Another reason therapists don't know

[Barrett Dorko]

Evanthis says:

You (me) are still claiming a causal relationship between what you do and someone’s instinctive behaviors.

Why do you suppose I wrote Do Nothing?

If there's a better word than catalyze I'm ready to hear it. I can't help but affect the behavior, instinctive or not, of another with my presence. It's simply my responsibility to understand as much as I can.

Isn't it yours?

[PatrickL]

I said

I just don't see any reason to think that the upper limit of acceptable risk for loss of locus of control, or for causing nociception is breached when one starts to move a patient passively.

Barrett said

Where did anyone say that?

This is a head scratcher of a reply. My comment above has been my position all along. Are you now stating that no one has disagreed with it? Isn't it a disagreement with my position that forms the basis of the replies I've received? I mean c'mon, if yours and johns position is not that a non coercive is more defensible than coercive/passive, what on earth have we been arguing about? It must be the basis, because all I've claimed is that neither is necessarily more defensible than the other.

[Diane]

I guess you must be all for condone rape then, Patrick.

[John W]

Patrick,
I think you know what I meant because I restated the question in my response to Blaise. I'll just quote Bas since he asked essentially the same question several posts back- maybe you missed it- and he's more economical in his verbiage than me:

Patrick stated:
But I have pointed out that the locus of control is tied to the narrative, not the manner of touch.
Bas asked:
Patrick, what makes you come to this conclusion?

I think it's impossible for at least this aspect of the conversation to move forward without an explication of this position.

You offered this most recently:

I've argued, or attempted to argue, that I don't think there is necessarily a greater loss of locus of control if one chooses a coercive manner of handling over a non coercive manner. Isn't mfr and cst evidence enough? Perhaps you could re-read post 432, which was a direct response to one of your posts, which to date you haven't directly addressed. I think it best summarizes my position.

And so from post #423

i argue that caring, exploratory passive maneuvering of the patient does not impinge upon locus of control (particularly if treatment is supplemented with choreographed or ideomotoric home exercises), nor does it necessarily contradict HPSG theory or impede a non-conscious shift in motor output from protection to resolution. Nor does it mean that the role of skin mechanoreceptors in the overall interaction are being ignored. Again, i'm not arguing that such passive maneuvering is more defensible than light touch. I'm arguing that if it is the incorporating of the breadth and depth of relevant science that makes a given manual therapy approach defensible, then "defensible" manual therapy can include passive maneuvering of the patient.

I still don't see an argument here. I see an unsubstantiated opinion that "passive" movement has no impact on the patient's locus of control as long as it is preceded by an "appropriate narrative". We don't really know what "passive" means, so I'm putting that in quotes. And you haven't defined what constitutes an appropriate level or type of education, and more importantly how you know that the patient has attained it.

I'm not interested in apologies; I'm asking for support for your position and clear definitions of your terms, if they exist other than in your own mind.

[Barrett Dorko]

I've been told that many others have defended their stated premises many times here but I can't find them. Looks like I need some help.

It would be hard to imagine that there aren't degrees of defensibility and that Patrick is simply saying that mine, being stated, is NO MORE useful than another that hasn't ever been stated.

I remain confused regarding what we're talking about here.

[Evanthis Raftopoulos]

Evan, if you've no way to speculate about what might happen when someone you trust (a variable thing) sits quietly next to you, I'd suggest you consider Boyd's premise.

Hi Barrett, I appreciate the reference to other threads and writings, but at the same time I find it distracting from the original arguments presented here. Having said that, this is Boyd’s premise based on your reference

"science could not have begun without our persistent inclination and ability to think beyond the here and now."

I assume that you are trying to make a point that it’s OK to speculate. I have no problem with that, but I have a problem with presenting a speculation as a conclusion. As mentioned many times before, this is one of the biggest problems in medicine. Moreover and as I mentioned in post 441 :We can speculate all we want, but if that's all we are doing then we can't criticize other people in our profession for doing the same thing.

If there's a better word than catalyze I'm ready to hear it. I can't help but affect the behavior, instinctive or not, of another with my presence.

I accept ‘catalyze movement’, it’s more parsimonious. To claim that we affect someones instincts and in a meaningful way towards pain resolution is wishful thinking IMO.

It's simply my responsibility to understand as much as I can.
Isn't it yours?

Of course, there is no need to ask such a question to anyone who participates here.

Thanks for the discussion.

[Barrett Dorko]

Evanthis,

Boyd's contention is that we are bound to tell stories; all of them increasingly full of speculation. You call speculation a conclusion but I don't know when that line has been crossed. I'd also say that my references are on point and don't represent a distraction. They simply add weight to the evidence and don't violate the principle of all knowledge being provisional - something else I'm sure you know about - and don't equate in any fashion with "wishful thinking."

I fail to see how your phrase is "more parsimonious." Your opinion that the movement isn't corrective simply ignores the evidence against an absence of instinctual movement designed to preserve life.

If I'm right in assuming you've always understood as much as you can, what premise might you state? What method follows that?

One more thing: When another speculates outside the laws of physics I will certainly criticize that. I don't do it.

[Evanthis Raftopoulos]

So, Evanthis is (perhaps) getting to the heart of meanings. I think he may have been through his stance on “instinct”; if I’m not mistaken he has put forward that this is equally well explained by learned responses, and which he explains is not the same thing. Is this the insect you refer to?

Thank you for following my point on 'instincts' Blaise. I think it's easy for one in this discussion to feel that his/her comments are brushed off, especially if 1. one thinks that he/she presented a sound argument and 2. the person responding refuses to change his/her position but also does not directly address the premises of the argument or does not seem to provide with a sound counterargument (it does not mean that it does not exist). This becomes more obvious if we go back and count how many times the regulars that have been questioning concepts like SC and ideomotion had to repeat their arguments in order for the discussion to progress. I'm not sure if this happens intentionally or not so I try not to blame people or get upset about this. I'm thankful that people are still around.

[Evanthis Raftopoulos]

You call speculation a conclusion but I don't know when that line has been crossed.

I think that this line is being crossed inevitably when a whole concept is created and taught to others (Simple Contact) based on speculations.

They simply add weight to the evidence and don't violate the principle of all knowledge being provisional - something else I'm sure you know about - and don't equate in any fashion with "wishful thinking."

Wishful thinking refers to the thinking that we can affect instincts in a meaningful way towards pain resolution while a) there is no such evidence as far as I know and b) the premise is not even testable as far as I know.

I fail to see how your phrase is "more parsimonious."

It makes less assumptions by not making a distinction between instincts and non instincts.

Your opinion that the movement isn't corrective simply ignores the evidence against an absence of instinctual movement designed to preserve life.

What kind of evidence is that?

If I'm right in assuming you've always understood as much as you can, what premise might you state? What method follows that?

I hope this is not a tu quoque attempt. I'm always waiting for that, that’s partially why I wrote what I wrote in post 659 "I'm also not suggesting that my speculations/approach to treatment is 'less wrong' than yours. " Nevertherless, since you are asking me, in the context of manual therapy here are my thoughts from this thead (which you agreed with).
"Manual therapy (hands on passive, active assisted, or resisted movement) can be 'science-based' in the context of facilitating/encouraging movement when there is an identifiable lack of movement, not unlike active movement and exercise."

[Barrett Dorko]

Evanthis asks:

What kind of evidence is that?

Do you mean "what kind" or is there any? Wouldn't the latter be a rather large document? I assume it's good evidence as well. Luke? Diane?

Reducing perceived threat with movement doesn't require the thought that a predator is watching us, though that helps. I presume that a painful output would be sufficient, even something we think will grow in that direction, as we learn and express our instincts in the midst of a culture that would often prefer we didn't.

Therapy remains present so that people in pain can turn to someone who's supposed to know some of this stuff. At this, the profession has failed miserably.

I'm way past ""only my opinion" on that.

[Barrett Dorko]

Evanthis,

I'm not trying to get you to display anything with my question, "What is your premise and method?" You've just never stated it and in this forum it seems a perfectly appropriate question.

You're not dry needling people, are you?

[nari]

...when one starts to move a patient passively.

This statement has appeared many times in Patrick's post. I remain curious about what sort of passive movement is done and how. As I stated before, neurodynamics is passive movement as a demonstration for the patient to perform it actively as a HEP. Just an example.

So, Patrick, can you give one specific example (or more) of a passive movement done to a patient by yourself?

Nari

[Ken Jakalski]

Hi Barrett!

The old saw of symmetry is evoked wordlessly and, once again, someone is considered an "expert" because they do more.

Ken, is this seen in coaching much?

Yes. With the best of intentions, coaches will often find some "cue" or movement they believe will enhance some quality that they believe is "coachable."

For example, coaches believe that high speed running can be achieved by reducing braking action, and that one means to achieve this is by having the athletes "pull the ground back" via a pawing type action of the recovery leg.

It sounds good, looks good, and seems to make sense, but that action actually puts the hamstrings at a mechanical disadvantage.

It becomes an isolation drill intended to enhance movements that will not be the same during a high speed effort.

As Jay Edwards (What Science Says About Sprinting) notes: "Form is undoubtedly important. The question is just how important are corrections of minor deviations and is time justifiable in terms of improved speed of movement."

[Barrett Dorko]

Yes Nari,

I demonstrate repeatedly. YouTube has made what I do (don't do, actually) rather hard to hide. I think I've written about it too.

Why are so few of us willing to do that?

[PatrickL]

I guess you must be all for rape then, Patrick.

I'd love to hear how you got to that conclusion. Who here moderates the moderators?

Over the past few months, if you link Diane's comments together, she has described me as a fan of rape with a hoarding problem.

Is this appropriate or relevant to a science based discussion website for PTs?