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  • #46
    Demonstrably false or unprovable?

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    • #47
      The premise is demonstrably false, i.e. there are people with tears who have no symptoms at all. Therefore, the conclusion that someone will invariably need a surgical repair of their tear is based on a false premise.
      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

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      • #48
        John and Barrett,

        This is a tripping point for me and I would like to try to work it out if you don't mind helping.

        "If the primary complaint is pain, the treatment of pain should be primary" - Barrett

        If the action that treats the pain is surgery, then that is the proper intervention. If fixing tissue is the thing that stops the pain, then fix the tissue.

        My challenge is that though all pain is neurogenic and an encounter with pain therefore implicates that system, that very system may be humming along perfectly with its highly accurate process of producing pain because of tissue damage/irritation. That tissue damage cannot be fixed with hands-on therapy. Perhaps level of impact from that tissue can be temporarily affected in such a way that lowers the noxious input, but if that system was receiving the afferent information and deemed threatening enough within that body's ecosystem, then the original representation of pain and limited movement was appropriate.

        With that said, I stand before you to say that I have worked on people via DNM who could not raise their arm beyond 30 degrees into abduction for all of 10 minutes only to have their arms go straight up to the sky. I sometimes feel it's similar to a gambling addiction.

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        • #49
          Originally posted by John W View Post
          The premise is demonstrably false, i.e. there are people with tears who have no symptoms at all. Therefore, the conclusion that someone will invariably need a surgical repair of their tear is based on a false premise.
          For that person.

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          • #50
            If the action that treats the pain is surgery, then that is the proper intervention.
            Nathan, this is a post hoc ergo propter hoc argument. Other options for "proper intervention" (depending on how you define "proper") exist. The evidence for the non-linearity between pain and tissue damage has become established science.

            If fixing tissue is the thing that stops the pain, then fix the tissue.
            There's a tautology here. You're making a prior assumption that the damaged tissue caused the pain. Tissue damage does not cause pain; nothing causes pain because pain is not caused. It's an emergent phenomenon created within a particular context by the organism's threat salience system.
            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

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            • #51
              Please remember that at the center of the neuromatrix is a mystery.
              Barrett L. Dorko

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              • #52
                I guess I am speaking from the perspective of therapy that I can provide. The motivating force behind my posting these questions and arguments is that I fail people sometimes. SS has giving me a new lease on how I see things but I am left with that crappy feeling that at the end of all the new perspective given by neuro/pain/brain science, the ACT of getting surgery was the thing that helped for person X.
                I understand the tautologies now and the propter hocs. I am not attempting to equate tissue damage with pain. The issue is with the PREMISE of therapy. Ok so meat masher hasn't wrapped his head around the latest science. He still gets results. Same with the surgeon. Same with us skin stretchers. We however have an added weapon of helping a person to not catastrophize. The pain isn't caused by the tissue, we say. Ya, but it really hurts, they say. Session 3,4,5...Screw it! I'm going for surgery. Pain GONE. How do you get the average bear to walk back into your clinic and believe that it wasn't the tissue? (Not that that is a fight that we'd need to have, I am just making a point)

                nathan

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                • #53
                  It's a testament to our being human - this tendency to improve just because another human is paying attention, even if they're totally wrong in their reasoning, thinking and most of their method. They'll say, "Hey, it works, so just shut up. I do what works." (A poor woman in Toronto said that to me to start the conversation. Poor woman.)

                  But our patients deserve for us read, change in response to scientific understanding AND treat them respectfully.
                  Barrett L. Dorko

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                  • #54
                    Originally posted by Barrett Dorko View Post
                    (A poor woman in Toronto said that to me to start the conversation. Poor woman.)


                    I remember her..
                    Poor woman indeed, sandwiched between us the way she was.
                    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

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                    • #55
                      It sounds like that is the final word then.

                      Let me ask another question then: though the less wrong answer points to a different mechanism/process behind the emergence of pain than the broken meat=pain POV, how have you and your clients benefited from your treatment premise? Especially when they don't improve under your care?

                      I lecture weekly on these things that I have learned here and through the top authors on the subject. While I can speak about the new perspectives on pain, what it is not, what to look out for in your choices in therapies and self help modalities like stretching, at the end of the lecture they still have that chronic pain. I often am able to book private sessions with interested lecture attendees as they are interested in the DNM model of treatment. Some don't get better. Is my answer to them, "oh well, we tried! But remember, your tissue cannot cause pain "?

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                      • #56
                        When did you decide that you should be able to help everybody?

                        Get over it.
                        Barrett L. Dorko

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                        • #57
                          I don't need to help everyone Barrett. I am trying to see how actually important all the ranting from the pedestal is when it comes to actually helping someone feel better.

                          You posed the question about premise. Great, you have a premise more aligned with the recent science. I am asking the question, how has your science aligned premise increased your pain reduction rates?

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                          • #58
                            I don't know.
                            Barrett L. Dorko

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                            • #59
                              The chronic pain patients generally have a better understanding about their pain, more control over their lives (the pain is no longer driving every daily decision) and many do feel less pain. But MOST feel better.
                              And that is much more that the usual dependence on manual therapy, nerve blocks, epidurals and constant medication teweaking that they were stuck with.
                              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

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                              • #60
                                Originally posted by zendogg View Post
                                I don't need to help everyone Barrett. I am trying to see how actually important all the ranting from the pedestal is when it comes to actually helping someone feel better.

                                You posed the question about premise. Great, you have a premise more aligned with the recent science. I am asking the question, how has your science aligned premise increased your pain reduction rates?
                                Well, it's helped me a LOT. For a chronic pain patient, instead of saying: "Well let's try some stretching and strengthening, maybe that will help?" now I actually have a clue, and an approach that not only aligns with the science but has a much better chance of helping. Patients not only feel better but have better understanding of how to help themselves in the long run.

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