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  • The "F" word

    Function; the kind of action or activity proper to a person, thing, or institution.

    Dictionary.com
    I hear the word “functional” regularly these days and it has begun to make my skin crawl.

    Turning every movement into something “functional” seems an excuse to make things harder, more painful and/or more attractive. That someone has assigned the word “functional” to what’s being done justifies all manner of goofy and, to me, senseless practice.

    I wasn’t surprised when I saw a certain word in the definition; a word I also struggle to stomach – proper.
    Barrett L. Dorko

  • #2
    Yes, so true.

    Then there are these, similarly applicable here:
    "- routine: a set sequence of steps, part of larger computer program" (a "set sequence of steps"!);
    " - the actions and activities assigned to or required or expected of a person or group";
    " - In engineering, a function is interpreted as a specific process, action or task that a system is able to perform"
    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


    • #3
      This is one of the favorite terms used to dehumanize patients so that therapists who practice in this way can muddle through another day.

      Unless you're a sociopath, I suppose you have to define what you do to your patient in such a way that makes them less human. Otherwise, you'd suffer a bout of conscience each and every work day, which is not particularly pleasant or stimulating on any level.

      At least with dehumanizing terms, PTs can make believe that they care while applying what they think is scientific rigor to the collection of flesh and bones in front of them.

      Terms like "functional" are coping mechanisms. They're little escapisms from the drudgery of the clinic day where human beings are reduced to their moving parts.
      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


      • #4
        I have asked many folks that use this term, "if that's (insert exercise, motion, whatever they are doing) functional, then is everything else you do, not functional? So; are all the other exercises you have your patient perform non-functional? What isn't functional training/exercise?"
        "The views expressed here are my own and do not reflect the views of my employer."

        Comment


        • #5
          Matt,
          You're asking people who are desperately scratching and clawing their way through their day to rationally explain why they resort to irrational and senseless ideas to hide the fact that they are scratching and clawing.

          Be careful, you may get scratched and clawed yourself. Or punched, even.
          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


          • #6
            It seems we need a term to express what we aim to do and that fits somewhere between pleasantist and functionalist.

            Flourishmentist?
            Adaptionist?
            "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

            Comment


            • #7
              Jon,
              I think we have one: "therapist".

              Now all we have to do is be one.
              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


              • #8
                Originally posted by John W View Post
                Jon,
                I think we have one: "therapist".

                Now all we have to do is be one.
                I thought of that but using "therapy" or "therapist" doesn't seem to escape this criticism

                Originally posted by Barrett Dorko View Post
                That someone has assigned the word “functional” to what’s being done justifies all manner of goofy and, to me, senseless practice.
                Substitute "therapist" or "therapy" for "functional" and you end up at the same place.

                Also, therapy is what we're doing but to what end, if any? Most would argue the purpose of therapy is to "increase function". I think function has it's place but it seems limiting or open to the problems Barrett points out.
                Last edited by Jon Newman; 20-10-2010, 05:56 PM.
                "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                Comment


                • #9
                  The ongoing destruction of the meaning of words is something that troubles me greatly. This word "therapy/therapist" is one that I'd like to take a stand on and wrest from the clutches of the "word-wreckers" and spinmeisters.
                  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


                  • #10
                    I haven't noticed the destruction you have. I mostly see creation*. Sometimes I don't like what's been created, sometimes I do. Good luck stopping the process. I'll join you where I can.

                    *Although, I suppose, destruction and creation are frequently two sides of the same coin.
                    Last edited by Jon Newman; 20-10-2010, 06:34 PM.
                    "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                    Comment


                    • #11
                      I'm with John and Jon.

                      I sat and wrote in long hand this morning about my struggle with the OT profession in general and COTAs in particular. As troubling as I see the practice of PTs and PTAs today, the OTs and COTAs seem to be even more firmly trapped in a model of "function" that has no relation to the patient's reality but only to their responsibility to bill for services.

                      Often I hear the patients themselves question the relevance of some "fun" activity to their recovery. If they do this loudly and/or persistently they pay a price, and it's not pretty. The very best OTs and COTAs can explain why the activity is essential but most don't know or just make something up. Failing that, despair surfaces.

                      The consequences of this are even uglier.

                      Any OTs out there with an opinion they'd care to state?
                      Barrett L. Dorko

                      Comment


                      • #12
                        Funny you should mention this, about OTs I mean.
                        I posted your aphorism to the Facebook page, and my good friend Bronnie in NZ (OT) spotted this issue right away, responded through OT mental set in the expected OT way, which provided an opportunity for explaining the whole mesoderm/ectoderm divide we, from our PT side of the mountain, have to address on-goingly to get anywhere at all (and usually just get moved by avalanches and downslides of mesodermalism further back down the hill all the time, being dead like we are anyway). She got it right away.

                        Me:
                        ‎"When the primary complaint is pain, the treatment of pain should be primary." Does this engage you or enrage you?
                        ~ Barrett Dorko
                        Some other posts, then, Bronnie:
                        "At some point in people with chronic pain, there must be a move away from 'treating the pain' and back onto treating the disability, otherwise the disablement gets progressively more difficult to treat. Actually, when I write this I find myself thinking that if you fail to address the disability, beliefs and emotions about having pain or the impact of pain on the person, then there can be little point in treating the pain. The idea that just by removing the pain 'all will be well' is the sort of argument people use to justify ignoring psychosocial factors."
                        To which I replied:
                        "I agree Bronnie. I think where Barrett is coming from is that it's more important to treat with the nervous system in mind ("ectodermally") than it is to focus on tissue ("mesodermally"). A lot of manual practitioners are still stuck at the level of thinking that it's the bones that are causing the pain, or the muscles, or the joints or fascia or discs, and focus their efforts on treatment of those (even though they can't really get their hands anywhere near them); in fact, as you well know, it's the nervous system itself that actually "hurts." The nervous system spans the human organism from skin surface to sense of self, so, treating "pain", in this sense, would easily include therapy for any disabilities deriving from the pain experience, and encompass or entirely replace tissue-oriented "treatment". Does this make sense?"
                        To which she replied:
                        "Yes, that makes good sense to me, thanks!"
                        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


                        • #13
                          The problem with the word 'therapy' is that anyone at all can use it to be nice to others. And even if they are not particularly nice to others it is still called therapy.

                          It's become meaningless.

                          Nari

                          Comment


                          • #14
                            I think that we are contextual architects. We treat context. It's the only thing we can directly impact. All else is indirect and comes solely from the patient even though we can predict some things about how a human tends to respond given certain contexts.

                            I think the only thing we can do directly with function is report on its status in various ways and that is done after the fact. This reporting, of course, further builds context.
                            Cory Blickenstaff, PT, OCS

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

                            Comment


                            • #15
                              Originally posted by BB View Post
                              I think that we are contextual architects. We treat context. It's the only thing we can directly impact. All else is indirect and comes solely from the patient even though we can predict some things about how a human tends to respond given certain contexts.

                              I think the only thing we can do directly with function is report on its status in various ways and that is done after the fact. This reporting, of course, further builds context.
                              I totally agree. :thumbs_up
                              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

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