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Hi, my name is Sarah Waldhorn and I'm on the cmmp road. Two probably very simple questions: 

1) after doing sherbacks friction along spinous processes client got very itchy along paravertebral muscles, she described as when she exercises outside in winter and skin gets itchy. But would the histamine reaction of periosteal friction happen so quickly and in a way that the client feels it?  (I thought it was all a more subconscious happening below surface etc). Or could it rather have been some kind of irritation of subcutaneous nerve branches?

2) can metatarsal necrosis be an isolated (so to speak I know nothing is truly isolated) phenomena?  Patient never complained of low back pain and never had plantar fasciitis  I would think she would have had something like these presenting before the fall into necrosis, no?

 

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Hi Sarah

1. Any itching sensation which appear while you are working on the patient has ONLY one explanation: mild irritation of the nerve which supply skin in the area patient feels the itch. As you remember from the lecture part of seminar the cutaneous branches of the nerves which supply the dermatomes on the back emerge under the skin along the paravertebral lines. While working on the spinous process of the vertebrae you target periosteum which covers it but also the superficial fascia which inserts there as well. If fascia carries even mild tension its additional stress (by your work, for example) will mildly irritate cutaneous branches of the spinal nerves triggering sensation of itch.

2. Metatarsal necrosis can be isolated phenomenon usually due to sustained pressure, trauma, improper shoes, foot deformation etc.It is more common in patients with osteoporosis. It has nothing to do with the lower back

Dr. Ross Turchaninov

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