Placeholder II - The Revival

[Barrett Dorko]

I’m pretty sure that there are some out there who would prefer that the thread titled Placeholder would just bury itself beneath the weight of all the others here on Range of Motion, and I’m sure it sucks for them that I’m reviving it today.

Too bad.

If they want the questions to go away they should come up with a coherent answer to them. So far, nothing. Without some sort of defense offered it’s difficult for anyone to grow - not that this is part of their agenda. We are obligated to defend what we do – simple as that.

Do I sound a little angry? Do I sound as if I think this “dry needling” is just another thing that has grown from a faulty and destructive premise?

I am angry. And I’ve decided to continue this campaign until some actual opposition decides to show up. Trying to kill a zombie comes to mind but it’s an image that hasn’t fully formed in my head just yet.

It will soon.

In Diane’s brilliant essay she explains why something commonly thought to be the case simply isn’t plausible, and how if an alternative explanation is acceptable it would change our reasoning, method and the entire manner in which we practice when interacting with a patient in pain.

A tall order to be sure.

We should ask for it anyway.

[Barrett Dorko]

Still waiting for someone who does "dry needling" to defend it here.

Anyone out there?

[Barrett Dorko]

For me, the limpid effort toward actual knowledge is often overwhelmed by a kind of nostalgia for those days when hard work and therapy were synonymous. This preceded the discoveries of neuroscience discussed here but are still unknown in most therapy clinics. The therapists in these places are stuck in the 50s, and some were born in the 90s.

From this thread

Maybe that’s it. Maybe those who do this stuff don’t use the Internet. Maybe they only learn from those who claim success doing senseless things.

They don't even know we exist.

[johnso]

I am not the one who is going to defend dry needling but i would like to see a debate about it. So for the sake of argument i have to understand better the question. Do you think that if we call for defense the PT 's who practice manipulation techniques, neurodynamics or others it would be easy to defend them in an Evidence based manner? There are conflicts in literature all over the place. Even the ''evidence based'' often is debatable http://www.badscience.net/2011/10/wh...ics/#more-2405 (Erroneous analyses of interactions in neuroscience: a problem of significance). I am on your side when it comes to find the possible true mechanisms of action for a procedure. That would change the clinical reasoning for when and how and for whom it’s appropriate or not. So why do you think we have to see dry needling separately from the others?

[Barrett Dorko]

I really appreciate your posting here.

The problems inherent to evidence based thinking have been discussed here and regular readers can certainly find those threads, this being the first - begun in August of '08.

We've been at this a while.

What I see lacking in "trigger point" conception in general and dry needling in particular is a plausible explanation despite a mountain of literature to the contrary. This is simply not true of neurodynamics and saying so won't make it true.

Somebody's relatively wrong here and a debate about these issues will require a defense of one side.

That's what these threads are about but so far, nothin'.

[Karen L]

In this video by Lorimer Moseley he talks at 45:00 about loss of inhibition and too much excitement, more sensitive and less precise activity by the brain. He goes on to say across disciplines there is an effort is to recruit mechanisms that reignite inhibition. Dis-inhibition and lack of precision may be a contributor to the problem of pain and contribute to physiological dysfunction in the tissue.

How does anyone imagine after listening to this presentation, that a pain inducing procedure on a painful person will cause a long lasting activation of neurosignature inhibition?

Karen

[Barrett Dorko]

Karen,

A great question.

Now all we need is for someone to answer it.

[Bas Asselbergs]

additionI'll take a stab Barrett, although I am not the one you are waiting so patiently for.

How does anyone imagine after listening to this presentation, that a pain inducing procedure on a painful person will cause a long lasting activation of neurosignature inhibition?

A couple of possible answers:
a) no imagination;
b) no understanding of the stuff Mosely talks about;
c) Mosely's is only "one" way of looking at our reality;
d) it does not matter;
e) I have no time for this.

I missed a few no doubt.

Johnso, defending neurodynamics and manipulation is easier to do, since there are some reasonable, plausible explanations that are consistent with human anatomy. I am not defending them, I am suggesting that trigger points have less than plausibility and less than anatomical consistency to lean on.

We have debated manipulation in depth as well, BTW.

[johnso]

I enjoy Lorimer ’s presentations every one of them. I would like to share though something that David Butler said in the WCPT 2011 congress in Amsterdam. This is the picture https://www.facebook.com/photo.php?f...type=1&theater. I believe that it is in our hands not to do with neuroscience applications for managing pain patients as PT ‘s what we have done with conceptualization of pain models with the disc’s, facet’s etc.. I mean as Butler said we have this new weapon of understanding pain mechanisms but "Crocodiles still exist". So everything we know has to be a part o our clinical reasoning for a specific patient with individualized needs and characteristics. And there is a need for sub grouping patients when we talk about them. And if it’ s dangerous to stick with explanations that have been rejected by literature (aka dry needling). Is not the same danger if we generalize interpretations about pain mechanisms? These thoughts are in my head for a long time now.. :-)

[Diane]

The crocodile creates "noise" or nociception. No one would dispute the ability of nociception to "hurt".. but only if the brain pays attention to it.

When it does, something else (called "pain") exists. When the brain doesn't pay attention to nociception, a pain perception does not exist.

The crux of the confusion is/has always been using those two words, nociception and pain, as if they were interchangeable. They are not. One is sensation, the other, perception of sensation.

[johnso]

Diane you are absolutely right but Butler was implying something else. That you we have to see and other parts beside CNS that in the end will corelate with CNS or not...

[Barrett Dorko]

I'd like to know what evidence there may be that someone like Diane doesn't understand the anatomy.

[johnso]

I was not implying anything for the anatomy knowledge of anyone here. i want to be clear about it. I just wanted to point the meaning of Butlers example inthe congress. And the point was that basic knwoledge as biomechanics , muscle function, dysfunction, is there ...

[Diane]

Hi Yiannis,

I doubt Butler is assuming those things have any true agency - it's more, I think, that he doesn't want to leave out any particular perspective or way of thinking about problems in a clinical setting, ways of thinking and treating that I would refer to as "operator models". (I'm referring to your mention of biomechanics, muscle function etc)

I'm sure he would agree that although these are useful ways of seeing problems, of filtering out large amounts of extraneous detail, they don't have actual agency in terms of causing pain. They are practitioner beliefs, and often patient beliefs, reinforcing each other.

[Barrett Dorko]

Butler sees these things clearly and, much more than I, pays homage to them – thus his popularity and mine, well, I’m not popular.

But it’s what Butler doesn’t see that I have problems with.

That is why I wrote Lacuna.

Bottom line: I’m not as polite.