Another reason therapists don't know

[Josh]

I'm still a little hung up on the statement SC doesn't have to be manual contact. That is not what has been stated or I guess implied. If it isn't manual contact, than this is not different than education, reassurance, therapeutic interaction, which all of us do with everyone everyday. It doesn't need a new name or a discussion with 850 posts.

I still contend that movement should be referred to as movement. With appropriate context setting, education and fear reduction to address the neuromatrix, "movement" passive active, choreographed, unconscious, subconcious, nonconscious, volitional, should help treat pain that has a mechanical component to it. I think conscious, volitional, choreographed movement, awareness of movement has a benefit to the brain's processing of said movement and threat.

Wow when I want to lift my arm it doesn't damage anything, no risk of injury, thats cool, let me try that again. vs when that therapist touched my arm (still thinking touch is needed for SC) and my culturally suppressed movement was expressed without pain.

[Jo Bowyer]

With appropriate context setting, ....... to address the neuromatrix, "movement", unconscious, subconcious, nonconscious

can be triggered by the presence of the therapist without touch in patients of all ages.

[nari]

I agree. Touch can be helpful for unsure patient and therapist, but not necessary. It is simpler and quicker than going in for passive, active, choreographed, active-assisted and whatever else comes to mind.
..and after 850 posts this is still not accepted as such.

Nari

[John W]

Evan,
You're original response to Barrett's request for a premise to base whatever method it is that you use or espouse was this:

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

I agree with Barrett that this does not constitute a premise. These are very superficial and essentially prima facie syllogisms that possess virtually no explanatory power whatsoever. A professional clinician should be able to articulate a premise upon which the deep explanatory model that drives their practice is based. The above explains nothing. Barrett referred to it as "pathetic", which sounds harsh, but I think that's an accurate description of this response.

You also said:

Almost every post in this thread can be considered to be a premise.

If that's what you really think Barrett is talking about when he asks for you to articulate a premise to defend your method, then I think you and he are going to continue to talk passed each other.

I'm dumbfounded by your more recent list of premises that included these two:

- the more the intelligence of an organism, the more it relies on learned behaviors and the less it relies on instincts

-there is no evidence that links the ideomotor effect to the pain experience

You've spent the last couple of weeks grilling Barrett and others to describe and differentiate various terms like "ideomotion", "volitional", "nonconscious" and "passive", and you've been indulged with very detailed explanations and even admissions of the limits of our current understanding of the complex phenomena associated with these terms. And now you throw out these utterly indefensible positions? What evidence do you have that there's an inverse correlation between intelligence and instinct? Relies on "learned behaviors" for what? For happiness? For survival? For pain relief? So, a person with a higher IQ is more likely to be able to "learn" how to resolve their pain than someone with a lower IQ, who relies more on their instincts? That sounds like social Darwinism to me, which is as misguided as it is potentially dangerous.

The second statement seems to be based on a strict adherence to Carpenter's definition, which Barrett and others have repeatedly stated was seminal, but not the final word on the concept. Much has been written since. Understanding of the phenomenon continues to deepen and expand- the language has not caught up, obviously. If I attempt to sit still and not move for even a few minutes, I will experience discomfort. No doubt I'm moving non-consciously as I type this- as are you as you read it. Whatever you want to call it that impels me to alter my position to find a position of relative comfort is what we're talking about that's linked to pain. Does that not constitute evidence?

[YT]UPw-3e_pzqU[/YT]

[Jo Bowyer]

mirror neurons

A distressed patient can be seen to settle in the presence of a calm attendant.

Fear/anxiety is sensed by the critter brain via hearing and sense of smell as well as those of touch and sight.

I have been asked by patients "Why is Dr X cross with me?" when I happen to know that Dr X isn't cross (s)he has just seen some horrible test results.

[John W]

I'm interested that the idea of enculturation and conformity is always a negative driver.

Blaise,
I know that I've read several times in comments made by Barrett himself in this very thread that the culture both helps and harms. I don't think this is a difficult proposition to accept. Turn on the radio and you're sure to hear both harmful and depraved as well as uplifting and beautiful song lyrics. I don't know, maybe moral relativism has blurred those lines so much that people can't tell the difference anymore. That's not a good sign.

In any case, I'm confident that Barrett almost never uses the word "always".

[Josh]

In defense of Evanthis: Wikipedia defines instinctive behavior as behavior performed not based on past experiences, or in the absence of learning. Also stating the more neurologically complex an organism is the greater the cortex and social learning are involved, relying less on instincts.

Interesting side note: education level was correlated with less pain in the rotator cuff study posted in a previous post. Not stating it is 100% predictive, just an observation from the article.

[John W]

Blaise,
I don't understand where you got the idea that I was accusing you of making an ad hominem attack. On whom? If I thought you were making an ad hominem attack on a particular discussant, I would state just that. If I make an assumption about anything, I will say so, I won't imply it.

Would you consider, perhaps, that many times (if not all) when "culture" has been mentioned in this thread it has been in the negative?

Of course we're discussing the negative influence of the culture- the issue is non-pathological pain of mechanical origin. Why would the positive influence of culture have an impact on or relevance to a discussion about how that comes about? You've adjusted the goalposts quite a bit here.

[John W]

Josh,
Of course, an organism that possesses "intelligence" will avail itself of that capacity, just like a whale will avail itself of its tail fin to propel itself through the water. That doesn't mean that instincts become irrelevant, particularly when it comes to responding to a perceived threat.

Is it necessary to provide examples of when the human forebrain can lead the organism astray? Have you considered the source of schizophrenia?

Your reference to the link between educational level and less pain associated with RC tears is relevant how?

[Barrett Dorko]

Thanks John,

You've said it better than I could. I'm fairly certain that Evanthis has some more questions to ask and continues to mistake statements for premises.

It comes back to me that, in our business, a premise isn't just something stated - it is also something defended successfully.

My favorite part was that video, though I prefer the imitation of Pacino's line by Silvio Dante.

[PatrickL]

I'm still a little hung up on the statement SC doesn't have to be manual contact

As you should be. The "non manual contact" exists independent of sc. It's the base upon which any manual therapy method should be built. The method of sc involves manually "asking the patient which way he/she wants to move". You can't do that without touching the patient.

[John W]

Blaise,
You seemed to be holding our arguments (Diane, Barrett and I, principally, have made similar ones in this discussion) to a higher standard. Do you think I meant that you hold us personally to a higher standard? Based on what? Our race, skin color or religious beliefs? My understanding of an ad hominem is when you resort to calling someone names or when you make irrelevant references to their personal beliefs or predilections in order to detract from the substance of their argument. I've never implied, stated and certainly not made an accusation that anyone has done this during this discussion. I still don't know what you're talking about.

I interpreted that your point, which was in agreement with Mason about the positive and negative influences of culture, was made to convey that you suspected that some cherry-picking was taking place:

Seems to me like we might be picking and choosing what we wish out of our primate backgrounds to justify our positions somewhat.

You seem to be claiming here that those who argue about the negative influences of culture on persistent pain is driven by confirmation bias, no? Frankly, I'm not sure what you're arguing.

I also don't know why you keep saying that I'm "accusing" you of stuff. I'm criticizing your arguments. That's what we do here.

[nari]

You can't do that without touching the patient.

Not true. There is NO need to touch unless, perhaps, the patient is very tense and/or anxious. Many therapists may prefer to touch and there is no issue with that.

The issue is that without touch the resulting movement or characteristics are called by a different noun and arise from a different part of the brain. True? Does not make sense to me, however.

Nari

[John W]

In Middle Eastern cultures, it's customary to get very close to someone when you meet them so that you can feel their breath. Is that not a potentially powerful form of non-haptic contact with another person.

When did Simple Contact become Simple Haptics?

[PatrickL]

Not true. There is NO need to touch unless, perhaps, the patient is very tense and/or anxious. Many therapists may prefer to touch and there is no issue with that.

Seriously nari? You can manually ask someone which way they'd prefer to move without touching them?