Announcement

Collapse
No announcement yet.

The Chasm

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • #76
    Frederic,
    I'm not sure it will completely answer you're concerns about 'what to do' but give The Toolbox thread a read.
    It is important to consider 'what' we do and eventually the results of RCT's will guide these decisions. However, I believe the aims of this thread, and for the most part this board, are to understand the 'why' of what we do. The chasm will be filled with understanding and not with tools.
    Eric Matheson, PT

    Comment


    • #77
      Sure enough Eric

      Yet, Many PT I know are a lot more interested by tools and outcomes than why's. So If you want to really reach them we will need some tools. RCT tested tools.

      The question asked by Rod in the ectodermal and evidence thread, posted by Jason a bit above, really meet my point.
      Frédéric Wellens, pht
      «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
      «
      Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
      »
      Friedrich Nietzsche
      www.physioaxis.ca
      chroniquesdedouleur blog

      Comment


      • #78
        I really liked the post by Eric, and I think it speaks to something a lot of therapists may know, and it is this: We can't always make human beings exist in ways that lend themselves to a clear,confined essential diagnosis that can lead to the studies we crave.
        __________________
        Barrett L. Dorko P.T.
        Despite what I said is requested earlier, I really like and appreciate what Barrett said in an another thread...
        Frédéric Wellens, pht
        «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
        «
        Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
        »
        Friedrich Nietzsche
        www.physioaxis.ca
        chroniquesdedouleur blog

        Comment


        • #79
          Frédéric,

          "Tools" of various sorts are presented here with a variety of levels of evidence. Examples include MFR, ART, Z-health, Simple Contact, DNM, spinal manipulation, etc. However, SomaSimple isn't here to promote or present designated tools. It's a place for discussion and learning. We don't sell concrete. We don't sell anything.

          What I hear is that you think people want a Civitas and not a communitas. (See the This Week for more on that.) Apparently, you're exactly right.
          "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

          Comment


          • #80
            Frederic,
            Sorry about the lack of accents but I'm too lazy to hunt them out .
            You are right about the 'lack' of RCTs providing 'tools' but as Jon and Eric said, we're not here to provide the sense of a toolbox as a remedy as to what we want to do.
            The problem with tools is that every patient is different and therefore providing a tool or two is almost impossible. But if the basic foundation is sound, ie, a deeper understanding of neuroscience, this is easier than it sounds.
            As in mathematics, it's worked from grass roots/basic principles. My mother who was an Honours Maths teacher, always worked on that principle. Maybe maths doesn't translate obviously into neuroscience, but the principle seems to.
            If PTs are satisfied with the outcomes of their 'mesodermally-based' treatments, then well and good. But I found using neurodynamics and ideomotion more effective and quicker, which can translate into economic value; this has to be demonstrated, but that takes a lot of time...

            Nari

            Comment


            • #81
              Frederic-

              I think this has to proceed in stages, this transition from mesodermal thinking to ectodermal, the process of crossing the chasm.
              I think the others are right to make sure you know it isn't about the tools you use, its about the science and your understanding of it.
              The moderators here would probably all self-identify as ectodermalists, but we use a wide variety of tools from DNM and ideomotion to neurodynamics to spinal manipulation and joint mobilization to exercise therapy.

              First, don't focus on your tools. Just use what you already have. But use them in a way that's consistent with your understanding of pain science.
              If you come from a traditional manipulative background, then let's start using those tools in a different way.

              You can start with assessments - things like stiff muscles and hypomobile joints. Realizing the overall poor reliability and validity of these assessments, and the fact that they are in all probability defenses and not defects, you can significantly cut down on your time spent hunting for these.
              I suggest you find one or two of these "impairments" that you can reason as related to the patient's primary complaint, and track those as you go along. Leave the rest alone.
              That alone with save you boatloads of time.

              Then to treatment. Realize that the bulk of the evidence shows we can't change mature connective tissue with manual therapy, and that the techniques we do use are nonspecific. So feel free to use the techniques described in RCTs, but realize they have been found sufficient to assist in recovery, and not necessary. For example, instead of carefully localizing manipulative techniques, I do several general area techniques and I don't worry about which joint I'm working with. So that takes about half the time since I'm not concerned that much about opening left facet at C6 or trying to fix a torsioned rib at T4. Those who aren't candidates for manipulative techniques can be helped with either gentler mobilizations (target areas associated with pain, not with hypomobility, or related to the patient's primary complaint) or even gentler skin-level manual therapy as described through DNM. Just make sure people know you're not aiming for fascia or anything.

              Now you've saved time through fewer assessments and smaller numbers of treatment techniques. On to exercise therapy.
              Teach exercise therapy as movement treatment for pain - skip the mandatory sets and reps and don't do strengthening until the pain is almost gone. For painful problems teach slow easy performance of the movements and tell the patient to learn to listen to their body and do the exercises when they have pain and a couple times a day besides. Only 1 or 2 exercises. Consider the feldenkrais suggestions Barrett provides and discuss positioning of hips and deep breathing/relaxation exercises also.

              Now we're coming to the end of the session. We have saved time on assessment and treatment and only taught 2 exercises. Use the rest of the session for pain education that you can find in Explain Pain (I humbly recommend my handouts also- though sorry they're only in English), and give the patient plenty of time to give you feedback about how they are feeling during the session.

              Now when the mesodermalists read your notes for peer review they're happy to see you finding stiff muscles and hypomobile joints. They're happy to see you using manual therapy and noting whether those impairments have changed or not. They're happy to see you tracking your outcomes with a patient self-assessment. They're happy to see you prescribing exercise. You're happy that your treatment makes sense, finally. Then when you're comfortable with that, reach out for other tools that fit the science. Get a Butler or Shacklock book on neurodynamics. Download and use Diane's DNM manual or post a case in her forum. Read Barrett's essays on manual care and ideomotion and read the published case report on ideomotion.

              There you have it. Traditional tools, ectodermal reasoning, and a blueprint for chasm-crossing. The thing is, you have to build your own bridge.
              Jason Silvernail DPT, DSc, FAAOMPT
              Board-Certified in Orthopedic Physical Therapy
              Fellowship-Trained in Orthopedic Manual Therapy

              Certified Strength and Conditioning Specialist


              The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

              Comment


              • #82
                Wow Jason.
                I call that post an illustration of a very good bridge.

                In the WW II history, Canadian and American armies built a lot of bridges over rivers. It looks like that continues....
                We don't see things as they are, we see things as WE are - Anais Nin

                I suppose it's easier to believe something than it is to understand it.
                Cmdr. Chris Hadfield on rise of poor / pseudo science

                Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                We don't need a body to feel a body. Ronald Melzack

                Comment


                • #83
                  Originally posted by Jason Silvernail View Post
                  The thing is, you have to build your own bridge.
                  Originally posted by Bas View Post
                  Wow Jason.
                  I call that post an illustration of a very good bridge.
                  And a good bridge is often beautiful... Even if the Chasm remains hidden...
                  Attached Files
                  Last edited by bernard; 16-01-2009, 02:50 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

                  Comment


                  • #84
                    Thanks Jason, I like your answer as it really describes well the process of what I am personnaly going through right now. I already started to do most of the things you said, slightly changing how, where and when I do a technic. I completetly change the rationnal I give to patient, take a lot more time to teach and worry a lot less with complex exercices.

                    I definitively get the point you people say about tools as it really is more about understanding how it works and then creating your own set of tools or using the one you already have in a way fitting with neuroscience. But like I pointed earlier, not everyone is OK with that, they rather crave for new «technics», often technics of assessment on finding new types of stiffness or new patterns of stifness followed by technics on how to eliminate it. So far that is what I feel many PT's want. Probably because it feels effortless compared to swimming against the traditionnal logic and also, it remains in the mechanical realm.

                    Fine allright the mechanical treatments don't mold CT. But how do you convince meso thinker to get the focus aways from trying to find a mechanical fault as one of the cause for the patient new painfull condition ? Unless in ectodermal world a insidious onset painful problem isn't possibly caused by somekind of mechanical fault.

                    The reason why we have to arrive to a conscensus in the original diagnosis.
                    Frédéric Wellens, pht
                    «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                    «
                    Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                    »
                    Friedrich Nietzsche
                    www.physioaxis.ca
                    chroniquesdedouleur blog

                    Comment


                    • #85
                      Jason,

                      An amazing post. I'm going to point my newsletter subscribers toward it this weekend.

                      I wrote a rather sarcastic post somewhere recently about what we should do in order to get others involved in the kind of bridge building we're talking about but I'l be darned if I can find it.

                      In any case, this isn't working. Not by a long shot.

                      Back to memes and Isaac Newton.

                      Midgley points out that while Newton's discoveries identified his genius, he was especially adept at figuring out what could and should be simplified and what should not. By making such a distinction things became clearer to us when we finally abandoned old ideas in favor of something for which there was better evidence. In my experience the mesodermal perspective does not embrace this process. Clearly, Jason has, and so have I.

                      Memes become our stepping stones, and soon I want to talk about which are solid and which aren't.
                      Last edited by Barrett Dorko; 17-01-2009, 03:25 AM.
                      Barrett L. Dorko

                      Comment


                      • #86
                        I suggest you find one or two of these "impairments" that you can reason as related to the patient's primary complaint, and track those as you go along. Leave the rest alone.
                        I used to get a lot of flak for that. My "evaluations" were sneered at. These were really chronic pain patients. So nice to see reality catching up with me.
                        Guess learning is a lifestyle, not a passtime.
                        Those people who think they know everything are a great annoyance to those of us who do. ~ Isaac Asimov

                        Comment


                        • #87
                          Jason,

                          Great post.

                          I doubt my patients would even notice if you were treating them instead of me.
                          Luke Rickards
                          Osteopath

                          Comment


                          • #88
                            Jason, you have a knack for boiling large amounts of "stuff" down into nice succinct summarizations that capture the kernels. On a wheat farm, you would be the combine.
                            Diane
                            www.dermoneuromodulation.com
                            SensibleSolutionsPhysiotherapy
                            HumanAntiGravitySuit blog
                            Neurotonics PT Teamblog
                            Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                            Canadian Physiotherapy Association Pain Science Division Facebook page
                            @PainPhysiosCan
                            WCPT PhysiotherapyPainNetwork on Facebook
                            @WCPTPTPN
                            Neuroscience and Pain Science for Manual PTs Facebook page

                            @dfjpt
                            SomaSimple on Facebook
                            @somasimple

                            "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

                            Comment


                            • #89
                              Originally posted by Barrett Dorko View Post
                              In any case, this isn't working. Not by a long shot.

                              Back to memes and Isaac Newton.

                              Midgley point out that while Newton's discoveries identified his genius, he was especially adept at figuring out what could and should be simplified and what should not. By making such a distinction things became clearer to us when we finally abandoned old ideas in favor of something for which there was better evidence. In my experience the mesodermal perspective does not embrace this process. Clearly, Jason has, and so have I.

                              Memes become our stepping stones, and soon I want to talk about which are solid and which aren't.

                              Definitively the mesodermal approach seem to always make the mechanical model an always more complicated one, make the mesodermalist pratice always more complicated and I would add, very frustrating. I really agree it should rather be simplified while the extend to wich the CNS is participating should be more contemplated.

                              I guess old habits die hard on the meso side and a bit (a lot!) of humble reading and reconsidering the pillars of their approach will bring both sides closer to one another. From what I've experienced myself trying to get my fellow work partners to change their perspective, it will have to come from them rather than from us. I mean, they will have to figure it by themselves by expending the scope of what they deam important to learn. Unless they realize that, i think our attemp will be fruitless. Our role should only be to feed them the evidence in such a way they think they discovered it themselves...

                              Am I a bit to harsh or does it make sense ?
                              Frédéric Wellens, pht
                              «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                              «
                              Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                              »
                              Friedrich Nietzsche
                              www.physioaxis.ca
                              chroniquesdedouleur blog

                              Comment


                              • #90
                                I'd like to add a few thoughts to the thread, in no particular order.

                                1. Memes: I think in PT (as with all other human primate social grooming professions) we tend to conflate what we do with what we think we do, instead of keeping those in separate domains, one as a verb and the other as an ab-, in-, de, -or perhaps even sub-ducted nounish conceptual construct. It doesn't matter that this happens, it only matters that we realize that we do this, mostly non-consciously, and that it's nothing to be proud of.

                                2. The chasm. Perhaps we all (on either side of the chasm) will find that neuroscience itself fills the whole chasm, like a rising water level - it may rise up level with the banks such that we can just go back and forth in boats. Hopefully all the anti-scientific memes in the chasm will drown in the process.
                                Diane
                                www.dermoneuromodulation.com
                                SensibleSolutionsPhysiotherapy
                                HumanAntiGravitySuit blog
                                Neurotonics PT Teamblog
                                Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                                Canadian Physiotherapy Association Pain Science Division Facebook page
                                @PainPhysiosCan
                                WCPT PhysiotherapyPainNetwork on Facebook
                                @WCPTPTPN
                                Neuroscience and Pain Science for Manual PTs Facebook page

                                @dfjpt
                                SomaSimple on Facebook
                                @somasimple

                                "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

                                Comment

                                Working...
                                X