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Battle Cry of the Puritan Ethic

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  • Battle Cry of the Puritan Ethic

    The earliest reference I can find is in Poor Richard’s Almanac, compiled by Ben Franklin in the 1700s.

    There is no gain without pain.
    More recently I’ve seen therapists wearing No pain, No gain on tee shirts, I’ve seen it on posters in rehab departments and, daily, I hear a COTA I work beside say this in a patient’s face followed by her own laughter.

    I don’t need to explain here how phenomenally stupid this is. Why do memes like this endure? Two reasons:

    1) It matches the Puritan Ethic that dominates therapy

    2) It rhymes
    Barrett L. Dorko

  • #2
    One could translate it into: no effort, no progress. And extreme effort can be painfull !

    Comment


    • #3
      Whenever I hear patients or the trainers in the gym I am located at use that quote, I refer back to Butler's "know pain, know gain". We should put that on a shirt.
      Mike Hoy, PT, DPT
      Orthopaedic Certified Specialist
      Fellow of the American Academy of Orthopaedic Manual Physical Therapists

      Comment


      • #4
        Once someone is in the physiological state of allodynia or hyperalgesia, pain is no longer an helpful indicator as to whether you're doing something helpful or not. Helpful things can hurt as well as unhelpful things. The "no pain, no gain" ethic, I think, leads people to flare-up more frequently and unnecessarily. It's insufficient if not frankly bad advice. The other major pain management strategy or ethic people frequently employ is "let pain be your guide." Again, in a physiological state of allodynia or hyperalgesia, pain has stopped becoming an indicator as to whether you're doing something helpful or not. It's insufficient if not frankly bad advice.

        I agree with Mike. Understand pain in order to help someone in pain. But even having a neurophysiological understanding is insufficient to actually help someone. Being able to apply the information is the crux of the biscuit.

        Corollary: Something helpful might actually feel good.
        Last edited by Jon Newman; 15-02-2010, 03:41 PM.
        "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

        Comment


        • #5
          Last night was watching an interview with Kristina Groves, who won a medal for speed skating. The interviewer asked her about pain or about skating throughpain, and she gave what I thought was a great answer. She said some times there is a lot of pain. Sometimes there is no pain. That hurt was not pain. That presence or absence of pain had no bearing at all on performance - some skates in which she had pain almost from the start were great skates, and other skates which were not painful turned out mediocre in terms of performance. So she pretty much just ignores pain as being irrelevant to anything.
          Diane
          www.dermoneuromodulation.com
          SensibleSolutionsPhysiotherapy
          HumanAntiGravitySuit blog
          Neurotonics PT Teamblog
          Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
          Canadian Physiotherapy Association Pain Science Division Facebook page
          @PainPhysiosCan
          WCPT PhysiotherapyPainNetwork on Facebook
          @WCPTPTPN
          Neuroscience and Pain Science for Manual PTs Facebook page

          @dfjpt
          SomaSimple on Facebook
          @somasimple

          "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

          “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

          “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

          "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

          "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

          Comment


          • #6
            Can "Ignore the pain, no gain" be applicable in certain circumstances? For example, when therapists screen for "faulty movement patterns" / or instruct in neuromuscular re-education in the presence of pain.
            Anders.
            "There is nothing so practical as a good theory." -Kurt Lewin

            Comment


            • #7
              I doubt that in a treatment context, with non-athletes, it would be very fruitful to ignore pain. I mean, look where that got us so far.

              Athletes, elite ones, are so.... "inputted" by everyone around them; they are the star but there is an entire crew around them cheering them on, motivating them, distracting them, keeping them focused on the glory of a possible medal, keeping them funded and buoyed up and distracted from their "pain"... pumping them full of encouragement and measuring their every little physiologic advance, looking after them psychologically and socially that they are carried through the "pain" of it all, i.e., it's about nation-building and all sorts of distracting notions that make their "pain" seem irrelevant, even to them.

              By contrast, a regular person has next to none of that going on.
              Diane
              www.dermoneuromodulation.com
              SensibleSolutionsPhysiotherapy
              HumanAntiGravitySuit blog
              Neurotonics PT Teamblog
              Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
              Canadian Physiotherapy Association Pain Science Division Facebook page
              @PainPhysiosCan
              WCPT PhysiotherapyPainNetwork on Facebook
              @WCPTPTPN
              Neuroscience and Pain Science for Manual PTs Facebook page

              @dfjpt
              SomaSimple on Facebook
              @somasimple

              "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

              “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

              “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

              "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

              "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

              Comment


              • #8
                The top speed and agility school near me here in North Jersey used to have 100lb boys lift 200lb tires. Functional strength you know. Till one of the boys injured his back. They have now moved away from the tire lifts. Not good for the bottom line and PR. You could say the boy's injury caused a lot of pain for the speed school. Train, but careful with the strain.

                That's a great find about Ben F., Barrett. Based upon that statement by Ben F., (no pain no gain), one might add S&M to Ben's other sexual picadillios.

                One might construe the no pain no gain philosophy as soft core S&M, or misplaced philosophy of stoicism. For the Puritans, it was misplaced stoicism, for Ben and wrestling coaches, maybe S&M.
                Last edited by smith; 15-02-2010, 09:57 PM.

                Comment


                • #9
                  I was a bit bored this afternoon...
                  Attached Files
                  Christopher Bryhan MPT

                  "You are more likely to learn something by finding surprises in your own behavior then by hearing surprising facts about people in general"
                  Daniel Kahneman - Thinking Fast and Slow

                  Comment


                  • #10
                    :clap2:

                    Now we just have to figure out how to get Chris bored more often. The poster was too much.
                    "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                    Comment


                    • #11
                      Our bodies are designed for regular amounts of physical stress. Stress does not equal "pain"...not sure where we picked that up but I'm ready to get rid of it as well. I think a read of Made to Stick might explain why this phase has survived the test of time.
                      Rod Henderson, PT, ScD, OCS
                      It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                      Comment


                      • #12
                        One might construe the no pain no gain philosophy as soft core S&M, or misplaced philosophy of stoicism. For the Puritans, it was misplaced stoicism, for Ben and wrestling coaches, maybe S&M.
                        Say it ain't so! Coach Edwards and Ben Franklin- perverts?!!

                        Great poster, Chris.:thumbs_up That one's going up on the wall tomorrow.
                        John Ware, PT
                        Fellow of the American Academy of Orthopedic Manual Physical Therapists
                        "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                        “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                        be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                        Comment


                        • #13
                          The problems with any slogan is that it is invariably a gross over-simplification. Especially with something as complex as pain.

                          Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series

                          Jan-Willem Ek1, Jan C van Gijn1, Han Samwel2, Jan van Egmond3, Frank PAJ Klomp4, and Robert TM van Dongen5*

                          Objective: To determine if treatment of longstanding complex regional pain syndrome type 1, focusing on functional improvement only while neglecting pain, results in clinical improvement of this syndrome.

                          Design: Prospective description of a case series of 106 patients.

                          Setting: Outpatient clinic for rehabilitation.

                          Interventions: Physical therapy of the affected limb directed at a functional improvement only while neglecting the pain, was performed following an extensive explanation. Normal use of the limb between the treatments was encouraged despite pain. A maximum of five of these sessions were performed in three months.

                          Measures: Radboud Skills Test was used to monitor functional improvement of the arms. Speed and walking distance was used as the measure of outcome for the legs.

                          Results: The function of the affected arm or leg improved in 95 patients. Full functional recovery was experienced in 49 (46%) of them. A reduction in pain presented in 75 patients. In 23 patients functional recovery was reached despite an increase in pain. Four patients stopped early due to pain increase.

                          Conclusions: Our results suggest that ‘pain exposure physical therapy’ is effective and safe for patients who are unresponsive to accepted standard therapies. Avoiding the use of a limb due to pain will result in loss of function. Forced usage of limbs restores the function, reverses these adaptive processes and leads to regain of control by practice with a reduction of pain in most cases.

                          First published on November 11, 2009, doi:10.1177/0269215509339875
                          Hat tip to "Body in Mind"/Moseley

                          Probably the key phrase in this abstract is where it says that
                          Physical therapy of the affected limb directed at a functional improvement only while neglecting the pain, was performed following an extensive explanation.
                          I guarantee that the explanation wasn't just "No pain, no gain"

                          Comment


                          • #14
                            Got to thinking more about why "no pain no gain" got so sticky. After reading chapters 1-2 in Made to Stick, this phrase does seem to fit the bill of sticky ideas. Simple, unexpected, concrete, credible(??)...

                            Is there an equally sticky retort?
                            Rod Henderson, PT, ScD, OCS
                            It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                            Comment


                            • #15
                              Originally posted by TexasOrtho View Post
                              Got to thinking more about why "no pain no gain" got so sticky. After reading chapters 1-2 in Made to Stick, this phrase does seem to fit the bill of sticky ideas. Simple, unexpected, concrete, credible(??)...

                              Is there an equally sticky retort?
                              Don't forget *stories*. Getting to the same end point with minimal pain often isn't as interesting of a story.
                              "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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