Premise

[Barrett Dorko]

Premise; definition:

NOUN: a previous statement or proposition from which another is inferred or follows as a conclusion.

VERB: base an argument, theory, or undertaking on.

From this

Perhaps we can settle something this week. This has certainly been spoken of elsewhere here and linking to those discussions may help us along. Here's my proposal:

Your method should have a premise that you can state clearly, simply and defend with an argument. This means that your premise and method are both plausible and supported by good evidence.

If someone feels that the premise proposed is inaccurate, let them say so.

Now it's your turn.

[Barrett Dorko]

Note: Your premise should have a deep model that you can explain and refer to when necessary.

It is not made more plausible by the effect of your method.

[Barrett Dorko]

Okay, I'll begin.

Premise:

1. The neurogenic nature of all pain implicates that system when a complaint of pain is encountered.
   
   
2. If the patient can alter their pain with position and/or use, mechanical deformation is reasonably considered an origin of pain.
   
   
3. Neural tension is considered the primary problem if rapid alteration in discomfort is reported with movement.
   
   
4. Naturally occurring and unconsciously generated movement inherent to life leads to an increase in neural blood flow and thus a reduction in pain.

Method:

The creation of a context that promotes ideomotion. This would NOT include the presence of threat or an operator action that promotes nociception.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

What I'm looking for here is support for each of the statements in the premise. I have them but would prefer your thoughts. Perhaps we can rank each of the four statements in the premise in terms of strength.

[Barrett Dorko]

Method follows premise.

Since my method is rarely used (I think), I'm wondering about the premise possessed by other clinicians. To me, this is a reasonable expectation.

I've worked beside many, many therapists who, according to the methods they employed for painful problems, toiled under the premise that pain came from weakness.

Does this sound familiar?

Isn't anybody going to make the case for that eventual method of care based upon that premise?

[Jamie R]

Method follows premise.

Since my method is rarely used (I think), I'm wondering about the premise possessed by other clinicians. To me, this is a reasonable expectation.

I've worked beside many, many therapists who, according to the methods they employed for painful problems, toiled under the premise that pain came from weakness.

Does this sound familiar?

Isn't anybody going to make the case for that eventual method of care based upon that premise?

Hi Barrett,

I've been reading Proud's thread on the FMS/SFMA with interest. I am FMS and SFMA certified. So I come from a sort of movement-based approach. One of the things that I guess led me to find SomaSimple was a dissatisfaction with my treatment results, and a dissatisfaction with "the system." While a good number of people improved, i.e. a large number ended up moving "better," however were still in pain. They would even be able to feel that they could move more freely, but lamented the fact that their pain/symptoms were largely unchanged. Keep in mind that a large part of my caseload is in 'reconditioning' injured workers. So while I was often able to teach them to lift, and increase their strength and endurance, they were ultimately expected to return to work following their program, still in discomfort. This obviously didn't sit well with me.

I don't think I toiled under the impression that pain came from weakness particularly. But I do think I operated very much in terms of biomechanics, and did things like teaching clients to brace into neutral position with lifting. Which worked decently in getting improvements in same in a four to six week program, and the referral sources were happy. But the client seemed to be at the bottom of the rung in terms of importance.

One of the quotes of yours that I liked when I started pouring through SomaSimple was "when the primary complaint is pain, the treatment of pain should be primary."


You mentioned that your method is rarely used. I can see how this inspired this thread on premise. As I had discussed with you I think in private e-mails (and also with Diane), I think I had mentioned to you that had I seen Simple Contact as recently as 1-1 1/2 years ago, I would have reacted in a very dismissive way. I still think I am dealing with cognitive dissonance since coming here, but I am hopeful that will be clearing up in the near future.

I don't think I added much with this post - just wanted to add a bit from the perspective from someone who is trying to sort out this information. There have been some good threads recently which I am keeping tabs on.

Jamie

[Barrett Dorko]

Jamie,

Wonderful response.

"Dismissing" any sort of handling as gentle as Simple Contact is very easy when your premise isn't challenged. That's why I began this thread.

18 hours up and, as yet, no one proposing that weakness or "motor control" problems has yet posted a defensible premise for their method.

So far, that is telling.

It may change.

[Barrett Dorko]

Jamie,

One more thing: What is "movement-based"?

[Rick Carter]

Okay, I'll begin.

Premise:

1. The neurogenic nature of all pain implicates that system when a complaint of pain is encountered.
2. If the patient can alter their pain with position and/or use, mechanical deformation is reasonably considered an origin of pain.
3. Neural tension is considered the primary problem if rapid alteration in discomfort is reported with movement.
4. Naturally occurring and unconsciously generated movement inherent to life leads to an increase in neural blood flow and thus a reduction in pain.

Method:

The creation of a context that promotes ideomotion. This would NOT include the presence of threat or an operator action that promotes nociception.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

What I'm looking for here is support for each of the statements in the premise. I have them but would prefer your thoughts. Perhaps we can rank each of the four statements in the premise in terms of strength.

Naturally occurring and unconsciously generated movement inherent to life leads to an increase in neural blood flow and thus a reduction in pain.

Is the above provable and/or disprovable? What is neural blood flow, are you referring to neural control of circulation?

[venerek]

I believe Barrett is referring to (and correct me if I am wrong, Barrett) intraneural blood flow from nervi vasa nervorum. Subtle mechanical deformation of the nervous system can cause profound ischemia of nervous tissue, which can make it quite cranky. Ideomotion, such as unconsciously shifting in your seat, corrects this.

Sunderland's work does a nice job detailing the physiology of this. Shacklock also summarizes it quite well in his "Clinical Neurodynamics" text

[Jamie R]

Jamie,

One more thing: What is "movement-based"?

Not sure if this is a set up question or not. There is a healthy discussion on the Proud's SFMA thread, and whether the movements they chose to test are functional or not, and how meaningful this information is. I see that you posted a few times in that thread.

A large part of Cook's premise was to come up with a baseline for human movement. His group has come up with a movement-based assessment (and FMS, the screen), and the interventions are designed to focus on mobility and stability/motor control based corrective exercises.

As near as I can tell, the SFMA crowd seems to be looking at things backwards. From Cook's book Movement: "The SFMA is a movement-based diagnostic system, a series of seven full-body movement tests designed to assess fundamental movement patterns in those with known musculoskeletal pain." (the italics are as written in the book)

Cook says that pain changes motor control, and had a rationale for why you leave the painful movements alone, and treat the pain, and the focus initially is on the "dysfunctional non-painful movements." It almost seems like you walk around on eggshells around the pain. There was some suggestion that improving the dysfunctional non-painful movements would clear the other dysfunctional movements. Which I guess makes sense if you subscribe to a pure biomechanical approach. But again, if you believe that pain alters motor control, it would seem the logical thing to do would to be to deal with the pain directly, and not dance around it.

I guess this is what I had issues with. The whole focus appears to be on movement, and restoring movement to what they deem as functional. As was mentioned in Proud's thread, Cook seemed to be getting into dry needling as an intervention. But otherwise the message seemed to be "treat as you see fit."

[Rick Carter]

I believe Barrett is referring to (and correct me if I am wrong, Barrett) intraneural blood flow from nervi vasa nervorum. Subtle mechanical deformation of the nervous system can cause profound ischemia of nervous tissue, which can make it quite cranky. Ideomotion, such as unconsciously shifting in your seat, corrects this.

Sunderland's work does a nice job detailing the physiology of this. Shacklock also summarizes it quite well in his "Clinical Neurodynamics" text

I found the Shacklock reference.

Tissues to Mechanical Stress
Intraneural Blood Flow

Intra-neural blood vessels take a tortuous course through nerve tissue in order to provide continuous adequate blood flow. These vascular curls are inherently relaxed before elongation takes place. When tension is applied to the nerve, the vessels straighten out until their slack is taken up, still permitting ongoing circulation. This vascular configuration is present in the neuraxis (Breig et al, 1966; Breig, 1978), nerve roots (Parke et al, 1981; Parke and Watanabe, 1985) and peripheral nerves (Lundborg, 1975,1988). However, the above protective features have limitations and excessive tension reduces intra-neural microcirculation by stretching and strangulation of the vessels. In the rabbit peripheral nerve, venous return starts to decline at 8% elongation and, by 15%, arterial, capillary and venous flow is completely occluded. At these values, circulation returns to normal once the load is removed. If the vascular capabilities are overwhelmed by excessive stretch, nerve damage occurs (Lundborg and Rydevik, 1973; Ogata and Naito, 1986). These observations in peripheral nerve correspond well with studies of the spinal cord where impaired blood flow and impulse conduction have been linked directly to increased tension (Cusick et al, 1977; Tani et al, 1987; Owen et al, 1988). It is unclear whether human physiological movement alters intraneural blood flow significantly but there are arguments that, in some situations, circulation changes may occur. Millesi (1986) found that the median nerve bed changed length by 20% from full wrist and elbow extension to flexion. This percentage is greater than that needed to produce experimentally total ischaemia in nerve tissue (15%) (Lundborg and Rydevik, 1973). Human evidence for neural ischaemia lies in holding the arm in the ULT test position for a sustained period, much like ‘Saturday night palsy’. Neurogenic symptoms in the farm of pins and needles appear with time because the neural elongation strangles the intra-neural blood vessels. The time-dependent nature of the symptoms suggests that, with ongoing vascular compromise, the axons become hypoxic and produce symptoms.

[Barrett Dorko]

It's a good question Rick.

I don't know that this has been proven though the effect of imposed stillness isn't something I can ignore. To me, it stands to reason that we would have evolved toward self-correction. Ideomotion, which is well-studied, is the best description of this I've seen. Still, for reasons beyond my understanding it remains unknown to the therapy community and is never taught in the schools.

People who lack nociception and thus an output of pain develop the diagnosable problems that movement from ordinarily occurring discomfort would prevent. This movement is as common as breathing but much easier to consciously diminish in its expression.

Why such a commonly reported finding as warmth while people move without plan? Why such a commonly reported response as profound relaxation?

Is the premise off, unprovable or inaccurate? Might it be replaced with something simpler?

[Barrett Dorko]

Okay, we've crossed posts a bit but I'm glad there's so much interest.

First, I don't believe that pain alters motor control, I

understand

that it must.

And I'll say it, poking a tender spot with a needle displays a phenomenal ignorance on the part of the practitioner.

What the SFMA has revealed is the therapy community's astounding and willful ignorance of pain science. When pain is encountered, the stumbling is amazing to watch.

[Barrett Dorko]

By the way, I'm still waiting for someone using ankle weights all the time to present the premise they espouse.

So far. Nothing.

[HeadStrongPT]

It's a good question Rick.

Ideomotion, which is well-studied, is the best description of this I've seen. Still, for reasons beyond my understanding it remains unknown to the therapy community and is never taught in the schools.

Barrett, I'm currently able to find approximately 64 articles indexed in PubMed using the search terms "ideomotor" and/or "ideomotion" and/or "ideomotor theory". Of these, few deal directly with its connection to persistent pain.