Cross Country 44 - Querencia

[Barrett Dorko]

It’s been a quiet week in Cuyahoga Falls…

I wasn’t well while traveling this week, couldn’t eat much and slept very little. While treating students I had to focus more than usual. Fortunately, I found my querencia.

On a website by Joyce Wycoff there is this:

Querencia – A Poem

Information changes
Skills obsolesce
Technology morphs
People move
And the world turns.

What is bedrock?
What merely shifting sand?
Where is our querencia,
Our home place of safety?

Querencia comes from the Spanish bullring. When the bull stops for a moment and finds querencia -- his place of safety -- he becomes truly powerful and dangerous. This is the moment he gives up fear.
This morning as I was thinking about our ever-changing world, I thought about our own querencia. What is that place of safety for each of us, that place that gives us power in the face of adversity, that place that takes away fear? What is your place of querencia?

Though nearly everyone I watch work with Simple Contact in my class accomplishes as much as I would with the same therapist as a subject, I know that very few have the same sort of success once they leave. I am convinced that patients and therapists are not significantly different so I have to consider the possibility that it is the therapist who changes once they hit the hotel exit. I don’t think they actually forget anything or lose a sense what to do. I don’t think they forget to ask the patient the questions I suggest so that their handling might be guided. Instead, I think once they’ve returned to work that they lose their querencia – their opportunity to gather themselves and consider what could happen next and what it might mean.

Unlike those few moments in class, when therapists are faced with the realities of their own clinics – the pressure exerted by their superiors, the referral sources, by patients demanding something forceful be done to them, by insurers who expect measurabe miracles – they lose that moment when they can consider the patient before them with calmness and a sense of purpose.

Most importantly, the therapist doesn’t “give up fear” as does the bull in the ring. I watch therapists with decades of experience approach their colleagues manually as if they were about to touch something that might harm them. The trepidation they display spills over into the patient’s awareness and the consequence is a stillness and passivity that isn’t therapeutic in any way. I’m increasingly convinced that it isn’t the moment when touch occurs that produces this – but rather the moment just prior. A slight, thoughtful pause full of awareness and a vow to accept what happens next would probably help. At least, this is how I go about it. Now all I have to do is figure out how to teach that.

Is there a place in your method of handling for querencia?

[Diane]

There is such touch phobia in this North American culture. I think PT has tried to bury the phobia by making touch a control issue instead of a means of gathering info. A slight, thoughtful pause full of awareness and a vow to accept what happens next would probably help. I agree. It would be the equivalent of "centering" and "grounding" but more an internal attitude with no actual yoga positions performed. Of course, unless someone has actually built in a sense of how this feels inside themselves, there literally won't be any "querencia" or place to go at first to gather together one's wits. We are back around to the onus being on the therapists to learn to thoughtfully examine how being in a body really feels, so that they can sense and become familiar with personal discomforts and feelings regarding physicality, existence issues, develop the ability to focus on them, learn to breathe through them, then;
1. set their own stuff aside at will for the purposes of being with patients, whose nervous system can immediately sense comfort levels in therapists, and;
2. eventually overcome them such that one can live (most of the time at work) in one's own quernercia.

So many twisty, intertwined issues when two nervous systems join up for a little while. I have no idea how one would go about teaching any of this. I think just talking about it is good however. Is there a place in your method of handling for querencia? Definitely. Love the new word. The older I get the easier it is to live in it.

[phil]

Barrett,
After reading your post I thought immediately of the poem by Octavio Paz that I found on your website a few years ago.

"Boy and Top"

Each time he spins it,
it lands precisely,
at the center of the world.

The difficulty (for me) lies in forgetting the realities of the clinic and becoming as focused as the boy.

[Barrett Dorko]

I think you've both hit upon the very thing that pretty much ablates the method; that and the paperwork that has no relation to the work we actually have to do.

In short, today's clinical environment promotes precisely the sort of therapist that will have difficulty pausing long enough to visually and manually "hear" what it is that Simple Contact requires.

[Nick]

Nice post. I think many of us find a bit of our querencia here. It is a place where we can come to find information and support as well as cut our teeth in debate. It prepares us for the objections we will encounter among our patients and our colleagues. It is nice to know one is not a lone voice.

I, too, have seen people excited about Simple Contact only to be deflated by the realities of their clinical life. Many of us have carved out practices that allow for eccentricity. They take many different shapes - as individual as each of us. One can build a model for others, but each must follow his or her own path. Most prefer a leader. There's nothing wrong with that provided the leader has a decent map and listens and learns from others scouting the territory.

:lightbulb Here's my suggestion...maybe it will even help lighten Barrett's hectic travel schedule. I suggest we turn this, or perhaps another, forum into an official online learning site (and maybe even certification program) for neurobiology and manual/movement therapy. Then we schedule a semi-annual or annual conference where we can gather and learn/share "hands-on" elements. There is more than enough talent and brains on this site. I love the free information and discussion on here, but maybe we can reach more people and make them value such things more if we can provide a structured learning opportunity that could qualify for CEUs.

I see many therapists struggle to let go of the well-established perceptual fantasy courses that have been held up as the gold standard of continuing education. Most new grads in Canada have been given the impression that they will not be a competent therapist until they complete the joint-popping:mad: courses outlined by the Ortho. Division. These courses are long and expensive and, in my opinion, teach a lot of questionable ideas and methods of management. No reason why the learning could not occur online. You all put more quality information on here daily then most continuing education providers would provide in 3 or 4 courses!:thumbs_up

I'm anxious to become a certified Dorkite, Dianesian, Narian, Newmaner, Bernardian, etc. Though I know most of you will likely shudder at the thought.

Nick

[nari]

I don't think it (the loss or absence of quernercia) is confined to the clinic, either.
In Oz, therapists talk a lot about the 'comfort zone'..that sense of being not so much in control of someone else, but able to handle anything that comes along. In other words...'connect'. There is an instance, a few moments after a patient has arrived, where the right words and body language can make the difference between a good rapport and a bad or neutral one. Many therapists do it by rote- the same words, same intonation, and that is their culturally-defined way of 'connecting'. It is more of a zebra crossing than a quernercia.

Touching is also 'banned' to some extent here, to the extent that we are more or less expected to inform the patient that we will be placing a hand or two on them in a certain area. Patients expect to be touched when they attend physiotherapy; but the meme of personal space is very strong amongst folk in general.

I don't know how to teach 'connectedness' either.

Nari

[Barrett Dorko]

Nick,

An interesting and complimentary post. This "Dorkite" thing is starting to grow on me. It sounds like an especially strong and rare form of rock. I get no sense that it glows in any way however, though that would be nice.

I wish I could be more enthusiastic about the interest out there. Last week I told 98 therapists that they could sign up here and that if they did the archives and links would be theirs. Of the 500some I've told this I believe a total of 7 have made this move. Perhaps a few more are lurking.

Come up with a way to draw more and I'll host the meeting myself.

[Nick]

My immediate thought is this...
People don't value knowledge. They value technology.

[christophb]

My company sent me to a Mulligan course over the weekend. As a seemingly lone neuro guy amongst the "manuals" I had to find my Quernercia. I actually came away from the course in a better place. Not because I have converted or anything, but because the way I saw it much of the manual stuff was more neuro stuff, explained in a positional fault/mechanical kind of way. The same old arguments were that it works so use it. From hanging out here, I could see (or thought I saw) the benefits from a neurophysiologic standpoint. The explanations given made my jaw drop and forehead wrinkle on more than one occasion. But where I work, the thinking seems sooooo mechanically oriented, there seems to be no easy way to advance some of Barrett’s ideas. I have this phrase from Chuang Tzu running through my head today "when the Tao is present, the sage advances, when the tao is absent, the sage rests” In my clinic, I feel like resting.

Chris

[Diane]

But knowledge IS technology, sort of.. so is experience.
I like your idea Nick, of online manual therapy training/support. There would definitely need to be "gatherings" in person, though, for puroses of consolidation of info. (The Nanimo Experience convinced me of that.)

Dorkite is just like kryptonite, except that it's purple, and only harmful to evil memeplexes. Actual people from all planets are safe from its rays.

I would like to check out how it would feel to be a Mathesonian. Or would that be another kind of rock, say, Nickite? Nickle?

Chris, (at the Mulligan workshop) did you feel like you were in somebody elses' dream? (and couldn't wake up)?

[Nick]

I agree Diane. My last post was incomplete, but more people prefer an instruction manual to socratic dialogue.

I think this idea could fly. Drawing people is just a matter of marketing and providing something people value. People tend to place higher value on things they pay for. This could be a great way for some of you to pass on your knowledge. A certification would be completed through participation in a course where you demonstrate you ability to do nothing!:teeth: This could be a way to start our pain group without having to get through all the bureaucratic red tape of our national organization. I suppose it could get bogged down by accrediting agencies and so on, but we have an incredible resource of international therapists right here. Online "lectures" every two weeks with reading assignments, discussion, etc. Monthly csae reports and research reviews. You've got a great start on embryology. Jon can teach everyone how to search for links (and read them!). Barrett's already got a lot of material. I think it's a great idea if I do say so myself.

Nick

[christophb]

Diane,
Actually I felt I was able to better steer through the nonsense. I did find the course practical, but my understanding of why it works was different than most (I think). I just did the floating/no resistance Taoist thing with plenty of critical thinking.

[nari]

Now we have been talking about rocks- I'm interested.

I see Barrett (Dorkite) as definitely igneous, and probably rhyolite- lots of colours. Never mind that it is volcanic in origin...
Dianite - definitely metamorphic; probably slate (highly resistant to erosion)
Newmanite - metamorphic, maybe limestone...

Nick's idea sounds good; but it rather excludes the Southern Hemispherians as far as get-togethers go. That's OK. :) Let's see how the larval idea develops.

Chris,

I don't know much about Mulligan, but I do know that it seems to be centred on eccentric lengthening. Interestingly, he has no idea why it works, or so he says. It's got to be neural, in effect but I see most things as neural-based. The problem with PTs who think mechanically is they will miss out on the reasoning behind their work - thus the difference between the 'how' and the 'why', and as a result the patients miss out on education...

Don't worry, I have not convinced anyone of thinking neurally either. they are simply not interested.


Nari

[EricM]

Nick I think you are on to something. I too have been contemplating how to package, disseminate and share what I have learned here. (Must be the Mathesonian lineage) "Build it and they will come." "We have the technology." There needs a better system of summarizing and cataloguing useful threads including their relevant references. An interactive, ever expanding, online thesis of sorts could be developed.

:teeth:

eric

[Jon Newman]

Nari, I'm pretty sure my rock is fool's gold or perhaps the same sort of rock Charlie Brown gets for Halloween.

[BB]

Nari,
I wouldn't say that you've convinced no one to think neurally. You and the others have brought me along.
Cory

[Nick]

No worries, Nari. I would love a good reason to visit the Land of Oz. The First Annual Conference of the International Association of Neuro-Nuts seems as good a reason as any.

Let's face it: as much as I admire the autodidacts on this site and the knowledge they impart, the world demands credentials. All we need to do is organize some of the information on here, charge a few dollars, and hand out a piece of paper when the practical is completed in Nanaimo or Sydney or Cuyahoga Falls. The lucky student becomes a certifiable neuro-nut, has the certificate to hang on their wall, and a license to change the way they practice. If a certain unmentionable can garner 50,000 supporters with a pocket full of nonsense, surely we can influence a few with a solid evidence base, some basic science, practice advice, collective wisdom, research methods, dialogues and blogs, just to name a few. We just need to have the carrot that makes them want the information / knowledge; ie. a certification. The greatest part is it could all be done from your computer without anyone putting much more effort into it then you already put into your posts. People would not have to travel to gain access to wonderful minds - just to get access to hands at "gatherings" where information is consolidated and people are initiated into our esoteric world.

Diane, doesn't this sound more appealing than dealing with the red tape of the Canadian Physiotherapy Association? We might even become legitimate some day. Walt might even agree to teach for us:angel: !

Nick

[Diane]

Nick, please continue to dream out loud and flesh out your vision. I'm sure Bernard will be willing to help. I can go pull threads and move them; I have access to the technology, but have less of the tech-knowledgy.. :)

Nari, you were the one who got me thinking hard about hands-off sort of educational PT. I'm much better at it than I was a few years ago.

I don't recall Mulligan as eccentric lengthening. I took an upper limb class once; it was all joint mob combined with twisting skin around over the joints and having the patient do active movement at the same time.

Nick, Diane, doesn't this sound more appealing than dealing with the red tape of the Canadian Physiotherapy Association? Yup.

We might even become legitimate some day. I think we'd have a shot! I like how your mind works Nick! Keep selling me.. keep selling me..
Walt might even agree to teach for us ! Well.. this part doesn't seem possible.

[nari]

Cory

Thanks for that.

I was actually thinking of my local colleagues, rather than the folks who post here. The local PTs are hard-wired to orthopaedic thinking, I believe, and it seems to be terminal. ;)

jon,

Nah...you are versatile and manufacture incredible shapes (read: thoughts)


Nari

[Nick]

Thanks for your encouragement, Diane. This idea is exciting me. I think I've found my querencia.

We develop a Neuro-Nuts curriculum:
Critical Thinking
Embryology
The End of Evaluation
Adaptive Potential
Handling Techniques
Education - Cognitive Behavioural Therapy
Nonconscious Movements
Somatics / Feldenkrais Exercises - Motor Learning

We start a thread on each topic and move existing threads there. We consolidate information into chewable form and appoint a Moderator for each topic. We add links, research, etc. Design a "course" that people can take to learn each topic. We can decide about testing later. This will be group think. It will be like those software developers who work on freeware and shareware and combat hackers. We will be the world's physiotherapy geeks saving people from the hackers in the continuing education word. Memebusters!

We can publish. Some can research. It will all be democracy at its finest until we have to sell out to the corporate sponsors. Just joking. I'm probably making people's hobby seem way too much like work, but...this really does have a lot of potential. And I guarantee that people will be more likely to participate if we have something of perceived value to strive for. Even moreso if it has real value. It will be up-to-the minute. No PhD's required, but of course welcome.

And the highlight is our conference. I am still jealous I missed Nanaimo. I think it was a watershed moment for physiotherapy. Future physios will talk about it for years to come and wish they had been there. We will build an option for people who do not want to follow the fossilized orthopedic curricula that dominate the con. ed. landscape. Others will be saved from drinking the kool aid. We can build on the great work done by NOI ("another tool for your toolbox") and Physiotherapy Pain Association, but surpass it by revolutionizing manual care with the neurophysiological backdrop it so desperately needs. We will maximize knowledge transfer through the use of the internet and gather to experience and transmit the importance of touch.

Nick

[Jon Newman]

Nick has got the "low spark".

[nari]

Nick

Your thoughts and plans are inimicable...glad you posted twice. ;) ;)

On the topic of improving the profession: even if we can get the muscle/joint aficionados to have a think about the reason why tweaking around vertebrae and ankles seems to get the said joints better, we would have gained ground.

One of the classic features of the Nanaimo Experience was the meeting of like minds. That had never happened before to me, having six or seven PTs(ooops, including one DO, sorry Luke) in a group thinking along the same lines.
At the most, in 22 years there have been only three PTs who didn't think I was sprouting irrelevancies.


Diane,

I haven't been to a Mulligan's course, but had some techniques demonstrated to me, which involved touching the lengthening side. Other than that, no similarity at all to SC. So his techniques are forced.....hmm

Nari

[christophb]

I don't recall Mulligan as eccentric lengthening. I took an upper limb class once; it was all joint mob combined with twisting skin around over the joints and having the patient do active movement at the same time.

Yup, but should not be painful... think its kind of an "Ah ha" moment for the brain sensing there is another option for movement. And I think there is a whole bunch of stuff being done with the skin and mechanoreceptors. I tried to put my 2 cents in but no one seemed interested in a neuro explanation... The safe place for them was in the joints.

Chris

[Diane]

Jon, what's a low spark?
Nick!! You are on a roll!! Keep going! I love it. Especially the "revolutionizing manual care with the neurophysiological backdrop it so desperately needs' part! :D

(And I'm pleased that the embryology isn't boring you silly. Hurray..)

Nari, just getting the bone/muscle/joint aficionados to admit that a nervous system exists and that it might have .. feelings, let along opinions, will be a major coup!

I love the idea that 20 years from now we could have many more Nanimo Experiences behind us. How about letting us come to France Bernard? ;)

[nari]

How about Iceland? The PTs there have a large component of neurophysiology in their Uni schedule...when I looked last. David Butler was there last year...maybe he would know.


Nari

[EricM]

Sorry you could not make it to Nanaimo Nick. How about Mexico (http://www.villalq.com/)?
:shade:

eric

[Tim]

This site is a querencia for me too. Going to Barrett's ititiatory for neuro-nuts was like waking up from a nightmare and entering Nervana. I am absorbing a lot from this site. Thanks to all of you for the opportunity.

I have shared a lot with my supervisor about this site and what I am learning. She recognizes the importance of neuromodulation, but seems too close to retirement to want to latch-on. So she encourages me and gives me her patients that the mechanistic approach fails on.

As you were speaking of the types of rocks we might be, I thought of the Scottish tradition on New years day of "first-footin'" and taking a lump of coal for the neighbor's fire. I'm thinking that Barrett gave me a lump of anthracite on 2/1/06, but it's not going to go out.

I too hope you can determine a way to catalogue and organize all the pertinent information on this site. I would also like to make any neuro-nut conclaves. :)

[nari]

Tim

I know what you mean, the same bit of anthracite was tossed at me in 1990 by David Butler. It's not only not gone out, it grew++. During the first hour or so, he referred to electrotherapy, in particular ultrasound, as "bull****".
Takes courage to say that to a large group of Maitland/McKenzie/sporty sort of PTs, and escape without being tomato-sauced.
I've never forgotten that first hour!

Nari

[bernard]

I too hope you can determine a way to catalogue and organize all the pertinent information on this site.
You're pointing out the major weakness of forums. Information is writen and lost, with time. We began to make some eBooks, last year, and I'll continue the job. Many readers are lost and I planned to put an index where you may find some useful indications.

All ideas are welcome.
It is certainly possible to make special folders about specific subjects.
It is possible to make quizzes enabling a way of learning.

The site enables also, normal html pages, a very good way to provide another possibilities to reach knowledge.

[bill]

Nick,

I think you have the basics for certification of sorts...and people would come but it has to be marketed well.

bill

[Jon Newman]

Hi Diane,

I made reference to "low spark" (http://en.wikipedia.org/wiki/The_Low_Spark_of_High_Heeled_Boys_%28song%29) in the "volume 5" thread (http://www.somasimple.com/forums/showthread.php?t=1994&highlight=volume+5) also. I might adopt it as the unofficial theme song of the effort at hand.

[Diane]

Nick has this listed above:Critical Thinking
Embryology
The End of Evaluation
Adaptive Potential
Handling Techniques
Education - Cognitive Behavioural Therapy
Nonconscious Movements
Somatics / Feldenkrais Exercises - Motor Learning It combines all I hold dear. I would love to take this, all packaged. I'd even participate in teaching it because I find it so compelling. I'm all for it. Jon, you have teaching skills already, I'm sure you could fashion an actual curriculum. Bernard, you could make it look pretty. Barrett, you could assign it value. Nick, you would be school CEO. Positions would be created/adopted by the rest of the neuronuts.

Marketing is just a matter of having something of real value, completely beautifully packaged, and placing it in front of the targeted sector. It should sell itself without any force feeding.

Our customers would be ... who?
Just PTs? Or any credentialed hands-on individual from any persuasion? Is our goal to upgrade just our own profession or to spread the word out in all directions to all manual therapists to help all of them upgrade and not afflict the public anymore with crazy ideas?

One large glitch (Barrett reminded me of this on the forum feedback thread): A huge number of manual therapists aren't online yet, are even anti-tech as a philosophy. Our marketing may have to include print. We will have to entice people to buy and use computers. One way might be to have part of the course on CD so that if people want it bad enough, they'll get a computer just to look at the CD. It's not such a big step after that to get connected and participate.

[Barrett Dorko]

Despite my personal phobia regarding higher education and being tested in any fashion, I find all of this quite intriguing - especially Nick's list and what it implies about what we should know in order to explain why we do what we do (or don't do, as the case may be).

I also have a very high regard for each subject here and would list their value in this order:

Critical Thinking
Embryology
Nonconscious Movements
Adaptive Potential
The End of Evaluation
Handling Techniques
Education - Cognitive Behavioural Therapy
Somatics / Feldenkrais Exercises - Motor Learning

It seems to me each simply follows from our understanding of the previous one.

There, I've done my part and can now just sit back and relax.

One more thing; School colors? Scarlet and Gray

[Diane]

Scarlet and gray? You mean, like House's ball? :D
How about Luke, as head of research along with embyology consultant? Want to play Luke?

Barrett, I'm glad embryology doesn't bore you either.
(I might as well spill; to write a little book explaining embryology to people interested in manual therapy has been my secret plan for several years now. I think I finally got the plane off the ground here at SS, for a test flight. The ideas are absolutely rolling, and I am learning all sorts of new stuff myself each day I post. I'll be tying in Lynn Margulis' ideas on cells and Dorion Sagan's Into the Cool ideas. Somehow.)

[Barrett Dorko]

Diane,

The way you've explained it, embryology is essential, especially when it explains what we should attend to in evaluation and treatment. Wasn't there a rationale for not focusing on boney position in one of your recent posts? How did that go again?

I like it - and I'm glad I don't have to teach it to my classes. I tell them "it's part of the advanced course" - and the advanced course is here on Soma Simple.

[Nick]

Eric - Mexico it is! Sorry Nari - maybe Oz can have the second annual conference.

Being the Forrest Gump of Physical Therapy, Barrett can no doubt share the details of how powerhouse organizations in the mobilipulator world developed. I'm betting it was little more than self-appointed experts. The gatekeepers then develop their courses and certifications to perpetuate their perceptual fantasies. 50,000 sign up for MFR and suddenly its credible!!! Yikes. IFOMT is/was the gathering of like minds and the formulation of standards that have been interpreted rather loosely - Norwegian system, Canadian system, Autralian system, etc. We owe a debt of gratitude to David Butler for writing that nice little book that helped bring physiotherapy out of the dark ages. Although he's built quite the organization, I think it would differ from the methods most SomaSimplers employ.

See how powerful forums are. This idea is already taking shape from others' contributions. A living outline. Bedrock and shifting sand at the same time.

We've got the colors. How about a name?

Nick

[christophb]

USUC University of self unconcious correction

[nari]

Seeing that this thread started with the concept of querencia, and the poem by Wycoff seems to encapsulate the intentions as set out by Nick...

Why not incorporate Querencia in the name?

Would go down well in Mexico.

May also have an association with a bullypit - if that is wanted.


Nari

[Diane]

Could we have the word "meme" in there somehow?
I would also like to make any neuro-nut conclaves.
Tim, of course. You've likely got a few or many very cool moves to show and explain, in neuronutese. As far as I know it's open to all. We might want to consider inviting Walt and Dave.. :) (to audit).

[EricM]

Barrett,
I was reminded recently of what you refer to as the '4-corners,' in your teaching. If I've remembered them correctly, Nick's list left out Evolutionary Reasoning and Essential Diagnosis. With these in mind I was wondering if you would revise the list again to include them all as follows:

Evolutionary Reasoning (Critical Thinking)
Embryology
Nonconscious Movements
Adaptive Potential
The End of Evaluation
Essential Diagnosis
Handling Techniques
Education - Cognitive Behavioural Therapy
Somatics / Feldenkrais Exercises - Motor Learning

Eric

[bill]

Diane,

As you said

"Marketing is just a matter of having something of real value, completely beautifully packaged, and placing it in front of the targeted sector. It should sell itself without any force feeding."

While succinctly put (and correct)...sometimes things aren't that simple (soma). "Real value" is a perception. An example could be MFR. The perceived value of MFR among those here is probably on the small side. However the perceived value among MFR folks is totally different.

Packaging is important as well...but a lot of beautiful things have come and gone.

Sometimes the "targeted sector" needs a slap in the face...a Homer (not the Iliad) Doh! moment interrupted.

Nothing sells itself.

An interesting book (to me at least) "Why People Buy Things They Don't Need: Understanding and Predicting Consumer Behavior" by Pamela Danziger provides a few clues and there are many out there along this vein.

An one last (perhaps) marketing thing from Dan Kennedy’s', "The Ultimate Marketing Plan"...2nd Edition (3rd out in April) YCDBSOYA...You Can't Do Business Sitting On Your Ass.

bill

[Barrett Dorko]

Eric,

That's perfect.

The "four corners" are those things I keep in mind as I work and certainly as I teach. At the end of a course recently after my speaking about the essay "Incantation" which forms the basis of the essential diagnosis idea (I do this while treating someone) I asked, "What essential diagnosis did I plug into her picture?" Several people said, "Ideomotor."

Obviously, I had managed to totally confuse an entire class once again. Fortunately, I was able to leave very quickly.

[Diane]

bill, perhaps you're right. I think we'll cross that bridge when we get to it. I think the vision is still being given birth to, not yet ready to be packaged and marketed. (How's labor going Nick? :teeth: )

[Nick]

I suggest the International Institute for the Manual Management of Pain.

I like Eric's list, except I'd change Evolutionary Reasoning to Evolutionary Biology and leave Critical Thinking as a separate topic. We might also want to include a Research Methods and/or Statistical Analysis/Research Translation Course, but maybe that could be done for a special project for those who were interested. I see a core curriculum and then lots of other courses that could be added as electives/special interest.

I nominate Bill for marketing. I'm having enough trouble marketing my own clinic!

Having said that, I see this as a grassroots thing that we start by collecting/organizing information (already in process) and then choosing how to disseminate it. No big investments and then no need to drum up customers. Obviously the goal is to get the information out there, but also to make this type of learning more accessible, more credible, and more rewarding (for those that need extra incentive to learn - need to get something for it). Again, if someone feels empowered to practice something as silly as MFR theory because of the organization, courses, certification, books, etc., that stand behind it, we can contribute to people feeling supported in practicing in a more, shall we say, rational way. After all, they'll have a certificate that gives them credibility for having studied with some great PT minds - but more importantly than who they learned from, what they actually learned.

YCDBSOYAIYBIOL - You can do business sitting on your ass if your business is online learning. It should be an Institute of Learning more than a business, but as I said before, people value what you put a price on and what they get at the end, which is the abililty to call themselves a Member of the IIMMP. I know several therapists who would like like this kind of opportunity. In spite of my best efforts, they still are looking at all the other courses out there and feeling like they're missing out on the joint-popping stuff. The quack stuff with big promises is also enticing due to glossy brochures and the promise of magical tricks to perform on you patients.

BTW, I want to ensure this doesn't cut in on Barrett's teaching gig. I do think it will only reinforce his work and he can still be teaching how to handle people and actually think while you do it or don't do it. There are a lot of people who need to learn how to think, rather than what to think. This will not be about more tools for the toolbox!

Nick

[Barrett Dorko]

Nick,

I'm not concerned in the least that this sort of thing will have a negative affect on my teaching. (Did I use "affect" correctly there?)

As I've said before, people come to workshops for one thing, typically the subject matter, and end up getting something else entirely that they hadn't anticipated. People end up paying for my presence, whether they like it or not. The payment I mean, not my presence. Well, maybe both.

If my way of disseminating information the past couple of decades is any indication of my goals you'd have to conclude that making a lot of money has never been one of them. I give away as much as I can and truly feel that I get paid to travel, not to teach.

Of course, I also hunger for fame and admiration. Let's not forget that.

[Nick]

I just got a brochure for a course in Osteopathy methods. It is all the rage in Halifax now. There is a Diploma available through a series of weekend courses and people are rushing to take the courses. It is, of course, little more than more fascial B.S. (with all due respect to osteopaths - I think they do some great work, but have some pretty ??? theories). It has proven attractive as an alternative to the ortho. courses and for the people addicted to learning techniques as opposed to gaining knowledge. The time has come for the Third Way (see www.barrettdorko.com).

People want structure. They want acknowledgement. They want belonging. Myself included. I am tired of being a misfit in a profession I think can do great things. There is so much misinformation out there about pain, movement therapies, and exercise. As Walt has stated, we all have our filters. Fair enough. I, for one, have been very glad to have someone wipe the crap off my perceptual filters and challenge me to stop telling fairy tales to my clients (except, of course, in the metaphorical sense that such stories were meant for). Enough hyperbole, already!

Nick

[Barrett Dorko]

We might begin to wonder why so many are dissatisfied with the ortho model for our patients in pain. Might it be that it doesn't fit? Moving toward other connective tissues that have unusual qualities as is the case of fascia - those qualities being ubiquity, variable thickness and the ability to filter chemicals, as opposed to memory storage and spiritual omniscience (for lack of a better word) - isn't going to help.

I suggest to my classes that the abnormal neurodynamic creates a patient that behaves more like someone who's suffered a stroke than someone who has broken their leg. Consequently, they need to be handled as Bobath would handle them. This is where I bring out the book The Bobaths by Schleikorn containing a comentary I wrote in '87. Pretty effective, I think. At this the class always grows especially quiet as they mull over the implications. Either that or they're just waiting for me to shut up. Maybe both.

Maybe The Third Way will require this sharp a break with tradition if it is ever to be noticed without being scoffed at.

[nari]

The sharp division that exists between orthopaedic and neurological thought as occurs with outpatient stuff and neuroRehab, has annoyed me for years.

It's a chasm. I've had clever junior PTs arrive in the acute neuro ward who tremulously told me they 'knew nothing' about neuroRehab. To them, it was another world, of vague and uncertain techniques, whereas jumping on someone's spine was 'definitive'; or 'you know what you're doing there.'

The orthopaedic model fits in with pain sometimes..provided the presenting patient has a definite 'cause'..eg, the surgeon hacked out the knee and stuck in an artificial one. The techniques work, but the reasoning behind them is off the mark. Like MFRers and their murky concept of the matrix.

A sharp break with tradition is needed; that is nothing new, but suggest that to the muscle and joint PTs and one is likely to be burnt at the stake.


Nari

[Diane]

How about Third Way Institute of Online Manual Learning? (TWIOML? OK, needs work. Becoming IIMMP-ish feels/seems ok...)

Nick, the osteos are advertising like crazy here too. (It's as if Canadian osteopathic group just got around to noticing that PTs exist, might be hungry to learn ways to use their hands, and seek to make $ marketing workshops. Not cheap either, at about $600/month over a three to five year period, to achive a sort of manual osteo certification; I worked it out a few years ago. Meanwhile I availed myself over the last 20+ years of similar workshops offered near Seattle.)

I can sooooooooooooooooo relate to what you said about feeling like a misfit, hanging out in manual therapy limbo between the joint poppers and their myths, and osteos' myths, but clinging to the techniques the osteos salvaged. I agree with your set of "things people need", structure, acknowledgement and belonging. We definitely could offer that. Your labor is progressing well. :)

Nari, I think the great divide has been there since the beginning. Remember the profession sort of was a marriage between massage nurses and army gymnasts who popped stuff. The girls and the boys. The neuro (more female probably) and the ortho (more male probably.) I like that we can be inbetweens and hybrids. Maybe the world is finally ready for our combinatory thinking.

[nari]

Yes, it has always been there. Reinforced by the study of anatomy into neat little sections.

I am surprised that folk like Bobath, whose work never really took off in Oz, did not have more flow-on effect into ortho. Perhaps, at that stage, the holistic view of other practitioners like chiros and osteos was too weird and 'magical' to even contemplate incorporating holism in physiotherapy; especially the notion that nerves are 'weak' and need manipulation of the hard and soft tissues to function better. However, in hindsight, the notion of a weak nerve may not be as silly as it sounds.....

nari

[Barrett Dorko]

Diane,

Following your lead I would be described as some sort of therapy metrosexual. I really can't quite describe how I feel about that.

Another thing comonly said by the ortho people is that they are "concrete" thinkers. I always felt that this implied I was spaced-out all the time - kind of like Phobe on Friends.

In other words, not exactly a compliment.

[Barrett Dorko]

Potential students of such a university should be told of what Charles Hayes says about the 21st century.

It’s to our advantage that technological advances are changing the emphasis in human learning and working skills from the ability to be storage repositories of knowledge to the ability to navigate through knowledge systems.

Too often I see that my students resist exactly what Hayes says we will/must become.

[Diane]

I would be described as some sort of therapy metrosexual There's no need to even go there, it's not what I intended.

Combinatory thinking of the sort we're doing here collectively has the benefit of being no longer gender based or gender reinforced. I.e., the one gift post-modernism has given us, is the blurring of all that segregated cognition/socialized role rigidity in thinking/expression. Hurray. That's all I meant.

I very much like Hayes vision and agree with it. I don't think we should squeeze ourselves into tighter and tighter definitions of who we are or what we can do. We can do it all. We can learn whatever we need to learn. Loren Rex D.O. said simply, "Don't ever let your education interfere with your learning."

[nari]

Here's my list: (References would be included with each section)

Critical thinking
Embryology
Consciousness and nonconsciousness
The Abnormal Neurodynamic
Essential diagnosis
Adaptive potential
The End of Evaluation
Basic CBT or DBT
Nonconscious movements
Somatics/Feldenkrais/Motor learning
CAM and traditional PT aspects - EBP significance



Nari

[bill]

Nick,

I'd love to take on the marketing when the time comes to do so. I think about it in a neuro sort of way...goes in the eyes...to the brain...to the arm...to the wallet...out pops the money.

I do think of this as a sort of hybrid of ortho and neuro. I've taken Barrett's course twice. Once as a relatively new grad...watching Barrett have a conversation with a couple of the "big hitters" at that time (Nyberg, Kraus)...thinking..."wow, those guys are right there!"...(had a similar thought when I literally ran into Schwarzenegger backstage last year, I digress...). The second time as a "seasoned" therapist years later.

The second time was after I had been practicing a form of manual therapy that is not like Ola/Stanley/Kaltenborn/Cyriax/Maitland/forgive me of who I am leaving out...no need to go into that here but after that course I felt that my "orthopedic model" definitely had some neuro aspects if I allowed that thought to enter my practice. Of course my mentor at that time thought I was full of crap...of course that is because it wasn't his idea.

There were certain things Barrett mention/looked for (lack of ext rot of hip in a previous post/picture) and some of the exercises we gave post treatment.

Long post...sorry...did I mention I'd help with the marketing?

bill

P.S. "Coming soon to an auditorium near you...the bridge between the ortho and neurological modes of care..."

[Diane]

bill, "Coming soon to an auditorium near you...the bridge between the ortho and neurological modes of care..." With all due respect, the word "bridge" seems so ... um.. downmarket. How about something like:

:eek: Tired of having to jump back and forth between perspectives all day long?
:eek: Exhausted from having to use multiple mindsets to manage your practice?
:eek: Sick of feeling unfairly s-t-r-e-t-c-hed beyond your own common sense?:thumbs_do
Hold on, your world is about to change.......
"NEWSFLASH!!!!"
The human organism is an integrated system!
This brand new System of Manual Care will TRANSFORM both you and your PRACTICE!!!
You are your own future!!!* Live it NOW!!!
BAM!!! The old neuro-ortho dichotomy is GONE!!!
In its place we offer a meme bending/busting/breaking/bombing process of integrated thinking that combines the two old views in ONE EASY APPLICATION that will leave you breathless and dizzy from cognitive relief!
Your patients will LOVE you!:love: :angel:

(Click here to read thousands of testimonials from thoroughly ecstatic satisfied ex-patients.:thumbs_up )

(*Sign now for this amazing training program 10% off! offer good only until end of March spaces are limited hurry place a small deposit to secure your spot in this amazing transformative adventure into your own prosperous future*)":D :D :D :D :D :D :D :D :D :D :D :D

[bill]

Diane,

You totally nailed it!!!!!!!!!!!!!!!!!!! The headlines are remarkable. I want to sign up already!

bill

i really have to dig around here and find out how i can make my post more expressive.

[Diane]

bill, it's completely .. (me at a loss for words) ... I hate anything like this, directly jerking on one's emotional chain, that makes our new institute sound like yet another oven cleaner... we can do better I'm sure.
It is instructive, I think, though, in pointing out the kind/flavor of advertising memes to which we are exposed on a daily basis.

(YOU TOO!! can write fancy posts by going advanced, checking out wrapping your text with color codes, fonts, font sizes, bolding and italics, and using the "preview post" feature to check your work before actually posting it.)
Cheers,

[bill]

Diane,

It's really all relative. Emotions drive the system. While I agree with you (again) about the chain yanking, people essentially don't buy products they buy benefits. A story I heard was that someone shopping for a drill at Sears really doesn't need a drill from Sears. What he needs is holes.

The headlines could be altered for sure and should be as this is in an embrionic stage.

You also aren't selling to yourself but the general PT that's walking around with the dimmer on low.

bill

gotta check out the advanced stuff when I get more time. wow I'm having fun again!

[Nick]

Diane,

I like the neuro-ortho dichotomy is gone! I see this as a wake-up call. Time for people to inform their practice. Research is not about producing a cookbook based on CPRs and RCTs. Yes, that stuff can guide us in practice, but it needs to become more about what we think. IIMMP will not be about a system of manual care, but about integrated systems thinking. That ought to lead to criteria for what sensible care would look like.

Barrett, can you post your complexity cartoon (1+1=2). That guides my whole treatment philosophy. I want to understand all the complexities I can, but I want to convey the simplicity to my client.

We are exploring the deep model of manual care. If we are talking about developing a educational product, what are the benefits that would make people buy?

Nick



Nick

[Barrett Dorko]

Nick,

I don't have that cartoon in my power point format but I'll see what I can do.


(Picture added)

[Nick]

"Scientific medicine was successful because it combined empirical proof with a deep model. This combination guards it, to a great extent, against chance, bias, and fraud. We will accept an empirical proof if it fits (even at the far, nebulous margins) the model of the physical world that we use. The model applies to the whole of the physical world, including our bodies. This model changes. A scientist can be defined a person who looks for explanations at the far fringes of the deep model and brings these fringes to the centre."

quote from BMJ editorial excerpted from "No Deep Model" on www.barrettdorko.com.


This is a good statement of exclusion criteria and overall philosophy:
"We will accept an empirical proof if it fits (even at the far, nebulous margins) the model of the physical world that we use."

Note to Walt, Dave, Pia, and other MFR lurkers:
Yes, you are BEYOND the far, nebulous margins.
And no, we can't change the model of the physical world to fit your theory. It does change, but based on scientific discovery, not Barnesian ideology.


The deep model is the core. We will accept all manner of manual care that at least attempts to make their model fit what is known rather than constantly pointing to all that is unknown. IIMMPers will be scientists moving appropriate manual care and movement therapy to the center of pain management.

Nick

[Diane]

Nick, I like the neuro-ortho dichotomy is gone! I see this as a wake-up call. Time for people to inform their practice. Research is not about producing a cookbook based on CPRs and RCTs. Yes, that stuff can guide us in practice, but it needs to become more about what we think. IIMMP will not be about a system of manual care, but about integrated systems thinking. That ought to lead to criteria for what sensible care would look like. Your vision takes crisper shape every day.
We are exploring the deep model of manual care. If we are talking about developing a educational product, what are the benefits that would make people buy? Good question. It must relate back to what you said before about what people want (structure, acknowledgement and belonging).

bill, the ad copy definitely needs tweaking. Just looking at it makes me jumpy.

[Diane]

Nick, the cartoon is up in Barrett's post.

[Nick]

Some food for thought...
"Only two centuries ago, we could explain everything about everything, out
of pure reason, and now most of that elaborate and harmonious structure has
come apart before our eyes. We are dumb... We have discovered how to ask
important questions, and now we really do need, as an urgent matter, some
answers. We now know that we cannot do this any longer by searching our
minds, for there is not enough there to search, nor can we find the truth by
guessing at it or by making up stories for ourselves. We cannot stop where
we are, stuck with today's level of understanding, nor can we go back. I do
not see that we have any real choice in this, for I can see only the one way
ahead. We need science, more and better science, not for its technology, not
for leisure, not even for health and longevity, but for the hope of wisdom
which our kind of culture must acquire for its survival.
...................Lewis Thomas, 1979"


Does anyone else agree that such wisdom ought to mean more than following Evidence-Based Clinical Practice Guidelines? Any thoughts on how to create boundaries without imposing restrictions?

I like that idea of far, nebulous margins. Maybe I just like the word nebulous. The deep model of physiotherapy is sorely lacking. We can't bring something from the fringes until we've helped clarify the deep model. We are dumb...but we can ask the important questions...and begin finding answers.

Nick

[Barrett Dorko]

This week here in the states on National Public Radio there's a daily report about the treatment of backache dominated by a few therapists at the forefront of the EBM movement. It makes me ill.

Nick, I love your question about creating boundaries without imposing restrictions. It mirrors one of my favorite cable series on HBO, Deadwood. Not a show for everyone, I know. But here the creator, David Milch, asks and attempts to answer the question "How do you create order where there is no law?"

It is a complex issue and will inevitably invite conflict. Leadership of a certain sort seems to be the primary answer - but not the only one. What I see the EBM people doing is imposing law upon a realm of dysfunction and care that cannot and will not be ordered to the extent they would prefer or dream it will be. I think the insurance companies are cheering for them, which is another reason to remain highly doubtful about the "goodness" of EBM.

They're going about this backwards and with a vision of clinical reality that has nothing to do with what I see in Cuyahoga Falls.

Having said that, if I should die mysteriously in the next couple of days, please point the detectives in the direction of this post.

[nari]

EBM and EBP restrict on the premise that the body behaves like a machine. There is no deep model concept, because the researchers who produce results are not interested in looking at far, nebulous margins. Neither are the organisations who put up the money. That's in the realm of deep water and they hate to tread water.
What widespread EBP will do is keep everyone near the shore between the flags. That's the restriction. The flouters of that rule are the board-riders who move on out until they run out of wave formation; their boundary is the rising formation of the wave that started somewhere off Chile....and that is no mystery or fable, it's a fact of ocean currents.

I've seen open minded PTs, keen as proverbial mustard, slowly dragged in to stay between the flags. It's subtle, pervasive and destructive; not the concept, but the widespread interpretation of EBP. In Oz, it is the fear of being labelled "a bit offshore"..and it is getting worse by the year. It hasn't anything to do with insurance, as we can practice whatever we wish and it has nothing to do with them. It's the 'leaders' within the profession.

Nari

[christophb]

While I have nothing to add, these discussions are definitely my little place to go and feel safe for a while. When things get to be a little too much in the clinic, I just return here for a while, read a bit, and all seems right in the world... Thanks

Chris

[Barrett Dorko]

Chris,

This is very nice to hear. Often I make therapists feel just the opposite.

This is from Ian Stevens:

Hello Nick, Barrett ,


Re models and depth .....it seems everything at a certain level may be
explainable by gene expression ? Louis Gifford suggested we are all gene
manipulators !

Ion channel density / physiological alterations may explain sensitivity
disturbances and reasoning may leave one to assess the usefulness of
defensive behaviours of the organism? Even at this purely 'reductionist' level it is amazing the potential for variability and unpredictability . A good account of this is Nature via Nurture by Matt Ridley.

I have been reading around narratives and the work of Rita Charon .
http://www.columbia.edu/cu/news/media/01/ritaCharon/
One thing I read which sounded useful is the analogy with analogue and
digital time pieces . With a watch with hands one can see the time before
and after (one has a reference so to speak) .With digital one can see the
numbers exactly .This is what EBM seems to me to be about, a snapshot which is applicable in isolated events which are reproducible. The variabilities and pecularities of practice in the real world just does not seem to square up with the dictats of the bright shiny logical world of EBM.

It seems to me that a pamphlet should cover 99% of problems -- lie down if
it really hurts for 2 days max, adequate analgeisa and get going ....simple
and should remove the whole industry . What I find is a complex narrative
bound up in suffering which one could possibly explain by a deep
neurophysiological model but one could equally use historical documentation
and personally relevant family events to explain why this person is just not
coping.....I think society needs an outlet for many existential problems and
pain is really it and for many the best reason and 'excuse' for personal
attention.

I think the sooner we acknowledge that suffering and 'illness behaviour' are
the root 'sociological' issues that are increasingly prevelant in our
culture and that medicine is now the way people cope the better .
I think there needs to be an overhaul and I am not convinced that EBM is the
answer either.

Often papers prop up ones interests, whether pharmacological or manipulative without a deep understanding of the major issues involved . To appreciate what are the major issues presenting and causing disabiltiy on an incresing scale it is my opinion that David Morris presents a better overview than any orthopaedically focussed clinician . It seems strange to me that English Professors (Elaine Scarry /David Morris ) grasp neurobiology and cultural aspects of biology clearer than many in the medical profession.

ian

[Nick]

"We have discovered how to ask important questions, and now we really do need, as an urgent matter, some answers."

Urgency seems to be what EBM is all about. I constantly hear all these things physiotherapists must do to survive. Fighting for survival is obviously an urgent matter. Many have woken up to the reality that a lot of what we have done for years is not very effective, if not outright ridiculous. Many are trying to build a foundation under tools that are not fit for the job in order to "prove" that they are in fact up to the task.

Ian, I completely agree with most of what you have said, but I'm not sure that a pamphlet is really going to solve existential problems. I think therapists should accept a role in supporting people through such challenges. Maybe I am wrong. Can you tell us what the overhaul you would suggest would look like?

Nick

[Jon Newman]

I agree with Nick that the current pursuit of EBM (as it pertains to PT and pain) seems to address urgency. Unfortunately, I think it is at the expense of relevancy. Perhaps this is what Ian was getting at with his post.

[Barrett Dorko]

From Ian Stevens:

Nick ,
No I didn't mean that a pamphlet would ! What I meant was that mechanical
lbp 'should' be simple -inflammation-threat response-avoidance -
remobilisation no disability (like the huge majority of ankle sprains)
I think that for many our task is more complex . In the pain clinic
situation problems are maintained by a huge range of issues ranging from
sudden assaults possibly causing an initially huge volley of nociceptive
information (ranging from physical trauma to invasive investigations around
the spine). Sometimes its a narrative that Cassells describes where the
grumbling discomfort is stoically ignored until social factors around the
person slowly or dramatically change that is the problem.

This side of life which is in my opinion extremely common may be reasoned
with neurobiolgy perhaps but may require a different approach which needs an open empathatic attitude .Sometimes this does help and many people simply come to accept their situation with a different attitude ......This happened recently with a lady who is the practice 'heartsink' . This lady has been for every test known to western medicine and her back flare this time was likely to have been promoted by an endoscope where the analgesia was botched.

When I treated this lady over a prolonged period --her back story was
metaphorically one of support or perceived lack of it .....It was if her
spinal column was a metaphor for her life in a way . As a younger person her
Father committed suicide after trauma in the war and her mother couldn't
cope and was incarcerated in a mental hospital .This left this woman the
task of coping which she was ill equipped to do so . Now she told me this with no attempt to elicit this kind of dialogue as I was touching her back and explaining some basic pain physiology and after she had read my copy of Butlers explain pain book. Periodically this lady will likely come back and I will do what exactly ??

This is exactly the conundrum that EBM will never address ....Many similar people slide into the 'care' system for pointless further tests and sometimes operations ........

ian

[bernard]

My proposal: :embarasse

Scientific
Internet based
Medicine for
Professionals:
Learning and
Experience.

[Diane]

The acronym is catchy Bernard! I propose we substitute "Manual therapy" for "Medicine." Except that would imply that hands-off treatment isn't included, which it is.. Hmmnn.

[bernard]

Scientific
Internet based
Manual Therapy for
Professionals:
Learning and
Experience.

[Diane]

That's actually pretty good! Not bad for a English as a second language speaker, brilliant even. Hats off, :D :thumbs_up:

[Diane]

Here is Nick' original IIMMP: International Institute for the Manual Management of Pain.

Here is Bernard's S.I.M.P.L.E. :
Scientific
Internet based
Manual Therapy for
Professionals:
Learning and
Experience.

Is there an IIMMP in SIMPLE?

I don't like the word "management" for so many reasons. Sorry Nick.
Too many letters.. I like the idea of the acronym being "simple" but ideas on reorganizing it aren't coming easily to mind.

When I read through the whole thread again I noticed that you have your heart set on some kind of certification Nick. Any ideas how that could be achieved? Would we need some sort of institutional acreditation ourselves?

[nari]

A suggestion:

Scientific
Internet-based
Movement therapy for
Professionals;
Learning
Experiencing
Reasoning


Nari

[EricM]

Good one Nari. A SimplerWiki. We can each become Simple Contacts representing the online collective of international therapists for the study and distribution of pain science. Its fun to play with words. :D

eric

[nari]

I think movement may be better than manual, for us weirdos who don't do much hands-on. The aim is the same : = movement.

Nari

[Barrett Dorko]

I agree that the movement part is far more important than the manual part. I put "manual" in the course title because I feel things start most efficiently in that way but emphasize its abandonment as soon as possible.

Whenever I hear a therapist carry on about their hands I know they'll have difficulty relinquishing this portion of the care they provide. I know that for many therapists passive manipulation and palpatory accuracy are both about the control they imagine they maintain and the skill they think they possess. But I always say, "Your patients will not be helped by the skills you possess nearly so much as by the depth of your knowledge."

This is good news for some and very bad news for others.

[Diane]

I like movement better than management but would like manual to be there too... somewhere.. as in manual/movement therapy? Two Ms buried into one? Could be both, or just one of them at a time?

Thanks for coming up with that Nari. Certainly there will be little if any place for exercise in our little school, so movement replaces that, and experiencing is preferable for an "E" word. :)

Here's a suggestion:

Science-based professional
Interactive
Movement (including manual) therapy for
Pain relief, emphasizing
Learning,
Experiencing, and
Reasoning.

[nari]

I like that one, Diane. :)
Perhaps it is a little wordy, but it encompasses a lot.

Nari

[Barrett Dorko]

Diane,

That last one did it for me. I think Movement/Manual, or vice-versa would be best. The word "manual" will draw many toward the work.

[Diane]

OK.. we're closer... how would you feel about letting go of the word "mangement" Nick? Or maybe we should keep "IIMMP" for the cover on promo we send out to attract the academics and use "SIMPLER" further in. We can turn it around for clinicians, use SIMPLER on the outside and IIMMP on the inside. :D

A course correction on the last suggestion:

Science-based professional
Interactive
Manually elicited movement therapy for
Pain relief, emphasizing
Learning,
Experiencing, and
Reasoning.

We can't go on hiding behind science anymore you know. We have to start flaunting it instead. :D

[Nick]

Diane,
I see where you're coming from with relief versus management. I have just found that a relief-focus lends itself to a fix-me mentality on the patient's behalf.

I like SIMPLER, but don't think it should be the name of the group. Maybe just the curriculum.

How about PSI for Pain Science Institute?


I do think certification of some kind ought to be an end point. Wrt to accreditation, I think it probably depends on CEU approval and what we'd like to achieve on that end.

As the poem that kindled this thought acknowledges, information changes rapidly. What we do in the clinic, may not change radically (although in some cases it should); however, what we understand is much more important. I think many could gain that information and build that wisdom though online interaction. No need for travel and a lot of wasted time and money to listen to a guru who acts like they've reinvented the wheel just because they've trademarked something and repackaged it with "quantum" marketing. It is outrageous what some of these folks think their ideas are worth. I'm sure most of you agree that what you have learned here and on other sites has been invaluable. Unfortunately, this kind of interaction is not as fascinating for many as it is for us. Therefore, we need to answer the "What's in it for me?" question. The answer - certified SIMPLER from PSI!!!

Nick

[nari]

Nick,

To me the word 'management' can be interpreted, easily, as the therapist managing the patient and the pain. It can also mean something quite different if we take the therapist's coercion/control out of the picture...we start to recognise self-efficacy and management by the patient. However, synonyms of management all suggest control of one person or persons by another. So at this point, I have no alternative to offer.

Maybe, what we want to achieve (that dreadful word mission statement :eek: ) needs to be spelt out further. Do we want to be missionaries? Or a friendly society? Are we evangelising or just presenting to anyone who is interested in changing? Do we try to catalyse that process, like a little bunch of enzymes? In a way, that would be interesting; however it has marketing problems...unreceptive listeners/readers.

Back to MI tactics?

Nari

[Jon Newman]

Nick, PSI is truly inspired.

[Diane]

I agree with Nari on what the word "management" usually conjures up.
Rather than "relief", I considered the word "wrangling" but thought it was probably too slangy or cowboyish... on the plus side, it does imply struggle though, and eventual victory - by the patient, not the therapist. Patient plus therapist, wrestling/wrangling/overcoming pain. Ideomotor movement can certainly appear like strong self-wrangling sometimes. A bit more active sounding than relief.

Deconstructing the word "relief"; even though it sounds like a passive state it still has to be achieved somehow within the brain of the patient. There's nothing in the preceding part, "manually elicited movement therapy," that sounds passive to me, although it doesn't sound aggressive either. It sounds like the patient is going to move, that movement is the therapy, which it is. Maybe we should change "Manually elicited movement therapy" to "Manually elicited consummatory actions." Then "relief" sounds less passive or bestowed, more fought for and attained?

I quite agree that SIMPLER remain curricular, and I very much like "PSI" for the school.

[nari]

I wonder about the use of the word consummatory?
It makes sense to us, but to how many others who might be just looking?
Sounds rather....offputting, perhaps.

Nari

[EricM]

On the news here tonight they did a story on a spelling B competition and one of the words they had to spell was 'bibliotherapy (http://www.minddisorders.com/A-Br/Bibliotherapy.html).' I found the definition of the word on this psychotherapy site and think that with a few minor modifications it describes exactly what I get from reading here. I'm not seriously suggesting including it in the title (yet) but the idea of learning here being therapeutic is interesting.

It also begs the question, should there be any precautions to learning on this site? :zip:
eric

[bernard]

Sorry guys but PSI isn't my preferred. Google will indexes it in the "technical" world.

PSI (http://www.ilpi.com/msds/ref/pressureunits.html)

Some more brain storming to do. :zip:

[nari]

I think some have already expressed a therapeutic effect from reading/learning on this site. If nothing more, it can be inspirational while still continuing to practice the same as before, and that is not a bad thing.
As to risks....the usual suspects, such as assertiveness vs aggressiveness, unrealistic expectations, the complexity of individual needs, etc etc. I suppose QA comes into that scene too.

I'm only half kidding.

Nari

[bernard]

Hi All,
I created a new forum for our project.
It is strictly reserved to SomaSimplers.

SIMPLER Project (http://www.somasimple.com/forums/forumdisplay.php?f=92)

[nari]

Looks good, Bernard.

PSI will lead people to tyre pressures....uhoh.

Back to the drawing board.

nari

[Diane]

About PSI, there are lots of different groups of widely differing variety all using the same acronyms out there in the world. Try googling PABC and you'll see. There's nothing wrong with Pain Science Institute and Pounds per Square Inch sharing the same acronym, is there? Educate and veils fall away. Get the acronym out there and it will successfully compete for meme space on google. :) :thumbs_up

About the word "consummatory", it has a specific meaning in science, meaning the reduction of a need or a drive that is instinctive. I think some education should happen around that word, to make it be one PT can adopt effortlessly. Pat Wall came up with that, specifically to do with pain reduction. Good enough credentials IMO for our school. :) :thumbs_up

[bernard]

Diane,

An internet tip : If you want to be found in the crowd, avoid names that bring you in the crowd.

SomaSimple was made like that and its uniqueness is its strength.

It is better to find an unique name.

[nari]

Bernard, I agree with you.

If this venture is going to work, the acronym needs to be unique..NOI is not unique, but there is very little competition. RehabEdge is unique.

I'm not fussed about the word consummatory - let it be.


Nari

[bernard]

NOI gives unfortunately more than 80,000,000 pages.

[Luke Rickards]

What about Institute for the Study of Pain And Movement, or iSPAM? :D :D

[Bas]

Can we not subtitle the whole beautiful process you folks here have developed: "A Unified Theory of Therapeutic Interaction?
Or anything with the term "unified"? I have been plodding away in many branches of science since connecting with so many here years ago, and my dipping my toes in quantum science makes me really appreciate the unification that neuro-ideomotor-etc brings to ANY therapies....
I don't contribute much, but I am positive that this major clump of knowledge/science deserves that classifier: Unified theory....

[Barrett Dorko]

Sebastian,

I really like this. The Cleveland Clinic uses the word "integrated" to excuse their use of crazy ideas and I can't stand it. "Unified" evokes the rigor of science and invites us to see connections were we had not previously looked. This ability to form connections between embryology, neuroscience, psychology, chemistry and clinical reality is, I feel, the true strength of this group.

As Ian I'm sure would remind us, literature, story and narrative should be included. I'm wondering if we can fit juggling and harmonica playing in here somewhere.

[Diane]

Luke.... iSPAM? :D
It's catchy and unique, but lacks cachet perhaps...

Bas, I like your UTTI. It would definitely attract practitioners who want to remain science-based AND consider/learn/include all aspects of care, how to become interactive, relational, catalystic both manually and just as people.

[ian s]

http://bmj.bmjjournals.com/cgi/content/abstract/332/7536/266

truth stanger than fiction ? Barrett keep up with the harmonica!

[Bas]

Thanks. I can really see this moving into a reality - with juggling included. Maybe with Occam's razors instead of chainsaws.
The playing of harmonica may need backing of a tuba (me)....I would borrow one...

[nari]

Playing a didgeridoo is like no other instrument, except perhaps the Swiss horn. I presume it is the effort and sustained control over a fair period of time that makes it unique. The players also breathe through the nose at the same time; quite an art.

Having read through a site called Integrated Manual Therapy which espouses treatment of all sorts but recognises the primary role of the brain in the whole shebang, I would stay away from integrated; way too commonly used and over used, by everyone under the sun.

Nari

[Diane]

I'm attaching something acutally useful from a chiro school, an article on teaching submitted today on Chirotalk, called "Avoiding Pedantism".
I think it will be helpful to bear in mind for our SIMPLER school.:thumbs_up

[Nick]

I want to revive this thread to discuss "alternative" (please excuse my word choice) educational opportunities for those who see the need for a path away from or, at the very least, along side biomechanical assessment and treatment. In the last month, three therapists have expressed anxiety to me about not having enough courses on their resume if they did not take their orthopedic specialization. As if quantity is any guarantee of quality. It isn't. As two minutes listening to an MFRer will attest. Many courses are just faulty ideas stacked upon faulty ideas with very shaky theoretical foundations.

I would like to get others' thoughts recorded on three things:
(1) recommended courses and comments (Butler, Moseley, Shacklock, Gifford, Dorko, Jacobs...and others?)
(2) other learning opportunities (besides SomaSimple, of course) - maybe provide your top 3 books, journals, websites or other ideas
(3) thoughts on whether or not we can get the SIMPLER project coordinated

Finally, I suggest we plan a real-time gathering for 2 or 3 days of hands-on teaching. Where would we have it? Who would go? When is the best time?


Nick

[Diane]

Great idea Nick. I'm glad you decided to saddle up this horse again.
Maybe instead of the term "alternate", which has just too many unfortunate memeburrs sticking to it, we could use the word "ectodermal." I don't think the word ectodermal is corruptible in the same way.

[nari]

I agree that we need to avoid the word "alternative" though you did imply that its use was dodgy, Nick.

In a response to your three proposals:
1) can be tied in somehow with (3); Cory is already doing a great job on the theme of a unified theory;
2) I have to think about that one more - there are so many....

I reckon a 2-3 day get-together would make a huge difference, particularly with a Jacobs workshop. :) Theory is one thing, translating it into practice can be another. Maybe a combination of Jacobs/Dorko....?

The catch is distance; folk like Luke and I are a long way from 3 days in the Northern Hemisphere. However, that does not mean the idea of the workshop could not go ahead. Of course you could venture out of North America...say Hawaii..... just kiddin', really.

Would be very interesting if Shacklock could attend. I think that there is a heck of a lot of common ground just with those three people and not a joint or muscle in sight.

Nari

[Diane]

Oh my gosh, I'd love to meet in Hawaii!
Just think, a year ago very few of us had ever met each other. Now several of us have, one way or another, a couple people having lunch here, a few people having a workshop there.. it's coming together bit by bit, don't you think? Querencia?

[Diane]

Maybe we could move Querencia to Ireland.. I just found this survey (http://taylorandfrancis.metapress.com/(g0ougsbxqwaizsv0ipqxcpn3)/app/home/contribution.asp?referrer=parent&backto=issue,27,28;journal,6,58;linkingpublicationresults,1:101208,1) in Eugene's blog, on "reflective practice in PT curricula" done by UK professional practice coordinators. :) Maybe things are looking up!

[BB]

Nick,
I would like to see how these lists come together. I'll think a bit on how best to answer for myself.

Also, Lorimer Moseley is coming to Portland, OR on Wed. Oct. 11th for any pacific northwesterners, or southwest Canadians interested. Diane, is he coming through BC again as well?

I would love to attend such a get together of somasimplers as well. Maybe it could be video'd as well for anyone who can't attend?

[EricM]

How about Ouray (http://www.ouraycolorado.com/Home) Colorado, the inspiration for Galt's Gulch (http://en.wikipedia.org/wiki/Things_in_Atlas_Shrugged#Galt.27s_Gulch); a respite from the outside world.
"If you find a chance to vanish into some wilderness out of their reach, do so, but not to exist as a bandit or to create a gang competing with their racket; build a productive life of your own with those who accept your moral code and are willing to struggle for a human existence. ... raise a standard to which the honest people will repair: the standard of Life and Reason. Act as a rational being and aim at becoming a rallying point for all those who are starved for a voice of integrity -- act on your rational values. In that world, you'll be able to rise in the morning with the spirit you had known in your childhood; that spirit of eagerness, adventure and certainty which comes from dealing with a rational universe. ...You will live in a world of responsible beings, who will be as consistent and reliable as facts; the guarantee of their character will be a system of existence where objective reality is the standard and the judge.”
Ayn Rand - From Atlas Shrugged


Wherever, count me in. Any opportunity to share ideas and talk in person is well worth the effort.

Eric

[nari]

Australia?? ;) you'd probably have to bring your own water in a tank...

New Zealand?

Clipperton Island? (Near Mexico)

Nari

[Diane]

Nari, Mosely is attending and speaking at the ortho Division symposium in Calgary in mid-October. Sounds like the mesodermalists of Canada are going to get an earful. Just hope it doesn't fall right out the opposite ear.:D

(1) recommended courses and comments (Butler, Moseley, Shacklock, Gifford, Dorko, Jacobs...and others?)

The first three, and the fourth, are no brainers. What does Gifford teach? I thought he was mainly a writer. I don't know about Jacobs. She seems too low-key and uncharismatic.

(2) other learning opportunities (besides SomaSimple, of course) - maybe provide your top 3 books, journals, websites or other ideas

Challenge of Pain, Science of Suffering, Tunnel Book Syndromes, anything written by Deric Bownds, William Calvin, Ramachandran, Damasio, Dorion Sagan, Lynn Margulis..

(3) thoughts on whether or not we can get the SIMPLER project coordinated

There are ideas being bandied about in another room here, a private room. Cory's Unified Theory is a sample, and other ideas are being incubated. I'm personally going to be taking on the PNS, already am, in the Seeing Light at the End of the Tunnel Syndrome folder. It'll be a very big folder by the time it's cooked, as is the embryology folder. This is all raw data for the SIMPLER project. It isn't exactly being "coordinated" yet, it's just unfolding here, and I'm blowing on it to keep it lit. Well, my small flame anyway. Others are blowing on their little flames..

[nari]

Lorimer Moseley once said that it helps greatly to have "Dr" in front of one's name, as far as credibility goes. Hope he can also assist with retention and recall of new knowledge. Wherever he is, he is brave talking to orthopaedic folk; they tend to have a lot of ammunition.

Nari

[bernard]

hi All,

The quickest route to "celebrity" is Wikipedia.
A page may be created in some minutes and we have already a ton of pages...