Another reason therapists don't know

[PatrickL]

It seems that this is the part of therapy for pain that is not comprehended and acknowledged because of an inherent need for the PT to direct and control whatever the patient does. Thanks for replying, though.

Wow that is a loaded comment nari. Not comprehended or acknowledged by whom? Which PTs are you accusing of having an inherent need to direct and control what the patient does?

[PatrickL]

Barrett, I assume you haven't forgotten it or you wouldn't have referred to it. Surely the onus is on you to elaborate on your own comment if asked?

[Barrett Dorko]

Patrick says:

Surely the onus is on you to elaborate on your own comment if asked?

Diane is on here everyday. She invented the term and has written extensively of its description. This isn't a boxing match, it's a discussion.

[PatrickL]

This "locus of control" thing is interesting and seems to have forgotten Diane's description of interaction.

Forgotten by whom?

[Bas Asselbergs]

My question to you, why do you feel the need to place your hands on the patient?

Evanthis, let me state here as I have done in other threads: I do not touch all my patients therapeutically. In fact, I probably touch them less than most.
As you know my approach is very heavily focused and tilted towards education (and I include Cory Blickenstaff's and Feldenkrais' movements as part of that).

Sometimes the situation appears to require a physical experience of a different order: depending on the moment and patient, I may use DNM, SC, or passive motion (often with TKAs and post surgical shoulders - very gently exploring - much like Patrick describes). Human hands seem to help provide a sense of security to the nervous system in a high state of alarm and defense.

bas' personal opinion re how it feels to him when he moves ideomotorically, vs when he is moved passively isnt relevant for a general claim about which movement is more detrimental to any given patient's locus of control.

Patrick, maybe I should not have used the word "I" in there.
I think it is wholly reasonable to consider the passive versus ideomotor from that perspective however.
In dismissing my example, you appear to suggest that there is no difference between the two experiences in the nervous system and the patient in question?

Furthermore, I have never said passive movement was detrimental to locus of control. I just think there is a difference between SC and passive motion in helping the patient retain or keep it.

these movement options on your own.

With regards to passive movement, the patient now needs to be told "it is not necessary to move in the same direction I moved you in, because active motion is quite different than passive motion"...and then spend some time telling them why.

[PatrickL]

Patrick, maybe I should not have used the word "I" in there.
I think it is wholly reasonable to consider the passive versus ideomotor from that perspective however.
In dismissing my example, you appear to suggest that there is no difference between the two experiences in the nervous system and the patient in question?

I think it's fair to expect that the experience of being moved passively vs moving non volitionally would be different.

Furthermore, I have never said passive movement was detrimental to locus of control. I just think there is a difference between SC and passive motion in helping the patient retain or keep it.

I agree with that. I just don't think (as I suspect you do) that light touch is more likely than passive movement to help the patient retain locus of control. That doesn't mean I think passive movement is more likely either.

I just think there is no way to predict what the patient needs. We can only consider the patient before us and guess. We can only judge in hindsight, and we can never hit the rewind button to try a different approach. Passive movement might be unhelpful for some patients. Light touch might be unhelpful for some. Passive movement might steal away the locus of control of the patient. So too might light touch.

With regards to passive movement, the patient now needs to be told "it is not necessary to move in the same direction I moved you in, because active motion is quite different than passive motion"...and then spend some time telling them why.

That's not a big deal... "Before you leave today I'm going to show you some movements to practice so that if there's ever a flare up you can rely on those rather than spending all your money coming to see me!" That, combined with an explanation during treatment about sensitization and defensive motor output, and how small a part a PT plays in the process of resolving it, returns the locus of control to the patient, I think.

I will use a similar spiel regardless of whether I have utilized light touch or passive movement.

[Josh]

Barrett I didn't ignore anything...I went to bed!
Funny in post 759 Nari states "is not comprehended" that was two posts after yours.

I don't want to distract from this thread by going down this road, so if I offended you by the "rabbit hole" post I apologize.

I honestly think many people here have read, thought about, studied, the method of catalyzing ideomotion to treat pain with SC and flat out disagree. Is it non threatening, does it encourage movement, absolutely. Does it help decrease pain, sure.
Is it ideomotion? I don't think so.
Does SC catalyze ideomotion? I don't think so.

[Bas Asselbergs]

I knew we were not far apart on most of this, Patrick.
But we still probably disagree that showing a patient how to move after moving them passively is similar to a patient explore their own ideomotion.

[Barrett Dorko]

Josh says:

Is it ideomotion? I don't think so.
Does SC catalyze ideomotion? I don't think so.

I know it's not your responsibility to name it, but I assume you can see it and agree it's there.

What would you call it?

Again, you don't have to call it anything, but if there's a better description I'd love to hear it.

[PatrickL]

I knew we were not far apart on most of this, Patrick.
But we still probably disagree that showing a patient how to move after moving them passively is similar to a patient explore their own ideomotion.

I'm actually with you on that bas! Barrett's ideas have very heavily influenced my career and im thankful for that. I think it is very important to impress upon the patient the idea of following instincts/urges to move, to consider why they might be ignoring that urge, and helping them to discover how to let said movement unfold. I like to try both (choreographed and helping with non volitional movement) and seeing which the patient prefers... Trial and error over a few sessions. As long as I'm delivering a reasonable narrative I think there is scope for that.

[Barrett Dorko]

After all of this, I'm wondering why it took so long. All I ever seek to do as I teach is as you've said.

I appreciate your taking all the time you have.

[Barrett Dorko]

In case anyone has forgotten what Diane has said about interaction:


Here and

here and

here.

[Evanthis Raftopoulos]

You have described what you support, but these hardly constitute a premise.

Hi Barrett, you seem very confident about this. Can you give me an example of what constitutes a premise in your lexicon then? Let’s say related to Simple Contact? This will help me better understand what you are looking for. Thank you.

[Ken Jakalski]

After all of this, I'm wondering why it took so long. All I ever seek to do as I teach is as you've said.

I appreciate your taking all the time you have.

What Bernard said:

A pleasant war with a mutually beneficial resolution.

Not many forums can achieve this.

[Evanthis Raftopoulos]

Sometimes the situation appears to require a physical experience of a different order: depending on the moment and patient, I may use DNM, SC, or passive motion (often with TKAs and post surgical shoulders - very gently exploring - much like Patrick describes). Human hands seem to help provide a sense of security to the nervous system in a high state of alarm and defense.

Hi Bas, this is debatable. Hands on can also increase defense in a pain patient with a hypersensitive nervous system. Moreover, I find it difficult to accept that hands on facilitates unplanned movement. The opposite seems to be true.

When you decide to try SC and you place your hands on patients, are you asking them to do or think of something specific? If people start moving in random directions, how much of that is because of the narrative/expectation and how much because of the hands on part in your estimation?