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  • I don't disagree with that at all

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    • Thank you Cory, a few points from my perspective,

      "To clarify my stance, a claim need not be falsifiable to be useful, it just isn't a scientific argument it is then an explanatory system. "

      I agree, but in the context of SC there are simple parts of the idea that can be tested and are found not to be consistently true. For example, touch cannot predictably facilitate movement. People here have reported that ( The response was not the same between therapists or the same therapist). This questions the usefulness of hands on and makes the theory behind SC even weaker. On top of that, the opposite can occur, movement may be already happening and our hands can actually limit it. This may be due to increasing self awareness or other reasons. Moreover, when movement after gentle touch does occur, there are competing plausible explanations why that happens. So there are questions worth asking here for those of us interested in SC.



      "The current research on ideomotion, to my understanding, concern intention. All movement occurs below consciousness, but a movement is considered "ideomotor" when the intention is assigned to ourselves."

      Is this definition established somewhere in the literature? My arguments have been based on Carpenter's definition, the only one I could find.


      "Skipping ahead a bit, and realize that I obviously am speaking only for myself, at this point I personally find ideomotor, instinctive, and volitional descriptions to be helpful only so far as they get us to the point to realize the importance of self efficacy. "

      I see where you are going but I think that we can already appreciate self efficacy without the help and potentially incorrect use of these terms.

      "I've argued in the past that the potential preference for skin deep manual therapy (as opposed to other kinds) is in its unlikelihood to foster an external locus of control given the predominance of certain expectations and types of thinking. "How can the problem possibly be a bone out of place when you feel better after nothing other than skin deep pressure?" That sort of thing. "

      This assumes though that you actually feel better with 'skin deep' vs something different. I think that many people would disagree and this is also easy to test in the clinic.

      "All that said, I passively move people all the time. I consider it a very useful way to introduce novelty and honestly, I'm often looking for the first point of entry for that so we have a direction in which to run and limit the exposure to any potential "medicalizing" encounter. And that has become increasingly my goal over time."

      Sounds good to me, I wonder if this response satisfies those who were asking for a 'premise' for passive movement.

      "Also, I believe you mentioned placebo's having specific effects. You can look physiologically and find specific objective measurable effects. But, when we are talking about the health effect of pain, when adequately controlled I stick to the null that manual therapy will always be non-specific in its effect. No one is suffering from a "manual therapy deficit." "

      Whatever favorable responses you are talking about (for the responders), we can potentially identify them and call the specific as they become our target. That was my point (that I stole from Bob).


      Sent from my iPhone using Tapatalk
      Last edited by Evanthis Raftopoulos; 02-06-2014, 03:55 PM.
      -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
      The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

      Comment


      • John, I still don't think it makes sense to simply state that we are self corrective. If this were the case, the culture, no matter how powerful, would not be able to suppress self correction.
        Patrick, my next question is with regards to the above quote.
        What makes you say that? What do you base that remark on?
        We don't see things as they are, we see things as WE are - Anais Nin

        I suppose it's easier to believe something than it is to understand it.
        Cmdr. Chris Hadfield on rise of poor / pseudo science

        Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

        We don't need a body to feel a body. Ronald Melzack

        Comment


        • On contemporary ideomotor theory.

          I agree, but in the context of SC there are simple parts of the idea that can be tested and are found not to be consistently true. For example, touch cannot predictably facilitate movement. People here have reported that ( The response was not the same between therapists or the same therapist). This questions the usefulness of hands on and makes the theory behind SC even weaker. On top of that, the opposite can occur, movement may be already happening and our hands can actually limit it. This may be due to increasing self awareness or other reasons. Moreover, when movement after gentle touch does occur, there are competing plausible explanations why that happens. So there are questions worth asking here for those of us interested in SC.
          Well, I think you raise several important questions that just need to be investigated. I think all of these questions are falsifiable. It may pose some face validity issues that need to be sorted out. My understanding is the the contact intends to facilitate awareness of motion already present.

          Whatever favorable responses you are talking about (for the responders), we can potentially identify them and call the specific as they become our target. That was my point (that I stole from Bob).
          Only if the favorable response is derived directly from the variable. Skin contact has a direct effect on skin deformation. Does skin deformation have a direct effect on pain reduction? My stance is the null that if properly controlled it will be a non-specific effect when the outcome of concern is pain. Hopefully Bob can add some clarification at some point.
          Cory Blickenstaff, PT, OCS

          Pain Science and Sensibility Podcast
          Leaps and Bounds Blog
          My youtube channel

          Comment


          • Thank you to all contributors for the extended effort in this thread.

            I have one question regarding "self-correction" illustrated in a quote from Patrick:
            If the therapist has to provide anything, then it raises some pretty obvious doubt over the premise that we are self corrective, no?
            Is there a difference regarding:
            1. the need for input of a therapist for resolution (ultimately dependent on intervention), or;

            2.input of a therapist for expedited/optimal resolution (within a period of time which would be beneficial for the sufferer).

            For the former example, is the capacity for an individual to "correct" exclusively dependent upon intervention from a therapist? Or, having other needs met, would individuals' experience reduce over an extended period of time (years?), barring noceboic education, practices, or comorbidities?
            The unexamined practice is not worth maintaining.

            Comment


            • Cory says:

              My understanding is the the contact intends to facilitate awareness of motion already present.

              Sounds right. Deformation of the skin (touching) is of special interest to the brain, and I certainly need to point that out here. Repeatedly, it has been implied that ideomotion begins when it's visible. Simply not true. As I've said, the patient's report of th characteristics of correction, often distant from the deformation of the skin, means something. I have just interpreted it in light of what neuroscience has taught us.
              Barrett L. Dorko

              Comment


              • It has also been suggested that countercultural movement; movement already possessed by the patient but suppressed, when catalyzed, might lead to a lack of self-efficacy.

                I'm aghast at such a suggestion.
                Barrett L. Dorko

                Comment


                • For the former example, is the capacity for an individual to "correct" exclusively dependent upon intervention from a therapist? Or, having other needs met, would individuals' experience reduce over an extended period of time (years?), barring noceboic education, practices, or comorbidities?
                  I think that "having other needs met" (by an external source) constitutes an intervention, a reliance on something other than the self. Im not suggesting an intervention has to be delivered by a PT. I'm just suggesting that if the premise is "we are self corrective", then it stands to reason that if people are left to their own devices, persistent pain of mechanical origin should not exist. But it does.

                  I think it's reasonable to assume that humans evolved from a species that possessed a homeostatic mechanism for keeping peripheral nociception in check. Perhaps it dates back to life under water, where the absence of movement meant death. I don't know. i think its reasonable to assume that humans still possess this homeostatic mechanism. However, humans have evolved a large neocortex. We have developed complex social structures because of it. And along with that comes the need to prioritize "survival needs". Collectively, humans seem to have decided that there are more important things to attend to than the instinct to regularly move in a manner that keeps peripheral nociception in check.

                  Unless a given individual works it out for himself/herself that moving in such a manner is important, well, I'm afraid it doesn't make sense to say we are self corrective.

                  Comment


                  • I get the impression that some contributors to this thread are thinking primarily in terms of pain management.

                    I find it easier to think of most of the symptoms I deal with in terms of movement/performance issues. Freedom of movement is a key issue for:

                    babies who can't shift wind upwards or downwards
                    children with idiopathic constipation
                    asthmatics
                    those recovering from illness and injury
                    golfers who can't hole out due to 'the yips'
                    expectant mothers
                    stammerers
                    musicians
                    cityboys/girls working eighty hour weeks
                    dizzy patients
                    those with mental health issues
                    the over eighties
                    those receiving end of life care
                    et al

                    I studied movement as a first year physio student and continue to study it obsessively in individuals,groups crowds and rush hour swarms. It is possible that my patients find it strange that I want to talk more about how they coped getting through rush hour/market day than their pain,dizziness,anxiety,shortness of breath etc. If I can get them sufficiently interested in exploring their boundaries of movement it is possible that their preoccupation with symptoms will begin to fade.
                    Last edited by Jo Bowyer; 03-06-2014, 02:13 AM. Reason: repetition
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • I'm just suggesting that if the premise is "we are self corrective", then it stands to reason that if people are left to their own devices, persistent pain of mechanical origin should not exist. But it does.
                      I don't agree here. If we are self corrective mechanical pain should have a natural course history, which it does.
                      Cory Blickenstaff, PT, OCS

                      Pain Science and Sensibility Podcast
                      Leaps and Bounds Blog
                      My youtube channel

                      Comment


                      • Self corrective does not imply a resilience to stay clear of pain. It implies the ability to clear it once it occurs. At least that's how I interpret it.
                        Cory Blickenstaff, PT, OCS

                        Pain Science and Sensibility Podcast
                        Leaps and Bounds Blog
                        My youtube channel

                        Comment


                        • I would add that suggesting to a patient that cultural influences are a reason their pain is not resolving and that outside influences easily suppress the mechanisms needed to get out of pain is not without potential harm to the person's self-efficacy.
                          I think that is conceivable
                          It has also been suggested that countercultural movement; movement already possessed by the patient but suppressed, when catalyzed, might lead to a lack of self-efficacy.

                          I'm aghast at such a suggestion.
                          Barrett, the suggestion was that explaining the cultural influences on movement might threaten locus of control. Consider the following... The culture is powerful. It suppresses movement without you realizing it. Overcoming the culture's power requires behaving counter culturally.

                          Counter cultural movement could be terrifying for a patient? It might cost them their job. Or friendships. You don't see how that might be a problem?

                          Comment


                          • I don't agree here. If we are self corrective mechanical pain should have a natural course history, which it does.
                            Always? What if mechanical pain progresses to maladaptive peripherally or centrally sensitized states? Does that mean that mechanical pain has run it's course? Or what about mechanical pain that emerges secondary to reduced movement from either adaptive or maladaptive sensitization?

                            Comment


                            • Self corrective does not imply a resilience to stay clear of pain. It implies the ability to clear it once it occurs. At least that's how I interpret it.
                              That is a good point and might help explain the differing views here, thanks. My understanding is that Barrett describes self correction as occurring in the absence of pain too.. A homesostatic mechanism for keeping nociception from ischemia in check, thereby keeping tissues oxygenated and healthy.

                              Comment


                              • But Patrick, doesn't all of artistic expression, especially the revolutionary ones, "break the rules" of the prevailing culture?

                                I wrote a whole series of posts titled "In praise of recliners" because they give us the freedom to move: IDEOMOTORICALLY

                                Just thought I'd say it.
                                Last edited by Barrett Dorko; 03-06-2014, 02:16 AM.
                                Barrett L. Dorko

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