Another reason therapists don't know

[Barrett Dorko]

Josh says:

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.

Here's something else interesting. I've spoken to many DPTs who have never heard of mirror box therapy. What do you suppose?

[Barrett Dorko]

Another thing: I say that Simple Contact is BOTH an understanding and a method.

It begins when I tie my tie in the morning.

[nari]

OK, Patrick.

Barrett, as you know, teaches SC with contact. That was how it was 8 years ago in his class. Before or after pain education, touch may or may not be employed to catalyse ideomotion.
So if touch does not occur, or if it does, the results are almost identical for the patient (or therapist, treating himself.)

If we are talking about two approaches with the same outcomes (both can fail, of course) then how are you sure about what is what isn't SC?

Nari

[PatrickL]

how are you sure about what is what isn't SC?

I'd hazard a guess that there have been therapists before Barrett who were aware of, and took time to build a non threatening context for their clinical encounters to unfold within. That aspect of sc is nothing new or limited to sc.

[John W]

Patrick,
What do you mean that these therapists were "aware of" a non-threatening context. If they were, I'm not aware of their effort to defend their method publicly. Does that count for anything?


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[Evanthis Raftopoulos]

Hi Barrett,

I don't know where that first one comes from or how it would be supported, anecdotally or otherwise.

It’s a plausible premise. Instinctive behavior has nothing to do with centralized intelligence. For example, behavior that microorganisms exhibit can be labeled as instinctive. Humans are way more complex. I don't see a way of differentiating instinctive vs. learned behavior in humans. Do you? Do you still think that movement that follows SC is instinctive and not learned? This also contradicts the whole concept of ideomotion, which is supposed to be movement caused by an idea. If it is caused by an idea (centralized intelligence necessary) then it's not instinctive. We can't have it both ways.

Reduction of pain secondary to the contributions of mechanical deformation is well-known. The characteristics of correction are concurrent with this. I thought we KNEW that. I'd really appreciate some academic resources.

Resources about what? That there is no evidence that links Carpenter’s ideomotor effect to pain/pain resolution?

As to the third, I have agreed that unconscious is perhaps not as useful a word as nonconscious.

Actually, nonconsious is even worse than unconcious as it is more ambiguous. For example, an object can be described as nonconcious, it implies that capacity for awareness never existed. As I mentioned earlier, subconscious makes the most sense to describe unplanned movement: we are not focally aware of it, but we can become so if we want to.

Secondly, how is an idea not a thought?

The premise is “ nor necessarily caused by an idea”. It does not imply that an idea is not a thought. The premise actually implies that movement can be due to other things, for example, due to relaxation and gravity. Are you suggesting that movement during SC is always caused by a thought or an idea?

You've equated movement with that which is only visible. Why would you do that?

If it's not visible, how do you know it's there? Are you suggesting that part of SC is to facilitate movement that is not visible? How? Are you talking about things like changes in blood flow from the gentle touch? If yes, then you are also suggesting that the touch is indeed necessary part of the method.

[Evanthis Raftopoulos]

Hi John

by definition “A premise is a statement that an argument claims will induce or justify a conclusion”

If I use a statement to support a conclusion, then it becomes a premise. Whether the argument is sound or not, or whether you like the premise or not is a different story. But don't tell me it's pathetic because it's not a premise. The whole thing about state your premise so I can attack it is a fallacy of diversion and I saw it coming. Don't get me started!

[John W]

"I don't see a way of differentiating instinctive vs. learned behavior in humans. Do you?"

Humans move in ways that can most reasonably be described as unplanned. Sometimes this is to reduce mechanical deformation. Sometimes not. I don't know why differentiating this matters. The fact that it exists and could play a role in our patients' persistent pain seems like something therapists should know about.


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[John W]

I don't think it was pathetic because it wasn't a premise; I think it was pathetic because it was vacuous. If you saw the diversion coming, then why did you bother to respond with that?


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[PatrickL]

Patrick,
What do you mean that these therapists were "aware of" a non-threatening context. If they were, I'm not aware of their effort to defend their method publicly. Does that count for anything?

Let me put it this way. If Barrett was ever to put a patent on sc (not that he would), he would struggle to have "context setting" included as his intellectual property. Massage therapists for example, have been dimming rooms and playing relaxing music for decades. Maybe Barrett should patent it... He would get a cut every time a PT puts a pillow under a patient's knees while they lie in supine. It appears as though you're arguing that if anyone who considers or attends to the context of a treatment encounter is by default practicing simple contact. That just seems strange.

Before this gets too tangential, I'll bring this back to nari's comments, which were really driving at the idea that if there is a favourable clinical outcome in the absence of touch, then it stands to reason that we are self corrective. I think this was in response to evan's questioning of this premise. I think we are inherently capable of self correction. However a favourable outcome following a hands off session of treatment isn't proof that we are self corrective. The premise itself is unfalsifiable and it's not testable and is therefore not scientific. It's a guess. I'm ok with that.

[nari]

Patrick,

Massage therapists for example, have been dimming rooms and playing relaxing music for decades.

Plus other treatments. All treatments by any therapist or HP have a significant placebo response (apart from those where the result is a noceboic response).

Do you see the placebo response playing a significant role, for instance, with your passive movements? More so than with other manual therapies?
Would it be more or less responsive if (I said if) the therapist guided them into moving?

Nari

[Diane]

The writing is on the wall.
Any good outcomes (be they surgical or physically therapeutic) are rooted in non-specific effects.
Yup. Sorry about that... It's reality.

[PatrickL]

Plus other treatments. All treatments by any therapist or HP have a significant placebo response (apart from those where the result is a noceboic response).

It reads to me like you're using the terms placebo and non specific (or contextual as bas says, and I prefer) effects synonymously. That makes it difficult for me to answer your questions. I understand the placebo response to be directly related to patient expectation. And contextual factors having their impact at a more non conscious level.

Do you see the placebo response playing a significant role, for instance, with your passive movements?

Yes. The patients expectation would likely determine the extent to which passively applied movements are placeboic or noceboic

More so than with other manual therapies?

The degree to which the manual aspect of any manual therapy method is placeboic or noceboic would depend on patient expectation.

Would it be more or less responsive if (I said if) the therapist guided them into moving?

It could be more or less. It would depend on patient expectation.

[John W]

Patrick,
Of course you can put it any way you want, but you haven't answered my question. Do you think it matters if a therapist is able to defend his practice scientifically?

I think you unfairly diminish what Barrett is trying to convey with his method by reducing it to relaxing music, dim lights, and a pillow under the patient's knees. You and I both know that this is done routinely down the streets from where we work, while the therapist waxes on confidently about meridians, energy fields, and all manner of indefensible nonsense.

I don't think you intend to lump Barrett in with those people.

However a favourable outcome following a hands off session of treatment isn't proof that we are self corrective. The premise itself is unfalsifiable and it's not testable and is therefore not scientific. It's a guess. I'm ok with that.

I think it's more than just a guess, although I admit that it requires a "creative leap" as part of an abductive reasoning process:
-Resolution of pain is reported (along with measurable functional improvement) following the creation of a non-threatening context that includes, through education, a change in the patient's cognitions/attitudes about their pain (which is also measurable).
-This would be explainable if patients with non-pathological pain of mechanical origin (a scientifically plausible condition characterized by an abnormal neurodynamic) possess an ability to self-correct.
-Therefore, there's reason to think that patients with this condition are self-corrective.

Lest we forget, there is a growing body of empirical evidence to support this abductive reasoning, which most notably started with Moseley's 2004 RCT showing that pain neuroscience education resulted in a change in pain attitudes and knowledge followed by significant improvements in forward bending and SLR ROM in subjects with chronic LBP. Moseley himself has explicitly stated that education alone is likely insufficient to result in meaningful improvement in pain reduction and improved function. One has to wonder then if providing permission, encouragement and a safe context for the patient to move (sound familiar?) would be sufficient for resolution to occur.

[Evanthis Raftopoulos]

"Humans move in ways that can most reasonably be described as unplanned. Sometimes this is to reduce mechanical deformation. Sometimes not. I don't know why differentiating this matters. The fact that it exists and could play a role in our patients' persistent pain seems like something therapists should know about. "

I agree, I'm not the one who is claiming that I touch patients and they move instinctually.

"I don't think it was pathetic because it wasn't a premise; I think it was pathetic because it was vacuous. "

It makes minimum assumptions, but that doesn't make it pathetic or vacuous.

"If you saw the diversion coming, then why did you bother to respond with that?"

My mistake.


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