Another reason therapists don't know

[PatrickL]

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.

I think my point would have been confused by my decision to start questioning the premise "we are self corrective" part way through this thread. Taken together with my point that light touch is not necessarily the most defensible type of touch a manual therapist can utilize, it is easy to see how my comments could be interpreted as advocating passive movement over light touch.

I also think that John, Diane, Nari and yourself have somewhat of a hair trigger defense reaction to any comments that sound remotely like an endorsement of any manual therapy approach that differs from either DNM or SC.

I think it's both a strength and weakness of somasimple.

[Bas Asselbergs]

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.

Please note that I said "seem to".

It is not my experience that gentle hands-on can increase defense reactions. I am very attentive to my patients, and as I said before, hands-on is NOT my first act of treatment.

I can understand that you have difficulty accepting the possibility of unplanned motion occurring. I did as well.
When I use SC, I do not to speak of motion at all. Sometimes, I talk about anoxia in nerves, possible defensive inhibition patterns, sensitization of the system etc. etc. And sometimes about nothing therapeutic at all.

[Barrett Dorko]

Gong to a place on the patient that they don't feel is threatening and handling them gently is a way of emphasizing what I've said to the patient before I touch them.

Should I sense a defense, I go elsewhere within three seconds. If I can't find a place to land, I stay with education.

I can't understand how it is that some seem not to know this.

Evanthis,

We seem not to agree on what the definition of a premise is. I gather that you think I haven't stated mine (I have) and that you think a description of method and some vague reference to belief and evidence of effectiveness is a premise.

It isn't.

Am I wrong?

[Evanthis Raftopoulos]

Hi Bas,
I do not have difficulty accepting that unplanned movement occurs, but I credit the narrative and general context, not the hands on part. I don't think that the hands on part facilitates the unplanned movement. How do we know if it affects it at all, or that it does not slow it down? Or how do we know that the patient is not just trying to please us or feels obligated to move? After manual treatments I suggest to people to get up and move around or let their head move which ever way it wants to go etc. I think that this is sufficient to achieve the therapeutic effects (if any) that Barrett is suggesting. I challenge the notion that the very gentle touch is doing something clinically significant. Moreover, the hands on part of SC makes the assumption that we are catalyzing ideomotion even more ambiguous and in my interpretation unsound. Imagine somebody gently touching the dowser in the video I provided. Will that catalyze his ideomotion? I don't think so.


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[Evanthis Raftopoulos]

Barrett, do you mind restating your premise?


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[Barrett Dorko]

The definition of premise, as both a noun and a verb is given in post#1 of this thread. The premise leading to Simple Contact as a method is in post#3. Please note that nothing is said about touching in either.

The term light touch certainly describes what I do, but I've always refused to say how light because that would distract from the issue of context, which I consider much larger.I would much prefer the term "non-nociceptive pressure." If the skin is the exposed brain (and it is) and if you're predisposed as a therapist to touch people, Simple Contact as a method makes perfect sense to me. If you've no understanding of pain because you've not read anything, there's not much I can do about it.

I've spoken to many wonderful therapists who aren't the least familiar with the five or six names or concepts I mention. That doesn't make them bad people, they're just willfully ignorant. Their patients pay the price.

Yea, I said it.

[Evanthis Raftopoulos]

Thank you Barrett. I know the definition of a premise and that’s why I’m not sure what you are asking me to state. Almost every post in this thread can be considered to be a premise. In post 742 I said

" When I do practice passive interventions, the goal is usually 1) to assist with movement when there is an identifiable (by patient and therapist) lack of movement, (pain may or may not reduce) or 2) to offer to the patient some form of temporary relief (assuming the pt responds positively based on hx and physical exam)."


I can place the above in an easy to read argument format if that makes a difference

a)

1. an identifiable lack of movement is perceived as problematic by the patient
2. the therapist can help the patient complete the movement with his/her hands

conclusion: manual therapy can assist with movement when there is an identifiable lack of movement

b)

1. the patient is experiencing pain
2. the patient reports relief during palpation in the area perceived as painful

conclusion: manual therapy with parameters similar to the palpatory exam can offer the patient relief from pain

[nari]

Please note that nothing is said about touching in either. (Barrett)

This is what I have been attempting to get across in this thread, with no luck at all.
If we leave all action concerning touch out of SC and the patient experiences partial or total pain relief afterwards and neither therapist nor patient is dreaming or in lala land, what is the likely premise for this?

Oh, and leave dowsers and ouijas out of it as well....it is doubtful they resolve pain.

Nari

[Barrett Dorko]

Nari says:

Oh, and leave dowsers and ouijas out of it as well....it is doubtful they resolve pain.

Evanthis,

You also seem not to understand that nonconscious expression is but one way ideomotion might apprear.

If that which you've stated is your idea of a premise, there's nothing I can say. You've just stated in one portion the apparent effect of a supposedly therapeutic action. It's pathetic - and it doesn't constitute a premise, not at all.

I wouldn't even agree with your first stab at what you've called a premise. Also pathetic.

I've failed to state something simple and clear to a therapist. Not the first time.

[gilbert]

Hi Bas,
.... How do we know if it affects it at all, or that it does not slow it down? Or how do we know that the patient is not just trying to please us or feels obligated to move? After manual treatments I suggest to people to get up and move around or let their head move which ever way it wants to go etc. I think that this is sufficient to achieve the therapeutic effects (if any) that Barrett is suggesting. I challenge the notion that the very gentle touch is doing something clinically significant....

We know it affects it by observation. To spell it out, when manual contact is added there is often visibly increased movement. Why is that hard to understand?

If you think "very gentle touch" is not doing anything clinically significant then your clinical experience is vastly different than mine. This is a powerful input into the neuromatrix that often assists the CNS to change the output of pain in a lasting way. I'm not just talking about SC. Have you ever tried using very light manual traction for upper cervical pain / cervicogenic headache issues for example?

[Barrett Dorko]

Yes, Evanthis states that, in his words, "light touch" doesn't accomplish much.

I have NO IDEA how he came to that conclusion.

[Evanthis Raftopoulos]

This is what I have been attempting to get across in this thread, with no luck at all.
If we leave all action concerning touch out of SC and the patient experiences partial or total pain relief afterwards and neither therapist nor patient is dreaming or in lala land, what is the likely premise for this?

Hi Nari,
If we leave touch out then it’s pretty much not Simple Contact anymore.
Total pain relief? Do you mean complete pain resolution caused by a brief treatment session? I highly doubt that this is even possible for most nmsk manifested pain conditions.

Oh, and leave dowsers and ouijas out of it as well....it is doubtful they resolve pain.

The dowsers are the ones expressing the ideomotor effect as defined by Carpenter. So they make a perfect example of what ideomotion is. I still fail to see how the ideomotor effect is linked to pain resolution. Unplanned movement =/ ideomotor effect.

[Evanthis Raftopoulos]

Hi Barrett,

You also seem not to understand that nonconscious expression is but one way ideomotion might apprear.

According to which definition? Not Carpenter’s.

If that which you've stated is your idea of a premise, there's nothing I can say. You've just stated in one portion the apparent effect of a supposedly therapeutic action. It's pathetic - and it doesn't constitute a premise, not at all.

What exactly do you find pathetic?It’s an argument with premises and conclusion. Do you disagree?
When I wrote about it here you thanked me and you replied “You've got it. At least, according to me.” What changed now? Seems to me like an appeal to emotion in a tu quoque attempt. I hope that I'm wrong.

I wouldn't even agree with your first stab at what you've called a premise. Also pathetic.

can you clarify?

I've failed to state something simple and clear to a therapist. Not the first time.

can you also clarify?

[Evanthis Raftopoulos]

We know it affects it by observation. To spell it out, when manual contact is added there is often visibly increased movement. Why is that hard to understand?

that's just post hoc story telling.

If you think "very gentle touch" is not doing anything clinically significant then your clinical experience is vastly different than mine.

I agree!

This is a powerful input into the neuromatrix that often assists the CNS to change the output of pain in a lasting way.

This sounds to me like wishful thinking.

I'm not just talking about SC. Have you ever tried using very light manual traction for upper cervical pain / cervicogenic headache issues for example?

Yes, but there is a large difference between some form of temporary relief and what you claim above.

[Barrett Dorko]

Evanthis says:

It’s an argument with premises and conclusion. Do you disagree?

Yes, I disagree. There's NO premise here.

You've said that if touch isn't included Simple Contact isn't present. Where on earth did you get that idea?