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The Problem with OMPT

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  • #16
    As I'm in an OMPT Fellowship now, I'll be writing at some point on "The Future of OMPT". I've written plenty on the old MDT models as well, on myphysicaltherapyspace.com.
    Thanks for your comment
    Jason Silvernail DPT, DSc, FAAOMPT
    Board-Certified in Orthopedic Physical Therapy
    Fellowship-Trained in Orthopedic Manual Therapy

    Certified Strength and Conditioning Specialist


    The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

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    • #17
      Jason....this is amazing, awesome...well thought, and perfectly put.

      I am reading it to my "mesodermal" collegues....great conversations ensue following. I love this place.....wow.

      Thank you for your frustration, your guts, your devotion to your patients and the profession, for advancement of scientific knowledge and understanding, your passion....whatever got you to place that post here.

      Steph
      Stephanie A. Mikoliczak, DPT
      sigpic
      And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom. - Anaïs Nin

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      • #18
        I'm going to go ahead and post that entire post #1 to facebook Jason. It's convenient for me to do it right now, strike while the iron is hot, all that. I'll take it off if you have any objection. Deal?
        Diane
        www.dermoneuromodulation.com
        SensibleSolutionsPhysiotherapy
        HumanAntiGravitySuit blog
        Neurotonics PT Teamblog
        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
        Canadian Physiotherapy Association Pain Science Division Facebook page
        @PainPhysiosCan
        WCPT PhysiotherapyPainNetwork on Facebook
        @WCPTPTPN
        Neuroscience and Pain Science for Manual PTs Facebook page

        @dfjpt
        SomaSimple on Facebook
        @somasimple

        "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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        • #19
          The "problem" one?
          Go ahead.
          Jason Silvernail DPT, DSc, FAAOMPT
          Board-Certified in Orthopedic Physical Therapy
          Fellowship-Trained in Orthopedic Manual Therapy

          Certified Strength and Conditioning Specialist


          The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

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          • #20
            Should be mandatory reading for all medico's involved with management of these conditions. As always, great Post JS. Keep us abreast of your fellowship. Dumb it down for me though.

            I was once at a conference where a PT explained the McKenzie approach. A surgeon was sponsoring the conf. so we could get educational units. The sx's impression of McKenzie was that there was too much movement for someone who already had LBP. Do these exercises, and if you get increased pain in the back but decreased pain in the periphery that's supposed to be good? Sx must have been a defense over defect guy. He finished by saying maybe he's old, and just doesn't get it. The pt sure get's it though:secret:.
            Last edited by smith; 27-01-2010, 11:28 PM.

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            • #21
              Jason,
              Thank you for this post. You have just summarized everything that I have been struggling with as I progress in my profession. The more I utilize the OMPT treatment approach that I have learned, the more I realize that I am missing something else. Many things about OMPT just don't seem to make sense when we start taking a critical look of what we are doing and why.

              I am new to the neuro approach but definitley excited to learn more about it and see the positive impact it can have on the care of my patients.
              Thank You.

              Bob Brady PT, OCS

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              • #22
                Bob,

                Nice to see you here. I try not to spend too much time on criticism of the usual paradigm so you may not have heard all of this from me.

                Jason put it much more succinctly anyway.
                Barrett L. Dorko

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                • #23
                  Very good post. I have found that the more I learn, the less I actually know! I consider myself very ecclectic when it comes to OMPT. I feel that having a sound foundation with both the orthopedic and neurological models can only make us better clinicians. I look forward to learning a lot here.

                  Chris Hansen, PT

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                  • #24
                    Chris,

                    You call them "models" and that might be accurate, but though a model may be accurate, it isn't necassarily relevant.

                    Theories, on the other hand, possess relative degrees of accuracy, ostensibly improving as evidence becomes available.

                    The orthopedic model used to drive coercive management for painful problems cannot be successfully defended when placed in relation to the neurobiology forming the basis of the methods you recently learned.

                    What you've learned, I think, is a new perspective. Orthopedics (mesoderm) is inextricably linked (@@@@@@) to the ectoderm, but is insufficient to explain much.

                    Relevance; it's everything.
                    Barrett L. Dorko

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                    • #25
                      I feel that having a sound foundation with both the orthopedic and neurological models can only make us better clinicians.
                      Chris,

                      I think the point of this thread was to describe and expound on how the orthopedic model is flawed with respect to treating patients with non-pathological pain.

                      I would assert that a "sound foundation" in orthopedics should include adequate training in recognizing pathological states of the musculoskeletal system that would inform the decision of whether the patient is appropriate for physical therapy intervention. After that, as Barrett just stated, the orthopedic model becomes completely irrelevant. The irrelevance of this model, and therefore it's lack of utility, has proven itself over and over again:

                      -The lack of improvement in outcomes for persistent conditions like low back pain.
                      -Ongoing, unfruitful turf battles with other conservative, quasi- and pseudo-professions that only serve to demean the value of our profession.
                      -Persistence of a- and pseudo-scientific interventions like MFR and craniosacral therapy by so-called professionals.
                      -Persistent guruism and various "schools of thought" within the OMPT community.
                      -Failure of our academic institutions to adopt current neuroscience into their curricula and translate this information into useful clinical applications.

                      Those are the broadest categories of evidence of failure of the orthopedic model that I can come up with right now, but there may be more. You have to admit, however, that these are undeniable facts of the current reality in which we practice our profession. I think the only reasonable explanation for these deficits is a failed traditional model that is based on orthopedics/biomechanics.

                      Why we continue to cling to this model is another matter altogether and includes all kinds of sociopolitical and economic factors.

                      Regardless, our job, first and foremost, is to be true to our patients and profession, which means to reject models or concepts that fail to serve the former and advance the latter. The orthopedic model has led us about as far away from those goals as I can imagine.

                      It's well past time to decide to fish or cut bait.
                      John Ware, PT
                      Fellow of the American Academy of Orthopedic Manual Physical Therapists
                      "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                      “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                      be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

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                      • #26
                        Originally posted by John W View Post
                        Regardless, our job, first and foremost, is to be true to our patients and profession, which means to reject models or concepts that fail to serve the former and advance the latter.
                        John,

                        I completely agree. I'd like to know what the collective agreement is as far as appropriate types of manual care.

                        Chris

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                        • #27
                          Brilliant post John :thumbs_up
                          Frédéric Wellens, pht
                          «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                          «
                          Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                          »
                          Friedrich Nietzsche
                          www.physioaxis.ca
                          chroniquesdedouleur blog

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                          • #28
                            I'd like to know what the collective agreement is as far as appropriate types of manual care.
                            Who on earth are you going to ask? Any group with a financial interest in a certain meme will say their ideas are the ones that should be learned, at a price of course. Guess where the money goes.

                            Soma Simple collects NO money from anyone.

                            I have always contended that my own teaching in person is NOT necessary to understand what I say or do.
                            Barrett L. Dorko

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                            • #29
                              Soma Simple collects NO money from anyone.
                              Well, Bernard does accept contributions, but there have never been any dues or fees to belong here. And I know of no other place on the web where such a large amount and wide variety of information on becoming a better and more informed therapist is so generously offered.

                              Within a few weeks or months anyone with a sincere interest in becoming better informed about the current state of pain science could acquire more information here than they did in their entire undergraduate and physical therapy education.

                              Within several more months, they could actually learn more than they did during those years. It's absolutely free and with no obligation other than being a decent and respectful human being.

                              Some of us with kids have even managed to do it.
                              John Ware, PT
                              Fellow of the American Academy of Orthopedic Manual Physical Therapists
                              "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                              “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                              be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

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                              • #30
                                Originally posted by chansen View Post
                                I'd like to know what the collective agreement is as far as appropriate types of manual care.
                                I think the defensibility has more to do with the explanatory model than the technique itself. I wrote a thread called Crossing the Chasm that has examples you might like to read.
                                Jason Silvernail DPT, DSc, FAAOMPT
                                Board-Certified in Orthopedic Physical Therapy
                                Fellowship-Trained in Orthopedic Manual Therapy

                                Certified Strength and Conditioning Specialist


                                The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                                Comment

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