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

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  • #31
    ...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.
    Be careful there proud, you may be accused of committing an "ad lagamorphum"* against ginger.

    *Apologies to Dr. Richard Wilson, former chair of biology, who taught my first year of introductory biology at Rockhurst University.
    John Ware, PT
    Fellow of the American Academy of Orthopedic Manual Physical Therapists
    "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
    “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
    be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

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    • #32
      Jason,
      'We need to apply the right foundational science to the right problem, and none of the BSP pain advocates have ever suggested otherwise'

      Exactly right and the quote probably belongs on the developing a good physiotherapy programme....

      Much more BPS integration is necessary .
      Practically I believe it is due to social influences.
      Many people get excited looking at very expensive fast cars (athletes) and their whole mentality is coloured by this .....adjusting the micro pedal adjustment/seat/top tube mechanics may very occasionally be relevant . Somtimes,obviously it really is a ball joint or stabilising structure that is amiss --TA rupture /ACL etc etc ....Mostly though the little annoying rattles on the suspension and the odd squeak are just that ...annoying and putting loads of investigations and money into sorting them out leads to the squeak appearing somewhere else .......Often its best to understand these anomolies for what they are . The majority of the general public just do not need highly trained race mechanics- they need more overlapping generalists.
      The biggest health related issues to do with MSK disorders are often more knowledge based ie how long will it take to resolve and whats the best thing to do about it ...balanced with an understanding of the effects of 'minor' routine psychological issues such as fear/misinformation .
      I got here via trauma orthopaedics/surgery , neuro disease management and mostly the knowledge is useful in the background but on a daily basis is often irrelevant. What is relevant is the more subtle protective neuro defensive physiology on populations that are often pretty unfit and relatively inactive ie the majority of the population.......Giving out structural/ mechanical 'race mechanic' inspired techno sounding information (and working from this paradigm when not warranted) is often iatrogenic --the literature whole heartedly backs this up (from the back pain revolution onwards )....

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      • #33
        Giving out structural/ mechanical 'race mechanic' inspired techno sounding information (and working from this paradigm when not warranted) is often iatrogenic --the literature whole heartedly backs this up (from the back pain revolution onwards )....
        Exactly. And that stems from a BM focused explanation of pain.

        Carl (if you're still reading) consider this quote from Adriaan Louw:

        "Why do people come see us in pain, and leave as experts in biomechanics?"
        Last edited by advantage1; 25-11-2013, 06:36 PM.
        Rob Willcott Physiotherapist

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        • #34
          Nice comments all.

          My thoughts are as follows...

          It's not biomechanics vs. neuroscience. It's integrating biomechanics into neuroscience (and other areas of inquiry including psychology, philosophy, anthropology). Biomechanics always happens within the realm of neuroscience (generally, I acknowledge is also occurs in the context of other factors), because we are talking about conscious, living humans (nervous systems)....

          (I commented on the Future and Direction of Manual Therapy a similar comment as below...)

          Neuroscience is actually a broader term and field than biomechanics. The invalidation of the bio-mechanical only model of pain is done through knowing the physiology of pain. No nervous system, no brain, no pain. Period. Absolutely theories and understanding will change, but it will always be in the realm of neuroscience generally. Our profession continues to fight the fact that pain is a neurologic problem...always. Does this mean that biomechanics doesn't matter? No. It's just that biomechanics are not the foundational guiding principles that matter in the lived pain experience. Pain is too complex, always.

          Until our profession whole heartedly embraces that pain is an emergent brain property, an individual experience resulting from complex and interacting neuro-physiologic processes that occurs in complex social-cultural-societal environments that is affected by all types of inputs, outputs, and internal states from context, cues, language, to expectation, stress, sensitization we will never move onto the bigger questions as well as external environmental and developmental forces. This does not even take into account the linguistic, philosophical, and societal underpinnings and complexities of this individual, subjective first person experience. And, admittedly this is likely not a complete list of the factors affecting and contributing to "pain" and/or "suffering."

          It's not biomechanics vs. neuroscience. We don't need to throw biomechanics away. We need to broaden our understanding. How do we understand and apply biomechanics within the context of physiology, neuroscience, and pain generally...

          How do we mesh the two?
          How do we better understand the neuroscience?
          How do grow and evolve our models based also on philosophy and linguistics and language?
          Kyle Ridgeway, PT, DPT
          PT Think Tank |@Dr_Ridge_DPT | Google+
          "It takes a deep commitment to change and an even deeper commitment to grow." - Ralph Ellison

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          • #35
            Is it logical, then, to say that neuroscience can explain a lot of the issues associated with biomechanics?
            Lead in with pain education, so they appreciate that a weak muscle or two doesn't cause pain, but if the pain is treated, strength returns? Or similar phraseology?

            Nari

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            • #36
              Is it logical, then, to say that neuroscience can explain a lot of the issues associated with biomechanics?
              Lead in with pain education, so they appreciate that a weak muscle or two doesn't cause pain, but if the pain is treated, strength returns? Or similar phraseology?
              I am not quite sure pain and strength (diminished or altered motor plans) are directly related. I suspect that they are each independent outputs from the neuromatrix. I do not suspect "pain causes weakness". I instead suspect "pain and weakness" are two potential results when body threat is suspected by the neuromatrix. So in all of its wisdom the neuromatrix, has several options, when something puts it on guard:
              a. Do Nothing (if not enough of a threat)
              b. Communicate with Your Consciousness (Pain)
              c. Make You Weak (Altered Action Programming and Motor Planning)
              d. Stress Regulation (Further altering fatigue/activity levels, weakness, etc)

              So in its playbook, it can choose any of the 4 options in isolation, OR it can do any combination of b-d.
              Joseph Brence, DPT, FAAOMPT, COMT, DAC
              "Great spirits have always encountered violent opposition from mediocre minds" - Albert Einstein
              Blog: www.forwardthinkingpt.com

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              • #37
                Joe, I really like that.
                is there not an option "e"; not enough to communicate with the consciousness, but enough to protect/move/correct for the low-level threat?
                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

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                • #38
                  This is great Joe:

                  a. Do Nothing (if not enough of a threat)
                  b. Communicate with Your Consciousness (Pain)
                  c. Make You Weak (Altered Action Programming and Motor Planning)
                  d. Stress Regulation (Further altering fatigue/activity levels, weakness, etc)

                  So in its playbook, it can choose any of the 4 options in isolation, OR it can do any combination of b-d.
                  I agree that option a exits. However, when it comes to b-d I beleive that they don't happen in isolation. I think that b-d will occur together just in varying degrees of each.
                  Rob Willcott Physiotherapist

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                  • #39
                    I instead suspect "pain and weakness" are two potential results when body threat is suspected by the neuromatrix. So in all of its wisdom the neuromatrix, has several options, when something puts it on guard:
                    a. Do Nothing (if not enough of a threat)
                    b. Communicate with Your Consciousness (Pain)
                    c. Make You Weak (Altered Action Programming and Motor Planning)
                    d. Stress Regulation (Further altering fatigue/activity levels, weakness, etc)

                    I think C could be c. Altered Action Programming and Motor Planning and execution ( Make You Weak and make you strong).

                    When I step on a nail etc my nervous system will alter in ways in which certain aspects of it will become more active and other parts (due to altered activity) will be less. I think of the increased torque I reflexively/preconsciously put through my contralateral leg when I step on the nail. Technically it would sequentially occur pre pain conscious-ising but would also possibly maintain existence after the pain aspect of experience emerges.
                    "Whereof one cannot speak, thereof one must be silent." ("Wovon man nicht sprechen kann, darüber muss man schweigen.“) Tractatus Logico-Philosophicus Ludwig Wittgenstein
                    Question your tea spoons. Georges Perec

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                    • #40
                      I agree that option a exits. However, when it comes to b-d I beleive that they don't happen in isolation. I think that b-d will occur together just in varying degrees of each.
                      Not quite sure...How do we explain the altered action programming that exists when we "hear a noise at night and sneak around the house to see if it was a burglar"? No pain exists. An altered action programming does. This is due to a "potential threat".

                      A few months back, I was consulted as an expert witness providing testimony in a case in which a woman was run over by a bus. In this case, the attorney representing the "bus", stated, that this woman should not have been able to get up and run to cover, if she was "really injured and hurt". I explained, that in all of its wisdom, the nervous system provided an alternative action program and stress regulation program until she reached the sidewalk. Once here, the brain switched strategies and sent an output of pain.
                      Joseph Brence, DPT, FAAOMPT, COMT, DAC
                      "Great spirits have always encountered violent opposition from mediocre minds" - Albert Einstein
                      Blog: www.forwardthinkingpt.com

                      Comment


                      • #41
                        How are we defining an altered or diminished motor program?
                        What does make you weak mean?

                        Would not salience of the bus/person interaction (Joe's example) dictate both run to safety which would be organizing movement to "make you strong"? Could not this same system "make you weak" once temporally removed from the onslaught of salient stimuli and the mind is attending to other sensory inputs? Would not an another description include a paring of the most relevant sensory stimuli with what has been behaviorally learned as the most optimal response to such stimuli. In the case of the bus, get out of the way. In the case an onslaught of nocioception with no perceived external threats, pay attention to me says the perceived body.

                        Eric
                        Last edited by Milehigh; 27-11-2013, 05:41 AM.
                        --------------------------------------------------------------
                        Body is imbued with mind, and mind is embodied.

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                        • #42
                          How are we defining an altered or diminished motor program?
                          What does make you weak mean?
                          Agreed! "Make You Weak" is the wrong phrase. "Make You Move Defensively" may be more appropriate? How would we describe the movements in the video below?

                          [YT]ZXZ6K21wvZM[/YT]
                          Joseph Brence, DPT, FAAOMPT, COMT, DAC
                          "Great spirits have always encountered violent opposition from mediocre minds" - Albert Einstein
                          Blog: www.forwardthinkingpt.com

                          Comment


                          • #43
                            Any threat to the nervous system is a potential disaster for the future efficiency of those afflicted. Far better, and more efficient to, whenever possible, adapt to a new posture that protects the nervous system, than to injure the nerve and suffer the consequences of neuropathy.

                            From Gifford, quoted here
                            Threats to the nervous system include anything that's painful to do, mainly because they threaten the nervous tissue by decreasing its nutrition. Weakness is not the problem, pain is the problem and the brain is doing what it can, via the muscles, to alter use. When it engages the culture, the culture usually prevails, if not immediately, soon.

                            Is it reasonable to say this? Is it hard to explain it to a patient? Is the hammerlock analogy a fair one?
                            Barrett L. Dorko

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                            • #44
                              Originally posted by Barrett Dorko View Post
                              Threats to the nervous system include anything that's painful to do, mainly because they threaten the nervous tissue by decreasing its nutrition. Weakness is not the problem, pain is the problem and the brain is doing what it can, via the muscles, to alter use. When it engages the culture, the culture usually prevails, if not immediately, soon.

                              Is it reasonable to say this? Is it hard to explain it to a patient? Is the hammerlock analogy a fair one?
                              I would think that threat, real or implied, is more the problem than pain, no?

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                              • #45
                                I would think that threat, real or implied, is more the problem than pain, no?
                                I think with the cyclical processing of pain, the experience of pain, and the experience of painful movements loop back around and become inputs into the threat detection processing centers of the brain.

                                So I agree ZD, just like any input, i think its the threat value assigned to it by the brain that counts.

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