An ugly hole

[Barrett Dorko]

Although we have been conditioned by personal experience and a long tradition in science to equate pain with injury (or objects that cause injury), they are not actually equatable.

David Biro

This is perhaps the hardest thing I have to teach. I can also quote Wall on the matter as well but it doesn’t make much difference. There have been many therapists look at me when I make this point, and I can tell what they’re thinking; “Oh really Barrett? How about I punch you in the nose, break your face and see whether or not you hurt?”

No, I don’t have to read their mind. The ideomotion is easily seen, especially the clenched fists.

When we take away the injury meme we expose the enormous hole in therapy.

It’s ugly.

[garydiny]

Barrett,

I have often used the example of pinching one's arm, or having one's arm get pinched.

It certainly will cause an experience of pain, yet no tissue damage is evident. Patients seem to get this nearly 100%. They realize that if whatever stopped pinching their arm, the pain would be resolved.

Pain did not mean something was damaged, but something was in a state of need for a different action/lack of action.

Maybe you could ask the participants in the class to pinch their neighbor, or them selves to "prove" the point.

Gary

[Barrett Dorko]

I've used this example, and others.

The problem is not the therapist's inability to understand, but their ability to change, admit they've been wrong their entire career and do what is necessary to know more.

They don't call me Barrett the Great Destroyer for nothing.

Well, okay, they don't actually call me that, but I'd like to hear one day.

[Jon Newman]

I'm just reading Biro now. On page 61 he states (bold mine):

...Wittgenstein assures us that we can communicate what we hold to be most private, but to do so we must rely on the public sharable aspects of those experiences.

I think another name for "public sharable aspects" would be "culture". There are numerous cultural stories that people can subscribe to even if they all share a similar narrative.

I think losing a well rehearsed story and having to learn (and teach to patients) a new one at least takes time for the therapists that are willing. It's probably too much for some.

I think the idea ties in nicely with an excellent question Frederic asked in the Ask Dr. Bialosky a Question thread.

Should'nt we try to find better/new ways to achieve these, and superior, neurophysiological effects instead of constantly revisiting the same ones, actually invented along the lines of a biomechanical paradigm?

Q5 : Do you think, these mechanically oriented treatments maintain their popularity because they fit nicely in the patients and therapists' default belief system?

[zimney3pt]

The problem IMHO is our continual need to justify our treatments. It is interesting that we choose to justify (to show to be just or right), the only way to justify something is right is for it to be right 100% of the time. Unless we get every patient to complete resolution of their symptoms 100% of the time, we can not "justify" our treatment. We have to accept we do not have the right to "justify" things because we are not infallible. This is one of humankinds biggest faults.

With changing behavior I think it sometimes is important to begin where other people are. Noiception (tissue injury/danger signals) is a variable in the pain equation, and can be a powerful one, but it is not the only variable. We have to appreciate the complexity of the nervous system and the pain equation. No complex equation can be solved with knowing one variable. I do not know anyone using algebra skills that can solve for P (pain) in the eqation P = I + T + N + S + B + E + M, if we only know the values for T (tissue) and I (injury). Especially since the brain can change any of the addition signs to subtraction, multiplication or division at any given time. Also some of the list of other variables is always changing. Wouldn't it be nice to try to learn about a few of the other variables a little? Don't your patients come to you for wisdom to help with solving their problem? How can we help out to the maximum with limited wisdom?

We have appreciate and except we can not justify any treatment, but we can do better.

[Frédéric]

Barrett,

You are right, once the ideas that there is an injury to the tissue or a maintained pathology in the tissus are out, the traditionnal mindset of most PT is left with a hole with a whole lot of cognitive/psychological issues that come with it. Ones that one will often protectively try to avoid. After all, the whole profession is resting on these pilars of sand. He who wants to willingly confront this is aware that agitated waters lay ahead.

Most have always based their whole clinical reasonning, pt's explainations, treatment justifications and so on, on this very premise.

Gary,

About the pinched elbow analogy :

It fits provided the pain is secondary to a mechanical deformation that can be alleviated.
Many chronic pain conditions are sustained without such mechanical influence, such that in the pinched arm analogy, the arm would remain painful even a long time after the pinching has stopped.

[Barrett Dorko]

Kory,

I really like your post, and, accurate or not, I'm going to call it The algebraic analogy of Zimney.

Sounds exotic.

[zimney3pt]

Thanks Barrett, interesting you would choose exotic as your description of this. From Dictionary.com

ex·ot·ic
 
–adjective 1. of foreign origin or character; not native; introduced from abroad, but not fully naturalized or acclimatized.
2. strikingly unusual or strange in effect or appearance.
3. of a uniquely new or experimental nature.

This is what I felt like (as I would assume most did) as a traditional mesodermal therapist when I openned myself up to additional wisdom of the ectoderm and what the brain and nervous system have to do with all of this in regards to pain.

(I left off definition #4 out on purpose, you can look it up for a good laugh, though it might somehow tie into skin....lol)

[Barrett Dorko]

True for me too - the "foreign" part, I mean.

Anyway, Zimney sounds like a foreign country or, at least, a region of one.

It's non-Euclidean, non-linear math by the way, which fits perfectly.

[nari]

Kory,

I really lke your algebraic analogy too.
Written out in full, it may help others in their pain/injury/pathology dilemmas.

Nari

[garydiny]

Kory, I love this equation you posted.

With changing behavior I think it sometimes is important to begin where other people are. Noiception (tissue injury/danger signals) is a variable in the pain equation, and can be a powerful one, but it is not the only variable. We have to appreciate the complexity of the nervous system and the pain equation. No complex equation can be solved with knowing one variable. I do not know anyone using algebra skills that can solve for P (pain) in the eqation P = I + T + N + S + B + E + M, if we only know the values for T (tissue) and I (injury). Especially since the brain can change any of the addition signs to subtraction, multiplication or division at any given time. Also some of the list of other variables is always changing. Wouldn't it be nice to try to learn about a few of the other variables a little? Don't your patients come to you for wisdom to help with solving their problem? How can we help out to the maximum with limited wisdom?

Can you fill in what each letter you are referencing. I have my thoughts, but want your thoughts. I would also like to use this in my presentation I am giving on Thursday 10-28-10.
P= pain
I= injury
T=tissue
S
B
E
M

I concur with Barrett in its title.

I'm going to call it The algebraic analogy of Zimney

Gary

[Diane]

If E = education, it maybe should be 2E
Education x educator= 2E

(haven't done any algebra in a long time. Is 2E the right way to describe a multiplied factor?)

[Jon Newman]

If E = education, it maybe should be 2E
Education x educator= 2E

(haven't done any algebra in a long time. Is 2E the right way to describe a multiplied factor?)

Education and educator wuold have to be 2 different variables (because they're not equal) such as Etion and Etor and their product would be EtionEtor. But 2E works for me and you've clearly got the right idea.

[Barrett Dorko]

As soon as Kory develops the model I intend to make a slide out of it.

I'm sure he's working on it feverishly.

[zimney3pt]

I'm glad it has been received well. Wish I could say I knew all the variables in the equation, it would make working with patients a little easier.

When I quickly was putting them down my thoughts were S = spinal cord, B = brain, E = emotions, M = motivation, I know I left out many others. I do like the 2E.:clap2:

That is the interesting thing about it, is it probably fits into Chaos Theory (if I could really grasp what that is all about). It is non-linear as you stated Barrett.