What the public sees

[Barrett Dorko]

The current (June 4th) edition of Newsweek features an article titled “The New War on Pain.” I haven’t read it in its entirety yet but thought it would be a good idea for us to discuss its implications here. After all, this is what our patients are reading.

On page 47 there’s a picture I found especially interesting. The caption reads: Barbara Canal works with patient Scott Brozena on a physical-therapy regimen for pain.

Check it out, and then let’s talk.

[EricM]

Here's a link to the whole article The Changing Science of Pain (http://www.msnbc.msn.com/id/18881802/site/newsweek/page/0/)
To begin with, I wonder why the physical therapist pictured is standing on her patient's chest?

[Luke Rickards]

The caption reads: Barbara Canal works with patient Scott Brozena on a physical-therapy regimen for pain.Step aside Ginger!

[Luke Rickards]

From the caption of the picture at the top - How pain works
Pain is first converted into an electrical signal... Hmm! Disappointing statement for a web page titled "New research into pain treatment"

[Barrett Dorko]

I'm no psychic, but I predict that this photo (Thanks for the link Eric) will trigger some actual conversation in the therapy community.

I have several questions:

What does this therapist imagine she is doing therapeutically?

What is the theory behind the technique?

What set of symptoms led her to its application?

Might we somehow contact Barbara Canal and ask her? (She might have contact information listed with the APTA)

What is the potential impact of such an image?

Is a letter to the editor appropriate?

Let's stick with this. I feel it's important and can provide much more than a punchline of some sort.

[Crazy Pole]

"Americans love deep brain stimulation, replacement discs, things that are sexy and magical and frequently hyped," Covington notes. Multidisciplinary clinics are a much harder sell. They're not a quick fix, and their emphasis on exercise strikes fear in some people who are already worried about injuring themselves.

Fellow Americans, any objection to this? Unlikely.

But, how do we change that?

Wes

[Barrett Dorko]

I'm still mulling over the worth of contacting the therapist and asking her to read what Cory's written about the nature of threat and its relation to painful stimulus. New readers to the forum will find it here (http://www.somasimple.com/forums/showthread.php?t=2823).

Would this be fair? Does it make sense not to do it? After all, as Achenbach reminds us in Captured By Aliens (http://www.amazon.com/Captured-Aliens-Search-Truth-Universe/dp/0806524960/ref=pd_bbs_sr_1/103-9374717-8174203?ie=UTF8&s=books&qid=1180540979&sr=1-1), In science, if you don't work hard enough to prove yourself wrong, your friends will gleefully take up the slack.

Maybe we should act like friends here.

I want to know if this therapist is proud, happy, appalled, neutral - whatever, about this picture and what it implies. I presume the foot on the chest is a clever use of her own body in order to gain some leverage. She could justify the technique itself as one way of assuring that the "stretching" is accomplished. I've too many questions about what she imagines she is actually doing to list here.

[Crazy Pole]

Barrett,

I think it is quite reasonable to question her and/or the editor regarding the context of the picture. I tried to find her on the APTA website, but have been unsuccessful thus far.

With my wife having worked as a journalist recently, I understand that there is often a disconnect between the story the words tell and the story the pictures tell. For now, I would give her the benefit of the doubt that she might have been unaware of the implications of her photo op, but that does not mean that it should not be pursued.

Would this be fair? Does it make sense not to do it? After all, as Achenbach reminds us in Captured By Aliens, In science, if you don't work hard enough to prove yourself wrong, your friends will gleefully take up the slack.

Maybe we should act like friends here.

Agreed, but we may need to consider the influence of the editor in this photo selection.

[Diane]

The image certainly has a "dominatrix" cachet, apart from the wearing of a high heel. Is this how the army wants to be seen/see itself - wounded soldiers as bad boys who "deserve" to be "treated" as doormats? Is this how PT wants to see itself, as domineering rather than helpful? :cool:

[nari]

Even the skeleton in the background looks rather dismayed.

It definitely sends a wrong message about physiotherapy to the public. It confirms the worst fears patients have about PTs; that they hurt you. The photo suggests her left leg is barely impacting the chest wall, but if she yanks the pt's left leg higher it is suggestive of 'holding him down'. Not good.

The whole article is odd and hardly says anything new that wasn't known years ago; as Luke pointed out, the notion of pain being converted into an electrical signal goes back to poor old Descartes....

Nari

[Bas]

A poor article, with a sensationalist title, apparently justifying the pictures of injection and domination. I am sorry for both the patient and the PT - she especially will NOT be happy with the implication of the shot (giving her thre benefit of the doubt).
I think this is her:

Canal, Barbara:
Physical Therapy
1211 E Howell St
Seattle, WA
98122
Phone: (206) 323-3022

No e-mail address found.

[Barrett Dorko]

I find myself in the midst of a dilemma. There are several things here to consider:

#1 I would love this therapist’s opinion of the picture. She might be proud of it or she might be desperate to explain its context. She might be oblivious as to its message and feels it demonstrates her commitment to doing what needs to be done, in her opinion. She might be too fearful of public speaking (very common) to ever say anything at all on the Internet.

#2 I did a workshop in Seattle last January attended by 78 therapists (a record for me) but, as usual, haven’t heard from a soul since or seen participation from any of them on this board subsequently. Multiply that number by the number of colleagues who had the workshop described to them (something X 78) and you get some sense of how little impact I actually have. But isn’t it likely that one of those lurking here knows this therapist?

#3 While it wasn’t explicitly stated, I’m guessing that this is a military facility attached to Fort Lewis. My son is stationed there.

#4 I had breakfast this morning with my sister Laurel, recently retired after many years in charge of child care at The University of Southern California. Her career was marked by enormous growth and change in the care provided. She was a phenomenal advocate for the children and always put their well-being ahead of any political concern. I can’t begin to describe her courage in the face of what that attitude created in the way of conflict. If she’s my model for how to approach a career with commitment (and she is), I should contact this woman and get it all on the table.

[christophb]

http://www.fmi-physicaltherapy.com/HTML/barb.html

here is the Website

[christophb]

I should add her clinic is only a few blocks from my home.

[Barrett Dorko]

Chris,

Wonderful detective work.

I'm guessing these therapists weren't with us in January. I'm not hopeful that they will be glad to present their theory to us, but maybe an invitation wouldn't hurt.

[Barrett Dorko]

Over seven years ago I wrote this review ( http://www.somasimple.com/forums/showthread.php?t=1348) of a book titled The War on Pain and said then that the title itself disturbed me. Similarly, the title of the article according to Newsweek’s front cover was The New War on Pain and I was equally wary.

It seems when we decide that battle is the proper metaphor for the way we practice that certain consequences are inevitable. This would include the patient’s body as a battleground. Perhaps this metaphor is more useful when rehabilitation is necessary, but when pain is the primary problem you have to wonder if it’s justified.

Coincidentally, Penn and Teller’s ( http://www.sho.com/site/ptbs/home.do) current episode of skeptical investigation on Showtime deals with anger management classes. They show how a researcher form the University of Michigan has demonstrated that “acting out” anger (punching a pillow) makes most people even angrier. Quiet contemplation is more effective when seeking to diminish the emotion’s effect.

Might the emotive component of the painful experience be handled with this insight in mind?

[Diane]

Barrett, that link only works for computers within the U.S., unfortunately.

I agree completely with your assessment of PT treatment memes embedded within language memes, or the other way round. Either way, one set needs to be deconstructed from the other when persistent pain is involved.

[bernard]

Barrett, that link only works for computers within the U.S., unfortunately
It works for me and here is the searched address.

http://www.fmi-physicaltherapy.com/images/barb1.jpg

bcanal@fmi-physicaltherapy.com

ps: I do not want to try such things.

[Barrett Dorko]

I see that “Functional Muscular Integration” began with the philosophy and practice of Françoise Mezières about 60 years ago. Back in 1977 I read The Body Has Its Reasons: Anti-exercises and self-awareness ( http://www.amazon.com/body-has-reasons-Anti-exercises-self-awareness/dp/039441134X/ref=pd_bbs_sr_2/103-9374717-8174203?ie=UTF8&s=books&qid=1180697335&sr=1-2) by Thérèse Bertherat. Mezières’ own texts on the subject of "Méthode Mezières" were published in ’49 and ’84. She was obviously a dedicated therapist and totally committed to her method. I can relate.

I recall distinctly that she used Greek statuary as the model of human bodily perfection, which is problematic for a number of reasons, but it would explain I suppose what I see the therapists on this site doing.

I’d suggest readers of this thread go to this site ( http://www.fmi-physicaltherapy.com/HTML/history.html) for more and then here ( http://www.antigymnastique.com/anglais/mezieres.html).

It seems to me that the therapists fortunate enough to have their work featured in Newsweek might want to share their expertise with us. They’ve obviously done a lot of work and maybe we can turn this into a useful discussion.

[ian s]

i think , context is important .

The article and the responses seemed to be discussing the conundrums , physiology and management of chronic pain conditions . It is likely that the gym/and dominatrix theme is common in some areas of manual therapy, particulary in atheletic training . However to put this picture in with the general theme of the article is misleading and probably not too helpful .
To show a therapist acting as a 'guide' and educator rather than mechanic is a far more postive but probably not so 'rewarding' . At least it got the board talking ! I posted it on the uk physio interactive site which has a discussion on the myth of core stability --I will let you know what the response is as its a restricted site for uk phyisos

ian

thanks for the links barrett