Announcement

Collapse
No announcement yet.

Tissue requiring healing or repair

Collapse
This is a sticky topic.
X
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • Originally posted by Josh View Post
    This had cetainly moved into depths not often approached.

    Because we can have pain without tissue damage, Doesn't mean specific tissue damage doesn't lead to pain. I know that we all know this, but it seems like all the discussion about linearity is searching for a 100% factual all or none statement regarding pain and causation.

    The key for us as PTs is too determine which of the many contributors to the neuromatrix is pushing the brain over the threshold to produce pain. Sometimes it is chemical due to inflammation, sometimes it is fear, beliefs, context, or local hypoxia of nerves etc.....

    I applaud you all for searching so much for the silver bullet, but does it exist?
    It's not about finding the silver bullet.
    It's about a better understanding of what's going on so we can discard all the blanks (that make loud noises, impress people but don't do what they are supposed to do).

    Comment


    • Barrett said:
      Abduction is a kind of reasoning that uses a theory of functioning to justify the appearance of findings. You end up saying, “If such and such were the problem all the findings would make sense,” and, making sense of things is the purpose of science.
      Eric said:
      Through posts by Barrett I am trying to wrap my mind around abductive reasoning. I think I like it a lot, when you realize that is fallacy, but that does not mean you can not use its power in trying to understand the present state of the patient. In the context of physical therapy, I would use abductive reasoning to abduce a hypothesis B that has lead to patient in a state A. When I realize there are an infinite number of possibilities that have lead to state A in the patient, I have chosen one.
      Eric, I like this thinking. To me, it demonstrates that although the uncertainty of the clinical encounter is unavoidable (because we can't know causation where pain is concerned), it doesn't lead the physio down a path of therapeutic nihilism or futility. We are essentially guessing a cause.. But that's ok because it's the best we can really do.
      If I know selected interventions will respond if my abduction is correct, then I can go about implementing such interventions and along the way see if the state of the patient has changed away from A. Realizing that my abuced hypothesis may be one of an infinite number of possible hypothesis I can reformulate if the patient state has not changed from A. This is my current understanding of abduction, I am curious if jives with the group.
      For whatever my newbie opinion is worth, I think this is a very reasonable application of abduction, within the context of treating pain.

      I read the link you provided about evolution of placebo earlier in this thread. Thanks for that. To what extent/depth do you think we ought to reveal our abductive clinical reasoning to the client. it seems possible, that the capacity for a placebo response could be thwarted by the client's knowledge that their therapist is engaging in a form of guesswork. I can think of some clients who just need to know that I know exactly what the cause of their pain is. Their trust in me, at least initially is dependent on my knowledge of what is causing their pain. Maybe they're the ones most in need of pain belief deconstruction. It's a delicate situation.

      Comment


      • To what extent/depth do you think we ought to reveal our abductive clinical reasoning to the client. it seems possible, that the capacity for a placebo response could be thwarted by the client's knowledge that their therapist is engaging in a form of guesswork. I can think of some clients who just need to know that I know exactly what the cause of their pain is. Their trust in me, at least initially is dependent on my knowledge of what is causing their pain. Maybe they're the ones most in need of pain belief deconstruction. It's a delicate situation.
        I have found that TELLING my clients why I think they have pain doesn't work as well as entering into a discussion with them, talking about their history, their injuries, lifestyle and essentially guiding them to tell ME why they think they have pain. I might add a few other possibilities in the mix for them to consider and build a scenario together. I feel in most cases the clients know more about their pain/situation than I ever could. For me the best mix is encouraging them to expand their awareness about how they are interacting with their world, their day to day activities, workouts, etc., while adding in what I understand about current pain science (stretching, central sensitization, over-training, static postures for hours) relative to said interaction style. From there the client seems to be able to either grasp why I have recommended certain modifications or they come up with them on their own and they are off and running, so to speak.

        Nathan

        Comment

        Previously entered content was automatically saved. Restore or Discard.
        Auto-Saved
        x
        Insert: Thumbnail Small Medium Large Fullsize Remove  
        x
        x

        Please enter the six letters or digits that appear in the image below.

        Registration Image Refresh Image
        Working...
        X