Neurodynamic Solutions
  • Home, Info & Contact
    • Dr Julian WANG
    • Hybrid Courses
    • Joseph Gravino
    • NDS Team
    • 2023 Course Schedule
    • Courses General Info
    • Online Course Inquiry
    • Online Mentoring
    • Host a Course
    • Free Updates
    • Send Message
    • One-Touch Survey
    • Upper Quarter 1 Course
    • Lower Quarter 1 Course
    • Upper Quarter 2 Course
    • Lower Quarter 2 Course
  • Content
    • Neurodynamics Videos
    • Videos
    • Newsletters >
      • October 2022 Newsletter
      • July 2022 Newsletter
      • Original Neurodynamics 1995
      • Median Nerve Specific Movement
      • #nervefact 10
    • Articles >
      • Nerve and Muscle Movement?
      • Ulnar Nerve
      • Efficacy of Neurodynamics
      • Pain Matrix
      • Acute Lumbar Nerve Root - Reduce Force
      • Lumbar Disc Function - Flexion
      • 1. Do Nerves Get Stuck?
      • 3. Integrate the evidence >
        • 2. No evidence
      • Central Pain Mechanisms - part 1 >
        • Manual Therapy, neurodynamics, muscle mechanisms
      • Neurodynamic Aspect to Heel Pain
      • Research Awards for UEF and NDS
      • Louis Gifford
      • Whiplash, Neurodynamics and the Slump Test
      • Painless Nerve Root Mobilisations >
        • Plantar Fasciitis and Medial Calcaneal Neuropathy
      • Diane Jacobs - Cutaneous Innervation
      • 20th Anniversary Neurodynamics Video - specificity of nerve movement
      • Nerve Compression - Hour Glass Deformity
    • Policy

Danger of Ignoring Nociception

Here is a case of a chronic pain patient in which nociception played an important role

The DANGER of IGNORING NOCICEPTION: Read THIS

This patient is a CHRONIC PAIN SUFFERER

Eight things we are told about pain:
  1.  nociception and pain are not the same thing
  2.  pain is not an indication that something is wrong in the tissues
  3.  paying attention to your pain will make it worse so focus on something else
  4. palpation is inaccurate so there's no need to do it
  5. pain and pathomechanics don't correlate, so don't worry about pathomechanics
  6. no need to do radiology either because pain and pathology don't match and it will create fear and dependence on tissue-based treatment
  7. don't fear movement, continue your rehab and be active. This will desensitise which is good.
  8. surgery is mainly placebo and, since pathology and pain don't match, don't even go there.


So, this is WHAT I DID:

  1. PAID ATTENTION to the pain
  2. BECOME CONCERNED that something was wrong in the tissues
  3. PALPATED the area that hurt and found swelling in the tibialis posterior tendon and, right next to it over the tibia, a small, hard lump. Thought "Could this be a tendinopathy caused by pressure from the lump?"
  4. GOT RADIOLOGY and found the pathology and pathomechanics
  5. a SCREW from ankle surgery was IMPINGING on the tibialis posterior TENDON
  6. got CONCERNED that more WALKING would DAMAGE the tendon, so gave the patient a MOON BOOT to AVOID MOVEMENT and PROTECT the tendon
  7. SURGERY done to remove the screw. It had partially cut through the tendon.


So I BROKE THE RULES and IT WORKED because, in this case, ALL of them were WRONG.

If I had ignored the patient's pain, the tibialis posterior tendon would have broken, requiring surgical repair and hindfoot stabilisation.


In summary:
- PAYING ATTENTION to the pain WORKED
- pain INDICATED that something was WRONG in the TISSUES
- PALPATION WORKED
- RADIOLOGY WORKED
- less movement, PROTECTING THE TISSUES from further damage WORKED
- SURGERY WORKED.

Now rehab is BACK ON TRACK.

This is an extreme case but IS IT EMBLEMATIC of many more complex and subtle MSK conditions about which we know very little? This relates to radiculopathy and disc protrusion. We are now advised that even radiculopathies often don't hurt.

TAKE HOME POINTS:
- generalisations about pain are often wrong
- it's about careful open-minded EVALUATION of EACH PATIENT - without bias.
- patients are full of surprises, so be prepared.
Picture
Plantar fasciitis and medial calcaneal nerve
Painless cervical nerve root mobilisations
Neural techniques and muscle function
Heel pain - neural aspect
Bilateral comparison in diagnosis

Contact 
Policy 
Unsubscribe
© Neurodynamic Solutions
Host a course
General course information
Upper quarter
Lower quarter
What's in store?