dashboard warning light if you took this approach? Clearly, this would result in the warning light going off and staying off. Plus, this would result in an optimal performance of the car. This analogy fits the human body. How good would it be if your warning signal, i.e.pain, alerted you to get every part of your body tested+ that could relate to your problem to find out which ones might be faulty? The next step is clear – fix the faulty part wherever it is – and when the most significant fault of the problem is fixed… then the pain goes away! i.e. the warning signal is no longer required to be ON. The bonus is that the body then functions at its highest performance. And the next step after that is highly valuable. Self checking that faulty part in the future and ensuring it remains in good shape is the best way of preventing recurrence. It even gets better than that… for proactive people, the faulty part can be tuned-up, before the warning signal comes on, i.e. before any pain occurs! Many people are this proactive with their car, and this proactive with their teeth, and their general health with a GP, imagine how much easier, and less expensive in the long run, it would be if we all learned to be this proactive for our musculoskeletal body parts. It is important to note that the vast majority of musculoskeletal condition’s ‘faulty parts’ are quickly fixable. We know from regular experience that the human body has an amazing capacity to change very quickly. Rebalancing unevenly distributed forces (even on warn body parts); releasing tension from strained areas; loosening stiff joints and supporting lax body parts can be rapidly changed (immediately in some and within a few sessions for most) for the vast majority of conditions. We certainly hope this brief introduction to the most recent understanding of pain makes as much sense to you as it does to us. Please me know if you would like more information.
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Since training in this new form of physiotherapy I have been obsessed with time. Not the length of time it takes to fix someone but the length of time it takes to diagnose and find the Primary Contributing Factor (PCF). The research shows that this process usually takes somewhere between 60 and 120 minutes depending on the complexity of the condition. My average is 75 minutes to find the PCF.
I have discussed this with my fellow Ridgway Method practitioners, my family and my friends. Because I really would prefer my initial assessments to be 90 minutes (or longer) I find it hard to limit myself to 30 minute or even 60 minute initial appointments, because we in fact may not find the PCF in the Initial Consultation, let alone start the treatment process. A non-physio friend said that as clients, we have been conditioned to only think of physio appointments as being 30 minutes. In her experience she has never had longer appointments and has in fact had shorter consults despite paying the same fee as for 30 minutes. And the Ridgway Method describes this concern about time as "unfounded and due to mainstream thinking". With my new way of thinking using RM I can concentrate on completing each step and focus on what the client receives from each step. Each step must be completed in full before moving on to the next step. A logical process involving a thorough approach. So, what does this mean for my clients? Well, it's easy! My clients have options! If you plan on seeing me for a consultation, you can choose the length of your appointment - ideally a 60 minute minimum for the Initial Consult but if you would prefer to take things a little slower, then we can have a 30 minute appointment. If you want to speed things along and get through all 10 steps as quickly as possible, then feel free to book in for a double or a triple appointment. The same goes for ongoing appointments....they may be 30, 60 minutes or longer. The revelation to the RM physios I have discussed this with is that, why don't we give clients options. Ultimately it makes no difference to me, it just depends on whether getting fixed as quick as possible is your priority or moving a little slower is better for you. The end result is that we will get through all 10 steps to actually achieve the goals you want. This might get a bit heavy, but I think it is so interesting because it challenges what I learnt as a physiotherapy student in 1990! Below is the start of a three part blog on pain....I have to make it clear...I didn't write any of this! This comes from the latest research from the RMII. And to be honest, i wouldn't be able to put it into any better words. I will add it as a page on my website for easy reference if you ever want to share it with someone you know who is suffering from pain. I have highlighted the part I find most interesting and that summarises what this is all about!
The number one misunderstanding about pain:
This research has clearly shown that there are no 'pain receptors', no 'pain signals' from the tissues, no tissues ‘feel’ pain and there is no pain ‘in’ any body part. This insight is very helpful to directing our attention to the factors that need to be fixed to get rid of pain. What does the latest research explain? Pain is actually created by the brain - for good reasons.
Why is this such an important differentiation? These signals tell the brain the state of the tissues This differentiation allows us to understand what is required to resolve pain most quickly. If we accept that pain is not a feeling, should we try to fix the problem by solving the pain? Imagine the scenario of a car that is malfunctioning with a bright engine warning light on the dash. Is it sensible to think that we can fix the problem by doing something to the warning light? Or would it be more sensible to acknowledge the warning light and then check out every possible structure that could be causing a problem to the car’s engine? Recent studies teach us that pain is the brain's equivalent of a dashboard warning light. When we stop to think about it this makes a lot of sense and this way of thinking fits all types and scenarios of painful conditions. In other words, this way of thinking appears to be the simplest and most ‘true’ way to understand pain. This warning light analogy is a simplification because the body’s the warning light, i.e. pain & symptoms can be created by the brain as an experience 'in' any part of the body for any problem anywhere in the body. Taking into account these variations, the principle of a creation of a warning signal is incredibly helpful. For example, it may be that when you hit your thumb with a hammer, the warning signal produced by the brain creates an experience like is pain 'in' the thumb - and usually this is a very successful protective mechanism that results in moving the thumb out of it's dangerous position to prevent further damage. Or it may be that injury occurs in the spine and the warning signal produced by the brain creates a pain-experience 'in' a limb (or vice versa). This way limping, or stopping walking, is a protective mechanism to stop strain to the spine - because the leg hurts.
Pain is a very important indicator to for us to pay attention and change what we are doing to protect us from harm. The brain is very smart and at least one step ahead of our consciousness. This is fundamentally a good thing because if we relied on our conscious awareness to avoid danger we would not do as well at protecting ourselves. For a start, our conscious awareness is too slow and distractible to respond effectively; and secondly, it would be too easy to consciously 'override' the warning by continuing our preferred activity despite the damage... until it's really too late. After the brain receives the signals it decides how to respond This way of thinking about pain does mean that we need to rely on atypical means of solving why the pain is occurring - to fix the problem most effectively. For example, if someone's right arm uses a mouse most of the day in an excessive forward-shoulder position and this creates a gradual build up of strain in the mid-back; in some people the response by the brain is to create the experience of pain like it is 'in' the right arm. Often this is also accompanied by muscles, nerves and joints suffering a condition (diagnosis) in the right arm also. This usually has the desired effect of changing the behaviour to avoid the poor mousing position with the right arm, and results in decreased strain to the mid-back. When effectively solved with good physiotherapy; release of strain to the mid-back results in the brain ceasing creation of the right arm pain (and rapid resolution of the arm condition/diagnosis); then changing the mousing position, or posture, to minimise mid-back strain results in the brain havingno reason to create the right arm pain again. This way of thinking gives us good reason to explain why pain and symptoms are not good indicators for figuring out how to solve a dysfunction. In the example above, treatments to the pain in the right arm would not solve the problem, or gain a rapid and long-lasting result. Just to build the suspense a little... Ridgway Method Certified Practitioners have much better ways for figuring out what is causing the dysfunction and what needs to be treated to fix the problem, than trying to fix the 'warning light' of pain. In all the excitement of opening my new physiotherapy practice this week, I TOTALLY forgot about the Ridgway Method Certified Practitioner Symposium that is on today. Luckily my children's Christmas party with Santa and Cinderella finishes a couples of hours before we start.
All Ridgway Method practitioners are invited to attend. Two things I am looking forward to is:
This is what I love...having access to the latest, most up-to-date research that there is. As a physiotherapist in my previous practices, I would undertake more training in a field whenever I felt like it but now I have access to this at at my fingertips all the time. I have been regularly staying in contact with another RMCP in Mackay. I actually contacted him at midnight the other night to sprout my successes with my first client. Rather than let me rest on my laurels of the significant improvements my client had achieved, he gave me suggestions of what to focus on at our next session. Which I did, with great results. During the last 20 years as as physiotherapist, I could count on one hand the number of times I discussed a patient's progress or sought advice from another colleague...I simply never had anyone with more experience to ask and all the physio's in our local area were seen to be competitors. The Ridgway Method encourages us to share ideas and ask questions of each other. I am the only physiotherapist on the Sunshine Coast who has trained at the Ridgway Institute. There are quite a few in Brisbane. During my training I was in awe of these physio's whose practices were only km's away from each other but who shared their knowledge and experiences freely. It was so refreshing and can only do great things for the Physiotherapy Profession by ensuring there are great practitioners out there who are achieving results that surpass a client's expectations. Looking forward to sharing and implementing all we cover today! UPDATE from Yesterday:
Another lot of great results from our physiotherapy treatment for my first client at the Refined Body. After achieving almost full range of motion in the neck and mid back we moved on to have a look at the shoulder. We achieved a very quick result in this increased range of motion by releasing a joint in the thoracic spine. We finished it off with a release of the same muscle in the shoulder that was responsible for the neck dysfunction yesterday. What I love most about this approach to treatment is that I thought we should check some of our other "asterisk" signs and this straight leg raise had significantly increased-and that was without going anywhere near the leg! You come in with one problem and we solve ones you didn't even realise were affecting you. Congratulations to James for all of his great results so far. He said it already has made such a difference to him. I am looking forward to heading to the gym with him next week and assessing his lifting technique to make sure it's not going to undo all of our hard work. An unexpected sneak peak! My first client at The Refined Body has generously offered for me to post his before and after photos and I am not going to say no. To say his results were amazing for the 2.5 hour session we had yesterday are an understatement. An ongoing history of neck pain and being unable to turn the head very far in either direction (in physio speak it was 0-1/4 range to the left and 1/4-1/2 range to the right and he had pain and tightness when he moved. There were quite a few other dysfunctions but the before and after photos say it all! And in his email today.... "I feel great today and slept really well.... - I woke up without being in pain". And this is the reason I love what I do. I wonder who is going to be the second patient at The Refined Body....it will be someone who wants to get rid of pain!
Below is a flow chart of the steps I go through with EVERY client to help you achieve your goals of pain free full function.
The evidence behind the Ridgway Method suggests that 95% of clients who go through all of these steps will achieve their goals. The other 5% may need to be referred on for further investigation. Whilst self explanatory in itself, it's good just to mention how thorough this assessment is and, to me, that is the secret of success behind this approach to physiotherapy treatment. With my first new clinic client yesterday we were able to perform the interview, clearing of neural tension, full body assessment, identification of a provisional PCF and commence treatment with some really "wow" results all within 2.5 hours. 95% Range of motion in the affected are was achieved in one direction and 85% in the other-I am really excited by those results and I am hoping the client is too. The topic for my next blog is all about System Wind-up. Today is the day! I have my very first REAL client booked in at The Refined Body today. And needless to say, I am just a tad excited! It is going to be so much fun! I simply cannot wait! Ok...i can sense I am going to have to tone it down a bit by the time they arrive. (When I say "they", I actually recommend clients bring someone with them to whom their problem affects or who can help keep them on track with their home program. Whether it be a spouse, or personal trainer, the more the merrier!). It is going to be full on - a thorough body assessment...will probably take the best part of an hour and a quarter until we find what the actual cause of the problem is. I've had a brief bit of background and from what I can gather this problem has been around a while and already a few very experienced practitioners from various professions have had a go at trying to solve this injury. Hmmm, no pressure! I think that trying to find the cause of someone's problem is the truly most intriguing part for me. That is probably the time, as a physio, I find I have to think the most. The treatment part is easy! I could treat with both eyes closed and one hand tied behind my back...well not really but you get my drift. I've been a physiotherapist for exactly half my life! I just thought of that!! The room is ready. I am ready. The Sunshine Coast's newest Physiotherapy clinic is now a reality! So, what is The Ridgway Method and why am I, a physio with 20 years experience, so enthusiastic about it? I used to eat, drink, live Physio-14 hours a day! I have to say I have always loved treating and I used to get pretty good results for my patients. I’ve always had 30 minute appointments so we always had plenty of time to treat. The Ridgway Method has taken this to a whole new level. Developed by Australian physiotherapist, Michael Ridgway, the theory behind The Ridgway Method is to get you better as quickly as possible with results that last a long time. 60-120 minutes to find the underlying cause of a condition There are 3 parts to this…the first is to diagnose. The assessment is thorough, so thorough. We assess every muscle, joint, nerve, movement patterns in the body to find out the underlying cause to your problem. This can take anywhere from 60 to 120 minutes. It really depends on how long you have had the problem for and how complex it is. At this point i must say that some people may need to go to Plan B – needing referral on for investigations or to see another medical professional. This is only when physiotherapy is not appropriate. 30-180 minutes to achieve PAIN FREE FULL FUNCTION The second step is to FIX! This is the part everyone loves. What I didn’t mention above is that we were looking for the underlying reason why the problem exists. And that is what we focus our treatment on. Our goal is for you to be PAIN FREE WITH FULL FUNCTION. We also go through how to look after your condition at home so that it doesn’t come back again. This part of the process usually takes between 30 minutes and 180 minutes. Graduate to 30 mins every 3 months. The last step is to prevent recurrence by having Tune Ups. What is the famous saying, Prevention is better than the cure. The aim of treatment is to treat anyaccumulative strain that might develop as a result of life’s challenges. The goal is to graduate these to 30 minutes every 3 months. Hopefully this gives some insight to what this most up to date approach to treatment is all about. More information is available on our website http://www.therefinedbody.com.au/the-difference.html Next post will be about the actual sessions and what you can expect from me. |
AuthorJacqui Moretto is a Physiotherapist with 29 years hands on experience with a private practice in Buderim on the Sunshine Coast, Qld. ArchivesCategories |