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  • Questions to Steven George

    Steven George presented at a few lectures at this year's AAOMPT conference. See here for some review of that material.

    The purpose of this thread is to provide you the opportunity to ask questions you would like to see being asked in the upcoming interview. I'll add some links to his work for those unfamiliar with it.

    For those that are familiar with his work, the mic is now open.

    And thanks to Eric M. for the idea that is this thread.
    Last edited by Jon Newman; 21-11-2008, 10:27 PM.
    "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

  • #2
    Dr George-
    You've been an investigator in studies looking at the neurophysiological effects of thrust manipulation. Many of us who are looking away from a biomechanical rationale and toward a neurophysiologic explanation for the effects of manual therapy draw on your literature for support.
    1. What do you think the most plausible mechanism(s) are for the effects of manual therapy in general and thrust manipulation in particular? Specifically, do you feel the results point to a neurophysiologic and/or reflexive effect, rather than the traditional view of a biomechanical or positional effect?
    2. What has your experience with the manual therapy community been like, given that it is still largely based on a strict biomechanical assessment and treatment construct?
    3. Do you feel there is value in teaching manual therapy through the traditional methods of palpatory diagnosis and treatment?
    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


    • #3
      Great questions Jason. I should note that not every question that gets asked here will be addressed but it gives us a flavor for what people want to know about. Feel free to chime in with "what he said" type posts.

      I promised a link to Steven George's work. There's not just a couple of things to post so let's see if this works

      http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22George%20SZ%22[Author]&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPan el.Pubmed_RVAbstractPlus

      If not, I encourage you to mosey on over to PubMed and do a search on your own.
      Last edited by Jon Newman; 21-11-2008, 11:24 PM.
      "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

      Comment


      • #4
        Can anyone get George's reply to Flynn's editorial here. I might have a question on this, among others coming up.
        Luke Rickards
        Osteopath

        Comment


        • #5
          Here it is.
          Cory Blickenstaff, PT, OCS

          Pain Science and Sensibility Podcast
          Leaps and Bounds Blog
          My youtube channel

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          • #6
            Some general questions from my random question generator:
            • I’d like to know what sparked his interest in studying the neurophysiological effects of manual therapy? Was there an 'aha' moment for him?
            • Are there any significant persons who have influenced his thinking and work?
            • Has his study of neurophysiology led him to change the way he practices in any way?
            • Is he satisfied with the level of pain neurophysiology currently being taught in entry level degree programs? If not, what more needs to be done?
            • Crystal ball time. How does he envision physiotherapy for the treatment of pain 50 years from now?
            Eric Matheson, PT

            Comment


            • #7
              1. What do you think the most plausible mechanism(s) are for the effects of manual therapy in general and thrust manipulation in particular? Specifically, do you feel the results point to a neurophysiologic and/or reflexive effect, rather than the traditional view of a biomechanical or positional effect?
              Jason,

              George seems to have given his answer to this question pretty clearly in his publications. Perhaps we could take it one step further and discuss exactly which neurophysiological mechanisms he would put his money on - non-specific, descending inhibitory, autonomic, peripheral/neurodynamic - and why.
              Last edited by Luke Rickards; 22-11-2008, 01:11 AM.
              Luke Rickards
              Osteopath

              Comment


              • #8
                Luke-
                Thanks and I'm aware of that - but I'm sure most people aren't and felt that would give him a good opportunity to talk freely about the concept in general. Though perhaps I wasn't giving our SomaSimple crew enough credit. In any case, I like your question better.
                Also I felt his response to my original question would be something I could point to in future discussions or blog posts, which makes me look like a shallow opportunist, but there you have it.
                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


                • #9
                  Hey, a lot of people make their living on shallow opportunism so don't knock it.

                  This whole thread is about throwing questions out there. Steven George will check out this thread as well as Cory (who will be conducting the final interview) and the curiosity expressed here, in whatever form it is expressed, will help form the basis of the interview. Some of the questions may be taken verbatim, some won't be addressed at all but all of them will help focus the interview. Since we're doing this for readers here and not for the purposes of a private conversation over beer we desire your input in whatever form it comes.

                  I think it is clear that mechanisms will need to be addressed.

                  I'll add my question--Based on the proposed mechanisms (whatever they are, and I'm assuming there is more than one); is thrust manipulation a necessary condition for improvement of the pains it is typically employed to reduce? I realize that while something isn't necessary it does not exclude the possibility that it is the best. I just want to explore first principles.

                  Brainstorm on.

                  Also, I think the little conversation such that is occurring with Luke and Jason is also helpful. It can help tease out devilish details that deserve attention.

                  Keep it up.:thumbs_up
                  "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                  Comment


                  • #10
                    Jon,

                    Your evocation of "first principles" immediately brought to my mind a line from The Silence of the Lambs. Okay, I admit I have a rather strange mind, but who doesn't?

                    Seated in his cage, Hannibal Lecter tells the FBI agent in search of a serial killer to attend to "first principles" and references this to a Roman philosopher whose name kind of escapes me but I think it's probably Heraclitus. He says, "Attend to first principles Clarise... Simplicity."
                    Later I realized that he was giving her a clue in the form of the name of a popular sewing machine, but I digress.

                    My point is this: If Dr. George has demonstrated in some way that it is the neurologic effect we seek, wouldn't that simplify manual technique in an effort to achieve our goals? And simplify it in a massive way?
                    Last edited by Barrett Dorko; 22-11-2008, 04:56 PM.
                    Barrett L. Dorko

                    Comment


                    • #11
                      Jason,

                      I didn't mean to suggest that it wouldn't be useful for the extended readership here for him to answer that question. I just thought that going into it a little deeper, while we have the opportunity, would implicitly answer your question as well as direct him to the more technical details we tend to discuss quite frequently here.
                      Luke Rickards
                      Osteopath

                      Comment


                      • #12
                        (Luke, perhaps you have no idea how EX-plicit things are going to have to get, in general.. for there to be any real.. let's say, "progress" in manual therapy constructs )
                        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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                        • #13
                          (Thanks for the reminder, Diane )
                          Luke Rickards
                          Osteopath

                          Comment


                          • #14
                            Here's a question that's been gnawing at me a bit for some time:

                            Way back in 1984, Clifford Woolf published an article which showed that C-afferent stimulation of muscle nociceptors resulted in an up to 3-fold prolonged flexor reflex response (20-30 minutes) compared to skin C-afferents via the sural nerve in rats (10 minutes).

                            Could this explain a mechanism underlying the benefits of manipulation for acute episodes of LBP where muscle C-fiber afferents are firing wildly?

                            Title:
                            Muscle but not cutaneous C-afferent input produces prolonged increases in the excitability of the flexion reflex in the rat.
                            Author(s):
                            Wall PD; Woolf CJ
                            Source:
                            The Journal Of Physiology [J Physiol] 1984 Nov; Vol. 356, pp. 443-58.
                            Publication Type:
                            In Vitro; Journal Article; Research Support, Non-U.S. Gov't
                            Language:
                            English
                            Journal Information:
                            Country of Publication: ENGLAND NLM ID: 0266262 Publication Model: Print Cited Medium: Print ISSN: 0022-3751 (Print) NLM ISO Abbreviation: J. Physiol. (Lond.) Subsets: MEDLINE
                            MeSH Terms:
                            Joints/*innervation
                            Muscles/*innervation
                            Nerve Fibers/*physiology
                            Neurons, Afferent/*physiology
                            Reflex/*physiology
                            Skin/*innervation
                            Animals; Axons/physiology; Evoked Potentials; Motor Neurons/physiology; Rats; Rats, Inbred Strains; Sural Nerve/physiology; Time Factors
                            Abstract:
                            Stimulation of cutaneous afferent fibres in the sural nerve and muscle afferent fibres in the gastrocnemius-soleus nerve at a strength that excites C axons produces a delayed and long-lasting burst of activity in posterior biceps femoris/semitendinosus flexor motoneurones. Following a 20 s stimulation at 1 Hz to the sural nerve the flexor motoneurones continue to fire for 20 s while a similar stimulus to gastrocnemius-soleus nerve results in an after-discharge lasting three times longer. Using stimuli to the sural and gastrocnemius-soleus nerves as conditioning stimuli (20 s, 1 Hz) changes in the excitability of the flexor reflex were measured by recording the discharge evoked by a test sural nerve stimulus or by a standard pinch to the ipsilateral and contralateral toes. Prior to any conditioning stimulus the flexor reflex remained stable for prolonged periods. Conditioning stimuli at strengths that activated large myelinated afferent fibres only, or large and small myelinated afferent fibres, failed to produce more than a very transient alteration in the reflex excitability. Conditioning stimuli at C-fibre strength to the sural nerve produced a marked increase in the excitability of the reflex for 10 min. C-fibre strength gastrocnemius-soleus nerve conditioning stimuli resulted in a similar increase in excitability followed by a second phase of facilitation peaking at 20-30 min and lasting for up to 90 min. The afferent barrage initiated by cutting the sural and gastrocnemius-soleus nerves resulted in similar patterns of reflex excitability increases with the muscle nerve resulting in a more prolonged effect than the cutaneous nerve. The results show that a brief C-afferent fibre input into the spinal cord can produce a prolonged increase in the excitability of the flexion reflex and that muscle C-afferent fibres evoke longer-lasting changes than cutaneous C fibres. The differences in the time course of the post-conditioning effects may be related to the well-described differences in the sensory consequences of injury to skin versus deep tissue.

                            © 2008 EBSCO Industries, Inc. All rights reserved.
                            EBSCO Publishing Green Initiatives
                            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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                            • #15
                              Originally posted by Luke Rickards View Post
                              Jason,

                              I didn't mean to suggest that it wouldn't be useful for the extended readership here for him to answer that question. I just thought that going into it a little deeper, while we have the opportunity, would implicitly answer your question as well as direct him to the more technical details we tend to discuss quite frequently here.
                              Luke-
                              Totally agree, and of course you're right. Going deeper would be what we want Dr George to do, as it would necessitate covering what are, to us anyway, the more superficial issues I brought up.
                              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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