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Do Biomechanics Matter?

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  • #16
    Originally posted by nykinvic View Post
    Maybe I don't understand the accepted definition of posture, but why do you (and I've heard it form others here) say it's unlikely for someone's posture to change?
    My perspective is changing someone's structure. If someone comes in with AS or a relevant scoliosis, I'm not going to change it. If the high school kid with low confidence comes in, a simple "sit up tall" "fixes" the posture. If its a behavioral thing, sure, some cuing can change things up. If its structural, there nothing I can do.

    ....and I don't know or understand the definition of posture either
    I may not be as smart as most people, but I'm sure as hell not as dumb....
    "The views expressed here are my own and do not reflect the views of my employer."

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    • #17
      Does poor motor control lead to stress on certain tissues and therefore to nocioception > pain.
      Frustrated, it may. The problem is that we generally do not know whether the person's motor performance is a result of pain, or the cause.
      There is quite a bit of research on the issue and most of it points to first concept.
      Pain leads inevitably to adaptations in motor patterns; pain does not necessarily precede those adaptations - these can occur before pain emerges as a conscious experience.
      Yes, poor motor control may lead to pain, especially in high tissue stresses, but establishing that would require knowing habitual motor patterns BEFORE any nociception occurs =- and that is a bit of a pipe dream.....
      We don't see things as they are, we see things as WE are - Anais Nin

      I suppose it's easier to believe something than it is to understand it.
      Cmdr. Chris Hadfield on rise of poor / pseudo science

      Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

      We don't need a body to feel a body. Ronald Melzack

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      • #18
        Yes, poor motor control may lead to pain, especially in high tissue stresses, but establishing that would require knowing habitual motor patterns BEFORE any nociception occurs =- and that is a bit of a pipe dream.....
        Not if you are able to establish a cradle to grave family practice, which I recommend as a great way to do this amazing work. It won't make you famous but it gets you out of bed in the morning.
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

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        • #19
          Jo, I have a practice like that for quite a few patients who remain in this city. No fame - great work indeed.

          It still does not allow me to draw any conclusions about the the role of motor patterns in the development of pain. Too many factors influence motor behaviour and too many factors are involved in pain for that.
          We don't see things as they are, we see things as WE are - Anais Nin

          I suppose it's easier to believe something than it is to understand it.
          Cmdr. Chris Hadfield on rise of poor / pseudo science

          Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

          We don't need a body to feel a body. Ronald Melzack

          Comment


          • #20
            Originally posted by Bas Asselbergs View Post
            Jo, I have a practice like that for quite a few patients who remain in this city. No fame - great work indeed.

            It still does not allow me to draw any conclusions about the the role of motor patterns in the development of pain. Too many factors influence motor behaviour and too many factors are involved in pain for that.
            It could indeed be wishful thinking on the part of an unregenerate people watching nerd. Apart from watching crowds, street scenes, railway stations and shopping malls, I am fascinated by father/son movement, gesture and postures.
            Jo Bowyer
            Chartered Physiotherapist Registered Osteopath.
            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

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            • #21
              I had a patient who was a post op shoulder and he had to get on another therapists' schedule for a visit.

              I had him doing prone horizontal abduction off of a plinth with with some weight. The therapist responded with why are you having him do it with that weight, he's clearly compensating with his upper traps, you should drop down in weight and cue him to keep his shoulder down. In my head I'm like "who cares, why does it even matter? What's wrong with using your upper traps? It doesn't hurt him". Instead I said "yeah you're right".

              Will having him learn to isolate his mid traps (if you can even do that) help him in any way? Who cares what his movement is if it doesn't hurt? Is it truly a bad movement pattern? How can you predict that him "compensating with his upper trap" will lead to anything negative? I don't think you can and I don't think it even matters.

              I think form somewhat matters but not really as much as most people think. Especially when it's not a high load.

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              • #22
                You've asked some good questions. Please duck if you ask them in person.
                Barrett L. Dorko

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                • #23
                  Originally posted by Barrett Dorko View Post
                  You've asked some good questions. Please duck if you ask them in person.
                  Another problem I run into when another therapist has a patient of mine is I will sometimes lose that patient to that therapist. I imagine it has to do with the perception of skill. When that therapist is telling them to keep their shoulders down to isolate their middle trap or when they manip them or do all these wacky PNF patterns or soft tissue in crazy body positions, they perceive them as more skilled than I am and they think they're getting more out of therapy. Are they though?

                  One time I had a patient who I was pretty buddy buddy with tell me how she really liked the therapist she had when I was out. I asked why and she said "they really stretched me out good."

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                  • #24
                    Nothing new.

                    I'm so glad I'm old, because I don't see this changing.
                    Barrett L. Dorko

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                    • #25
                      Originally posted by Barrett Dorko View Post
                      You've asked some good questions. Please duck if you ask them in person.
                      Originally posted by Barrett Dorko View Post
                      Nothing new.

                      I'm so glad I'm old, because I don't see this changing.
                      I'm not even a year in and I want to retire already.

                      :cry:

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                      • #26
                        Just retire from that type of PT.
                        I am into my 34th year as PT, and the progress science has provided me, has kept my work with patients MUCH more interesting and challenging!

                        The cognitive challenges, the stories and analogies required for change, the individualization and tailoring of each session to each individual keep me on my toes.

                        No goldmine, but a happy face in that mirror each morning. With a healthy dose of worry about the whole of the profession.
                        Despite the Moseleys, Butlers, Shacklocks, Giffords, Ramachandrans, Dorkos, Silvernails and Jacobs' of the world, the resistance to deep change is strong.......
                        We don't see things as they are, we see things as WE are - Anais Nin

                        I suppose it's easier to believe something than it is to understand it.
                        Cmdr. Chris Hadfield on rise of poor / pseudo science

                        Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                        We don't need a body to feel a body. Ronald Melzack

                        Comment


                        • #27
                          You will never be able to change human nature. In the states the kind of therapist you describe is rampant. We have people chasing their tails to "fix" something, and when you keep the patient doing something simple, they "fix" it by changing the stimulus. Then they get "better" because of the other therapist. The shitty part is when that idiot therapist takes credit for it.

                          You cannot let the dinosaurs walk over you like that. They are infected with old information and a stubbornness that is tough to crack. Couple that with the disdain everyone feels for the millennial generation and you get a recipe for frustration. Simply keep to what you know, based on your interpretation of the evidence. Not based on another therapists eminence. If they cannot back up what they say with a premise that is provable, then they have no reason to question your equally skilled decisions. Not to mention it is significantly unprofessional.

                          It will not stop until you speak with the therapist, or their supervisor and let them know they need to stop it. Unless they are your mentor, ask them for advice on how to fix the documentation software, and that is about it. Many times the information they give clinically is based on old memes.

                          This stuff just gets me angry as hell.
                          Michael Heinrich DPT.

                          My opinions and statements on this site are not a reflection of the Department of Veterans Affairs or the Federal government.

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                          • #28
                            In this Age of Information there's little reason to practice as it is.
                            Barrett L. Dorko

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                            • #29
                              Originally posted by nykinvic View Post
                              I look forward to attending Greg's course here in Victoria in October. One of the questions I'm hoping to better understand is why he thinks biomechanics/alignment may matter in high load situations but not in low load situations?

                              I think it's curious that Lehman and others support statements such as "just load it " and "we improve specifically at what we do and by doing it enough." but then only count some of the loads (the higher intensity ones) and only some (typically exercise) of the what we do. This strikes me as odd when in a sedentary culture like ours the 'what' most of us do (including children) in our waking hours is sit mostly still.

                              Katy Bowman has likened this to counting only the input of a kale salad for dinner while eating candy bars all day when considering our nutritional health.

                              Sorry, I've not read through this thread completely yet, but just wanted to comment, and it might only partially speak to your questions.

                              I've had the pleasure of seeing Greg's Reconciling Biomechanics with Pain Science twice now.

                              Greg has a section in his course titled When Biomechanics Matter.

                              So, as an example, everyone thinks that knee valgus during loaded movements such as squatting, or changing directions, etc, is the root of all knee evils.

                              He would say that he isn't too concerned when this happens during a resistance training exercise. It might matter more if you jumped off a building, and landed on one leg in valgus collapse. Obviously an intentionally extreme example. I think the relevant slide in his presentation said "Is there a better way to jump off a roof?"

                              His big thing is whether the region is adapted to whatever load you place on it.

                              I got the distinct impression that he is constantly vigilant that what we say doesn't result in what he described as the "Cascade of Delicacy" in our patients. He is always focusing/emphasizing on what clients are good at. He doesn't want to focus on faults - I think a quote of his says "I can't have patients thinking they're an inherently unstable stack of blocks."

                              So, I think he say would say that biomechanics matter under certain conditions, and biomechanics can influence capacity. Ultimately, the load cannot exceed the capacity, but with exercises/activity the body will adapt to stress/load.

                              I hope I haven't butchered his stuff. I do hope you enjoy his course - I find him quite funny and engaging.



                              P.S. As a side note, I found it curious that people can come away from the same course with very different interpretations. A chiropractic friend of mine didn't seem to enjoy the course, apparently taking offense to what he interpreted as a message of "don't do manual therapy - it doesn't do anything."

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                              • #30
                                I think you nailed Greg's presentation quite well.
                                Diane
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                                "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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