Rehabilitacja FILIP-MEDICA Filipowicz Paweł

02/05/2025

W tym roku dołączyłem do zacnego grona KEOMT Poland na czele z Terapia Manualna - Mirosław Dębski. Podczas warsztatów mogłem pomagać uczestnikom i służyć swoim doświadczeniem podczas treningu pokazywanych technik leczniczych.

12/12/2024

Superwizja czynna- praca z pacjentem pod okiem międzynarodowego instruktora KEOMT- Mirosława Dębskiego. Bezcenne móc czerpać wiedzę i doświadczenie od Mistrza KEOMT Terapia Manualna - Mirosław Dębski.

06/12/2024

Serdeczne podziękowania dla Terapia Manualna - Mirosław Dębski za doprowadzenie mnie do poziomu mistrzowskiego KEOMT. W swojej pracy wykorzystuje tylko techniki sprawdzone przez Międzynarodowego Instruktora Metody KEOMT. Uważam, że są one bardzo skuteczne w pracy z Pacjentem. Szlifując swój warsztat pracy pod okiem Mistrza w swojej profesji- Pana Mirka- utwierdzam się w przekonaniu, że warto iść tą drogą, a dodatkowo móc poddać weryfikacji swoje umiejętności pracy z Pacjentem- BEZCENNE. Za co bardzo dziękuję ! :) Jest to niewątpliwie trudna droga i osiągając ten poziom wiem, że jeszcze dużo pracy przede mną aby być jeszcze lepszym !

06/12/2024

14/10/2024

15/09/2024

W ubiegłym tygodniu doskonaliłem swoje umiejętności w Centrum Ortopedycznej Terapii Manulanej Kaltenborn- Evjenth. Obserowałem pracę intruktora Mirosława Dębskiego- specjalistę OMT. Była także okazja do treningu wyspecjalizowanych technik leczniczych.

17/06/2024

Dobrze pokazana radikulopatia- czyli inaczej ucisk korzenia rdzeniowego przez w tym przypadku "przepuklinę". Popularną radikulopatią w odcinku lędźwiowym jest tak zwana rwa kulszowa- czyli ucisk i podrażnienie nerwu kulszowego. Ucisk, podrażnienie powoduje stan zapalny toczący się w okolicy ujścia korzeni rdzeniowych nerwów obwodowych. Objawowo daje to ból oraz uczucie napięcia i sztywności okolicznycn tkanek. Czasami dochodzi do uszkodzenia nerwu rdzeniowego co objawia się niedowładem mm unerwianych przez uciskany nerw oraz osłabienie odruchów ścięgnistych.

The Pathophysiology of Radicular Pain 💡

👉 Radicular pain is a form of pain caused by irritation of the sensory root or the dorsal root ganglion (DRG) of a spinal nerve (https://link.springer.com/referenceworkentry/10.1007/978-3-540-29805-2_3710).

👉Radicular pain is not nociceptive pain, for the neural activity arises from the dorsal root, and not from stimulation of peripheral nerve endings. Therefore, it is not synonymous with somatic pain or somatic referred pain and needs to be distinguished from them. Nor is radicular pain synonymous with radiculopathy. Whereas radicular pain is caused by the generation of ectopic impulses, radiculopathy is caused by the blocking of conduction along sensory and motor axons, and is characterised by loss of nerve function (https://link.springer.com/referenceworkentry/10.1007/978-3-540-29805-2_3710).

👉 Mechanistically, radicular pain is characterized by spreading of the afferent nociceptive input combined with complex cellular and molecular processes that initiate and maintain the increased nociceptive signal input. Furthermore, both anatomical (https://pubmed.ncbi.nlm.nih.gov/10568867/, https://pubmed.ncbi.nlm.nih.gov/17850967/) and electrophysiological (https://pubmed.ncbi.nlm.nih.gov/20147564/) studies suggest that the spreading of radicular pain involves adjacent spinal segments. This supports the common clinical observation of involvement of multiple nerve roots, despite a single level of pathology.

👉 Although the spreading of the radicular afferent signal is a complex phenomenon, a certain sequence in the inflammatory cascade is apparent (s. figure, https://pubmed.ncbi.nlm.nih.gov/24553305/). Beginning with the disc degenerating nerve, proinflammatory cytokines are released at the site of lesion and at a distance through Wallerian degeneration (WD). During degeneration of the distal axon by WD, TNF-α is released by Schwann cells, endothelial cells, mast cells, and resident macrophages at the site of nerve injury. This causes ectopic firing at the dorsal root ganglion (DRG)), leading to an increased release of neurotrophins and ectopic firing at the dorsal horn, eventually leading to central sensitization (https://pubmed.ncbi.nlm.nih.gov/14624855/, https://pubmed.ncbi.nlm.nih.gov/15120588/, https://pubmed.ncbi.nlm.nih.gov/2388084/, https://pubmed.ncbi.nlm.nih.gov/10366647/).

👉 The cellular-molecular cascade may also start form the herniated disc material. The extrusion of material from the nucleus pulposus onto the spinal nerve leads to edema and ischemia. Experimental work has shown that exposure of nerve root (proximal to the DRG) to material from the nucleus pulposus material increased endoneurial fluid pressure and decreased blood flow into the DRG with secondary edema (https://pubmed.ncbi.nlm.nih.gov/9854750/). A key mediator released after disc herniation is the proinflammatory cytokine TNF-α. When TNF-α reaches the nerve root, production of the neurotrophic factor (NGF) in the surrounding inflamed tissue is initiated (https://pubmed.ncbi.nlm.nih.gov/9179382/, https://pubmed.ncbi.nlm.nih.gov/14615047/, https://pubmed.ncbi.nlm.nih.gov/12237190/).

👉 This, in turn, induces the production of another neurotrophin ,brain-derived neurotrophic factor (BDNF), in the DRG (https://pubmed.ncbi.nlm.nih.gov/12237190/, https://pubmed.ncbi.nlm.nih.gov/22280975/).Besides their neurotrophic qualities, such as the induction of nerve sprouting, both NGF and BDNF are also recognized as important factors in the development of central sensitization (https://pubmed.ncbi.nlm.nih.gov/16543102/) and may play important role in the pathophysiology of radicular pain. The release of cytokines may also directly interfere with both activity and expression of various ion-channels in the DRG (https://pubmed.ncbi.nlm.nih.gov/19339603/).

👉 In radicular pain, ectopic discharges can be generated at different locations of the nervous system. from electrophysiological analysis, it was calculated that approximately 75% of the overall ectopic firing was generated at the DRG and only 25% at the lesion or neuroma (https://pubmed.ncbi.nlm.nih.gov/10781925/). Cytokines and neurotrophins can initiate modulation and phosphorylation of ion channels, which forms the basis for generation of ectopic action potentials or ectopic firing (https://pubmed.ncbi.nlm.nih.gov/7999002/, https://pubmed.ncbi.nlm.nih.gov/21525373/). Because repetitive firing of the pain afferents forms the physiological reason for central sensitization (https://pubmed.ncbi.nlm.nih.gov/15120588/), this clearly contributes to the clinical syndrome of radicular pain (https://pubmed.ncbi.nlm.nih.gov/24553305/).

20/05/2024

Patellofemoral joint contact areas during knee flexion 🦵

🦵 The patella does not contact the trochlear groove in the fully extended state of the knee joint, and when the 30 degrees flexion, the distal portion of the patella begins to contact the proximal portion of the trochlear groove.

🦵 As the knee joint flexes, the contact portion of the patella surface moves from the proximal to distal patella, and until 90 degrees, the contact surface is constantly increased to help lower the patellofemoral contact pressure (https://pubmed.ncbi.nlm.nih.gov/3379503/, https://pubmed.ncbi.nlm.nih.gov/2394060/).

🦵 Using cadaver limbs and pressure sensitive film, Powers (https://pubmed.ncbi.nlm.nih.gov/11415841/) reported a 68% increase in contact area between 15° and 60° knee flexion, whereas D’Agata (https://pubmed.ncbi.nlm.nih.gov/8465915/)reported an 81% increase between 20° and 60°. Between knee flexion 20° and 60°, an 80% increase in total contact area was observed Salsich et al. (https://pubmed.ncbi.nlm.nih.gov/14646727/). An 74% increase in total contact area was observed with knee flexion from 30° to 60° during strair ascent and decent by Wang et al https://pubmed.ncbi.nlm.nih.gov/37770867/).

🦵 Male subjects display mean unloaded patellofemoral joint contact areas of 210, 414, and 520 mm(2) at 0 degrees , 30 degrees and 60 degrees of knee flexion, respectively. Female subjects' unloaded contact areas were similar at full extension (0 degrees ), but significantly smaller at 30 degrees and 60 degrees (p

19/05/2024

Pathophysiology of lumbar disc degeneration, disc herniation, and discogenic pain in a nutshell 💡

👉 Interaction of chemical and mechanicals factors as illustrated by Netter

📸Illustration: https://link.springer.com/chapter/10.1007/978-3-031-50357-3_24

07/04/2024

Drodzy Pacjenci !
Od jutra będę dla Was dostępny w gabinecie Fizjo In Plus na Morenie- Osiedle Słoneczna Morena. Zapraszam do zapisywania się na wizytę :) Pozdrawiam serdecznie, Paweł Filipowicz

Z przyjemnością informujemy, że od poniedziałku do naszego zespołu dołączy fizjoterapeuta- Paweł Filipowicz 👍 Już dziś możecie dzwonić na rejestrację ☎️692 510 588 i umówić się na pierwszą wizytę. 😀💪
Paweł swoje umiejętności rozwijał w klinice ortopedii i medycyny sportowej w Warszawie oraz klinikach specjalistycznych. Ukończył szkolenie podyplomowe w zakresie Ortopedycznej Terapii Manualnej Koncepcji Kaltenborna - Evjentha. Zajmuje się leczeniem pacjentów ortopedycznych, po urazach oraz z dolegliwościami bólowymi kręgosłupa. Dużą uwagę skupia na profilaktyce przeciążeń i urazów. Prywatnie w wolnych chwilach stawia na aktywność - trening na siłowni, jazda na rowerze, gra w piłkę nożną, pływanie.

01/03/2024

Pracowite 4 dni szkolenia wg metody KEOMT 💥💥💥

14/02/2024

Ból pięty- jak widać przyczyn bólu pięty może być dużo.

Locations of tenderness for diagnoses of heel pain 🦶

👉Proximal plantar fasciopathy will have tenderness over the medial aspect of the calcaneal tuberosity, and distal planar fasciopathy will have tenderness more distally. https://jamanetwork.com/journals/jama/article-abstract/2812902, https://link.springer.com/chapter/10.1007/978-3-030-65335-4_17

👉A squeeze test of the calcaneus is performed by medial and lateral heel compression, and if positive, suggests calcaneal stress fracture. https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

👉 The fat pad of the heel is palpated more proximally and centrally than the origin of the plantar fascia, and tenderness with softening in this area suggests fat pad atrophy. https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-022-00568-x

👉 Tarsal tunnel syndrome (TTS), a posterior tibial compression neuropathy, can often be mistaken for plantar fasciopathy and vice versa. Whereas plantar fasciopathy will have pain with passive toe dorsiflexion, tarsal tunnel syndrome is exacerbated by percussion of the nerve within the tarsal tunnel, reproducing numbness and tingling with radiation to the plantar heel. As a distinguishing feature with regard to plantar fasciopathy, dysesthesia, paraesthesia, numbness, tingling and burning pain in the sole of the foot are common in TTS. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8693231/

👉 The first branch of the lateral plantar nerve (Baxter’s nerve, BN), due to its proximity to the medial calcaneal tubercle, is prone to entrapment and can coexist with plantar fasciitis, thus making it difficult to distinguish between the two diagnoses. BN might be the most common cause of chronic heel pain of neurological origin. (https://pubmed.ncbi.nlm.nih.gov/2797751/, https://pubmed.ncbi.nlm.nih.gov/30368565/)
BN often presents with neuropathic pain features (i.e. burning pain), associated with numbness and tingling around the medial heel, radiating to the lateral foot mimicking the typical course of the nerve. Paresthesia with motor weakness of the abductor digiti minimi muscle (abductor minimi digiti or abductor digiti quinti) may be present. (https://www.exporthopaedicjournal.com/articles/aceo-aid1012.php)

📸Illustration : https://link.springer.com/chapter/10.1007/978-3-030-65335-4_17