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Forum Moderators' Current Consensus on Pain

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  • Mary C
    replied
    Now I need the 10 points translated into French.

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  • Luke Rickards
    replied
    The wording of points #8 and #10 have been altered following comment from Steven George.

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  • Mary C
    replied
    News reports about Nadia Comaneche (?) a few years after her Olympic gold medals said she had advanced, painful OA of the lumbar spine.

    Add abuse to genetics and youth.

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  • Frédéric
    replied
    part of the answer

    Originally posted by Nick View Post
    Genetics and youth.

    It certainly acounts for part of the reason but I think it is not enough by itself

    Leave a comment:


  • Nick
    replied
    How are we to explain how gymnasts (an exemple) became so flexible (both muscular-ligament-and other connective tissu) ?
    Genetics and youth.

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  • Frédéric
    replied
    Did it last ?

    Luke,

    In those studies, was the outcome mesure taken only after the treatment, or was it also taken at a later time, say 2-3 weeks later ?

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  • Luke Rickards
    replied
    Both static stretching and ballistic stretching increase range of motion, most likely as a result of enhanced stretch tolerance rather than changes in muscle elasticity. (LaRoche,2006)
    The constancy of the muscle resting tension suggests that merely the subjects' tolerance to higher stretching strain brings about the enlargement of ROM after short-term stretching exercises. (Weimann,1997)
    Long term stretching increases joint range of motion as a result of elevated stretch tolerance rather than a viscoelastic accomodation.] [ The effectiveness of different stretching techniques is attributed to a change in stretch tolerance rather than passive properties." (Magnusson, 1998)

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  • Frédéric
    replied
    Why the teaching and mentality asn't changed yet ?

    Some very well knowned IFOMT and CAMT teachers would fermly disagree with you Luke

    Altought I think I am more on the skeptic side (your side), I am still wondering why there asn't been a shift in thinking in manual therapy world.

    I don't think it's money driven, as most of the PT I discuss this issue with are very convinced they actually changed the flexibility of a given tissu. I can only think it's because it is too highly deceiving and very prone to drive therapists to depression... or sort of.

    It kind of takes some of the meaning you are/were giving to your work away from you. And to a subcouncious level, many PT are not ready to accept that.

    Although I begin to realize/admit it myself, (doubt always was in the back of my mind though) I still find it a bit disstabilizing.

    Fred

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  • Luke Rickards
    replied
    Frederic,

    Yes, it is possible to produce permanent changes in connective tissue with large and prolonged forces. I can't imagine the number and frequency of manual therapy sessions it would take to give a patient the flexibility of a ballet dancer or yoga master.

    Standard applications of stretching cannot produce such change.

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  • Frédéric
    replied
    About # 9

    How are we to explain how gymnasts (an exemple) became so flexible (both muscular-ligament-and other connective tissu) ?

    I would assume a high volume of streching is involved and repetitive extreme postures maybe.

    Now, since painfree (understand : with usual forces below microtraumatic changes in the tissu) manual therapie (including streching) can't induce lasting changes in tissu lenght, I would assume that the streches those gymnasts are doing are very painfull to produce sufficient forces for permanent tissu deformation.

    Unless those persons were already very flexible to begin with.

    I am just thinking outloud here because I can't help but thinking that tissu lenght is modifiable without extreme forces provided enought time/freqency for the specific strain applied to the tissu.

    I might agree though that typical manual therapy might not provide that amount of time/frequency in straining the tissues.

    An example : strech an elastic with your fingers for 3 minutes twice a week : chances are it won't change in lenght

    Now, strech it less put for 2 weeks without stopping, I would assume (I did not try) that there would be permanent changes in that case.

    That exemple could also apply to mecanical rubber belts in a car that could need so re-tightening after many miles of strains that are not strong enought to damage the rubber.

    So maybe it is more a duration/frequency of the applied forces in manual therapy that are insufficent rather than the amount of force.

    This is not based on a physic book, but I now that the creep theory relates to that to some extent.

    Anyone has any thoughts on that ?
    Is my logic wrong ?

    Frédéric
    Last edited by Frédéric; 18-10-2008, 08:21 PM.

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  • bernard
    replied
    Originally posted by TexasOrtho
    I think we can all learn a great deal from each other and look forward to the continued interaction.
    Most of us, here, are initially ortho grounded but evolved to give more importance to the neural component.
    There is actually no good reason to make an inverse shift, again.

    Leave a comment:


  • HeadStrongPT
    replied
    I appreciate the modifications Luke and regret if my comments in the other discussion came off sounding like sour grapes. Initially Jon was the only one who acknowledged the modification to #9. I appreciate the willingness to embrace alternate ideas.

    My comment on the rehab edge discussion stemmed from the notion that none of us has all the answers and shouldn't act as authorities on specific topics. As I'm sure we can all agree, there are no authorities in science. We are all here to learn, exchange information, and not belittle each other in the face of disagreement. Backhanded comments such as "mesodermalist" and "neuroreflexologist" (my phrase) only serve to polarize the discussion. I think we can all learn a great deal from each other and look forward to the continued interaction.
    Last edited by HeadStrongPT; 24-02-2008, 09:47 PM.

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  • Luke Rickards
    replied
    Roderick,

    I understand from another discussion that you feel your input into this thread was essentially ignored by everyone, except Jon. Please know that this isn't the case. Jon's response here involved behind the scenes input from the other moderators. Further, I was under the (mistaken) impression that your response in the post following this indicated a general concordance with the concerns raised.

    Nevertheless, as I stated before, these are not rules, and are thus subject to change in light of all reasonable input. After further discussion, No. 9 has now been modified.

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  • Luke Rickards
    replied
    Hi Roderick,

    Jason has given us a very good background to these issues here. It's well worth checking out. Also, now you have ten posts you should be able to access our Sounds of Silence forum, where you'll find the Red File. There are dozens of papers that provoke a re-examination of the dominant thinking behind common approaches to manual therapy diagnosis and treatment. The list is not exhaustive, but its growing.

    I want to address your questions more specifically but it's late now, so I'll leave it till tomorrow. In the meantime, there's something I really like from Max Zusman's 2002 paper that pointed to the direction that recent understanding seems to be moving us.
    The evidence will then be interpreted to create a new image for manual therapy (MT), namely that of informed ‘desensitizer’ of this system. The process of physical and psychological desensitization is proposed to involve a combination of mechanical stimulation (movement-based therapy), accurate information [see Moseley for more on this], reassurance and instruction. It is anticipated that this evidence-based image of MT would be readily recognizable and acceptable to all of the major ‘stakeholders’.

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  • HeadStrongPT
    replied
    Originally posted by Barrett Dorko View Post
    Dear Yul,

    I really appreciate your work here and look forward to being able to answer questions about AC with more than "It seems that this condition is unique in the body, and, as far as I know, mobilizing the involved structures in order to create more range, enhance recovery and reduce pain isn't a good idea."

    Maybe this new thread will improve that answer.
    Thanks...Yul was the man.

    Leave a comment:

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