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Crossing the Chasm - Meso to Ecto

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  • #76
    A good article, Line. :thumbs_up

    I think Australia lurks somewhere between Network and Solar. In my experience of management in a hospital setup, the final decisions come from the top (ie head of physiotherapy) but only after consultation with the senior PTs and then with the entire staff.
    Suggestions on improvements are taken onboard, considered, and either accepted or rejected.

    The reason for rejection are many, but the deciding factor is the number of people pushing for a change in practice; a lone voice is unlikely to change anything. But three lone voices, along with a senior PT, can swing the pendulum towards improvements.

    Which is why this board has a strong chance of swinging others away from the meso-ortho culture towards ectodermalism - but it takes time.

    Nari

    Comment


    • #77
      Having scrambled around in the depths of the archives, in particular the 2005 discussion around tendinopathy, I wondered if Jason (or others) might, with his clarity of thought, revisit his understanding of tendinopathy from an ectodermal perspective? I am aware this may need to be shunted elswhere from this thread.

      ANdy
      "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

      Comment


      • #78
        I cannot download this article as adobe reports it damaged. Could a kindly person please repost it?

        in anticipation

        ANdy
        "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

        Comment


        • #79
          Here....
          Hopefully this works better...
          Attached Files
          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

          Comment


          • #80
            thank you Diane, much better

            ANdy
            "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

            Comment


            • #81
              About the CPR for the «stability» (TrA) treatment protocol

              This is how I ectodermalise (!) the results and the logic

              The supposition I make from the stability and manip CPR's is as follow :

              if you're less than 40 y/o, don't have a positive SLR, don't have pain below the knee, don't have to much fear or others psycho issues with pain and don't have concurrent adjacent joint problems (the hip rotation thing), well, I guess you have a high likelyhood ratio of doing much better in a few weeks, and that, whatever I do... or almost !


              The other bad thing with CPRs, is that because the treatment was effective it is supposed the logic behind that treatment makes sense. This is a bit bizarre, because some of the predicting factors seem to have nothing to do with the logic anyways.

              Plus, it's disregarding other reasons for the findings :

              Someone with abberant motion in Lx spine because of fear avoidance is very likely to feel pain on a P/A because of central sensitization. It's seems normal to me that this person will do some gripping with his erector spinae muscles while moving to prevent movement. The prone instability test is doing just that. So less mvt with the P/A : less pain. Because mvt and fear of it is causing pain. Could have nothing to do with trA and joint stability.

              Why the exercices worked : the patient was told it would strenghten his back, make it more stable. He thus gained confidence and now as less fear avoidance, and so, less pain.

              Coincidally, no fear avoidance is a failure predictor for stabilising exercices. How funny is that!

              I guess some good pain education and some graded exposure would have gotten that hypothetical pt an even better result.
              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

              Comment


              • #82
                I'm posting this paper I've written for the Differential Dx course in my DHS work here because it's an attempt to provide some ectodermal reasoning for a patient with traumatic onset of LBP and imaging evidence of spondylolysis.

                It's a pretty good example of where meso to ecto reasoning could take us.
                Attached Files
                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

                Comment


                • #83
                  Hi Line,

                  Am a bit late with seeing this article you brought in.
                  Thanks for this... I hope it can be of help for my understanding of the cultural differences ......
                  Funny that Dutch connexxion

                  Esther

                  Comment


                  • #84
                    John,

                    This is wonderful work. I think it should become an example for future students but would especially like to hear what your instructors have to say about it.
                    Barrett L. Dorko

                    Comment


                    • #85
                      John, I agree that it's wonderful. Love that you included an embryological point.
                      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

                      Comment


                      • #86
                        Well-done indeed. What a resource treasure many of you folks are!
                        With my personal calculation, I owe you all about 275 martinis, 100 cases of beer, 32 cases of wine, and a stinkload of home-made indonesian snacks.....
                        We don't see things as they are, we see things as WE are - Anais Nin

                        I suppose it's easier to believe something than it is to understand it.
                        Cmdr. Chris Hadfield on rise of poor / pseudo science

                        Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                        We don't need a body to feel a body. Ronald Melzack

                        Comment


                        • #87
                          Great job, John. Thanks for sharing this.

                          Exciting to see the winds of change blowing harder all the time!
                          Nick Matheson, PT
                          Strengthen Your Health

                          Comment


                          • #88
                            Thanks, everyone.

                            I have to give kudos to Frederic for his discerning posts in this thread as well as this one on the lack of discriminatory validity of the various LBP CPRs. This particular case that I present is a good example of where mesodermal thinking goes awry.

                            On its face, a spondylolysis would seem to fall in a "stabilization" category due to the inherent "loss" of structural stability resulting from the pars defect/fracture. However, this patient met the criteria for both stabilization and specific exercise (flexion) based on most the current version of the "Treatment-Based Classification System" per Fritz et al and Brennan et al.

                            Notice also that this patient received manual therapy on the first visit. So, while he didn't meet any criteria for the "mobilization" category, I committed the heresy of therapeutically placing my hands on him in order to down-regulate superficial tenderness in the lumbosacral region.

                            None of the CPRs or classification categories directly address the neuromatrix. Rather, the tangential metrics of fear-avoidance and days since onset superficially deal with the cognitive and affective dimensions of the pain experience. This just won't do for persistent pain.

                            These classification systems are the product of decades of mesodermal thinking and logic. They are by-products of the biomedical lens that is talked about in this concurrent thread.

                            I'm going to Indianapolis this weekend for the on-site portion of this course- it's going to be long one...
                            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

                            Comment


                            • #89
                              Thanks for the report John. I enjoyed reading it.

                              Regarding the latest classification study, does anyone have access to it in full?

                              Brennan GP, Fritz JM, Hunter SJ, et al. Indentifying subgroups of patients with acute/subacute “nonspecific” low back pain: results of a randomized clinical trial. Spine. 2006;31(6):623-631.
                              Anders.
                              "There is nothing so practical as a good theory." -Kurt Lewin

                              Comment


                              • #90
                                Anders,
                                I don't have that one on my laptop at work, but if someone doesn't post it sooner, I will later tonight (early tomorrow morning for you) in the SoS.
                                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

                                Comment

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