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Jones Counterstrain Technique for sesamoiditis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Scorpio622, Jul 6, 2006.

  1. Scorpio622

    Scorpio622 Active Member

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    Does anyone have information on the Jones Counterstrain Technique for sesamoiditis?
  2. Craig Payne

    Craig Payne Moderator

    With one hand, apply a slight distraction force to the MPJ (grip the hallux IP joint and lift). Compress the painful sesamoid with your thumb of other hand. Rotate the hallux medially and laterally to end RoM's, then dorsifles and plantarflex until find least painful position during compression of sesamoid --- hold the compression on the sesamoid in this position for a minute or so without moving and see how it feels and maybe do it again. .... it is surprising how often it works dramatically on the pain - some have called this "turning the pain off" ... then again at other times it does not work - I have not seen any consistent pattern yet.
  3. Craig Payne

    Craig Payne Moderator

    I should have also added, that this whole technique does put a question mark over the diagnosis of 'sesamoiditis' (at least in my mind).

    To start with, it never really is a 'sesamoiditis' (as the sesamoids do not get inflamed) - its probably really a 'peri-sesamoiditis' (as its the peri-sesamoidal structures that get inflamed). The standard treatment is to off-load the painful structures and the inflammation generally goes down and patient gets better.

    Since using the Jones technique, I question the diagnosis of 'peri-sesamoiditis' and start to wonder if we are really dealing with some sort of first MPJ and/or sesamid-met head joint dysfunctions in many or some of the cases. In thoses when the Jones technique does not work, maybe it is a true 'pressure' related peri-sesmoiditis..... :confused: ... or it could be that the peri-sesamoiditis in some induce some sort of joint dysfunction that the off-loading does not address.. or :confused:

    What say you?
    Last edited: Jul 6, 2006
  4. Admin2

    Admin2 Administrator Staff Member

  5. Scorpio622

    Scorpio622 Active Member

    I agree, and feel that the painful structure(s) is intra-articular rather than plantarly. I have several patients seen by previous practioners who have given plantar injections to no avail. When giving these patients intra-articular injections, they respond much better, not to mention avoiding potential fat atrophy of plantar injections. But some patients have persistent pain despite prolonged off-loading and diagnostic tests to rule out other dx. I will try this Jones technique in those cases. Any other suggestions?? Any orthotic suggestions other than a FFO with dancers' pad??
  6. Firstly, ensure you have a set of radiographic images - AP and sesamoid-axial skyline view to establish whether you have a sesamoid fracture. In severe cases, where the sesamoids are intact, consider a BK Wilson's cast with the ankle (and hallux) in a 10 degree plantarflexed position for 4-6 weeks. If there is a fracture present, non-union is a common occurence so you may wish to undertake surgery to remove any fragments, although this is probably best performed after cast immobilisation. In less acute cases, ice, immobilisation, steroids and local deflective padding can be administered/applied as part of your conservative management. Functional orthoses should be considered to correct any mechanical pathology (where it occurs) as part of your long term strategy.

    Mark Russell
  7. Stanley

    Stanley Well-Known Member


    I have taken several courses in Applied Kinesiology, and they have a dyfunction called "holographic bone subluxation" :confused: . This is a fancy name for a bone that has been strained.
    I have applied this to the foot, and have found that when this occurs in the first metatarsal, the tibial sesmoiditis results. Correction of this bone strain corrects the tibial sesmoiditis. I have been doing this for the last 10 years, and have done this on all my patients during that time with this condition. Only once it didn't work fully, and that was on a football player who was treated for the prior 4 weeks with injections and cast immobilization to no avail. He also had a weak extensor hallucis longus that was secondary to an injury of his extensor retinaculum. I corrected this also and two days later he ran for 270 yards in a football game :D .

  8. musmed

    musmed Active Member

    Dear All

    Maybe I should stop studying and have a look more often.

    Sesamoiditis is a very common problem. Moresos than you think.

    Often you will only find it when you compress the bone. Watch them jump. I assume every woman who has been in arear end collision has one in their right foot and left for those who drive on the wrong side of the road!

    Recently I saw a professional dancer who had seen all the gods in Sydney and was told that at 32 she was too old to dance and that she should quit!!

    We have beautiful garbage specialists here. They use the old technique at the next visit, 'do you still dance?'/ The answer is 'yes' of course and then they can come back at the poor patient with "see I told you so.." instant admonishmnet for lack of knowledge.

    I have yet to see this technique fail. Like Craig says, there is no constant pattern of turning off the 'Jones' Point'

    For a very clear image go to my website and have a look on the bottom of the left slider called 'sesamoiditis' . This is how Jones' did it.


  9. kate_stonestreet

    kate_stonestreet Welcome New Poster

    Re: Sesmoiditis

    Hi Stanley,
    How do you correct a bone strain?
    Katie :)
  10. Stanley

    Stanley Well-Known Member

    Hi Katie,

    Thanks for reading my reply.
    To answer your question, I want to first give you some background.

    Quadrupeds absorb shock in their upper extremities and push off with their lower extremity. We are bipeds, and we absorb shock and push off with our lower extremities.

    One of the mechanisms to absorb shock is with our flexible bones. To prevent these bones from breaking, we use muscles to change eccentric loading (loading with bending of the bones) to concentric loading (loading with no bending of the bones). The sensor that alerts the body of the bending of the bones is the periosteum. The periosteum has an additional function, and that is to prevent stress risers. Therefore, for a bone to fracture, the periosteum must fail first which then allows a stress riser to occur.

    There are times that the periosteum can fail, and the bone does not break (in cases when the body off loads the part just a moment too late). This is what I call a strain of the bone.
    As a result of this, we have scarring of the periosteum and a change in the sensory mechanism and I think possibly a change in the structure of the bone via the shortening of the periosteum.
    Treatment is directed at freeing periosteum. I do this by rubbing deeply along the plantar shaft of the distal metaphyseal area (as this is the weakest part of the bone and the part that will tend to bend the most under pressure). I find that distal friction works best.

    About 15 strokes seem to do it.

    Try it and let me know how it works.



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