Another reason therapists don't know

[John W]

Nathan says:

Outcomes studies show many effective techniques.

They do? Can you site the studies that you're talking about? Effect sizes for manual therapy interventions in patients with persistent pain are unimpressive. Perhaps we have lost sight of that rather sobering fact during this long and detailed discussion. We shouldn't.

[zendogg]

sorry, poorly put by me. I should not have said outcome studies.

Do people improve their back pain when doing Pilates? yes
Do people feel better after and adjustment? yes
Do people feel better after DNM? yes
Do people feel less pain after dry needling? yes

Not always but yes, sometimes. The mesodrmal explanations are not plausible. But change occurred (sometimes). Anyway, my point in that statement was that many manual therapy and exercise interventions can be ectodermalized in terms of premise.

[Diane]

sorry, poorly put by me. I should not have said outcome studies.

Do people improve their back pain when doing Pilates? yes
Do people feel better after and adjustment? yes
Do people feel better after DNM? yes
Do people feel less pain after dry needling? yes

Not always but yes, sometimes. The mesodrmal explanations are not plausible. But change occurred (sometimes). Anyway, my point in that statement was that many manual therapy and exercise interventions can be ectodermalized in terms of premise.

Well, they could, but their proprietors don't want to, for some strange reason..

[nari]

Something which has not been mentioned -yet - in this still growing thread is the placebo response, which probably does more than anything else to move a patient of any description towards resolution of pain, with or without the therapist's intervention.

Some patients expect to be handled and pushed and pulled and when that happens, they are satisfied.

Others are afraid of therapist control and respond to hands off plus lots of education.

Yet others are somewhere in the middle arena.

Our job is to sort out what is the best approach for the patient. That should be the first consideration but it is the hardest decision to make. No wonder we get defensive about our skills.

Nari

[PatrickL]

Well, they could, but their proprietors don't want to, for some strange reason..

Oh boy, this kind of response pops up again. Does this really need to be pointed out to Nathan? Is it that hard to suspend lamenting about the sad state of the culture surrounding treatment of injury and pain? Can you see how continued references to how misguided/Poorly informed/willfully ignorant the therapy culture is actually derails threads like this?

Nathan is clearly pointing to what the therapy world might look like if everyone worked from a defensible premise. I think he is suggesting that in such a world, there would exist scope for the defensible use of a range of coercive, non coercive touch and active/choreographed movement, based on the therapist's weighing up of his/her and the patient's preferences. What is actually happening in the world today is irrelevant to that point.

P.s just because a PT considers the patients preferences in deciding upon an approach to use, it doesn't necessarily follow that he/she appeases the preference.

[Diane]

Oh boy, this kind of response pops up again. Does this really need to be pointed out to Nathan? Is it that hard to suspend lamenting about the sad state of the culture surrounding treatment of injury and pain? Can you see how continued references to how misguided/Poorly informed/willfully ignorant the therapy culture is actually derails threads like this?

Nathan is clearly pointing to what the therapy world might look like if everyone worked from a defensible premise. I think he is suggesting that in such a world, there would exist scope for the defensible use of a range of coercive, non coercive touch and active/choreographed movement, based on the therapist's weighing up of his/her and the patient's preferences. What is actually happening in the world today is irrelevant to that point.

P.s just because a PT considers the patients preferences in deciding upon an approach to use, it doesn't necessarily follow that he/she appeases the preference.

Yes, it's that hard to stop lamenting about the sad state of the culture surrounding treatment of injury and pain.

[Evanthis Raftopoulos]

I still haven't heard a better word than ideomotion for movement that is unplanned.

Hi Barrett, but ideomotion is not synonymous to unplanned movement. While Carpetner’s ideomotion can be considered as unplanned movement, most unplanned movement is not ideomotion. Carpenter constructed the term/concept of ideomotion in an effort of logically explaining (and thus predicting)behavior of dowsers. Similarly and if you wish, you can construct a new term to describe unplanned movement that you think explains some specific phenomenon. The obvious question to ask is what is the phenomenon that you are trying to explain, and why is unplanned movement a rational and scientifically sound explanation for it?

[John W]

Nathan is clearly pointing to what the therapy world might look like if everyone worked from a defensible premise.

Pilates? A defensible premise is possible.

Adjustment? Not by that name, of course. It doesn't get much more coercive than thrust, however. There's no guiding or exploring of movement with the patient here at all.

Dry needling? I think the search for a premise to support this one has been exhaustive both here and in other forums. It remains an unanswered question as far as I know.

[gilbert]

Hi Barrett, but ideomotion is not synonymous to unplanned movement. While Carpetner’s ideomotion can be considered as unplanned movement, most unplanned movement is not ideomotion. Carpenter constructed the term/concept of ideomotion in an effort of logically explaining (and thus predicting)behavior of dowsers. Similarly and if you wish, you can construct a new term to describe unplanned movement that you think explains some specific phenomenon. The obvious question to ask is what is the phenomenon that you are trying to explain, and why is unplanned movement a rational and scientifically sound explanation for it?

You have to be kidding Evan. Barrett has been writing for DECADES about "the phenomenon that you are trying to explain" describing, explaining, relating it to known basic science, etc. And if he wants to use the term ideomotion for it, that works fine for me. As far as I know Carpenter is not around anymore, and language evolves.

[Evanthis Raftopoulos]

Hi Gilbert, in your understanding, what is the specific phenomenon that unplanned movement explains?

[Evanthis Raftopoulos]

For example, is it pain resolution? Is it movement towards it?

[Evanthis Raftopoulos]

Hi Blaise, I share your concerns about the operator-interactor dichotomy. IMO the context of 'therapy' pre determines our role as both operators and interactors, like it pre determines the role of the sufferer.

[PatrickL]

Yes, it's that hard to stop lamenting about the sad state of the culture surrounding treatment of injury and pain

Ongoing lamenting of the current state of affairs predisposes one to a polarized view of what is defensible practice and what is not i.e. light/non coercive touch is defensible, any other touch is not is not.

The science just isn't that conclusive. And I think to present such a polarized view (which is implicit in the continuous resistance to the argument that there is no way to measure the relative "defensibility" of non-coercive touch vs coercive touch) is to reveal a lack of impartiality in weighing up the available evidence.

In short, it's not science based reasoning to conclude that non-coercive touch is more defensible than coercive touch... it's biased, emotional reasoning.

I wonder what it would take to make you guys satisfied? In an ideal world, there's no scope for the use of coercive manual therapy? Does the science suggests this? Should the whole profession be only practicing DNM and SC? Are the wilfully ignorant PTs getting off too easy if they simply learn to adopt a defensible narrative and adjust their preferred methods accordingly? Should they be made to practice only DNM and SC as a form of enforced "get square" cognitive discomfort? Should they be forced to only practice DNM and SC to disconnect them entirely from the confirmation bias and post hoc errors of their previously willfully ignorant ways?

[zendogg]

Adjustment? Not by that name, of course. It doesn't get much more coercive than thrust, however. There's no guiding or exploring of movement with the patient here at all.

This is interesting. Neither is there for DNM.

[PatrickL]

Hi Gilbert, in your understanding, what is the specific phenomenon that unplanned movement explains?

i think the proposition is that the unplanned movement reflects movement away from a culturally imposed mechanical deformation of nervous tissue.

i think it is a defensible idea. Although for a given presentation of pain, i think that blaming the culture in one sweeping term is not particularly useful. i think one can dig down into the history of the case, and probably find more obvious/specific drivers of the defensive motor output that can be pointed to, thus saving the need to embark upon broad social commentary about the oppressive and lamentable nature of our culture. I don't think patients pay money to hear such unsolicited philosophizing, nor do i think its in our scope of practice to link such broad issues to the patient's pain in such a causal manner.

i dont know if ideomotion is the right word for the unplanned movement, based on what evan has been writing.