Fred & half a sheep

Meet Fred
Fred was a patient of mine. He was about 55 and came from the far north of South Australia and only came to the city once a year. He used to call in to see me for a bit of physio and he frequently brought a present – usually a piece of lamb, but occasionally a lump of beef that I am not really sure which part of the animal it came from.

Anyway, Fred used to say “the second and third are out in the neck, have been for a few months since I came off the motorbike; I reckon the L5 is out too and the hip might be going out too. Can you whack them back in. By the way, I have half a sheep in the truck for you. Mind you with the drought they are a bit dry, but you did say once that you liked mutton. And another thing – don’t give me any exercises, like you tried last year. I get too much bloody exercise on the place these days”.

Share my quandary
I take a breath and reflect….”but these days I am supposed to be evidence based and offer more self management, graded exercise and neuroscience education. I even wrote a book on what you are supposed to do. How did I get it so wrong with Fred? And what would my students be thinking now if they were watching this clinical encounter?”

Judge my therapy
I assessed Fred, I was interested in the motor bike accident so I checked him out as best I could for any contraindications to “whacking things back in”. There was a bit of stiffness in the upper neck and low back and I “whacked them back in” (grade 5 rotation for the lumbar spine, and lateral flexion grade 5 for the C2-3 joint or thereabouts). “Beautiful”, says Fred, jumping up and playing with his new neck movement. “Did you hear that neck go back in…still a bit out in the low back. Give it a bit more of a whack will you.” I did just that. Fred handed over the half a sheep, shook my hand and said “see you next year”.

What’s in a whack?
Was I wrong? I know that my therapy doesn’t follow any recent guidelines for chronic spinal pain and I know that the efficacy of manipulation is not that strong. I have got Fred addicted to me from years of successful annual treatment (at least I call it successful as I don’t know what might have gone on in the previous 12 months) and I have little chance of initiating an education and exercise based approach.

I don’t think anything goes out except fires and me on occasional Friday nights. Joints may get a bit stiff or rarely, locked, but that is about it. I am happy that I probably manipulated Fred’s perceptions as well as perhaps doing something to the joint structures. You could call it a placebo treatment but then again I am reminded by a Patrick Wall comment “In the end if many treatments are shown to be placebo, then we should work out what it was in the placebo that was the active ingredient.” There may have even been something helpful in the swapping of the sheep and the manipulative techniques.

Your turn
This month, four of the new shiny red NOI posters go to:
(a) The person who tells us of the most novel and interesting gift that a patient has given them.
(b) The person who tells us of their most novel placebo treatment and convincing rationale for it.

Email your response(s) to info@noigroup.com

The peripheral nerve stories from last month
Thankyou so much for your upper limb nerve injury stories from last month. There is clearly an endless number of ways to injure nerves. But there was also the realisation that people can have severe injury (eg Janet’s story of the patient whose whole arm was crushed to 3mm for two hours and they got away with a neurapraxia) and the nasty humeral fractures, yet with radial nerves spared – it makes you realize what a mechanically strong and resilient structure peripheral nerve is.

And what a sad story from Lyn – about a young mum working as a pole dancer and whose abusive boyfriend zapped her ulnar nerve with a cattle prod, eventually leading to an ulnar nerve problem and her falling off the pole ….and losing her job.

Thanks too for the descriptions of nerves and tendons hanging down like spaghetti after traumatic amputations (must be hand therapist contributors).

And Nic – who for the sake of science subjected himself to a sustained ULNT2 position for 15 minutes to see what would happen – well his shoulders went numb and he had burning pain in both arms for a week – thanks for this contribution to science Nic!

Nicola goes for the more exotic injuries – the water polo payer who put his hands in another player’s bathers to “restrain him” and ripped the FDP off and presumably the median nerve.

We have so many poets amongst our readers – the final two line of Deborah’s “loadaphone blues” about repetition strain injury from mobiles was:…

“the message on the screen read “text us”
Oh my poor brachial plexus”

This has a nice ring to it (sorry about that)

And other ways to injure nerves – serving ice cream cake (digital), leaning over the crib to sooth a crying baby (probably radial), untrained medical practitioners manipulating backs, strawberry picking and spider bites (median nerve), dancing and the femoral nerve, and tight caps and the occipital nerves.

We also have a “star wars” injury also. One of our valiant readers “Josh Obi Wan” sustained a radial sensory nerve injury following an epic battle with his 4 year old son “Anakin.” Read about this and therapeutic application of the neural force. Read the full story here…

And the winner comes from Canada!
Marie Ilowiecki from Alberta wins because she has described a previous unknown way to injure a nerve. So Marie, you’ve got a new NOI Mirror Box heading your way now – congratulations!

“One of my patients had a one sided true scapular winging after smoking dope and competing in a ‘who could sleep in the longest’ competition. He could not remember what position he slept in, how long he slept and he did not win the contest.”He obviously sustained a long thoracic nerve injury, in this case, probably from prolonged thoracic lateral flexion.

What’s new at NOI?
NOI’s NEW DATING SERVICE
An international conference list which we’re maintaining as a resource for health professionals interested in relevant extended learning and participation.

BAREFOOT INTERVIEWS

A collection of short videos about some products from NOI. (No shoes!)

NOI NOTES ARCHIVE

They’ll always be right here!

New EXPLAIN PAIN POSTERS
Now with a bright red look, these huge posters are A2 in size and come in a more sturdy, plasticoated finish.


New MIRROR BOX

All the squares have been kicked out of NOI! This triangular mirror box is easier to assemble, more durable and now comes with a larger mirror.

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