Another reason therapists don't know

[Barrett Dorko]

No doubt that's a big part of my message. After all, the cultural expectation and context of the room we're trying to get better in are the 800 pound gorillas in the room - often they're unseen like in that famous video and for the same reasons, pretty much.

What are we disagreeing about again?

I seem to assume more than some are comfortable with and Mason said something a few posts ago that might have come directly from a PT supervisor's or factory foreman's mouth. It sounded very familiar, and it's why I speak very little to my coworkers.

[PatrickL]

Let's not get ridiculous:
"when there is no touch, it is not simple contact anymore".
Really?
I can not believe that all the non-MANUAL aspects are dismissed as not being "contact".

Every time we meet with a patient, we are on contact.
SC is not SMC (simple MANUAL contact).

My understanding was that sc is a manual handling method. Doesn't sc involve the asking of 5 questions... One of which is asked manually?

If there's no touch, then there hasn't been 5 questions asked... Is what remains still sc?

[Diane]

Speaking of the cultural influence is a tactic, helping people understand the nature of the brain's output of pain is a strategy.

Thank you for pointing out the difference between tactic and strategy. Improving movement overall (with or without pain being present) is the strategy, and simple contact is a tactic (to overcome fear of movement, with or without pain being present). Ultimately motion will be the lotion required to move easier, more fearlessly, and set up negative feedback loops for pain de-production, break positive feedback loops that have become the current (culturally reinforced) balls and chains impeding movement.

My current favourite positive feedback loop-busting ideation/ideomotor movement concept comes from Bronnie Thompson, who suggests we think about back pain the same way we do headache.

"..perhaps we could think of back pain as a lot like having a headache. A headache of the back. We don’t think of head pain as “head injury”, we think of it as a headache – we usually take a bit of pain relief, go for a walk, de-stress, and it’ll settle down. Occasionally a headache is a sign of something more serious – but most of the time it’s a nuisance and a wakeup call to take more care of our wellbeing.

If we could think of back pain in the same way, I think we might be better off. What would it be like if we thought of back pain as “just a nuisance”, or “I’m a bit stressed”, or even “I need to go for a walk”?

A new idea or way of conceptualizing movement plus-or-minus pain, plus a bit of reassurance physically applied but not necessarily, and maybe not even necessary.

[PatrickL]

No doubt that's a big part of my message.

What else is there?

[Evanthis Raftopoulos]

Hi Barrett,

"In post #788 you say that I thanked you for stating what a premise consisted of. No, I didn't. I thanked you for seeing how corrective movement wasn't always painless."

You didn't seem to have a problem with the stated premise then. Now you find it pathetic? Why? Can you expand?

"I still don't think you know what a premise is or how to defend it with an argument, a deep model and clinical reasoning."

Based on what? Agree to disagree.

Can you answer the rest of my questions in post 788? Thanks.


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[Mason]

Mason said something a few posts ago that might have come directly from a PT supervisor's or factory foreman's mouth. It sounded very familiar, and it's why I speak very little to my coworkers.

Here are the points I am looking for clarification on that I haven't seen addressed yet.

To say that the self-corrective movement is suppressed and is catalyzed by the context created during the patient interaction implies that the therapist has knowledge of the cultural variables inhibiting movement and is able to create a context that removes or lessens the relative influence of those barriers to motion. Barrett, you listed some of the many variables that influence a persons response to context, so I think we agree that the influence of the culture is different on each patient.

So to me this seems indefensible that a therapist would be able to identify the cultural contextual variables suppressing an individuals ideomotion. Yet this is what would be needed to change the context to one that allows the free expression of self-corrective motion. Right?

If the new context is only defined as non-threatening input/interaction etc. then we can't say that the motion is the expression of previously inhibited, culturally suppressed non-conscious motion relieving deformation because it can just as likely be something unrelated (e.g. patient expectation, reduction in perceived threat).

I'm looking to understand how you've determined that your method catalyzes inhibited motion.

[Bas Asselbergs]

a therapist would be able to identify the cultural contextual variables

The cultural movement related restrictions are not very variable. And that is THE variable I think Barrett is talking about

Random, free, unsuppressed and unchoreographed motion is completely counter-cultural on our continent. I think we can agree on that.
This is the cultural variable that can be assumed to influence most any of us.

[Barrett Dorko]

Once again, I agree with Bas. Within the cultural milieu of Ohio there are general rules and just about every small child has them drilled into them. This varies, of course. Wanting to know specifically which of the factors possibly involved should be addressed is WAY more than I could ever hope to know or teach.

For some reason I'm reminded of two of my former bosses arguing for a long time about whether the unplanned motion emerging from the patient should be billed as "therapeutic exercise" or "therapeutic activity." I'm not kidding.

As far as I know, they never agreed, and couldn't have cared less about the patient's opinion or mine. Nor did they care about its use, purpose - whatever. They would have been much happier if I just dragged patients down the hall after some time with the ankle weights. Batting a balloon around would have been acceptable too.

[Mark Hollis]

The aspects of the cultural context inhibiting the expression of movement need to be specified to claim that the therapist is able to create a different context that elicits culturally-suppressed movement.

And it isn't the culture, it's the enculturation (a very big difference imo as one is external and minimally controllable and the other internal and hopefully somewhat more modifiable), How is a person oriented to their social and physical environment and how do they express that orientation (suppression is a form of expression)?

[Barrett Dorko]

Evanthis,

You seem to think that since Carpenter was the first to introduce the term ideomotion that he is the only one who has written of it, studied it or spoken about its manifestations. You're WAY off.

Despite being given a recent definition of premise, you seem to assume it is present when a method is described. I refuse to agree to disagree with you. You're not even wrong.

I have failed to get myself and/or concepts understood many, many times. Now you want a list?

[Bas Asselbergs]

"Sit still. Stand straight. Slouching is bad for you. Slouching is ugly. Do not twitch. Do not get up in the middle of mass/meeting/meal. Do not draw attention to yourself. Be normal. Do not jump. Do you WANT to look weird?" etc. etc.
External cultural factors all.
Now, any individual may have slightly different internal responses to those, but do you see random, unchoreographed motion anywhere around you in public?

[Diane]

"Sit still. Stand straight. Slouching is bad for you. Slouching is ugly. Do not twitch. Do not get up in the middle of mass/meeting/meal. Do not draw attention to yourself. Be normal. Do not jump. Do you WANT to look weird?" etc. etc.
External cultural factors all.
Now, any individual may have slightly different internal responses to those, but do you see random, unchoreographed motion anywhere around you in public?

And hasn't it been true that our profession has been interventionist with respect to "rehabbing" anyone outside the "norm", for example, children with cerebral palsy, by trying to stop any behaviour that's normal - for them - like W sitting, because of fear it would lead to structural problems, forcing these kids to sit "properly", i.e., like "normal people", fit in, instead of letting them have whatever position they feel best in, most stable, so they can focus on the colouring book or whatever..

[nari]

Interesting thoughts.
I thought the myth of ruining the hip joints in the W sitting position had died out decades ago; apparently not.
I don't think the culture has the stranglehold on kids the way it did in the fifties. I recall sitting at my grandparents' dining table aged around 8 and I was not allowed to talk. My sister, 5 years older, was allowed.
So many of our patients who lived through the 50s, for instance, are probably those kids who were shackled for the sake of good manners and family attitudes.

Nari

[Diane]

In Canada, the profession hasn't evolved past the 50's, except for ortho, which became ossified into a black belt system.

[nari]

I think in Oz the broad spectrum of physiotherapy is still in the 80s.
I suspect that Scandinavia is somewhere around the top in modern thinking of treatment.

There is a faint indication going on in our APA journals, that they are considering to accept
1) pain is an output and 2) muscles and joints are not always to blame for the reasons patients come to physios.

Nari