A Unified Theory for Physical Therapy and the Treatment of Pain

[nari]

Diane, everything in this post I agree with; and in many ways we have lost perspective of what is important and needed for our patients with symptoms.

I think this is why Barrett always refers to caring for patients' authenticity rather than treating their various symptoms in fits and starts. GPs used to do that and then got lost in the maelstrom of technology.

You have echoed the thoughts I've had for years - neuro physios are quiet, they get on with the job of trying to make sense out of neural function,often undervalued, usually misunderstood and yet they have a far more complete refrain to sing about than the mesodermalists have had and ever will have.

Nari

[Barrett Dorko]

No man or woman will ever unfold the capacities of their own intellect who does not at least checker their life with solitude.

De Quincey

I got this quote from a book recommended by our friend Ian Stevens. It’s titled Solitude: A Return to the Self by Anthony Storr. On page 74 Storr refers to an essay he once wrote titled “The Concept of Cure” in which he wrote the following:

The first factor is that the patient adopts some scheme or system of thought that appears to make some sense out of his distress. The second is that he makes a relationship of a fruitful kind with another person.

In other words – what Diane just said. Perhaps truly effective and/or rational therapy begins by teaching the patient that the first task is possible given what we’ve learned and the second part defines the therapeutic relationship as it progresses toward its formal conclusion.

In order to practice reasonably (perhaps for the first time) and to make sense PT has to become ectodermal on several levels. Back when care (read time and proper attitude) was available to us we didn’t understand neurobiology as we do today. Our appreciation for the mesoderm overwhelmed us and the various mutations of that knowledge misled us; all while a culture bent on controlling us nodded approvingly. What I see around me today is the result of that irritating alchemy. When this is made clear to therapists many actually behave as if they are just victims of poor basic schooling and subsequent fealty to departmental decrees of protocol and productivity. Trying to change any aspect of that carries too high a price, so nothing changes.

Returning to the quote at the top of this post, I see among many of the regular contributors here the regular pursuit of solitude, even if that solitude must be purchased at a great cost. Perhaps it is no coincidence that we ask our patients to “checker” their life with something similar when it comes to their self-care. No large classes, no exercise regimens dominated by choreographed movements and unique realizations regarding function as they progress.

We are our ectoderm, and I’ve no problem knowing that at every available level – anatomic, physiologic, embryologic and philosophic. Some of us individually resonate with different aspects of that, but here we can all display our passion and share it. For a few moments at a time we are not completely solitudinous, and then we return again.

Our patients might be better off learning how to do something similar with their painful sensation, and therapists should be perfectly positioned to teach them that.

Almost without exception, they aren’t even close.

[Diane]

We are our ectoderm, and I’ve no problem knowing that at every available level – anatomic, physiologic, embryologic and philosophic. Some of us individually resonate with different aspects of that, but here we can all display our passion and share it.

Yes, that is why Somasimple exists.

So, in summary, I'd say that one can definitely treat physical nerves/the nervous system through/via skin, almost as if one were a mesodermalist, and thereby help tissue change itself. Nerves stand out remarkably when they are not happy (feel like clothesline cords), but change relatively straightforwardly and rapidly, becoming homogenous with everything else once they are no longer "cranky". Usually all the mesodermal mirages vanish in the process, and subsequent functional tests indicate all is well.

Learning about nerves and teaching about them and learning to treat them and teaching other therapists how to treat them, might look like promotion of the use of leeches, but that isn't quite the same thing as using more leeches. I think instead, it's a matter of using the right sort of metaphorical and physiotherapeutic leeches to do the right thing at the right time, as in hirudotherapy, the modern medical application of actual leeches.

I am looking forward to the arrival of my copy of the book Solitude this week. :thumbs_up

[Jon Newman]

I saw this Secret Life of Scientists video (featuring Gavin Schmidt) today and knew I had heard of Mills Mess before and specifically, here at SS. A quick search revealed that it was this incredible thread and specifically post 105. Sorry about the stream of consciousness here. Consider it a long over due bump of an important thread. Serendipitously, the previous post in this thread also happened to answer a question I posted in another thread.

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[ste5e]

This is going to take some time to assimilate. Does anyone have a link to a condensed presentation of Cory's themes within this thread? It is tricky one scrolling page at a time to follow a complex thread like this. Are there highlights as a pdf or doc to download? I want to read this lots and make notes!

[Sheffphysio]

I'm not aware of any doc's or pdf's. You'll lose yourself for months reading up on past threads.

[CDano]

This is going to take some time to assimilate. Does anyone have a link to a condensed presentation of Cory's themes within this thread? It is tricky one scrolling page at a time to follow a complex thread like this. Are there highlights as a pdf or doc to download? I want to read this lots and make notes!

FWIW I've been following this site for about a year and think i'm just starting to get the idea.

Be patient.

[Barrett Dorko]

I recommend this writing to every student. There's some amazing stuff here and an entire workshop could be built around it quite easily.

Oh wait...

[ste5e]

....How long shall I wait?
Is there a workshop out there in the SS site that presents this in a handy format? If not then it is going to be a cut and paste session which I would then attach to the thread. Just don't want to chisel myself a wheel only to find one around the corner.

[zimney3pt]

I don't think there is a shortened version of the info in this thread. If there was I think I would have found it by now, as I think I have read and absorbed this thread more than any other on the site over the years. Would enjoy seeing your notes and thoughts about it. That is the fun of bringing up some of these old threads with new eyes looking at them.

Barrett, is referring to his Simplifying Manual Care course. If you want to fly him to the UK I bet he might come.

[ste5e]

I will pull it together over the weekend and post it up when it is done. Deep stuff.

[ste5e]

Down, down, Deeper 'n' Down.

It turned out that this was more than a weekends toil. Still think it is worth it and I am plugging away at it. For those, who like me, find the thread difficult to follow and are willing to print it out (double sided and two sheets to a page) so they can highlight, annotate and scribble (and doodle slug cats) and aid in the understanding here is the thread as a word.doc
Enjoy.

[BB]

Wow, Ste5e. Thanks for doing this! Hard to believe this is now 6 years old.

[zimney3pt]

Cory, does it kind of feel like watching one of your kids grow up? It's amazing sometimes how they get older, while we don't.:teeth:

[Barrett Dorko]

Earl,

No one would argue that we're especially good at learning in early childhood, but I see this observation being used as a justification for the shenanigans often foisted upon clinicians and patients by an unscrupulous instructor. I imagine you know to whom I am referring.

Such an extrapolation places the therapists here in the role of counselor; and one who spends a lot of time delving deeply into a client's psyche at that. That's not necessarily a bad thing, but it's not something I'm trained, educated or licensed to do.

One can only speculate about such things. Knowing where problems come from is an interesting journey toward the discovery of cause, and the world simply doesn't have a causal nature.

I don't feel it's my business to figure out how people came to be or feel the way that they do, but only my business to investigate how they currently are.