Another reason therapists don't know

[PatrickL]

It's just that it would be so d^&* easy for you to try ideomotion yourself, experience what it feels like, describe it, and then go on arguing about it if you like....

What's the cost of you spending 5 minutes of your time on an effortless activity?

i dont understand why evan is being asked to "experience" ideomotion before he continues to ask questions about its role in resolution of pain.

Patrick says:

Quote:
The degree to which a patients pain results from the culture's suppressive effect on corrective movement is unknowable.
That's not quite there. The culture suppresses movement, it doesn't cause pain.

True. That was poorly written by me. Lets try... the degree to which a patients brains threat processing is influenced by the culture is unknowable.

If motion isn't inherent to life; if it isn't present to enhance sufficient blood flow, why has it been studied so carefully, why are there so many books on its meaning and its use? Why do we hold the "badly behaved" still? Why do we punish others first and foremost by restricting their motion?

Are these unfair questions? Is it now up to us to demonstrate once again that corrective movement is inherent to life?

Barrett, my point about your premise was that it is ambiguously stated and that it is at odds with your other central idea- that being that the culture suppresses movement, and therefore self correction. You're premise is open to being interpreted as "we are self corrective beings, apart from those times when we're not".

I take the phrase "we are self-corrective" to mean that this is an inherent property of being human- and that's all it means. Asserting it doesn't preclude the possibility that this inherent, homeostatic (thank you tallpaul) mechanism cannot be interrupted or suppressed either consciously or subconsciously.

It is ambiguous enough to be interpreted as if that possibility has been precluded. If it were my premise, i'd want as little ambiguity as possible.

My point is that just because the influence of the culture is difficult to tease out (and is likely highly individually variable based on genetic/epi-genetic factors and rearing) does not mean that its influence is being over-stated. I think the cross-cultural evidence suggests that it is a very important contributor to the epidemic of persistent pain problems in the West.

i agree. To tie this back to my other posts, I dont contend that barrett's ideas are wrong or indefensible, i have simply made the case (post #432) that the method born from these ideas (or other similarly defensible ideas) need not involve light/non coercive touch.

[PatrickL]

Hi Patrick,

I would be very interested in hearing a bit more re your experience....

when you said " non volitionally" what you meant??

Since it was a strange feeling to you, did you get the characteristics of "correction" after that??

Did anyone try simple contact on you on that day? If yes, what the response you got? What do you think of the role of Barrett himself eliciting your motion??

non volitionally = i didnt intend to rotate my torso to the left but it was happening as i observed it, like a spectator or something. The movement was unexpected so i guess that fits as "surprising". it was also effortless. I didnt feel any warmth or softening.

Yes, others carried out SC on me that day... i cant remember who it was... but i didnt get any of the same movement going. also, on another occasion when barrett handled me while i was lying on the bed, i remember feeling like i was following where i thought i was supposed to move... which was very different to the non volitional movement that occurred in standing.

I dont write any of this in a critical sense... it is just what i remember feeling.

[Barrett Dorko]

Patrick,

I've said that self-correction was always present in the same way your spoken words might always be forming and are formed in your head. Whether or not you voice them is dependent upon many things. For similar reasons, the movement necessary to resolve the mechanical deformation may not emerge as would be necessary for prolonged or complete relief. This is rather tough to measure and speculation without treatment (which is just corrective, instinctive movement) might be large.

But if I held you finger twisted for ten years, wouldn't hurt for ten years? I know several things might contribute to that output of pain, but isn't the simplest way to treat it to just let it untwist? Might something aside from physical impediment retard the motion?

You're right, touching another within what I've described as a context including permission isn't necessary.

But it sure helps.

[PatrickL]

your spoken words might always be forming and are formed in your head. Whether or not you voice them is dependent upon many things. For similar reasons, the movement necessary to resolve the mechanical deformation may not emerge as would be necessary for prolonged or complete relief.

Well if there are "many things" that can limit the voicing of my words or the movement necessary to correct mechanical deformation, it stands to reason that whatever inherent self corrective mechanisms we possess, they are ineffective. Perhaps your premise could be "we are inherently self corrective, but we suck at it".

[PatrickL]

But if I held you finger twisted for ten years, wouldn't hurt for ten years? I know several things might contribute to that output of pain, but isn't the simplest way to treat it to just let it untwist? Might something aside from physical impediment retard the motion?

Thought experiment: lets take a group of those primitive tribal people john referred to who have

virtually non-existent incidence of persistent, non-pathological pain problems in more "primitive"

The logical conclusion to draw here is that these primitive folk, free from the inhibitory effects of western culture on movement probably wouldn't be walking around with any significant degree of mechanical deformation of nervous tissue. Why? because their culture doesnt suppress movement in a manner that leads to non pathological mechanical pain (as john pointed out).

So what happens if one provides a non threatening context and light touch to one of these folks? What does it mean if the person begins to move non-volitionally and report characteristics of correction? How would one interpret a lack of non volitional movement, and/or the absence of characteristics of correction

Do we now assume that the presence of non volitional movement and characteristics of correction means that the culture of these primitive people must be exerting its own suppression of instinctive movement (can you say confirmation bias)? would the absence of movement and characteristics of correction mean an absence of mechanical deformation of nervous tissue (confirmation bias again).

Or could we reasonably argue that the non volitional movement that occurs with light touch in this primitive "instinctive movement permitting" culture points away from a purported relationship between the non-volitional movement and the resolution of mechanical deformation of nervous tissue in our western (or any) culture?

Just putting it out there.

[Barrett Dorko]

Patrick,

I wouldn't disagree that many aspects of the culture, which is huge, can inhibit our movement toward correction. There are aspects that assist us though. Seeking freedom through creative acts seems mysterious enough, and, I guess, we would be at our best when encouraging and, perhaps, praising creative acts in others.

That doesn't sound much like traditional therapy, but I think that improvisational dance is needed for the abnormal neurodynamic and say so explicitly.

Training others is efficient, convenient, well-compensated and easy to document.

No wonder so many of us here are dead.

[Barrett Dorko]

Patrick,

In response to your last post, I find your reasoning interesting but difficult to imagine.

If "confirmation bias" has driven my method and observation I wouldn't know it. There is the matter of my reasoning though, and, unless something else comes along I find more compelling, I'll stay with it.

[Bas Asselbergs]

Patrick -

"we have a capacity for self correction"

Thanks. Appropriate modification.

[zendogg]

Patrick,

In response to your last post, I find your reasoning interesting but difficult to imagine.

If "confirmation bias" has driven my method and observation I wouldn't know it. There is the matter of my reasoning though, and, unless something else comes along I find more compelling, I'll stay with it.

Barrett, I find Patrick's question very interesting. Do you have anything to say directly about what he has asked?

Nathan

[PatrickL]

There is the matter of my reasoning though, and, unless something else comes along I find more compelling, I'll stay with it.

how do you reconcile the presence of non volitional movement during simple contact for a person with no complaint of pain (i.e. when you worked with me- i was totally pain free)?

do you presume that what is occurring is the resolution of mechanical deformation of nervous tissue that hasn't been processed as being sufficiently threatening to warrant a pain output?

[John W]

Anyone who has been following this thread either passively or actively should also take a look at this one- it's only 15 posts long. Oliver Sacks has much to tell us about therapy.

To answer Blaise regarding my reference to "hairsplitting"- maybe that's not the right term. It seems that many of the questions being asked in this discussion are the wrong ones, or at least the context seems very narrow and almost trivial with respect to this problem of pain that we face as clinicians. For instance, we are not going to figure out here the nature of consciousness. And I think we could spend weeks trying to decide the precise moment that passive motion becomes coercive and never reach a conclusion- probably because only the patient "knows" that

I think we need to widen our focus and consider the lived experience of the patient within the culture that the living occurs. We are provided a very narrowly focused view of human suffering and disease in our training. And I'm not just talking about the inaccurate and misleading focus on biomedical and biomechanical explanations for pain. I'm referring to the very minimal exposure to the science of culture (sociology) and the study of human development within the culture (anthropology). How can we possibly provide a foundation upon which a manual therapist can interact with another human and not discuss the comparative biology of touch among other mammals? How can we adequately prepare clinicians to treat a growing epidemic and fail to frame it in the sociological and anthropological terms that cause it to exist in the first place?

It's laughable, really, the training we receive. No, it's pathetic. We come out of school with these little inverted telescopes on our eyes. It's no wonder so many flounder around blankly bumping into walls while they strap ankle weights onto patients. It's perfectly understandable that the curious among us- starving it seems for some semblance of a rationale for placing our hands on patients- expend tremendous effort to differentiate subconscious from nonconscious, ideomotive from non-volitional, and passive from coercive. It makes perfect sense that there are those among us who want to understand what these distinctions are- and we should work to understand and define them better. But we shouldn't lose site of the fact that there are entire branches of legitimate science that are relevant to what we do to which we have almost no exposure much less a working understanding to inform our clinical decisions.

It took an Aspergian in Ohio who trained with Stan Paris in "classical" manual therapy and who currently works as a contrast therapist in nursing homes to get us to consider the possibility that some other class of movement (whatever the hell you want to call it) may have profound implications for the care that we provide. From a sociological and anthropological standpoint that fascinates me. Does it not you, too?

[John W]

Patrick,
I put the term "primitive" in quotes in order to convey a common understanding of tribal cultures in the developing world (another term that I'm not entirely comfortable with). I wouldn't use the term without the quotation marks because I'm not entirely convinced that their cultures are altogether more primitive than ours. In fact, in some ways they are more advanced (the fact that they lack persistent pain problems, by and large, being one such measure of that).

I have to admit that I chuckled to myself as I read your hypothetical scenario of providing a non-threatening context for one of these individuals. I'm thinking about the people, whom I lived amongst, who live under despotic tyranny and may have their few belongings confiscated by a local government or military official at any moment, have no concept of what constitutes a civil right, and live a subsistence lifestyle-not knowing for sure that there'll be meat in the pot tomorrow to feed themselves or their families. For one of these people the concept of pain and it's relationship to suffering is so at variance of what we in the West understand it to be that I can't even conceive of how a "non-threatening context" could be created for that person. I don't even think they know what life is like to not be under an immanent threat of either death or destitution.

Undoubtedly. there are examples of non-Westerners who don't live under these extreme conditions of depravity in the sense of basic human rights, but even these are people living a subsistence life where disease, tribal war, and nature itself imposes a daily threat to their next breath. I struggle to even conceive of what a therapeutic context for one of these people would be, as well.

[nickmPT]

That's practically a 'band of brothers'-level speech, John. Thanks for that.

Is simple contact better for acute pain or chronic pain? Joking aside, I think what is important to realize is that this style of treatment may or may not resonate with your patient at different points in your time together. I've had patients who appeared to respond really well to simple contact style and others who did not and required a more directed approach. No biggie, just flow like water with what your patient will give, injecting educational tidbits here and there via storytelling and metaphor and sometimes more hard science stuff.

What I found most important from Barrett's teaching was finding a way in with your patient, who happens to be just another human being trying to get by.

[nari]

Nicholas,

What I found most important from Barrett's teaching was finding a way in with your patient, who happens to be just another human being trying to get by.

Well said.

Nari

[PatrickL]

And I think we could spend weeks trying to decide the precise moment that passive motion becomes coercive and never reach a conclusion- probably because only the patient "knows" that

Man is this for real? I've gone to great lengths to explain why I think a non coercive touch is not necessarily more defensible than passive maneuvering because I think the defensibility lies in the reasoning used by the PT ie reasoning that takes the broader perspective john speaks of.

John, the thread has continued because you continue to argue for the superior defensibility of light touch over passive maneuvering.

And now you seem to be suggesting that we can't distinguish between coercive and non coercive movement anyway, and that it's not relevant in the broader scheme of things anyway.

I think that's been my point all along.