31 Aug 17, 12:21 PMErson: most are derengement and will respond rapidly
6 Sep 17, 03:21 PMMichael: Hi Dr. E. Any suggestions on when to re-introduce ipsilateral loading in cervical radiculopathy patients?
6 Sep 17, 03:22 PMMichael: I have been focusing on opening that side with manual therapy and patient education as my patient is in the acute phase but when do you start encouraging loading that side again?
7 Sep 17, 08:35 PMErson: I very rarely start with gapping, most of the time I start with loading. But I start when they meet the Upper Quarter Clinical Practice Patterns - See Eval, Reset, and Stabilize
7 Sep 17, 08:35 PMErson: If you're starting with gapping, you haven't watched the basics of this site
7 Sep 17, 08:36 PMErson: I'm not saying gapping does not work, anything can work, but gapping is not novel as most of the time, patient is unloading already/moving away from the pain
10 Sep 17, 05:37 PMMichael: Yeah I've watched the info on the site but loading is so painful with immediate reproduction of C/S, shoulder and radicular symptoms with red light presentation pattern...
10 Sep 17, 05:38 PMMichael: I've had good success with loading the ipsilateral side with other patients, especially those without radicular symptoms but this patient is so irritable with ipsilateral loading.
11 Sep 17, 07:37 AMErson: Oh, if it's this a particular patient, I didn't realize. Not everyone fits into the patterns. But that's where manual therapy comes in. Light IASTM to the involved side, try resisted isometrics
11 Sep 17, 07:37 AMErson: to the involved side to see if either neuromodulates the pain
11 Sep 17, 07:37 AMErson: try moving just short of the reproduction ipsilaterally, then breathing strategies
11 Sep 17, 07:38 AMErson: or retraction without sidebending but resisted isometrics to the involved side
11 Sep 17, 07:38 AMErson: often helps restore loading
11 Sep 17, 07:38 AMErson: look for my video on acute cervical progressions
12 Sep 17, 12:20 AMMichael: Yeah this is for a specific patient haha. Sorry I should've clarified that. Nice those strategies sound good. I'll give them a shot and look for the video. Thanks!
17 Sep 17, 09:56 PMKelvin: Dr E, how hard would you recommend patients push during the isometrics? The patient feels a "soreness" at the R rib around T4 level during a Cx retraction + R lateral flexion?
17 Sep 17, 09:57 PMKelvin: Repeated Cx retraction + lateral flexion improved her R lateral flexion ROM, but the soreness increased after a few resisted isometrics. Would using 2/10 strength be a good starting point?
17 Sep 17, 09:57 PMKelvin: Thanks
20 Sep 17, 08:53 PMErson: Kelvin, sometimes pushing lighter or harder or changing angles makes the isometric pain free. Try it at neutral instead of at the barrier but resist into the direction of limitation
20 Sep 17, 08:53 PMErson: If after several varying attempts at force and direction it's not pain free, abandon isometrics