Physical Therapy Continuing Education

Physical Therapist Rachel Katz Teacher Boulder School of Massage Therapy

7/14/2020

Muscle Discharge/releasing patterns you can feel with your Hands

In response to a question about incorporating Somatic Experiencing Trauma Therapy into a hands therapy setting, I want to share some ideas.

Gentle light touch can be highly effective for many clients because the therapist can help the client’s body start to wake up in the area that is being touched. Dialogue can support the sensations and help the client keep focus on the area that is being worked with. The therapist does need to titrate to match the client and to help the session stay within what works for the client. Severely dissociated clients may not be good with this…be aware that for some…on body is just simply too much.

But, for many it is a great help. Start incorporating the ideas of exploration of sensation into dialogue while your hands assist. Basic body orienting can be facilitated by noticing of surfaces and their locations. Most people can instantly tell you are on the frontside of their body or the side or the backside.

This might seem too simple to bother with but it can be a good starting place. Similar to the Notice 5 things you see, hear, feel exercise that can be used to stabilize and reduce Central Nervous System arousal.

I noticed in my work that muscle “freeze” feels like an unhappy cat that your hands are touching. Feels board like. Also, postural holding patterns that may not be freeze, and old injury patterns in muscle that may not be freeze, also can feel like an unhappy cat. Technically I’d say it’s a state of co-contraction that limits the areas fine motor regulation.

Hands on contact can help all of the above muscle dysfunctions to shift into discharge patterns. I feel many kinds of releasing patterns via my hands that would not be visible to my eyes. I look for the feel of segments moving in each of the 3 planes of motion which are Flexion-Extension movements, Sidebend right-Sidebend-left, and rotations on a horizontal plane right and left. Often rotation patterns show up first.

A 4th movement pattern is telescoping shorter-longer.

A 5th pattern I call a Fault line. A segment of body shifts off center from the segment of body below.

And then there are the visible discharge patterns of twitches, trembles, shaking etc.

Hands on work that is not intrusive, but is exploratory can help a person shift from muscle rigidity into more fluid muscle behavior.

2/9/16

Article on Theoretical Considerations for Chronic Pain Rehabilitation

by authors Martin, Lotze, and G. Lorimer Moseley in September’s Journal of the American Physical Therapy Association, Sept 2015, Vol 95/Number 9

This article is worth thinking about.  I will briefly summarize the points in it for you.

There is a new paradigm developing in the field of chronic pain relevant to Physical Therapy treatment.  The explanation is changing from a model based on structural-pathology to altered perceptual processing.

In the altered perceptual processing model, pain signals are associated with the perception of a need to protect in some manner. There is a shift towards understanding the pain issues in danger versus safety constructs.  This model certainly has validity for some kinds of chronic pain.

The article discusses the need for clinicians to be much more attuned to:

1.) Clinician observations and recognition that behaviors and dialogue reflect neural representation. (i.e. What you see and observe can add to a cohesive sense of what the client’s brain is processing in relationship to their pain.)

2.) Clinical inquiry into the patient’s framing of their pain in a biopsychosocial manner. This ties into a need for improving the client narrative aspect therapy.

3.) Then, as clinicians we are to attend to the importance of our relationship with the client. We help redirect and create measures of safety.  We are to help reduce the client’s need to protect which is associated with their pain. We need to include education about their pain, “Explaining Pain”.

The “Explaining Pain” model seems to me to be a very conscious process of mental reframing to quell pain signals. This is a top-down approach.

I recommend also using methods of bottom-up processing involving restoration of the perception of safety in a manner uniquely relevant to each patient.

The authors note that there may be maladaptive neuroplasticity involved “…whereby body-related neural representation become less precise, an abnormality thought to be important in some of the multiple system dysfunctions that are seen in people with chronic pain”.

This article supports in a clear way the need for new ways to interface with our clients for treatment.  It does not talk in specific ways how to accomplish the above. And, if you’re like I was as I began to delve into these concepts, I really didn’t know how to get started doing something different in my clinic.

The manual therapy methods I will be sharing directly relate to rehabilitation of maladaptive- neuroplasticity, which I usually term negative neuroplasticity.  There will be more info on negative neuroplasticity coming up.

Are you interested in addressing concretely how to do a better patient narrative, how to work with issues of safety on multiple levels, how to evaluate and therefore “see” what’s in front of you better, and how to sort out what is a right course of rehab for chronic pain?

Please feel free to send me clinical questions. I work so much better when I have something specific to address.

Your comments are really important and helpful to all of us as we seek to better help our clients.  Please send a quick comment to me so this can be a discussion not a one-way street.

Warm regards,
Rachel

10/28/15  New post on the Evidence Elephant in chronic pain blocking the road.  Take a look at a commentary on an article from the American Physical Therapy Journal on Interpreting Effectiveness Evidence in Pain written by Neil E. O’Connell,   Lorimer Moseley, James H. McAuley, Benedict M. Wand, and Robert D. Herbert. See in blog under Teaching Mind Body Physical Therapy.

10/3/15

Comments and Responses to  the Special Considerations in Chronic Pain Treatment in Physical Therapy (and what to do about it) lecture video.

“I just LOVED your videos.  This is so  needed and you are being so clear and connecting.  I love how you are speaking from personal experience (both in the SE training and your personal recovery).  I love your examples (something was wrong and it was that she’d lost her arm!???) OMG.  I also love your example of working with someone and how you might perceive the discharge pattern through subtle sensations of the left to right to left movement. I’m so glad you are getting your work and insights and skills out there like this.” V.M. somatic psychologist, SEP and retired physician.

9/1/15       Special Considerations in Chronic Pain Treatment in Physical Therapy (and what to do about it)

The lecture was presented for APTA Colorado North East district chapter in Feb this year to an audience of about 30 interested PTs.  It  has been filmed and edited.  You can take a look all segments.  The total view time is about an hour.  The material is sensitive and for this reason you will be asked for your email and name on the sign in page.  You may reach me at rachel@mindbodyphysicaltherapy.com. for any questions about this, and I of course welcome all your comments.  Please share your thoughts on this with me.  The access URL is:

http://forms.aweber.com/form/72/1209146772.htm

3-2-15
I recently lectured on the topic of Special Considerations in Chronic Pain Treatment in Physical Therapy (and what to do about it). The lecture was for the NE District APTA February meeting in Loveland, CO. Nearly 30 Physical Therapists came. Surveys of the material showed strong interest in the topic and interest in further learning opportunities in the next 6-12 months. The lecture was filmed and will become available for viewing as soon as I can figure out that tech hurdle. I would like to think of this lecture as a core concepts nucleus for future, more detailed teaching of specific techniques.

I welcome hearing from anyone interested in this topic.
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There have been a few changes over the past few years related to teaching  therapists about working with chronic pain.

My dear friend, Elaine Calenda, MT, passed away in 2012.  She was an academic dean at The Boulder College of Massage Therapy. She helped bring my coursework to life in the form of a 2 day post graduate continuing education workshop sponsored there. The Boulder College of Massage Therapy itself expired, so to speak, of terminal financial issues in 2013.  It’s the passing of an era in many ways.

My current thinking is that PT’s are becoming more interested in this topic, and there is more research that supports brain changes and influence as part of the chronic pain picture.

My goal is to create understanding and accessibility of the treatment processes I’ve developed for resolving chronic pain.

I will be sharing my therapy rationale and methods.  I am interested in your feedback along the way.  Please feel free to contact me by phone, text or email. I welcome your input and your comments.  Let me know where I am being helpful and clear, and where something isn’t making sense.  Be gentle with me though.

There’s a certain amount of challenge working with filming, editing, writing, and imagining a sensible progression of information.  I struggle with hammering things out and endless tweaking. I’ll try not to be too wordy and I’ll try not to be too general.

I expect much to be revised as I go along, so bear with me.

I will be adding info into the blog on Teaching Mind Body PT.  Keep checking in.