Manual Medicine Workshop / Sharing Session: February 21, 2010 CERVICAL AND BEYOND

This is a call to our Colleauges, almost a plea.

I heard a German Quote last year which translates roughly to:
"How you shout into the forrest
determines the echo you get."

So we shout: Help us evolve this healing field.

I think it was the hockey sensation Wyne Gretzky that said: "Invariably, The Goals i never make are those i never take."



Session I-b (February 21, 2010)
The Head, Neck, and Jaw in Focus

Temporary and Evolving Outline:

Notions / Theoria:
How to use Bayliss Collapse / Engagment to determine local versus distal / compounded bony locks.
How cervical locks differ from other subluxations.
Tracing vectors as a way of noticing Neuromyofascial Full-Body Unwinding.
The Therapeutic pulse and how to use it.
Descriptions of the Cranial Mechanism.
Introduction to "Brain and Beyond" Techniques.

Palpation Lab

Individual Techniques:

Cervical Rotation taken into flexion-extension cycles; active nodding; sidebending. Compare with pre-harmonic patterns.

Spaceman / Floatation Unwind, Supine. Can you imagine what it would be like to let your patient's body guide you into its own healing mode?

Mandible Disconnection from Cervical Back-bending. Biomechanics meets proprioception.

The Non-surgical Facelift

Upper Masseter Intra-oral

Maxillary Lift

Epicranial Aponeurosis Release (CI: lateral Sphenoid Wing Compression)

Cranial Vector Releases:
AP L,R
Fronto-Occipital Diagonals L>R, R>L
Occipital L-R

cranial-sacral dural release posterior hookup

posterior cervical wedging, advanced, RRDT modifications

cervical FB-BB in rotation, supine; Facet opener variations and LVLA openers

cervical side-bending in rotation, supine

multistack unwind (ever seen Eight Degrees of Freedom?), focal, vector-locking openers

digastric release

masseter release, local, direct, external-internal

palatal arch-basing

maxillary anterior lift

galea aponeurosis / aponeurotic releases

disconnecting jawdrop from cervical backward-bending

laryngeal anterior release

Neurologic Integrartion:
How to fit in Neural Sliders
How to use Reflexes as a treament tool (Introduction to the Reflexive De-afferentation Technique Paradigm)

Protocols and how to dissect and modify them:
Treat headaches in minutes (sometimes in seconds!)
RDT checkpoints
Parasympathetic Rebooters
The Still Point and Beyond

Do in minutes what others do in sessions or followup days!


NOTE that Content of proposed Session I-b above may change at any time, without prior notice, and may be modified by how many participants are present, and how much good coffee we've had.
Yes, that's a hint! Bring coffee. Bring food. (AICA this time)
Bring more coffee.


FEES:

For those who register / commit to participate during the
February 21, 2020 Seminar-Workshop
Manual Medicine: Going Beyond Cervical Treatments
An Introduction to Scope, Synthesis
and Clinical Bases of Reflexive De-afferentation Techniques
(An Overview of Manual Medicine Techniques)

the following cutoff dates and corresponding fees apply:

Date of registration: cost share:
Up to December 29, 2009 P500
Up to January 31, 2020: P555
Up to February 07, 2010: P777
Up to February 14, 2010: P888
February 15 onward: P1,200
On-site: P1,555

Regret that free slots are already taken.

Yes, we are essentially rewarding early commitment. Many already understand that this is valuable information we're sharing. The techniques themselves are, in practice, invaluable.

Still, some people do not value what comes free. Yes, we know you're not like that. You know what we mean. So they are also most welcome to register late. And anyone who registered early is still most welcome to bring enough pizza for a baranggay. Or coffee. Or both. My cat likes Whiskas Ocean Fish Flavor. Yes, she asked me to tell you that. The rest of this post is very serious.


You now know how to use the Therapeutic Pulse.
Next up: How do you maximize that gift?

Ideal Audience:
Practicing Manual Therapists, Doctors progressing into Soft Tissue and Neural Work.

GUARANTEED RESULTS!
Simple, straight, no-B.S. 100% Refund Money-back Guarantee:

Take the techniques you get from this into the clinics, into your patient's homes.

If you don't make up your money in professional fees from using at least one of the techniques here, we'll refund your money.

Experiment. Try it for thirty days. Use it! Prove us wrong! If, in that time, you have not recrued your costs because the techniques have not worked (one possible reason: whatever you DO NOT TRY does NOT WORK.)

Next, if you have ANY technology that works better, faster for any of the indications we overlap technologies with, we'll refund your money, and pay you to show us what you have!


P.S.:
If this Challenge feels rude,
Who is it that's reacting?
If you have any resistance to this,
Why is that?

Ever notice how peak moments and life-changing events can be scary right before you get a grip on them?


WHERE IS EVERYONE'S REGISTRATION DATA?
To confirm registration, please leave a note with your nearest coordinator, to be forwarded to Dionne with your coordinator's endorsement, with the following data:

Your name, designation, institution, position occupied or maintained
A brief statement declaring why you're attending
The names of your two study-buddies
A brief list of what you already know, what you're certified to practice, and what you have mastery of.

WE RESERVE THE RIGHT TO TURN AWAY ANYONE WHO DOES NOT COMPLY WITH THIS REQUEST. This also lets us free us your seat to others who are raring to join us. Did we mention we overbooked early?


P.S., we truly are sorry. While certificates will be issued, if you are merely looking for a piece of paper to stuff your portfolio or crowd your wall with, please offer your slot to any colleague you believe will more benefit from this. Your understanding with regard this matter is much appreciated.


ATTIRE:

Please come in either loose, comfortable clothing (anything easily removable is preferred) or in thin, body hugging clothing (no neoprene dive suits or Gortex body armor).


EQUIPMENT:

Please bring a large towel. One neuro hammer per group would be useful. One goniometer per group would be great. Those who prefer to bring along an anatomy atlas will be most welcome to do so. One skin marker or eyeliner pen per group may prove useful. One small, thin, long towel (Barbero towel) would be useful as well. A skin marker or eyeliner per group would be very useful for newbies.


SUGGESTED WORKSHOP FORMAT:

Preferably, three people will be assigned per group / table / plinth. They will alternate roles: patient, practitioner, and preceptor. This enables each participant to see each technique twice in their own time. Corrections and adaptations may be incorporated during each second demo.

Group numbers will be assigned. Each group will rotate a member at the main demo table at the front of the class at the start of each new technique demo. That group's two other members come closest to the main table to observe and ask questions re each new technique. This enables each group of three to become the resource persons for at least one technique. They can then proceed to master that technique and pass it on. They are thus encouraged to learn each technique they are decked to a degree worthy of peer review and learning. One or more groups may thus, over time, pass their mastered technique onto others. This will also engender a collaboration between colleagues (and perhaps between institutions), who may choose to meet to master each other's sets in between workshops. They are encouraged to pass on well-mastered techniques to uninitiated colleagues.

As in life, these are mere suggestions. (They do, however, make the ride much more worthwhile.)


(Per request, this is now starting to look like a manual! That's a hint, colleagues! Anyone want to volunteer to have their name printed as a co-author on a manual?)


One of the best ways we know of
to get out of a rut
is amazingly simple:
ASK GOOD QUESTIONS.
So,
here's a little attempt at that.

Have you ever walked away from a workshop remembering nothing?
Have you ever walked away from a workshop with a bunch of techniques and no idea how they all fit?
Are you regularly using techniques from the last few workshops you've been to?
Have you ever wanted to design your own workshop?
If you could do things better, what would you do?

It's happened to us, so we're asking.
And now we're asking you.
Help us do this better.
Help us so this works for you.



Paraphrased from the Late Pope John Paul II:
"This is one way,
not necessarily
THE way."

WHAT IS YOUR WAY, and where does it lead?

See you at the Sessions.

Yours in the Evolution of Manual Medicine,

January 24 2010 Manual Medicine Sharing Session RESOUNDING SUCCESS

Thank you for coming!
See you on February 21 2010,
When we refine your skills and "Go beyond" Cervical treatments.

Completed Workshop / Seminar / Sharing Session:
Manual Medicine: An Introduction to Scope, Synthesis
and Clinical Bases of Rapid Reflexive De-afferentation Techniques
(An Overview of Manual Medicine Techniques)
January 24, 2010
Time: 10 a.m. to 4 p.m. (ask Rheysonn how long that actually is)
Call time and late registration: 9 am.
Venue: DLSU Dasmarinas Cavite (with many thanks to the faculty offer to host this session)

Contact: DIONNE at +639054269496

Content: A view of the forest, with a fair look at the trees. For the inquisitive, you may actually see the leaves, too.

Or, for the suddenly enlightened, the ecosystem might begin to make sense.

Course Hours: Six.

Pre-requisites:
Anatomy and Physiology Courses and continued Familiarity
License to Practice
Vertebral Artery Screening
Vestibular Screening
Maintained blood pressure
Open Mind [While most material presented will be mainstream, new technology will always look like magic do anyone who's never seen it.]
(For everyone else, you won't get left out! No judgments here. We all have something which can benefit our fellow living beings. It's all cool. Everyone is exactly where they have to be at the moment. In fact, Friends of mine are starting support groups:
(1) Critics for the Sake of Criticism
(2) Debate Club - also open to pre-teens onwards
(3) Understanding Evidence-Based Clinical Practice


Session I-a:
Technique Set: Neuromyofascial
System Focus: Head and Neck
Additional Techniques, Introduction: Articulatory, Thrust, RRDTs.

Techniques / Coverage / Flow:

intro / backgrounder
intent / vision / goals
Why NMFR / NiMFA ?
the path of ease
the importance of breath
the therapeutic pulse

Session Proper:
Evaluative Phase:
1. Postural Cues (landmarks, bearing, loading; seated / standing)
2. Zink Assessment for Junctional Freedoms (what is physiologic / compensated / uncompensated?)
Degrees of freedom demonstrated for the H&N (how many degrees of freedom are there?)
3. NOD testing for AO (how freely is the cranium suspended?)
4. VOR - Vestibular-Orienting Release (allow for gravity drop) (also proprioceptive)

Neuromyofascial Realeases:
(1.) Cat grabs for upper traps (traps drain / MFR)
(2.) Neck-Shoulder Differential Release, Superficial, in neck rotation and FB
(bind outer layers at restrictions, mobilize inner layers, shoulders, chest) (compare to Lederman's Cervical Harmonics) (broad versus specific releases)
(3.) Platysma (rotation bind at superficial pectoral fascia + active facial recruitment)
upper rib releases
(4.) SCM attachment release
active head movement; minimize SCM movement
(5.) anterior scalene release
supine; broad contact at scalenius anterior
posterior palpatory feedback: cervical segment tabledrop
indications: thoracic outlet syndrome, Anterior Neck Syndrome

(6.)Sleeve-Core Differentiation in Cervical Rotation:
Sleeve Bind, Core Roll
(a.)Bind with back of phalanges "Mano Po"
(b.)Overweight Turtle: Occipital hold against Neck-bind Caudal Drift
"Help that head out."

(7.)The 69 (Ulnar Traction Bind, Active Creep) (Cervical Rotation, FB, BB)
prone head-drape over plinth edge; Broad ulnar contact
(8.)Sidelain rotation releases
(a.) Downfist hold at neck; ceiling roll
(b.) Open Backhand hold at shoulder; ceiling roll


NMFAR = ARTICULATORY-NEUROMYOFASCIAL TECHNIQUES:

(1.) First RIB positional release, PA gravity-drop (slow Articular)
*** If time permits, we'll have a very superficial description of alternative 1st rib manipulations, when they may be useful, and why we usually DO NOT use them (other Doctor's techniques).
(2.) Cervical Stack Release:
"Casino Chips"
(3.) Cervical Circumduction with C7-T1 Lock
Pistol-cup handhold
(4.) CT Hold Augmented Side-bending:
feel extension of technique into neck and torso
knee-hand fulcrum hold
(5.) cervical vertebra translation|side-bending
note inverse relation of translation and SB


JUNCTIONAL Articulatory TECHNIQUES:

Cervico-thoracic Techniques:

(1.) Articulatory-thrust / Flexion-Distraction
(Low-velocity Low Amplitude) (LVLA/MVLA-Art)
FB-distraction Articulatory thoracic Anterior Techniques:
(C7 upon T1; T1-T3)

(2.)Cervico-thoracic Junctional collar release
cylindrical rotatory handle (Crankshaft)

Atlanto-Occipital Techniques:

(1.)Cervical Vertebral Mobility, Prone
Check rotation
Stabilizer / Contact hand versus Mobilizer hand

(2.)Dial Release for Atlanto-Axial C1-C2
45 degree forward-bending lock
local atlas-transverse process release
notion of TP posteriority with rotation SD
direct transverse process derotation
one-handed versus two-handed techniques
indirect technique, positional release (PRT)

(3.)AO lift glide: "Deep throat"
anterior translation - backward-bending
posterior translation - forward-bending
Hand-hold variations: Vertex-AO versus Two-handed collar

(4.)AO Wedge Release
AO freedom
Inhibition notion
Description of RRDT variation
AO-dural release: occipital traction through Dura, Posterior longitudinal ligament..
N.L.P. language / semantics

(5.)Towel and T-band releases:
infra-occipital hook
traction in backward-bending
"curved-angular" traction for brachial plexus, nerve sheath releases, levator scapulae
pre-harmonic swing-rock
rotational rolls - gentle
thoracic hold swing rock harmonic
dural cord


proprioceptive conditioning techniques:

(1.)ghost on the shell

(2.)Xiphoid-Halux Hookup:
middle finger, left hand
big toes, both feet, right hand
kinesthetic-proprioceptive connection

(3.)Head floater
Comparison to Dorn Method floater
N.L.P language re frontal headfall into palm, occipital cradling
NM Re-education


Nuchal Releases:
(1) Longitudinal
lengthening
occipital FB traction
spidermouth mounting hold, static
(2) Horizontal uncrowding

Nonlocal Integration / Completion:
(1.) antero-lateral sacral wedging
medial to PSIS
(2.) Dural-sacral release, prone


With Gratitude,

Yours in the Evolution of Manual Medicine,

TENS is NOT recommended for treatment of low back pain

Why are we not at all surprised?

If you've been using TENS for ages, noting how poorly it works for anything other than transient pain gating for neurologic pain, here's another shot againt that practice that you may want to review.

From Medscape Medical News
AAN Guideline Recommends Against TENS for Chronic Low-Back Pain
Susan Jeffrey


December 31, 2009 — A new evidence-based review from the American Academy of Neurology concludes that transcutaneous electric nerve stimulation (TENS) is not recommended for use in treating chronic low-back pain but adds that TENS should be considered to treat diabetic neuropathy.

The report, from the academy's Therapeutics and Technology Assessment Subcommittee, was published online December 30 in Neurology. Authors on the new document are Richard M. Dubinsky, MD, MPH, from Kansas University Medical Center in Kansas City, and Janis Miyasaki, MD, MEd, from Toronto Western Hospital, Ontario, Canada.

"In the highest-quality studies of chronic low back pain, there was no benefit of TENS compared to sham or placebo TENS, leaving us to conclude that it is of no benefit, and make a recommendation that it should not be used for chronic low back pain," Dr. Dubinsky told Medscape Neurology.

In diabetic polyneuropathy, some studies showed slight benefit, he added. "We concluded it should be considered in the treatment of diabetic polyneuropathy."

Systematic Review

TENS has been used to treat neurologic and other disorders for decades, the authors write. The biologic basis of its analgesic effect is not known, but it is used is based on the gate theory of pain, they note. In this assessment, the authors carried out a systematic literature search of Medline and Cochrane Library up to April 2009, looking for controlled clinical trials in which TENS was used to treat pain associated with neurological conditions.

Acute low back pain not normally seen in neurologic conditions was not considered in this review. All but 1 of the studies excluded patients with known causes of low-back pain, such as pinched nerves, severe scoliosis, severe spondylolisthesis, or obesity.

"We only found 2 conditions that had adequate rigor in the research, and that was chronic back pain and diabetic polyneuropathy," Dr. Dubinsky said.

The studies included showed conflicting results in chronic low back pain. Two class 2 studies showed benefit, but 2 class 1 studies and another class 2 study showed no benefit. "Because the Class I studies are stronger evidence, TENS is established as ineffective for the treatment of chronic low back pain," they write.

Two class 2 studies suggested that TENS is probably effective in treating painful diabetic neuropathy. The only specific neurologic cause of chronic low-back pain in which TENS was studied was multiple sclerosis, for which TENS was not shown to be of benefit.

The document makes 2 main recommendations:

TENS is not recommended for the treatment of chronic low-back pain because of a lack of proven efficacy (level A, 2 class 1 studies).
TENS should be considered for the treatment of painful diabetic neuropathy (level B, 2 class 2 studies).
The document also gives some guidance on the need for further research into TENS, Dr. Dubinsky noted. Among their recommendations were determining what the best paradigm is, in terms of current, pulse-width, and frequency, and then using it in patients who are naive to TENS so that they will be truly blinded to treatment allocation, and studying TENS in patients with well-defined neurological conditions.

Absence of Evidence

In an editorial accompanying the new document, Andreas Binder, MD, and Ralf Baron, MD, from the Division of Neurological Pain Research and Therapy in the Department of Neurology at Christian-Albrechts-Universität Kiel, Germany, write that the conclusions of Dr. Dubinsky and Dr. Miyasaki "may heat up the discussion on the usability of TENS and may be viewed as supporting the critics who questioned the value of TENS in pain therapy.

"However," they add, "absence of evidence is not evidence of absence. The clinical impact of meta-analyses is always limited by the quantity and quality of conducted trials."

TENS has had a long-standing role in pain management, is easy to handle, has a favorable benefit-to-risk ratio, and can be discontinued easily if it is not efficacious — all "desirable properties when treating pain," they write. The new document calls for further trials and even provides "clearcut recommendations for their conduction," they note.

"This updated evidence-based review is valuable in providing the limits of our evidence base," Dr. Binder and Dr. Baron conclude. "Nevertheless, it is not unreasonable to take a practical position that, in spite of the relatively weak scientific and clinical evidence, TENS still represents a valuable therapeutic alternative in neurologic pain disorders.

"Taking the favorable benefit-risk ratio when compared with other pain relieving methods into account, TENS remains a valuable part in the armamentarium of pain therapy."

Dr. Dubinsky serves on a scientific advisory board and speakers' bureau for Allergan Inc, receives honoraria from BrioMed, and receives research support from Allergan Inc, Merz Pharmaceuticals GmbH, and the National Institutes of Health, the NIAM/National Institute of Neurological Disorders and Stroke, and the National Center for Complementary and Alternative Medicine, and his spouse owns stock in Abbott. Disclosures for coauthors appear in the paper. Dr. Binder has received travel expenses for lectures and educational activities not funded by industry and has received honoraria for speaking engagements and educational activities from Grünenthal, Allergan Inc, and Pfizer Inc. Dr. Baron serves on scientific advisory boards, as a consultant, and on speakers' bureau for Pfizer Inc, Genzyme Corporation, Grünenthal, Mundipharma International, Allergan Inc, Sanofi Pasteur, Medtronic Inc, Eisai Inc, UCB, Eli Lilly and Company, and Astellas Pharma Inc; has received travel expenses for lectures or educational activities not funded by industry; serves as an associate editor of Pain and on the editorial advisory boards of Nature Reviews Neurology and the European Journal of Pain; and has received research support from Pfizer Inc, Genzyme Corporation, Grünenthal, the German Ministry of Research, and DFG, Deutsche Forschungsgemeinschaft.

Neurology. Published online December 30, 2009.

Authors and Disclosures
Journalist
Susan Jeffrey
Susan Jeffrey is the news editor for Medscape Neurology & Neurosurgery. Susan has been writing principally for physician audiences for nearly 20 years. Most recently, she was news editor for thekidney.org and also wrote for theheart.org; both of these Web sites have been acquired by WebMD. Prior to that, she spent 10 years covering neurology topics for a Canadian newspaper for physicians. She can be contacted at SJeffrey@webmd.net.

Medscape Medical News © 2009 Medscape, LLC
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