Another reason therapists don't know

[Barrett Dorko]

Josh,

Good to see you back here.

If your point is that ideomotion has been more fully defined than Carpenter offered I would say that's true. He seemed to stop at its tendency to express us. I attribute his tendency toward this verbal parsimony to the Victorian Era around him (see Pride and Prejudice for more, though I know it was published a few years earlier). Anyway, I think it's more than that, and I've written a great deal about the connection between creative acts and pain relief.

Elaine Scarry's extensive work on this comes to mind and I spoke and wrote of it specifically here.

I know instinct has a dictionary definition as well, but I wrote:

There are instincts we'd be better off expressing and instincts we'd be better off suppressing. Sometimes the culture encourages both of these things appropriately and sometimes not. Times change, people change, circumstances change and then they all change again.

Vigilance by our cortex (thoughtfulness) is the best we can do, and that doesn't work all that well.

in Whence instinct (a seven parter) in 2011 and questioned the entire concept.

We would like a definition; a single description.

I don't think we're going to get one.

[John W]

Patrick said:

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.

Patrick, do you have an example of a "more obvious/specific driver of defensive motor output" in a persistent, non-pathological pain experience?

And then Evan says:

Movement behavior is context sensitive. Culture is part of the context but not everything. It may not be wise to generalize 'culture' as the dominant influence variable to all movement behaviors. Moreover, one could argue that culture enhances and not suppresses movement in many cases.

I think this is a straw man. I've never heard anyone even suggest that culture is the dominant influence over all movement behaviors. The argument has always been that culture has a strong influence on movement behaviors, and often, in our Western cultures in particular, instinctive movement is suppressed. This does not always or necessarily lead to a pain experience.

There seems to be an effort here to assign a causal relationship between cultural suppression of instinctual movement and pain. I've never heard Barrett make that claim. In fact, he has consistently argued against trying to draw linear relationships between the various inputs and the pain experience.

[Barrett Dorko]

Yes, sweeping statements and any use of the word "causal" is exceedingly rare coming from me.

I do say, "All pain is neurogenic" and, as far as I know, that remains acceptable.

[Evanthis Raftopoulos]

I think this is a straw man. I've never heard anyone even suggest that culture is the dominant influence over all movement behaviors.

The argument has always been that culture has a strong influence on movement behaviors,

My bad if it’s indeed a straw man John, perhaps I should have not said ‘dominant’ as it is not synonymous to 'strong'. So I'm assuming now that it has not been implied that cultural related reasons play dominant role in pain manifestation and behaviors. Nevertheless, culture can enhance, suppress, modify movement etc. The % contributions of cultural variables to the pain experience seems to be unknowable.

[Barrett Dorko]

I would certainly agree that it's unknowable. I've said here and I always say to my classes that the culture offers us permission to behave in ways that many people see in different ways.

We bring our own stuff with us, and it changes. What changes not at all (or with such slowness and drama the Nobel Committee gets involved) are the laws of physics.

The culture is to us like water to a fish.

[nari]

What changes not at all (or with such slowness and drama the Nobel Committee gets involved) are the laws of physics.

True - although there are mutterings from folk like Laurence Krauss and other cosmologists that we just might have figured the certainty and steadfastness of the laws of physics may not be a certainty.....
Basically nothing is certain and set in concrete anymore! Especially opinions and beliefs.

Nari

[PatrickL]

Patrick, I'm sorry I seem to have skipped or conveniently forgotten your premise. Isn't there sufficient evidence to expand upon it without diving into what you call "supposition"?

No, I don't think there is. That's been my point all along

[Barrett Dorko]

Patrick,

Well, how far along toward E. O. Wilson's "obvious" would you say you are?

Anybody else?

[Mark Hollis]

Moreover, one could argue that culture enhances and not suppresses movement in many cases.

I've always wondered why people didn't breakdance/robot dance in the 18th-19th century, in terms of artistic expression so far the 20th-21st century rocks!

So I'm assuming now that it has not been implied that cultural related reasons play dominant role in pain manifestation and behaviors. Nevertheless, culture can enhance, suppress, modify movement etc. The % contributions of cultural variables to the pain experience seems to be unknowable.

Evanthis,

I can't see how the % could ever be determined aside from possibly comparing one culture (which how do we define that ... geographically? ideological? generational/) with some tribe who has little or limited contact with the wider world. With the advent of the internet and communications (and to a certain degree capitalism) culture is becoming more homogenous in some aspects.

It may only ever be a speculatable concept that lays outside the realms of the scientific process.

Doesn't make it less true, just less testable (and thus I guess more debatable)

[PatrickL]

I agree with you that "passive" handling can be explorational and novel (although I would exclude thrust/HVLA); however, it comes at a risk of creating exteroceptive nociception and it may promote passive coping strategies. I agree that the explanatory narrative that is provided along with the intervention can ameliorate the chance of the latter, but there's no current clinical tool of which I'm aware that can measure whether your "appropriate education" has been learned. The former is at a level of unpredictability that I am usually not comfortable with.

I have thought a lot about passive coping strategies and locus of control. I just don't see that a coercive touch = higher risk than non coercive touch. As I said up thread, mfr and cst both utilize non coercive touch... I don't think the narrative ameliorates a risk inherent to the manner of touch, I think the narrative accounts for the whole risk. As for causing nociception, I agree that a heavier touch is more likely to create nociception... I just don't think that we can say, as a general rule, non coercive touch will not create nociception, while coercive touch will.

I still fail to understand how you can argue against the use of coercive touch, while admitting to utilize said touch. You even stated in a thread a couple months back that the occasional judicious use of a hvla was acceptable. How does that make sense? Does your effort to "minimally" use coercive touch get you off the hook? You said that the risk of causing nociception is so unpredictable that you're "usually" too uncomfortable to utilize coercive methods? So on occasions you are comfortable? Or is it the case that using a coercive method is only acceptable after a certain amount of internal cognitive wrestling with one's self? How long should one wrestle with the dilemma of utilizing coercive touch before going ahead and utizing it anyway? Does that make the decision anymore defensible?

[PatrickL]

Patrick,

Well, how far along toward E. O. Wilson's "obvious" would you say you are?

Anybody else?

I don't know who Wilson is so I can't comment. What's with the cryptic question? Is Wilson's work compulsory reading for this thread? Isn't it up to you to explain how Wilson's work fits in this thread? Or do I have to go away and read his book before answering your question?

Before we shoot off on tangents about what "obvious" means, my point is that it seems to me that you hold a view that a non coercive touch is "obviously" more defensible than a coercive touch. I simply disagree and argue that none of us know which is more likely, as part of the context of a clinical encounter between PT and patient to bring about corrective movement.

So it boils down to which is the most risk averse approach (coercive vs non coercive). As I just stated in my previous post, I think that risk lies in the narrative, not the touch. A defensible narrative precludes the provision of "threatening" physical input, which takes care of the risk of causing nociception.

[zendogg]

Patrick, you have made what I see as an extremely clear point. I have yet to see clear arguments against it. There have been tangential discussions but no one has diffinitively taken it on and said "no you should not use coercive touch because..." This makes this thread frustrating. I would very much like to hear a departure from the defense of the techniques I THINK most of us have tried and successfully helped folks with like DNM and SC and hear some stances on your points.

Diane, I have taken your course. Let me be clear- I have never been more successful in decreasing pain and improving ROM than with the combined usage of DNM and TNE. However, I recognize through what I have read here written by yourself and others that much if not ALL the magic is in helping a brain feel safe enough to stop the fight or flight stranglehold it has on the system. Therefore, and with the complete understanding that creating more nociception noise is a bad idea, I feel fine employing suggestive, passive movement, and exercise recommendations to help patients recover a sense of possibility.

John,

This is interesting. Neither is there for DNM.
Nathan,
I was referring to Patrick's suggestion that passively moving a patient is a form of movement guiding aimed at exploring novel movement, which I don't disagree with. Obviously, when you perform a thrust technique any guiding and exploring ends at the moment you apply the movement over which they have no control. Isn't that the definition of a high, velocity thrust?

If you think that DNM does not include some guiding and exploring of novel movement, then I don't think you understand fully the rationale and physiological underpinnings of this technique.

Unless you have a clear point to make as to what I missed in class, I feel confident that I got it. I do not claim to be able to stop someone's pain with coercive movemt and the like. I do however use it to help a person realize what may have become inappropriately verboten. As for HVLA, I see zero difference IN THE MOMENT between that and DNM. it's no less operator in the hands of an ectodermally disposed therapist.

Patrick has made a similar argument in the past that I feel was brushed aside for the sake of bias and disillusionment with the state of affairs in PT today. He argued against the notion that deeper pressure, something clearly used by some of those who hold very strongly to their argument against coercive techniques, does not provide therapeutically useful to the brain, or that the info is superceded and therefore negated by faster traveling dermoneuro info. I think it is the same discussion we are having here in different clothes. I cannot understand the resistance and unwillingness to broaden the perspective of our practice and use what is useable (or conclusively blow it out of the water. As of yet I've not seen this done.)
Nathan

[PatrickL]

Patrick, you have made what I see as an extremely clear point. I have yet to see clear arguments against it. There have been tangential discussions but no one has diffinitively taken it on and said "no you should not use coercive touch because..."

well diane did respond with

because. just because

i guess that is pretty clear

[PatrickL]

I cannot understand the resistance and unwillingness to broaden the perspective of our practice and use what is useable

For now, I've concluded that john, diane and barrett assume that anyone who uses coercive touch either hasn't read enough of, or has misinterpreted the relevant science. Given that both diane and john utilize coercive touch, this is a little ironic.

[nari]

Cognitive dissonance on both sides or just unilateral, (doesn't matter which) is more of a turn-away than the issue of tone, which seems very significant to some and irrelevant to others. A pity...

Nari