Enough is Enough

[John W]

Jason,
The sparring over there about your article got to be like hitting a concrete block wall with bare knuckles. Or maybe your bare forehead. I literally got a headache from all the convolutions of tortured logic and outright disingenuousness of the arguments.

Anyone who complains of being insulted when you poke a little fun at their ideas after accusing you of participating in an "echo chamber", is being not a little bit hypocritical. I mean, how much more insulting can you be than by telling someone that s/he is incapable of thinking for her/himself? I mean, that's like comparing you to a cult member or adherent of a fascist movement for crying out loud!

But put a dollar sign in the middle of the word fa$cia and you've committed the most heinous ad hominem of the century.

Please...

Speaking of "please"- I implore you to not mess with your avatar.

[Jason Silvernail]

I think you are right Rajam. That's a big part of the problem. My Facebook page has a bit of a postmortem today on this weekend.

[rkathryn]

I also enjoyed reading this paper and I think people take themselves too darn seriously-- it seems that your terms of "fasciahead", etc were a humorous way to explain your points.

Although we build our businesses on what we do for our clients/patients, it doesn't make us who were are in total-- we are more (or less) than that. People are associating themselves so much so with their work that they can't bear to see anything that opposes (or seems to) what they believe without feeling like their personal lively-hood or sense of self is being insulted.

[Diane]

Seriously Jason, they can't think of any way to fight you - logically - so they indulge in pooh-flinging.

[Jason Silvernail]

A few people have focused on my current avatar picture mentioning the weapon as if I might threaten someone with it. I don't appreciate the implication. I'm in the Army, it's a picture of me at a skills competition, that's it. Shall we focus on the clinical and scientific issues?

[docjohn]

good idea...piss off a guy with an automatic weapon!
this reminds me of a recent job interview I had with a professional team in my area.
i started ruminating on the cns role in modulating pain, and the looks glossed over as fast as the republican candidate chances in Massachusetts.
I feel your pain (and anger), however I am not armed!

[Diane]

Valpo, here is a link to the Welcome forum, where you can start a thread and introduce yourself, what you do, what you're interested in, and where we can welcome you to Somasimple.

[John W]

Hi Valpo,
I'm curious how you ferret out the "dysfunction" from the pain. Based on what we've learned about clinician's abilities to reliably identify these dysfunctions- several of which you've listed- do you think this is either possible or useful?

[Jason Silvernail]

Valpospine-
I don't understand what you are trying to say here. It is difficult to determine the relationship of many of these clinical findings to a patients pain and chief complaint. Clinical reasoning strategies such as Maitland or MDT provide a possible framework for making those judgments in the context of clinical care. Like Barrett, I'm not really sure what you are trying to get at.

[Jason Silvernail]

Charles-
I don't really understand your question. Are you asking me about what to say to a patient you have not been able to help?

[Barrett Dorko]

I find your post very confusing and often contradictory. I can tell you, Paris said that because he didn't understand ANYTHING about modern neuroscience. I was there. He still says this and it tells us a lot.

[valpospine]

enough is enough?

enjoyed your post. agree with many of your statements , however, the one thing that catches my attention is that you continue to talk about "pain treatment"
Stanley Paris in the 80's "treat function not pain", Vladimir Janda in the 90's "treat the cause of pain , not the site", Karel Lewit " he who chases the site of pain is often lost, and so is the patient"....so
I totally agree that there is a need for a better understanding from our pts side that their pain is not just in the affected tissue (specially when dealing with chronic conditions)
there is a need for a better understanding from the clinicians standpoint that this is happening.
there is a need for approaching pts in a different way...
but again... as I understand Craig Liebenson also meant to say (hope I'm right) there is also a need and a time for applying years and years of scientific work (either that be muscle, joint, fascia, facet or whatever they will find soon) ... we could potentially say the same for the ones who try to approach a msk problem "just " using a neuro approach (pain modification , modulation, re-organization or whatever name they will find soon!!)
we are now at a moment in which many "neuro" theories on how to approach pain are coming to light, so..... lets be careful, this approach will not improve a posterior glide, nor elongate a shortened muscles, nor re-create a muscular balance in an affected region!!
I think your comment is a great wake-up call for many. Let's not just take the path of least resistance(Sahrmann) as many of our movements tend to do.
if there is dysfunction, then it needs to be treated, maybe not just by itself though...
as Gregory Grieve said. "technique is not of outmost importance, but a deeper understanding of the problem is"

[theramass]

Comment

Hi Jason:
I enjoyed reading your comments and I think that I understand the point you are trying to make. One question: What do you do when your processes don't work for a particular patient? Regards, Charles McGrosky, Remedial Massage Therapist

[Diane]

Oh boy.
I don't usually tell patients they're wrong. They only know what they've been led to believe. After they tell me, "The doctor told me I have degeneration in my (fill-in-the-mesodermal-blank)" I do direction change, but not a direct contradiction.

I say, "I see. Well, you may not have also been told that a lot of people have imaging that might show that, but have no pain from it - it's just something that shows up when they're getting checked for something else.
Likewise, a lot of people can have pain, but nothing at all on xray.. so there you go. Pictures of tissue don't always line up with pain."
They stop to think about that.
Then I move right in and start to talk to them about how the nervous system is the only thing that can make pain, that pain is an opinion the brain has about the body, that it isn't always right, etc. We are standing in front of a picture of the nervous system, and I tell them that this is the system I want to treat, it's 72 kilometers, only 2% of the body but uses 20% of the fuel, is high maintenance, has only three neurons between their big toe and the map of the toe inside the brain, that if the body of the neuron were the size of a tennis ball the axon would be a half-mile long and the size of a garden hose, that it needs fed all the time, that the brain is their survival machine, that it puts them to sleep at night and wakes them up in the morning, that it's the boss, and they are part of it more than it is part of them, that it looks after them very well, keeps the heart beating and the lungs working, etcetcetc... that this is the control system.
By now they are usually nodding along and willing to hear me out. I show them pictures of what's inside a nerve, how it's fed, that I'll do things that will help the nerves get a good meal, that everyone is less cranky if they get fed, etcetc.. that we'll get them fed and see what happens to the pain.
I show them pictures of the nerves in the area, and what I'd like to do, that it's not going to hurt, and to tell me if there is any discomfort. I don't usually get into the neuromatrix on the first visit. But I've got a picture of that available if I sense yellow flaggishness going on.

This is usually enough to talk them out of being stuck on whatever bit of mesodermal mishap they come in thinking they may suffer from forever. It usually takes a few sessions, but they usually do fine with much better movement immediately after, and with some movement homework.

Link to blog series with more detail: New treatment encounter I-V

[Betty142]

Great post Jason. I am also getting frustrated with having to explain to patients that their pain is not due to muscle, disc, fascia, joint etc. I recently had a new patient with a 10 year history of back pain. Within the first 10 seconds of the subjective history he mentions his disc. In my mind I'm thinking 'here we go'. He then goes on to explain how it slips out of place from time to time and another practitioner from another province puts it back in place. I then take a deep breath and say 'why do you believe it is the disc'. I listen to his weak explanation and then state 'its not your disc'.

There was a time when I would try to work around the patients belief. At this stage I can't with the knowledge that I have about pain science. At one time I may have lacked the confidence to challenge the a patients strong beleifs regarding their pain caused by tissue. Thanks to the many amazing contributors to this site I have the confidence to accept the challenge.

Question for you - does the patient take it well when you contradict their long-held belief? I'm always a bit worried about making the patient mad by telling them they have been given erroneous information...I recall one incident where the patient got QUITE upset - she gave me a stern and lengthy talking to, and refused to return.

Bettina.