Another reason therapists don't know

[Barrett Dorko]

Ryan,

Finally.

In my teaching these days I say that Simple Contact and ideomotion occupy a niche within the pantheon of manual care and movement therapy we might offer.

Without question that's a niche that might expand in size depending upon our understanding and experience, but they by no means must be employed by any therapist willing to provide a premise they can defend and a method that they might employ.

I have always emphasized both the simplicity of application and the expanding/contracting complexity of the problem they seek to alter as part of common practice.

I am very glad that someone can see this and bring this to the attention of manual care and movement providers who assume I'm saying something more.

[John W]

advantage,
I can't believe I've never heard that analogy in pattern-seeking with astrology. That's a good teaching tool. :thumbs_up

[Josh]

Ideomotion, as I understand it, is implicitly produced. Therapies attempting to free ideomotion from implicitly held cultural constraints similarly uses the explicit (giving permission, education, social touch, etc.) to affect the implicit. Like psychotherapy this is a very imprecise and complex process.

That's what I think....very imprecise and complex. I was told numerous times that this was the simplest least convoluted approach/explanation. That's been my point of contention. Using Ideomotion and simple contact to treat mechanical pain, relies on many things that can not be tested, known, falsified, validated, etc. So it serves as a great debate because there is no right or wrong.

Using education and exercise, choreographed movement, neurodynamics, etc also uses the explicit to treat the implicit, does it not?

Is it not an assumption that our culture suppresses motion in a patient with mechanical pain treated with ideomotion? Is it not an assumption that ideomotion is responsible for reducing mechanical pain (especially if its the kind not visible)? Is it less convoluted to use the GMI in place of SC/ideomotion because couldn't SC/ideomotion theoretically trigger the painful neurotag?

[nari]

....because couldn't SC/ideomotion theoretically trigger the painful neurotag?

I'm lost for words. What else can I or anyone else say to this remark???

Nari

[gilbert]

That's what I think....very imprecise and complex. I was told numerous times that this was the simplest least convoluted approach/explanation. That's been my point of contention. Using Ideomotion and simple contact to treat mechanical pain, relies on many things that can not be tested, known, falsified, validated, etc. So it serves as a great debate because there is no right or wrong.

Using education and exercise, choreographed movement, neurodynamics, etc also uses the explicit to treat the implicit, does it not?

Is it not an assumption that our culture suppresses motion in a patient with mechanical pain treated with ideomotion? Is it not an assumption that ideomotion is responsible for reducing mechanical pain (especially if its the kind not visible)? Is it less convoluted to use the GMI in place of SC/ideomotion because couldn't SC/ideomotion theoretically trigger the painful neurotag?

Are you serious? How is promoting gentle active (non-volitional) movement for a patient in pain "complex" or "convoluted"?

It is extremely simple, founded on a solid scientific basis, very plausible, and something the patient can easily learn to continue to use on their own.

[Barrett Dorko]

It would seem that Josh imagines himself as one who controls, or would prefer to control, movement.

Josh, you never answered that question I had about "proper" movement toward shoulder elevation. Why not?

That whole thing about ballet was about the problems inherent to choreography.

[Bas Asselbergs]

Using Ideomotion and simple contact to treat mechanical pain, relies on many things that can not be tested, known, falsified, validated, etc.

(my bolds)
Josh, just to make this clear: SC and ideomotion are only PARTS of "treating" pain. whatever that really is.
What are those "things" that can not be tested, validated, known(!?) etc etc.?

Furthermore, this

very imprecise and complex

implies that what YOU are describing is more precise and less complex? You still have not shown the arguments to support that (or I may hacve missed that in this long thread - if so: sorry).

How convoluted or complex is the concept of having a patient move without direction? Allowing a natural corrective motion - visible or not - to reduce neural tension?
Remember, no-one claims SC or its related ideomotion is better than other methods/approaches - examine it for itself, especially its premise.

[gilbert]

What I said was, "founded on a solid scientific basis". In other words the idea of using gentle movement for people in pain does not rely on some "energy medicine" theory, ideas of meridians, or some strange application of quantum physics, as some other PT interventions do. It has a basis in modern neuroscience, and thus good prior plausibility.

I never said or implied "proven beyond doubt".

[Josh]

Josh, you never answered that question I had about "proper" movement toward shoulder elevation. Why not?

Proper elevation in my mind is one of outlined in many biomechanical texts, and the one we all know, elevation with prime movers followed by scapular rotators with a 2:1 ratio, not one with substitution patterns.

What are those "things" that can not be tested, validated, known(!?) etc etc.?

Did ideomotion occur? Was it coerced? Was it suppressed? What suppressed it? Was it responsible for decreased nociception, mechanical deformation?

Why does natural correction need a therapist? To me natural correction should occur without a therapist. Once a therapist is involved isn't it "coercive" in some small way?

Sorry for all the questions, this helps me mentally digest......I apologize

I guess I am a control freak, and I can't quite rely on our own natural instincts to work through a painful condition.

thanks for the discussion

[Barrett Dorko]

Blaise,

You're right, "solid" isn't going to get it. In fact, I'm not certain what that would mean anyway.

All I've ever said is that the idea is plausible, given what we know across several scientific disciplines. The premise seems pretty good, and since the method simply follows that, I think I'll stick with it. After all, there's very little about the nature of coercion I didn't once practice and teach.

[Barrett Dorko]

Josh,

I have the distinct impression that ideomotion is suppressed as a natural consequence of enculturation. We (the culture) know that infants just can't continue to behave that way, and that's how it begins.

It then becomes an important part of the culture to admire the further suppression of it. I think I've written a bit about that.

Josh:

Why does natural correction need a therapist? To me natural correction should occur without a therapist. Once a therapist is involved isn't it "coercive" in some small way?

I have always contended that it is the therapist's job to sort through the positive, negative, necessary and inevitable influences of the culture. Of course, without a doubt, coercion might be a word to describe all of this. When I say coercion I mean passive movement in a direction the therapist imagines is corrective.

[Bas Asselbergs]

Josh, yes, I agree that you may be suffering from control-freakism so common among us PTs .

Proper elevation in my mind is one of outlined in many biomechanical texts, and the one we all know, elevation with prime movers followed by scapular rotators with a 2:1 ratio, not one with substitution patterns.

Here we have the word "proper" again. What does that mean? Biomechanical texts are descriptors of human motion as if it is a machine - which supposedly functions the exact same way for each human! Most of what we know is derived from observational studies (whether with video or historically simply visual data collection), computer models (by nature mathematically derived) and by poor in vivo EMG studies. Why poor? A) surface EMG is inaccurate, B) needle EMG alters the neurophysiology locally and centrally and cannot be determined as representative of "normal" neuromotor behaviour.

This is the gold standard or "proper" movement. Don't you see the weakness in that model?

Where is the issue of variability between people? And in the same person, between different days and moods?
The amputee with completely different motion patterns, yet without pain? The polio patient without pain, yet with a lurching, fully asymmetrical and biomechanically "poor" gait motion?

One can NOT establish what a "normal" pattern is in the human before you. First of all: they have pain, so the patterns are likely screwed up. Second, we do not know what their non-painful patterns were, so we have nothing other than books to compare it to.

The motion patterns are what people's brains themselves make of them. Therefore, it may be logical to let that brain correct it.

[Bas Asselbergs]

BTW, that does not mean that we should physically DO something different - we should THINK differently about what we do, and explain it somewhat differently to our patients.

And Josh: ask yourself this question about the biomechanical approach:
Was it responsible for decreased nociception, mechanical deformation? Was it the "proper" movement that helped?
Those types of questions will always plague any method of treating humans - we can expect research to answer some of those questions (as is happening by studies like those from Miciak's and Fuentes').

[Barrett Dorko]

You're right Bas, and I'm certain that no less than Mel Siff demonstrated that our tendency to move in markedly different ways from one trial to the next had no deleterious effect on outcome or performance.

It's unlikely this man's name was ever mentioned to Josh or in the schools today despite the fact that his book was titled Supertraining and physical therapy has been led around by the strengthening community for decades (see this and two others in a three part Sunday series).

But Ken's here, and he's an expert on what Mel taught us. Maybe he can help.

[Diane]

We should not presume to make diagnoses based on palpation of biomechanics, according to Adam Meakins. His fabulous blogpost: Diagnostic Palpation, is it a skill, an art or an illusion?

Yes, the now famous dog butt image is pictured in here. It's very cute. You have to see it.

What I really liked about this blogpost was he took everyone out to the palpatory pareidolia cleaners, triggerpointers and spinal stiffness biomechanists and SI joint palpators alike. :thumbs_up