Hi This is my experience only and is not to say that it is the norm… I have seen this in multiple patients in my time (30yrs). In my experience with these patients, I have never seen it go well. For them, the TOS signs and symptoms returned post-surgical with more dysfunction and adhesions. My initial questions are: how old are you, when did this first start, what is the possible Mechanism that contributed to this change, what treatment/management has been tried and for how long, have you exhausted all non-surgical options…? Surgery is always a last option, but it is necessary in specific cases.

Hi, thanks so much for your comment. Although it may feel and seem as if the ligament is becoming “tense” due to some influence and that it feels like it is “releasing” during treatment, this is not the case. Ligaments do not have the properties that permit them to contract or relax such as muscles do. Ligaments are innervated and classified as sensory organs. The sensations you are feeing can be in part due to changes being placed on the ligaments and their sensory response to that stimulus. Ligaments undergo a stress/strain/hysteresis phenomenon that permits some temporary length change with or without fibre damage. According to the research, a rule to remember pertaining to stress/strain/hysteresis - for every 1 hour of stress placed on the tissue, it takes a minimum of 28hrs for the tissue to start to feel normal and function normally… providing you haven’t continued to challenge the tissue during that time. If you did a repetitive activity for 8hrs (ex. Gardening) you are potentially looking at 2 weeks recovery. When stress is placed on ligaments for a long period of time (sustained loads or repetitive) or very quickly (ankle sprain) and beyond their tissue tolerance, they relay sensory messaging to the Peripheral Nervous System then to the Central Nervous System and then to our sensory, motor and cognitive centres. The signal/message gets processed and depending on your individual life experiences, you may experience the sensations of tension, stiffness, ache, discomfort, pain or other sensory disturbances and so on… or nothing at all. When appropriately and safely treated by a therapist/clinician you trust, this can bring a change in sensory messaging from the ligamentous tissues and relief. I Hope this info helps.

Hi, Massage Tehrapists, Physiotherapists, Chiro's and Osteopaths are all capable of utilizing this technique. My go to would be an Osteopath as it's in their education. A full history and assessment needs to be completed in order to determine a plan of treatment which may or may not include this technique. Good Luck with everything and I hope you find some help that improves your breathing issues.

Thank you so much, I really appreciate you getting back to me. I will make an appointment with an Osteopath 👍

Hi, Thanks for your questions. Yes, the discomfort can refer to those areas you mentioned. The research has documented the following potential areas of referral for L5-S1: local pain to the affected vertebral level, referred pain, deep, dull ache, nauseating, boring and cramp-like, similar to muscle soreness, laterally along the posterior flank, anteriorly to the lower external oblique, groin area, trochanteric area of the femur, gluteal region, posterior and lateral thigh region The research has documented the following potential areas of referral for Iliolumbar ligament: local pain over the iliolumbar ligament, referred pain, deep, dull ache, nauseating, boring and cramp-like, similar to muscle soreness, distally to the gluteal region below the iliac crest, lateral hip, groin area, lower abdomen, anterior medial two-thirds of the thigh, testicles or vagina, upper anterior thigh to the knee. I have had some patients who find inversion tables beneficial and some who do not. I would make sure you could return it if it didn't work for you. Also there are a lot of varieties and brands so do some research, talk to others who have them, read reviews and then take a chance and hope for the best. Thanks again!

@@robertlibbeyrmt thank you so much for a detailed response. My pain management clinic wants to schedule a nerve ablation on L5. I’m kinda struggling to know if I should go through with it. Again, I understand the arthritis and the osteophyte formation is present and that can cause pain, but I question the pain coming on suddenly. I feel arthritic would be more a gradual onset. But I felt a sudden pulling like tear. I’m at a loss of which direction I should go. My insurance certainly won’t cover another mri. But nothing was notes on my MRI in regards to any soft tissue damage. I wonder if I could ask it to be reevaluated in that regard. I don’t mind surgery, but doing the right thing under surgery is what I’d rather do for sure

@@guitardds To be honest, pain is confusing and something we know a bit about and not much about at the same time. Much has advanced with knowledge of its physiology, mechanisms of how it occurs and the potential ways to decrease it, but it's not the same for everyone and not always linked to tissue. Someone has a similar back to you and has no pain or dysfunction, but you do. Also, someone has a back that on imaging looks perfect, and they are more debilitated than you. The "Why" is very complicated and multifaceted and sadly there is no "one-fits-all all" cure. Sometimes surgery is very necessary and has a life-changing positive effect, other times, it's less than anticipated. It's important to go in with real-world expectations and knowledge. The speed of onset of pain is not linked to anything, injury, pathology, trauma etc. All we know is that certain nerve fibres send messages quickly and some send them slowly. Both have a certain threshold for stimulus and are either stimulated mechanically (actual or potential tissue trauma), chemically (typically inflammation) or thermally (applications of heat/cold time, duration/intensity dependant). I suffer myself with Chronic pain/discomfort, tension, ache, stiffness... pick a term... It's frustrating as I know the science and yet still experience it. I hope you find an avenue that improves your quality of life in some way.

Hi, Thanks for your comment. Yes, this technique can be done by a Physiotherapist, Massage Therapist, Chiropractor, Osteopath or any manual therapist.

Depending on the accident and the areas involved, it is possible that the SC jnt has changed its position and function. As this joint is innervated, any other tissues innervated by the same nerve can be affected causing discomfort and dysfunction. It's best to have a trusted clinician, therapist perform an orthopeadic assessment of all the areas affected. Good Luck.

Hi, thanks so much for watching the video. The easiest way to do this by yourself would be to lie on your front, and assume the one leg standing yoga pose... similar to the position in this image (www.antarayoga.nl/standing-balance-one-leg-yoga-pose) NOTE: I just did a simple google search for this image and have no affiliation with the website. You can adjust the knee height to your comfort level. I prefer to find a comfortable position, hold for 5 seconds, come out of that position for 5 seconds then go back into it but this time with a little more stretch... repeat. There is no set amount of sets/reps. Go at your own pace and comfort. Let me know how you do. Robert Libbey, RMT

Hi, thanks for your comment. Concerning muscles, there are a few muscles that cross the joint space that can contribute to muscle cramps, Gastrocs, hamstrings, popliteus. These would need to be investigated with your trusted healthcare therapist or clinician. There are many underlying factors (instability, degeneration, previous injuries sprain/strains/fractures) that can contribute to the muscular protection presenting as cramps. These also need to be addressed clinically. Robert Libbey, RMT

Hi, thanks for the comment. How did the appointment go on the 6th? What was the diagnosis and recommendations? Robert Libbey, RMT

Hi, Thanks for the comment. When we move our arms backwards, the head of the clavicle sitting in the SC Joint will glide anteriorly. This is a normal forced coupling motion for this joint. As long as it's stable, and doesn't cause discomfort or dysfunction this is most likely a normal range for you. Both sides will move slightly differently from each other as they are asymmetric in shape, structure and function. If you have any concerns, see an assessment from your trusted medical orthopaedic health care clinician/therapist. Robert Libbey, RMT

Hi, Thanks for the comment. Not knowing the particulars of the injury pre surgery, the surgery and post op re-assessment and follow up outcomes, I would suggest searching for a clinician to perform a thorough re-assessment. Based on that then you will need to decide your options both surgical and non-surgical. Clicking can most times just be a clicking sound that isn't causing you harm or damage... it's not what you had previously, but it might be what you have going forwards... still it would be nice to understand why something is clicking. Hopefully the lateral soreness will diminish over time. Most things take far longer to improve than we anticipate. I typically tell my patients to give it a year. Don't stop investigating but it will be different a year from now. Whether it's better, worse, no better, no worse needs to be determined. Keep me informed as to how you are doing. Robert Libbey, RMT

Hi, thanks for the comment. I would seek medical help for an orthopaedic assessment and possible imaging of the area. Regardless of what it is, having it investigated and having peace of mind is primary. Otherwise, you may alter how you compete as a player/athlete.

Hi, The Talus sits in a mortise joint that has very minimal tolerances for displacement. If the foot is pronated for any reason, this needs to be assessed fully and treated/managed specific to that patient. Management of my patients with pronation issues includes manual therapy along with active rehab and potentially temporary stabilization via taping or orthoses.

Hi, Great question. No, this is not Logan Technique. This is LASTechnique developed by AT Still, DO.

Hi, With any dislocation, all surrounding joint tissues will be affected to some degree. This technique could make up part of a manual treatment plan for such a patient.

Hi, thanks so much for the comment. Well, to be honest, you really don't want a loose ligament there. How was it determined that the Subclavian Artery was the primary issue?

Hi your pain is gone or not please update

Thank you so much for watching the video. Try it today with your patients! Pay this video while you are treating and let me know how it went.

@@robertlibbeyrmt sure

Hi, Thanks for watching the video. I hope it helps. Besides the Popliteus muscle, I've seen in the clinic that the big Gastrocs muscle also contributed to preventing the knee from extending fully as it crosses the joint to attach to the distal femoral condyles. Have your rehab professional provide you with stretching for these and let me know how it goes.

Hi, Thanks so much for the comment. Over the past 5-8yrs, my wife, her mother and my father all went through cancer. I also had a major MVA that I've been told I should not have walked away from, so rehab has also taken up every day since then. It's been challenging to keep up with everything social media and my priorities were family first.

Hi, thanks so much for the comment. there are various causes of discomfort. I would need to know more about your complete medical history. Possibly causes of discomfort in feet when walking/hiking could be but is not limited to: too fast graded exposure to the distance - your body isn't use to the distance, speed or type of activity previous injuries that have sensitized the area - sprain/strains inappropriate foot wear for the terrane - flip-flops/ non hiking footwear for hiking - not a good combination undiagnosed physiological concerns such as pre-Diabetes etc

Hi, thanks so much for the comment, sorry for getting to you late. It's unfortunate that you are needing to rehab the joint now. I would recommend seeking rehabilitation services from clinicians who can treat with Prolotherapy and seeing active rehab from a PT and or Osteopath.

You're very welcome!

Hi, thanks so much for the comment, sorry for getting to you late. Issues at this are can occur through many mechanisms, sport activities, pregnancy, compensations from other seemingly non related issues -other injuries that alter movement patterns etc. Sometimes the DRG's that innervate this tissue becomes sensitized due to issues in other tissues innervated by the same DRG's. This would be a great example where the clinicians is required to perform an in-depth history and assessment.

check your dms

@@hakanhallin3800 I don't have dms 😂

Hi, thanks so much for the comment, sorry for getting to you late. Any manual therapist (MT, PT, DO, DC, MD) can perform this technique.

Hi, thanks so much for the comment, sorry for getting to you late. Concerning "persistent spasms due to the over-stretching" - The sacrotuberous and spinous ligaments are considered sensor organs in research rather than structural supports. Is saying this, "healing" of the tissues requires desensitizing the innervating nervous system in order to decrease discomfort and return normal ligamentomuscular reflex's of the tissues. Sacrotuberous and spinous ligaments are both innervated by DRG's L2-4 and S1-4. The nerves from L2-4 travel through and innervate the tissues of the lower back, so these areas will need to be incorporated into the manual therapy and active rehab programs. Once thing the clinicians and patients often forget is a very large influencing factor is "time." It's takes a lot longer to possibly modulate ADL's and qualify of life than we all think it should... if it can be modified.

Hi, thanks so much for the comment, sorry for getting to you late. The simple answer is: Directly - no. Indirectly - it depends...

Hi, thanks so much for watching the video. I hope it helped in the treatment of one of your patients. Here is the link to the Iliofemorral Ligament Video: kzbin.info/www/bejne/f32pZqSwhbplrrs Here's a link to where you can find more courses and videos to help your patients: www.lastsite.ca/featured-online-courses/

Glad it was helpful!

Hi, thanks so much for the comment, sorry for getting to you late. If you are sill in Calgary, and wanting a Massage Therapists I would contact the MTAA www.mtaalberta.com You should have an assessment with a therapists, MT, PT, DC who is current with their knowledge of Pain Science and understands the multifactoral aspects of pain. coccydinia is very discomforting and can make a long time to diminish. In some cases it can take a year or more.

You didn't read the video description. Video aim is to educate the therapists.

Hi, thanks so much for the comment, sorry for getting to you late. Remember that pain and structure are not linked. Some of the worst looking medical images are of people with no pain, the reverse is also true. The SC jnt tissues are innervated by C3-6, while the GH jnt tissues are innervated by C5-7. There is some overlapping of innervation so possibly if nociception is happening a the GH tissues, there may be a sensitization occurring at the overlapping DRGs potentially causing sensation alterations at the SC tissues. The current recommendations are to continue movement and doing activities you enjoy within discomfort free ranges, then increasing those ranges gradually.

You're awesome! Thanks for watching the video. I hope it helps.