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  • Shepherd?
    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

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    Comment


    • ...you'd have three times the evidence supporting a specific treatment in the management of a flexion contracture.
      Rod, I know you know this; but there is an ocean of difference between a contracture and stiffness/muscle inhibition per se. Potential contractures take days/weeks/months to develop the histological changes required for the stiffness to be called a contracture.

      Can you alter a contracture?


      Nari

      Comment


      • Originally posted by Texas Ortho
        What are your outcome measures in your patient population? How do you know when your treatment is a success or failure?
        Did I said it was about LBP?
        The preliminary study was engaged to see if patients may "respond" to an electrical current in a specific way.

        The first results were something like this:



        It may be dangerous to suppose the population fits some very specific "spiky" classes.

        The only thing you must consider is a damped graph



        This is the general rule but you can't apply it to an individual.

        By the way, the biggest problem you have is that you're unable to understand that a functional problem may be only functional and will may be not seen with graph and studies.
        Last edited by bernard; 21-03-2008, 08:53 AM.
        Simplicity is the ultimate sophistication. L VINCI
        We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

        Everything should be made as simple as possible, but not a bit simpler.
        If you can't explain it simply, you don't understand it well enough. Albert Einstein
        bernard

        Comment


        • An another problem comes with "hard" sciences.
          Too much science kills science.
          The hyper specification implies that you must find something in the sub-branch you're working but the risk is you'll fail to embrace the whole model.

          This conclusion is not mine but was carried by a silly French Physicist: P G De Gennes

          Functional problems can not separated in specific branches => You must consider the tree. :angel:
          Simplicity is the ultimate sophistication. L VINCI
          We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

          Everything should be made as simple as possible, but not a bit simpler.
          If you can't explain it simply, you don't understand it well enough. Albert Einstein
          bernard

          Comment


          • As Nari points out, contractures aren't what we're talking about changing, and Rod, for someone so proud of their scientific thinking you're a little loose with your terminology.

            I'm perfectly happy to say here as I would if you were in the same room that I am increasingly disappointed in the way you post on this board. Isn't there someone else from the classic and traditional camp out there?
            Barrett L. Dorko

            Comment


            • Originally posted by Jon Newman View Post
              Rod, rather than characterize people a certain way consider answering the QUESTION (not an assertion).

              And you did imply a thought process by stating "so sayeth the shepherd..." when Barrett asserted that changing an actual contracture with manual therapy can't be done. What else were we supposed to conclude? I certainly didn't think "Oh, Rod agrees. I can tell because of the disparaging response."

              I should add that I no longer think I can change any contracture although I made a number of people miserable while proving this to myself.
              Barrett made a proclamation with nothing behind it. If he expects us to simply fall in line without questioning...I'll let you fill in the rest.

              Originally posted by Diane View Post
              Shepherd?
              Yes.

              Originally posted by nari View Post
              Rod, I know you know this; but there is an ocean of difference between a contracture and stiffness/muscle inhibition per se. Potential contractures take days/weeks/months to develop the histological changes required for the stiffness to be called a contracture.

              Can you alter a contracture?


              Nari
              I agree completely Nari and never made I claim I could alter a contracture. I know many interventions peformed in my clinic consistently lead to improvements in a patients ROM. The mechanism of this improvement is certainly in question. I'm looking for the answers beyond someone's assertion that it can't be done.
              Originally posted by bernard View Post
              An another problem comes with "hard" sciences.
              Too much science kills science.
              The hyper specification implies that you must find something in the sub-branch you're working but the risk is you'll fail to embrace the whole model.

              This conclusion is not mine but was carried by a silly French Physicist: P G De Gennes

              Functional problems can not separated in specific branches => You must consider the tree. :angel:
              So you really aren't going to answer my question are you Bernard? Best evidence or nothing in the case of the internist?

              Originally posted by Barrett Dorko View Post
              As Nari points out, contractures aren't what we're talking about changing, and Rod, for someone so proud of their scientific thinking you're a little loose with your terminology.

              I'm perfectly happy to say here as I would if you were in the same room that I am increasingly disappointed in the way you post on this board. Isn't there someone else from the classic and traditional camp out there?
              I'm not proud of anything other than my beliefe that we should be gravitating toward the scientific method in practicing evdidence-based physical therapy. Beware - logic follows: This does not mean doing nothing in the absense of evidence or being hyperspecific in our approach. It does mean that if we have a notion on how things work it should obey the natural laws of science and be generally measurable in some form. Sacketts definition clearly allows for clinical judgement in the presence of best evidence and this is all I'm implying.

              Barrett - it sounds like you are trying to tell me how to behave. I don't do well in the presence of such a thing and doubt I ever will. If you don't like what I say, you are welcome to ban me like others who happen to disagree with your point of view.
              Rod Henderson, PT, ScD, OCS
              It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

              Comment


              • Originally posted by texasOrtho
                So you really aren't going to answer my question are you Bernard? Best evidence or nothing in the case of the internist?
                I just missed it (and busy at the time). :embarasse
                Simplicity is the ultimate sophistication. L VINCI
                We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

                Everything should be made as simple as possible, but not a bit simpler.
                If you can't explain it simply, you don't understand it well enough. Albert Einstein
                bernard

                Comment


                • Barrett made a proclamation with nothing behind it. If he expects us to simply fall in line without questioning
                  You didn't question him, you characterized him. Then when asked if you agree or disagree you avoided the question three times by saying "I never said that". No one ever said you said it. However, a number of people stated they don't think they can change a contracture and wondered whether you think you can.
                  "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                  Comment


                  • Originally posted by TexasOrtho
                    So we should stop looking? Also, can you try to answer my question about the internist and the hypertensive/high cholesterol patient? Best evidence or nothing at all?
                    No but perhaps look at an another place.
                    If hypertension is lowered by simple breathing exercises (functioning) is it better to give a statin that lowers only a blood level but that do not change the functioning?
                    The essential is to understand why the tension augments and how it is possible to change it.
                    If the patient eats too much salt => change his habits. Statin has nothing to see with bad habits.
                    Simplicity is the ultimate sophistication. L VINCI
                    We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

                    Everything should be made as simple as possible, but not a bit simpler.
                    If you can't explain it simply, you don't understand it well enough. Albert Einstein
                    bernard

                    Comment


                    • Originally posted by Jon Newman View Post
                      You didn't question him, you characterized him. Then when asked if you agree or disagree you avoided the question three times by saying "I never said that". No one ever said you said it. However, a number of people stated they don't think they can change a contracture and wondered whether you think you can.
                      Sorry Jon...let me try to answer this question. My approach to a knee flexion contracture was previously discussed on another thread. I have no illusions that what I define as a "contracture" is entirely valid. What I do see on a regular basis is a limitation in motion that consistently responds to a treatment to the point where a relationship can be described. This is the treatment-ouctome connection. We may all differ in what we call the "treatment" or what we call the "outcome" based on our education, personal/political bias, or notions.

                      It doesn't change the fact that treatment x leads to result y and that this relationship should be measurable on some level. The precise mechanisms behind the change is certainly in question and I have made absolutely no proclamations otherwise. However this is the basis of many, if not most, western medical interventions whether we like it or not.

                      Case in point: A patient's fasting blood sugar changes following the administration of glucophage and a fairly quantifiable relationship is determined between the dose and response. Of course there is a great deal of debate as to the nature of this change (as their shold be). Out of this debate will likely come an even more productive and specific treatment for hyperglycemia. It doesn't mean the endocrinologists are gluco-philes who refuse to see the big picture of another system. It only means they are treating patients with the best treatment they have avaiable within their skill set.

                      I am not trying to convince you to treat a contracture the same way I do or implying my way is superior in any way. I am saying is that we should constantly ask ourselves how much we are contributing vs detracting from the practice of science-based therapy.
                      Rod Henderson, PT, ScD, OCS
                      It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                      Comment


                      • Originally posted by bernard View Post
                        No but perhaps look at an another place.
                        If hypertension is lowered by simple breathing exercises (functioning) is it better to give a statin that lowers only a blood level but that do not change the functioning?
                        The essential is to understand why the tension augments and how it is possible to change it.
                        If the patient eats too much salt => change his habits. Statin has nothing to see with bad habits.
                        How would you know if relaxed breathing and eating less salt worked?
                        Rod Henderson, PT, ScD, OCS
                        It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                        Comment


                        • Originally posted by TexasOrtho
                          It only means they are treating patients with the best treatment they have available within their skill set.
                          No, they are unable to educate their patients and also unable to change the fast food/sugar industry...:angel:
                          Simplicity is the ultimate sophistication. L VINCI
                          We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

                          Everything should be made as simple as possible, but not a bit simpler.
                          If you can't explain it simply, you don't understand it well enough. Albert Einstein
                          bernard

                          Comment


                          • Originally posted by TexasOrtho View Post
                            How would you know if relaxed breathing and eating less salt worked?
                            Measuring the tension. :embarasse

                            But I know already that salt augments blood volume and breathing helps heart.
                            Simplicity is the ultimate sophistication. L VINCI
                            We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

                            Everything should be made as simple as possible, but not a bit simpler.
                            If you can't explain it simply, you don't understand it well enough. Albert Einstein
                            bernard

                            Comment


                            • Originally posted by bernard View Post
                              Measuring the tension. :embarasse
                              Right! :clap2:Welcome to my cult...we have cookies.
                              Rod Henderson, PT, ScD, OCS
                              It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                              Comment


                              • You're wrong! I'm against cults.
                                And BTW, did I said I was against measures or outcomes? :angel:
                                Simplicity is the ultimate sophistication. L VINCI
                                We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

                                Everything should be made as simple as possible, but not a bit simpler.
                                If you can't explain it simply, you don't understand it well enough. Albert Einstein
                                bernard

                                Comment

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