You don't have to care what I think. But you should care about the holes in your own thinking that I've pointed out.
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What might look like holes to you, I prefer to think of as space I've managed to open up by decluttering.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
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WCPT PhysiotherapyPainNetwork on Facebook
@WCPTPTPN
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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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One last post from me, and I will declare this thread done to death.
1. Manual therapy is not a "thing" - it's an intrinsic behaviour evolved from social grooming in vertebrates and conceptualized by human primates, taught from the time humans could talk, bottom-up/operator style.
2. Manual therapy should be about pain and pain relief.
3. Pain, and relief of pain, is strictly a top-down phenomenon. It occurs only in ectodermal derivatives, specifically the brain. Nerves and spinal cord are antecedent, and very important physiologically, to a emergent pain production.
4. Manual therapy models must adapt, teach about pain, teach top-down, not just bottom-up, and interactively, not only operatively.
5. The senses are the only way into any patient's brain. Talking/education are paramount; furthermore, touching is allowed us; skin receptors have the fastest highway into the brain (DCML), and to its output mechanisms, by any manual therapist, so these should be in sharp focus.
6. People who get stuck in a bottom-up mindset because they ponder far too hard about what deep receptors are where, how to affect them, are going to lose sight of the whole point of touching somebody on their skin, i.e., stress and pain relief.
7. Nociception is mostly irrelevant to the brain and is handled immediately, effectively, automatically, by the internal regulation system, without ever becoming or having to become pain.
8. If anything out in the periphery needs moved, by a manual therapist, it's nerves themselves: neural anatomy is unique, crossing many tissue boundaries, and the connection to accompanying vascular supply is vulnerable to mechanical deformation (e.g., simple inactivity, habitual resting positions, or repetitive strain); enough signalling from these, over a long enough period, will challenge spinal cord cell interaction/immune cell physiology enough to change it, which can give rise to an actual pain situation.
9. Worrying or perseverating about anything else, i.e., receptors that may lie in deep tissue other than nerve tissue, or arguing to include them/it in a treatment or in an explanatory model of manual therapy, is a massive waste of time, and would serve to keep the profession mired in mesodermal mutterings, whereby we see misled therapists misleading ever more therapists into the fogbound foreseeable future.Last edited by Diane; 22-06-2014, 03:03 PM.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
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I think you're obliged to spend time thinking about "receptors that may lie in deep tissue other than nerve tissue" so long as you are (even just incidentally) activating them and until you can rule out their influence. That is straight forward. These receptors are part of the nervous system too.
The only PT who is off the hook, I think, is someone who exclusively practices sc, where any activation of deeper receptors is likely to be mostly internally generated.
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Originally posted by PatrickL View PostI think you're obliged to spend time thinking about "receptors that may lie in deep tissue other than nerve tissue" so long as you are (even just incidentally) activating them and until you can rule out their influence. That is straight forward. These receptors are part of the nervous system too.
The only PT who is off the hook, I think, is someone who exclusively practices sc, where any activation of deeper receptors is likely to be mostly internally generated.
I for one am never going back into that particular swamp.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
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And about what is best for the profession. Good luck driving change by constantly sending the message "you're wrong" to all and sundry. I tried that for 12months over at linkedin. It's pointless. There's gotta be a better way. I suspect that better way involves some sort of meeting in the middle with those PTs we wish to educate.
I get that you guys "have been dead for too long" to take that approach. But an uncompromising, rigid approach seems counter productive to me. I think getting PTs to think about changing their explanations via the introduction of the idea that it is receptor activation that counts, is the first step towards the position you currently hold, Diane. Perhaps once there's been some generational change in curricula, edging more towards an interactive approach, there will come a day where that post of yours above might form the intro page to a PT university manual.
I'm opting for a different means to the same end.
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With regards to what a "waste of time" it is to ponder the relative influences of different tissue's receptors to any observed clinical phenomena. I don't waste any patients time on such matters. If I'm holding a patients leg while he lies in supine, and carrying out a sustained traction longitudinally along the leg, and the patient reports that it relieves his pain, I will wonder if there is a relevant sensory/discrim component to the reported pain relief. I will wonder if the key sensory/discrim input was derived from mechanoreceptors in the skin, or from movement of nerve trunks, or from mechanoreceptors in spindles or other dare I say it mesodermal derivatives. I wonder these things and conclude that there's no way to know. I accept that. I'm certainly not going to pretend I know and tell the patient as such.
My job is to provide a narrative that is broad enough to cover that which I can't rule out, while being confident enough to convince the patient that I know what I'm doing.
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Diane, with all due respect, I don’t think that your reply to my post addressed my points/concerns.
I still haven’t heard from you: what you think is going on at the peripheral receptors level when we experience stronger stimuli?
You say,Too much info for the nervous system to process favourably (for the patient) in too short a time and too small an area. See spatial and temporal summation. See post 124.
We should be jet planes coming down on a patient on a long runway, low angle of entry, not helicopters plunking down then pressing down.-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.
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adding to the above: assuming that all parameters to choose from are equally safe/ appropriate in the context of quality care.-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.
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Originally posted by Evanthis Raftopoulos View Postwhat you think is going on at the peripheral receptors level when we experience stronger stimuli?
A sensory neuron either fires or doesn't. It either mounts an action potential or it doesn't.
The brain doesn't care about the strength of a peripheral stimulus. Only about how they mount up, temporally and spatially, and about how to predict and mount an output based on prior experience and context.
Which is why we have to grok that nociception and injury, injury and pain, pain and nociception are not, have never been shown to be, and never will be shown to be, quantitatively linked.
Why we have to realize that we aren't doing ANYthing "specific" when we do manual therapy, we are creating a treatment context and providing a storyline for an event called a "treatment encounter" which will either help (due to non-specific effects in the patient's brain) or won't (because of some dumb tissue-based nocebo comment issuing forth from the well-meaning but not very cognizant therapist.)
You say,That’s not true, how do you explain the fact that some people respond favorably to stronger stimuli?
Stronger stimuli can be applied in accordance to the above. Nevertheless, what if the patient finds more helpful a relatively perpendicular pressure than a lateral soft tissue stretch? Who is to decide what parameters are optimal in the context of pain relief, us or the patients?
The therapist should not aggravate anything that already exists.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
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Thank you for replying Diane. I much appreciate your willingness to engage in discussing these issues.
Same as when we experience weaker stimuli.
A sensory neuron either fires or doesn't. It either mounts an action potential or it doesn't.
Why we have to realize that we aren't doing ANYthing "specific" when we do manual therapy
The patient has locus of control over the therapist. One hopes..
The therapist should not aggravate anything that already exists.-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.
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-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.
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Evan, please read this, then if you have any further questions, get back to me.
None of this is explainable in any sort of bottom up way, which is kinda the point I'm trying to make, all the way through this thread.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
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