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

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  • #46
    I agree too.
    Diane
    www.dermoneuromodulation.com
    SensibleSolutionsPhysiotherapy
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    Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
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    @dfjpt
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    @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

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    • #47
      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 am not sure Barrett, I think there is a difference from those who take a mechanical view of the nervous system and threat and a processing view. The view I would ascribe to the points you made is a mechanical view. I tend to ascribe pain to a more processing view, i.e. it is something that is processed by the brain regardless of the input and has more to do with the context and the intent of the threat.

      Joe, in regards to intent and referring to the video. Watching the video, the two persons going through the haunted house responded in ways that would not be described as weak. Often they responded quickly and abruptly. The intent of the threat was an approaching being (zombie) therefore the logical defensive response was withdrawal. If you looked at where the zombie was, front, back or side, they always moved away and pulled their limbs toward themselves. If the threat was behind they arched their backs away to escape.

      Also, if you flipped the context. Let's say you were a zombie actor, and your role was to scare others. Would you be as easily scared if you were walking through the haunted house? I think not. When entering a haunted house you are entering an implicit agreement to be scared. This is not the same if you are on the other side of the presentation i.e. an actor.

      Returning to the nervous system processing versus mechanical metaphors for pain processing, most of the people reacted defensively without any physical input. The input was interpreted through vision and audition. The context (haunted house) provided the direction for the brain to attend to the sensory system with the most relevant stimuli for cueing (vision and audition).

      Healthcare and therapy does the same thing. Our words can shape the context that directs someones attention away or towards a painful area, thus effecting their perception of threat in that area. Pain is often an ambiguous stimuli of threat that does not carry intent, or its intent is masked culturally learned meanings of that pain (bulldging disc etc.) Therefore the subsequent behaviors that arise in reaction to it may be quite variable.

      I do have some doubt about the nature of a mechanical nervous system versus a processing level of threat. Anecdotally, I have what I believe to be a cyst impinging the tarsal tunnel and effecting my sensation in a medial plantar nerve distribution. I have minimal pain. This one would think be a substantial threat if there ever was one to the nervous system. Additionally, I have a friend that had a extensive brain tumor that grew insidiously around his brain stem. That tumor developed over a period of years to the point it grossly deformed the shape of this brain system all without pain and only late onset neuro symptoms.

      Therefore, I much more inclined to believe that threat or intent of threat is much more valuable information. I think to speak of something as inert such as a cyst, or a tumor or a bus bearing down on you sounds a bit illogical. Yet, with respect to a being's health regardless of the agency of the other (cyst, tumor or bus) they are intent on destroying you unless something different is being done. The martialing of resources in response to threat is in essence the defensive response.

      Eric
      Last edited by Milehigh; 29-11-2013, 10:32 PM.
      --------------------------------------------------------------
      Body is imbued with mind, and mind is embodied.

      Comment


      • #48
        Originally posted by Milehigh View Post

        When entering a haunted house you are entering an implicit agreement to be scared. This is not the same if you are on the other side of the presentation i.e. an actor.
        Eric
        Something, I have been thinking about a bit. In regards to the implicit agreement. Most people that enter biomedicine expect the result that they will be treated, that their symptoms will be alleviated. It can be a bit off putting for the patient who believes in the implicit agreement of relief and gets told that no such relief is in store. Or at the very least it may not look like they previously imagined it would.

        Imagine if you entered the haunted house, and you were greeted by a tea party--a none to threatening one at that. Perhaps someone good chime in with some Alice and Wonderland parallels.

        At least a portion of my work is telling people, medicine does not treat pain very well. I think we as therapists could expand our practice with these segment of the patient population. But of course, we would then have to drop the implicit agreement of pain relief. This may also mean we have to drop the "shaping of expectations".

        Does anyone else sense this tension?

        Eric
        Last edited by Milehigh; 30-11-2013, 12:10 AM.
        --------------------------------------------------------------
        Body is imbued with mind, and mind is embodied.

        Comment


        • #49
          Eric asks:

          Does anyone else sense this tension?
          Every day.
          Barrett L. Dorko

          Comment


          • #50
            Originally posted by Milehigh View Post
            Does anyone else sense this tension?
            Yes, you nailed it.
            -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


            • #51
              What challenges me with respect to the notion of biomechanics and the biopsychosocial models, is how some therapists will dedicate themselves to one therapy like SC or DNM. Diane has said that if someone does not respond to 4 sessions of DNM them they won't respond to manual therapy. I presume that manual therapy does not include movement and exercise (biomechamically speaking). If we are to include both models should we not evaluate for signs of both/all?
              For me personally this is one reason why would have to agree with some of what is said about what appears to be a dismissal of biomechanics as a potential part of the solution set. There are some at SS who's treatment set revolves around one modality. It therefore seems like they are either choosing to not offer biomechamical interventions or feel that their treatment modality inherently covers it all.
              Nathan

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              • #52
                Nathan says:

                It therefore seems like they are either choosing to not offer biomechanical interventions or feel that their treatment modality inherently covers it all.
                This sort of comment makes me wonder what you're reading.
                Barrett L. Dorko

                Comment


                • #53
                  There are some at SS who's treatment set revolves around one modality. It therefore seems like they are either choosing to not offer biomechamical interventions or feel that their treatment modality inherently covers it all.
                  Who?

                  Nari

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                  • #54
                    Nari,

                    It seems that Nathan reads very selectively and has NEVER read anything about our interest in the neurobiologic revolution, signals in posture, Feldenkrais movement or the intricacies of handling and education. I use all of this and more but to Nathan that's "one modality."

                    I guess.
                    Barrett L. Dorko

                    Comment


                    • #55
                      I said there are some, not all.

                      Barrett, do you also prescribe specific exercises? Have you ever asked your patients to strengthen their trunk muscles? I have read as much as a guy could read in the short time that I have but I can't recall any of your posts that stated you give exercise beyond feldenkrais.

                      Diane also gives exercises that would seem to be ROM nature or perhaps nerve sliders. But nothing toward strength that I can recall.

                      Yes I have heard of the neurobio revolution. However, How can you separate strength from fear avoidance relief? Just because a strong person also has pain?

                      Perhaps Diane could help to understand the meaning of the paraphrased quote I posted above?

                      I posted what I did because it was my perception of what I have read so far. If I am wrong about that then I would aquiese.

                      Comment


                      • #56
                        Originally posted by zendogg View Post
                        What challenges me with respect to the notion of biomechanics and the biopsychosocial models, is how some therapists will dedicate themselves to one therapy like SC or DNM. Diane has said that if someone does not respond to 4 sessions of DNM them they won't respond to manual therapy. I presume that manual therapy does not include movement and exercise (biomechamically speaking). If we are to include both models should we not evaluate for signs of both/all?
                        For me personally this is one reason why would have to agree with some of what is said about what appears to be a dismissal of biomechanics as a potential part of the solution set. There are some at SS who's treatment set revolves around one modality. It therefore seems like they are either choosing to not offer biomechamical interventions or feel that their treatment modality inherently covers it all.
                        Nathan
                        I don't think "biomechanical models" can encompass "biopsychosocial models"

                        On the other hand, I think "biopsychosocial models" can completely encompass "biomechanical models" - to the point of making them totally optional.

                        Biomechanical models are like training wheels.
                        Biopsychosocial models are like riding a bicycle, usually without them.
                        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


                        • #57
                          What of that "single modality" crack?

                          Do you still think strength is necessary for pain relief and fear avoidance?

                          Do you think I tell people NOT to strengthen themselves?

                          Do you think I'm a personal trainer?
                          Barrett L. Dorko

                          Comment


                          • #58
                            Originally posted by zendogg View Post
                            Barrett, do you also prescribe specific exercises?
                            I think specific exercises are useless when it comes to persistent painful conditions.


                            Have you ever asked your patients to strengthen their trunk muscles?
                            Do you think lack of trunk strength actually plays a role in persistent pain?

                            I have read as much as a guy could read in the short time that I have but I can't recall any of your posts that stated you give exercise beyond feldenkrais.
                            So again, do you think specific types of "exercises" make a measurable difference really?

                            Diane also gives exercises that would seem to be ROM nature or perhaps nerve sliders. But nothing toward strength that I can recall.
                            So lack of strength in your mind is a relevant indicator of why pain might persist?

                            Yes I have heard of the neurobio revolution. However, How can you separate strength from fear avoidance relief? Just because a strong person also has pain?
                            Indeed the literature clearly suggests that lack of strength and persistent pain are not related in such a way that it would even register on my radar by and large.

                            Comment


                            • #59
                              It therefore seems like they are either choosing to not offer biomechamical interventions or feel that their treatment modality inherently covers it all.
                              Hi zd, can you define what you mean by a biomechanical intervention?

                              Comment


                              • #60
                                I can't answer for Nathan, but when others speak of a "biomechanical" things they mean "alignment born of strengthening."

                                Some would say, including me, that they were very, very wrong.
                                Barrett L. Dorko

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