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  • #31
    Respect Randy - your world of pain is first person. Mine is a smaller, safer place to view from however having watched that woman snap that other womans elbow in the MMA last month with an arm bar my view (after my insular settled) was that the top down inhibition was well out of balance. Tap out lady!
    But from a cognitive neuroscience view what was switched off there? She was not going to roll out of it. She was not going to run the clock down. The ref was not going to help her. And the woman on the happy end of the lever was not stopping and may have even had a point to prove. Tap out. But no she stayed over-riding her instincts and got her elbow dislocated. I have my thoughts on why but what are yours?
    Kind thoughts,
    Steve
    Peering over the shoulders of giants.

    Know pain. Know gain.

    Comment


    • #32
      Randy,
      However, having been on the other end of an arm bar, I can attest that it really does matter what that other person does to the arm.
      The other person may "do" something to the arm, but you as the recipient will; not feel it unless your brain produces that experience. Turn it around: the famous case of a arm amputee who "feels" his hand painfully clenching for (I think) 3 years or more. Excruciating pain, yet no clenching hand.

      2) IF IF IF Tissue has been damaged (=muscle, tendon, ligament or even nerve) then what place does physical therapy serve?
      guide, educator, graded exposure and stressing tissues in appropriate way to get best healing.
      Bang on, Dave. No modalities, no magic.
      We don't see things as they are, we see things as WE are - Anais Nin

      I suppose it's easier to believe something than it is to understand it.
      Cmdr. Chris Hadfield on rise of poor / pseudo science

      Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

      We don't need a body to feel a body. Ronald Melzack

      Comment


      • #33
        Warning: long anecdote coming up:

        I love the example of a sprained ankle - why? Because I had exactly that, about 7 years ago. Was walking across a damp meadow where horses had been frolicking, trying to walk and put a sweater on over my head at the same time, wasn't looking where I was going, stepped on the edge of a horse horseprint, couple inches deep, and bam! my body tossed itself to the ground.

        (I.e., my brain sensed I was about to tear something, and caused my motor control to cancel its anticipation of my forward momentum, just long enough to allow gravity to bring me safely down. Not that I realized or framed it that way at the time.. In fact I was sure I had "sprained the ankle" and that the "tissue damage" or "giving way" had caused me to fall!)

        The ankle was awfully painful, immediately swelled up, I limped horribly and slowly the rest of the way to the room where I was staying. I had all the signs of a sprain, swelling, a bit of bruising, acute pain like crazy, couldn't bear normal weight.
        I happened to have kinesiotape along. It's my only first aid kit because it's so easy to pack and weighs nothing. I've taken it with me anywhere I go, for years now, ever since I learned how effective skin stretch is for pain (any kind of injury pain, at least), and about the stretchy tape itself.

        Anyway, I threw that on everywhere at the ankle, just little strips. Up at the knee too, the "top" of the ankle, i.e., head of fibula. Oh yeah, there was pain and tenderness there too. Heel cord, top of foot, over lat mal.

        It was way easier to walk after that. I left the tape in place for the next several days. The pain was all gone by day three, the day really normal, carefree walking returned. The swelling etc was gone by the very next day.
        True story.
        Bear in mind I was an overweight 50-something unfit woman at the time.

        If I HAD had "tissue damage", no way would it have healed up that fast. I think the brain is quite capable of dishing us kinesthetic illusions (e.g., tissue damage at the ankle), just as rapidly and effortlessly as it is capable of dishing us up visual illusions. I think it takes longer for us to figure out that's all they are, is all. Especially when we've all been hypnotized by them for so very long, and they are so reinforced by the medical and physical treatment social worlds.

        I've stopped believing in something called "tissue damage" being the "cause" of something else called "pain". It correlates usually, but doesn't "cause" "pain" - it may "cause" some nociception, however... but with intelligent (and swift) handling, and some thorough understanding, it needn't take over one's life or even one's function, even one's physiological function, for long, at all.
        Diane
        www.dermoneuromodulation.com
        SensibleSolutionsPhysiotherapy
        HumanAntiGravitySuit blog
        Neurotonics PT Teamblog
        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
        Canadian Physiotherapy Association Pain Science Division Facebook page
        @PainPhysiosCan
        WCPT PhysiotherapyPainNetwork on Facebook
        @WCPTPTPN
        Neuroscience and Pain Science for Manual PTs Facebook page

        @dfjpt
        SomaSimple on Facebook
        @somasimple

        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

        Comment


        • #34
          Originally posted by zendogg View Post
          The question which I still have not seen answered directly is about tissue damage.
          !) has an ankle sprain torn a muscle, tendon, ligament? I guess no one has ever decidedly imaged a before and after? I say that because no one seems to tackle by way of a direct answer that bleeding is occurring, therefore something got broken.
          Yes, with an MRI we probably could find out if it was a ligament, muscle, tendon or combinations of any. But what would this imaging help with? Does not all tissue (muscle, ligament, tendon) primarily heal and recover over time given the proper environment? (Not talking complete muscle or tendon rupture as this is pretty easy to figure out when you can no longer move the joint of get a deformity for example with bicep tendon rupture). Will a ligament not go through repair, or a tendon or a muscle? I (as a PT) am not going to change the healing properties each individual has. I can create a better environment for that healing to take place.


          2) IF IF IF Tissue has been damaged (=muscle, tendon, ligament or even nerve) then what place does physical therapy serve?
          See this blog post , by Tony Ingram, as I think it does a nice job of summing up what as PT I can help with to guide a patient through the healing stages. This is specific to muscle strains, but I think we can see that the same principles fall into suit whether a muscle, ligament, tendon, etc.

          3) I totally get that if A) the body has miraculously resolved the damage that it should be able to return to all functionality, but, B) if a pain groove has been worn into the nervous system a skillful intervention that reduces that groove is warranted. How much should be dealing with the honest to goodness tissue damage and how much should be dedicated to avoidance issue? (I know these can't be answered directly in terms of an A-Z protocol but I am hoping that someone sees the underlying question of tissue damage vs. threat avoidance strategies). And C) I would love somebody to comment on trying to restore function to a system that has modified itself to be able to deal with an unreconcilable situation such as a severed ligament as it pertains to locomotion. wouldn't it be best to add "strength" to this most unusual asymmetrical choice the body has made to cope with missing ligaments and therefore muscular leverage?
          I think adding strength and improving movement awareness is generally a good thing from an overall health perspective with our bodies no matter what. I don't think that adding strength will do anything specifically from a pain perspective. Can the movements and motor control gained during strengthening movements help with a painful problem, absolutely as long as not adding nocicebo or nocicpetion. In your ligament issue, let me take you back to a new born baby. Can you teach a new born baby how to walk or do they just figure it out on their own? I think when it comes to a ligament damage, the patient is most likely going to figure it out on their own better then me telling them how to do it. I might give their nervous system some novel inputs to let it evaluate them to see if they are useful as it tries to figure out a new way to move. But I'm not going to force it to move the way I think it should move.

          In your question to how much to put toward tissue healing and pain resolution I would say 100% to both. They are different and each deserve 100% attention.

          Hope this helps, keep asking questions that is the only way to add to your learning.
          Last edited by zimney3pt; 27-03-2012, 08:07 PM.
          Kory Zimney, PT, DPT

          http://koryzimney.blogspot.com

          "Study principles not methods, a mind that can grasp principles will create its own methods." - Gill

          "All truths are easy to understand once they are discovered; the point is to discover them." - Galileo Galilei

          Comment


          • #35
            Randy,

            Not sure this will help or not but lets use your arm bar example with a herniated disc example with no radicular symptoms.

            With the arm bar we realize that most probably 99% of people will feel pain when in this biomechanical position. I feel pretty confident that taking someone out of an arm bar (biomechanical position) it will help decrease their pain.

            With the herniated disc (on MRI) but no radicular symptoms, I know around 50% of the population walks around with the exact same biomechanical finding. Taking the bulge out I can't say with as much confidence that the disc was the problem now can I? I think this goes for many of our biomechanical faults we find on people. They are there, but what is the range of normal variance and how much can the body adapt to make the differences not a major issue? Are their people walking around with flat feet and no pain? How about high arches? How much increase lordosis is bad or how far forward does the head have to be? How tight do the hamstrings have to be to know that they will be a problem with a high enough percentage to be certain that is the issue? I hope you can see where the biomechanical faults start to get a little murky. Can they be a problem sure but again not so sure how much or to what extent I would need to change them.

            Driving over the speed limit can be a problem with increase accidents, but it does not mean that just because I drove over the speed limit that I will have an accident and reducing my speed to the speed limit will allow me to never have an accident again.
            Last edited by zimney3pt; 27-03-2012, 08:35 PM.
            Kory Zimney, PT, DPT

            http://koryzimney.blogspot.com

            "Study principles not methods, a mind that can grasp principles will create its own methods." - Gill

            "All truths are easy to understand once they are discovered; the point is to discover them." - Galileo Galilei

            Comment


            • #36
              Diane and Kory,

              Great posts! THank you. Crazy story on the ankle sprain Diane. I think you have finally got me straightened out. I suspect that now I will have to let time do the rest as I let all this sink in.

              Nathan

              Comment


              • #37
                Originally posted by Diane View Post
                I've stopped believing in something called "tissue damage" being the "cause" of something else called "pain". It correlates usually, but doesn't "cause" "pain" - it may "cause" some nociception, however... but with intelligent (and swift) handling, and some thorough understanding, it needn't take over one's life or even one's function, even one's physiological function, for long, at all.
                Diane, your comments consistently adhere to the neuromatrix model (as I understand it) in that you pay no credence to the mesoderm for the production of pain. I think some of the other comments (below) do not, and since they have been made by people like Barrett and Eric, who from what I gather are very knowledgeable when it comes to pain, I've been having trouble reconciling their comments with the neuromatrix model

                Eric:
                "I think a large proportion of my patients present with clinically relevant nociception"
                Barrett:
                "In my experience, knee pain often contains a good deal of mesodermal irritation and problems that require healing or repair."
                To my way of thinking, Eric and Barrett are assigning value to the contribution nociception makes to the pain output. If the neuromatrix model holds true, assigning such value is impossible because we can never know the extent to which nociception contributes to pain experience.

                Does this make my line of questioning clearer?

                Comment


                • #38
                  Patrick,

                  I agree with Diane's statement 100%. 'Tissue damage' may or may not occur with pain. These two things are not dependent on each other. The language and the common model of dysfunction in orthopedics, medicine and physical therapy is predicated on such language. Nociception with tissue damage is a normal response. Nociception is part of a natural defense and protect response of the CNS to an unexpected perceived threat. The perpetuation of such a response may in part be due to nociception but is reinforced by many other aspects of the CNS.

                  I think a large proportion of my patients present with clinically relevant nociception
                  I am not sure what post you got that from as I scanned the ones one on this thread and I cannot find it. I suppose I agree in as much as I think my patients present with clinically relevant body parts with which I am treating them. Nociception is part and parsel of human physiology just as are their body parts therefore it is always clinically relevant. Is there any clinical way of determining its role greater than other part of an individuals physiology, no prob not. It is one of the many inputs onto our CNS that informs of its interoceptive status of our being.

                  If you could provide the post where I made the above comment it would be appreciated.
                  --------------------------------------------------------------
                  Body is imbued with mind, and mind is embodied.

                  Comment


                  • #39
                    Patrick, I agree. I think each of us is probably in a different pace re: understanding, and/or sometimes one thing might be meant while another is written.
                    Diane
                    www.dermoneuromodulation.com
                    SensibleSolutionsPhysiotherapy
                    HumanAntiGravitySuit blog
                    Neurotonics PT Teamblog
                    Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                    Canadian Physiotherapy Association Pain Science Division Facebook page
                    @PainPhysiosCan
                    WCPT PhysiotherapyPainNetwork on Facebook
                    @WCPTPTPN
                    Neuroscience and Pain Science for Manual PTs Facebook page

                    @dfjpt
                    SomaSimple on Facebook
                    @somasimple

                    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                    “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                    "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                    "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                    Comment


                    • #40
                      Eric I am soooooo sorry, it was a quote from Luke from the more than placebo thread.

                      Embarrassed,

                      Pat

                      Comment


                      • #41
                        Hi Patrick, I think you meant Luke, not Eric. Milehigh, Patrick got that from here.

                        Double-blind, placebo controlled diagnostic nerve blocks are an interesting consideration here. There's no doubt that context can significantly affect the generation of a threat response by the brain. However, the brain gets little choice over what sensory experience will be had under a regional anaesthetic block: if the source tissue is injected or the supplying nerve blocked, the pain just goes (everything goes) - irrespective of the degree of relevant psychosocial distress, negative pain beliefs, or dysfunction coping strategies, etc.

                        A true positive with complete pain relief from a double-blind, placebo controlled diagnostic block tells us a lot about the relevance of local nociceptive afferents to a regional pain experience.
                        Luke Rickards
                        Osteopath

                        Comment


                        • #42
                          Yes, you and Diane (amongst others) thrashed this out in the more than placebo thread. It's what got me thinking about all this in the first place. If I recall correctly Diane's response when pressed on these findings was (to Jason)

                          Jason:
                          "Well what are we to make of placebo controlled trials of analgesics then? There was no grooming going on there."
                          Diane:
                          "Just a bunch of chemistry Jason."
                          Can you expand on this at all Diane?

                          Comment


                          • #43
                            If you could provide a link to the post in question (click on the little number in upper right hand corner to obtain the post's own link), that would be helpful, thanks.
                            Diane
                            www.dermoneuromodulation.com
                            SensibleSolutionsPhysiotherapy
                            HumanAntiGravitySuit blog
                            Neurotonics PT Teamblog
                            Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                            Canadian Physiotherapy Association Pain Science Division Facebook page
                            @PainPhysiosCan
                            WCPT PhysiotherapyPainNetwork on Facebook
                            @WCPTPTPN
                            Neuroscience and Pain Science for Manual PTs Facebook page

                            @dfjpt
                            SomaSimple on Facebook
                            @somasimple

                            "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                            “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                            “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                            "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                            "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                            Comment


                            • #44
                              Thanks Diane, Here is the link

                              http://www.somasimple.com/forums/sho...8&postcount=73

                              Comment


                              • #45
                                Thank you for making it easier to find, Patrick.
                                In response, I offer you a higher up post, Post 57.

                                In it I assert that touch is important. It helps the brain sort out its top-down management of sensation, interoception, nociception, proprioception, the chemistry that has gone awry, the critter brain that is freaked out.
                                I suggest that people are defending the hoarding of their mesodermal training wheel concepts instead of letting go of the "need" they think they still have for them - that hoarding reflex.
                                Diane
                                www.dermoneuromodulation.com
                                SensibleSolutionsPhysiotherapy
                                HumanAntiGravitySuit blog
                                Neurotonics PT Teamblog
                                Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                                Canadian Physiotherapy Association Pain Science Division Facebook page
                                @PainPhysiosCan
                                WCPT PhysiotherapyPainNetwork on Facebook
                                @WCPTPTPN
                                Neuroscience and Pain Science for Manual PTs Facebook page

                                @dfjpt
                                SomaSimple on Facebook
                                @somasimple

                                "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                                “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                                “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                                "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                                "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                                Comment

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