Cross Country 74 - Azimov's Insight

[Barrett Dorko]

It’s been a quiet week in Cuyahoga Falls…

The most exciting phrase to hear in science, the one that heralds new discoveries, is not 'Eureka!' (I found it!) but 'That's funny ...'

Isaac Azimov ( http://en.wikipedia.org/wiki/Isaac_Asimov)

The way it works is this: I talk for about two hours and then I let them begin. By this I mean that I spend a long time making the case for the existence of ideomotion and the abnormal neurodynamic and then I demonstrate how their coexistence becomes simultaneously a manual and movement therapy once Simple Contact is employed.

Nothing to it. (That’s a pun for those of you who have attended my course)

For about 15 minutes I let people practice handling each other. Always the same questions rise. When should I let go? What if my hands are cold? What if the movement hurts? How do I know whether or not I’m moving them? How much pressure? Should I push them in some direction in order to get them started? What if they start to fall over? Should I just let them hit the floor?

Obviously, some of these questions are better than others. I have a way of dealing with each and I welcome them. Well, maybe not that last one. Often before their time is up many stop practicing and are just sitting quietly. This was especially the case in one of the East Coast cities I worked in last week, and that’s what generated the writing today.

I’ve used Azimov’s quote above in previous posts and will probably do so again. It’s a wonderful insight by one of the greatest literary figures in history – a man once referred to as “the great explainer.” He came to understand that profound discovery, especially when you’ve found something you weren’t looking for, was not only exciting, it was deeply disturbing. It heralds a battle of the memes ( http://en.wikipedia.org/wiki/Meme) and that can be disruptive, to say the least.

At the end of my first hour’s lecture I demonstrate ideomotion as I employ Simple Contact upon the head of an arbitrarily chosen student. The class watches wide-eyed, and then I say, “Before lunch today everyone in here will be able to do what I just did.” I can sense in the class two responses, excitement and distrust. And that’s okay. After all, I’m probably the first workshop instructor ever to tell them that I have no skill, just understanding; that my manual care reflects that understanding, not endless practice. I say, “By lunch your understanding will be sufficient.”

This week I finally figured it out: Therapists stop practicing Simple Contact after a couple of minutes not because it didn’t reveal what I said it would. On the contrary, it revealed too much, and true discovery of this sort will force us to pause and think. It requires stillness and quietude in order for us to digest its implications. No wonder people sit down rapidly.

Now I realize this: Therapists revealing ideomotion in others haven’t just realized that their careers might change unless they choose to ignore this (and, of course, most go on to do that very thing). They pause rapidly because they have discovered something else.

They’ve discovered themselves.

[OaksPT]

Barrett,
I remember the 1st course I had gone to of yours ( 3 or 4 years ago, it's hard to remember), I felt like I had a basic understanding, of the principles you were teaching, of course I think most of us come from a background of patterned protocols, a recipie book (if you will) of what to do next. It was very hard for me to let go enough at 1st, too let the inevitable just happen. Now days, I would probably just let my partner hit the floor, maybe that would have a bigger impact on them utilizing this new understanding.

Scott Oaks PT, DPT
"Life is just a series of moments, seize yours."

[Barrett Dorko]

Scott,

I remember that course and your attendance, probably in June 2004, in Norfolk VA.

True story. A year later one of your classmates attended the workshop again – same hotel, different meeting room. After the first hour she said rather loudly, “I took this course last year! I think we were across the hall. I didn’t know this was going to be the same thing, but I remember you now! Oh yea, I never read any of that stuff you recommended.” She smiled throughout this announcement while her colleagues from work looked at her horrified.

I didn’t say a thing but couldn’t resist shaking my head.

Thus the legend grows.

[Jon Newman]

Hi Scott,

I think the DPT behind your name is new. Nice work.

[OaksPT]

Barrett,
It's been said many times, but it's sad how many are proud of just getting by day in and day out. Maybe you should recommend Dr. Suess on your reading list, it would be easier, and I'm sure you would be able to integrate it somehow, you do have that knack.

Jon,
Yes, recently obtained, hopefully now I'll have time to post more often, if my honeydo list shrinks some(now working on #7 of 2,336).
Scott Oaks PT, DPT
"Life is just a series of moments, seize yours."

[Barrett Dorko]

This thread runs parallel, in time, to yet another remarkably fractious conversation over on the MyPhysicalTherapy Space ( http://myphysicaltherapyspace.leveragesoftware.com/mypage.aspx) site. There I am often derided as a failed clinician and businessman, a lying and deceptive “guru,” a charlatan and, well, pretty much a terrible person overall. It’s just delightful.

What strikes me as especially off-base (assuming some of that other stuff is as well) is the persistent impression that some have of the state of the profession. They claim that the few outcome studies that have emerged the past few years have somehow transformed physical therapy into a lean, mean, scientifically based machine full of clinicians demanding outcome evidence above all else.

I get around, and nothing could be further from the truth. In fact, in the past three years of my travels for Cross Country I have seen very little in the way of real interest in outcome studies, theory or, to be honest, significant reading of neuroscience or clinically relevant research.

Still, in relation to all of this drive toward something “new” in therapy in the way of “outcome only” thinking I’m reminded of this from Ludwig Wittgenstein ( http://en.wikipedia.org/wiki/Ludwig_Wittgenstein):

The problems are solved, not by giving new information, but by arranging what we have always known. Philosophy is a battle against the bewitchment of our intelligence by means of language.

[Barrett Dorko]

I thought I'd add this today. There's a therapist over there named John Ware who commonly resorts to name-calling and the like. He is especially critical of what he calls "the legion of fools" who attend courses such as mine where outcome studies are either unavailable, in the works or de-emphasized in favor of an examination of evidence that supports theory. He's gone on a couple of rants where God, Florence Kendall, capitalism and patriotism are mentioned in defense of his opposition to me and a few others.

Today I responded in this way: From the book Why Truth Matters (http://www.amazon.com/Why-Truth-Matters-Jeremy-Stangroom/dp/0826495281/ref=sr_1_1/103-9374717-8174203?ie=UTF8&s=books&qid=1178019474&sr=1-1) by Benson and Stangroom (I fell asleep reading this last night).

On denial: "…the moment you declare a set of ideas to be immune from criticism, satire derision or contempt, freedom of thought becomes impossible…This tactic is a powerful way of shutting people up because it acts not as an external authority (which can be laughed at etc.) but as internalized guilt and bad conscience.”

Immediately I thought of the appeals to capitalism, Florence Kendall’s theories and hand-over-the heart patriotism that Jon has brought out of the blue to this discussion. As the authors go on to say: “This is arguably one of the most powerful and effective tools of denial going on at present. Simply invoke the name (of something sacred) and disagreement will slam to a halt in a fog of embarrassment and guilt.”

They don’t call it The Neurobiologic Revolution for nothing. It leaves in its wake all sorts of sacred and deeply entrenched ideas – painful tests of provocation among them.

I have to remember that most of this battle occurs silently within the heads of my students. The icons of therapy rise up in response to the new information I give them and especially in opposition to the thing they just felt (ideomotion) in another. They realize, hopefully, that their handling should undergo a distinct change when they see a patient with an abnormal neurodynamic - and that they have to change as well.

No wonder the silence.

[Diane]

I saw that post Barrett. The cognitive dissonance must be fierce.

[Barrett Dorko]

I want to emphasize again what Azimov conveys with this wonderful quote.

There’s an increasingly vocal and influential group of therapists who seem to want everything decided before care even begins. In fact, this is the only kind of care they think should be performed. But no surprises would ever emerge if the outcome of every intervention was predicted reliably beforehand, and, of course, when medications are used this might come close to happening. In fact, mesodermal problems containing actual injuries to linear tissue respond wonderfully to methods, sequences, time and protocols that have been established brilliantly by our profession.

What these therapists seem not to understand, and perhaps never will, is that fractally shaped organs like the nerves aren’t going to give you this. I’ve written a lot about this in the past, not that it’s likely to get read. (If interested, check this ( http://www.barrettdorko.com/articles/fract.htm) out) My experience has been that mesodermally focused therapists don’t like to discuss fractals much.

But when our care is required to change a nervous irritation leading to persistent pain I doubt that a protocol or clinical prediction rule will ever be found. For this, I think our approach must emphasize an examination of the tissue’s potential response. That’s what we do here on Soma Simple.

Those who do this maintain the attitude described by Azimov. Many others prefer not to be surprised in this way.

Maybe they never will be.

[Nick]

I checked out the MyPhysicalTherapy Space for the first time last night and, as much as I'd like to weigh in against the inane ideas on there, I can't stomach the idea of having to read more of SJBird's posts. Even through the internet her screeching is like a banshee. I haven't missed it since abandoning RehabEdge. Thanks to those of you willing to carry the banner of debate.

It is very interesting to see just how fractious the debate is. Assuming that Ware represents his EIM colleagues as he suggests, it is frightening that there is so much willful blindness to something that should be incredibly obvious among the self-proclaimed leaders of the profession.

As discussed previously, the debate is not one of technique. Manipulation may be perfectly appropriate in some instances (though increasingly fewer based on their outcome research and prediction rules). The real debate seems to come down to research outcomes and how they should constrain our thinking vs. development of theory based on plausibility and basic science. I agree that both would be nice. I applaud that there has been some movement to alter the theory of manipulative care (and base it more on neurophysiological principles). I am thankful to those who are trying to provide outcomes for other approaches based on more solid theory.

If we do not allow ourselves to think outside the box and yet contain that thinking within a certain scientific framework, this profession will die a quick and painful death. Most of the outcome studies that have been done has basically shown that much of "traditional" physical therapy is useless. Those studies that have demonstrated support for manipulation have also challenged the way it is traditionally practiced and who it is practiced on. We are very far from being a scientific profession.

Nick

[Barrett Dorko]

Nick,

Believe me, I know how hard it can be to read through Bird’s stuff. Last night’s tirade about how (in her opinion) Cory has yet to explain anything is truly mind-boggling, but I must admit that I loved it on a certain level. There are a couple of posts in the file section beneath the “Pain” discussions about my brochure that are pretty good as well. There she complains that Soma Simple doesn’t offer any clue about what literature we ought to read. I’m not kidding.

As I said in my last post, this basic problem of effectiveness in our methods may have to do with the fact that our colleagues are bent upon blaming the wrong tissue and then compounding that by refusing to understand the right tissue as it must be understood. Other than that, we’re doing fine.

As you saw in Boston, half of the therapists in my classes hurt chronically and most of this pain can be traced to an abnormal neurodynamic. They have abandoned the sort of “care” the traditionalists in our profession continue to embrace and have placed it in a sacred space where they assume it will be safe from criticism. It isn’t. “Alternative” care isn’t helping them in any significant way and they are lost. I show up and tell them that they need only to understand something. When they resist that (Bird’s especially good at this) I don’t know what more can be done.

[nari]

SJ's ranting and JohnW's raving may well destruct the life of the pain forum. I hope others are waiting for them to disappear, but I'm not hopeful.

Nick, I have despaired of the profession several times.
Starting with the Aust Physiotherapy Journal in the 80s, which used to publish papers nobody understood unless they were academics; then with my "failure" to convince other PTs to read and listen to Butler and practise neurodynamics in the early 90s; then with PTs whose knowledge of pain physiology was good, but they never practised anything other than joint and muscle-focused techniques.

It is quite true that outcome studies have shown a great deal of what is practised today is no more effective than a Bex and a good liedown... (OK, so I made that control factor up).

The fierce obsession with outcomes is hard to fathom. Makes one wonder what these PTs actually do when there is so little positive-outcome stuff published.

I know a lot of PTs here want to know about CPRs before they even consider any technique. When there isn't one, they often just go ahead anyway, if the technique or approach fits their think tanks. I think the surprise factor does occur, often, even when the PT is not at all sure of its effectiveness and this is perceived by the patient. There will never be CPRs for complex pain patients, and these people will fall further by the wayside, if a lot of PTs wait for 'permission' from studies.

Many science guys happen on something great by chance. Fleming was one, and when he looked closely at the mouldy petri dish, I would bet he muttered:
"That's funny...."


Nari

[Diane]

I have a suspicion that what fuels the continual rage-a-thon over there may be too much trash-talk radio, a form of mental us-against-them poison found commonly in the US. I truly do not look forward to driving across the border into the US with the radio on - as soon as CBC gets fuzzy, then cuts out, I feel stranded and alone in my car a crazy foreign country - there is little to listen to but stations that propagate ill-formed opinion as a form of misinfo-tainment. It deforms the brain, puts it into conceptual looping mode, makes it incapable of producing anything but blinkered verbal diarrhea. Some of the posters sound like that's all they ever listen to. Maybe they have it piped directly into their treatment facilities (must be s-o-o-o-o relaxing... )

[Jon Newman]

I feel like I'm taking crazy pills!--Mugatu from the movie Zoolander

I just watched this movie last night and that's the line that jumped out at me. I wonder why?

The protagonist, Derek Zoolander, had the specific disability of only being able to turn one direction (to the right.) To adapt he would turn 270 degrees to the right in order to get himself going in the correct direction.

I don't know about anyone else but right now I think I need an Orange Mocha Frappuccino!

[Nick]

Interesting as well that some of those on the site are ready to abandon persistent pain patients to their spiritual suffering (at least I think that's what they mean). I have to wonder who these people are treating if not persistent pain patients.:confused: I know they make up the greatest share of my clients by far. But perhaps that is just because they are desperate enough to see me because of our screwed up medical system. I mean honestly their clinics cannot be full of ankle sprains and post-op total knees, can they? If so, no wonder they get such stellar outcomes.:angel:

I also have to wonder about how they are actually practicing. What goes on beyond the all-powerful manipulation. Since they now only allow themselves to perform those twice, it takes less than 15 minutes to learn, and assessment should be minimal since you no longer have to go searching for those pesky facets that you cannot feel anyway...should be some more business failures around soon.

Nick

[Bas]

That thread shows how passionately SOME there are about WINNING - personal attacks are always used in such "debates". Contemplation on how the actual meat of the presented info may be important, tends to be overshadowed by a desire NOT to be found wanting...

I make silly little forays into the thread by trying to sound reasonable (and that's a stretch of the first order!) and middle-of-the-road to try and focus on the IDEA...But that seems to be not interesting enough....
Not enough "fire". I keep some of my stronger opinions to myself about some of those posters, because it would not further the purpose of the thread there.

Sad how that degenerated - and kudos to the endurance of you folks.

[Barrett Dorko]

It's always nice to see you there Bas. I agree, endurance is required.

For some, ignoring reasonable questions is another. I've lost track of the number of times those who oppose Diane's ideas or mine have just waited a few hours after being called out after a massive error only to go on to something else without a word in defense or apology. One of my favorites was John Ware's assumption that I "tried to start" a practice devoted to a certain way of thinking and handling others and quickly failed. When I pointed out that this practice paid my bills and raised my family for 28 years he said nothing.

It's the cyberspace equivalent of waving your hand in your opponent's face and saying, "Whatever."

Come to think of it, this is what you often see on The Jerry Springer Show.

You know, I might be on to something here. Those who go to EIM from Soma Simple bring our explanations gleaned from the scientific literature with us. Bird and Ware bring their TV remotes.

[Diane]

It's the cyberspace equivalent of waving your hand in your opponent's face and saying, "Whatever."

Come to think of it, this is what you often see on The Jerry Springer Show.

Trashtalk radio on a TV screen instead. You are what you eat, mentally as well as physically.
They seem to have calmed down slightly since yesterday. Maybe they're getting a bit tuckered out.