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The Edge of the Spoon

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  • #46
    I begin my classes by speaking of the importance of origin (there are four) and how it is important to distinguish this from cause (these are infinite in number).

    Now I’m planning a section on mechanism and will of course speak of the two we’ve discussed, making sure that the therapists understand that there is no edge. Heck, I’m not even sure there’s a spoon.

    Anyway, it occurs to me that I will be asked at some point what the difference between origin and mechanism may be.

    How would you guys approach an answer?
    Barrett L. Dorko

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    • #47
      Melzack has said the following

      First, a matrix is defined as “something within which something else originates, takes form, or develops.” This is exactly what I wish to imply: the neuromatrix (not the stimulus, peripheral nerves, or “brain center”) is the origin of the neurosignature; the neurosignature originates and takes form in the neuromatrix. Although the neurosignature may be triggered or modulated by input, the input is only a “trigger” and does not produce the neurosignature itself.
      "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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      • #48
        Anyway, it occurs to me that I will be asked at some point what the difference between origin and mechanism may be.
        The former is somewhere, the latter is something. To get somewhere, a journey is undertaken. To get something, a goal must be identified. Whether that object has been sought as opposed to stolen or contrived can be difficult to discern. On the other hand, a quest is a much more difficult thing to steal or fake because there are so many signs and markers along the way (laid by earnest predecessors) that will betray whoever attempts to mislead.

        The effort by many in manual therapy to trumpet outcomes, results and the "cause of dysfunction" has been an elaborate, if not contrived, description of objectives, while completely discounting the means by which they were "discovered." Whether there's real discovery, then, becomes a shell-game of mathematics and statistics.

        Ask yourself the same question with each of these words inserted:

        "What is the mechanism of a river?"

        "What is the origin of a river?"

        Now, which question is meaningful and has an answer that requires a journey of discovery, and which contains a compilation of multiple facts and phenomena that don't necessarily lead anywhere?

        Which question lends itself to story?
        John Ware, PT
        Fellow of the American Academy of Orthopedic Manual Physical Therapists
        "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
        “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
        be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

        Comment


        • #49
          Early in my career I was armed primarily with notions about function and pain that proved untrue. Among other things (stiff spinal joints could be reliably assessed and blamed for painful movement, for instance),
          Again, this reminds me of one of my labs in school, where we were "assessing" spinal movement. Granted, I feel now the professors were not very proficient themselves in this task, but still, I went along with the "oh yeah, I can feel this 1/16th of a motion beneath all this tissue and muscle"...uh-huh, sure.

          What is a relevant dysfunction and how did you determine that it was present?
          Relevent, to me, is the patient's presentation. If it's painful for them to perform motion/movement "X", then that's it. Who am I to tell a patient, "No, I'm sorry, I know you thought that was your problem because it hurts, but actually your problem is a stuck facet at C4-5."

          No wonder I would get these bewildered looks.
          Nate Mosher, PT, DPT, SCS, CSCS
          Board-Certified Clinical Specialist in Sports Physical Therapy

          Comment


          • #50
            Originally posted by John W View Post
            The former is somewhere, the latter is something. To get somewhere, a journey is undertaken. To get something, a goal must be identified. Whether that object has been sought as opposed to stolen or contrived can be difficult to discern. On the other hand, a quest is a much more difficult thing to steal or fake because there are so many signs and markers along the way (laid by earnest predecessors) that will betray whoever attempts to mislead.

            The effort by many in manual therapy to trumpet outcomes, results and the "cause of dysfunction" has been an elaborate, if not contrived, description of objectives, while completely discounting the means by which they were "discovered." Whether there's real discovery, then, becomes a shell-game of mathematics and statistics.

            Ask yourself the same question with each of these words inserted:

            "What is the mechanism of a river?"

            "What is the origin of a river?"

            Now, which question is meaningful and has an answer that requires a journey of discovery, and which contains a compilation of multiple facts and phenomena that don't necessarily lead anywhere?

            Which question lends itself to story?
            John,
            That is some of the best stuff I have seen you write...excellant post

            Comment


            • #51
              Taking a cue from John's post, asking, "What is the mechanism of pain?", doesn't make sense since pain isn't a thing per se. Or maybe I should emphasize "pain isn't A thing."

              John, I enjoyed your post. When you state

              To get somewhere, a journey is undertaken. To get something, a goal must be identified.
              are you suggesting these are mutually exclusive? It seems to me that getting somewhere is goal oriented also. And getting something may also involve a journey.
              Last edited by Jon Newman; 08-09-2008, 03:01 PM.
              "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

              Comment


              • #52
                getting something may also involve a journey.
                I guess that would depend on whether you are floating down the river in an inner tube or swimming furiously upstream like a salmon.
                (That was intended to be a metaphor for use of intellect.)
                Diane
                www.dermoneuromodulation.com
                SensibleSolutionsPhysiotherapy
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                Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
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                @dfjpt
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                "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

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                • #53
                  Jon,
                  The upshot of my post was that many manual therapists choose to take a variety of elaborate "short cuts" to explain to themselves and their patients why what they do does what it does. These so-called "short-cuts" are actually borne out of laziness, greed and arrogance, which are as old as human-kind. They don't want to embark on a journey that requires subservience of self and self-seeking motives. It's just too hard or too threatening to their egos and beliefs.

                  Look at the characters from all the famous journeys in literature: Tom Sawyer and Huck Finn, Odysseus, Don Quixote, to name a few. The hero is the one who subordinates himself to a greater purpose. Mark Twain showed the stark difference between Huck Finn, the ill-educated, unshoed son of an alcoholic versus the spoiled, incorrigible, brat Tom Sawyer as they traveled down the Mississippi on a raft. In was Huck who appreciated the beauty and power of the river. For Tom it was just a means to get somewhere.

                  I have come to see, by no easy journey of my own, that Barrett Dorko is the Huck Finn of our times.

                  The vast majority of PTs I think are just too lazy, disorganized or overwhelmed to do the necessary work to understand what they do better. A small group are the opportunistic sort who see this "log in the eye" of their colleagues, and exploit it to build themselves up. They're much more dangerous to the profession in my view. Kind of like the drug addict-drug dealer relationship- I sort of feel sorry for the former, but think the latter should be jailed at hard labor for the rest of their lives.

                  So, Bob, what is it you took from my post that excited you so much? I suspect you may have misinterpreted me, but I'll give you a chance to explain.
                  John Ware, PT
                  Fellow of the American Academy of Orthopedic Manual Physical Therapists
                  "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                  “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                  be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                  Comment


                  • #54
                    Originally posted by John W View Post
                    Mark Twain showed the stark difference between Huck Finn, the ill-educated, unshoed son of an alcoholic versus the spoiled, incorrigible, brat Tom Sawyer as they traveled down the Mississippi on a raft. In was Huck who appreciated the beauty and power of the river. For Tom it was just a means to get somewhere.

                    I have come to see, by no easy journey of my own, that Barrett Dorko is the Huck Finn of our times.

                    Better be careful, John, "ill-educated" and "unshoed" could be libelous.

                    Though I'm pretty sure I get what you mean and expect Barrett will like the analogy. Though some may say its ill-educated, the way of an autodidact is a difficult and impressive journey. And while eccentric, he is definitely not unshoed.
                    Nick Matheson, PT
                    Strengthen Your Health

                    Comment


                    • #55
                      John,

                      I really, really like this somewhere and something distinction. It nearly fulfills the criteria for creating an edge where one is hard to find.

                      I'll use it, if you don't mind, and from this effort there will come some more understanding. I can now say, "When the patient is complaining of pain there are four origins and two mechanisms to consider. If you know nothing of these or what they represent it isn't because neuroscience hasn't taught us - it may be because you have yet to read it. Let's begin..."
                      Barrett L. Dorko

                      Comment


                      • #56
                        Nick,
                        I can assure you that no insult was intended in the comparison. Quite the contrary. And I think Barrett, whose literary breadth is wide and deep as far as I can tell, gets it. It is no small feat to appreciate the power and beauty of a river.

                        Twain knew that heroism comes in all shapes, sizes, dialects and levels of formal education. But it doesn't come often.

                        In Barrett's case, in addition to Huck Finn, I'd throw in a little Rodney Dangerfield with a smattering of Hemingway.

                        Whether this is a tragic play is yet to be determined, and likely depends on those of us watching and perhaps choosing to participate in it.

                        P.S.
                        I just read the forgotten shoe thread that you referenced, and I rest my case: Barrett Dorko is Huck Finn. He just didn't know it at the time.
                        Last edited by John W; 08-09-2008, 07:26 PM. Reason: added P.S.
                        John Ware, PT
                        Fellow of the American Academy of Orthopedic Manual Physical Therapists
                        "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                        “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                        be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                        Comment


                        • #57
                          It probably won't surprise anyone that the river metaphor has been considered before now.
                          On the River.
                          Tributary part 1, part 2
                          As two rivers meet.
                          Last edited by EricM; 08-09-2008, 08:02 PM.
                          Eric Matheson, PT

                          Comment


                          • #58
                            Floating down the river, I was struck by the timeless quality of the day. Without my watch the “current” events (pun intended) were intensified because they all involved “body time.”
                            -Barrett Dorko from "On the River"

                            And afterwards we would watch the lonesomeness of the river, and kind of lazy along, and by-and-by lazy off to sleep...So we would put in the day, lazying around, listening to the stillness.
                            -Huck Finn from The Adventures of Huckleberry Finn

                            I emphatically rest my case that Barrett Dorko is the modern day Huck Finn of PT!
                            (Thanks, Eric.)
                            John Ware, PT
                            Fellow of the American Academy of Orthopedic Manual Physical Therapists
                            "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                            “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                            be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                            Comment


                            • #59
                              Hi John,

                              They don't want to embark on a journey that requires subservience of self and self-seeking motives. It's just too hard or too threatening to their egos and beliefs.
                              You may be right. What can we do to make it easier or less threatening? If the answer is nothing then where else can we focus our energy?
                              "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                              Comment


                              • #60
                                Why would you believe I misinterpreted your statements?
                                Having the courage and vision to undergo a journey without predetermined beliefs AND the knowledge to differentiate, process and grasp new evidence along the way is a must for anyones profession to grow. Appreciating the new scenery and magnitude of events along the way from several perspectives leads to more gratified senses and sensibilities. Watch out for Ijun Joe.

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