A New Workshop - Opinions Sought

[Barrett Dorko]

I’ve entered into my third full year of teaching for Cross Country and have been asked to alter my course. Having visited a number of cities three times at this point I can appreciate their concern about saturating the local therapy communities with my ideas and offering something else seems like a good idea.

Toward that end I’ve put together a new seminar title and brief course description and have submitted it. It will look familiar to many of you and I’m soliciting opinions regarding its possible popularity. It’s up to me to make it useful and relevant.

Thanks in advance.

Seminar Title:

Manual Magic
The Application of Modern Neuroscience to Manual Care


• Learn how to reveal your patient’s self-corrective abilities
• Explain to colleagues and referral sources the nature of neurogenic pain
• Learn and apply safe and painless home programs for chronic discomfort
• Learn how to solve clinical problems by using the Internet

Course Description

Persistent discomfort for which there is no surgical or chemical solution is a remarkably common problem and accounts for over half of the population attending treatment in the therapeutic community. Many of these patients appropriately seek a mechanical solution and hope to find that in the hands of a therapist who understands the ways in which they need to move in order to feel better. Many therapists spend their careers searching for a solution to these problems and add “tools” along the way, hoping to find the right one. Still, the problem persists, and is in fact growing.

This workshop proposes that the best tool we may possess is a reasonable and defendable understanding of the underlying problem and that this understanding begins with the realization that all pain is neurogenic. Once a therapist can see this, a relatively simple strategy for a manual approach to both examination and treatment will emerge. It will be demonstrated that this approach is easily learned and that the patient’s therapeutic response is both predictable and readily translated into a home program. Our patients aren’t helped nearly so much by our skills as they are helped by the depth of our understanding, and that understanding will be made available to all who attend. Sufficient workshop time will demonstrate that we already possess the skill necessary to make Manual Magic. In this course Barrett uses his skills as a veteran clinician, juggler, harmonica player and magician to bring every concept alive and unforgettable.

Course Content

• The Concept of Manual Magic (30 minutes)
How and why manual care appears unusual when it is most effective

• The Nature of Neurogenic Pain and Self-Correction (60 minutes)
The Neurobiologic Revolution and the birth of Ectodermal Care

• Clinical Reasoning in the 21st Century (45 minutes)
Ultimate and Abductive Reasoning – This Changes Everything

• The Application of Manual Magic – Workshop (60 minutes)
The importance and result of a non-threatening approach to manual care

• Internet Connections for Clinical Problems (45 minutes)
Where to go, how to assess information, how to ask questions

• Active Exercise for Neurogenic Pain (60 Minutes)
Movement therapy that is carefully choreographed, painless and effective

• Patient Presentation – Examination Form and Documentation of Progress
Making the most of the time available

[Jon Newman]

I like it which likely means it's doomed. When do you plan to take the show on the road?

[nari]

I like it too.
Not sure about the reaction to 'magic', knowing how hidebound so many PTs seem to be.
But the truth is in the telling..............:)

Nari

[Barrett Dorko]

Nari,

I'm in agreement about the possibility of rejection because of the word, but while this inevitably draws attention, the subtitle appears intriguing enough to keep them there. Maybe they'll even stay long enough to read the description.

I think this might be enough to create confusion.

Just what I need.

[Jason Silvernail]

Some part of my brain wants to see "science" or "evidence" three times for every use of the word "magic". Maybe I'm just jaded after reading about too many questionable CEU courses.

My knowledge that your course is packed with cutting edge research evidence in neuroscience and pain physiology doesn't seem to temper that need as much as I would hope. Oh, and no "evidence-based practice" buzz phrase? What gives?

I like this a lot - especially the subtitles and the material about using the internet to find evidence and how to document progress and evaluate the patient.

This seems like a very good combination of teaching people to understand more and at the same time offering them a course that seems to be saying "here - do THIS..." which we all know they tend to want.

I love it. Don't change a thing.

[nari]

Confusion, I would say, is just what you need.

If the reaction is a confusion between what they think they know and what they don't know, that's good. Room for thinking.

If the reaction is: That's rubbish and nothing to do with what I know about muscle and joints...then that is a problem, but it remains their problem....

Here's to confusion.

Nari

[BB]

I think it looks great Barrett. If many people are like me (which may be a scary thought) they'll search the internet for the name of a course that draws their interest. Searching "manual magic" will of course lead them here. I can't imagine a therapist truly interested in growth that would not be interested in attending after browsing your wonderful thread and then reading through what will be addressed in the course. Any chance of you kicking off the new tour in Portland? Pretty please?

[Barrett Dorko]

Thank you for the response and encouragement.

Like many baby boomers I remember quite well ”Mr. Wizard” (http://www.cnn.com/2007/SHOWBIZ/TV/06/12/obit.mr.wizard.ap/index.html) who, as it happens, passed away last night. The actor Don Herbert played the role of a kindly but intensely focused gentleman who made everyday objects and observations bristle with the forces of nature that they truly represented.

Perhaps I can play a similar role in this presentation, regularly taking the opportunity to reveal what’s actually happening in the deep model when we handle another and observe movement. Today my head is full of the possibilities.

[Bas]

Barrett, you may have already considered this, but be prepared to see many PTs and others looking for the "next MFR"......Manual Magic may well be a big magnet for the "woo-woo" crowd. Just a thought.

Then again - also a chance to make converts away from the "dark side" of CST, PR, MFR, WALOC.

[Barrett Dorko]

Bas,

Actually, I had thought of this. Of course they're welcome to attend, mainly because their money will spend like any others (ha,ha).

Seriously though, I really want everybody who handles others there. I'm in a perfect position to speak to them about the importance of theory and can easily draw the distinction between a magician and a superhero. I can introduce them to Newton's Second Law and watch as they begin to consider its significance to their thinking.

I can show them how trivial the "secrets" kept from them by other teachers truly are.

Actually, in my current course I already do all of this and have met many wonderful though badly misguided therapists along the way who respond to my information quite well. Almost without exception, they're grateful for it.

[rfairbanks]

Barrett,

From paragraph two of your course description:

"This workshop proposes that the best tool we may possess is a reasonable and defendable understanding of the underlying problem and that this understanding begins with the realization that all pain is neurogenic"

This phrase, in my opinion, is the key to the workshop. I have been thinking since your course about culture affecting our patients expression of authentic movement, but also affecting our ability as clinicians to integrate new information. Self help books teach us techniques to be succesful. We are programmed by society to look for ways to better leverage our resourses for better outcomes. As you state, what we really need is better knowledge and understanding, not better techniques.

For those not in tune to the ideas on this forum, that may not be evident from the subtitle. They might benefit from a more prominent display of that sentence/idea.

Just my two cents,

Rich

[Barrett Dorko]

Rich,

I agree entirely. I suppose that the best I can do is to have the statement you've mention printed in bold type.

Anybody have a better idea?

[Crazy Pole]

Barrett,

I think it looks great, but has much more of a marketing spin/sound than I would have expected from you. That's not meant to be an insult, so I hope it doesn't sound like one.

What I continue to see as a strength of your seminar is that it is a one-day format, without additional levels and prerequisites. Perhaps others see this as a weakness, without the potential for "certification" or "specialization". Also, all of your work and thoughts are readily available online before and after (and during, for that matter) the seminar.

I like the marketing twist, and I suspect it will catch the interest of a great many.

Wes

[OaksPT]

I'm with Jason on the word "magic", and that word may be fuel for some of your naysayers to lump you in with the likes of MFR/CST, it would make me cringe at first, but as I read on my interest would be peaked. Of course since I already know you, I'll attend if possible when you come around.

Scott

[Jon Newman]

Hi Wes,

I'm working on getting the course to come to central WI. Since you display more pro-social behavior than myself, do you have any feeling for whether there would be interest in such an event from the therapy types you converse with?

I'm going to try to arrange it on my own and skip the employer assited version.

[Crazy Pole]

Newman,

I will send you a Private Message to protect the names of the "innocent".

Wes

[Crazy Pole]

Jon,

Interesting that you should mention that idea. I was thinking earlier that therapists might be more likely to share their thoughts and experiment more if it was done at or near their clinic, amongst many of their colleagues. Being that they work amongst these people on a near daily basis, they probably have less to hide than when amongst a bunch of strangers. One could say that context matters...

Wes

[Diane]

Barrett, as long as you don't include a picture of yourself with a pencil mustache and cloak, with lightening bolts coming out of your hands, or clouds around your head, I think your new package sounds very good.

[Barrett Dorko]

Diane,

Well, there goes my deposit with the costume store, but I'll tone it down upon your advice.

Not even a top hat?

Wes,

I am bowing to the gods of marketing and will make no effort to hide that. There's a line though, and I've spent my career eyeing it carefully. I won't cross it. I appreciate your concern.

[Luke Rickards]

Barrett,

This looks great. I wish I was a little closer to the US.

I've been thinking about the issue raised by Scott and Jason in using the word "magic". Because I already know your work I am aware that it will be made perfectly clear in the workshop exactly what you mean by this. However, perhaps you could make a small qualifier in the course description with a sentence from the MM essay.
E.g. Our patients aren’t helped nearly so much by our skills as they are helped by the depth of our understanding, and that understanding will be made available to all who attend. [Self-corrective movement solutions for neurogenic problems appear like “magic” and the therapist in their presence like a magician.(or something to that effect)] Sufficient workshop time will demonstrate that we already possess the skill necessary to make Manual Magic. In this course Barrett uses his skills as a veteran clinician, juggler, harmonica player and magician to bring every concept alive and unforgettable.
Just a thought.

[rfairbanks]

Barrett,

I just had a patient whom I instructed in ideomotor movement earlier in the week explain that he has renamed this movement "Holy Spirit Yoga". I thought that could be the start to your third workshop.

Rich

[nari]

Barrett,

I'm still tossing over the use of the word 'magic' and wondering if PTs will interpret its usage in the way as you intend.
For many people, the gaps in our knowledge of the sciences need to be filled, and the sort of magic they are thinking of is faith, which replaces uncertainty with acceptance of some higher power's supremacy. Maybe I'm wrong, but people tend to do that as a whole. If their big gap is neuroscience, and that seems to be the case, I have visions of instinctive movement being interpreted as something else altogether.

On the other hand, your package stands alone as something quite extraordinary for thoughtful PTs to take up. My niggling doubts over the word 'magic' are probably irrelevant, and to some, irreverent.

Nari

[Nick]

Finally...Level 2 :teeth: Do I get advanced credit for taking Level 1 three times?

I agree about raising the ire of the EBP guardians and the interest of the "woo-woo" crowd with the word magic. Then again, this is likely a good sign. It is "A Third Way."

Maybe the 'Magic of Neuroscience' or 'Neuroscience for the Neglected.' I keep hearing the Sunderland quote about the irritative nerve lesion - "No one is treating them!" 'Manual Magic and the Middle Path' - include a discussion on theory and evidence in the Clinical Reasoning section.

The outline looks great. How about kicking it off with a SomaSimple reunion - Nanaimo 2? Diane could enlighten us with DNM as well.

Looking forward to seeing you again.

Nick

[Jon Newman]

I noticed "ideomotor" and it's derivations didn't make the course description. Will discussion of it still feature in the course?

[Barrett Dorko]

Absolutely, but despite my constant effort to generate acceptance and understanding one of our new members calls it a "weird dance." This both saddens and infuriates me. After all this time I have no choice but to de-emphasize it in some way.

Perhaps I need to talk about how ironic it is that a culture that won't normally permit its fuller expression also won't accept its gift; self-correction for pain relief.

[rfairbanks]

Barrett and others,

I did not intend to condone my patient's statement. I spent the remainder of the session reviewing again for him ideomotor movement starting with the quote from James, reviewing (again) the neuroscience basis of his movment and that is all related to his brain and science and not faith. My comment was intended with sarcasm. Please do not think that I misconstrue your teaching or that I am teaching it as coming form a higher plane.

I do think that Nari has hit in on the head. In my area of the midwest, the only interoceptive experience people have had is when they belong to a charasmatic church and assume that their movement is guided from without instead of from their motor planning. I assume that in other areas of the country and world various forms of religion/spirituality/mysticism would take that place. I have been very aware of the therapy community misplacing idemotor movement under headings such as MFR. This is my first experience with the general public's misconception. I am sure it is not yours, and I should have been more sensitive to that fact.

To finish my thought, I find it said that a very well read, well educated patient who seems to understand what I am teaching him as well as any of my patients leaps to this type of thinking. As I stated above, I think this is because he has experienced ideomotor motion before in the guise of a charismatic church "experience". What I found humerous at first is clearly a huge hurdle for teaching certain patients.

Rich

[JaneS]

Hi Barrett,
I agree with the problems of using 'magic' in the title. Writing lyrics and naming racehorses is a quiet hobby of mine and I applied myself to the challenge of an alternative but attractive name.
Considering your broad spectrum of manual care, education (of patient and therapist), goal of self-efficacy, what about "Manual Mosaic"? Your aim is for the clinician to weave the pieces into a total picture of manual care. The Word Manual, focuses on manual care, while mosaic might be interpreted as a picture made up of many individual pieces smoothly blended together. (This is not a dictionary definition, but general perception - one thinks of art).
Just a thought
Jane

[Diane]

Jane, you are a very sharp namer. :)
You (and Emad) helped come up with a name for my offerings.

I like Manual Mosaic. However, it doesn't "conjure" up sidetrails of magic - which Barrett might still want to do.

Rich, those are sharp insights into ideomotor movement and a powerful example of when (domesticated) people are encouraged to use it - i.e., only when given permission by a cultural group to sense a "higher power" and to feel good in a body (need to be socially facilitated by people around doing the same thing, putting ideomotor movement squarely back into the hands of "culture" for its own purposes of exerting social control over the movement of the individual and reinforcement/perpetuation of itself). Wow, there are so many takeoff points here I hardly know where to start, but I'll start with this: subversion by religion of something that comes to us biologically for free. Why am I not surprised by this? How typically human primate. :rolleyes:

[Jon Newman]

I still think magic is quite realistic. Not only that but controversy sells and it clearly has that. Go with magic.

[Barrett Dorko]

Jane,

I appreciate your thoughts and concerns.

The word "mosaic" might to some extent describe the nature of my many thoughts regarding clinical reasoning and consequent effectiveness. After all, our complex systems are "sensitive to initial conditions" as the chaos theorists like to say. To me, this means that taking a great deal into account is what we must do when trying to explain how something got to be the way it is - that we can make the case for numerous influences when it comes to describing our patient's path toward dysfunction and or pain.

But this is also precisely why we cannot use all we might know in order to proceed reasonably with care. This is the basis for my essay The End of Evaluation? (http://www.barrettdorko.com/articles/end_of_evaluation.htm) which I needn't get into here.

Manual Mosaic makes me think that a variety of techniques will be taught; that a whole lot of "tools" will be added to the box many therapists carry around with them. As previous threads have indicated, I think very little of that.

Again, thanks for your thoughts and for making me consider again the difficulty the word "magic" may present.

[nari]

In one way, the use of mosaic is accurate; and I've thought about it since Jane suggested it.

It could be regarded objectively as a kind of jigsaw toolbox, where bits and pieces are put together to produce some sort of contrived result; which is not desirable.

Then again, it describes the physiological process rather well, and suggests a big-picture awareness. But I am not sure that meaning would gel with traditional PTs.

Barrett, it is your baby and yours to bring up as you see fit. I'm happy with magic - I think we are trying to look into how some others would regard it, especially the very confident PTs.

Nari

[EricM]

The Manual Magic thread explains exhaustively how Magic is probably the only appropriate word to describe what Barrett teaches. I have no problem with it. I do like Luke's suggestion though, of inserting the qualifiers "like magic" and "like a magician" in the course description.

[Luke Rickards]

I agree Eric, the word itself is perfectly appropriate, and I have no problem with it either. The only thing I'd change is to add a little of the context that will be revealed in the workshop.

[Diane]

From Ian's thread (http://www.somasimple.com/forums/showpost.php?p=33759&postcount=4) on the Paradox of Progress (http://www.somasimple.com/forums/showthread.php?t=3884).

THE MAN WHO WAS MAGIC

This reminds me of a short book by Paul Gallico that I once read called The Man Who Was Magic.

The story was about a medieval town in which everybody was a magician. Every man, woman and child in the population had some sort of trick or illusion which they could perform and they had an annual festival when they showed them all off to one another.

Once upon a time a young stranger came to the festival. And the thing about the young stranger was that he could do real magic…

When everybody had performed their vanishing lady acts and their handkerchief acts and their fire breathing acts, he took his turn and quietly unscrambled an egg. Slowly and undeniably, the scrambled egg changed into an unscrambled egg and then got back into its shell.

To find out what happened you really ought to read the book, it is beautifully written. Suffice it to say here that the people did not appreciate somebody really doing what they spent their entire lives pretending to do. They didn’t appreciate it at all. My bold.

[Anne Bower]

Hi Barrett-

Any idea on when you'll be "touring" the west coast again? I've been reading many of these threads and the info on your site. It seems from what you've written, I should be able to "get" Simple Contact without the class. While I think I'm starting to wrap my little brain around the idea, I would like to see it in action. I have been trying it with a few patients, but am not having great success...likely due to me and not them. Then again, the majority of my patients have had work injuries and a significant percentage have some yellow flags...angry at work, angry at the insurance company, etc. These folks seem to progress slowly, no matter which treatment approach I choose.

Do you still find good results with SC in situations where a person may have these types of emotions wrapped up with their symptoms?

Thanks-
Anne

[Barrett Dorko]

Anne,

In answer to your last question, I think that our view of our patient’s emotional state has to be reconciled with our training, and our training with regards to such things is almost non-existent. I tend to ignore this issue and focus on the neuroscience of pain. You’d be surprised (perhaps) how much that explains the things you thought “emotion” accounted for.

I won’t be on the west coast for a while. You’ll see on my site’s (http://www.barrettdorko.com/) front page that it’s almost all east coast for me the next few months. Keep checking there. I update my schedule regularly.

Of course, anyone else is welcomed to sponsor a workshop. Just contact me for details. bldorko@bright.net

I appreciate your interest.

[christophb]

Anne,

I have seen supposed complicated workers comp patients with emotional issue resolve a significant amount of pain in one visit. Of course this involves treating them from the start as someone who is capable of resolving pain in one visit. And as Barrett suggested this is helped by understanding the neuroscience of pain. It is easier though if they haven't had many contradictory and incorrect explanations given for their pain.

Chris

[nari]

Anne, I worked in a pain clinic, and agree with the posts above; the real problem comes, I think, with the overloading of incorrect and irrelevant information on pain that has been doled out to the patient for 15 years or so.

Emotional states do not matter as much; when the 'importance of psychosocial factors' was osmosing through PTs, it had more to do with the traditional approach - getting patients to be compliant and meeting expectations. There is very little we can actually do about their past history, but if pain responses reduce or resolve, it gives them an opportunity to deal with history by themselves. Maybe...


Nari

[Luke Rickards]

Anne,

I have to agree with the above answers also. I have recently finished a research paper on Simple Contact that contains the following in relation to your question. Of note is the score of 5 (best possible) on the depression subscale and a slight decrease on the anxiety subscale at C7 coinciding with the significantly lower levels of pain intensity seen on the QVAS and decreased levels of disability seen on the PSFS and the NDI at this data point. Although it may be possible to propose that a reduction in negative affect has resulted in the positive change in pain and disability, Bogduk50 has pointed out that there is no evidence that psycho-emotional factors cause pain or its persistence. In fact, the available evidence is to the contrary, suggesting that psycho-emotional disturbances are secondary to pain and its persistence.50 We may therefore postulate that the decrease in pain and disability could be responsible for the reductions in negative affect seen at this point.

[Barrett Dorko]

Luke,

Impressive to say the least.

I look forward to seeing this published.

[Sarah]

Luke,

Where can I get a copy of your paper??

Sarah

[Luke Rickards]

Sarah,

You can see it in the International Journal of Osteopathic Medicine hopefully in a few months. There may be an In Press preview available for SomaSimplers earlier. There will also be a bigger study in another journal by early next year.

[Anne Bower]

OK,

Thanks all for the helpful remarks. I have had to try to eradicate many preconceived notions-- largely picked up on school rotations-- already this past year working mainly with work comp patients. I see I have some more ideas to dump. I suppose, the one nice thing about being new is I have less stuff to un-learn.

Another question, if you don't mind: How do you assist with ideomotion when you're treating someone and there is a language/cultural barrier? Usually about 10-15% of my load requires an interpreter (or they suffer through my abysmal Spanish.) Does having an interpreter in the room inhibit the process? Have you found cultural differences in how people respond to SC?

One interesting side note...my hispanic patients usually use the word for nerves when discussing pain. The interpreters tell me that tranlates to tendon, muscle, etc. Seems the patients are getting it right after all...

[Diane]

Not only that, but Spanish gets it "righter" because it translates to "the (whatever) hurts me", reflexively, rather than the part itself hurting, as in "my (whatever) hurts" in English.

[Sarah]

Anne,

I recently used Simple Contact (after DNM) on an Iranian woman with her daughter present to translate. I also explained to the patient, through her daughter how she can practice at home. Neither of them seemed to think it was strange, in fact, they seemed more open to it than most Americans.

I wouldn't worry too much about cultural barriers to the idea that movement helps pain, just keep in mind cultural differences in appropriate touching.

Sarah

[Barrett Dorko]

Anne,

Years ago I was treating an old Italian woman from North Hill here in Akron who brought in her daughter to translate.

I did what I do for a while and then asked the daughter to question her mother about what she was feeling. The old woman said something, a phrase I came to understand was an idiom in Italian. She turned to me and said, "Mama says you have the hands of a saint."

Not bad. I considered indicating this on my sign in the yard or on my business cards but thought better of it eventually.

Probably best. Too much pressure.

[clarett]

Hi Barrett

Do you ver do courses outside of the States? I'm in Mexico at the moment with no chance of funding a course but I'll be moving to the UK next year and I'm really interested in doing your course. Each time I read about it on this forum I get more and more drawn in.

Diane - I'll be knocking at your door too.....

[Barrett Dorko]

Clarett,

I'd welcome any invitations, and if you're drawn to the idea every time you read about it here I can only conclude one thing:

My evil plan is finally working.