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Scrutinity Sunday I

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  • Scrutinity Sunday I

    Facts are stubborn things.

    John Adams, in the 1700's
    Knowing what is true (as far as we know) tends to be somewhat lasting, and it lasts for a long time. It haunts us and, like the casual comment, tends to be remembered.

    Is there something about therapy that has haunted us? I should ask why an injury or painful event commonly not noticed before it is brought to the attention of the one it actually happened to. How might the context affect this?
    Barrett L. Dorko

  • #2
    Scrutiny is defined as " critical observation or examination." What does examination (as it is taught) reveal? I'm not suggesting that therapists stop examining people. It seems that examination has not kept up with what might have been discovered (and verified) by the scientific method as we live our lives. This would, of course, include the lives of therapists as well. (duh). This is why I say that science has been bypassed. There's a reason I began this Sunday series with a quote from John Adams in the 1700s.

    I'm always wondering about therapists who proclaim that they're "too busy helping others" to answer questions. I have called them "thoughtless' before. If they're alive, I still think so.
    Barrett L. Dorko

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    • Richard Finn
      Richard Finn commented
      Editing a comment
      " What does examination (as it is taught) reveal?"

      I've included standing postural and muscle length testing in my evaluation for many years. I originally did it to discover what was "wrong" and needed "fixed." It gave me information to put in my notes and reports. It was important for patients to see that they were in the hands of a "professional." The way the therapist interprets the information to the patient sets up how the information is interpreted by the patient. Now I don't really think the tests are telling me all that I thought before.

      I still do all of the same tests and I've added a few more. The narrative has changed. Instead of saying "That's really bad" or "Really poor posture, dude" I explain that this is how the brain has decided to protect itself. It took in all kinds of information from your thoughts , feelings, and input from the body and created this posture and ROM. Your muscles appear to be doing their job. Then I ask - Have you ever been wrong? That usually gets a laugh.

      Then I explain that the brain doesn't always get it right. We need to give it some more information and see if it changes it's output. After a bit of treatment we perform a few tests again. The patient gets to see that changes are happening. I think this gets to be a bit limbic - the change often sets them up to expect more change. I think that this is a bigger part of improving my outcomes than my "skill." The tests are an important part of how I communicate on a level that includes more than conversation.

  • #3
    You're right Richard, as usual. How things are interpreted and explained makes all the difference. I love your question about ever being wrong. Of course, I've never been. This is the introduction of humor and honesty (an aspect of what is funny) into something "more than conversation."

    I'm wondering how many of us could tolerate the kind of scrutiny therapy does. I sure couldn't.
    Barrett L. Dorko

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    • #4
      The narrative has changed. Instead of saying "That's really bad" or "Really poor posture, dude" I explain that this is how the brain has decided to protect itself. It took in all kinds of information from your thoughts , feelings, and input from the body and created this posture and ROM. Your muscles appear to be doing their job.
      Hey Richard!

      I really liked your last post, and the passage above (the notion of muscles doing their job) seems to be a good way for coaches to approach what they might initially interpret as a mechanical flaw when, in the absence of any pain, that apparent flaw may in itself be a correction for some structural asymmetry they don't even knows exists.

      That's something Mel continued to bring up in our discussions years back, and it continues to make perfect sense to me.

      Comment


      • #5
        Ken,

        "Making sense" seems to be the job of science. No wonder it seems to have disappeared. Making sense of things isn't any longer considered. It is commonly claimed by many that they're "too busy" to offer any arguments - only opinions.
        Barrett L. Dorko

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        • #6
          Watching a magician look at (scrutinize) another magician is telling. The one watching notices how they move, interact and "fool" others. They (other magicians) are watching for performance. They are not looking for actual "magic," because it doesn't exist. That doesn't mean there aren't other things to look for.

          In therapy, there are other things to question the one acting (the therapist) about. What has happened to that time?
          Barrett L. Dorko

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          • #7
            The likes of Penn and Teller, and Derren Brown would be welcome additions to most therapy departments.

            Therapist says "yes! What a great outcome!". Magician says "That was a good outcome, but I saw how you did it. What worries me is, that despite the outcome, you yourself didn't see how it really happened. And if you as therapist are unaware, then you cannot possibly optimize the process for yet better outcomes".

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            • #8
              Magicians offer no arguments to explain "how they did it," just go on to next "trick." You should read more.
              Barrett L. Dorko

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              • #9
                The two I just mentioned are big on explanations. You should read more.

                By the way, I'm very observant. I know all your tricks.

                Comment


                • #10
                  There's a difference between a "trick" and an argument. The first depends upon the unreliability of our senses, and the second the thoughtfulness that is present. I have offered an argument that has to do with what we know (so far), I'm not depending upon our not "knowing" something because it's invisible. There are sources that are reliable and those that are not.

                  Some explanations make no sense or depend upon physical law that has shown to be untrue, I've followed science - thus my arguments and my tendency to dismiss "belief." I once said, "I'm a skeptic. I don't believe in things. I understand them as best I can."

                  I got in some trouble for that, but I would say it again.
                  Barrett L. Dorko

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                  • #11
                    Hi Eg!

                    What worries me is, that despite the outcome, you yourself didn't see how it really happened. And if you as therapist are unaware, then you cannot possibly optimize the process for yet better outcomes".
                    I get what you're saying, but is total awareness of how something worked--or why it worked---ever really attainable considering that it is the patient who whose movements (and perceptions) are what determines success?

                    This makes me think of something coach Gerard Mach used to say about the dangers of making certain mechanics interventions in sprinters: the operation was success...the patient died. Charlie Francis often said the same thing.

                    Comment


                    • EG-Physio
                      EG-Physio commented
                      Editing a comment
                      Not really sure about your question Ken.

                  • #12
                    Thanks Ken!

                    I notice that I put an extra "I" in scrutiny in the title of this series. I should look more carefully.

                    Anyway, your point about how the patient might consider things is well-stated. I'm reminded of a movie about Bobbie Knight's (an Ohio boy) coaching career, He had talked a player into Indiana's program but didn't like his motion on his shot.

                    I knew there was something wrong with that.
                    Barrett L. Dorko

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