Enough is Enough

[Barrett Dorko]

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.

[Diane]

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).

[Barrett Dorko]

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.

[Jackson]

"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

[advantage1]

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!

[Diane]

I don't mind.

[Jason Silvernail]

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.

[Barrett Dorko]

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.

[John W]

...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...

I'm wondering where this impression came from? It's a very common misperception of what those of us who have made a paradigm shift to an ectodermal approach do with patients.

Do our colleagues think we sit there in the room and psychoanalyze our patients? What is it they think we do?

I don't remember Jason ever saying or implying that he does not try to address peripheral nociception.

It's like the person who suggests that maybe the reason a ship's sail disappears over the horizon is because the earth is round, not because it's flat resulting in the ship falling over the edge of the earth, is then asked, "Well, then what do you suggest we do to our ships so this doesn't happen?"

So what doesn't happen? We're not suggesting that anything change necessarily other than our acceptance of a better explanation. We're not suggesting that the properties of the ship or methods of sailing necessarily need to change, but to move "further from the shore", we need a better explanation for why the sails seem to fall over the edge of the earth.

We'd like not only to see our patients improve, but know why they improved. This is how methods and treatments progress and become refined.

[Jason Silvernail]

Thanks for that John. I am continually disappointed in the extent people associate peripheral treatment with one particular connective tissue explanatory model.
I've said before,

It seems you are unable to understand the difference between a physical treatment and it's rationale or I am unable to effectively communicate that difference to you. I'm honestly not sure which it is.

I have had trouble getting this sort of thing across before and maybe my approach could use some assistance, I'm open to suggestions. Other examples from one of the most frustrating threads here, in my opinion here, here, here and here.

Them: "You don't think joint dysfunction isn't closely related to pain? You must not mobilize joints then."
Me: "Uh - what?"

I think this particular criticism is telling us something useful, actually. Its telling us more than we might want to hear of the catastrophic failure of our programs to produce clinicians who genuinely understand critical thinking, the difference between a treatment and the theory behind it, and the basic science that underlies our practice. There's some good news for us this friday.

[Jess Brown]

I'm wondering where this impression came from? It's a very common misperception of what those of us who have made a paradigm shift to an ectodermal approach do with patients.

Do our colleagues think we sit there in the room and psychoanalyze our patients? What is it they think we do?

I don't remember Jason ever saying or implying that he does not try to address peripheral nociception.

It's like the person who suggests that maybe the reason a ship's sail disappears over the horizon is because the earth is round, not because it's flat resulting in the ship falling over the edge of the earth, is then asked, "Well, then what do you suggest we do to our ships so this doesn't happen?"

So what doesn't happen? We're not suggesting that anything change necessarily other than our acceptance of a better explanation. We're not suggesting that the properties of the ship or methods of sailing necessarily need to change, but to move "further from the shore", we need a better explanation for why the sails seem to fall over the edge of the earth.

We'd like not only to see our patients improve, but know why they improved. This is how methods and treatments progress and become refined.

John, you've hit the nail on the head. When my co-workers ask me about "the cause" of low back pain, and then start talking about "segmental dysfunction", I know that they just don't get it. They've been fed a line of woo about being able to percieve motion at isolated segments, etc. And, often enough to perpetuate that myth, they "work on the joints" and their patient's pain lessens, which in their minds validates the flawed theory. I think that this flawed theory also perpetuates that "treat function and not pain" garbage. If we are able to perceive when a joint is in a dysfunctional state, all of the joint driven interventions must be treating "function", right?

*sigh*

[Steve Hill]

never say never

I have seen patients who do come in without pain, but do complain of functional problems. In fact, I saw one today. It is an oddity, but it does occur. The environment in which I work is an outpatient department in a large university hospital. The patient had a THA a few months ago, and had no pain upon her first visit. She had concerns that her thigh was rolling inward more than it should, and given the dislocation precautions she had heard shortly after surgery, this concerned her. She also had functional problems due to physical challenge with walking up stairs. She had global LE weakness but she had no pain, and still doesn't. She had trouble donning her socks, but no pain. Motion loss into flexion and ER, but no pain. It does happen. It is rare. And man is it easy to handle! One goofy thing about this that it is hard remembering that this patient in front of you does not hurt! I found myself out of habit asking about pain at nearly every visit, and having her correct me each time!

[Jason Silvernail]

Great example Steve. The exception proves the rule?


[From my iPhone, please excuse typing]

[valpospine]

ok. I'll do my best to answer all comments.
first of all, Max G, please forgive me. forgot to answer your question. Yes, when I was talking about the neuro-based approaches , I was talking about the "non contact intervention" (pain physiology) , not about neurodynamics .
Jason and John W: yes, I did say that that I was glad to see Jason using peripheral approaches too because for a while, in his initial comment, it looked like he was throwing it all away, since he was so tired of us (the MuscleHeads, JointHeads etc)(plus , his thread title says a lot: "enough is enough" ) but anyway, good to see it's still happening Jason.
sad to see that your "teammate" Bar does not think the same. he was able to "shed the luggage from all those methods"!!!(PainHead?)
Jason: no, I do not work in an uncommon facility, and we do see the same type of pts, with the same issues. we just approach them in a different way.
it is true, pain is what brings the pt to us and it is from the pain that they seek relief from . while we seek to manage their pain, we must adress our attention to the cause of pain. (treat the underlying dysfunction which is probably why they hurt!!)
a couple of interesting things: pain is not always a warning sign, pain is not in proportion to the severity of the pathology, lessening of the pain does not always signal improvement and pain is affected by stimuli other than dysfunction. (hope you all agree with this!!)
Lorimer said it so clearly in his speech in SAU, "the use of this tools (neurophysiology) does not imply that we must forget nor stop treating the periphery"
please understand: this is all I mean to say. there is a place for it. maybe you are just making it too big... but I guess its ok. it's your way of going.
Barrett: excuse me, but you are totally wrong saying that being a manual therapist excuses me from learning modern neuroscience.
it does make me want to learn it, to utilize it in the proper place, at the right time, with the right patient.
however, it does look like knowing neuroscience excuses you from being an evidence based manual therapist!!
modern neuroscience has a place in our tool box... just as much as the joint, the facets, and the muscles do.
best regards.

[Barrett Dorko]

I didn't say what you've said I did.

My confusion about where you're getting these ideas remains.