Another reason therapists don't know

[Josh]

Bas and Barrett I respect both of you and your thoughts, thanks for your input.

However I don't think the parachute analogy is a good one, because I can test for placebo effects of wearing a parachute vs actually opening one, and multiple sizes of parachutes to determine which if any are effective at preventing death jumping out of a plane. I can't test anything realted to SC in any setting to know if I'm doing anything, catalyzing anything, more than placebo.

All I'm asking, why is this method better or more defensible than ginger doing CM, travell releasing trigger points, flynn's HVLAs, or Barnes doing CS. All of these examples claim they decrease protective motor output and encourage freedom of movement following. It seems SC and ideomotion thoery as it applies to treating pain gets a pass when others do not.

In regards to practices: I would think patients in a SNF would benefit from effort, sweat, motivation, and goal setting to help them transition home. Wondering why that is more wrong vs utilizing SC in a SNF.

[Barrett Dorko]

I didn't say that effort or sweat was wrong. I don't contend it is. I have observed that it is the only thing offered.

Home? For most patients from an SNF?

I've stated my premise and all the others you mention have not.

The method, such as it is, flows from that. Simple Contact as a method and understanding hasn't been given a "pass." Certainly not by me.

Do any of the moderators think it has?

[Bas Asselbergs]

All I'm asking, why is this method better or more defensible than ginger doing CM, travell releasing trigger points, flynn's HVLAs, or Barnes doing CS. All of these examples claim they decrease protective motor output and encourage freedom of movement following. It seems SC and ideomotion thoery as it applies to treating pain gets a pass when others do not.

Josh, I think I see where this comes from. SC and ideomotion does NOT introduce unsupported factors (causes of pain - fascia, joint alignment/stiffness, TPs) or creates constructs in which the technique is the master factor, or suggests that the therapists' manual skill is the most important.

In fact, the value of SC and ideomotion is explained by a deeper understanding of the organism in pain and neurophysiology.
Barrett has never claimed SC to be to be "better", more effective or required for pain resolution. The claim is that it is the LEAST convoluted approach with a very defensible premise.

How is this "being given a pass"?

BTW:

because I can test for placebo effects of wearing a parachute vs actually opening one, and multiple sizes of parachutes to determine which if any are effective at preventing death jumping out of a plane.

Really, Josh? Please tell me you are joking. This is as far fetched as controlling for contextual effects in a controlled study of SC.

[Barrett Dorko]

Thanks Bas. Now that you mention it, I had forgotten to say that I made no claims of success. I've said this so many times it no longer occurs to me.

The other methods mentioned are MUCH easier to sell and teach precisely because they offer an explanation beyond the pale. Many therapists live there and their tendency to be politically correct keeps them silent in the presence of an instructor.

Finally, my emphasis on reducing painful movement is of NO INTEREST to many therapists today.

Amazing.

[Josh]

Bas how many times a day do you use SC and discuss ideomotion with your patients in pain?
Barrett how successful are you at reducing pain in your patients with SC?

Restoring suppressed ideomotion to decrease mechanical deformation through touch in which the practitioner does nothing more than interact with a patient doesn't seem like the least convoluted approach with the most defensible premise to me. Obviously I seem to be in the minority in this discussion, I shall continue to look into it and see what happens

[Diane]

It's a complex approach in terms of what you have to learn in order to understand it, but it's the least invasive approach which leaves the patient with locus of control and harms no one. Ever. Socially (in terms of introducing nocebo by overstepping therapeutic boundaries) or psychologically (in terms of adding nocebo and contributing to images or breakage or damage to be dealt with) or biologically (in terms of overwhelming the boundary that must be allowed to establish itself between human brain and critter brain, for eventual pain management or pain vanquishment).

[Evanthis Raftopoulos]

it's the least invasive approach which leaves the patient with locus of control and harms no one.

Diane, excuse my enjoyment of playing devil's advocate, but it seems to me that one could easily argue that the least (physically) invasive procedure that harms no one is Reiki (https://www.youtube.com/watch?v=jEREaXoC9Zo). It’s even 'evidence based' in the context of improving well-being, relaxation, pain relief, sleep quality and reducing anxiety for some people http://ajh.sagepub.com/content/29/4/290.short .

Evan

[Jo Bowyer]

I see Reiki and raise you 'Active Listening'. As this is usually done seated there is less risk of orthostatic hypotension on arising and it gives the mirror neurones a workout.

[Bas Asselbergs]

Restoring suppressed ideomotion to decrease mechanical deformation through touch in which the practitioner does nothing more than interact with a patient doesn't seem like the least convoluted approach with the most defensible premise to me

Can you say why that is?

Can you point at another method with a plausible scientific explanation that is this straight forward? I would point at pain neurophysiology education as one - do you have others?

[Barrett Dorko]

Evan,

Obviously, the least invasive form of care out there is treatment over the phone. I'm not suggesting that our words accomplish nothing either. We both know better than that.

Josh's last post might have been foreseen. I especially like the words "does nothing more than interact." Actually, I'm waiting for Bas to answer with his count. This should be good.

Josh works about 30 miles from me. We've never met and, I don't suppose, ever will. In a few years perhaps he'll revisit the issues of touch and interaction and understanding and study. He needs, I guess, to spend some time actually experiencing what many of us have before he makes a distinction between care and treatment, between understanding the power of context and a complete ignorance of such.

My mind turns to what I heard a COTA say to a patient one day and within earshot of several others. He told of his fantasy of killing his ex-wife.

There are a million stories in ankle weight city (this is a play on the opening narration for every episode of Naked City.

I'm old.

[Diane]

Diane, excuse my enjoyment of playing devil's advocate, but it seems to me that one could easily argue that the least (physically) invasive procedure that harms no one is Reiki (https://www.youtube.com/watch?v=jEREaXoC9Zo). It’s even 'evidence based' in the context of improving well-being, relaxation, pain relief, sleep quality and reducing anxiety for some people http://ajh.sagepub.com/content/29/4/290.short .

Evan

I disagree.
Reiki is invasive, abusive even, to the cognitive domain. It does not encourage self-efficacy. It's a totally operator-model, a-scientific/anti-scientific, so-called treatment.

[Barrett Dorko]

I'm with you Diane.

There's a modification of a famous saying that goes:

Sticks and stones can break my bones but words cause permanent damage.

I first head it said in this movie.

1988. Many therapists were not yet born. Maybe that explains it.

[Chunk]

Evan,

Obviously, the least invasive form of care out there is treatment over the phone.

This actually works quite well! I've done my time on Physioline!

[John W]

why is this method better or more defensible than ginger doing CM, travell releasing trigger points, flynn's HVLAs, or Barnes doing CS.

Josh,
I'm not sure what you're asking here, but I think you might be hung up on what the DPT programs are selling as "evidence-based practice". You seem to want some statistical confirmation that a therapist is able to promote or catalyze a patient's own instinctual tendency for correction, and there's nothing wrong with that. However, if that's the case, then your comparison of SC to all the other methods above makes not sense at all.

All of those methods have been questioned here on the same grounds: they lack a defensible premise to explain why they are necessary, much less effective, to help a patient with a non-pathological pain problem (or to alleviate the non-pathological aspect of a pathological pain problem). In all the years he's been here, ginger has never presented anything remotely defensible- "spinal protective behavior" remains a mystery to everyone but him. Barnes is known for MFR (not CS), and he gets a bit aggressive when his theory, such that it is, is questioned. I would be very careful there.

Barrett simply presents his method based on as far as I can discern, an eminently sound and plausible theory. And, as far as I know, he's never attempted or threatened to sue anyone for questioning it.

There aren't teams of researchers around the world investigating methods to catalyze ideomotion because it represents a significant threat to the current operator-based paradigm that dominates rehabilitation for painful musculoskeletal conditions. Until that changes, I don't think you'll get the hard numbers that you seem to crave.

[Barrett Dorko]

As usual John, you're right there and seeing the world of therapy through Josh's eyes is possible. It takes some work when (like me) you were born during the Truman administration, but, still being able to read and reason, you can see through the arguments in opposition presented.

Saying my ideas are no different really than Barnes' is easy.

Very easy.