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  • "You'll torture me on my birthday"

    Posted by Jason Silvernail<script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,15,15,23,0), dfrm, tfrm, 0, 0, 0, 0)); </script> (Member # 4433) on 15-11-2005 22:23<noscript>November 15, 2005 03:23 PM</noscript>:

    So, a mere seconds after I read the closed "Torture" topic, I met an ex-patient of mine at the front desk of our clinic. After a long and unsuccessful course of multimodal therapy for his anterior knee pain, he is being scheduled for a "ritual mutilation"... oops, I mean "diagnostic arthroscopy".

    Upon receiving his appt date, he stated, "Great, it's my birthday, too. So you'll torture me on my birthday."

    I thought of the torture thread, and specifically how this reputation came to be associated with our profession. He is an example of a patient that I have handled with much TLC (tender loving care) since day one, gently progressing him, encouraging him, and above all, moving toward painfree exercise for his knee. He had very little education as to his ailment from either his primary care provider or his Orthopedic surgeon (a shocker, I know) so we did quite a lot of education, reassurance, and coaching, too.

    I found it particularly strange that he would refer to me and my care as "torture" when I had worked so hard to instill the opposite in him.

    I have been known to tell patients "you can move your (insert relevant joint) OR I can move it for you, but you'll like it a lot better if you do it." However, this was always gentle handling with constant communication and careful observation of pain tolerance. I have read much basic science which supports more progress to be made with gentler lower load, longer duration stretching than with short term, aggressive and painful ROM attempts.

    How powerful must this cultural assumption be of our care if even this young man is so convinced?

    J
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,15,15,51,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 15-11-2005 22:51<noscript>November 15, 2005 03:51 PM</noscript>:

    If one thinks the science of memes is accurate, I think the meme for physical therapy = more pain is well installed in the public's mind, and in some other health professionals' minds as well.

    Maybe his perception is quite different from your perception of what you were doing at the sessions; despite all the care you took in avoiding any exacerbation of pain. Perhaps he considers his painful knee as 'exposed' to movement of any kind, be it active or passive; he walks and sits with pain (presumably) and when he goes to a PT the same thing happens.

    Maybe he was just joking, going along with the 'meme' that PTs are there to inflict pain.
    I have had quite a few patients who have said to me when movement (passive or active) was stopped because of pain increase: "Keep going, it has to be done, it's OK, I can stand it".

    Possibly it has something to do with the fear of being seen as NOT tolerating a 'bit of pain'...ie demonstrating a weakness of mind or some such thing.

    It is such a mixed bag, dealing with other people.

    I saw one man who had experienced chronic pain for years, and he said at the end of the first session (which was education and discussion of goals only): "...I feel great. The pain has practically gone. And here I was expecting to be in agony once more". His past history of PT experience was PT = pain = more drugs.

    Nari
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,15,17,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-11-2005 00:36<noscript>November 15, 2005 05:36 PM</noscript>:

    Hi Jason,

    So what did you say in response?

    jon
    <hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,15,18,35,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-11-2005 01:35<noscript>November 15, 2005 06:35 PM</noscript>:

    I think that what Nari said about the patient looking for an opportunity to show how tough he is rings true. We shouldn't underestimate the desire to tell a story once recovery is complete.

    What kind of story would gentle care produce?
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,15,23,8,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-11-2005 06:08<noscript>November 15, 2005 11:08 PM</noscript>:

    Expressions of surprise and some head scratching that 'nothing' can lead to positive outcomes.

    But the grape vine story might be 'that funny PT who doesn't DO anything, but you end up feeling renovated/painfree/warm/relaxed/etc....something to do with the brain doing its own thing'.
    Patients have some amazing stories to tell about experiences with PTs; some of them are hair raising and others, enlightening.

    Nari
    <hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,16,6,46,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-11-2005 13:46<noscript>November 16, 2005 06:46 AM</noscript>:

    I told him I thought he knew me better than that.
    He sort of smiled and then said something like "we'll see how it is after surgery."

    I think he was expressing worry over the surgery and the subsequent necessary movement of an inflamed joint as much as concern over the care he was likely to receive.

    However, I found the coincidence with the other thread interesting.

    I must say I am guilty of, earlier in my career, being one of those therapists who encouraged patients to bear all sorts of pain while relentlessly cranking on their painful joints. I never really enjoyed it, but felt it was necessary. I knew that deep down, I was uncomfortable with it, because I would get that cold and empty feeling in my chest (the sympathetic/adrenaline dump you get before giving a public speech) while the patient squirmed.

    I went to an Army course on therapy for those with burns and multiple trauma, and was introduced to some of the best burn therapists in the country. It was there I learned a lot of the basic science about tissue adaptation to stress, and how much better a slow prolonged gentle force is, than an aggressive short term one. Looking back, I think this is some of what Barrett must be talking about when he says that many therapists do not seem to understand the nature of the materials they are handling. Definitely true of me at one time, but that is improving. Slowly.

    I can imagine that gentle care leading to long term pain relief might be close to an optimal therapeutic situation. And great for referrals, I would imagine.

    J
    <hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,16,8,42,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-11-2005 15:42<noscript>November 16, 2005 08:42 AM</noscript>:

    Diane would probably blame most of that meme on PT's military connection, I attribute a lot of it to PT's connection to sport and the sporting mindset.

    I remember reading Bowerman, a great running coach at Oregon, actually put his hands around the throat of Prefontaine, a great runner, out of frustration because he wanted him to train easy runs and Pre always tried to exhaust himself. The idea of pushing until you can't push anymore being the best way is hard to get rid of.

    I thought there was an interesting take on Vitaly Klitschko, now retired heavyweight champion, he once quit during a fight because he injured his shoulder. He was berated and scorned by the fans and press for taking what was a sensible action. He didn't regain his popularity until he fought Lennox Lewis and got a bad cut and continued fighting.

    I just love the fight game. In judo/jitsu there isn't any, or at least much, shame in tapping out, but it's expected that you gave everything you were capable of.

    Going back to the "T" word. I think there is a certain parallell between certain parental behavior that is abusive and the actions of some therapists. A belief that the inflicting of pain is for the patients own good, along with a feeling of that somehow they deserve it. A certain anger for the patient for hurting when they shouldn't be. I know I have felt it. I believe it is a result of a mixture of frustration and a fear of incompetence and lack of control. I have felt the same thing in my parenting, but I knew to look for it, recognize it and not act on it. I don't know that therapists ever get that training, except through experience.
    <hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,16,8,59,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 16-11-2005 15:59<noscript>November 16, 2005 08:59 AM</noscript>:

    Randy, you're right about how I'd think.. furthermore I think there's huge overlap between the mindsets. "Be all that you can be" = army/military on the one hand, and "give a 110%" = sports/team spirit on the other. Don't forget PT had its origins in army gym trainers. Gyms= sports= fitness training = military training. I don't really see a lot of difference, frankly.

    Happy to engage in simple walking every day, happy to see PT try to evolve a bit further away from physical and more toward therapy,
    <hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,21,13,7,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-11-2005 20:07<noscript>November 21, 2005 01:07 PM</noscript>:

    I thought I'd bring this link here; although it involves intuitive eating rather than intuitive movement, I thought it was an apt parallel with many features that are useful in highlighting simple contact/ideomotor movement as opposed to "working out"...

    Maybe ideomotor movement is like "intuitive eating" for the same reason that working out is like "dieting"..

    Too much rumination or tinkering, working out obsessively or moving wrongly or not moving enough leads to body dissatisfaction, pain, sense of being trapped inside of or at the mercy of or "tortured" by one's own body. Moving when needed, the amount that is needed, the way that is needed, leads to sense of health and bodily wellbeing, relief of pain.

    Rigid attitudes to food and too much tinkering of diet leads to poor health, food fixation, eating disorders of too much, too little, or wrong kind, and or distancing of self from body/ bad relationship with body. "Intuitive eating" leads to correct weight, good relation to food and eating motivations and behaviors, optimal health.

    quote: <hr> To be an intuitive eater, a person has to adopt two attitudes and two behaviors.
    The first attitude is body acceptance...personal worth is not a function of body size. The second attitude, that dieting is harmful, is related to the first.

    “Dieting does not lead to the results that people think it will lead to, and so I try to help people foster an anti-dieting attitude,” said Hawks. “You have to say to yourself, ‘I will not base my food intake on diet plans, food-based rules, good and bad foods, all of that kind of thing.’ For people who are deep into dietary restraint and dietary rules, again, that’s a very difficult attitude adjustment to make, to give up all those rules.”

    Behaviorally, the next step is learning how to not eat for emotional, environmental or social reasons....finding better ways to manage our emotions is part of the process.

    The final step is learning how to interpret body signals, cravings and hunger, and responding in a healthy, positive, nurturing way.

    One part of intuitive eating that may be counterintuitive to people conditioned to restrictive dieting is the concept that with intuitive eating there is a place for every food. In other words, there’s no food that’s ever taboo, there’s no food you can’t ever have.
    <hr>
    Substitute words such as move, movement, moving, mover, etc. for the words food, eating etc. and the words exerciser, exercising for the words dieting, dieter etc., and I think we have a good description of ideomotor movement and why it is both a.) needed and b). a tough sell.
    <hr> Posted by Christophb (Member # 3884) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,21,13,54,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 21-11-2005 20:54<noscript>November 21, 2005 01:54 PM</noscript>:

    Oddly enough, I was just researching interoceptive awareness and came across things such as what Diane posted above. Interoceptive awareness or lack of would make it more difficult to distinguish between different feeling states in the body... any connection to intuition? I was thinking about it in relation to a meditation study Jon found for me stating that meditation increased interoceptive awareness. One problem I see though is to be too focused on internal feeling states and try to consciously adjust them by tinkering instead of being aware and allowing the unconscious/intuition to do its thing. This is a challenge I see in the clinic while doing ideomotion, people hyper vigilant and trying to control the movement vs people without the awareness of the movement. Or, it could just be me.

    Chris
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,21,17,22,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 00:22<noscript>November 21, 2005 05:22 PM</noscript>:

    I tried out the substitution of 'movement' words in the quote - and it does work well. Restriction by external rules and internalised ones never seems to work, whether it's food or movement.

    But I do like the notion that there is NO food that is 'bad', it's only the quantity that is a problem for some. (Apologies to Jason who may disagree with this 'no bad food' theory! [IMG]wink.gif[/IMG]

    Interoceptive awareness...have to think more on that concept. There is a difference, though between concentrating too much on internal feeling states (not necessarily a 'good' thing') and being aware of intuitive feelings. It's all about control, as I see it and then, control can be slivered into positive and negative.....and it then starts to be complex. (Note, not complicated)

    Nari
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,21,18,22,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 01:22<noscript>November 21, 2005 06:22 PM</noscript>:

    Nari,

    Your words of caution are similar to Theodore Roethke's

    Self-contemplation is a curse
    That makes an old confusion worse.

    The mirror tells some truth, but not
    Enough to merit constant thought.
    <hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,21,21,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 04:40<noscript>November 21, 2005 09:40 PM</noscript>:

    I occasionally do a bit about the book Wild Health by Cindy Engle. It concerns the studies done the past 20 years of how animals in the wild maintain their health through intricate and precise dietary manipulation as opposed to the sort of eating a domesticated animal is more likely to do.

    If, as Wall says, the consumatory act necessary to terminate the "need state" produced by pain is movement, and the need state to terminate hunger is best terminated by instinctive eating, wouldn't it follow that instinctive movement would be our best choice as well?
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,21,23,9,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 06:09<noscript>November 21, 2005 11:09 PM</noscript>:

    It would.

    Re wild animals -in fairly good times, our brumbies (wild horses) are as sleek and fit as the domesticated ones or often much healthier; they don't need hoof trimming and shoeing on wild stony country (eg the Alps)or even on softer ground.
    Domestication, and thus nonintuitive feeding and care, has its problems.

    Nari
    <hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,22,0,49,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 07:49<noscript>November 22, 2005 12:49 AM</noscript>:

    But if you compare the health of a normal wild animal and the health of a domesticated one, you will find that overwhelmingly the domestic animals are healthier. They also live much longer lives. As we have discussed, the wild animals we see are also the result of fairly intensive culling, we are seeing the cream of the crop.

    I have read several articles which have found that animals don't choose foods that have the nutritional requirements they need if allowed to choose between several. While I agree that we need to maintain in touch with our "instincts", I don't think this is a good example.

    I'll have to see if Wild Health is one of the books I have read. I sometimes forget. I will also see if I can find the other articles.
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,22,6,40,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 13:40<noscript>November 22, 2005 06:40 AM</noscript>:

    Randy,

    This opens up the interesting question of what "healthy" is.

    jon
    <hr> Posted by paulpt (Member # 5125) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,22,6,57,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 13:57<noscript>November 22, 2005 06:57 AM</noscript>:

    This should probably be attributed to the closed post on torture... BUT

    http://www.foxnews.com/story/0,2933,176205,00.html
    <hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,22,7,21,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 14:21<noscript>November 22, 2005 07:21 AM</noscript>:

    Randy,

    Forced to actually live in a natural environment any domesticated animal would probably look even worse than others of the same species who are used to it and haven't had their instincts surpressed through enculturation-including humans, of course. Isn't this one of the primary lessons of the book and movie Cold Mountain?

    Paul,

    Your amazing credulity aside, we already know the deed's been done, and it will continue.
    <hr> Posted by paulpt (Member # 5125) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,22,7,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 14:38<noscript>November 22, 2005 07:38 AM</noscript>:

    Barrett: that was good. I have added the word credulity to the list of words whose meaning I learned this year. Thanks, have a great day.
    <hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,22,7,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 14:39<noscript>November 22, 2005 07:39 AM</noscript>:

    Torture that various agencies don't want to do, or that has been outlawed here in N.A. (Canada and US) simply gets farmed out to countries where it is still allowed. Canada and the US are so integrated now, both economically and militarily, that Canadian citizens can be detained if flying through US airspace and sent off to Syria or somewhere to be tortured for a few years, and Canada doesn't (can't or won't) make a peep. Seems to me the border between these two countries is a mere (in)convenience to keep regular people from either side from traveling freely, and to irritate Canadians by ripping us off with tarriffs on soft wood lumber that are supposededly illegal under the free trade agreement. We always win in court on these things, but we keep getting harrassed in this bullying manner anyway, and have yet to be paid the 5 or so billion that we are owed by your country. No true sovereignty here, even if we still have multi-colored money that depicts a granny queen who lives in yet some entirely other country. Torture can be conducted at very polite levels in this sort of "economic erosion" way.
    <hr> Posted by paulpt (Member # 5125) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,22,10,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 22-11-2005 17:39<noscript>November 22, 2005 10:39 AM</noscript>:

    Diane: thanks for the interesting viewpoint, it is one that I have not seen synthesized in this manner.
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,22,17,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-11-2005 00:14<noscript>November 22, 2005 05:14 PM</noscript>:

    Randy

    Elephants in the Namibian desert are living on the margin of survival, yet "know" to travel very long distances away from their sparse vegetation just to maintain their salt intake,plus mineral requirements. A domesticated elephant probably would not do this in a similar environment where such essentials are lacking.

    Diane,

    Torture (odd how this word keeps appearing) can be very subtle according to the definition of the word by any party with vested interests.
    This would apply to many organisations (including health organisations)around the world, but its effects are hidden behind policies and apparently transparent procedures. Oh, and forgetting to pay money owed...

    Nari
    <hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,23,0,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-11-2005 07:14<noscript>November 23, 2005 12:14 AM</noscript>:

    Nari,

    Experience has taught these elephants where the salt is, cows also seek out salt. The argument isn't that animals in the wild never eat the correct foods, the argument is that given a choice of a steady diet of their favorite food and a diet that is optimal they will over choose their favorite, just like us.


    The point of my argument is that it is clear that in the case of nutrition that an imposed, controlled diet, especially one that is researched and has some science behind it, is better for the health, as measured by longevity and disease, than one that is "instinctive". The argument is not that wild animals never crave food because of nutritional needs or that wild animals are better at surviving the wild than domesticated ones. So I am saying that using "instinctive eating" as a parallell to "instinctive movement" is probably not a good one.

    I am aware that I am picking nits.

    Diane,

    I can't believe the citizens of the 51st state are still whining about being pushed around by their southern neighbors. I mean, we would make it official, it it weren't for the need for the rest of us Americans to have a second identity when visiting countries like France.
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,23,2,42,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-11-2005 09:42<noscript>November 23, 2005 02:42 AM</noscript>:

    Randy

    I would accept your argument more easily if humans choosing an 'instinctive' diet were not brain washed by TV ads for inappropriate diets by mega corporations. To that extent, what you say is probably true. For animals, it is somewhat different as they don't read or watch TV much.

    I am fairly doubtful about the evidence for a controlled, imposed diet; the 'experts' change their minds every few years. First protein was bad, then good, then bad, and now it's good, and carbohydrates are now bad and make people fat.

    Not the sort of thing one can take too seriously.

    For lots of people in this world, an instinctive diet of whatever they can lay their hands on will keep them alive another day.

    Nari
    <hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,23,9,19,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-11-2005 16:19<noscript>November 23, 2005 09:19 AM</noscript>:

    Nari,

    I think the fads have changed and will continue to change regularly, just like in many aspects of healthcare. The consensus of the experts though have been quite consistent about nutrition in the last 30 years or so. My sister is a registered dietician, I used to think she was overly conservative in her beliefs but now I think she had it right all along. What also changes is how the information is presented and how they try to get people to follow their advice.

    Interestingly, nutritionists seem to have some of the worst eating habits of any people I have seen.
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,23,10,27,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-11-2005 17:27<noscript>November 23, 2005 10:27 AM</noscript>:

    Hi Randy,

    In general, what are the (nutritional) beliefs of your sister?

    jon
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,23,15,22,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-11-2005 22:22<noscript>November 23, 2005 03:22 PM</noscript>:

    Randy

    I'd certainly agree with your last sentence! Indeed, quite a proportion of nutritionists are overweight to the point that they become quite fanatical about wanting their clients to lose large amounts of weight. Seems odd..
    I too would like to know the basis of nutritional beliefs as your sister sees them. Apart from the famous pyramidal concept which we are all familiar with, I think.

    Nari
    <hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,23,16,2,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 23-11-2005 23:02<noscript>November 23, 2005 04:02 PM</noscript>:

    "quite a proportion of nutritionists are overweight"

    That was never my experience; all the ones I've ever met or rubbed shoulders with were of perfect weight, and were quite exercise conscious. In conversation about that, they sort of indicated that taking in nutrients doesn't do any good unless they get delivered to all the cells through exercise, true albeit simplistic, I suppose, especially for diabetics. (Come to think of it, diabetes is a condition where diet and exercise must be calculated obsessively, doled out in relatively equal portions every day, no room for error or sloppiness, because the body can no longer tolerate too much of one and too little of the other without destruction of tiny vasa vasorum/nervorum structures by gooey syrupy blood. What self-imposed 'torture' that must be.. no opportunity for instinctive eating without a price to pay.)

    At a hospital I worked at long ago, it was the dieticians who devised a very nice employee dancersize program for after work! The PTs joined in enthusiastically but it was the dieticians who initiated it.
    <hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,23,22,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-11-2005 05:20<noscript>November 23, 2005 10:20 PM</noscript>:

    I wanted to respond to my own answer about instinctive eating, an "on the other hand.."

    I was going to ask that given the epidemic proportions of obesity today do you think we would have more success trying to educate people on what a healthy diet is and imposing that on them, or simply let them eat instinctively.

    I considered the question almost rhetorical, but as soon as it entered my mind I realized that the first approach has been a massive failure long term and that aspects of the second approach are necessary. That learning to connect with the body and learning to differentiate between physical signals and emotional and social cues is a big part of healthy eating habits.

    As far as my sister's views, basically what you were taught in grade school. Lots of veggies, some grains, a little meat, lots of variety. Supplements not necessary. Her actual diet consists mostly of Dr. Pepper and chicken nuggets. Her most interesting work was in the Ketogenic diet, a very high fat diet, for certain forms of epilepsy. The kids would remain symptom free while on the diet. There are, of course, the expected side effects.
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,23,22,28,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-11-2005 05:28<noscript>November 23, 2005 10:28 PM</noscript>:

    I honed in on the very high fat diet and resolution of epileptic seizures- very interesting. I wonder what the epilepsy incidence would be amongst Inuits on their natural diet; there would not be too many these days on such a diet, but I wonder if this was worth following up..I was trying to think of the biochemistry behind the findings of the Ketogenic diet, but did not get very far. Might google...

    nari
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,23,23,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 24-11-2005 06:20<noscript>November 23, 2005 11:20 PM</noscript>:

    I did a search on the ketogenic diet and it has been used since the 1920s for intractable epilepsy. It induces a state of ketosis and, as a result, a loss of weight, but the latest info suggests, of course, that it be used only for severe cases because of its negative nutritional side effects. Sounds extremely controlled and nonintuitive! Glucose will immediately negate the anti-epiletic effect.

    Nari
    <hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,25,10,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-11-2005 17:36<noscript>November 25, 2005 10:36 AM</noscript>:

    Personally, I always thought my see-food diet is instinctive. Not necessarily healthy.
    I have a theory of why men are always looking over their shoulders, and women are always thinking about food.
    Men were the hunters (sometimes the hunted), and women were the gatherers, and were depended upon when the hunters were emptyhanded.
    <hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,25,10,44,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-11-2005 17:44<noscript>November 25, 2005 10:44 AM</noscript>:

    Good theory Yogi. (Like that "see-food" comment. The only way I can get through my earthly existance without weighing 800 pounds is to not look at the many bakery and gelati shops as I walk to and from work.)

    Plus evolutionarily I expect we banded together to chase off lone predators, cheetahs etc, from their fresh gazelle kills, picking up the "robber" strategy from hyenas.
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,25,14,50,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 25-11-2005 21:50<noscript>November 25, 2005 02:50 PM</noscript>:

    Going back to the original theme on this thread, I guess for some people food-avoidance/dieting is a kind of torture.

    Yogi - do women always think about food? Are you saying they always think about the preparation of food for others, or just themselves? Or both?

    Some people snack during the day, five or six times and do not worry about a regular 3-a-day meals. This seems to make sense, as our Aboriginals used to snack on berries and nuts and roots while on walkabout, and if there was a goanna or kangaroo kill, well and good. That lasted for some days with the group of maybe 6-8.

    Snacking on 'normal' foods, not processed and sugared stuff, seems to make more evolutionary sense, and more satisfying than having to consume a large quantity at a pre-destined time. I don't know, snacking seems intuitive to me.

    Nari
    <hr> Posted by Luke R (Member # 3561) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,26,3,25,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-11-2005 10:25<noscript>November 26, 2005 03:25 AM</noscript>:

    Nari,

    I agree on the snacking. 5-6 meals and plenty of snacks seems intuitive to me. [IMG]biggrin.gif[/IMG]

    Luke
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,10,26,3,38,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 26-11-2005 10:38<noscript>November 26, 2005 03:38 AM</noscript>:

    Luke,

    Careful ....some readers might think you are just kidding! [IMG]wink.gif[/IMG]

    Nari
    <hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,5,8,58,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 05-12-2005 15:58<noscript>December 05, 2005 08:58 AM</noscript>:

    Amazing how these threads change over time...
    I would have a lot to say about instinctive eating, but I think Randy said most of it for me.

    We seem to be done with the torture concept (related to PT culture, I mean) anyway.

    I would caveat the instinctive eating thing with the fact that it has been our slow and deliberate reduction in some instinctive behavior such as murder, rape, and theft that marks a civilized society. I don't believe either instinctive behavior or eating make as much sense in a deep model sort of way as ideomotor motion for pain relief does.

    J
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,5,10,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 05-12-2005 17:39<noscript>December 05, 2005 10:39 AM</noscript>:

    I'd like to offer a reminder of what, to me, is the appropriate definition of instinct for the context we are discussing.

    From Webster's 3rd International Dictionary,

    quote: <hr> complex and specific response on the part of an organism to environmental stimuli that is largely hereditary and unalterable though the pattern of behavior through which it is expressed may be modified by learning, that does not involve reason, and that has as its goal the removal of a somatic tension or excitation <hr>
    When it comes to decreasing hunger I think we eat whatever will do that. For some people the choices are amazingly few by default of their environmental situation. For others the choices are outrageous. Regardless, the instinct is the behavior of eating. What gets eaten is the unique expression of the instinct. Many things may influence that expression (culture comes to mind).

    In Jason's reasonable example, rape, murder, etc are expressions of certain sorts of instinct. Perhaps reproductive (a shallow first guess) and self preservation respectively. Does anyone suppose we have different ways of expressing these instincts (as opposed to no longer having them)? Also, do we have any instincts that are worth displaying in their authentic form?

    Lastly, it might be that intuition is a subset of instinct.
    <hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,5,10,55,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 05-12-2005 17:55<noscript>December 05, 2005 10:55 AM</noscript>:

    quote: <hr> I don't believe either instinctive behavior or eating make as much sense in a deep model sort of way as ideomotor motion for pain relief does. <hr>
    I'd pretty much agree with that statement J.
    quote: <hr> We seem to be done with the torture concept (related to PT culture, I mean) anyway. <hr>
    I don't want the topic to end quite yet because I think they are still intertwined, perhaps indefinitely. This is from the dolor blog:

    quote: <hr> Wednesday, February 16, 2005
    Grrr....

    In the new issue of Philosophy and Public Affairs, David Sussman gives essentially my view on why torture is bad.
    ..torture forces its victim into the position of colluding against himself through his own affects and emotions, so that he experiences himself as simultaneously powerless and yet actively complicit in his own violation....torture turns out to be not just an extreme form of cruelty, but the pre-eminent instance of a kind of forced self-betrayal, more akin to rape than other kinds of violence.
    <hr>
    So, forms of coercive treatment, manipulation for example, forced exercise, could be seen as something that forces someone into a powerless state just as pain itself does. Even if the 'person' (part of the brain with the sense of self) doesn't sense powerlessness any more, perhaps some part of their motor output system does, and even if pain lessens, the brain may not have connected itself back up or have "learned" anything new or resolved its own intRArelationship(s).

    Ideomotor motion is the antithesis of torture or powerlessness in that:
    1. it does not create any pain from the outside in; any pain that is felt by the patient in the course of "treatment" is self-generated and therefore "understood" and simultaneously downregulated by the patient as they move toward better sensory-motor function, i.e.; no one is ever asked to move themselves or any part of themselves or is moved by any outside force (e.g., therapist or machine) into the direction of pain.
    2. the sensorymotor brain actually learns new ways to be in the field of space/gravity, better. (I wouldn't say "subcortical" brain, because I think the cortex is very much involved (that's where the sensorymotor cortex is located after all) but I could say "postfrontal" and feel I was being correct.)

    Here is more from Adam, on pain being a fundamental evil:
    quote: <hr> Pain is a fundamental evil. Understanding pain and its place in human life is a fundamental religious and ethical concern. From Pandora, to Job, to the Buddhists' first Noble Truth that all life is suffering, to modern secular questions about the value of life, all philosophical and religious traditions have struggled with pain's evil. From the source of our moral obligations and our understanding of what makes life good, to the role of suffering in redemption and the idea of a just god, making sense of pain is making sense of humanity. Yet, despite its central place in our understanding of ourselves and of what matters most, virtually everyone has misunderstood what pains are and therefore wherein their evil lies. I shall give a new account of both.

    This is a dissertation on pain's intrinsic badness. It is also a dissertation on the nature and sources of value. The account I shall give yields insights into perennial philosophical questions including, inter alia, the ubiquity of reasons to alleviate other's pains; the nature of rationality; the role of subjective desire in ethics; the possibility of reducing value to natural properties; the value of autonomy; the nature of torture; and the normative significance of animals' pain.
    <hr>
    This speaks to me. Although I think there are entire subcultures out there (like the SM communities) that would beg to differ with him, my intrinsic sensibilities about pain, and why I became a PT (while still an energetic but fairly focused teenager), was in order to be able to do direct battle with it! What a great place to pour myself out onto the world, I thought at the time. (I also very practically realized that the job would be never-ending and that I'd always have work to do, for my whole life long, as Buddhism points out.)

    I find as a middle-ager that my sentiments still pretty much line up with his, although his are more finely nuanced and include religious overtones, whereas mine were/are about quashing physical pain at its source, in any/all its manifestations/infestations, more along the lines of reestablishing harmonious physiological order to free people up to do more creative things with their lives than have to come for treatment. On another much more neutral level I can see pain for what it likely is, an attempt by one part of the brain to signal other parts of the brain that there exists a sensorymotor miscommunication or disconnect or tipping point.

    It's a logical extension to therefore find myself combatting as a human, a PT, not just the fact of physical pain and its ubiquity, but despising social orders that impose it on others, especially those social orders that should know better and do it anyway from greed and by obtuseness.
    quote: <hr> I would caveat the instinctive eating thing with the fact that it has been our slow and deliberate reduction in some instinctive behavior such as murder, rape, and theft that marks a civilized society. <hr>
    Really? I still see lots of murder etc. around.. Maybe it's just more outsourced/exported.
    <hr> Posted by freetomove (Member # 2735) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,5,18,41,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-12-2005 01:41<noscript>December 05, 2005 06:41 PM</noscript>:

    I think pain is being maligned somewhat in the above quote. As a biological signal, pain is very useful and serves a protective purpose. I think the greater problem for a large number of our clients is their misunderstanding of pain. They perceive pain as a danger signal and avoid movement when it is actually a signal telling them they need to move (this is pain of the persistent irritation - not the tortures you're referring to). Better to do battle with ignorance and cruelty than with pain.

    Nick
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,5,19,0,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-12-2005 02:00<noscript>December 05, 2005 07:00 PM</noscript>:

    Hi Nick,

    It sure is nice to hear from you. Your post reminded me of a situation I often encounter in acute post-operative total knee replacements. I'm charged with setting up CPM's on these folks (don't get me started on that topic) and on occasion I'll have someone whose pain is "poorly controlled". The nurse is doing all she can do which usually consists of giving the person as many narcotics as they can and still stay on this side of respiratory failure. I think that is a reasonable course of action in general however it is not uncommon for me to have the following experience. I'll uncover their leg (the patient's, not the nurse's), give them permission to move it where they will and assist them to the extent of carrying the weight of the limb for them. Sometime the move hurts quite a bit and other times not but the end result is a distinct decrease in pain that the narcotics just weren't helping. They needed to move but couldn't. Of course this doesn't do much for the chemical pain they are feeling status post surgical trauma but that's what the narcotics are for.
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,5,20,6,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-12-2005 03:06<noscript>December 05, 2005 08:06 PM</noscript>:

    On the torture theme, there is reportedly a reduction in crime (per capita) but we still have the desire in one form or another to inflict pain and suffering on people.
    I think the recognition of torturous activity has changed from the standard definitions. But if we go back a couple of centuries or more, there was certainly a delight in both delivering and watching torture; think of the ****** Revolution amongst countless other examples.
    Apart from the potential psychpaths, the general public would not even think of cheering at a slow execution via torture. In that way we have changed.

    I agree with Diane that,if one considers the broad definition of torture as a method of causing pain or increasing pain, then it can apply to physical therapy.
    Maybe many people expect it (as discussed before) but it does not mean it is necessary. The intent to hurt may not be there; but the belief that ROM must be gained at all costs is alive and well.

    Forceful movements really have no place in therapy, and that includes exercises which come off the sheet as a protocol of sorts; there are always patients who will overdo the regime. Those that listen to pain education probably do better.

    I've lost count of people I have seen who have struggled and taken extra analgesia, just to "do the exercises the last PT gave me.."....I cannot find any rationale for that sort of misunderstood 'cruel to be kind' attitude.

    Pain is essential when it is not administered by another party; a darn nuisance at times, but better alive with some pain than dead without.

    Nari

    Ooops censored again....
    <hr> Posted by Gil Haight (Member # 691) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,6,10,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-12-2005 17:10<noscript>December 06, 2005 10:10 AM</noscript>:

    Jon,
    [Does anyone suppose we have different ways of expressing these instincts (as opposed to no longer having them)? Also, do we have any instincts that are worth displaying in their authentic form?]

    This is very insightful. It reminds me of a chapter in Thomas Moores' " Care of the Soul" entitled the 'gifts of depression'. I think we need to differentiate between instinct and impulse. Although it can be valuable to explore impulsive tendencies, instincts do not need analysis as such.
    Gil
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,6,14,15,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-12-2005 21:15<noscript>December 06, 2005 02:15 PM</noscript>:

    jon,

    Are CPMs still being used? They were shown to be fairly useless some years ago. I am sure that is a moot point with you; can you show them the literature which points strongly to their being a waste of everyone's time?

    Is impulse an instinct gone haywire?
    I watched an interesting program of a consummatory act gone crazy - the Prader-Willi syndrome where the instinct to eat never gets to the consummatory stage, and the hypothalamus fails to register hunger satiation. So the syndrome kids become huge (25-40 stone) and die early. A definite form of torture as they are institutionalised for rigid diet control. Sounds like an impulse and instinct gone crazy.

    Nari
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,6,15,28,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 06-12-2005 22:28<noscript>December 06, 2005 03:28 PM</noscript>:

    Some rather long essays on impulse/instinct from William James and John Dewey:

    http://www.psychclassics.yorku.ca/Ja...les/prin24.htm

    and

    http://www.cpsiconference.com/handou...out_199876.ppt

    Nari
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,6,18,12,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 01:12<noscript>December 06, 2005 06:12 PM</noscript>:

    Hi Nari,

    In a way the CPM issues could easily tie in with the thread on expectation. I've most definitely have presented literature in a formal setting to all of our ortho MD's and the upshot was that CPMs aren't harmful, the patients expect it (this was a big issue) and ultimately the surgeon who orders it doesn't have to worry about the time or cost because they don't actually have anything to do with it so it continues to get checked marked on their order sheet. As I said, don't get me started. Personally, I think there is role for them but I think the role is limited and best determined by the PT/patient after a day or so of the patient trying to get things going on their own.

    Gil,

    I agree that it is worth making that distinction and in retrospect I think it was where I was trying to go with instinct versus intuition. As I was writing it I could tell it wasn't quite what I wanted or meant. I think you named it for me.

    I know of few people who don't have a behavior they desire to do more of or less of. Impulses (and compulsion) are interesting if not potentially disturbing behaviors for the neurotic among us. In the example of eating, it would seem that while eating may be the instinctive act brought about by the need state of hunger, eating may also serve other purposes and so while the behavior looks the same, its origins can be distinctly different and likely difficult to sort out. Luckily, with pain, we can be fairly certain of the origins.
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,6,20,15,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 03:15<noscript>December 06, 2005 08:15 PM</noscript>:

    In the spirit of the above post, how many of us suffer from this?

    Repetitive information injury
    <hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,6,20,20,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 03:20<noscript>December 06, 2005 08:20 PM</noscript>:

    May I ask, what is a CPM?
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,6,20,34,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 03:34<noscript>December 06, 2005 08:34 PM</noscript>:

    Hi Diane,

    Sorry about the abbreviations thing. It stands for Continuous Passive Motion.
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,7,0,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 07:10<noscript>December 07, 2005 12:10 AM</noscript>:

    I am definitely liable for a case of NII,especially after trying to read all of jon's links. [IMG]wink.gif[/IMG]

    Somewhere along the line information should get mutated into knowledge; but it doesn't always happen to me.

    Diane, CPM comes in the form of a very expensive machine which passively moves the post-op TKR into the permitted flexion/extension range, repetitively, nonweight bearing, lying in bed, etc.... Then the studies came out and almost all orthopods here have ceased using it. Another example of technology going beserk before it is proven as far as it can be. Might be helpful for very anxious patients who are scared stiff of moving the knee.

    Nari
    <hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,7,0,26,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 07:26<noscript>December 07, 2005 12:26 AM</noscript>:

    CPM's seem to have some justification for their use, probably not for their expense though. They cost about $1500-$2000, so as an in-patient procedure or even home health procedure it isn't very much added cost. I don't know what the billing is. Like Nari said though, they are probably of most value for those who you know aren't going to move their leg without them.

    http://www.cochrane.org/reviews/en/ab004260.html
    <hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,7,0,39,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 07:39<noscript>December 07, 2005 12:39 AM</noscript>:

    Thanks for the translation. I do know what they are..
    A patient I treated about 10 years ago, an 88 year old woman, was attached to one postop TKR. Something went wrong and it jerked her badly. She had bad persistant pain for the rest of her life. Not a great boon, that thing.. not for her anyway.
    Diane
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,7,6,36,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 13:36<noscript>December 07, 2005 06:36 AM</noscript>:

    Hi Randy,

    The clear justification seems limited to short term gain of ROM. Analgesic use and manipulation rate seem more debatable both from a literature standpoint and anecdotal experience. It appears, with the limited information currently published, that you would be unable to distinguish between CPM users and non-users in outcome studies with time frames of 3 months or beyond.

    Since a specific knee ROM is not typically a criteria for discharge from an acute care hospital (although a specific ROM may be a goal prior to DC) it doesn't seem that their is much benefit to the short gain of this ROM. As others mentioned there is a cost associated with CPMs yet the hospital is not reimbursed differently for their use due to fact most people who get these are medicare patients and we are paid a per diem for their diagnosis (versus treatments provided).

    I agree with you that some may benefit from CPM use but perhaps it would be clearer who those people would be after they tried moving and walking etc rather than before.

    There are probably some unmeasurable benefits to it too. I use the set up time to lay the groundwork for the next day's activities and try to ease any potential anxieties they may have. I also try to take the time to explain what it is I understand from the literature regarding CPMs and thus if they find it torturous (to try to tie it into this thread) they can make an informed decision.
    <hr> Posted by Christophb (Member # 3884) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,7,14,13,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 21:13<noscript>December 07, 2005 02:13 PM</noscript>:

    "Well Arnold doesn't have pain." I looked at this lady with a puzzled look as she remarked what her MD told her. I finally asked what the heck she was talking about, "Arnold Schwarzenegger doesn't have pain and he's strong, so my doctor told me I need to work out." "I'm really here to see if PT works better than a personal trainer, I don't like to work out but the doctor says strength training helps my joints (of course the source of pain), he's going through a rough divorce and weight training helps him." At the end of the session, she wasn't impressed enough and decided the intial eval was enough. I guess I put this here cause I feel tortured having to listen to the advice this MD is offering. I have nothing against working out but what the heck kind of advice is "well arnold doesn't have pain." Is this even true? Grrrrrrrrrr!
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,7,14,33,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 21:33<noscript>December 07, 2005 02:33 PM</noscript>:

    Chris, it seems that one of our many challenges in PT is to defuse/correct/translate a lot of things that doctors say to patients. Especially about PT-related things...perhaps he thought he was 'relating' to the patient by talking about film stars and governors and glamorous sweatshops. (my term for gyms)

    Nari
    <hr> Posted by Christophb (Member # 3884) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,7,15,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 22:14<noscript>December 07, 2005 03:14 PM</noscript>:

    Relating is fine, I doubt this woman found Arnold appealing. I wonder how many PT's would have taken the ball and ran with it... "Yes it's true, we need to pump your quads and blast your lats!"
    Since when did we become inferior to personal trainers in knowledge of the human body and treatment of painful conditions? Oh yes, I remember, when health came to be equal to beauty and strength...
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,7,16,35,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 07-12-2005 23:35<noscript>December 07, 2005 04:35 PM</noscript>:

    We have similar problems here, to a lesser degree, between exercise physiologists and PTs. The former are trained to well folk, wanting to get fitter; the latter are trained to deal with unwell/dysfunctional folk with all sorts of variables in performances.

    Strength still rules the roost. I wonder how long it will take for the meme to submerge under other more logical memes.

    Nari
    <hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,7,23,48,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-12-2005 06:48<noscript>December 07, 2005 11:48 PM</noscript>:

    I think that you missed a golden opportuntiy Chris. To me their is a large gap between the current medical model which treats people with dysfunctions and the fitness model which tries to prevent these dysfunctions. PT's are in a perfect position to bridge that gap, to me this is one of the functions that all PT's should be working toward, not just treating those with injuries/pain but on preventing them before they happen. Here was a lady asking for exactly that and who only needed a better model than the one presented to her by the doctor.
    <hr> Posted by Randy Dixon (Member # 3445) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,7,23,49,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-12-2005 06:49<noscript>December 07, 2005 11:49 PM</noscript>:

    BTW, Arnold was rushed to the hospital today with heart problems.
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,8,6,12,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-12-2005 13:12<noscript>December 08, 2005 06:12 AM</noscript>:

    Don't worry Randy, he'll be back.
    <hr> Posted by SJBird55 (Member # 3236) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,8,6,12,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-12-2005 13:12<noscript>December 08, 2005 06:12 AM</noscript>:

    How do any of you argue the facts that have been presented in literature for certain conditions in which manual treatment combined with exercise improve outcomes? To be so anti-strengthening and anti-exericse isn't necessarily a balanced view, because there is a time and a place for strengthening.
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,8,6,21,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-12-2005 13:21<noscript>December 08, 2005 06:21 AM</noscript>:

    I agree SJ,

    Is that time and place upon greeting someone who is seeking help for a painful condition? Is that when you hit the gym, when you hurt the most?
    <hr> Posted by Christophb (Member # 3884) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,8,7,29,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-12-2005 14:29<noscript>December 08, 2005 07:29 AM</noscript>:

    Randy
    I agree, and did offer her a preventative model to bridge the gap. For her the bridge was just to move more and relax... I think.

    SJ
    Agree that there is a time and place for strengthening, I didn't say anything about anti-strength training, but like jon said, when is that? Also, I was offering exercises to improve coordination, would this increase strength also?

    Jon
    hilarious

    Hasta la vista baby
    Chris
    <hr> Posted by Yogi (Member # 3083) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,8,10,14,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-12-2005 17:14<noscript>December 08, 2005 10:14 AM</noscript>:

    Nari, I have just noticed that when I worked with a crew of men, lunchtime wasn't worried about until lunchtime, but now that I'm around women I notice that (generally) they talk about food more, plan lunch starting about 9:30am, and they worry when the pantry gets low, where a man is ok as long as there's something still to eat.
    That all probably came about because the man didn't really have to worry, if he didn't get ate by the sabertooth and didn't find a mammoth to spear, he would still have a root or seed to eat at the camp, thanks to the diligence of the women.
    Anyway, that was my theory. Now some woman antroplogist put it akilter with her theory that everyone cooperated to chase the mammoths over the cliff, even the cavechildren. Despite her evidence, I think I'll stick to my deep model (no offense, Barrett), or shallow model, whatever it is, just because it fits the observations so well.
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,8,13,18,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 08-12-2005 20:18<noscript>December 08, 2005 01:18 PM</noscript>:

    Yogi,oddly enough, I have noticed the same thing as you, generally speaking.
    Women in many cultures provide/d the supplementary food - roots, berries,nuts, etc - while the men went after the big game. Basically, women have been providers of small items and the cooking thereof, and if this was fiddly and time-consuming, they tended to think about food every day.
    I believe in some circumstances, women did go hunting (or so I read somewhere) but one can't believe what you read....
    I think it all comes down to one thing:
    one either lives to eat, or eats to live. One either thinks or dreams about food and the other grabs on the run so they don't fall over in a heap....that's my shallow model.

    Re strengthening: It is an old war with me, but strengthening does have its place, certainly. It is just the meme/notion that if something hurts, the environs need strengthening because they are weak, even if nearly 5/5. That's what bugs me about the gym concept. Mobility is one thing, weights and pulleys and things that cost half the earth is another. The purpose of gym work for some is an easy pace, puddle along, do your own thing and enjoy. That sounds sensible. I don't think it happens that way very much...

    Nari
    <hr> Posted by Mike T. (Member # 4226) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,9,12,32,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 09-12-2005 19:32<noscript>December 09, 2005 12:32 PM</noscript>:

    "Pump your quads and blast your lats!"

    Everyone in the office looked at me when I snorted and almost launched a nose goblin.

    In regards to strengthening, I think what some on this forum are disagreeing with is the cookie cutter approach to strengthening. Knee hurts --> strengthen the quad. Shoulder hurts --> stengthen the supraspinatus. Back hurts --> strengthen the abs. Neck hurts --> strengthen the ... the ... the ... crud. That is probably the type of strengthening the MD was referring to.

    mike t
    <hr> Posted by Jason Silvernail (Member # 4433) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,9,13,22,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 09-12-2005 20:22<noscript>December 09, 2005 01:22 PM</noscript>:

    I agree with your thoughts, Mike. A focused strengthening approach has been found beneficial for a lot of orthopedic problems. How much of that has to do with strength per se and how much has to do with other factors (encouragement of movement, a CBT intervention - brain realizes it's OK to move and use the painful part, etc) is anyone's guess.

    Nari - while it is sensible to take an easy pace approach at the gym, that is not the approach that improves fitness parameters! [IMG]smile.gif[/IMG]
    Some of us rather enjoy going hard and the smell of slightly rusting iron and sweat. But I agree 100% with the idea that such an approach has nothing to do with pain relief, despite the notions many PTs have. Talking to you, Diane, and Barrett has effectively reinforced that idea, at least for me. [IMG]smile.gif[/IMG]
    J
    <hr> Posted by Christophb (Member # 3884) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,9,13,55,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 09-12-2005 20:55<noscript>December 09, 2005 01:55 PM</noscript>:

    Pump your quads and blast your lats!"

    As I wrote that I had an episode of the Simpsons in mind when future Milhouse was ripped and trying to impress Lisa... "But everyone knows the calves are the hardest place to add mass!"

    Jason,
    "brain realizes it's OK to move and use the painful part"

    I find it nearly impossible to do any strengthening or ex without considering this... it's driving me close to mad.

    Chris
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,10,2,10,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 10-12-2005 09:10<noscript>December 10, 2005 02:10 AM</noscript>:

    Chris

    Why are you going mad - or nearly?

    Nari
    <hr> Posted by Christophb (Member # 3884) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,10,10,27,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 10-12-2005 17:27<noscript>December 10, 2005 10:27 AM</noscript>:

    Not really going mad, but if you stop to contemplate how the brain generates movement and how that can be influenced other than just doing 3 sets of 10, it can fry the ol brain. I mean all of this in a good way. Plus I'm a little crazy to start with.

    Chris
    <hr> Posted by paulpt (Member # 5125) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,10,10,28,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 10-12-2005 17:28<noscript>December 10, 2005 10:28 AM</noscript>:

    This is an addendum of sorts.
    Page 114 of the most recent 'Sports Illustrated' - the one with Tom Brady on the cover - refers to Physical Therapists as 'physical terrosists' in an article about servicemen who lost a limb in Iraq / Afghantistan.

    The article is about those who ran (and finished) the Army 10 Miler as a part of 'Missing (parts) in Action' a team of veterans who had lost a limb and decided to run the annual event in the DC suburbs.
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,10,13,6,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 10-12-2005 20:06<noscript>December 10, 2005 01:06 PM</noscript>:

    It is just a play on words, but if you break up 'physiotherapist' into three distinct syllables after 'physio',you get another expression that is familiar....
    Such is our image (?!!)

    Nari
    <hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,11,7,21,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-12-2005 14:21<noscript>December 11, 2005 07:21 AM</noscript>:

    I found Chris' comment about his "madness" interesting, and I'll have to take his word for his predisposition to craziness. Perhaps this is why we liked each other immediately when we met in Nanaimo, and why he liked my son as well.

    While demonstrating Simple Contact on an older woman in Tyler Texas last Thursday I watched the reaction of a therapist my own age who had last heard me speak in '79 in El Paso. He's a fan, I guess, and shows up at my courses every 25 years or so.

    This woman's cervical ROM improved dramatically in every plane, painlessly and effortlessly. It had been severely, painfully restricted for many years and her colleague in attendance with her watched with her mouth agape.

    The reaction of the markedly mature (remember he's my age) and, dare I say, "grizzled" fan from El Paso was this: he couldn't help snapping his head back repeatedly as if someone had just said something shocking to him. He'd then put down his pen, shake his head and take a deep breath, clearly trying to figure out how he could have missed this approach all these years, and, I imagine, remembering how many times he'd failed to help the same sort of patient with coercive technique and choreographed exercise.

    Is this madness? I don't know. But I know that when your colleagues are shown the same thing and find it meaningless it can sure make you wonder about your own sanity.

    Maybe that's what Chris is feeling.
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,11,15,23,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 11-12-2005 22:23<noscript>December 11, 2005 03:23 PM</noscript>:

    If a simple response can be found, it makes all the complicated responses and their purveyors look rather foolish, perhaps.
    I know my responses to experiencing SC varied from: "This is weird" to "why do physios go through all this palaver of evaluation and complex (choreographed)programs with a patient?"
    and finally to: "Why the h--l are we spending time and money researching minutiae unrelated to the real problem of pain..?"

    Having thought more about your madness statement, Chris,I can understand it better. Not only does one think that madness is creeping up on her/himself, BUT that other colleagues think one is rather dotty and off with the fairies on a New Age trip. I have not had any ongoing interest expressed by colleagues in learning SC; but. taking Barrett's point, my age tends to make folk think that senility is the next step... [IMG]wink.gif[/IMG]

    Your youthfulness is definitely an advantage.

    Nari
    <hr> Posted by Christophb (Member # 3884) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,11,19,49,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-12-2005 02:49<noscript>December 11, 2005 07:49 PM</noscript>:

    Yeah, that pretty much sums it up. I give a SC presentation on Wed. and have spent the time since nanaimo reading, researching and practicing. Hopefully I have all my bases covered. We'll see how people react. It has been an interesting journey so far.

    Chris
    <hr> Posted by Barrett (Member # 67) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,11,20,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-12-2005 03:01<noscript>December 11, 2005 08:01 PM</noscript>:

    Chris,

    Considering the number of times I've totally bombed when trying to explain all of this to my colleagues, I might not be the best person to offer advice-but I'll say this:

    Focus on origin and the tissue most likely at fault. The rest will fall into place.

    I think, I'm almost sure.
    <hr> Posted by Jon Newman (Member # 3148) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,11,20,52,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-12-2005 03:52<noscript>December 11, 2005 08:52 PM</noscript>:

    Hi Chris,

    quote: <hr> Hence I would judge the sanest man to be him who most firmly realizes the tragic isolation of humanity and pursues his essential purposes calmly -- Joe Gould <hr>

    <hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,11,21,4,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-12-2005 04:04<noscript>December 11, 2005 09:04 PM</noscript>:

    I favor a new definition of crazy. Today's "crazy" practitioner will be the sane one any day, and today's "sane" ones will be eccentric and looney anachronisms.
    <hr> Posted by Christophb (Member # 3884) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,11,21,15,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-12-2005 04:15<noscript>December 11, 2005 09:15 PM</noscript>:

    Barrett, thanks for the advise , I'll keep you posted as to how it goes. I'm gonna keep it sweet and simple (is there any other way [IMG]wink.gif[/IMG] . Jon, I like that quote, a similar thought came to me on a walk a few days ago. Diane, in that case I'll quit taking my meds.

    Chris
    <hr> Posted by nari (Member # 2772) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,11,21,51,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-12-2005 04:51<noscript>December 11, 2005 09:51 PM</noscript>:

    I also keep thinking of our two Aussie doctors who have just carried off the Nobel Prize for medicine - they were snorted at, deriled and passed off as loonies for about ten years. The stress meme firmly implanted in the world becomes the answer when nothing much else is around to demolish it.
    jon, that quote fits poor old Einstein in his early years - he was regarded as a looney patent officer in isolation until he found a mentor.

    Nari
    <hr> Posted by Diane (Member # 1064) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,12,9,1,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 12-12-2005 16:01<noscript>December 12, 2005 09:01 AM</noscript>:

    http://dolor.blogspot.com/
    I though this entry from Dec 8th was interesting, and appropriate for this thread:
    quote: <hr> Pain hurts less when it is inflicted by a woman, researchers have found.
    Students were asked to put their fingers in a clamp which was tightened until the pain was unbearable. Researchers from the University of Westminster found that people allowed women to turn the clamp much further than men.

    Dr David Williams, who led the research said the study suggested people do not expect women to inflict as much pain. He said: "This effect is likely to be a result of what participants subconsciously expect, based on socially acquired gender stereotypes - people feel that they are less likely to experience intense pain from a stimulus given by a woman rather than a man.

    "This effect is less likely to be down to males trying to appear macho in front of a female - a conscious and deliberate act - as the result applied to both genders." He said the fact there were no differences in how men and women responded to the test suggested women do not actually handle pain better.

    Dr Williams said people's sensitivity to pain was also shown to depend on their surroundings. In the study, people appeared to suffer more if there was a poster on the wall which might trigger negative feelings, such as a chart of wounds or a poster calling for blood donors.

    Dr Williams, who carried out the research for his PhD, said: "People subconsciously evaluate their environment. "This evaluation can result in identical stimuli being perceived as more or less painful for the same participant or, in some cases, an innocuous stimulus being perceived as painful or a relatively intense stimulus perceived as innocuous."

    He said the finding could have implications for how patients are given potentially painful treatments. "Individuals can be 'primed' for pain by qualities of their environment and, as a result, may suffer unnecessarily during acutely painful clinical procedures. "Awareness of these principles may be useful in developing methods of reducing suffering in those situations."
    <hr>
    Interesting I thought, in light of the fact that PT was until quite recently a "female" profession.
    <hr> Posted by Sarah C. (Member # 4115) on <script language="JavaScript1.3" type="text/javascript"> document.write(timestamp(new Date(2005,11,12,20,12,0), dfrm, tfrm, 0, 0, 0, 0)); </script> 13-12-2005 03:12<noscript>December 12, 2005 08:12 PM</noscript>:

    Diane,
    That's great. I'm going to relay this information to my patients next time they try to figure out why I'm not hurting them like my male colleague. LOL
    Sarah
    Last edited by bernard; 29-12-2005, 06:03 PM.
    Simplicity is the ultimate sophistication. L VINCI
    We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

    Everything should be made as simple as possible, but not a bit simpler.
    If you can't explain it simply, you don't understand it well enough. Albert Einstein
    bernard
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