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The Problem with OMPT

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  • GreigT
    replied
    Mostly a bump. I've read "Crossing the Chasm" a few times, but I think that this is a more (for me anyways) clear and succinct summary of what the argument against an orthopedic model is. I relate strongly to the idea that the more I learn the less dogmatically 'sure' I am about anything in treatment. Having now posted more than 10 times I am beginning to appreciate what an amazing resource this board is. I have filled my ebook with papers to take with me on vacation this week.
    Thanks all!

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  • gollygosh
    replied
    DAS-PTA
    Defense, or defect? I keep asking myself, and my coworkers this question.

    Suppose a patient is evaluated, diagnosed, and treated for a mal-alignment for the sake of fun let's call it a LOL( left on left, or laugh out loud).
    Possibility 1: After the application of a mobilization or technique the landmarks appear to change.(Seems they did exactly what the therapist was hoping would happen) The therapist says that's better, and the patient isn't sure what to think or say. If it still hurts, or feels worse, we say "well we just moved some things that haven't moved, but the alignment is better--with some ice, and diligent attention to postural symmetry, you will feel better tomorrow
    Possibility 2: After the application of a mobilization or technique the landmarks appear to change. The patient stands, feels great, walks better, and leaves the department only to be in pain by the time he gets to the car, or by the time he goes to bed, or by the time of the next treatment.
    Possibility 3. In the process of deciding what is you are going to do, you rest your hands on the patient's sacrum, or iliac crest, or spine, and the body gently begins moving--maybe the sacrum softens, and the patient says ''that feels good", or relaxes. You decide to "follow the motion", attempt to educate the patient that this motion is what the body needs most, and try to teach him how to listen to his body, and give him a valuable self management strategy.

    I work as a per diem therapist which means that although I have more autonomy than you, I continue to be inherit other therapist's treatment plans. In the limited visits that I have I am trying to introduce the patients to the neuromatrix , substitute motion re-education/awareness in a variety of positions, promote non isolated movement, encourage deep breathing, and impress on the patient that they must move--motion is lotion. This information complements what the other therapist's may or may not be doing. The more people see, hear, and read what I say to the patients, the more they know what I'm thinking. There hasn't been a revolution, but I haven't been kicked out yet.

    Geralyn

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  • DAS-PTA
    replied
    Thanks Jason and Geralyn for your responses!I feel the challenge of trying to give so many directions their justice or due diligence,and it is almost paralyzing.While I am a PTA,my skills with soft tissue,jt mobs and problem solving are used and applied by the primary therapists that I work with.I had mentioned to Barret that I work with graduates of St.Augustine,and both are dual certified in PT/OT,DPTs,and certified manual therapist.I have worked in the past with another manual therapist from England,and these therapists seemed to accomplish more with their manual skills than many of the therapists who weren't manual.Not the greatest form of evidence,anecdotal.So when I ask for your mind set in your approach,I know the main answer is it depends.I feel your answer,Jason was concise and not a dodge.Geralyn,I like what I've read and applied from Diane's DNM.My task is learning how to keep incorporating new ideas,evidence based,and keeping it in a working manner that is consistent with our primary therapists approach.Being the driver of change/review is a bit challenging,which is why I read,especially at this site,and strive to practice and implement so I can discuss it intelligently and see if I can add to my overall environment.As always,feedback is appreciated!

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  • gollygosh
    replied
    DAS-PTA

    Before Soma Simple I was a champion of keeping the patient actively and dynamically involved in their treatment. Since Soma Simple I am a bigger advocate of keeping the patient actively, and dynamically involved in their treatment. I assess Range of motion, and strength, and posture quickly as a baseline. I watch them walk, transfer, looking to see if they move segmentally, or more like a tin man. I love to touch, was excited by myofascial release until it started making no sense at all--so I found that the DNM was a great way to touch that actually made some sense. Currently I make sure I educate every patient in what I've learned about the neuromatrix. The idea that pain is a warning from the brain-- a hunger that needs to be fed by gentle motion has been very helpful in seeing some of my acute patients get out of the clinic in fewer visits. The motion I use tends to be active or active assisted with use of mirrors, tactile cues, and verbal cues--a little Feldenkreis, a little Trager, with intent of encouraging playful, and variable experimentation with motion. I really am a new kid on the block here, but Crossing the Chasm gave me the comfort to proceed with my brain asking more questions, and my patients are hearing about what I learn almost every day.

    Geralyn

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  • Jason Silvernail
    replied
    Hi DAS. You've got a lot of good questions, more than I can answer in one post.
    I would say I have a basic clinical reasoning paradigm built on basic science, published evidence, and manual therapy decision-making primarily from Maitland's work.
    For patients with mechanical low back pain everyone gets thorough history, medical screening and manual examination. Some are treated primarily through education and advice, some with brief manual treatment and exercise, some with just exercise and some with a more detailed manual therapy approach. Exercise can include include general ex, MDT/McKenzie progressions, motor control ex, neurodynamics, feldenkrais/somatic type stuff, ideomotion, etc. I've used mechanical traction a few times too. It's tailored to the patient's presentation and goals. No electrotherapy. Nothing to do with "trigger points" or "fascia" etc etc.
    Sounds like a non-answer but it's the truth. The foundational issues here are pretty complex and more than just a few sentences would be needed to get that across.
    Does that help or just seem like a dodge?

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  • DAS-PTA
    replied
    Thanks for the replies!I feel strongly about growing in my ability to take care of patients and effectively make a difference.Jason,I hope you understand my tone is of interest and respect for your present abilities as well as your future abilities.When looking at a LB patient,do you use a manual therapist paradigm,or is it the evolving paradigm?I know that the feeling is not all patients will respond properly to manual therapy,but most or many?And if they didn't,what is your next approach?I respect the feedback of so many therapist when discussing neuro as the answer,but the variety of approaches is still unique and varied.I remember one post where 3 people answered how they would explain pain from lactic acid(if I'm remembering correctly),and each had a slant/component that the others didn't,but all appeared valid.
    So my question goes back to how to evolve from my present problem solving skills to a more efficent,yet accurate approach.Your path uses manual skills,Dianes' has the manual soft tissue skills,Barrets' has the Simple Contact,etc.I always look forward to the application of a new technique,while realizing I may not be doing it justice or fully understand.You all co exist well,but going back to evidence and reproducible results,how do you evolve that path that has everyone on the same page?Or do you use the tool bet analogy and say I go from this tool to this tool to this tool,until I get the best result for that particular patient?Again,thank you for you time and feedback!

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  • gollygosh
    replied
    In the months since I found soma-simple, I have made the following obsevations:
    DAS-PTA
    Since I starting visiting Soma Simple I've been led to the following thoughts:
    1. As a physical therapist I am interacting with a patient's nervous system.
    2. My patients benefit when treatment begins with education about pain. I can't educate my patients about the neuro-matrix until I learn. This site definitely has the info/ and the repitition to facilitate the learning process, and Butler's Explain pain was helpful in further organizing the thought process.
    3. Manually when I touch my patients, I am amazed at the difference in the interaction. Where MFR seeks, and maniplates barriers, ignring the skin, DNM, and Simple Contact interact with the most external sensors in the body.
    4. I am learning that I can't fix people--quite the blow to the ego, but I can help them to understand the nature of pain, and develope strategies to return to their painfree lives.

    So, what you have to do is learn about the neurology of pain, teach your patients, and when you touch your patients do so with the intention to interact and help the patient find correction. That is a starting point. There is Wealth of knowledge that I have yet to discover

    Geralyn

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  • Jason Silvernail
    replied
    As you are obviously deeply enamored with manual skills and and problem solving pathways from your experiences...
    What leads to this conclusion?

    I think I approach a patient with low back in a similar way to my other patients.
    I should write a future post maybe called The Future of OMPT, but things are a bit hectic at the moment.

    [QUOTE...but your credentials and ongoing growth as a manual therapist make me curious about your personal development and how you choose to bridge where you are to where you are going.[/QUOTE]
    This is a fair question and something I'm thinking about a lot as I move forward. Do you have any specific questions I can address?

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  • DAS-PTA
    replied
    As a new member who hasn't had the chance to read all the threads and learn about your current approach or how you deal with the patients who don't respond to manual therapy,I guess I'm curious how you would approach a patient who presents with LBP.As you are obviously deeply enamored with manual skills and and problem solving pathways from your experiences,how do you decide to approach a patient?I am in agreement that the evidence should help us to evolve our toolbelt as well as our mind set.I apologize that this may have been discussed and put to bed,but your credentials and ongoing growth as a manual therapist make me curious about your personal development and how you choose to bridge where you are to where you are going.This is a question that helps me grow as well,so thank you for your insight!

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  • Fletch
    replied
    Another great post, thanks!

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  • Diane
    replied
    Hi Devdeep, please consider starting an intro thread for yourself here in the welcome forum, so we may know you better. :angel:

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  • devdeepahuja
    replied
    Start of a Bumpy Ride

    Hi All,

    Though I have been a member of this wonderful forum for 2 years, I have never actually spent much time here... but now that I have spent an hour today, I feel sad that I have lost out on the depth of knowledge that this forum has to offer anyone willing to learn and challenge traditional beliefs.

    Hope I can continue learning... This is an excellent post and makes one challenge the thoughts and constructs we have been brought up on...

    Regards,

    Devdeep
    Last edited by devdeepahuja; 07-10-2010, 10:45 PM.

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  • chansen
    replied
    Thanks, Jason, John, Diane and Barrett for the clarity.

    Chris

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  • Diane
    replied
    @Chris, I think it depends on whether you think of manual "treatment" as noun (i.e., a categorical "type" with a guru's name associated with a "system" or name-package for delivery/getting paid) or just a verb (i.e., qualities are dependent on speed, force, entry angle, inter-personalized observations of patient/nervous system response).

    I'm all about the verb of it, really don't like nouns of it.

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  • John W
    replied
    Chris,

    I forgot to answer your question:

    I'd like to know what the collective agreement is as far as appropriate types of manual care.
    I can unequivocally say that there is none.

    There are those here who use very intricate manual therapy techniques and those who use it much less intricately, albeit thoughtfully.

    Although I think there is collective agreement by at least the moderators here that manual care has a basis in neurophysiology/biology that accounts for its effects, and these effects cannot be adequately or rationally explained by the following:
    >releasing fascia
    >unwinding
    >craniosacral rhythms
    >mobilizing or manipulating joints
    >quantum mechanics or energy medicine
    >arthro- or osteokinematic joint motions
    >segmental spinal mobility
    >posture
    >strength
    >the price of tea in China

    Actually the price of tea in China may actually have more bearing on how manual therapy works than the previous nine examples, but I was trying to make a point in a glib sort of way. (You may think I'm joking about that, but I'm not.)

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