..a brief preliminary report on the 7th World Low Back and Pelvic Pain Congress
Myself, examining Gary Cooper’s hand-prints…..
This is preliminary –
It is not definitive –
I am teaching (Positional Release Techniques) all day today, in a post-congress workshop, and then fly back to the UK, then Greece…at which time, when duly recovered, I’ll add more to this brief post.
4 days of lectures and 4 days and evenings of networking, is exhausting – even in the totally artifical sumptuous surroundings of Beverly Hills/Hollywood at its glitziest.
My first impressions:
a consensus seems to be emerging that static assessment is relatively unimportant (positional structural relationships for example) – whereas movement patterns and functional features are where attention should be placed (motor control, cognitive and behavioural features)
A tension has emerged between those who believe that passive treatment should be minimised and – some suggest – be virtually phased out, with most therapeutic effort being towards the broad theme of enhanced motor control, via well designed exercise and movement patterns, alongside cognitive behaviour approaches..
This view is in contrast to those who argue that these objectives can better be achieved if biomechanical/postural eatures are modulated/improved/corrected before the more functional approach….removing obstacles to rehabilitation, creating windows of opportunity for enhanced function.
Mountains of evidence emerged on both sides…I don’t think either camp convinced the other
….to be continued…..
The real highlight for me was real-time ultrasound imaging (video evidence) of fascial planes (lumbodorsal fascia) sliding and gliding on each other during normal movement (flexion and extension) in asymptomatic individuals, and how the slide/glide is inhibited/”stuck” in individuals with (in this instance) back pain.
Helen Langevin PhD once more excelled in guiding us towards a better understanding of the reality of human function
Another bonus was a video of fascial motion and behaviour, in the body, taken with mini-cameras inserted during surgery (with patient permission). The film was made by Dr Guimberteau – a plastic surgeon who works on hand reconstruction. This is his 3rd and best movie (Journey under the skin to the muscles, lumbar fasciae and structural architectures)
I admit to having tears running down my cheeks during this, marveling at the sheer beauty of strands of fascia – identical to a spider’s web with dew drops glistening and shining as strands detached, moved and reattached in milliseconds, in response to movement.
Unless and until you have seen/or appreciated, the amazing degree of free fascial movement in living human tissue you have actually very little idea of how the body actually works. These fascial planes can get “stuck” and dense as a result of trauma/overuse/inflammation gone wrong/age etc and that corresponds with palpable “densification”, pain and limitation of movement.
It appears that much of the work that practitioners do, achieves its results via restoring slide/glide potential to these superficial layers of densely innervated (mechanoreceptors, nociceptors etc) loose connective tissue – whether we are aware of it or not.
Also imaged (presentation by Jay Shah of NIH) were myofascial trigger points – shown as dark masses in colour-coded images, using elastography
High points of some otherwise dull (even if pertinent) presentations, included:
The avuncular presentation by ligament genius Moshe Solomonow (see picture)
The recent research findings of legendary German researcher into pain Siegfried Mense (see picture of him and Moshe), as well as that by Robert Schleip who is rapidly emerging as a superstar in the fascia fermament.
Yesterday a passionate Craig Liebenson DC launched into a detailed blast at misconceptions and ‘Holy Cows’ in the field of rehabilitation. His passion and detailed analysis was refreshing….I hope he will write this up for JBMT in due course!
I was one of 3 British DOs there – out of 650 delegates – Phil Beach (parallel session presentation) , Matt Wallden (poster presentation) and myself (keynote)..
The next of these jamborees is in Dubai in 2013