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That Grinds My Gears: "You Say Biomechanics Doesn't Matter"

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  • #16
    Originally posted by Ken Jakalski View Post
    I always look forward to your insights, because you really make an effort to see things from the other guy's point of view. You remain considerate even though frustrated by those who have not considered thirty years worth of compelling research. That's not always easy to do.
    The Principle of Charity
    Jason Silvernail DPT, DSc, FAAOMPT
    Board-Certified in Orthopedic Physical Therapy
    Fellowship-Trained in Orthopedic Manual Therapy

    Certified Strength and Conditioning Specialist


    The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

    Comment


    • #17
      Originally posted by Barrett Dorko View Post
      This is a wonderful thread.

      Any comment made in response to this complaint should begin: "A straw man is...And this complaint of a our ignorance of biomechanics is a straw man because...

      It seems to me that this would put you not only on the high ground, but it would display your knowledge of the issue.

      As the Boy Scouts say, well, you know.
      My comments are not about pain research, as I have spent a lot of time reading the suggested authors and respect what they do. My focus is how does one use this information in a clinical setting when athletes are injured. So far, for about three months most of the responses have been citations of pain theory. Good reading and I appreciate how things work and going to Amazon is not hard or even OPTP for reading isn't hard. Only 5% of the posts is clinical in nature, meaning if I had to refer an athlete to someone who is in sports medicine I just wanted a light case study or explanation of what a person would do with an achilles problem that had referred pain. To things happened that are very high profile. An athlete had degeneration of the achilles tendon and was told the pain was in his head. A week or two later it tore. Some told that the trend was there after a few medical imaging sessions some said it was random and pain was not a warning. So I am at a point that I see coaches not suggesting medical help when pain exists, and if the athlete goes on their own they are suggested self-talk audio files from websites without physical evaluation or looking at movement. Guidance of what is normal would be a big help.

      -Carl

      Comment


      • #18
        Carl,

        IMO case history and examination are extremely important in order to arrive at a BPS working diagnosis. The Bio part should never be skimped and is always part of the overall management of the patient. Hands on treatment and education/advice must also be science based.

        Many if not most TA ruptures that I have treated have happened in the absence of pre existing pain.
        Last edited by Jo Bowyer; 24-11-2013, 04:05 PM. Reason: context
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

        Comment


        • #19
          Hi Carl, welcome aboard.

          Would you mind starting a welcome thread to provide a back story as to how you arrived here and your interests/profession? Thanks...I was just introduced to your thoughts on FB (comments under Anoops recent video link?), but it seems that you have been speaking to some members of the board off site and you are already midstream in conversation/debate.

          Respectfully,
          Keith
          Last edited by Keith; 24-11-2013, 01:39 PM.
          Blog: Keith's Korner
          Twitter: @18mmPT

          Comment


          • #20
            Originally posted by Armandos View Post
            To things happened that are very high profile. An athlete had degeneration of the achilles tendon and was told the pain was in his head. A week or two later it tore. Some told that the trend was there after a few medical imaging sessions some said it was random and pain was not a warning.
            It sounds like you are dealing with individuals who are ignoring the Bio- in the BioPsychoSocial approach, which is unfortunate. Meanwhile, many on this site complain about how many in the field who only pay attention to the Bio- and ignore the others. In either instance, we increase the odds of a patient becoming acutely injured or susceptible to chronic pains, respectively.

            No one here will advocate for the care you describe above.

            Respectfully,
            Keith
            Blog: Keith's Korner
            Twitter: @18mmPT

            Comment


            • #21
              Here's what I said about yet another false equivalence and baby/bath water game by the biomechanics boosters.

              "I don't think that's a fair characterization of this at all. As more pain information comes out, it's a challenge to apply it. In some types of problems, like pain and motor control, it's way more important than biomechanics. In other types of problems, like strength and performance training, biomechanics and connective tissue strain models are more relevant.
              But we don't see people pushing pain science as a solution to performance issues, do we?
              We DO see performance people pushing biomechanical solutions for pain problems. Then they complain that 'oh it's not all about pain, it's all the same. Don't throw the baby out with the bath water.'

              I call bullshit on that whole enterprise. We need to apply the most relevant science to any problem and the kind of problem should determine the most applicable science. When performance people stop explaining pain with strict biomechanics models I will stop explaining performance with strict biopsychosocial models. Oh whoops I never do that in the first place. The errors here seem predominantly on the performance and biomechanics side and playing false equivalence doesn't change that. "

              For many of my patients who I reason as having primarily nociceptive origin pain I spend very little time "explaining pain" using the BSP model and most of our visits determining what the movement problem is and resolving it with manual therapy and exercise. We need to apply the right foundational science to the right problem, and none of the BSP pain advocates have ever suggested otherwise.
              Jason Silvernail DPT, DSc, FAAOMPT
              Board-Certified in Orthopedic Physical Therapy
              Fellowship-Trained in Orthopedic Manual Therapy

              Certified Strength and Conditioning Specialist


              The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

              Comment


              • #22
                Jason,

                I appreciate your professional and intelligent responses to those who seem to think that the treatment paridigm is either one or the other.

                What I gather most people who frequent this site likely do is incorporate therapeutic neuroscience approaches with mechanical treatment. I'm not sure why certain people think it has to be one or the other. As you mentioned, the approach may be more weighted in one direction depending how the patient in front of you presents.

                Aaron

                Comment


                • #23
                  Thanks for sharing Jason, what forums are you currently active on in addition to here? I enjoy following your debates (even when we disagree).
                  -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                  The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                  Comment


                  • #24
                    Evan that's on Facebook, on Anoop Balachandran's page where he notes Kelly Starrett did not approve of his book review. Facebook is very limited for those discussions because it's nearly impossible to find previous useful debates you've had.
                    I am considering a move to Twitter and keep the substantive material here as it's searchable and persistent.
                    Jason Silvernail DPT, DSc, FAAOMPT
                    Board-Certified in Orthopedic Physical Therapy
                    Fellowship-Trained in Orthopedic Manual Therapy

                    Certified Strength and Conditioning Specialist


                    The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                    Comment


                    • #25
                      Since he's come up already in this thread, if Carl Valle posts to SS, we've made another valuable outreach. In the area of speed enhancement and performance training, Carl Valle is a key figure, and a good guy!

                      In terms of speed and strength training protocols and approaches, forums often wane for various reasons. Sometimes it's a matter of posters simply running out of points of discussion that haven't already been argued in detail in previous years, and they are not interested in covering old ground. Other times, it's a matter of not finding anything "new" worth presenting.

                      This is not Carl. He is a prolific blogger who reviews current research carefully and analytically, and keeps writing at a time when many others in the speed world seem less inclined to explore or debate controversial issues.

                      I can't find much of anything he's written that I haven't found thought provoking and beneficial.

                      I like that fact that the SomaSimple regulars who also post at other places are able to attract more interest in this group from the applied guys (coaches) like Carl.

                      Comment


                      • #26
                        Originally posted by Jason Silvernail View Post
                        Evan that's on Facebook, on Anoop Balachandran's page where he notes Kelly Starrett did not approve of his book review. Facebook is very limited for those discussions because it's nearly impossible to find previous useful debates you've had.
                        I am considering a move to Twitter and keep the substantive material here as it's searchable and persistent.

                        Sometimes you can find threads through regular google. But yeah, it's hard. No archive function.
                        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

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                        • #27
                          Originally posted by Jason Silvernail View Post
                          Facebook is very limited for those discussions because it's nearly impossible to find previous useful debates you've had.
                          I'm not on FB but I feel the same way about linkedin. After hundreds of posts there it seems that everything I say goes out the window.
                          -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                          The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                          Comment


                          • #28
                            Great thread. I am constantly running into this argument on twitter. Once I mention pain science and the shortcomings of the biomechanical model, it's assumed that I ignore the patients ability to move. What gets me even more irritated is when people say that I must be only talking to my patients and telling them that all their pain is in their head. Carl provides an example of this argument:

                            An athlete had degeneration of the achilles tendon and was told the pain was in his head.
                            So I am at a point that I see coaches not suggesting medical help when pain exists, and if the athlete goes on their own they are suggested self-talk audio files from websites without physical evaluation or looking at movement.
                            Where did this erroneous idea come from? If anyone was to watch a video of me treating a patient with the audio off they would not be able to tell whether I am using a BM or BPS approach. I still use manual therapy, exercise instruction, taping, the odd modaility. The only difference would be that when the same video is viewed again with audio on the stark difference in apporach between BM and BPS would be heard. You would not hear me mention misalignemnt, subluxations, upslips, stretching of muscle, breaking up scar tissue etc. Instead, you'll probably hear me say reduce stiffness, reduce protection/defense, improve movement, promote inhibition, pace your activity, 'motion is lotion', hurt vs. harm, irritated nervous tissue etc.

                            Carl you said:

                            My focus is how does one use this information in a clinical setting when athletes are injured.
                            Find a local PT who understands pain science and ask if you can come in and sit in on an assessment/treatment. To base you're understanding of pain science in PT on what you read on-line is a mistake.
                            Rob Willcott Physiotherapist

                            Comment


                            • #29
                              Hi Advantage1!


                              You would not hear me mention misalignemnt, subluxations, upslips, stretching of muscle, breaking up scar tissue etc. Instead, you'll probably hear me say reduce stiffness, reduce protection/defense, improve movement, promote inhibition, pace your activity, 'motion is lotion', hurt vs. harm, irritated nervous tissue etc
                              .

                              This is good stuff. Sadly, it's not what coaches are hearing from many trainers and PTs. Injured athletes in our area are often told exactly what you've mentioned--misalignments, more consistent stretching, scar tissue that needs to be broken up, etc.
                              Last edited by Ken Jakalski; 26-11-2013, 01:23 AM.

                              Comment


                              • #30
                                Originally posted by advantage1 View Post
                                Great thread. I am constantly running into this argument on twitter. Once I mention pain science and the shortcomings of the biomechanical model, it's assumed that I ignore the patients ability to move. What gets me even more irritated is when people say that I must be only talking to my patients and telling them that all their pain is in their head. Carl provides an example of this argument:





                                Where did this erroneous idea come from? If anyone was to watch a video of me treating a patient with the audio off they would not be able to tell whether I am using a BM or BPS approach. I still use manual therapy, exercise instruction, taping, the odd modaility. The only difference would be that when the same video is viewed again with audio on the stark difference in apporach between BM and BPS would be heard. You would not hear me mention misalignemnt, subluxations, upslips, stretching of muscle, breaking up scar tissue etc. Instead, you'll probably hear me say reduce stiffness, reduce protection/defense, improve movement, promote inhibition, pace your activity, 'motion is lotion', hurt vs. harm, irritated nervous tissue etc.

                                Carl you said:



                                Find a local PT who understands pain science and ask if you can come in and sit in on an assessment/treatment. To base you're understanding of pain science in PT on what you read on-line is a mistake.

                                So true. On a whim, I scooted on over to Rehabedge just to see what that wasteland had become and low and behold I see our good old friend Geoff Fisher rabbiting on about how those at SS spend too much time explaining and too little time using their hands.

                                He's hasn't a clue what I do obviously.

                                I certainly haven't a clue what he does...

                                But alas, even from within (ie people who have read here for years and you would think would form a fundamental understanding of how to incorporate a science based model of care)....seem confused.

                                I'm somehwt sure that stems from only a partial understanding of the science. In other words...just not reading near enough.

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