Pot-Pourri

[Johnny_Nada]

[YT]rzo5V11_OEY[/YT]

[Barrett Dorko]

John,

Any therapy that reduces the output of pain seems to have been abandoned. It has not been discussed at all, to say nothing of acute or chronic behavior. "Chronic" takes over after a while, I guess.

This is well-written, but it begs some of us to ask questions.

[mortene]

I find my travels in this chasm reflect a premise. This premise has been discussed by other influential writers. Their predicaments are what I see daily in the clinic. Their view has been going on for quite some time and it challenges even those that have crossed the first chasm.

decisionaid provides the same advice as doctor skeptic. A similar "strategy" might also be relevant with regards to the hip patients you mention FNG?

Eric Meira and JW Matheson have done some really good podcasts lately, talking about cost/benefit and the difference between wellbeing treatments and medical interventions - well worth a listen.

And Johnny, thanks for posting.

[Johnny_Nada]

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So here we see three deconstructions of shoulder non sense in front of what I can only imagine are very influential physios from around the world. I'm sure many publish and perform research. Why would it be so difficult for these folks to come together with the major rehab journals and call this out as bullshit?

[Johnny_Nada]

Next Saturday I'll be attending my first IASTM (instrumented assisted soft tissue mobilization) course. I asked to course director if there is any pre-course reading assignments. There isn't. Its eight hours long. In case you're wondering, I'm taking it because its free CEU's, close and easy access.

I could have said no. But now I can say I did so; for that day when I hear "you should take a course in...."

I'm required me to take CEU's to maintain my license. Gotta stay up to date and ensure I'm providing best care for my patients....

[proud]

Next Saturday I'll be attending my first IASTM (instrumented assisted soft tissue mobilization) course. I asked to course director if there is any pre-course reading assignments. There isn't. Its eight hours long. In case you're wondering, I'm taking it because its free CEU's, close and easy access.

I could have said no. But now I can say I did so; for that day when I hear "you should take a course in...."

I'm required me to take CEU's to maintain my license. Gotta stay up to date and ensure I'm providing best care for my patients....

Over at EIM, someone just suggested that if those that oppose TDN only took a course from Kinetacore...it would serve to fix their "bias"

Ya....I responded by saying I did take a course in TDN from Kinetacore and it did absolutely nothing to convince me that this tool is a requirement.

No response....as yet.

That's why I take course now....so that some clown can't accuse me of "not understanding" because I "never took the course"

Love to hear your feedback once you've taken the skin scrapping course Johhny.

[Johnny_Nada]

I'm going in with a few questions:

What is the premise? Sore tissue/structural, fascial, neurophysiological, etc...

If structural, do we have any in vivo studies supporting this?

If neurophysiological, why tools?

Any well done research for effectiveness over anything else?

[Barrett Dorko]

Johnny,

I look forward to your taking the course and I understand perfectly well why you're taking it.

Remember, your questions may not be welcomed, but neither were Socrates'. Probably you should smile while asking them, but you'll know best what to do.

I look forward to your report on this.

[Johnny_Nada]

Johnny,

I look forward to your taking the course and I understand perfectly well why you're taking it.

Remember, your questions may not be welcomed, but neither were Socrates'. Probably you should smile while asking them, but you'll know best what to do.

I look forward to your report on this.

So after attending an IASTM course, let me say, to whomever out there has confidence in our profession's ability to clinically reason or critically think...are you serious?

The course was short, therefore the ability to have any real discussion didn't happen

So, first a few positive things:
-Placebo and nocebo were mentioned
-Mechanisms were mentioned
-Lack of evidence was mentioned
-Patient expectation was mentioned
-Test treat re-test was mentioned

Now the criticisms:

-Those positive things were MENTIONED, not highlighted or discussed.

-In light of the mechanisms reviewed (placebo), lack of science and evidence supporting the intervention, the course should have been 30 minutes, not 8 hours.

-Clinical reasoning is: do what the evidence supports first, work your way down the chain, until, if necessary, use placebo based things the patient wants or thinks will work. Play up the placebo. "Test treat re-test" gives us the ability to use whatever the hell we like.

-No discussion of scientific plausibility. Left out completely.

-"This is the quad anatomy, we rub here like this." "This is the hamstring anatomy, we rub here like this."

-"This is the money spot." "You'll feel it get grisly...." "Work that area for a little bit..."

-The instructor is a very intelligent individual from some very well respected programs.

-The participants will be using this on Monday....

[Barrett Dorko]

Johnny,

Thank you for your report. None of this surprises me, and the absence of scientific plausibility doesn't surprise me at all.

We might recognize that science and defense are now absent from treatment. They cost money.

IASMT is a step toward the use of a robotic therapist, which would be really cheap.

They aren't "treating" actual problems. That costs money too.

Maybe human complaints of pain will begin to mimic the complaints described.

Maybe.

The teacher's credentials don't surprise me either. Being hard-working, competent, curious and lucky aren't all equally powerful or likely to occur. They're in the future after all, and I tend not to be a betting sort.

Your list of "positives" is remarkably generous, to me anyway. Everything is "mentioned' and nothing is discussed - thus the inching toward a robotic future. Robots don't discuss things.

[Johnny_Nada]

Barrett,

I found it humorous after leaving the course, I got into my car, turned on NPR radio and this was on...

http://freakonomics.com/podcast/outs...dio-podcast-2/

[Barrett Dorko]

Johnny,

It's good you find this situation funny. I find it funny as well, but not everyone would laugh at it. Many would wonder why we're smiling and laughing. Nothing new.

I wrote of Barry Marshall somewhere on my website and thought what he did was both courageous and "outside the box," to use modern parlance. Even the fact that he was from Australia seemed used against him. I was pleased to see him mentioned on Freakonomics.

Again, I was proven right. Sometimes I'm spectacularly wrong.

[proud]

-The instructor is a very intelligent individual from some very well respected programs.

Quote:

"The man who has won millions at the cost of his conscience is a failure". - B.C. Forbes

My recent interaction at a certain blog has me convinced that some really intelligent and well respected folks remain failures in my eyes.

[Johnny_Nada]

Some patient quotes from the clinic...

These signal me that I've got some work to do....

"So is this going to fix it?"

"I don't care. I'll do whatever you tell me to make this pain go away."

"Just tell me what to do."

[Josh]

more quotes

My personal kiss of death:
"What brings you in today?"
"I fell off a horse when I was 10 and my back hasn't been right since" says the 58 yo with lbp!