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  • #16
    I hear you Rod. Ideomotion is thought primarily to be present in order to express us, not lead to nutrition of the nerve.

    Luke? I need your help again to defend this portion of my premise.
    Barrett L. Dorko

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    • #17
      By the way, I'm still waiting for someone using ankle weights all the time to present the premise they espouse.
      I have never used ankle weights in my life on patients (actually, rarely any weights anywhere at all) but if they are used and no premise is offered, perhaps it is a "therapeutic" way of confining patients to their chairs. What else could we possibly assume for their use?

      Barrett, if someone responds with a protest, you might get a premise or two.....

      Nari

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      • #18
        Nari,

        You've always struck me as an incredibly tough person, but without ankle weights you wouldn't last five minutes in an Ohio nursing home.

        I think I've finally asked the right question, and it's only taken about forty years.

        That's why no one's answered.
        Barrett L. Dorko

        Comment


        • #19
          Originally posted by Barrett Dorko View Post
          I hear you Rod. Ideomotion is thought primarily to be present in order to express us, not lead to nutrition of the nerve.

          Luke? I need your help again to defend this portion of my premise.
          I like rattling sabres and have been rattling the saber of self-correction for at least 3-4 years now. My biggest challenge is that biological plausibility exists in the absence of a robust evidence-base. Unfortunately I don't see a ground swell of interest in systematically studying the ideomotor effect clinically.

          ...apart from Luke of course!

          It won't stop what I'm doing, but it would sure improve the gradient.
          Rod Henderson, PT, ScD, OCS
          It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

          Comment


          • #20
            Originally posted by Barrett Dorko View Post
            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?
            That is why I thought you might be referring to neural control of circulation it didn't seem to fit that you were referring to intraneural blood flow from nervi vasa nervorum from the very little I know of ideomotion.

            Warmth and relaxation seem to occur frequently with treatment.
            “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” Buckminster Fuller

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            • #21
              I hear you Rod. Ideomotion is thought primarily to be present in order to express us, not lead to nutrition of the nerve.

              Luke? I need your help again to defend this portion of my premise.
              Barrett,

              Rod is right, there is exactly one (case) study examining ideomotor movement for pain relief (two if I can find a little more time). The closest it gets to supporting this portion of your premise is the literature on the end-state comfort effect. This phenomenon is a well-documented example of ideomotor expression and describes how we instinctively choose movement patterns that predict the most comfortable positioning of the body at the end of complex, task-oriented movement.


              Is the premise off, unprovable or inaccurate? Might it be replaced with something simpler?
              The premise list above essentially outlines a specific scenario of nociception following ischemia and its resolution via movement. Nothing controversial there. I wonder if others see this as too simple though. Does something need to be said about central modulatory processes here? What effect might the "context that promotes ideomotion" and narrative interpretation have beyond the mechanical effects of ideomotor movement?

              This thread has reminded me of the discussion we had over at Suppose This Were True, way back in 2007, and your comment here.
              Last edited by Luke Rickards; 17-10-2013, 03:41 PM.
              Luke Rickards
              Osteopath

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              • #22
                Premise

                Premise:

                1) The neurogenic nature of all pain implicates THAT system when a complaint of pain is encountered. (indeed all pain is an interpretation about stimuli entering the brain, processed by the brain taking into consideration other sensory input, emotional status, memory based, etc etc). Pain as an output is a complex interaction of all of these brain areas.

                2) If the patient can alter pain with the position and/or use, mechanical deformation is resonably considered the origin of pain....

                · couple of toughts: Why assume that if the patient is uncomfortable or in pain in a certain postion or movement, it is due to mechanical deformation of tissues? The mechanical deformation of tissues can be quite normal, sending up sensory info to the brain can be quite normal (or not if nervous system is sensitized), only the brain can perceive the normal info as a threat and respond with pain. When pain persists there can be a strong relation between motion or position and activation of the neurotag where that particular movement, position evokes a pain output....

                3) Neural tension is considered the primary problem if rapid alterations in discomfort is reported with movement.... Why is that? if there is inflammation from tissues, and nerves report info about position, chemical state of tissues etc to the brain, why must there be anything wrong with the neural tissue? The brain reacts protectively with pain and changes motor output in response to what is going on in the tissues.... Fast alteration, doesn’t always implicate the there is strain on the peripheral nerves.....

                4) Natural an unconscious generated movement leads to increase in neural bloodflow and the reduction of pain....



                Tissue damage isn't always necessary to get a pain response.... Agree on that, but we can't ignore the fact, that when I cut my finger, there will be tissue damage and there will be pain.... Never saw anyone tear his/her ankle ligaments with a smile on their face during a football match..... What i mean with this is that we can't toss the tissue related pain experience.... Tendinopathy is a nice example of a 'chronic' condition that leads to much discomfort in a lot of people (we can see those with tendinopathy and no pain, but that doesn't mean with those in pain we have to ignore the tissue state).... We see that tissues aren't normal, that there is neovessels and nerve ingrowth in the tendon.... Therapy that addresses the tissues, eccentric/isometric exercise..... We see alterations in collagen matrix, people experience less discomfort or become pain free.... My point is we can not ignore the tissues in people in pain, we have to integrate this in the broader spectrum of the biology/biochemistry pain.....

                Method:

                Creation of context that promotes ideomotion... This would not include presence of a threat or an operator action that promotes nociception....

                We need indeed create context for the patient to understand their pain, find a way why they are in pain, create an environment where they can practice that doesn't induce pain, reduce fear, take into consideration the person that sits in front of us....

                With simple contact, you try to restore ideomotion.... you don't push or pull, you follow the movements the patient makes, you create a context in which the patient is able to do this.....

                How do you know for sure that the ideomotion is that of the patients? With the patient’s stories, complaints, patient pointing out where they hurt.... The patient has created a context for your brain to work with, you have absorbed a lot of unconscious info that your brain might take into consideration before you start treatment.... You say simple contact, but maybe the way you place your hands gets interpreted by the patients brain: I have to move in this or that way.... Potentially nothing ideomotor about that, it follows directions you subconsciously implement on the patient.... Though to the patient it feels involuntary, he certainly does not say that he doesn't feel pressure from you......

                How do you know for sure your ideomotion isn't forced on the patient, to make him move the way you want him to move (like the pendulum sway of a clairvoyant

                Comment


                • #23
                  Do you prefer we address you as Sausage or should we call you Mr/Dr Finger? Can I suggest introducing yourself in our Welcome Forum?
                  Rod Henderson, PT, ScD, OCS
                  It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                  Comment


                  • #24
                    You can call me however you feel appropriate....

                    Comment


                    • #25
                      I think I'll call you SF. Please just call me Barrett. It's actually my name.

                      SF says:

                      How do you know for sure your ideomotion isn't forced on the patient, to make him move the way you want him to move (like the pendulum sway of a clairvoyant)?
                      I've been asked this question repeatedly for over 30 years.

                      If I KNEW which way to move people in the direction of correction I'd be glad to claim that, teach it and explain how it is I knew.

                      I don't.

                      Do you think that a pendulum is alive?
                      Barrett L. Dorko

                      Comment


                      • #26
                        Pendulum not alive...

                        But how soft your contact is or even no contact, just entering the peripersonal space of a person is sensory input and can have influence on the patients movements... Conscious or non conscious.... No way IMHO you can be sure what is activated is purely ideomotion....

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                        • #27
                          I will call you "Sausage", mostly because I prefer the informality of using first names.

                          My understanding is that Barrett's method is one primarily concerned with communicating with the patient in a such way to build a context that reduces the threat associated with movement. Part of that includes applying light manual contact. I don't think Barrett necessarily uses physical contact on every patient, but I suppose it is a key aspect of this method of communication.

                          In any case, he's been constructing his argument for several decades and has written of it extensively. The presence of ideomotioni is widely accepted. What Barrett's done is bring it to us in the physical and manual therapy communities for consideration to explain the results we see or, as it happens, don't see with our patients.

                          The only way to know for sure if Barrett's method is superior to a sham or comparable method is to design a clinical trial with adequate blinding and randomization. This has not been done yet. Just one SSRD has been published by McCarthy, Nicholas and Rickards on patients with neck pain. You should take a look it- it was pretty well done.

                          The problem is that many clinical trials have been done on a lot of other methods used by therapists (e.g. CST, various exercise approaches, etc) and found to be seriously lacking in efficacy and/or a theoretical basis; yet, PTs and others continue to use these methods anyway.

                          Does that concern you?
                          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


                          • #28
                            SF says,

                            No way IMHO you can be sure what is activated is purely ideomotion....
                            Who said anything about "purely"?

                            Perhaps you don't know that we've discussed ALL aspects of context that we can identify and have done so for years. In other words, you're going over old, well-trod ground here.

                            I'm unconcerned with the effectiveness of my method here, and I've never claimed it WAS superior. This particular thread is about stating a defensible PREMISE. Can you do that?

                            I must ask, why all the "..." in your writing? Have you more to say? Are you giving us time to think about what you've said? If so, thanks!
                            Last edited by Barrett Dorko; 17-10-2013, 07:34 PM.
                            Barrett L. Dorko

                            Comment


                            • #29
                              Sausage, there are some serious issues with some of the stuff you wrote.
                              "Why assume that if the patient is uncomfortable or in pain in a certain postion or movement, it is due to mechanical deformation of tissues?
                              Because, as Barrett clearly states above, altering position or motion decreases the pain. It is, in absence of any other findings, the most parsimonious explanation.
                              If it is due to hypersensitivity, this is unlikely to occur as readily.


                              3) Neural tension is considered the primary problem if rapid alterations in discomfort is reported with movement.... Why is that? if there is inflammation from tissues, and nerves report info about position, chemical state of tissues etc to the brain, why must there be anything wrong with the neural tissue? The brain reacts protectively with pain and changes motor output in response to what is going on in the tissues.... Fast alteration, doesn’t always implicate the there is strain on the peripheral nerves.....
                              You seem to be suggesting that motion has the ability to rapidly diminish the chemical effects of inflammation. That is new to me.

                              Finally:
                              Agree on that, but we can't ignore the fact, that when I cut my finger, there will be tissue damage and there will be pain.... Never saw anyone tear his/her ankle ligaments with a smile on their face during a football match.....
                              Those are not facts, and are not consistent with what we know of the emergent phenomenon called pain. There are multiple examples of people with tissue damage and no pain whatsoever. In my experience alone: two athletes (one football, one squash player) felt a snap in their lower calf and found they could not walk proper anymore. Hobbled to the side, got evaluated and found a full AT tear. No pain at all. Not even after learning about their tear. The journals are full of these.

                              Do not assume that there are certainties at any time connecting pain and tissue damage. Ever.
                              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


                              • #30
                                Stated in my post that that tissue damage is not always necessary to get a painresponse, but it is not impossible.... Am absolutely aware of disc hernia's in people who aren't in pain, tendinopathies in people that are not in pain etc etc etc list is endless... Never stated that tissue damage is absolutely necessary to be in pain...

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