Ligaments of the spine

I spent some time reading up on deep ligaments of the spine today:
Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flavum
Interspinous ligament
Supraspinous ligament

I non specific low back pain it's really virtually impossible to pin down one structure as the source of pain. But in the light of a detailed clinical examination it's useful to have some suspects.

New Job!!

I have a new job.

I will be working for Bodies Under Construction physiotherapy in Putney.

Here we work within the Putney Clinic who also have a Blog on Blogspot!

Search for putneyclinic to find them!

Sunshine

A beautiful day in Hammersmith today!

Online work

I worked from 9:30-11:30 today updating our company website with Wordpress for the benefit of our clients and the other physios I work with and the company. I added and resized some photos and biogs for our newer physiotherapists. I hope it helps people to find the right therapist for their needs...

Weber's Fracture

I had a patient with a Weber's fracture (of the ankle) the other day: so I've been brushing up on my orthopaedic surgery rehabilitation skills.

Research driven clinical practice - neurodynamics

On my recent cervical spine (neck) course I was instructed by a lady who has been researching nerve pain and nerve movement.

This is an area I have been excited to be involved with.

In people with say non-specific arm pain: there is often a restriction on nerve gliding testing (neurodynamic testing ULTT1, 2, 3 etc.).

It was thought originally that sustained stretching the nerves would help but it was found that this was provocative and made things worse. Thus techniques were modified to be gentler and to glide or slide the nerve.

The most recent research of my lecturer showed little movement of the nerve on these tests certainly longitudinally. Thus it is now thought that the nerve does not become so much resistant to sliding in its tunnel, as irritated and this mechanosensitive.
This mechanosensitivity translates into muscle guarding on movement of the nerve. It is thought that the nerve often becomes irritated at its interfaces, or points where it touches neighbouring structures.

Thus, the most productive approach would be expected to be mobilising these interfaces with techniques such as myofascial release.

This ties in well with what I have been experiencing clinically. Certainly I have very rapidly relieved treatment resistant arm and elbow and shoulder pain with such work in a variety of patients.

It also ties in with my qualifying Masters research project which was never published. At the time (2005) there was concern among physiotherapists that the ULNT (Upler Limb Neurodynamic Tests) could themselves traumatise the upper limb nerves. Certainly they often provoked transitory symptoms. This my prow t was to sensitively measure and disruption in healthy volunteers following testing. This was done with vibration threshold testing. In conclusion no change in vibration threshold was found. But this was after me cautiously applying ULNT 1 to normal individuals.

This new research helps to explain my finding. If little longitudinal movement occurs in the upper arm nerves with ULNT 1 then it is not surprising that they are not much affected by it. The resistance felt us that if the muscles guarding an irritates nerve. Muscles are quite robust things and heal easily: compared with nerves.

All this is very interesting to me!

If you are a non Physio or anatomist reading this: the upshot is : if you get an arm pain and it ends up being to do with your arm nerves: I now more likely to be able to fix it : and most likely quicker than before!

Plantaris

After discussing Plantaris with a fellow Physio at a conference I've the weekend I have been looking up its exact anatomy. I see it's insertion is slightly medial to the calcaneus tendon. This may well be relevant to a client of mine.