CT Pot-Pourri

[Johnny_Nada]

Some random thoughts. I'm unsure how to put this into a formal thread. Feel free to address or comment on any random ones that show up. I plan to use this in the future as my thoughts show up.

-The more I read and learn about pain, the further away from manual therapy, modalities or other methods defined as 'treatment' I get…

-The more I read and learn about pain, the less equipped I feel when attempting to help people suffering from it.

-I have no idea what normal means or why it matters when speaking of human movement, posture and symmetry.

-I don't understand the term 'movement specialist' (see above). To me movement is your fingerprint.

-The more I read and learn about pain, the more I see continuing education courses and pseudoscience continuing. If context, expectation and other factors are so important in the modulation of pain, tissue targeting courses will continue.

-Any intervention going through skin is equal to the next if provided in the right context. This is why learning 'new' techniques doesn't make sense to me

-I have yet to fix or cure anyone, and I have no intentions to do so in the future.

[Johnny_Nada]

I wonder if the positives of a placebo are more, less or equal to the negative of a nocebo?

[nickmPT]

In agreement to your list above.

To your second post, obviously it depends on the individual, but I think that nocebos can outweigh placebos in most cases. Just from a survival standpoint, we are probably going to remember that negative crap much more than the positives.

[nari]

I have no idea what normal means or why it matters when speaking of human movement, posture and symmetry.

Neither have I.
What is considered normal for one person is not for another.

It makes it so much easier to channel all personalities and sizes together under one standard sort of diagnosis and remedy, doomed to fail a lot of them (that's a guess).
Which is why so many of us are frustrated by the toolbox therapy approach.

[Mikal Solstad]

I envy those who, as John Ware recently said, work with patients who are actually sick.

I can not see myself working in this profession 10-15 years from now...

[beatmama]

The more I read and learn about pain, the less equipped I feel when attempting to help people suffering from it.

-I have no idea what normal means or why it matters when speaking of human movement, posture and symmetry.

-I don't understand the term 'movement specialist' (see above). To me movement is your fingerprint.

-Any intervention going through skin is equal to the next if provided in the right context. This is why learning 'new' techniques doesn't make sense to me

-I have yet to fix or cure anyone, and I have no intentions to do so in the future

Very nicely put , as a student the more i understand and learn about pain , context etc. the more I am confused as to what to do with patients regarding manual therapy techniques ...but patient expectations have to be managed, after all that's why they come to see us. The challenge as I see it is finding a way to merge better explanations that give the patient the opportunity to see things from a different angle .... which is the real 'fix' (hate that term) so many often refer to.

[drmarty]

What does this patient need, at this moment, to help them release their patterns of pain and suffering?


Not every patient is ready to hear a new model of pain (or therapist). But I feel your pain (haha) on the points you listed above.

[gollygosh]

Drmarty.

I explained to a new patient today that my goal is to teach her not to need me. There may be manual therapy in the beginning, but I push that pt toward active self - efficacy as soon as possible.

Geralyn

[drmarty]

Isn't that refreshing for them to hear? Or not for those who want a crutch.

In chiropractic, often patient's ask "do I have to come here for life". Nope. Parts of my explanation are probably still quite "mesodermal..." though.

[Johnny_Nada]

-I understand strength and pain have little correlation, but feel its important to be strong, because being weak can make life challenging.

-I don't fully understand the link between depression and pain, but when someone presents with the primary complaint of pain and depression, it is very challenging.

[Josh]

I wrestle with all of your points each and everyday.

Its really hard to explain that if one watched my treatment encounter from the other side of a two-sided mirror with no sound, it would look really boring and "unskilled". Seven years ago, the same situation would have looked much more skilled and dramatic....and repetitive!

I have to reassure you that the more you learn about pain.....the more you are the one best equipped to help them. Because you know what you can and cant change and you won't lie to them, setting them back into a whirlwind of confusion!

[Johnny_Nada]

Regional interdependence

A method I used to justify my manual therapy approach as a new grad.

How would I, as a CI now, talk to me, as a student then?

Now: Why are you wiggling/rubbing his toe?
Then: Regional interdependence?
Now: Citation?
Then: Wainner et al editorial
Now: Really? Do better...
Then: Manual therapy RCTs by Walker, Whitman, Jull, Deyle x 2, etc etc etc
Now: Do you think it was the "manual therapy" that really mattered?
Then: yes because of neurophysio….
Now: (interrupting) Really?
Then: Well what else could it be?
Now: think harder!
Then: context? expectation? patient confidence? my confidence? therapeutic alliance? decreasing threat? decrease fear? enhancing efficacy?
Now: So do you think you could do that without rubbing, pushing, pulling and/or cracking?
Then: I think I could….
Now: I agree, lets start working on that.

[Johnny_Nada]

I have a feeling there are many physical therapists seeing patients after a motor vehicle accident that have some form of whiplash associated disorder. I have a feeling many are seeing these patients for quite some time. I have a feeling they would not appreciate or feel comfortable telling their patient they may be better off NOT seeking "treatment"

[Steve Hill]

You mentioned

-I understand strength and pain have little correlation, but feel its important to be strong, because being weak can make life challenging.

If the patient feels weak, they feel vulnerable. If they have been told they are weak, that feeling increases. I tend to explain to the patient that strength should be defined as the ability to handle stress.... physical, mental, whatever the stress might be. Of course I explain that pain has nothing to do with strength in the physical sense, but also that if one can lose the sense of frailty through the reassurance that indeed her tissues can handle strain without pain, this fuels the idea that improvement can be made.

It can be a very depressing thing, to realize that a significant portion of one's career has been based on a significant amount of BS. However what we do with that is up to us, no matter how the rest of our field may do things. There will be a pendulum swing. But, these things take time. Until then, I refuse to be one of the dead.

[REKIV]

I will freely admit that this site frustrates me.... but in a good way. I feel frustrated that this subject was never touched on in school for me, or in any of my continuing education courses (which now shows me that some were pretty poor C.E. courses...). Context? Patient confidence? Threat? Patient-centric self-drive motion?? None of that! I was very good at the mesodermal explanations of what I was doing, but never knew enough to question why I was doing what I was doing, or even if I was having the effect I thought I was having.