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  • CT Game-Changer

    Having arrived here at SomaSimple after struggling the better part of my career to read- let alone understand- all the small type in those neat little boxes of the Treatment-Based Classification System and then later the seemingly endless and overlapping lists of alignment faults in the Movement Impairment System, I was confused and exhausted.

    At some point during that time I had read one of Barrett's essays about him and his dog Buckeye: the two of them walking and one of them responding behaviorally to his instinct- that would be Buckeye.

    It occurred to me, What if the movement from pain is instinctual? Uh, oh- that might actually make some sense: limping, lateral shifts, “stiffness”. All of those neat and tidy algorithms and mal-alignment/movement clusters would be just big, fancy imaginative boondoggles. All the books, articles, RCTs examining these topics would be no more real than fairy dust, not to mention the fairy that sprinkles all that dust around.

    Not only that, it would be a huge game-changer.

    What was your game-changer?
    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

  • #2
    I can think of three sets of events that marked phases of change for me. Definite game changers, all.

    1) Defense vs. Defect
    2) These 2 papers from Quintner. (One and two is his article on pain models which I can't find at the moment.)
    3) Nortin Hadler's amazing book on medicalization: The Last Well Person
    Cory Blickenstaff, PT, OCS

    Pain Science and Sensibility Podcast
    Leaps and Bounds Blog
    My youtube channel

    Comment


    • #3
      Mine was sitting in Butler's workshop and hearing about nerves, for what seemed like the first time in my life, and realizing what sensory capacity really meant, what the hideous yet completely liberating implications of that implied. Hideous in that world views (mine) had to change. Completely liberating in that world views (in general) had to change.
      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


      • #4
        Found the other Quintner article.

        The game changer in it was the idea of the aporia of pain.

        Also, here is one of my all time favorite threads where we discussed some implications of pain as an aporia and monism/dualism.
        Last edited by BB; 08-12-2012, 03:56 PM.
        Cory Blickenstaff, PT, OCS

        Pain Science and Sensibility Podcast
        Leaps and Bounds Blog
        My youtube channel

        Comment


        • #5
          For me, since I graduated in 2007 I always viewed PT, especially manual care, with a lot of skepticism. I read David Morris The Culture of Pain in 2008. That is when I learned that there was a whole lot more out there than just posture and movement.

          It was not until I took a per diem job 1.5 years ago, that I got pushed out of my comfort zone (i.e. working in really horrible PT clinics) and needed another community. SS found me. It took until I met Diane at her DNM workshop did I finally reconcile the fact it was "okay" for me to be a manual therapist.

          Eric
          Last edited by Milehigh; 08-12-2012, 04:21 PM.
          --------------------------------------------------------------
          Body is imbued with mind, and mind is embodied.

          Comment


          • #6
            1. Diane's insistence that nerves are behind -and only the beginning of- every perception.
            2. Moseley's talk on pain perception. He is such a great presenter and this talk really super-charged my fascination with the neuroscience of pain.

            Comment


            • #7
              Originally posted by Milehigh View Post
              For me, since I graduated in 2007 I always viewed PT, especially manual care, with a lot of skepticism. I read David Morris The Culture of Pain in 2008. That is when I learned that there was a whole lot more out there than just posture and movement.

              It was not until I took a per diem job 1.5 years ago, that I got pushed out of my comfort zone (i.e. working in really horrible PT clinics) and needed another community. SS found me. It took until I met Diane at her DNM workshop did I finally reconcile the fact it was "okay" for me to be a manual therapist.

              Eric
              [How great it is, that a new generation of HPSGs are developing themselves with their heads on straight, right from the start. ]
              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


              • #8
                Mostly on straight, while in PT school Sahrmann did help me abandon most of the OMPT. However, by the time I was done, and into my first year, I was kicking her to the curb as well. Even though it took me until I found SS, to really refine my language--which admittedly was a little sloppy with meso memes.

                Now that those are gone, things are soooo much easier and sometimes harder

                Eric
                --------------------------------------------------------------
                Body is imbued with mind, and mind is embodied.

                Comment


                • #9
                  :angel::thumbs_up
                  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


                  • #10
                    Yea, Cory, that "aporia" paper gave me a huge headache.

                    However, "game-changers", in my view anyway, are often very subtle shifts in the emotional tide- some little nugget that lodges itself in the subconscious- that creates a definitive shift in thinking. Often, unlike an "ah ha" moment, you don't realize how important it was until much later.

                    This is why Barrett's writing is so important for our profession. We used to have Jules Rothstein to provide this unique kind of insight, but as far as I can tell, Barrett's writing's all we've got to MOVE people.

                    To change the game.


                    John Ware, PT, FAAOMPT

                    Sent from my iPhone using Tapatalk
                    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


                    • #11
                      Originally posted by BB View Post
                      1) Defense vs. Defect
                      +1

                      This changed EVERYTHING.

                      Respectfully,
                      Keith
                      Last edited by Keith; 01-01-2016, 11:03 PM.
                      Blog: Keith's Korner
                      Twitter: @18mmPT

                      Comment


                      • #12
                        Defense vs defect
                        This was very significant for me later in the game-change, but it all started in a flash with Butler in 1998.

                        His words just made so much sense in what I saw was a very boring world of muscle and joint therapy. The final musculoskeletal firng squad came with Barrett D in 2005.
                        Like Eric, I was dissatisfied with traditional muscle/joint therapy and was looking for change.

                        That makes all the difference - some PTs are quite happy with routine cookbook recipes.

                        Nari

                        Comment


                        • #13
                          Barrett's relentless messages and Mel Siff's postings on PTHER (e-mail based discussion forum) - followed by a Butler course.
                          Barrett softened me up for Butler's teachings to make sense.
                          Then Diane.
                          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


                          • #14
                            Like Eric, I need to give credit where it is due, and Shirley Sahrmann does deserve some credit for opening me up to a more hands-off less ostensibly operator-dominated mode of treatment.

                            It's one thing to think you can alter someone's mesoderm by having them do some precise and finely tuned movement, it's a whole other category to the nth degree of operator mentality to think that you can alter someone's mesoderm with your hands.

                            *********************************************************************

                            My son hit a bloop single into shallow right field this evening scoring the tying run. This came after I resigned as statistician because the head coach decided to bury him in the bottom of the line-up despite the fact that he's got the 2nd highest on-base percentage on the team at just under .500, which means that each time he comes up to bat, there's a 50% chance that he's going to get at least to 1st base, whether by getting a hit, a base on balls or getting hit by a pitch (he's 2nd on the team in that category as well, unfortunately.)

                            But he's not a big, strong kid and he doesn't hit with a lot of power like some of the other kids. He's a solid athlete but not flashy and doesn't like to draw attention to himself (don't know where he got that :angel. He kind of just blends in, does his job, hustles, gets too mad at himself when he makes a mistake (definitely know where he got that) and consistently contributes positively to the team. And for that he bats in the 9-hole (that's the very bottom of the batting order for you non-North Americans). This not only injures my son's confidence, but it also hurts the team. You want your players who get on base to get the most chances at the plate. Common sense, right?

                            Barrett Dorko consistently makes "base hits" (and not a rare "home run") with his writing at this site; yet, not nearly enough PTs take the opportunity to avail themselves of this tremendous resource. This rare talent is far too under-appreciated for its po"wer to change the game".

                            Scotty, a specimen of an athlete at 5'10" tall and 150lbs of pure muscle and also our ace pitcher, hit a batter who stole 2nd base and then gave up a 2-strike hit allowing the run to score from 2nd. Game over, we lose. Conner had a total of 3 at-bats in 2 games. He went 1 for 2 with a base on balls. He nearly legged out an infield hit to go 2 for 2 (his dad thinks he was safe, of course.

                            It's not always the stars who make the difference. It's not always the "stars" who are the stars.
                            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


                            • #15
                              My game changer moment was really a series of moments that began with my leaving the 'nursery' that was my first place of employment following graduation. The clinic was/is very much aligned with diane lee's integrated model of joint function (form closure, force closure, motor control, psychology/emotions), although to their credit they did add a 5th component to the model- that being the client-therapist relationship. My boss used to say "If you cant connect with the patient you are screwed".

                              In that setting we all worked to a system of assessing form closure and force closure, using palpatory skills to determine if restrictions were local or global, or if there existed any segmental hypermobility and then treating with specific mobilization or stabilization interventions. I was immersed in it and althought I knew I couldnt feel specific hypermobility/hypomobility, i was certain that it was my skills that needed developing rather than the treatment model.

                              When I left this clinic and started in nyc, i was initially (quietly) skeptical, even cynical of my new workplace as the PTs there, who for the most part used trigger point therapy. That was/is the model that the owners filter down to new grads and other employees alike. I would think to myself "How the hell are you going to get anyone better if you dont get in their with your hands and determine what's moving and what's not moving? Squashing trigger points won't do anything to free up a locked facet joint!"

                              But to my surprise, I saw all these patients responding beautifully to trigger point therapy. That made it painfully obvious that there was something missing in both my former and current workplaces. The good results for each clinic create confirmation bias for those sheltered within it... but I couldnt help thinking that the good results in each clinic proved that the other clinic's model could not be right. Neither clinic's model could explain the good results in the other clinic. So I started hunting for better explanation and thankfully discovered SS, and the concept of defense vs defect.

                              Comment

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