Varied Questions for Coach Sonnon

[Jarlo Ilano]

Coach,

Thank you for your continued encouragement of my random writings here on your forum! I hesitate to write anything of which I know little about, but I do feel confident enough to jot down some thoughts on physical therapy in general, and manual therapy in particular.

I will clean that last posting up, and also the Dangers of Diagnosis essay as well, I would like to submit that to the CST mag.

As for my questions, I noticed some time ago you had Z-health workshops for health professionals. Do you still engage in these? Or are any particular workbooks available for these that I may buy? I would imagine Freedom by Degree is the closest video offering. (That is next on my list to purchase!)

Also, the next time I am in Seattle, would it be possible to purchase a bit of your time to discuss how to incorporate more of your work into my therapy practice?

There are limitations in time and idiosyncrasies in both individual patient and therapy itself, but I have tried to integrate your findings as I can. The latest was adding progressions of the multi planar bridging into a patient's program. Very successful! And he has had MRI findings of a herniated lumbar disc.

I am most excited about the parallells of your work with my past instruction. Your "cloverleaf" patterns are similar to what an instructor called "figure 8s" in terms of diagnosing and treating joint arthroses.

Thank you for your time.

[Scott Sonnon]

Jarlo,

It's my pleasure. Your posts are very insightful, and I've learned many interesting things from them.

I don't conduct private sessions for hire any longer, as my schedule keeps me too commited to R&D and project completion. However, if you're ever in going to be in Bellingham, drop me a line and see if we can't arrange a time for you to come join me and the CST Head Coaches for daily practice.

Congratulations on your application of CST to physical therapy! I hope to hear more of your reports!

I am most excited about the parallells of your work with my past instruction. Your "cloverleaf" patterns are similar to what an instructor called "figure 8s" in terms of diagnosing and treating joint arthroses. I would love to hear more about this from you. Please tell me more.

[Scott Sonnon]

I neglected to add that the specific project of bringing CST to health professionals has been put on ice bumped down by several other projects RMAX chose to prioritize over it.

[Jarlo Ilano]

Coach,

Thanks for attending to my questions! I would love to take up the invitation to observe your folk's practice. I am sure I would learn alot.

I understand the priorities, you can definitely help a much broader audience with the work you are focusing on now. I guess I should just take more advantage of the forum, and try to glean as much information as I can out of you. :wink:

I would love to expand upon my take on your cloverleaf patterns, I think I can express it somewhat clearly in a little bit. Right now I am a bit burned, expanding upon the joint "sounds and noises" post took me longer than I thought! :roll: It is very interesting though and I'd like to hear what you think of it.

Posting here is very helpful to me as well, since it allows me to flush out some ideas and hear good feedback.

With appreciation,

[Jarlo Ilano]

Coach,

As far as I know, the use of combined movements to assess joint function is a fairly recent development. Looking through old osteopathic, physical therapy, and orthopedic texts (I don't know about chiropractic, but they should be quite similar to the osteo texts), the main focus is on cardinal planes of movement.

Not to say that individual therapists, haven't tweaked their exams to include combined movements, but as far as a systematic approach, I think the forerunner is the Australian Mr. Brian Edwards. http://www.amazon.co.uk/exec/obidos/ASIN/0750642904/wwwlink-software-21/026-4257534-9702062

Maybe not the first, but definitely the most detailed investigator that I am aware of.

What I had mentioned previously about how similar your description and cloverleaf exercises were to an instructor of mine, is from a video I watched of one of his seminars in 1992. Erl Pettman, a British expatriate Physio in Canada, explained his notion of arthrosis in the cervical spine. The use of combined motions, "figure eight" patterns, we can observe/feel restrictions in certain planes that aren't necessarily seen in straight planes of movement.

Though demonstrated as a manual technique, and focused on the practitioner feeling the mobiity hitches and crepitus, the movements are essentially as you demonstrate. The rationale is the same as well, to "lube" the joints with synovial fluid and restore free mobility. Manually, we are trying to "scour" the joint. This is definitely a poor description that does the method little justice, but it has been a long time since I've watched that video.

He and other Brit expats are the group of Physios that created the bulk of the methodologies that I primarily employ.

In the lumbar spine, the first I saw of this was called the "H" and "I" tests.
Here, we examine the quadrants, approaching the endrange of the quadrants through both possible avenues.

For example, you can reach the terminal combined motion of right sidebending and flexion, by either sidebending first or flexing first. This allows a quick and dirty scan to see which side lumbar joints are the restricting limiters of motion. i.e., If I cannot right sidebend and flex, but I can left sidebend and flex, than it appears that lumbar facet on the left cannot "open". (Again, simplified :) )

It was then surmised that if you can reach an endrange combined movement in one way, but not the other, that you have a joint instability/arthrosis. Some type of intra joint dysfunction that is not allowing free movement, because in a healthy joint it should not matter in which direction you approach the endpoint. You could call it a subluxation, joint degeneration, or whatever. Jim Meadows is a primary source in this.
http://www.amazon.com/exec/obidos/ASIN/0070412359/qid%3D1087892350/sr%3D11-1/ref%3Dsr%5F11%5F1/102-1276719-8592145

More recently, the factors of intersegmental muscular restrictions and neuro coordination issues are also being addressed and debated. The narrow joint focus has given way to more wholistic approaches.

At any rate, as far as I have seen, specific active exercises such as yours have not been widely promoted in therapy.

However, it is obvious to me, that your work is along the same path as the men I have mentioned. Which is all the more interesting to me, because they are not well known outside of the physical therapy community. So it is amazing to see an expansion of these ideas brought forth from someone, I assume, that hasn't been privy to these past theories.

Though I am sure that there are some enterprising therapists that have devised similar exercises such as yours, much like the aforementioned Mr. Edwards, you have brought a systematic, detailed system to the fore.

I always look for, and am amazed, when great ideas connect from different areas.

Which is why I am so intrigued by your innovations.

Regards,