Announcement

Collapse
No announcement yet.

Free online learning from leading meat experts(including the thoracic ring people)

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • HeadStrongPT
    replied
    Originally posted by PRPerformance1 View Post
    Kory,

    I really think there are many practitioners trying to do just that. We'd all love to discover some sort of panacea, but as you mentioned, it is a difficult task. I don't think any practitioner is arrogant enough to state that his approach is that panacea, that they don't experience failures on a regular basis, or have all the answers. If someone were to boldly state such things, I think most of us would wisely run in the other direction.

    Considering all the potential perceptions, it's no wonder that there are so many ways to access the system that may demonstrate potential benefits. While we share commonalities in anatomy and physiology, we do not share our brains (if you're looking for a driver). There will always be controversy.

    Bill
    Hi Bill and thanks for participating. I don't see those on this forum advocating for the discovery of a panacea. We are looking for some degree of skepticism, critical thinking, and hell even some common sense from our fellow providers in the management of painful problems.

    What we continue to get are these labyrinthine assessment and treatment approaches having little to no scientific plausibility or peer-reviewed support for their use. (See Kory's examples above)

    I'm ready to prune, not fertilize.

    Leave a comment:


  • Greg Lehman
    replied
    Hi Proud,

    While I agree with the sentiment of what you wrote here:

    5) Patient leaves with the understanding that some assymetry, some weakness, some remote "joint" was at fault (this seems to be the underlying premise that is inevitably conveyed to the patient as far as I can tell).

    Thus...the explanatory model conveyed to the patient (but apparently neurologically rationalized by the clinician) is noceboic in nature...
    I'm afraid that any time we suggest that we are doing something Specific to patient to influence some sort of nociception than we run this risk.

    For example, I try to do Diane's DNM. One part of my pain education includes the possibility that nociception is occurring because of ischemia to part of a nerve. This idea may or may not be true. My treatment interaction is trying to influence it. It seems to me that this explanation can be just a noceboic.

    Are these explanations (some joint dysfunction versus a tunnel syndrome) viewed so incredibly different in the eyes of a patient? Especially, if you find a "movement dysfunction" that the patient can influence themselves?

    If you do anything with your hands and suggest that you are influencing some dysfunction in the patient that they can't catalyze to a resolution themselves alone, then we run the risk of the nocebo.

    Greg

    Leave a comment:


  • proud
    replied
    Why are all these people getting people better?

    1) Therapist believes in what they are doing...is confident, caring, likely charasmatic.

    2) Patient "buys in"....subsequently restores hopefulness and downregulates threat.

    3) There is some neuromodulatory input in most cases which further enhances the expectation of improvment and downregulates threat. A clinician might see a reduction in "tone" (if you will) which the clinician interprets as something they've done for the patient.

    4) Patient improves despite the premise of treatment being innaccurate.

    5) Patient leaves with the understanding that some assymetry, some weakness, some remote "joint" was at fault (this seems to be the underlying premise that is inevitably conveyed to the patient as far as I can tell).

    Thus...the explanatory model conveyed to the patient (but apparently neurologically rationalized by the clinician) is noceboic in nature...

    Cart.....>ahead.....>of......>horse.

    Leave a comment:


  • PRPerformance1
    replied
    Originally posted by Barrett Dorko View Post
    Dominance is the word, not tone.

    Is Ron still too busy?
    Thanks for that.

    I can't offer a response to your question.

    Bill

    Leave a comment:


  • Barrett Dorko
    replied
    Hruska's secretary said he was "too busy" and his follower seemed to lose the thread at the end. I'd refer you to it.

    Dominance is the word, not tone.

    Is Ron still too busy?

    Leave a comment:


  • PRPerformance1
    replied
    Originally posted by zimney3pt View Post
    So instead of looking at the unique tricks and being caught up in a new trick these different approaches can teach us, maybe lets look at why so very different approaches can correct different biomechanical primary drivers of a painful problem and still get patients better. To me it comes down to threat. They had the ability through their words and interaction to reduce threat in that patient and it has less to do with a biomechanical fault. Sure biomechanical faults matter, but how do we consistently measure these with validity and reliability and say with extreme confidence that correcting is necessary and not just sufficient?
    Kory,

    I really think there are many practitioners trying to do just that. We'd all love to discover some sort of panacea, but as you mentioned, it is a difficult task. I don't think any practitioner is arrogant enough to state that his approach is that panacea, that they don't experience failures on a regular basis, or have all the answers. If someone were to boldly state such things, I think most of us would wisely run in the other direction.

    Considering all the potential perceptions, it's no wonder that there are so many ways to access the system that may demonstrate potential benefits. While we share commonalities in anatomy and physiology, we do not share our brains (if you're looking for a driver). There will always be controversy.

    Bill

    Leave a comment:


  • proud
    replied
    Originally posted by zimney3pt View Post
    So instead of looking at the unique tricks and being caught up in a new trick these different approaches can teach us, maybe lets look at why so very different approaches can correct different biomechanical primary drivers of a painful problem and still get patients better. To me it comes down to threat. They had the ability through their words and interaction to reduce threat in that patient and it has less to do with a biomechanical fault. Sure biomechanical faults matter, but how do we consistently measure these with validity and reliability and say with extreme confidence that correcting is necessary and not just sufficient?
    I think you nailed it Kory and I'm quite sure the scientific literature would support this. It's the attention, the apparent procedural evaluation, coupled with the certaintly potrayed by the evaluating/treating clinician that get's the ball rolling. It's not the technique.

    I'm sure if all of these experts thought about it for a few seconds, they would all ask themselves the same questions...why are we all getting patients better when we are all looking at different potential...supposed...drivers?

    I mean...even a high school student with a minutia of scientific inquiry would ask these questions. Why not these guys?

    Leave a comment:


  • PRPerformance1
    replied
    Originally posted by Barrett Dorko View Post
    Bill,

    The Postural Restoration thread begun in 2006 has had nearly 31,000 views and 239 replies - none by Hruska.

    Unless this changes I'll conclude that he doesn't want to discuss his premise or method, both of which seem to be changing and confuse the daylights out of me.

    Oh yes, and the word tone is meaningless.
    Barrett,

    I'm sure there are many practitioners that don't see value in participating on SS.

    May I ask how you would describe the level of activity of the ANS if tone is a meaningless word?

    Thanks

    Bill

    Leave a comment:


  • zimney3pt
    replied
    Originally posted by Cupplesperformance View Post
    I would be cautious in suspecting what some of these practitioners may or may not say. As science changes and new information comes out, oftentimes one's stances/understanding/explanations change to account for this shift.

    Is it fair to say let's listen to what the speakers have to say and then discuss that?

    Many of the people on this list appreciate the nervous system's influence and intertwining that with other systems. See below.

    1. Ron Hruska - I have taken many PRI courses; posture is not talked about causing pain. They do not even discuss posture in the traditional sense. I see the goal with these people is movement freedom and variability achieved via the autonomic nervous system a la breathing.

    2. Val Nasedkin - The omegawave deals with measuring HRV, which is thought to correlate with the status of the ANS amongst other things...sounds neuro.

    3. Andreo Spina - I cannot speak on his behalf fully, but I have heard this guy pulling a lot of research into his method. He has a few quotes regarding the nervous system here -

    http://www.jeffcubos.com/2013/12/23/...-andreo-spina/

    4. Gray Cook and other FMS/SFMA people - Gray based most of his system off of PNF...neuro

    5. Linda Joy Lee - I may not agree with how the Lees assess/treat, but I have read her book "The Pelvic Girdle" and in one of the first 5 chapters (chapter 5 I believe) they talk a great deal about pain science and the nervous system.

    6. Charlie Weingroff - Talks a lot about the nervous system and most of what we are dealing with influencing the ANS

    "Ultimately, the nervous system is any part of the organs that allow for transmission of signal. It’s an exchange of volitional action or non-voluntary reactions on how a body does what it does, whether it’s movement or whether it’s homeostasis and just maintaining normal mechanisms of health and sustenance." ~Charlie Weingroff

    7. Patrick Ward - Discusses much about the ANS and influences not just on pain but performance.

    http://optimumsportsperformance.com/...-for-a-way-in/

    It seems that at least a bulk of the group speaking appreciates the nervous system; so let's learn, discuss, and debate what is said once it is said.

    I really like this list of all these different approaches and individuals and I think we could add many, many more to it. The thing that troubles me and is a question I would like answered is that if each of these approaches is treating some biomechanical movement function that needed correcting and producing movement freedom because they were the "primary driver" then how is it they all can take these different paths and get the patient better?

    How is it we most likely could take the exact same patient with a pain experience and put them in front of any of these clinicians there is a good chance each will find a different primary driver and provide a different treatment approach and get the patient better. I do believe that most of the time everyone of these clinicians gets many of their patients (90% or more, but not 100%) a lot better. How come the Lees' can fix a 5th ring dysfunction, Hruska will improve their dysfunctional left AIC problem, Cook clears up the squat pattern, someone else will release their fascia, another will TDN a trigger point, still another will fix the cranial-sacral rhythms, and we can go down the list. If each of these was the primary driver how come the other methods and their primary driver also fixed the problem?

    Have you ever worked on a patient and felt like you needed to improve their posture and you work to correct it and they get better and their posture never changed? Have you ever worked to improved someones core stability and they get better in 3 days (last time I checked we can't increase muscle strength that fast)? Have you ever mobilized or manipulated a stiff T5 and have the patient get better but when you reassess you question if it really feels any less hypomobile then before?

    So if all these approaches and their ability to find the primary driver is different and they all get patients better, what is really the primary driver? And was the treatment approach necessary or just sufficient?

    To me understanding the nervous system and it's interaction with the body and culture comes down to humility. It's complex and anything might be sufficient to improve their condition, but most likely not necessary. As I listen to some of these individuals (I will admit I have never had the opportunity to sit and chat with any of them so this may very well be an unfair assessment) their seems to be a bit of a lack of humility at times. They demonstrate they know what to fix and how to fix it, won't you like to know and do what I do? Also I hear how they use science and research to their advantage often to tear apart another method. Yet it when it comes to their own you hear things like well intuition is needed and science and RCT can't prove everything. I agree there is some sort of intuition that might play a roll and we can't rely on just the evidence for everything, but then that needs to be equally applied to all methods even our own and if we criticize with evidence we should criticize our own as equally well.

    That is one thing I have learned from Adriaan is that treating pain is hard and complex and we don't have all the answers. We teach mobilizations, TNE, neurodynamics and we offer the success stories (heck I just published a case study of one), but we also openly admit that there are some patients that walk out of our clinics thinking we are the biggest jerk this side of the Mississippi. Believe it or not some of these experts don't get everyone better either, they might actually make some people worse.

    So instead of looking at the unique tricks and being caught up in a new trick these different approaches can teach us, maybe lets look at why so very different approaches can correct different biomechanical primary drivers of a painful problem and still get patients better. To me it comes down to threat. They had the ability through their words and interaction to reduce threat in that patient and it has less to do with a biomechanical fault. Sure biomechanical faults matter, but how do we consistently measure these with validity and reliability and say with extreme confidence that correcting is necessary and not just sufficient?
    Last edited by zimney3pt; 18-01-2014, 12:17 AM.

    Leave a comment:


  • Barrett Dorko
    replied
    Bill,

    The Postural Restoration thread begun in 2006 has had nearly 31,000 views and 239 replies - none by Hruska.

    Unless this changes I'll conclude that he doesn't want to discuss his premise or method, both of which seem to be changing and confuse the daylights out of me.

    Oh yes, and the word tone is meaningless.

    Leave a comment:


  • PRPerformance1
    replied
    Originally posted by keithp View Post
    Some might wonder if they are reading 'lip-service' acknowledgment of the NS; I will simply state that it seems as though I am reading very mixed signals.

    Respectfully,
    Keith
    Hey Keith,

    I totally understand where you're coming from in seeing conflict in presentation of some of the materials. I felt the same way initially.

    Having spent a fair amount of time with PRI instructors and a few conversations with Ron, I'll try to give you what I think is the reasoning behind it.

    Consider how most, if not all, PT's (or all medical people for that matter) are trained. Very isolative, separated systems, and with a strong influence of the biomechanical model.

    As Jason Silvernail has recently posted on FB, moving to a different model (muscles, movements, positions, and fascia toward BPS/nervous system) takes time. Utilizing common language may provide a less threatening atmosphere for orthopedically/biomechanically minded practitioners to seek out the material and make a confortable transition to understanding a much broader system model.

    Ron's first course in 1996 was a "knee course," but it wasn't a knee course. It was a neuro course utilizing knee pain to expose biomechanically thinking therapists to a model that sees the nervous system as the dominant influence. Good luck getting your top orthopedically minded crowd to show up. I wouldn't have at that time.

    The foundational courses bridge the gap between that biomechanical model and the human as a singular system. Without question, PRI is as deep a model as you're willing to take it. I can assure you Ron sees things as a unified system thus the inclusioin of all sensory inputs in the model (stomatognathic, peripheral sensory, vision, audition, etc.) as potential influences and the interdisciplinary integration with dentists, optometrist, podiatrists, etc. as he recognizes the limitation within PT to influence those inputs.

    Description of posture (not even sure if that term came up at the last course) or alignment is in reference to identification of predictable motor output resulting from ANS tone. Some will see this as a bitter pill to swallow and that everyone is different and couldn't possibly adapt to specific posturing, movement limitations, etc. I would ask you this then. When your sympathetic nervous system dominates do your pupils dilate, does your HRV decrease, does HR increase, does BP increase, does muscle tone increase, does breathing rate increase. If you're human, I would assume so. It's not a tremendous stretch to see that motor outputs, limitations in movement or positions, if you will, will also be produced in a predictable pattern such as that seen with increases and anti-gravity muscle tone.

    PRI merely uses common orthopedic testing, again familiarity, less threatening, and convenient perhaps, to determine system dominance. When PRI speaks of "neutral," they don't speak of neutral as in posture but as restoring capacity for movement variability [my words]. Sympathetic dominance restricts system variability (movement or HRV for example) which may prevent or limit the ability to alleviate mechanical deformation of the nervous system or perceived threat. Any subsystem may attempt to accomodate to perceived threat and any resultant adaptation of any (other) subsystem may perpetuate the sympathetic dominance by influencing sensory inputs.

    Any approach toward symmetry is in regard to the ability of the body to perform reciprocal and alternating movement which would be a sign of reduced sympathetic dominance. Again, I use the perspective of restoring variability. Providing options so movement is less threatening and reducing mechanical loads. It is not about making posture look a certain way or fitting into some perceived ideal model. Perhaps we can blame the name of the system to a degree as it certainly creates preconceived notions as seen on several threads here on SS.

    I think we are all attempting to influence the ANS with any form of treatment. How else would so many methods have such profound effects on restoration of painfree movement? PRI provides a clinically accessible measure of ANS tone to guide treatment.

    Again, this is my explanation not Ron's or PRI's but my interpretation that allows me to utilize the model. I also apologize if this is a bit disjointed as I'm writing between patients.

    Bill
    Last edited by PRPerformance1; 17-01-2014, 06:46 PM.

    Leave a comment:


  • proud
    replied
    Originally posted by GregLehman View Post


    Whats interesting is the huge difference in opinion on "optimal" movement's relationship to pain or injury between those speakers and many people here on this board
    The vast variation (and these speakers are only the tip of the iceberg) should be serving as a lamplighter. The wide variation in what is "optimal" movement to explain away pain exists because there is no such thing as "optimal movement" to explain away pain.

    Perhaps in the training world optimizing how someone moves through strength and motor control enhances performance...but it generally has never been demonstrated that it reduces injury risk (sorry SFMA) or that somehow correcting faulity movement patterns plays any significant role in the pain experience.

    I'm pretty sure that this love fest for faulity biomechanics stems from two things; 1) the Physiotherapy profession desperately trying to compete or maintain a piece of the alternative medicine pie (ie compete with chiropractors, myofascial massuers etc) and; 2) many Physiotherapists get into this racket because they think it's some sort of an extension of a kinesiology or phys ed degree.

    I'm with John here, what I see is many industry "experts" have been forced to acknowledge the nervous systems role in pain but are jamming a square peg into a round hole. We ain't moving forward until our tools change and we start recognizing...we've got a round hole.

    In other words...they are working backwards.

    Leave a comment:


  • rex08
    replied
    Originally posted by GregLehman View Post
    At its very simplest I think the rationale is based on how important you think Nociception is to the pain experience
    Movement "flaws" create compensations which lead to nociception
    Address the movement flaw and ameliorate nociception.
    All these models assume Nociception is occuring and is the primary driver of pain
    I think the issue is not that movement "flaws" are hardly relevant or that nociception associated with mechanical deformation can lead to pain. I think that everyone can agree to that. The issue may be that nociception is a just a small part of the entire pain process that we do not fully understand. I would change your sentence to Movement "flaws" create compensations which may lead to nociception which may lead to pain.

    I would say that all of us treat "movement flaws" with manual therapy, movements, and pain neurophysiology education. It's the context of the treatment that is based on scientific publications. Most educators leave things out or forget to mention important concepts regarding the pain process.

    1. We are making an assumption when we think a specific manual treatment that we did is the driver of decreasing someone's pain. This statement is based on the over 70+ articles on pub med that have found that palpating anything under the skin has limited reliability and validity. It doesn't mean that we don't do the manual technique, it means we have to be careful regarding how we explain what we are doing because of the possibility of catastrophization of pain.

    2. Promoting catastrophization of pain may lead to more pain or recidivism of pain. For example telling a patient that a disc, a muscle, joint, and etc is causing their pain may increase negative effects in the pain process. How do we truly know that performing a innominate mobilization to correct a pelvic obliquity to improve a movement flaw or compensation is actually decreasing pain. There are many possible mechanisms that may explain why a patient improved symptoms.

    3. More and more studies are showing that educating patients regarding the neurophysiology of pain helps to decrease pain. That means we need to understand the pain process in a deeper fashion. We need to understand the strengths and flaws of the Cartesian model, Gate theory, Neuromatrix model, the biopsychosocial model, and even the theories that you practice. That is what Soma Simple is about.

    4. How do we know what the primary driver of pain when

    - soldiers who had amputations required 25 to 75%(i dont remember the exact number) less morphine compared to civilians who had amputations because the context as to why they had the amputation was different. The soldiers felt relieved they are no longer in battle and the threat (person shooting at them )of their problem was removed. For civilians the threat could be the leg itself.

    - We can experience pain when observing someone else in pain watching someone move, or even thinking about an activity. Graded Motor Imagery may be an important aspect of treatment.

    - a child feels less pain after kissing their boo boo - the child now feels safe. Perhaps this is a part of what manual therapy does.

    - there are a lot of people out there with dysfunctions and do not have pain

    5. and most importantly, what about those patients where we did everything we could but they didn't improve??? This is where I starting applying the neurophysiology of pain and I am still learning.

    Sincerely,
    Rex Fujiwara, MPT, OCS

    Leave a comment:


  • GregLehman
    replied
    Last post:

    For anyone interested here is a blog I wrote suggesting that no manual therapy can influence the structure of Connective Tissue. Andreo Spina ( a friend for a decade) wrote a long reply.

    Related here is a review of mine of Charlie Weingroff's course and the SFMA[/URL]

    Greg

    Leave a comment:


  • GregLehman
    replied
    Oh and if you think nociception plays a tiny role and pain is emergent from a big Fuzzball then you probably think movement "flaws" are hardly relevant.

    Where you fall on this divide determines what you teach people about pain, certainly of mechanical origin

    Leave a comment:

Working...
X