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  • #91
    That is FUNNY, Barrett.
    I agree though - saying "it's just placebo" is a sign of ignorance indeed. The fact that the time frame of placebo is not even on the radar of many scientists, tells us that it still is considered "a scientific variable" in controlled studies - NOT a valuable avenue of exploration. Hence the pooh-poohing of biofeedback as a valid rehab tool, because its studies were not properly "placebo-controlled".....
    Placebo-controlling a technique that aims at the very brain/system the placebo takes place in.....Mmmmh, now how are YOU going to do that Diane?
    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


    • #92
      Mmmmh, now how are YOU going to do that Diane?
      Alas, Bas, I will have to do 3 month to 3 year to 3 decade followups. I guess when the subjects finally die without having any pain recurrance, we will be able to assume that either
      1. the treatment effect was not "just placebo", or..
      2. it was placebo that lasted the rest of their lives, which in retrospect will have to be reframed as not such a bad thing at all..

      That's likely the only thing that will convince mesoderm-for-brains out there.. :cry: :cry: :cry: :cry: :cry:
      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


      • #93
        That's likely the only thing that will convince mesoderm-for-brains out there.. :cry: :cry: :cry: :cry: :cry:

        "mesoderm-for-brains" - I love that.

        BTW, I am meeting with a local new MD who is starting a chronic painclinic in town with a few more MDs - He had heard about me (always a scary idea!) via via, and wants to see if I could bring "my ideas and expertise" to the table.....

        Could we be that lucky? A chance to yack about skin, motion, brain, etc etc... I can see what their approach is and hopefully I can convince them that they don't have to get carried away with injection-type therapy :angry: , but I am only mildly optimistic.....Even if they will use PT as an option to refer chronic pain pts to, I will be happy. At least a possibility of MD-recognition of chronic pain as something other than "depressed personalities"....

        Just had to let that out.
        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


        • #94
          Bas,

          Best of luck. You'll need it by the way. My personal refusal to pose as a personal trainer that the insurance company will pay for or a pseudochiropractor somehow acceptable to the medical community has generated enough disinterest and apathy to all but end my clinical practice, and that's not far off.

          I think we often have ideas about what the physician wants for their patients that have nothing whatsoever to do with reality. It's certainly the case that the physician has no clear idea of what some of us know or might do. Nor do they care.

          At least, not in Ohio.
          Barrett L. Dorko

          Comment


          • #95
            Dunno about people ignoring the placebo effect...doctors tend to generally dismiss it, but 4-5 years ago a lot of Oz PTs figured that there was no real way the placebo response could be excluded from treatment, so we should make the most of it.

            Quite a few of PTs I have come across over the last several years figured that most of physiotherapy is primarily placebo-based in effect, but we had to make a show of being all objective and importantly mesodermal to look good, and separate us from the complementary practitioners. Probably true. And maybe a lot to do with the fact that many Aussies don't tie themselves in anguished knots over whether they are 'doing it right' or not.

            I fib...I added the importantly mesodermal bit. They didn't. Skin has not been invented yet here.

            Nari

            Comment


            • #96
              Hey Bas, good luck being a PT ambassador to this pain clinic guy.
              If you make even a dint it will be very good. Dint with all your might.
              Nari, maybe someday Aussie therapists will evolve skin. We can only hope.
              Barrett, when you don't have the ball and chain of the clinic you can retire into full time teaching.
              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


              • #97
                Bas, I recently wrote a letter to an anesthetist who runs a local pain clinic. To be as specific as possible about what I do without condemning myself as a therapy side-show I wrote that the aim of my treatments are to "optimize the cognitive-evaluative, sensory-discriminative and motivational-affective inputs to the body-self neuromatrix in order to positively influence its output." I figure if he's worth the car he drives in that should mean something to him. I haven't heard anything yet.

                Eric
                Eric Matheson, PT

                Comment


                • #98
                  Eric, that's hilarious.

                  Anything over two syllables could make him miss that red light.
                  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


                  • #99
                    Barrett - I have the distinct feeling that I will need all the latest research and papers memorized (the latest Newsletters from our Canadian CPPSG included) to make even an impression of having some knowledge of chronic pain and some options for its treatment. It is not likely they will appreciate my (our) particular approach, since there is not much for them to do - at least not things they LIKE to do...

                    Eric, that is funny. I might steal your line....

                    I do want to talk about skin to them and gentle handling and motion. Plant a seed - provide them with a link to SS and the great stuff you all have been posting and the "Great conversations" and "Deconstructions"...

                    Don't hold your breath...
                    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


                    • Sebastion, it's straight out of Melzack's article in the Journal of Dental Education, it comes complete with a picture.
                      Attached Files
                      Eric Matheson, PT

                      Comment


                      • Thanks Eric.
                        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


                        • I thought I would come back to this thread started by Nari so long ago now, to put down the piece I wrote for the May CPPSG newsletter (there a lot more in it than just this piece, so I'm attaching the entirety of it again, here, as well).

                          What I'd like is that anyone who feels this small article, separated out and printed off, complete with a picture of a cutaneous nerve attached to skin, would be in any way helpful in supporting their credibility, please feel free to download and use it. Free. Straight up. No holds barred. No restrictions. Nada.

                          Toward a deeper model for Manual Therapy
                          Cutaneous Innervation, Skin Ligaments, and Small Scale Neurodynamics
                          By Diane Jacobs


                          Figure 1: Right arm view from medial to lateral. Lateral cutaneous nerve of the forearm (LCNF) and its cutaneous rami, still sleeved in skin ligament tunnels, are shown in black. Superficial branch of radial nerve is shown in red anastomosed to LCNF. Medial cutaneous nerve of the forearm is shown in green, partly dissected.

                          For decades I’ve been a soft tissue kind of manual therapist, using gentle means to elicit pain relief in patients. My preference for kindness to both tissue and patients was instilled during neurorehab days and has carried over into private practice. A large part of the process in neurorehab is about treating in modest amounts followed by watching and waiting for the patient’s system to self-correct rather than about perfecting one’s treatment “technique”. This kind of handling seemed to work well for most types of pain, so I just plugged along doing my best. Over a decade ago I came across Butler’s first book1 on neurodynamics. In what appeared to be a long step forward, his theory combined the idea of neural tunnels, manual treatment, and good pain science.
                          Fast forward a few years: an article appeared that discussed skin ligaments (SLs), responsible for holding the skin onto the body and the various layers of skin to each other, and this statement jumped out: “When a blood vessel or nerve was present, the fibers of the SLs formed a fibrous sleeve around the structure/s”.4 I wanted a chance to see these structures for myself and how nerves were conveyed to the skin, what their general orientation was, and how did it all look in situ?
                          Eventually an opportunity arose to dissect skin to take a look at it from the inside out, explore cutaneous nerves and their skin ligaments, and photograph the results. There were some surprises in store, such as how firmly the cutis is connected to subcutis, how extensive the ligament system is, and how thick the cutis/subcutis (CsubC) is compared to how small the musculoskeletal system is (e.g., biceps were only about an inch and a half in diameter, but the CsubC was a half inch thick in the upper arm). Through past research I have gained much appreciation for the role played by CsubC and its innervation in terms of physiology and homeostasis. Therefore, since dissecting a few cutaneous nerves and their branches, it has become increasingly clear to me how considerate and careful handling might have large positive effects on common persistent pain at a basic physical level. All these sensors and autonomic effectors are directly embedded into the CsubC from underneath. My working hypothesis has expanded to include the following: stretching the skin introduces motion into the cutaneous rami below, relative to each other and also between individual rami and their own little sleeves or “neural tunnels” (SLs). Mechanoreceptors of deeper (but still soft) tissue are affected, not just surface cutaneous mechanoreceptors.
                          When dealing with people in pain I’ve noticed all along that they seem to relax a lot better if their exteroceptive input (i.e., contact from me) remains mostly non-nociceptive. Since studying the layout of neural “twigs” into skin, even in only one arm, I can now understand more clearly from a practical point of view why some grips and methods are more comfortable and relaxing for patients than other ones.

                          Are there broader implications? I think there may well be.
                          At the moment, physiotherapists who want to treat pain manually are confronted by a bewildering plethora of methods and techniques each accompanied by its own explanation; many involve handling or needling of the superficial layer of the body, often with muscles or fascia or ‘trigger points’ in mind. Orthopaedic manual therapy targets, mobilizes, manipulates, tries to improve joint motion. Australian neurodynamic approaches based on modern pain theory are relatively new manual applications that introduce movement between large deep nerves and their tissue containers1.2.3. Many PTs use combinations of all of them, but with no consistent model to guide them, they tend to shift from one entire treatment construct to another as well. Many of these treatment constructs are dubious and outdated.
                          In general I think it’s fair to say this important and sensitive layer of the body has been ignored for too long by most manual therapists– certainly the cutaneous nerves have. It seems obvious to me now, post dissection experience, that any form of manual therapy, whether it is targeted to superficial tissue, superficial nerves, deep tissue, or deep nerves, whether it is based on pain theory or some other theory, cannot be performed without first mechanically deforming and thereby neurologically affecting the outer layer. Therefore I’m of the firm opinion that a good detailed survey of these little structures and of the CsubC everywhere in the body would be of good use to manual therapy as a whole. Letting this layer and its nerves remain “unknown” is to let them remain a potential confounding factor to continued scientific investigation of manual therapy applications. To this end I encourage manual therapists everywhere to approach anatomy labs, study the physical layout of the cutaneous nervous system, its branching patterns and everything it supplies, and add these findings to our collective understanding.

                          ACKNOWLEDGEMENTS My sincere thanks and appreciation to Dr. Donna Ford at UBC for facilitating this study, and to Dr. Wayne Vogl for permission to photograph. A full article is being written.

                          REFERENCES
                          Books
                          1. Butler DS; Mobilization of the Nervous System, Churchill Livingston 1991
                          2. Butler DS; Sensitive Nervous System, Noigroup Publications 2000
                          3. Shacklock M; Clinical Neurodynamics; Elsevier 2005


                          Articles:
                          4. Nash, LG et al.; Skin Ligaments: Regional Distribution and
                          a. Variation in Morphology; Clinical Anatomy 17:287–293 (2004)
                          See attached.
                          Attached Files
                          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


                          • I decided to move a copy of this thread from the PPP forum to the DNM forum. Nari started it, so I renamed this copy, "Nari's thread".

                            For the longest time skin stretch had no name. In this thread is the sequence of interactions that led to the adoption of the name, dermoneuromodulation, and, I suppose, eventually to the creation of a forum to put the thread into.
                            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


                            • I don't know if this Lumpkin article on mechanical transduction was ever added to this thread, but I'm doing it now.
                              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


                              • Nari mentioned this article a long time ago in another context, and I recently unearthed it. I thought it would be fitting to bring it here.
                                The topic is on circadian rhythms found in skin cells. I'll see if I can find the actual article and post a link to this thread.
                                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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