In a recent thread called The Chasm, we were discussing the distance between two groups of therapists in physical therapy, though this applies equally to other manual medicine professions.
One group is typically referred to here on Soma Simple as "Mesodermalists" and the other as "Ectodermalists". Many people on both sides are attempting to figure out how best to cross this chasm, and how best to integrate the kind of evidence found here on Soma Simple - the neuroscience of pain in particular - to their practice without leaving their previous practice patterns behind. I hope to provide some ideas here and welcome your suggestions and feedback as well.
Mesodermalists refers to the majority of those in the manual medicine professions, those who were taught models of pain and human function centered around posture, joint movement, and biomechanics. People hurt because they aren't keeping proper posture, or a joint has a mechanical fault, or their muscles are too tight or too weak or are imblanced in some way. Background for the mesodermal approach can also be reviewed in The Problem with OMPT. As of this writing, I think its fair to say that this is the predominant school of thought and teaching paradigm used in physical therapy schools.
Before anyone gets too upset about any "political" ramifications of using names for the groups, be advised that everyone concedes that there are many patients and many problems for whom a mesodermal approach is perfectly appropriate. Conditions requiring reconditioning or restoration of movement due to connective tissue injury or repair are good examples of this. The literature shows that physical therapy has an excellent track record for these patients - and the post-surgical literature is a good starting point to see that borne out. The Problem with OMPT post has more positive things to say about the mesodermal approach in the appropriate patient.
The second group of therapists is typically referred to here as "Ectodermalists". This group has accepted a model of pain and human function centered around the nervous system rather than around connective tissue biomechanics. While acknowledging the value of mesodermal reasoning in appropriate patients, they question its value (some more stridently than others) for certain patients. Specifically, ectodermalists see the traditional biomechanical model as inadequate and often counterproductive when attempting to deal with a primary complaint of pain that is typically not associated with a connective tissue injury. See The Problem with OMPT for more on that.
Many therapists read the evidence presented in favor of ectodermal reasoning and become confused as to what their next step should be.
Should I stop doing what I've been doing?
Do I stop doing [insert manual therapy or exercise technique here]?
How should this change how I treat?
Where do I go from here?
In this thread, we'll answer some of those questions.
Your feedback and suggestions are welcome.
One group is typically referred to here on Soma Simple as "Mesodermalists" and the other as "Ectodermalists". Many people on both sides are attempting to figure out how best to cross this chasm, and how best to integrate the kind of evidence found here on Soma Simple - the neuroscience of pain in particular - to their practice without leaving their previous practice patterns behind. I hope to provide some ideas here and welcome your suggestions and feedback as well.
Mesodermalists refers to the majority of those in the manual medicine professions, those who were taught models of pain and human function centered around posture, joint movement, and biomechanics. People hurt because they aren't keeping proper posture, or a joint has a mechanical fault, or their muscles are too tight or too weak or are imblanced in some way. Background for the mesodermal approach can also be reviewed in The Problem with OMPT. As of this writing, I think its fair to say that this is the predominant school of thought and teaching paradigm used in physical therapy schools.
Before anyone gets too upset about any "political" ramifications of using names for the groups, be advised that everyone concedes that there are many patients and many problems for whom a mesodermal approach is perfectly appropriate. Conditions requiring reconditioning or restoration of movement due to connective tissue injury or repair are good examples of this. The literature shows that physical therapy has an excellent track record for these patients - and the post-surgical literature is a good starting point to see that borne out. The Problem with OMPT post has more positive things to say about the mesodermal approach in the appropriate patient.
The second group of therapists is typically referred to here as "Ectodermalists". This group has accepted a model of pain and human function centered around the nervous system rather than around connective tissue biomechanics. While acknowledging the value of mesodermal reasoning in appropriate patients, they question its value (some more stridently than others) for certain patients. Specifically, ectodermalists see the traditional biomechanical model as inadequate and often counterproductive when attempting to deal with a primary complaint of pain that is typically not associated with a connective tissue injury. See The Problem with OMPT for more on that.
Many therapists read the evidence presented in favor of ectodermal reasoning and become confused as to what their next step should be.
Should I stop doing what I've been doing?
Do I stop doing [insert manual therapy or exercise technique here]?
How should this change how I treat?
Where do I go from here?
In this thread, we'll answer some of those questions.
Your feedback and suggestions are welcome.
Comment