Arachnoiditis Q & A with Jerry Hesch, MHS, PT
This is a reply to a Q&A. I have modified the inquiry in order to make it anonymous, hiding the source. Please note that this case describes a chronic condition, not acute arachnoiditis. Arachnoiditis Inquiry
Dear Group
………………” called me today asking about treatment ideas for the following case:
Post-partum ……. had an epidural during labor, bleeding at epidural site caused sub-arachnoid scarring. The patient with LBP was diagnosed arachnoiditis. Prolonged time standing aggravates symptoms with "shooting" quality, rest relieves symptoms. Nothing relieves sx lower than 3-4/10. ……….The PT saw her today for the first time and initiated gentle neural glides. ………Thank you in advance for your assistance.
Jerry’s Reply regarding neural/dural glides
Dear______
I have a few thoughts.
RE neural glides, the unknown is how far circumferentially the arachnoiditis
extends.
#1 position
Of course the posterior region of the cord is primarily affected, and
Butler's (et al) glides target the posterior elements and reasonably with
some carry over, at least laterally.
Muslim Prayer Position is an alternate position to the sitting, may isolate
more?
#2
using the same logic one can place client in side lying end-range L/R and add
cervical side bending and ankle eversion to enhance/sensitize the primarily
lateral neural glide.
Later adding trunk, pelvic, hip and LE, and cervical rotation might take the
effect further anteriorly and also gives more of a transverse and oblique.
The trial and error of later adding rotation applies to all positions, 1, 2, 3
#3
same logic can be applied to stacking positions and motion to affect an
anterior glide (supine extension, plantar flexion, cervical extension.
Another Method
A pure glide in neutral with client supine, gently pulling on ankles until
resistance is encountered seems to isolate the circumference. One can
accomplish similar yet different effect keeping neck in neutral, applying
very gently traction on parietal region. A PT friend found this to be almost
uncomfortable, but found the opposite very helpful. Will elaborate in next
post.
I hope this is helpful, sometimes they respond very well as others
have stated, unfortunate when they don't.
Sincerely,
Jerry Hesch, MHS, PT
Hesch Method
Jerry’s Reply regarding: the opposite of neural/dural glides, slackening the structures
Dear____________,
My PT friend who found the supine traction unremarkable found the slackening
maneuver very therapeutic. Upon standing and walking, he felt much freer
with a trophic sense of well being, greater arm swing, etc.
The effect could also come from resetting muscle spindles along the length
of the body, same for joint mechanorecetors perhaps types 1-3.
Technique: In supine neutral, apply gentle force though the heels until
movement stops and maintain that for up to 5 minutes. It is no greater than
10# of "pressure". Sometimes the force initially or later, goes as high as
the occiput, gentle head nod noted.
The same can be done at the other end, very gently (less than 5#) of
"pressure". Contact above the ears does more isolation/inclusion of the
Occipito-Atlantal joint, and force includes the anterior Dura, which is
otherwise missed with contact on occiput. Gently push the parietals towards
the body with straight force.
Can distal stretches/shortenings enhance overall mobility, thus indirectly
easing stress of arachnoiditis?
I always use caution with these very gentle methods as they seem to
"shotgun" many receptors along the length of the body. Sometimes, the body
has to adjust upon arising and starting to walk. I did have to stop with one
client who started to become fearful.
Wish I were there to demo in person, as empirical experience trumps email
description.
Sincerely,
Jerry Hesch
Dear Group
………………” called me today asking about treatment ideas for the following case:
Post-partum ……. had an epidural during labor, bleeding at epidural site caused sub-arachnoid scarring. The patient with LBP was diagnosed arachnoiditis. Prolonged time standing aggravates symptoms with "shooting" quality, rest relieves symptoms. Nothing relieves sx lower than 3-4/10. ……….The PT saw her today for the first time and initiated gentle neural glides. ………Thank you in advance for your assistance.
Jerry’s Reply regarding neural/dural glides
Dear______
I have a few thoughts.
RE neural glides, the unknown is how far circumferentially the arachnoiditis
extends.
#1 position
Of course the posterior region of the cord is primarily affected, and
Butler's (et al) glides target the posterior elements and reasonably with
some carry over, at least laterally.
Muslim Prayer Position is an alternate position to the sitting, may isolate
more?
#2
using the same logic one can place client in side lying end-range L/R and add
cervical side bending and ankle eversion to enhance/sensitize the primarily
lateral neural glide.
Later adding trunk, pelvic, hip and LE, and cervical rotation might take the
effect further anteriorly and also gives more of a transverse and oblique.
The trial and error of later adding rotation applies to all positions, 1, 2, 3
#3
same logic can be applied to stacking positions and motion to affect an
anterior glide (supine extension, plantar flexion, cervical extension.
Another Method
A pure glide in neutral with client supine, gently pulling on ankles until
resistance is encountered seems to isolate the circumference. One can
accomplish similar yet different effect keeping neck in neutral, applying
very gently traction on parietal region. A PT friend found this to be almost
uncomfortable, but found the opposite very helpful. Will elaborate in next
post.
I hope this is helpful, sometimes they respond very well as others
have stated, unfortunate when they don't.
Sincerely,
Jerry Hesch, MHS, PT
Hesch Method
Jerry’s Reply regarding: the opposite of neural/dural glides, slackening the structures
Dear____________,
My PT friend who found the supine traction unremarkable found the slackening
maneuver very therapeutic. Upon standing and walking, he felt much freer
with a trophic sense of well being, greater arm swing, etc.
The effect could also come from resetting muscle spindles along the length
of the body, same for joint mechanorecetors perhaps types 1-3.
Technique: In supine neutral, apply gentle force though the heels until
movement stops and maintain that for up to 5 minutes. It is no greater than
10# of "pressure". Sometimes the force initially or later, goes as high as
the occiput, gentle head nod noted.
The same can be done at the other end, very gently (less than 5#) of
"pressure". Contact above the ears does more isolation/inclusion of the
Occipito-Atlantal joint, and force includes the anterior Dura, which is
otherwise missed with contact on occiput. Gently push the parietals towards
the body with straight force.
Can distal stretches/shortenings enhance overall mobility, thus indirectly
easing stress of arachnoiditis?
I always use caution with these very gentle methods as they seem to
"shotgun" many receptors along the length of the body. Sometimes, the body
has to adjust upon arising and starting to walk. I did have to stop with one
client who started to become fearful.
Wish I were there to demo in person, as empirical experience trumps email
description.
Sincerely,
Jerry Hesch