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Diary of a mobilised foot

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Ian Linane, Feb 9, 2010.

  1. Ian Linane

    Ian Linane Well-Known Member

    Members do not see these Ads. Sign Up.
    Thought this tale might be of interest.

    A wet, grey, English winter morning greeted my groggy eyes as I climbed out of bed and moved to open the window blinds. Something did not feel usual though, my right foot seemed to be a bit awkward in its movement. Walking back round the bed I checked it out and yes it felt different. Not bad different, but struggling to know quite how to function, as though a little confused, wanting to do its usual thing but also wanting to do another.

    I then noticed that it was not just my foot but my knee and hip felt different in their function….

    Five years earlier whilst holidaying I slipped on the surround of the hotel swimming pool. Glorious moment of pretending it hadn’t happened followed and I sauntered away from the pool. My left knee really hurt. The rest of the day passed uneventful and by the evening the knee had settled but I was getting some discomfort in the lateral right foot, near the cuboid.

    The next four days of walking in 40 degree heat along Italian pavements in Rome became increasingly excruciating.

    On return to England and back into supportive shoes and my orthotics things seemed to calm down and some massage to the area and off loading seemed to ease it up.

    Over the coming months there were occasions of discomfort in the area and an increasing sense of walking on a stone. The years went by and I lived with the foot issue as no one seemed able to solve the problem. Over time the stone like feel increased and 18 months ago the vague stone like sensation on pressure to the foot became a very palpable lump around the cuboid area. I had started to walk with an increased external rotation of the foot and low limb and I felt my foot was increasingly “undoing” as I turned corners in the house barefoot. On top of that during a recent trip to Geneva (lots of walking) I developed a very sore spot, weight bearing, in the 3rd and 4th met head area. In the last month this had become very painful and was altering my gait.

    …..back to now. My foot, knee and hip are feeling different in their function. The foot no longer feels to be undoing as I turn corners barefoot, the knee feels as though the soft tissues surrounding it are tensioning and more stable when previously it had become increasingly uncertain, feeling unstable. Tom Dick and Harry around the medial malleoli and under the immediate medial foot and ankle feel to be tensioning better in gait as though they have been kick started into improved function. The hip musculature is feeling to stretch as the low limb and foot seem to function in a less externally rotated manner.

    Perhaps the different feel in function I am experiencing again this morning is simply the previous gradual alteration in a 5 year history of soft tissue and low limb function arising from altered foot function, being fairly immediately altered via a mobilised joint restoring more usual function prior to injury.

    The lump in question turned out to be the lateral cuneiform that seemd to have come out of position. The mobilisation approach at the weekend seemed to have resolved it.

  2. TedJed

    TedJed Active Member

    A couple of physiological principles at play in your diary Ian;

    1. Everything works best when it's in the right position.

    2. Connective tissues adapt to their shortest functional length.

    I'm glad to hear of your body's ability to restore its functional capabilities after being mobilised. But really, could a problem that spent 5+ years forming and consolidating be improved in just one weekend? The sceptics won't believe it but my anecdotal experience tells me, 'sure, why not?' Our bodies are constantly recruiting whatever resources are available to restore & maintain function (homeostasis). Makes sense to me.

    Happy dancing! (and sight seeing, you get around to some nice places!)


    PS Did any of the mobilisations hurt considering how 'stuck' some structures must have been?
  3. Deborah Ferguson

    Deborah Ferguson Active Member

    I too was a little sceptical that dramatic improvements could be achieved with mobilization in a short space of time. I attended a course this last weekend on mobilization of the talus and lower limb run by Paul Coneelly here in the U.K .
    I have had a stiff,painful neck with very limited cervical rotation to the right for years and years. Paul kindly treated me during the workshop and the results have been impressive. I now have painfree movement.
  4. drsarbes

    drsarbes Well-Known Member

    I reread this instead of taking my Ambien tonight.
  5. Ian Linane

    Ian Linane Well-Known Member

    Hi Ted

    Having done mobs on others for quite a few years it has been quite informative to note the "changes" for myself, post mobs, both in terms of altered foot position in gait and where the centre of pressure "feels" now to be going. It is also useful having had a quite specific issue that has been addressed so that I can compare more clearly the before and after sensations and functions. Also been interesting to note how the restored foot wants to do its thing but the last few years of acquiring a compensation pattern tries to resist it.

    Certainly no pain occurring during the mobs, nor any pain after. However, there was the sensation of tissues"stretching" as the foot moved differently post mobs for a couple of days. This has now settled down.

    The net product of this for me is that it affirms the value of the treatment being applied in some cases before we even go down the orthotic route. Be that padding or FFO's. For example I used it yesterday on a lady with irritation to the nerves in the 3/4 met area. Immediate relief from the pain but still some slight tingling left in the end of the affected toe.

    Hi Sarbes
    Glad the post helps with the insomnia;) It was a frequent occurrence that I could read my young children to sleep. Perhaps I should extend the skill to older folks as well. :D

  6. TedJed

    TedJed Active Member

    As your clinical experience will tell you Ian, your description above is fairly typical from people receiving a manual therapy treatment. How we 'quantify' these sensations is always going to be a challenge. This is where the sceptics demand an objective, empirical measurement of the changes or results. For scientific purposes, this is understandably required.

    Until then, it seems that the deductive reasoning that joints work better when they're not limited by connective tissue restrictions might be the best rationale we've got.

    Interesting though that the physiotherapy, chiropractic and osteopathic professions have been basing their professional practices and services on the physiological principles of adaptation for decades. I suppose we have to repeat the process in RCTs to 'prove' that manual therapies work in podiatry.:bash:

    This is particularly useful when you are planning on prescribing an orthotic device to treat a condition where soft tissue restrictions are involved such as a neuroma, plantar fasciits or shin splint. Releasing the tissue restrictions allows the orthoses to work more effectively because they're not having to 'fight' against the resistance of the restrictions.

    This would appear to be a logical step when providing orthotic therapy. Especially considering the evidence being presented now on 'joint stiffness'.

    K.Kirby Pod Arena 31-12-09

  7. drsarbes

    drsarbes Well-Known Member

    hey hey..I'm not THAT old!!

  8. phil

    phil Active Member

    With all this talk about manual therapies, i'd love to know if anyone has any resources on techniques and indications for treatment.

    What I mean is- how do you do it? and when do you do it?

    Cause i never heard of in my training, and it's all quite mysterious.

    I have seen some of the u-tube video links, which are interesting. But is there any textbooks/ resources describing techniques?

    Phil M
  9. TedJed

    TedJed Active Member

    Like most pods Phil, we seem to hear about foot mobilisation techniques (FMT) by accident. My 1st encounter was in 1994 when a reflexologist told me about a DPM from LA was coming to Australia to teach foot mobilisation.

    Here's some suggestions for you to follow up;


    Useful texts with techniques described;

    Foot Orthoses and other forms of conservative foot care by Thomas C Michaud (Chiro)
    Peripheral Manipulation by GD Maitland (Pioneer of Manipulative Physiotherapy who recently passed, Jan 22 2010.)

    While some techniques are described, students usually benefit from an experienced tutor to help them along.

    I have an article currently being considered for publication titled 'FMT Guidelines'.

    Further discussions;


    The Plug:

    I am running the Level 1 FMT courses throughout Australia, NZ and the UK this year.
    (QUT in October) Dates and locations at; www.footmobilisation.com

  10. musmed

    musmed Active Member

    Dear Phil
    Yes it is me.
    I learnt these techniques in 1991 and Ted has been to two of my worhops as recently as just on 2 years ago.

    The technique is simple when taught correctly. Like all things it requires practice. As a medical practitioner I can go to many parts of the body and treat these, but I have found over the years if you want lasting results, start at the feet.
    This is what we did in the workshop.
    As mentioned in another post, one lasy had 20 years of neck pain.
    In all of my wsorkshop we measure pre and post values and one is cervical rotation in the standing position after six steps on the spot have been taken while ones eyes are shut.
    This poor soul hadonly 25 degrees motion to the left and right (normalis 85 to 90) degree depending on whose book you read.
    Now remeber her partner had never doen any mobes prior to this workshop.
    Post mobilisation to both feet and ankles her cervicaol rotation hadincreased to 75+ degrees to the left and right and a pain she had experincedin her right neck for 20 years had gone.
    I am certain you find this hard to beleive, but after doing the number of feet that I have mobed in all but 20 years, I do not.

    In this workshop we measure pre and post hamstrings along with many other parameters. Several had 100% in hamstring length on measuring themafter mobilisation.
    I find these results as normal.
    Even scapular distances apart change.

    for more information email me or Ian Linane who started this thread.
    Remember, no one on this workshop last weekend in Brighton had performd any mobilisations before and most recorded major changes to their partner's parameters.

    One who did not make great changes went home to a friends house and removed apain of 10 year duration. 2 MRI's,surgery offered etc.

    You too can learn these techniques and cahnge your patients lives.
    Next week I am off to the eastern side of New South Wales a 7 and a 1/2 hour drive where I see feet patients. Most driver up to4 hours to see me. I only carry out the workshop.It must be working or they would not come.

    Anyway speak to Ian.

    I am happy with the 36C here!

    Paul Conneely
    ps when yoo get good at this 1-2 visits is all that is needed along with a follow up when they feel they need it, unlike what other teachers will tell you.
  11. TedJed

    TedJed Active Member

    I am in total agreement with Paul's comments on the value of FMT/mobes with the exception of the comment above. Then again, it depends on what your 'objective' in providing manual therapies is.

    If it is to only provide symptomatic relief when needed, FMT will be very helpful.

    I strongly disagree with concept of providing a 'follow up when they feel they need it'. This is akin to giving someone antibiotics and then if they feel fine after 2-3 days, they can then stop taking the remainder of the course and only return to the doctor when the symptoms return.

    I believe it's important to remember that when symptoms occur with a joint dysfunction pattern, the pain is usually the last thing to feel and the first thing to disappear. With joint dysfunction, multiple events occur; articulation irregularities->collagen contractures->synovial fluid production disruption->neurological interference->gait pattern alteration->symptoms might occur here (or sooner, or later) but you can improve the dysfunction much sooner than waiting for the symptoms.

    The exception is an acute subluxation like a rolled ankle or cuboid subluxation. But in my experience, these are in the minority of cases.

    Think of dental cavities; if you only went to see a dentist when you felt a toothache, wouldn't you expect your dentist to say 'you should have seen me earlier'? 'But Dr Dentist, I thought I only need to see a doctor when I hurt...':bang:

    How many times have we as health practitioners said to our patients; 'If only you had come and seen me sooner, it would have been easier (and cheaper) to fix this problem'.:craig:

    I believe that relying on patient feedback solely is an unreliable management method. E.g. a person with hypertension or hyperglycemia cannot 'feel' the effects of these potentially catastrophic conditions. Objective testing is required for initial diagnosis and ongoing management. Paul's pre- and post- mobes session testing is a simple clinical testing method that is worth applying. 'Patient Management' and 'Clinical Review' of your cases is as important as your treatment.

    As a teacher of FMT, I will strongly encourage you to follow-up your work in an organised manner. Your FMT treatment may only require 1-2 sessions but the follow-up is what a responsible, caring practitioner will do. Our policy is to have all patients leave us with a follow-up appointment booked, even if it is in 12 months.

    When your objective is to improve the functional capabilities of dysfunctional joints resulting from connective tissue adaptation, one needs to remember that people are adapting entities always under the force of gravity. We are not a lump of wood that, once fixed, will stay put.

    Life, sport, accidents, injuries, vocations, footwear etc. are forces that make our bodies constantly adapt. Some adapt better than others. Our role as practitioners is to help those that need some extra assistance.

    Last edited: Feb 14, 2010
  12. musmed

    musmed Active Member

    You sound like a chiropractor and thus most lilkely act like one.
    If a patient has ahd sore feet for ears and you fix the problem, why not let them decide when their feet are hurting?

    Wealth creation is not my go.
    Paul C musmed
  13. TedJed

    TedJed Active Member


    Slandering the whole chiropractic profession to justify your philosophical position is a poor show. And anyway, how does a chiropractor act? You're suggesting all chiropractors are only in it for wealth creation. I don't agree with your opinion and I'm sure a lot of chiropractors would be offended.

    And if you're suggesting that I'm in it for wealth creation then get real. I've found when given the choice, patients would much rather prevent than treat problems. You're suggesting the public can be hoodwinked into doing something against their better judgement.

    I've no doubt patients can tell when their feet are hurting. I'm suggesting that 'prevention is better than cure'.

    Do you think the dental profession has got it wrong with educating the public that 'regular check ups' is a good idea, whether they have toothache or not?

    I believe in what I'm doing because I do it with my own health. I see my physio every month whether I'm sore or not. Admittedly, I fractured my spine 2 1/2 years ago and since my recovery, have been diligent in having a monthly check up without fail. I have also been asymptomatic for the last 2 years. $55 per month is a very small price to pay for maintaining the functional capabilities of my spine. I'm not willing to wait until I hurt again before seeing my physio. I know the time, effort and cost involved would far exceed my current investment in my own health maintenance.

  14. musmed

    musmed Active Member

    Dear Ted
    Don't go there as you have not been forthwright at all.
    I did not come down in the last shower you know, despite what others may feel.

    what happened to the world's population prior to the invention of podiatry, physio chiro etc. ?

    What happens to 99% of the world's population today?

    In 2000 we had the Olympics. What percentage of African Continent attendees had ever had a massage but still won gold medals?

    When a painful foot becomes a medical condition as you only quoted about in your emails, please let me know.

    PAul C
  15. TedJed

    TedJed Active Member


    I think I must have come down in the last shower because I can't make sense of your last post.

  16. David Wedemeyer

    David Wedemeyer Well-Known Member

    Paul would you kindly explain that comment? I'm curious which field your training is in, MD, DO, DPM, DC?
  17. ackers

    ackers Member

    [Check4SPAM] RE: URL Attempt


    Are your courses later in the year in melbourne part of the CPD programme?

  18. TedJed

    TedJed Active Member

    Re: [Check4SPAM] RE: URL Attempt

    Yes Ackers, (do you play for the Bulldogs?)

    Just finalising the CPD requirements in SA which will then apply nationally.

  19. Lawrence Bevan

    Lawrence Bevan Active Member


    I have read your comments on the Arena over the years and always thought that you had something very interesting to contribute but sometimes I never quite grasped your points. However in my opinion "the more the merrier".

    Vis a vis foot mobilisation/manipulation, I have not yet had chance to do one of your courses - I missed the last due to an urgent holiday need! I have however done several of Ted's and used the content learnt on patients. I would agree that sometimes a dramatic change can occur but I find this rare. I agree with Ted that chronic conditions need longer term treatment and I find that view totally logical. You refer to that as "Chiropratic" are you saying then in the same breath it is wrong?

    You may say, as the actress said to the bishop "you ain't doint it right", in which perhaps you to post a video like Ted has done to openly allow us to see your method.

    However, I know that Ted suggests that mobilisation is a treatment that aims to breakdown collagen cross-linkages in soft-tissue joint restrictions and in doing this restores normal range of motion. This needs to be done carefully and progressively.

    How do you suggest FMT works?
  20. David Wedemeyer

    David Wedemeyer Well-Known Member

    It is always amusing to me to see other professions utilize our techniques and then disparage the chiropractic profession in such a bold manner. I truly do not feel that Paul will respond to my question above or to the other responses but feel that he certainly should.
  21. TedJed

    TedJed Active Member

    Looks like it's got too hot in the kitchen :boxing: and someone seems to have opted out?
  22. musmed

    musmed Active Member

    Dear All
    I have just received an email to say some one has written something, Ted the kitchen ain't hot, I am ao glad you know where it is,
    As a patient recently said to me he know knows where the kitchen is. I said to Mick how come, and he replied that the Misses moved the bar fridge there!

    Ted You shoud read the recent report regarding wellness follow-up in healthy children. It found that statist ically, reviewing health children was a total waste of money and manpower. This came out on Monday.

    As for your techniques. I suppose you lot should repay the Babalonians for how to manipulate the neck. These stone carving can be found there on the walls in Babalon *hope the spelling is correct.

    I would like to know when one profession developed the right to own something?
    Amazingly childish...

    As for Ted's Idea that you need to change to tissue slowly over many visits. I just can't believe such rubbish. Just do it and get results then and there, unless you need the money.

    I am happy to demonstrate these things the mob on line deny that occurs, anywhere, anytime.

    Paul Conneely
  23. Lawrence Bevan

    Lawrence Bevan Active Member


    cool, any chance you could do a video?

    How do your mobilsations work?
  24. TedJed

    TedJed Active Member

    Hey Paul, it's not my idea, it's simply the physiological fact, as was so elegantly articulated by Videman; 'Connective tissues always adapt to their shortest functional length'.

    From Videman’s research, restoring the full RoM and functional capabilities of a joint simply takes time, work and effort. If a patient has had their ankle immobilised in plaster for 6 weeks for a fracture, because of the connective tissue adaptation, the joint(s) will have a reduced RoM. Rehab will consist of mobilising and stretching over time to restore the RoM.

    If you can restore the full RoM in 1-2 visits, you must be doing some ‘special’ healing, Paul.

    Given the physiological facts, improving a joint's functional capacities that have been reduced by connective tissue adaptation due to joint immobilisation, will simply take some time and work.

    Videman T Clin Orthop Relat Res. 1987 Aug;(221):26-32.

  25. David Wedemeyer

    David Wedemeyer Well-Known Member

    Oblique as your response is, following your logic I suppose we would then have to wonder then how much modern medicine has evolved since Hippocrates (who also practiced bone setting) eh Paul? Do pay homage

    You could ask the American Medical Association the same question. It is infinitely more childish to be a hypocrite inter-professionally in my opinion.

    Let's see your technique Paul. I'd bet dollars to donuts that I have been doing the same exact thing for years but at least I am not ashamed to call it by it's proper name. Just so that we're clear, what you are selling is that manipulation performed by a physician or anyone other than a chiropractor is efficacious but the same techniques performed by licensed, trained chiropractors (who do "own it" by the way in the U.S.) is anathema and their practitioners are fair game to deride and insult? I understand you a little better now.

    Have a good life Paul

  26. musmed

    musmed Active Member

    Dear All
    I agre with homage payments. I have never claimed I own anything, do not put word int my mouth as it were.
    Secondly I do not manipulate anything. I mobilise and it is a skilled technique.
    Thanks for the kind words. I have a very happy life thank you
    Just a parting comment. How come I can never ever heard a patient say this is what my chiropractor does? Many equate to what I do is similar to what theyr chiropractors do,
    Paul C
  27. TedJed

    TedJed Active Member

    Paul, you are a confusing, contradictory minefield of information. Your website states you teach manipulation and even Dananberg calls you a manipulator, also on your website. See below.

    Having attended your lower limb workshop, you definitely teach manipulation techniques as defined by Sandoz, Maitland and Michaud. The action that is applied after 'loose pack' is established, is clearly a manipulation because it takes place at the paraphysiological limits and occurs at a speed and force that the patient is unable to overcome. It is these factors that define manipulation (apologies for the jargon quoted here from Paul's workshop, which will be meaningless to those who haven't attended).

  28. musmed

    musmed Active Member

    Dear Ted
    I find it hard to beleive thet cannot resist what we do in the mobes because it is impossible to perform if they do not relax their foot you are working on
    Paul C
  29. TedJed

    TedJed Active Member

  30. David Wedemeyer

    David Wedemeyer Well-Known Member

    Ian I apologize for intruding on your thread. I had tried to afford Paul a simple and polite apology and move on. Apparently that just will not happen.

  31. Ian Linane

    Ian Linane Well-Known Member

    Hi David

    Thank you.

    I made the original OP as I thought people might be interested in a series of personal observations as to the affect of correction / improvement of a persons foot function (and consequently rest of body changes). For example, having had a stuffed joint function in my foot for 5 years:

    1 What did the treatment do to my gait?
    2 How did fixing it change things?
    3 What did the soft tissues feel like in function in their response to functioning
    differently with immediate change as opposed to gradual adjustment since the
    injury? (Ted noted above about the need to monitor and assist as the tissues need
    this.) This may be the case in some but I have to say that this has not been the
    case for me.
    I am aware of a physiotherapist recently pointing out research
    which indicated that immediately after mid range manipulations is the best time to
    then apply mobilisations to sustain affects ( can't tell you the research though)

    I backed of making further observations once the thread went the way it did. However, I have been interested to follow the "debate" or lack of "debate"

    Although I have recently undertaken Paul's course here in the UK I have no axe to grind and no financial incentive behind my OP and following observations. Clearly there are some aspects of all this that is beyond my simple understanding but hopefully what follows makes some contribution.

    Mobs/Manips: Which one is it?

    Having trained in Maitlands approach for the low limb (which some call manips and others mobs) I am conscious that one of the defining elements of mobilisations is that they are meant to be, generally, under the pts control.

    I think defining what we mean by their control would be a good starting point and interesting.

    Now whilst I agree this concept is possible, in practice a prone pt with knee flexed undergoing a posterior anterior draw of the Talocrural joint is really only going to exercise control in two ways. Asking you to stop or forcefully pulling the leg down. This is certainly control but not perhaps as we might envisage it when we talk of mobilisations being more gentle than manipulations.

    Equally, having trained in osteopathic techniques (J M Hiss approach) for the foot and ankle I am conscious that this motion, by contrast to Maitland's, is relatively sharp in its thrust technique. Motion that occurs is minimal and I have never heard anyone indicate they were hurt by it but certainly a patient would not be able to resist the thrust once it has begun, only prior to it.

    On Paul's course (and possibly Ted's though correct me if I am presumptuous Ted) I found the use of the arms as a lever (which looked like a strong thrust) translated to a application of force (subjectively noted of course) of way less that Hiss's technique and certainly less than that I might have to apply when performing a Posterior anterior draw of the Talocrural joint at point of contact, let alone if I was to use the Maitland technique to mobilise the hip.

    Now are these moves mid range manip's or end range mobs. I can't answer this but they are certainly, at point of contact of the hand on the foot, very much more gentle than anything else I have used todate. In fact I have sometimes wondered quite how it works except that there is demonstable change, for example, in quality of movement in the fib, there is improved 1st ray function (passive) and there has been immediate pain relief in situations where I might previously have require a few extra treament session using more established techniques.

    (I did wonder if the net effect may be like McTimoney approaches to chiropractic which seem to rly on a harmonic or vibration affect - though I may have this very wrong :eek:)

    Now could we do with more reasoned discussion? I'm sure we could and would welcome it (though this is about the maximum academic ability I could bring) but for me the work is about practical application and this was the reason for the original post.

    Most of our patients cannot tell us how the soft tissues feel after treatment in a way that may help us grasp the personal affects of our treatment. Take another example, it would be interesting to know a Pod who has undergone foot surgery and who can describe what the before, after and consequent soft tissue / gait adaption felt like, perhaps.

  32. Ian Linane

    Ian Linane Well-Known Member

    Hi Ted
    I wonder if you could square something for me and this is not an attempt to take any ones side in this.

    In one of your responses to my OP you suggested that the efficacy of the technique is indeed fast and suprising to skeptics. There is also a possible implication that the tissue response can be quickly adapted without follow up. You then go on to say that followup is an essential part of your protocol to address soft tissue concerns. I am comfortable that both can apply in given circustances and need not be diametrically opposed. As you seem to keep stats , the question is how many follow-ups on average do you pts require? It would be useful for m to guage.

    I would want to address on matter though which I have highlighted:

    You said: "The action that is applied after 'loose pack' is established, is clearly a manipulation because it takes place at the paraphysiological limits and occurs at a speed and force that the patient is unable to overcome. It is these factors that define manipulation (apologies for the jargon quoted here from Paul's workshop, which will be meaningless to those who haven't attended).

    The term "loose pack" is not meaningless to those who have not attended Paul's course.

    In the paper "Principles of joint mobilization" (Vince Lepak) reference is made to the term "Loose pack" and "Closed pack" position as being more defined by Tomberlin and Saunders 1995 and Hertling and Kessler 1996.

    Closed pack: maximal congruency and compression of the articular surfaces, the ligaments and capsule are taut
    Loose pack: any position that is not closed pack

  33. Lawrence Bevan

    Lawrence Bevan Active Member

  34. Lawrence Bevan

    Lawrence Bevan Active Member


    Your thread has been hijacked but Im sure Ted will answer your questions directly! The points that have come up are very interesting and they cut to the heart of the matters though. What we often fail to remember in Podiatry is that a lot of the practitioners that use manual therapy as a core treatment (Osteopaths and Chiropractors) use a model of care that is different to the "find it, fix it, forget it" approach that is the Medical model. The fact that the medical model is the dominant one does not mean that it is the best. Of course Medical practioners charge the most and make the most money!!

    I would only re-iterate that whilst it is possible to find bones that are slightly malpositioned by trauma and "pop" them back in - or at least thats our conceptualisation - this is not the biggest use of FMT.

    Ian, (Paul please to come in to the round) do you know:

    Is there a video of Paul's 'techniques'?
    What happens physiologically with his techniques?
    When his patients are 'fixed', what actually happens?
  35. Ian Linane

    Ian Linane Well-Known Member

    Hi Lawrence

    I agree with you that the model with which we work or have grown up in can also dictate our perceptions as to "what" should be done. That is partly why I suggested I'm comfortable with both in my post. My manual therapy approach was developed alonside physio's so follow-up is a part of the protocol. To be fair to Paul, in my conversations with him, the idea of a one off treatment being the "all" was not the case. My suspicion is that he is concerned with the potential for unnecessary over follow-up.

    I am not aware of any video material avaiable so Paul will have to answer that one.

    Now, to make sure I answer your other question as best I can, can you just make it clearer for me what you mean by "What happens Physiologically". I'll answer if I can but don't want to waste your time going down the wrong road!!

  36. Here is the whole paper that Ian refers to Sorry can´t make it a PDF file from the computer Im at today.

  37. musmed

    musmed Active Member

    Dear Lawrence
    Firstle may I say that 'a pop' is quite rare when I mobilise, but there is an instant change in motion.
    When I work the foot, I select each joint from medial to lateral and mobilise them one at a time. It is performed with a gentle force.
    In the workshops I teach a much bigger force, but we all have to start somewhere. As time progresses, one becomes more skilled and less and less force is needed to get the result you are looking for.

    Outcomes: immediate increase in ROM to the joint you have just mobilised and often to the foot as well in the vast majority of cases.
    Immediate great reduction if not cessation of pain to that joint in the vast majority of cases. If there is no change after performing the procedure twice, note it and move on.
    The reason for this is that the dysfunction you may be finding is held there from another point/ part of the body.

    I have seen in workshops where the patients foot is still plantar flexed on passive testing at say 15 degrees despite doing all the workshop but one joint, in this case I am referring to, until the superior tib. fib joint was mobilised. Afte this procedure the patient had a passive dorsiflexion of +15 degrees to the amazment of the patient and podiatrist performing it for the first time.

    One never knows why this sort of thing happens but it does.
    This is why I treat dysfunction, not pain, but if a joint has a dysfunction and it is also painful, I just treat the dysfunction and hope this painful spot is due to the dysfunction under that spot.
    Always remember the pain they are receiveing may be referred pain and have nothing to do directly with the painful spot.

    As regards video There is none as I do not have a video camera.

    I do not beleive that you can learn these techniques by distance learning, otherwise I would have set this facility up on line several years ago. I am asked to do this often but I have refused to do so.

    Hope this helps
    Paul Conneely
  38. TedJed

    TedJed Active Member

    Thanks for posting this article Michael. The facts will help clear the air for further discussion.

    Thanks for the distinction Ian. I was making an assumption that most readers of this thread would have limited 'manual therapies' experience and would, therefore, not be familiar with the term 'loose pack'. Thank you, too, for revealing your background and interest in manual therapies. You referred to definitions including;

    I think this is important because often confusion arises when we aren't all on 'the same page'.

    I’ve found this thread particularly interesting. It’s great to hear different opinions and perspectives that come from a broad cross section of experiences.

    This is completely case dependent but if I can outline the guidelines we use FYI;

    Before a patient undertakes out treatment (after initial consult, bio exam, diagnostic tests where required, explanation of finding and proposed treatment, prognosis, expectations, anticipations) they will complete the Foot Health Status Questionnaire (FHSQ) so we can empirically record their status before treatment.

    A formal clinical review will typically take place after 1 month of treatment of 1 or 2 treatments per week depending on their case. FHSQ is completed again.

    From here, we will then typically see the patient in 1 month, then 2 months, then 3 months, then 6 months, then 12 months. We keep spreading the time out between visits as long as the patient is maintaining their functional capacities and the connective tissues/joint positions have not regressed.

    We implemented this system when I found that patients, who are inherently creatures of habit and can be lazy, would be returning to say that 'their symptoms are coming back' or 'I've been slack with my exercises'. As I wrote before, when given the option, our patients prefer to prevent a relapse by having scheduled follow up visits. It ends up giving them a quality of life that they prefer. After all, prevention is better (and cheaper and easier) than cure.

    In an acute subluxation, the tissue adaptation is short term. If corrected quickly, say within 7 days, the body restores the tissues' integrity quite quickly. However, soft tissue adaptation of more than 1 month will be well organised cellularly and physiologically will require time to restore. It's just like when a person has had their arm in plaster for 6 weeks; stretching, mobilising and exercises are required to restore the tissues back to their pre-injury state - that's physiology for you.

    It would have been nice to hear Paul say this. He’s suggested nothing of the sort in this thread.

    I would suggest this is due to the release of hydraulic tension in the joint. This is a very different result from releasing collagen cross-fibril contractures in a joint’s capsule. The cellular changes required here will take time to achieve. I think this is where Paul’s objectives differ from mine; Short term improvement in RoM vs long term cellular change in connective tissues. I’m wanting to have a scientific basis to the work, based upon clear physiological facts.

    It’s offensive when the scientific rationale for a treatment protocol is dismissed as ‘such rubbish’.

  39. TedJed

    TedJed Active Member

    Hang on Paul,

    First, you accuse me of 'acting like a chiropractor' in a derogatory tone, then, you declare that you 'treat dysfunction, not pain'.

    But this is the premise of 'straight chiropractic' as established by DD & BJ Palmer.

    No wonder I get confused...:wacko:

  40. Ian Linane

    Ian Linane Well-Known Member

    Hi Ted

    Thanks for the reply and the rationale behind it, all very helpful.

    Having done Paul's course I can see similaririties between some aspects of both your approaches.

    On the acute verses chronic I'm sure that some of the physio's I have worked with would agree in terms of length of time for tissues to readapt though there is usually a cut off in terms of follow-up, people returning as and when needed thereafter.

    For myself, a five year stuffed foot joint affected many aspects of low limb function and, for me, the more previous usual function I would expect from my low limb has more naturally returned without any further intervention needed (though I can see where some limited further intervention has a value).

    I suspect the issue of follow up is, in part, philosophical and as Lawrence ably pointed out above the protocol is likely determined by the medical model we have been raised with or choose to follow. I certainly follow up but reach a definite discharge point.

    Now moving on a little.

    If my experience of using Paul's technique (and as mentioned I suspect there may be more similarities than disimalarities between you) is correct and continues to bring consistent results, then I think their implication upon Podiatry treating many normally conservatively treated mechanical dysunctions in the foot and ankle is signficant.

    To date (early days), it seems to be a simple and very efficient technique that I would apply to most foot and ankle MSK issues prior to going down the orthotic route, if indeed the orthotic route is required post these mobs.

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