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  • Barrett Dorko
    replied
    I'm with you Jason. In 40 years I've never seen it either.

    The phrase excuses our colleagues from having to learn modern neuroscience and its counterintuitive lessons - simple as that.
    Last edited by Barrett Dorko; 02-03-2012, 07:14 PM.

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  • Jason Silvernail
    replied
    Originally posted by Jackson View Post
    While some patients come to me with functional problems, they are probably 95% of the time related to pain. My favorite quote of Barrett's (and sorry if I don't get it exactly right), "When a patient's primary complaint is pain, our primary goal should be to reduce their pain."
    Nick
    This is what I don't understand about the "I don't treat pain, I treat function" mantra. Where are these people working where people come in to the clinic and say, "You know my shoulder feels fine, but I just can't raise it up very far anymore. Can you help me with that functional problem of mine?"
    I've been in this line of work since 1997, and I've yet to work anywhere, at all, where this ever happens. You do have a few rare examples of this - painless full thickness cuff tear in an older patient, for example. But 99.99% of the time its for pain.

    That's why I was thinking maybe Valpo just works somewhere different than where I do. Somewhere different than all the places I've ever worked in 15 years of clinical practice. I suppose it's possible.

    I get many patients from other therapists that have attempted to "functionalize" them or exercise them out of their pain, pursuing function first. It's uniformly been counterproductive and the physical therapy profession has largely earned the reputation from some people that we are heavy handed and try to strengthen people out of their problems. It makes no sense to me.

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  • Diane
    replied
    I don't mind.

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  • advantage1
    replied
    I would agree but qualify it by saying, they remain committed to the conflated mess their mind was taught, i.e., a conceptual hallucination (operator model, noun) welded to their preferred handling (manual interaction, verb), based on a perceptual fantasy: the sense they make from what they sense coming from the patient's body (fleeting nouns and verbs).
    I love this quote from Diane. If you don't mind I am going to memorize it and repeat it to the next manual therapist I fall into debate with. I can't wait to see the expression on their face!

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  • Jackson
    replied
    Originally posted by valpospine View Post
    "if we are treating painful problems..." from the beginning , I do follow a different philosophy which is "treat function , not pain "
    While some patients come to me with functional problems, they are probably 95% of the time related to pain. My favorite quote of Barrett's (and sorry if I don't get it exactly right), "When a patient's primary complaint is pain, our primary goal should be to reduce their pain."

    Nick

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  • Barrett Dorko
    replied
    You're right Diane.

    The issue of a wine officianado's abilty to taste the difference between expensive and cheap wine was recently exposed on a Freakenomics podcast. They go with what they've been told is expensive, of course. Then they commonly grow angry.

    Our committment, against all reason, toward something that represents time and money should never be forgotten.

    It's just human. Too bad that in this business other humans pay the price for our willful ignorance.

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  • Diane
    replied
    Originally posted by Barrett Dorko View Post
    I also applaud the comment.

    Therapists seem inordinately committed to their way of handling. I imagine that this has to do with the fact that they are convinced that the thing in their hands is basically different from the unique, unpredictable and fragile creature they know they are. I am also aware that this sounds harsh.

    Unless we embrace the uncertainty scientific thought always produces we won't tolerate ANY questioning perceived to be of our methods.

    I would agree but qualify it by saying, they remain committed to the conflated mess their mind was taught, i.e., a conceptual hallucination (operator model, noun) welded to their preferred handling (manual interaction, verb), based on a perceptual fantasy: the sense they make from what they sense coming from the patient's body (fleeting nouns and verbs).

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  • Barrett Dorko
    replied
    I also applaud the comment.

    Therapists seem inordinately committed to their way of handling. I imagine that this has to do with the fact that they are convinced that the thing in their hands is basically different from the unique, unpredictable and fragile creature they know they are. I am also aware that this sounds harsh.

    Unless we embrace the uncertainty scientific thought always produces we won't tolerate ANY questioning perceived to be of our methods.

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  • Jason Silvernail
    replied
    Originally posted by MaxG View Post
    I think many people that oppose the general ideas surfacing here completely miss the fact that it's not always about questioning the therapeutic intervention, but the theory behind it, or the idea guiding its implementation.
    :clap2:

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  • MaxG
    replied
    Originally posted by valpospine View Post
    just to answer a few comments.
    Diane: you wanted to know something about me. briefly: Certified Manual Therapist (Paris), trained with Lewit in Prague, Janda in the US, finished Muscle Imbalances with Sahrmann.
    hope that helps to identify the approach I follow . (Barrett: sorry to hear your opinion on Stanley Paris) (he did change the way I approached our profession)(maybe you did not stay long enough)
    Jason , John and Barrett: I'm not a fascia guy, nor I intend to be.
    Jason: you had questions about the main idea of my comments. Just to summarize it: again, you said it at the beginning "if we are treating painful problems..." from the beginning , I do follow a different philosophy which is "treat function , not pain "
    my comment was intended just to be a wake up call since you mentioned that you are tired of the FasciaHead, and MuscleHead, and so on..., so none of us becomes a NeuroHead nor a PainHead. cause you know what? ... that could potentially be dangerous too.
    glad to hear that you do utilize peripheral treatments too, for a while it looked like you were so tired of them that you could not use them anymore. as you mentioned, there is a lot of evidence based manual therapy that could very well be utilized in the care of our patients. hope there is equal or better evidence in the "neuro based" theories!!
    anyway, maybe I was misinterpreted. as I said it, I do accept that in the care of pts, specially chronic ones, there is a need for a much more complex approach that the pure mechanical one. maybe the pain perception, behavior, physiology theories have a piece in this puzzle too. not just the whole puzzle though.
    ps: hope that your fill in the blanks final quote wasnt talking about the PainHeads!!(just kidding)
    anyway, it is great to see this happening. I think it helps us all. best regards, and Jason , thanks for starting it.
    Valpo, I'm fine with you not going into my previous post, but I repeat my question:
    What is a "neuro" approach to you?

    I think many people that oppose the general ideas surfacing here completely miss the fact that it's not always about questioning the therapeutic intervention, but the theory behind it, or the idea guiding its implementation.

    I assume, and correct me if I'm wrong, that you mean non-contact interventions when you say "neuro-approach" (ie. explaining pain physiology, graded exposure).
    Or do you mean neurodynamics?

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  • Jason Silvernail
    replied
    Thanks Ken. My S&C background happened after I started my career in therapy so I didn't spend much time in the S&C industry per se. My online discussions started at the NSCA forum where I was humbled by some great coaches who had a lot to teach me about motor control, skill acquisition, and training effects.

    Valpo-
    Maybe we just work in different environments. It makes sense for me to be focused on pain (painhead if you like) because that's what my patients come to see me for. I use my knowledge of biomechanics, exercise phys, motor control, pain neurophys and rehab science to help my patients feel better. I do plenty of functional stuff but in most cases pain is the primary issue. Maybe you work in a place where people come in because they aren't functioning well and they want your help. I've never heard of a place like that but i guess those places are out there. If that's the case I suppose it makes sense to not focus on pain because your patients don't really have that as a complaint, they come in not being able to do something and you help them with that (or something).

    I don't think that would work for me since my patients have issues with pain primarily and when that's sorted out their function seems to return without too much trouble. Its been my experience that for mechanical pain cases i can't get function unless most of the pain has resolved. Trying to get function too soon just over-exercises them and exacerbates the problem and that's usually what they are doing on their own that lead them to see me. In order to help them, I have to get them to slow their function down so we can resolve the mechanical problem first. If they could stretch or strengthen their way out of pain they wouldn't have come to see me in the first place, since my patients are Soldiers in the US Army (currently).

    For those with more central sensitization (eg Fibromyalgia) issues I guess focusing on function over pain might make sense since we aren't as likely to influence pain given the mechanism, but we do need to improve quality of life - taking more of a graded exercise/graded exposure approach is a viable option. Ironically you kind of have to be a painhead to recognize that. Funny huh?
    Last edited by Jason Silvernail; 02-03-2012, 03:23 PM. Reason: fixed typos from iPhone entry

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  • Ken Jakalski
    replied
    Hi Diane!

    pain is an opinion the brain has about the body, that it isn't always right
    I really like this line. It's easy to remember...and essential to share with others serious about treating pain, but seriously mired in approaches that make little sense.
    Last edited by bernard; 02-03-2012, 05:58 AM. Reason: quote

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  • Ken Jakalski
    replied
    Hi Jason!

    What continually amazes me about you is that you're also an S&C guy--who doesn't think like most S&C guys I know. That you are able to separate yourself from so many who have a "collegial certainty" on many of this issues is pretty impressive.

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  • Bas Asselbergs
    replied
    "treat function , not pain "
    Valpo, I need some further explanation. What function do you treat? My credo is: "I treat people in pain, not parts or systems". And my background is Cyriax, then Maitland and Kaltenborn, then Janda, Sharmann, Dos Winkel, Mitchell and Greenman, Kuchera - and despite the many many hours I spent learning from them, there was not one with enough understanding of pain.
    Not one.

    Now that that knowledge is available, I have been able to shed all that luggage from those methods and principles. Since it is not about function - it is about pain resolution.

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  • Barrett Dorko
    replied
    (Barrett: sorry to hear your opinion on Stanley Paris) (he did change the way I approached our profession)(maybe you did not stay long enough)
    I worked and taught alongside Paris for four years during the late seventies, talked to him intermittantly, saw him present over the years, conducted a workshop for Stan, his faculty and staff in Florida in '08 and listened to him interviewed recently.

    No real change as far as I can see.

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