It was all so much easier when we thought that end range loading reduced disc protrusions! Patients totally got the jelly donut theory!
Then it turns out repeated loading to end range works just as well for the extremities, and in most, there is nothing to derange, must less reduce. How I currently explain the importance of end range
- it's analogous to grade 3-5 mobilization/manip
- you fire more mechanoreceptors, thus bombarding the CNS with novel proprioceptive information
- the novel info is deemed "green light/safe" by the brain and pain and movement thresholds re adjusted accordingly - motor control also returns
- every input (movement, position, sensation) gets 1 of 2 decisions from the brain
- dangerous/red light, safe/green light
- if an area is under protection, whether from perceived or actual threat, the brain locks that area down
- motor control/coordination often is altered, muscles guard
- patients often move away from the pain
- the brain craves novel input (new food to try, new music), a novel movement would be convincing it through slow, graded exposure into the perceived threat
- attaining full threat free motion into the biggest motion loss often resets the alarm in your brain
- think of it as walking on ice which feels dangerous - you take baby steps
- do you feel safe taking baby steps - or big full strides?
This analogy has helped patients realize the importance of attaining end range. Of course, if the repeated loading strategy is painful, use some Modern Manual Therapy to help (pain free).
Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!
Keeping it Eclectic...