Another reason therapists don't know

[PatrickL]

Quote:
To your question above, if a light manual contact is enough to encourage increased effortless movement and awareness of the movement, why would that not be the "preferable way of facilitating 'ideomotion'? (gilbert)

Yes, why not?
If a coerced/choreographed movement is done by the patient and/or the therapist, is the evidence of its usefulness shown to be better than eliciting ideomotion?

Nari, my contention is that given appropriate education and context setting, we have no reason to think that any one of three broad approaches being discussed here (active/consciously generated movement, passively applied movement or non coercive/gentle touch) is likely to be most effective at catalyzing a non conscious motor output change from protection toward resolution.

And as far as I know, we don't have any evidence comparing the usefulness of these three broad approaches for catalyzing this altered motor output. We don't even know if the altered motor output precedes or follows decreases in a pain experience (since it's likely cyclical).

The argument for non coercive touch is based on the assumption that lighter touch ensures that greater locus of control stays with the patient. I disagree with this assumption because I think the explanatory narrative is a much more powerful dictator of where the locus of control lies.

So long as a PT is providing a reasonable explanatory narrative, and he/she doesn't provide treatment that is painful or that could reasonably be assumed to be causing nociception, I think there is a defensible scope for PTs to consider his/her own preferences and the patient's preferences in deciding whether to proceed with non coercive touch, passive movement or active/conscious movement, or some combination of all three.

I get pretty tired of the implicit view that gentle, non coercive touch is the most defensible method for treating people with persistent pain. I don't see that it is. This doesn't mean I think coercive or choreographed methods are more defensible. It means that we don't know which is best for which patient, and there exists defensible scope for the use of noncoercive, passive and / or active/conscious movement interventions

[Diane]

Yes, you need to connect with both the human brain and the critter brain.

[Barrett Dorko]

Patrick,

Superior evidence of effectiveness has NEVER been my contention, but I've made the case for Simple Contact and ideomotion and when I asked for the premise behind methods used otherwise I did not get an answer.

Is there a defensible one?

[gilbert]

Patrick - I totally agree
I think all 3 of the broad approaches you mention (active motion, passive motion, gentle touch) are defensible and I personally use all three in combination for treating persistent pain. As you said, it is important that the context is non-threatening, appropriate education is given, and the treatment does not provoke pain.

[advantage1]

Nari, my contention is that given appropriate education and context setting, we have no reason to think that any one of three broad approaches being discussed here (active/consciously generated movement, passively applied movement or non coercive/gentle touch) is likely to be most effective at catalyzing a non conscious motor output change from protection toward resolution.

Yes and all three are forms of sensory signalling input to the body self neuromatrix which does not discriminate between the three.

[PatrickL]

Patrick,

Superior evidence of effectiveness has NEVER been my contention, but I've made the case for Simple Contact and ideomotion and when I asked for the premise behind methods used otherwise I did not get an answer.

Is there a defensible one?

From my post up thread

The premise is that the patient is stuck in protection and needs some help to get to resolution. The method is the provision of novel and non threatening input. I think that's the best we can state in support of any manual therapy (non coercive, passive or active).

[PatrickL]

Thank you for this Patrick. This would require a diagnosis of "stuck in protection". Is there a way to successfully identify those who fit this model/diagnosis, or are we generally assuming that experiencing msk manifested pain=stuck in protection?

I'm ok with assuming the patient is "stuck in protection" if symptoms have outlasted the typical timeline for resolution of a given injury. For scenarios where the onset of symptoms is not related to an obvious precipitating event, I think we can argue that "protection mechanisms" (pain/defensive motor output) have inappropriately emerged.

[Evanthis Raftopoulos]

"Evan, ideomotion IS active movement. Those modalities you listed are not. DNM by being a gentle hands-on approach can often facilitate ideomotion (in my limited experience). "

Hi Gilbert, on the one hand you are implying that active movement is necessary as a form of treatment in order to facilitate ideomotion, but on the other hand you suggest that DNM can facilitate ideomotion. If DNM can facilitate ideomotion, then why not any somatosensory input including needling or any form of massage or manual treatment?

I’m going back to the definitions again, ideomotion is small movement that we are not aware of thought to be generated by expectation/idea/belief. Two major issues that it’s difficult for me to ignore 1. I have yet to see a good argument defending why this form of movement is therapeutic /effective or more therapeutic/effective than any other form of movement that the patient is already expressing prior seeking any help 2. how do we differentiate ideomotion from ANY movement that is not in our focal awareness for the purpose of assessment and treatment?
The argument I hear seems to be.
A.you are in pain
B. when you are in pain your ideomotion is suppressed,
C. With the help of my hands and my instructions you will find your ideomotion easier,
D. if your pain reduces, it’s because of the expression of this particular movement ( ideomotion)

Is that right or I'm I misinterpreting things here?

"From what you write I wonder if you would find it helpful to elicit some more noticeable non-volitional movement in yourself to see what it feels like. "

How do I elicit non-volitional movement? This sounds like an oxymoron to me.



"To your question above, if a light manual contact is enough to encourage increased effortless movement and awareness of the movement, why would that not be the "preferable way of facilitating 'ideomotion' "?"

How can you know that hands off is not already sufficient for generating the same effects in the context of pain resolution?it's more reasonable to me to assume that there is no difference in outcomes unless we have evidence suggesting otherwise. Thank you for the discussion.


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[Evanthis Raftopoulos]

"Evanthis asks:

Quote:
Why is contact necessary?
No one says it is, but haven't we had several threads here about the power of expectation?

Hasn't it been anyone's experience that our own self-awareness is enhanced with touch?"

Using the same argument in the context of ideomotion, one could argue that heavier manual pressure or manipulation maximizes self awareness , expectation, and thus ideomotion.



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[nari]

I still think, rightly or wrongly, that SC/ideomotion is thought by quite a few here that it is elicited in isolation with no education or other options. It is one of the most interactive of Rx options. I don't know where the idea came from but it is wrong. It's not just one out of three options.

Is "passive movement" being seen as synonymous with neurodynamics?

Evan,

How do I elicit non-volitional movement? This sounds like an oxymoron to me.

If you do a search on the site you should find threads (possibly quite old threads) explaining ideomotion. In short, you are giving yourself permission for non-volitional movement to occur. No oxymoron.


Nari

[PatrickL]

I still think, rightly or wrongly, that SC/ideomotion is thought by quite a few here that it is elicited in isolation with no education or other options.

that is not my read on it, nari. For starters, i dont think SC and ideomotion are the same thing so i don think we can bundle them as "SC/ideomotion".

What I have suggested is that if a shift in motor output from protection towards resolution is described as ideomotoric (sidebar: i dont see why the protective motor output itself is not also described as ideomotoric)... light non-coercive touch is not necessarily the most defensible method for catalyzing such ideomotion.

It is one of the most interactive of Rx options. I don't know where the idea came from but it is wrong. It's not just one out of three options.

the three broad approaches i've referred to are

1. light/non-coercive touch (not necessarily simple contact)
2. passively applied movement
3. active/conscious movements by the patients

I've argued that given equal education and context setting, any approach is as defensible as the other.

Is "passive movement" being seen as synonymous with neurodynamics?

within the context of thus question, i dont know what you mean by neurodynamics, sorry.

[nari]

OK, I should have said ideomotion (as touch is not needed for ideomotion).
Why is passive movement of value? Neurodynamics is taught passively - that's what I meant.
Anyway I'm a solitary voice on this topic, so I will back off.

Nari

[weni888]

I still think, rightly or wrongly, that SC/ideomotion is thought by quite a few here that it is elicited in isolation with no education or other options. It is one of the most interactive of Rx options. I don't know where the idea came from but it is wrong. It's not just one out of three options.
Nari

Hi Nari, thank you for honestly saying this. Having success with any claimed approach is not only with that technique. Lots of factors interact intimately affect patients' pain experience.

I would agree with "that is not my read on it" from Partick. Maybe Barrett has not explicitly explained how he actually goes through it.

Regards,

Weni

[Barrett Dorko]

Weni says:

Maybe Barrett has not explicitly explained how he actually goes through it.

What about all that stuff about my tie?

How long after I start speaking to a class do I wait before demonstrating on a patient?

I need someone from the class in Hamilton to estimate this.

[Bas Asselbergs]

Did not check the elapsed time, but it was before our first break, shortly after Mary had started to ice her LEFT knee first (inside joke). So about an hour?