Enough is Enough

[Jason Silvernail]

Geoff-
Ive thrown out no methods here, only bad explanations. The fact that after all these years here you don't see that is a testament to how deep seated these issues are.

[ginger]

Yes Jason , my issues are deap seated. Curiously though I also identify strongly with the nervous system as the primary construct affecting MSK problems. I have many points to agree with in your rant. I don't get perplexed any more by others lack of understanding though, just go about the business of teaching those who listen a better way of recognising their pain experience . My hands are still and always wil be my primary tools, explanations always work best in the light of a positive experience I find.
The babies can wait.
cheers

[zimney3pt]

Great read Jason.

My wife and I just had some dinner with some friends and one of them asked for some input on her back pain she has been having. I had to cringe inside as I heard about the Chiro and then PT treatments and explainations she had been getting (see your initial post for all the things that made me cringe). As I enjoyed my salmon and a good Sam Adams Winter Lager I tried to do a little deconstruction, but so much damage done.

Thanks for your rant, we need constant reminders (even though we get it daily from many of our patients), of the changes that need to be made with improved education and treatment for our patients and the society as a whole.

[Johnny_Nada]

I will be starting in a new location with a different company this coming week so I thought I would go in and shadow a PT to get an idea on paperwork, the who, what, where of the clinic. As I shadowed a PT I kept hearing the term 'alignment.' Prior to getting a pt. from the waiting room I was told that the patient is now in alignment so we would be working on stabilization to maintain said alignment. Then the pt. had 7/10 pain. The patient's SIJ was re-assessed with palpation of the long dorsal SI ligament, seated PSIS alignment, supine to sit test. Only positive was pain with palpation, 'alignment' was good, however pain persisted. Hmmmm?

So, I went back to read the original posting, which I think is great BTW. I am curious why this never made it to the EIM blog. I have a feeling it would get some comments...

[Gil Haight]

Jason,
Great stuff. Obviously there is a common denominator here and clearly the nervous system (study of) lies outside it. It is entirely possible they will never "get it". I think Barrett is right. For them, there is no other side. It is sort of like the Catholic Bishops. Since I'm the chairman of my parish council, I get to say this.
Gil

[Jon Newman]

Gil,

That's something I didn't know about you. You have an insightful voting constituency.

[Craig Liebenson]

Jason,
Well said. Definitely not a rant. Pain is in the brain as those here know (or believe). If amputees feel limb pain; and individuals born without limbs feel those limbs, then clearly people who feel pain in a tissue are "feeling" this with their minds. S Dworkin said in chronic pain patients that the "hurt that you feel, becomes the feeling that you hurt.".

For those of us in the trenches to help our patients I agree we must not perpetuate the myth that the problem is "in" the tissues. It is certainly "felt" there, but this is because the brain houses representation zones where learned sensations are "neurotagged" as Butler/Mosely put it.

A modern neuroscience based patient education approach is liberating for patients and does not mean we can not perform manual therapy or offer exercise training. As Diane shows w/ her dermatoneuromodulation posts.

Reducing threat value of pain should be job 1 as we evolve our appreciation of where pain is coming from. Or better how pain persists and what we can do about it. Your post lucidly points out the pain persisting influence of a tissue specific educational approach.
Thank you!
Craig:thumbs_up

[Jason Silvernail]

Body In Mind blogpost

Thanks to Lorimer Moseley for the exposure!

[Jon Newman]

Even more street cred for you Jason. :thumbs_up

[Jason Silvernail]

The tissue-based holy grail continues.
This is post 41 here: http://www.somasimple.com/forums/showpost.php?p=114461

We've been over this process before with these tissue-based models.

In the 1970s it was all about the spinal joints. Congresses, research, studies, interventions, etc, etc. You were a fool if you didn't think the joint was "where the real action is". Everybody who is anybody was talking about the joints, treating the joints, manipulating the joints. Does pain come from joints? No. That research was fine but showed most of the structure and degenerative changes of these joints to be not relevant to everyday clinical practice. We learned some interesting things about the joints, how they move, how they are innervated, and some treatments targeting them were tried. We did learn some things on the periphery of painful issues, but no huge breakthrough. So we looked elsewhere.

In the 1980s it was all about the intervertebral disks.Congresses, research, studies, interventions, etc, etc. You were a fool if you didn't think the disk was "where the real action is". Everybody who is anybody was talking about the disks, treating the disks, manipulating the disks. Does pain come from disks? No. That research was fine but showed most of the structure and degenerative changes of these diskss to be not relevant to everyday clinical practice. We learned some interesting things about the disks, how they move, how they are innervated, and some treatments targeting them were tried. We did learn some things on the periphery of painful issues, but no huge breakthrough. So we looked elsewhere.

In the 1990s it was the core muscles. Congresses, research, studies, interventions, etc, etc. You were a fool if you didn't think the core muscles were "where the real action is". Everybody who is anybody was talking about the muscles, treating the muscles, manipulating the muscles. Does pain come from muscles? No. That research was fine but showed most of the structure and degenerative changes of these muscles to be not relevant to everyday clinical practice. We learned some interesting things about the muscles, how they move, which exercises activate which ones, how they contribute to spinal stability, how they are innervated, and some treatments targeting them were tried. We did learn some things on the periphery of painful issues, but no huge breakthrough. So we looked elsewhere.

Now those boosting the fascia want me to ignore all this history, and pretend that now, just now, we have key important information that will change things - and it's in the fascia. This time it's for real. Sounds like a familiar story to me.

I'm willing to bet there's some interesting information in these Congresses. I'd like to think that this sort of basic science can change practice in some way. I think there may be good material I'm overlooking because I haven't investigated the fascia research in more detail. But why can no one point out even one study that has even one clinically relevant pearl of information that changes anything we are doing in the clinic?

When asked, they respond with accusations of personal attack (none have been made), refusal to look at evidence (silly seeing as how we are asking for it), bias against fascia (there may be some truth to this but its not without reason), and vague accusations of "tone."
When they do respond, only one person (to his credit, Don Solomon) has so far provided one article (Chaudhry et al J Am Osteopath Assoc. 2008;108:379-390) that actually seemed to contradict most of the major claims of fascial importance. Subsequent responses have been "orgies of evidence" with multiple YouTube clips, and random citations with author opinion statements taken from the article without clear evidentiary support. This is a very familiar pattern with purveyors of pseudoscience, and it does not help the community of practitioners who think fascia is important to approach the issue in this way.

I'm still listening. If someone who thinks fascial knowledge really changes something in the clinic, really has a clinically relevant piece of information, I'm open to hearing it. Provide the citation and let's discuss it. I don't expect it to be perfect - the studies I base my practice on (available on request) aren't perfect either. I'm not looking for perfection but for information that a reasonable clinician would judge to be relevant to their practice in some important way. I don't think that's too much to ask, and alternatively silence and then a barrage of citations and opinion statements from respondents is no way to have a clinical conversation. And no way to convince people, either.

[amacs]

Hi Don,

is it necessary to invoke fascia in order to explain the effects of treatment observed or is there alternative explanation with sufficient explanatory power for the same effects.

If there is an alternative then surely it comes down to which is the simpler explanation?

does the fascia fulfil such criteria?

regards

ANdy

[Clark]

Dear Jason,
At some point in my life I would like to buy you a beer. Or maybe 2. That totally just made my day, as I am doing a clinical under a CI who is under the impression that painful passive range of motion 30 minutes a day somehow improves hip fractures.

I also learned from this thread that I can put a passive aggressive "cheers!" at the end of anything and make it sound less backhanded. I'll have to remember that!


Cheers!
Lauren

[Diane]

Don't forget the equally useful "have a nice day" and "with all due respect."

[Johnny_Nada]

A bump to this thread is always a good thing.
So are visuals...

[John W]

Matt, that's brilliant. :thumbs_up