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Old 09-03-2011, 12:17 PM   #1
Barrett Dorko
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Default Butler's brilliance

I read his first book, Mobilization of the Nervous System, as soon as it was published in 1990. This was back when you had to take a letter for Australia to the post office, figure out the postage and then wait. He wrote me back immediately, and I still have the reply.

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It seems to me that the great majority of physical therapists are stuck at one end of the afferent neuron and even then their treatment avenue is via target tissues. We need to encourage therapists to look along the nerves, trunk, cord, autonomic nervous system and the forgotten brain!
Perhaps I sensed something. David Butler’s star has continued to rise since, and for good reason. He has worked diligently to remain connected to the research and academic communities, and has completed an educational degree himself. I haven’t done any of that.

Still, we continue to agree on many aspects of theory and technique. In fact, the only thing I see missing from his treatment is the encouragement of instinctive motion for correction. I guess that’s my thing. He just doesn’t care for it, I guess.

Anyway, this interview with David is something every therapist should listen to.

He says many things but two really stood out for me. He speaks briefly of what the sciences say about observable clinical phenomena and the support for proposed theory, seeming to distinguish this from evidence of effectiveness. It sounds like a movement toward “science-based” thinking to me though he never says that. (see The Wrong Question for more about this)

Butler also questions the sharp distinction between acute and chronic pain. I’ve been questioning that since 1980.

Finally, there is his renewed appreciation for neuroplasticity. The man interviewing him seemed averse to this though it is obviously a fact clinicians shouldn’t ignore. I expressed my feelings about this in the Suppose This Were True thread.

I’d love to hear what Butler has to say about that, but I guess he doesn’t read such things.
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Old 09-03-2011, 01:37 PM   #2
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Just listened to the whole thing again.
What comes very strongly to the forefront, is that David has a BIG capacity for patience: the interviewer is so clearly out of his league that he keeps tossing in the non-sequitur reactions. David has a gift of gently staying, or steering matters back on track, while communicating the science very well.

I think that is where his status has grown from - his ability to communicate so effortlessly about complexities - and not by alienating others. I remember Cyriax' talks, Kaltenborn, Evjenth and Janda for instance - all big names in the rehab world (set aside their concepts for a moment); none of them brought their message as effective and non-offending as David.

I do not mean to take away from his scientific endeavours or great insights - just saying that I think his ability to speak and write so effectively are crucial to the quickness and size of his "revolution".
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Old 09-03-2011, 01:57 PM   #3
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I appreciate what you're saying. What revolution?
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Old 09-03-2011, 02:13 PM   #4
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The focus on the nervous system as primary entry point for therapy.
It wasn't his alone, not was it fully new, hence my quotation marks.
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Old 09-03-2011, 02:15 PM   #5
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Quote:
...his ability to communicate so effortlessly about complexities - and not by alienating others.
I agree w/ Bas on this...it is this that is making me actually stick with (and *want to* stick with) making my way through his 400 pages in "The Sensitive Nervous System"

And Barrett, this quote from your original post:

Quote:
In fact, the only thing I see missing from his treatment is the encouragement of instinctive motion for correction. I guess that’s my thing. He just doesn’t care for it, I guess.
put a question into my mind- do you find that therapists that are more left-brained, "structured" types have more difficulty with grasping Simple Contact? From what I'm reading about your method (which is really my only exposure to it so far-interested in learning more!) it sounds like something that requires an ability to put aside a "need" to do things a certain way and in a certain order... which is "OCD"me in a nutshell sadly Any tips on getting around this mental block? (I do think the "interactor vs operator" idea has helped me make progress in this area but still have a way to go)(sorry if this sidetracks from the topic)
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Old 09-03-2011, 03:31 PM   #6
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Quote:
Originally Posted by Bas Asselbergs View Post
David has a BIG capacity for patience: the interviewer is so clearly out of his league that he keeps tossing in the non-sequitur reactions. David has a gift of gently staying, or steering matters back on track, while communicating the science very well.
I suspect that doctorate in education that he obtained during the last decade has been very useful in that regard.

What a handy "tool kit" to have gone back for. Learn how to educate by learning all the conceptualized steps and how to apply them. Not just be stuck chasing one another around in the gerbil cage of this profession.
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Old 09-03-2011, 03:37 PM   #7
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Especially after 19 minutes or so . I think there was a post here ages ago on sound is like touch at a distance ? This is what I get from David . His educational interests and understanding of threat based physiology has probably informed his demenaour/communicatin style . He consistently sounds reasonable and non threatening despite having his own agenda and interests . I read a book by a Psychologist on the science of compassion and this is something that I often feel when I hear David --this can only be a good thing if you are trying to understand something complex or challenge existing paradigms.
Tony have you read Jill Bolt Taylors My Stroke of Insight on her experience of laterality defecit?

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Old 09-03-2011, 03:42 PM   #8
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@ Ian,

No, I'm not familiar with that title; I'll have to check it out! Thanks!


Edit: after checking out her book on Amazon, I think I remember seeing a video last year of Ms Taylor giving a talk about her experience...her book is definitely now on my "to get" list!

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Old 09-03-2011, 07:00 PM   #9
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OK I'm listening to the interview right now and I had to LOL at this:

David Butler: "are you avoiding the brain in this discussion???" that was great!
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Old 09-03-2011, 08:21 PM   #10
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I was annoyed by the inane interviewer as well. Gee..great stuff....!

If it had been Margaret Throsby (the presenter who interviewed Lorimer Mososley) there would have been a difference. She extrapolates what the interviewee says, instead of just asking another question.

I agree that the differentiation between acute and chronic pain is very tenuous but one that is firmly entrenched. Pain is pain with a change in the brain after a few months or less.

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Old 09-03-2011, 10:37 PM   #11
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Having sat and listened to David Butler on several occasions, not only in the context of courses but also at the NOI conference (and dinner), I have found him a charismatic and entertaining,humble educator who, as noted above, oozes compassion for those in pain and simutaneously passion for the very subject of pain. I can imagine his patients just love his warm gracious concern whcih alone must bring such reassurance that they are not unreachable in their pain.

I think that without the discovery of this board and the NOI MOTN course, where I heard David first, I don't think that I personally would be choosing to continue to practice as a physio. In short the man engenders inspiration.

regards
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interesting collection of interveiws on that site
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Old 09-03-2011, 11:27 PM   #12
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Early today I invited the site owner here to see how much we've appreciated the interview.

I'd love to do one myself.
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Old 10-03-2011, 12:09 AM   #13
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Hi Barret,
Thanks for the invitation, and thank you for helping spread the word about the interview.

I hope that people can forgive my lousy interviewing skills and inadequacies in this subject. This is just a hobby for me, I am no way claiming to be a professional interviewer or an expert.

Feel free to mute me when ever I talk and just listen to David.

The truth is I've been out of my league in all the interviews I've done so far, whether it is talking Manual Therapy with Brian Mulligan, Stanley Paris or Tim Flynn; or ACL injuries with Tim Hewett; or Rehabbing the Spine with Stuart McGill or Gwendolen Jull.

That is kind of the point of the site and the interviews, an average PT getting to chat with some of the giants in our profession.

Anyway I hope people got something out of the interview and I invite you to check out the others.

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Old 10-03-2011, 12:27 AM   #14
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Welcome to SomaSimple, Sasha. I think it's great that an (other) "average" PT is taking on interviewing. Good! (Rod has done some podcasting.)

No way should you be "muted" - it's a conversation.

And now, not only do you know more about Butler, where he's coming from, you have enlightened the rest of us, and everyone has been reminded that "brain" is also "nervous system"!
So it's all good!
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Old 10-03-2011, 12:54 AM   #15
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Sasha,

I rarely get a reply to specific invitations such as the one sent you, so thank you for this.

Putting the thoughts of people with something to say out there for therapists to easily access is extremely important, and I appreciate your doing this.

Rod Henderson, a regular contributor here has done the same thing on a smaller scale and has one example posted I especially like here.

I think your interviewing style is fine, and, as I said, approaching the huge and somewhat disturbing topic of brain dominance is daunting. I have hesitated to do so as well.
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Old 10-03-2011, 12:54 AM   #16
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I really appreciated the ability to listen and pause to take notes. I have only seen brief youtube videos and this was and excellent recording. I can't afford to see David anytime soon so thank you very much Barrett for the link and Sasha for the leg work.

You can find Sasha on twitter @PTCEU

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Old 10-03-2011, 01:13 AM   #17
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I have emailed him a couple of times and he usually replies back. So you should email him and ask about instinctive motion.
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Old 10-03-2011, 01:42 AM   #18
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Sasha, I do apologise for my offbeat remarks; they were due to spur of the moment writing. Sometimes I get too nitpicky...

Having an "average" PT conducting an interview certainly has merit.
Hope you stay with us.

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Old 10-03-2011, 01:47 AM   #19
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I've spoken to David about this personally and had one of his instructors attend a workshop.

Nothing.
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Old 10-03-2011, 03:41 AM   #20
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Sasha, welcome and thanks for coming here!
I think I was the first one to criticize your interview part.

What gets lost in my writing and others' as well, is that sitting on the sideline and criticizing IS the easy part.
Actually sitting down and conducting an interview is a whole different issue - so, I owe you a big thanks for making the damn thing in the first place, and sorry for not acknowledging that first off.
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Old 10-03-2011, 04:16 AM   #21
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this thread reminds me that david already sent me an email while i havnt sent him any email before. i was really very surprised. i double checked the name and domain of the email just to be sure that i wasn'T dreaming. it was in 2007. i had a blog and i was discussing things he wrote on his own blog. the goal of his mail was to tell me to keep a copy of a picture i borrowed from his blog, as a backup! again i double cheked to be sure he wasn't asking me to remove the picture because of copyrights...!
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Old 10-03-2011, 09:58 AM   #22
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Thank you, Barrett for pointing me in the direction of this link and Sasha for making it happen - I really enjoyed listening.

I found David Butler's last point about maintenance vs. cure very interesting. I seem to have got told quite a bit recently that in order to practice 'ethically' I have to be 'realistic' in my prognostic statements for patients. That generally seems to be interpreted as 'err on the side of pessimism'. It was great to hear someone with David Butler's level of knowledge say (as I understood him) that actually it was verging on unethical to be pessimistic about outcomes if the science is telling you otherwise. His opinion seemed to be very much that the science was telling us otherwise in a lot of cases. I find that very exciting

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Old 10-03-2011, 12:36 PM   #23
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Welcome Sasha! Thank you for making the interview available. I just took the "Mobilization of the Nervous System" course this past weekend and the interview was a great review for me!

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Old 10-03-2011, 07:26 PM   #24
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In the interview David mention's questionaires as assesment tool for patients in a painstate. "find out what's going on in the brain" if I'm correct

I am wondering which ones any of you use? (thats if you do)

Really liked to hear David speak especially on the subject of outcome prognosis.

Am going to attend the "explain pain" course by L. Mosely in june looking forward to that one a lot.

Along with the course info there's one (among 2 more art.) very interesting article from his hand:
"Masterclass : A pain neuromatrix approach to patients with chronic pain"
Manual therapy (2003) 8(3) 130-140
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Old 11-03-2011, 04:42 PM   #25
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Another question might anyone know of article(s) in which the lack of painscience knowledge among part of the PT field world wide is discussed especially when it comes to predicting outcome prognosis?

Thx have a nice weekend
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Old 11-03-2011, 05:42 PM   #26
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Not sure if this article exactly matches your question @Marcel, but Moseley did a study in 2003 looking at patients and health professionals understanding of the neurophysiology of pain.

See here for abstract to article titled: "Unraveling the barriers to reconceptualization of the problem in chronic pain: the actual and perceived ability of patients and health professionals to understand the neurophysiology."
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Old 12-03-2011, 04:24 PM   #27
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My reply is a little slow but thanks for the welcome and thanks for the comments.
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