Cross Country 56 - Why I Work Alone

[Barrett Dorko]

It’s been a quiet week in Cuyahoga Falls…

Route 422 through central Pennsylvania is mainly two lane blacktop and for 100 miles I had to focus carefully on the sudden turns and the possibility of police patrols in the small towns that straddle the road. I wasn’t scared, but I was wary. I often wonder what people in isolated areas do for a living, how a beautifully maintained home and garden came to be so far from any neighbor and if I would take that kind of care if I were the owner. Like everyone else, I spend some portion of every day looking for my self. Occasionally I see things that resound with my personal inclinations and other things that repel me. I’ve driven enough to know that there may be a surprise around the next bend in the road.

My email server is set up to intercept the spam that has grown enormously over the years and I find it does a pretty good job. So good in fact that I find it necessary to check the list of messages that are diverted because I know something I want to see might show up. Today amongst the ads and scams and come-ons I saw in the subject line: “Painkillers are here.” The epidemic of chronic pain in our culture has been well documented and I don’t see or hear much from my own profession that encourages me to think that we’re making much of dent in that. Epidemiologists will tell you that denial of any condition’s presence is sure to aid in its spread. Unlike AIDS, pain isn’t transmittable, but the things that make our treatment of it so ineffective seem to be. I’m talking here about an absence of knowledge, absence of plausible theory and fear of rejection.

I live in a neighborhood with tiny yards where the houses are close-packed. People walking their dogs often gaze at my lawn and the flowers I plant each year. I know myself well enough to imagine that I wouldn’t work nearly so hard on these things if I weren’t sensitive to this constant scrutiny. When I see that someone in the middle of nowhere and without pedestrians has put forth an even greater effort I both admire and wonder about it. It’s not me, though something inside wishes I was like that. Sort of.

Early in every course I say, “I work alone.” And then I pause. Often I see a slight startling in a few present at such an odd situation and, I think, a little envy in others. Working alone reveals so much about who we really are. I don’t spend any time trying to do things as my boss would prefer and I am free to alter programs without worrying about what this patient will say to the therapist who may treat them tomorrow. My thinking doesn’t have to find a level that the department is comfortable with. I know from talking to countless students that my information, while sensible and even exciting, would be immediately rejected by their colleagues. They say, “This stuff is great. But where I work…”

As I travel it seems that in most neighborhoods the houses and yards are maintained in a uniform fashion. I feel certain that this standard was set silently and powerfully long ago by persons no longer present. Their legacy remains and it is nurtured by those in charge at this point. Most of us know that their disapproval carries a very high price for those with the courage to risk it. It is simply easier to deny that any problem exists at all and thus stick with the program. This is something like my computer rejecting the “painkiller” message. I imagine that it assumes I don’t have any.

One evening in Altoona I opened Richard Holloway’s Looking In The Distance ( http://www.amazon.com/gp/product/1841956031/sr=1-1/qid=1156686170/ref=pd_bbs_1/104-7213658-3536738?ie=UTF8&s=books) and saw a passage explaining the work of Antonio Damasio, a leading neuroscientist. Here it is made clear that “…evolution has endowed us with a complex neural system that enables us to regulate our life in a way that maximizes well-being and minimizes pain. (Damasio) tells us that those neural reactions of pain or pleasure we call ‘feelings’ were built from simple responses to external events that promoted the survival of the organism.”

I have to remember that when I ask my colleagues to change dramatically the “garden” that surrounds their house that they will rightfully be concerned with the standards of the neighborhood in which they live. I need to remember that remaining the same from day to day, even in the absence of success or sense, is a survival mechanism they cannot just ignore. In fact, it’s easier to simply deny that there is a problem to begin with.

In the end, attempting to change the landscape of any practice that includes many neighboring therapists is both dangerous and impractical.

This is why I work alone.

[christophb]

Oh boy. Well after about a month vacation I am finally re-motivated to post again. That's what a wedding, honeymoon, and a job search will due to you I guess. I had the fortune to be able to work mostly alone after taking Barrett's course. I was still under corporate rule, but on a daily basis I was free to explore the things I learned at his course and those that I learned here. Now, I am moving on and will be in a busy clinic with "manual" therapists. One of my criteria for working in a clinic was that they had to of at least heard of Butler and Shacklock (the name Dorko didn’t ring any bells... sorry ;)). While searching for this opportunity it became painfully obvious the nature of the majority of private outpatient clinics... Mesoderm was the order of the day. It seemed clear the only way to avoid this was either to open my own clinic, quit the profession, or work in that environment and "infect" them slowly with some of the ideas presented here at soma. I chose the last option, mainly because I need to eat. One therapist I talked to while interviewing was accepting of my thought process concerning painful need states, but stressed that patients have certain expectations with manual PT and these new ideas have to be introduced slowly and taking into consideration what patients expect. I think patients, while they would benefit from simple contact, and they do, wouldn’t be resistant to it mainly because it just looks too different from what they expect. And there is a lot of momentum carrying the mesodermal expectations if my recent job search indicates anything.


Chris

[Barrett Dorko]

Chris,

Your last sentence confused me. If you are saying that patients commonly reject this sort of care because they expect something else (and you may not be saying that), I can't agree. Rejection of self-correction by patients in my office is rare. I suppose that this has something to do with the manner in which I approach the subject and each individual patient.

On the other hand, rejection of this sort of treatment and understanding (ectodermal thinking) by my colleagues is phenomenally common. Their arguments in opposition, if present at all, usually consist of "my patients do fine with the care already provided" and little else. Mostly I just get silence and denial. This works well too.

When a therapist says, "Patients expect a certain type of care and I have to provide it," I ask them, "When did you put your patients in charge of therapy?" "Didn't you go to school in order to know more than they did?"

This, of course, is a very popular approach for someone like me to take.

I'm being sarcastic.

[Diane]

there is a lot of momentum carrying the mesodermal expectations
This is true, unfortunately.
It's a quagmire and both feet are usually stuck. In a world comprised of patients on the one hand (or foot) and therapists on the other, it usually plays out like this (short version):

Patient (explaining how their body feels to them): I have a lot of pain. I feel like there's a bone out of place in my back (neck, hand, foot, whatever).

Therapist (just back from his/her 85th workshop on Bones&Joints): Wow. Right there? I can feel that too. Here, let me fix that bone for you.. there, back in place now.

Thus is the mesodermal myth reinforced daily at the level where rubber hits road; it has been this way since forever. It fractals onward and outward into 'therapy world', our own profession's cognitive realm that we are supposed to be able to control, and keep aligned with essential scientific findings, but don't care about enough to bother to update once in awhile. Courses on manipulation of joints continue to "sproing" up instead, are self-organizing, self-reinforced, self-perpetuated, people teaching people to go ever further into the kinesthetic monkey mind and ever further out of the sifting, thinking, Occam's Razor mind, because of the money making potential of pandering to perceptual fantasy. Decades later the meme is fully rooted into therapists' and therapy's neural synapses as a belief system so entrenched as to be accepted as simple fact, against all sensible, scientific, or scholarly thought. At that point it becomes "treatment culture" and the profession sinks into ever further into a pseudoscience quagmire.

Instead the therapist could do the patient, the profession, and his or her own mind a huge favor by translating what the patient says through an inner mental meme decontamination program that would identify such statements as metaphorical perceptual fantasies. They could take the opportunity to listen to the history, educate the patient for a few minutes about pain and where it arises, why, how it perpetuates, how to combat it on various levels. Their hands-on could be exploratory of, and interactive with, that patient's nervous system, like holding a flashlight up over problems out in the periphery so the patient's own nervous system could rush in to mop up it's own inner sensory-motor conflict.

But it would require learning to think, and it's just so much easier to pop, push, stretch, strengthen, manage, mobilipulate, and hope the pain goes away or define anyone whose pain doesn't go away with our professional bullying as a problem who doesn't belong attending PT in the first place, further reinforcing Mesodermality.

Chris, it won't be easy, but the fact that you know now and can't go back now, have gotten picky about your working environment for better or worse, means you're an Ectodermalist.

http://www.helendesignsaz.com/products/YOU'RE%20A%20STAR!.JPG

[gary s]

Barrett,
As much as I've bitched over the years about being "stuck" in home care, a while back I had an epiphany---This is the best environment for me! I work alone, I determine my own productivity . I am free to be an ideomotorator/tai chi-ist. I have little contact with my co-workers and prefer it that way. My patients are usually very pleased with my "methods" and often share their satisfaction with my supervisors. I once was "moved' to present an inservice on Tai Chi and rehab. It was well received, but like you, I got few "hits" afterward.
BTW Barrett, about a month ago, the chief ortho surgeon at our hospital, who does nothing but hip and knee replacements asked me how I would feel about seeing ALL of his post surgical homecare patients. Coming from him, that was a real compliment. Without sounding too sychophantic--I owe it to you.

[Barrett Dorko]

Consigliori,

You needn't thank me now, but one day, and that day may never come, you will be asked to do a service...

What turned this surgeon in your direction? This has yet to happen to me. In fact, I've heard the opposite.

[christophb]

I guess what I meant was that PT's do a good job of marketing a mesodermal approach that's easy to buy into given our cultural expectations (assuming I know that they are) I see patients taking the bait and expecting that sort of care from me. But they don't reject the correction of ideomotor movement. And most enjoy the care I provide ;). The job hunt made me think somehow that if I didn't have the extensive manual/mesodermal background that I am somewhat less effective as a therapist. The bigger the tool box, the better the PT seemed to be the thinking.



Chris (Also a ideomotorator/tai chi-ist and apparent ecotdermalist)

[EricM]

This thread has an uncanny timeliness for me as I reflect on my first 2 months in a small private clinic and dream (and plan) about starting my own solo practice. I would prefer to work in a place with other like-minded therapists, there just aren't any where I am.
I've often heard that it takes a certain kind of therapist to like working in private practice, this from therapists who may have tried it once, before opting for acute care where they seem resigned to spend the rest of their careers getting people out of bed. I have wondered what to make of this sort, is this their version of 'working alone?' Did they dislike the assembly line type of therapy and the business challenges, or at some level did they sense that something was wrong somewhere (the hole in therapy), and not having read any of Barretts work, lack the ability to define what they felt was missing? They can often be heard saying things like "I could never work in outpatient orthopaedics again, I've lost all of my manual skills!"

Having tried the acute stuff, briefly, I can say I don't want to go back, so I guess it's working alone in my future too. Damn it.

eric

[gary s]

Barrett,
It's a totally different situation. Our homecare agency, which is an arm of the hospital, gets practically all of his post-ops. He sees that the patients I get, progress much faster than with other therapists. Happy patients--less headaches for him--so it makes sense. No extra income for me--just that I get to do hands on, instead of the working with the usual suspects.

[nari]

Chris et al,

I came from an intense team environment with surgeons, nurses, OTs, psychs, social workers and one other PT (a junior) to eventually working alone in a health centre. The treatment room was mine to do what I wanted with, and I could employ any method as seemed appropriate. This was great - and I began to feel I was truly an autonomous PT. (We are anyway, but working alone enhanced this feeling of self.) The only frustration was convincing others about neurophysiology and the pain state; I found that other PTs were interested and supportive, but did not see it as relevant to what they had done for years.
As for patients, there was the occasional one who would insist on ultrasound or machines that go ping; if they didn't get them, they would go off elsewhere. I am all for placebo, but there is a limit to indulging patients' whims.
That has always been an aspect of my care; and when it blew up in my face a few times, when patients formally complained they didn't get their US and exercises, I just stood my ground and said that was not how I worked.
No problem; others may have just thought I was weird, but never said so. We are fortunate to have ingrained in us, the right to practice as we wish or see fit, provided we do no harm.
The bigger the toolbox, the better the PT.

True. But no-one actually looks closely at the circumstances of selecting the right tools. It is thought that if one owns dozens of tools, they are cleverer than the reductionists. In our own way, although we decry the phrase "more is better" that is precisely what toolbox owners are doing....going from one to the other in the hope one will 'fit' the patient's nuts and bolts.

Working alone is special. It can be a real step up from the run of the mill therapy.

Nari

[BB]

I to have been working in the "team" environment for a while now. I really work with some good people, and I appreciate the opportunity to have that social aspect at work daily. I am not limited in the manner I choose to treat either, not directly. However, the team approach brings in its own limitations. I often find that as one of my patients has had to follow up with an assistant or other therapist the message becomes mixed and all placebo is lost or worse, turned into a nocebo. All of the sudden a toolbox has been introduced and they wonder about my missing toolbox.

Working in an accepting environment is still limiting for me.

Add me to the better off (for the patient especially) working alone club.

[EricM]

Here is (http://www.hoise.com/vmw/00/articles/vmw/LV-VM-06-00-26.html) yet another reason why I want to work alone. Mesodermalists are literally grasping at straws by using this sort of fancy gadgetry to make their admitedly boring exercises engaging. I wonder how much a system like this would add to one's overhead??? Too many exotic plants not indigenous to the local climate in this garden.

eric

[Barrett Dorko]

We've discussed tools here before in at least two threads, one of them archived from years ago, and it seemed that some of us (me included) felt that there was an inverse relationship between the number of tools one was willing to use and the strength of their theory. I have very few tools, being rabid about theory as I am.

I believe Chris was saying that the people who interviewed him wanted him to have a lot of tools, and since he does, they were impressed. I'm guessing he didn't emphasize the fact that he uses very few of them. Very, uh, clever of you Chris!

I've been known to pile tools in the box in decades past and can drop names of those I've taught and worked with in the past with more speed than just about anyone in my generation of therapists. I try only to do this if I find it necessary to impress others of if I sense I'm losing an argument.

Tools such as these are extremely useful then. Otherwise, not so much.

[Diane]

Specifically about working alone or with others..
Over 35 years I've gradually distanced myself from being in the near vicinity of other PTs when working; I mean, being part of a team that is supposed to be working toward some shared goal, and having to:

a) deal with the people themselves, who I may or may not find agreeable to be around;

b) deal with the cloud of "belief" or treatment culture, feeling obliged to counter it or have to defend myself against it or horror of horrors, wake up one day and find that I actually share it against my will and better judgement.

It just takes too much energy for an introvert. Much easier to just peel away and do my own work, as I have for around 25 of those 35 years.

(A different dynamic entirely is someone shadowing me, to see what I'm doing because they are interested in learning. That is a completely unique scenario and a welcome change.)

[Luke Rickards]

You may have to get used to that Diane.:D

Luke

[Nick]

Luke is right, Diane. I look forward to a visit to Vancouver.

My life at work has been an interesting one for the last couple of years. For some reason...temporary insanity, perhaps greed, maybe simply a desire for a new challenge - who knows?...I've stretched myself WAY outside my introverted comfort zone and into a business model that, part of me at least, has begun to abhor. I long for the simpler days of life in my basement clinic. At the time, however, it felt a little claustrophobic, even for an introvert. Oh, and I had to keep the lawn looking nice for the patients. I've never liked having to keep my lawn looking nice and know that if I lived in the middle of nowhere, the "garden" would not be particularly well kept.

Since first meeting Barrett and learning Simple Contact, I felt we had a simple marketing problem on our hands. I also heard many claim that, while they like the work, it simply would not do in their own neighborhoods. I was fortunate enough to work on my own at the time and had no one to answer to except my patients (and the omnipresent, omnipotent, omniscient insurance companies:mad: ). I carved my niche and life was good. Then came my desire for more. I wanted to spread the meme. For me, I thought I could do it best by hiring people and teaching them how to think about treating people in pain. I wanted to create a business model within which the meme could propagate. I wanted a therapists to find a treatment environment that was not hostile to "doing nothing." It remains to be seen if my expensive experiment will succeed or not, but it certainly has not been easy.

Here's what it has looked like so far...
Two and half years ago, I hired a therapist to work with me in my home clinic. New grad, very open, very keen to learn. She began just in time because six months after her hire, my life went topsy-turvy with the illness of my daughter. I was away from the clinic for most of the next 6 months. A business that had been built mostly around me and my reputation ground to all but a halt and was in need of major resusciatation when I returned. We rebuilt within a month or two when my wife and I decided we needed to move to be closer to the Children's Hospital. Interestingly, the whole experience contributed to my rethinking of my business model and made me desire a business that could, potentially at least, continue operating in my absence. Begin phase 2...

So I close my practice and move 2 hours away to the city. I had decided to open a new clinic that would combine pain management and strength-based rehab and also offer personal training. yes, unlike many of you, I think there is a role for strengtheening and conditioning once pain has been adequately addressed and for a number of other conditions for which a pain management approach simply is not appropriate. Being a contrarian by nature, I chose a method / philosophy of exercise which I think is great but which is very different from people's expectations. More meme-busting. In addition, although properly applied pain management and strength training can be complementary, they are often at cross purposes and I have inadvertently set up competing memes within the same office. For example, the client in pain who wants to "get stronger" because they believe it will solve their problem and I have to talk them down from an exercise approach because it is not appropriate for them at that particular time. So now I have a training room full of expensive equipment, two trainers trying to develop a contrarian approach to exercise in an industry WAY more full of ridiculous memes than even the rehab world, another therapist vaguely interested in pain management who thinks Simple Contact is interesting at best, and a ton of stress from trying to manage it all and make it work.

Now they say you can't go back again and I'm not even sure I want to, but damn you people make working for yourself sound good. I will no doubt rejoin you some day.

Nick

[Jon Newman]

Wow, Nick. Difficult wouldn't do justice to what you're tackling. There isn't a "life change scale" to accommodate your circumstances I don't think.

The 'work for yourself' folks do make it sound good. I like to think I'm waiting and not procrastinating.

It sounds to me like you're the best kept secret in your neighborhood. Too bad for you...lucky for those that find their way there.

jon


ps I lifted weights tonight in a manner similar to what you've described elsewhere and enjoyed it very much (in a "I'm glad I'm done" sort of way).

[Barrett Dorko]

Nick,

Yours is a remarkable story. I always describe you to my classes as a solitary practitioner who sits and thinks up great threads like "A Consumatory Act" and I see I'll have to change that to "He used to be..."

The weights and the treadmill still play an important part in my personal life. I just don't see how they contribute to my tolerance for prolonged sitting. No doubt, regular aerobic work enhances adaptive potential, and its relation to pain relief probably lies in that.

You're right about the contrarian memes attempting to co-exist in a culture where the division between health and appearance, painlessness and strength, endurance and tolerance is so poorly defined. As David Morris reminds us in Illness and Culture in the Postmodern Age, “Health no longer refers, via metaphor, to the ideal social state that generates it but instead signifies the perfection of a single private self. Further, good health is not exactly the issue. What matters is that the individual body appears healthy. Image is everything. The average family lives in a realm of pictures created with the favored postmodern technologies of camera and videotape where they cannot avoid versions of the same subliminal message: the healthy-looking body is the beautiful body; and the beautiful body is the healthy-looking body.”

Given this, those places where training is provided often resemble beauty parlors more than they do therapy departments. It’s no wonder that those who go there for care become inordinately concerned with posing rather than being themselves. I think this attitude is commonly reflected in the therapists as well. I see no evidence that either the staff or the patients suffer less discomfort than the general population.

In effect, you’re serving two masters. Good luck with that.

In any case, as always, I admire your effort, and I will never forget how much your thinking has contributed to my own practice and teaching.

[Barrett Dorko]

Here's an idea. Print out Martin Luther King's "I Have A Dream" speech (which was some pretty good writing, I'm sure you would agree) change it to "I Have A Meme" and substitute some lines appropriate for an evangelistic ectodermalist.

Something like, "I look forward to the day when our patients will not be judged by the strength of their muscles, but accepted for their unique ability to self-correct their abnormal neurodynamics!"

Okay, this might take a little work.

[Diane]

You go Barrett! I like it, it's a good start!

[Nick]

"In effect, you’re serving two masters."

Actually Barrett, I prefer to think of it as mastering two servants. Either way, a good deal of luck is apparently required. I don't think you would find my clinic much like a beauty parlour, but it is certainly an interesting juxtaposition between our two services.

I do like the speech idea.


Almost one score ago, a great Australian, in whose shadow we stand, wrote Mobilization of the Nervous System. This momentous decree came as a great beacon light of hope to millions (okay, a few hundred) physical therapists who had been seared in the heat of the hydrocollator. It came as a joyous daybreak to the end of a long night of confusion. But sixteen years later, we must face the tragic fact that the physical therapist is still bewildered.

Sixteen years later, the life of the physical therapist is sadly crippled by the manacles of managed care and the chains of evidence-based medicine. Sixteen years later, the physical therapist lives on a lonely island of illusion in the midst of a vast ocean of research. Sixteen years later, the physical therapist is still languishing in the corners of health care and finds himself an exile from the doctors' lounge.

So we have come here today to dramatize an appalling condition. In a sense we have come to SomaSimple to cash a check. When the architects of our profession wrote the magnificent words of our Code of Ethics and Scope of Practice, they were signing a promissory note to which every physical therapist was to fall heir.

This note was a promise that all physical therapists would be guaranteed the inalienable rights of life, liberty, and the pursuit of happiness. It is obvious today that Blue Cross has defaulted on this prmissory note insofar as physical therapists are concerned. Instead of honoring our work, insurance cos. have given physical therapists a bad check which has come back marked "insufficient funds." But we refuse to believe that the bank of HMOs is bankrupt. We refuse to believe that there are insufficient funds in the great vaults of financial institutions of this nation.

So we have come to cash this check -- a check that will give us upon demand the riches of freedom to think and the security to practice in accordance with the natural law of the universe. We have also come to this hallowed spot to remind people of the fiece urgency of now. This is no time to engage in the luxury of cooling off or to take the tranquilizing drug of gradualism. Now is the time to rise from the dark and desolate valley of mesoderm to the sunlit path of neurophysiology. Now is the time to open the doors of opportunity to all extodermalists. Now is the time to lift our professions from the quicksands of superstition to the solid rock of science.

It would be fatal for the profession to overlook the urgency of the moment and underestimate the determination of the SomaSimplers. The sweltering summer of the SomaSimpler's discontent will not pass until there is an invigorating autumn of thinking and theory. Two thousand and six is not an end, but a beginning. Those who hope that the SomeSimpler needed to blow off steam and will now be content wil have a rude awakening if the profession continues with business as usual. There will be neither rest nor tranquility in Physical Therapy until theory is considered at least as important as evidence, until why has ascended to the level of what and how.

The whirlwind of revolt will continue to shake the foundations of our profession until the bright day when thoughtfulness emerges. But there is something that I must say to my people who stand on the warm threshold that leads into the palace of the brain. In the process of gaining our rightful place we must not be guilty of wrongful deeds. Let us not seek to satisfy our thirst for placebo power by drinking from the cup of mobilipulation.

We must forever conduct our struggle on the high plane of dignity and discipline. We must not allow our creative protest to degenerate into name-calling and condescension. Again and again we must rise to the majestic heights of meeting physical force with gentle hands.

The marvelous new militancy which has engulfed SomaSimple must not lead us to distrust of all other therapists, for many of our colleagues, as evidence by the occasional surfing of the net and lurking on our board, are coming to realize that their destiny is tied up with our destiny and their freedom is inextricably bound to our freedom.

We cannot walk alone. And as we walk, we must make the pledge that we shall march ahead. We cannot turn back. There are those who are asking the devotees of neurobiology, "When will you be satisfied?" we can never be satisfied as long as our bodies, heavy with the fatigue of sitting at our computers, cannot gain an audience in the greater health care community. We cannot be satisfied as long as the physical therapist's basic mobility is from one tissue to another. We can never be satisfied as long as a therapist in Cuyahoga Fallls cannot get others to listen and a therapist in San Diego believes he has nothing to listen to. No, no, we are not satisfied, and we will not be satisfied until action potentials roll down like waters and synapse like a might stream.

I am not unmindful that some of you have come here out of great trials and tribulations. Some of you have come fresh from Myofascial Release courses. Some of you have come from areas where your quest for knowledge left you battered by the storms of guru worship and staggered by the winds of postural assessment and manual muscle testing. You have been the veterans of creative suffering. Continue to work with the faith that unearned suffering is redemptive (especially teaching Cross Country).

Go back to British Columbia, go back to Ohio, go back to Wisconsin, go back Down Under, go back to the departments and clinics, knowing that somehow this situation can and will be changed. Let us not wallow in the valley of despair. I say to you today, my friends, that in spite of the difficulties and frustrations of the moment, I still have a meme. It is a meme that must grow roots within the meme of Physical Therapy.

I have a dream that one day this profession will rise up and live out the true meaning of its creed: "Physiotherapy - it'll move you!" I have a dream that one day on the rocky shores of Nova Scotia the daughters of neurodermomodulators and the sons of manipuloids will be able to sit down together at a table of consensus. I have a dream that one day even the state of Ohio, a desert state, sweltering with the heat of ignoring the obvious, will be transformed into an oasis of free movement and thoughtful touch. I have a dream that my three children will one day live in a nation where they wil be judged not by the strength of their muscles or the erectness of their posture or their ability to sit still but rather by their willingness to move freely without permission and their authenticity and enduring comfort in the face of cultural challenges. I have a dream today.

I have a meme that one day the world's physical therapy associations, whose press releases are presently dripping with the words of myokinematics and joint biomechanics and even fascial fantasies, will be transformed into a situation where little chiropractors will be able to join hands with little physical therapists and walk together down a path enlightened by neurobiology. I have a meme that one day every neuron shall be exalted, every joint glide made low, the muscle will be made plain, and the skin made alive, and the glory of the nervous system shall be revealed, and all flesh shall see it together. This our hope. This is the faith which I return to the Internet. With this faith we will be able to hew out of the mountain of despair a stone of hope. With this faith we will be able to transform the jangliing discords of our professions into a beautiful symphony of social grooming. With this faith we will be able to work together, to write together, to juggle together, to go online together, to stand up for thinking together, knowing that we will be free one day.

This will be the day when all physical therapists will be able to sing with a new meaning, "Neurology, 'tis of thee, sweet subject long forgot, of thee I sing. Orthopedics has died, study of therapists' pride, from every con ed course, let freedom ring." And if Physical Therapy is to be a great profession, this must become true. So let freedom ring from the prodigious hilltops of Nanaimo. Let freedom ring from the mighty mountains of New York. Let freedom ring from Barrie and Adelaide and Sydney and Vancouver and Dunblane. But not only that; let freedom ring from SomaSimple! From every keyboard, let freedom ring.

When we let freedom ring, when we let it ring from every village and every hamlet, from every state and every city, we will be able to speed up that day when all social groomers, PTs, chiropractors, osteopaths, massage therapists, hairdressers, surgeons, will be able to join hands and sing "Free at last! Free at last! Thanks, Barrett Dorko, we are free at last!"


Wow, that took a whole lot longer than I expected. What a geek I am. And what kind of ending is that?? I will forever live under the suspicion of guru worship.

And I gotta say, Barrett, in retrospect, it seems a little bit melodramatic. Perhaps even a bit sacreligious or someting. Can I be arrested for such defamation? My apologies to anyone who takes offense. :angel:

Nick

[Diane]

O. K. Nick!!!
What a blast!
You don't post often but when you do, look out!

For speechiness like that I nominate you for the Nobel Prize in Oration. Very very nice. Will be podcasted for posterity by Jon, Pdf-ed and emailed far and wide by Bernard. :teeth: :thumbs_up :thumbs_up :thumbs_up :thumbs_up :thumbs_up

[nari]

Nick..

Holy toledo..I'm speechless. Phew....

I like the mention of an Aussie battler who started it all over 20 years ago.
He is still battling; as is the other battler from Ohio. Butler shattered my working life; Dorko cleaned up the detritus.

How did you manage to encapsulate so much and so well that which should be right with physical therapy/physiotherapy/EBMtherapy and what is so wrong now with it?

This stuff should be published somewhere.

When you listed Down Under, you mentioned Adelaide and Sydney...not Canberra! I'm offended..;) ;) ;)

I get very cheesed off with the traditionalists and EBM worshippers (which can be obvious at times) but your remark Orthopedics has died is worth putting on the wall. Cheers me up no end.

Thanks for that.

Nari

[Randy Dixon]

For the non-Americans on the list, who may not be familiar with Martin Luther King's speech:
http://www.americanrhetoric.com/speeches/Ihaveadream.htm

[Jon Newman]

I guess I shouldn't be surprised that I was actually moved by that Nick, such is the power of culture and words.

[Barrett Dorko]

Yea Nick, something along those lines should do.

Too bad you can't see my face. I knew you had some good stuff in you - but I had no idea it could be like this.

[EricM]

It doesn't bother me if it is Super Slow, worth the wait. Thanks Nick.

eric

[Mr. PNI]

Chronic pain is but one symptom of chronic inflammation. Pain, fatigue, anhedona, cognitive changes, mood changes, decreased apetite, and changes in various musculo-skeletal functions such as strength-coordination-activity tolerance are symptoms of what is termed "sickness behavior." Sickness behavior is the result of pro-inflammatory cytokines such as Interleukin I (IL-1), Tumor Necrosis Factor-alpha (TNF-a), and Interleukin-6 (IL-6). These chemicals are produced by immune cells such as macrophages and microglia. While acute pain and other sickness behaviors are necessary for healing and survival, the chronic production of these pro-inflammatory chemicals is now being considered the "common denominator for most chronic disease.

Thus, trying to "treat" the pain-symptoms primarily in terms of the local tissue can not be more than temporarily palliative. It is the inflammation which must be healed. The chemicals move in blood and other fluids. Which tissue is affected at a particular time is mostly a result of the previous experience of that tissue with inflammation, and genetics.

Of CRITICAL relevance here is that the immune and nervous systems are enmeshed!! Immune cells possess the ability to make many known neuro peptides and neurotransmitters, and to have receptors for them as well. So, inflammation is part of the basic "stress response" in mammals. Another accepted principle is that immune cells can be CONDITIONED to make inflammatory chemicals-- as in classical conditioning. How a person behaves (our lifestyle) is the independent variable here. Patterns of emotional reaction, social behavior, diet, and muscluo-skeletal function can be changed if and when a person is truly motivated. There are the twin goals of reducing/changing the behaviors which result in inflammation, while stimulating the endogenous anti-inflammatory system.

Mr. PNI

[Diane]

Hello Mr. PNI,
Another accepted principle is that immune cells can be CONDITIONED to make inflammatory chemicals-- as in classical conditioning. How a person behaves (our lifestyle) is the independent variable here. Patterns of emotional reaction, social behavior, diet, and muscluo-skeletal function can be changed if and when a person is truly motivated.
It's an interesting idea Mr.PNI.. can you back that up with some links?
1. Accepted by whom?
2. "Patterns of emotional reaction, social behavior, diet, and muscluo-skeletal function can be changed if and when a person is truly motivated." Is that not nervous system? Are you talking about immune system or nervous system in this paragraph?

[bernard]

Here is the paper for the Nobel Prize of Physiotherapy =>

[bernard]

And I uploaded the file on another site so you can cite it on RehabEdge. :lightbulb

The link is:
http://www.algoless.com/pdf/meme.pdf

[bernard]

Nick,
Could you please give me your complete name. I will add it to the file. It is a fabulous writing. Thanks! :thumbs_up:thumbs_up:thumbs_up

[nari]

Randy, thank you for the original MLK speech. I was familiar only with a few phrases of that famous speech.

OK, who is going to cite it on RE???

Nari

[bernard]

Nari,

It is not a problem for me.
I made few changes (added a link to somasimple).

[bernard]

Done. :angel:

[nari]

Wow, Bernard. And the SS name got past the censors.

I didn't see Nick Adams' name as author?

Nari

[bernard]

Nari,

Since somasimple is embedded in a file that is not a problem.
I didn't know the name of Nick. I'll make the changes in few minutes. [DONE]

[Nick]

Actually Bernard, my full name is Nick Matheson. Not that I have a problem with a pseudonym.

Nick

[bernard]

I didn't see Nick Adams' name as author?

Sorry, Nick. :embarasse
I was fooled by Nari. (didn't know what was an Adams' name).

I'll make immediately the necessary changes.

[bernard]

I made it.

[Diane]

On the issue of working alone, I found a link to a nice site on cognitive behavior (http://www.cognitivebehavior.com/theory/perspective.html), which contains this quote:
"I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives.

Leo Tolstoy [As Reported by James Gleick, 1987]
This pretty much sums up mesodermalism, IMO. Does anyone realize how radical we seem, dragging in and dusting off and holding up/forth on ectodermal notions/ideas/information?

(Bernard, what do you think of that (simple) 6-sided figure within the text, visually conveying the notion of many perspectives, as a possible logo for our own site here?)

[bernard]

This one ?

It may be enhanced in a very good way!

[Diane]

That's the one! :) (It's mandala-esque and kaleidoscopic enough to satisfy my love for that aspect of thought.)

This text appears beside it: The illusion to your left has eight different perspectives or ways of delineating relative positions. Some people with study will be able to see all eight perspective and others will not. Even those who can see the different views will have trouble holding some in mind and getting them to come to mind when they want to evoke them. In some ways, this illusion, because of its multiple perspectives, provides the best concrete example of what lay people refer to as personality. The personality of an individual person is based on the attitudes and behaviors that they convey to others in various situations. Some attitudes and behaviors will only become apparent in certain situations, while others will be fairly obvious at all times.

The difference between the illusion and life, is that the illusion is much less complex.

OK, back to the topic of working alone, but keeping this image in mind; when one works alone one can freely access every available perspective in one's own mind, and in the patient's mind. When one works with others, the 'group think' tends to erase or at least eclipse several important inner lines for both practitioner and patient.

[nari]

Apologies to Nick for getting your surname wrong and to Bernard for the b*m steer. Sometimes I should shut up more...

Diane, I think we are seen as extremely radical; Tolstoy is right.
On illusions - there are pages of intriguing illusions at a site which I will have a search for; they are the sort of illusions that Ramachandran refers to often.
I did wonder about using a simple illusion for a logo; but that could be used against us by the firmly mesodermal thinkers....

And on working alone - group dynamics between PTs in the same facility is powerful; one tends to merge towards a collective middle ground that may be simply mediocre, without awareness. It's that social grooming thing.
At the very least, working within a group keeps one aware of what others are thinking and doing; at the worst, it will inevitably destroy creativity.

Nari