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  • #76
    Diane-
    So my understanding of post 73 is that you have acknowledged that there is a role for examination and treatment of the periphery then?
    Or are you still saying that all peripheral treatment is irrelevant?

    If placebo controlled trials of anti-inflammatories make sense, then there's no reason to also think similar attempts to reduce mechanical afferents don't also make sense.

    I think if your over-arching point is that we need to pay close attention to the brain and what neuroscience is telling us about pain processes, and consider in all that we do, I agree. But that doesn't strike me as new. If you're saying, as I understood it before, that all peripheral treatment constructs are irrelevant and the central changes are all that matter, then I disagree.

    I think one can practice from many different paradigms and still make sense from a Neuromatrix point of view - DNM, ideomotion, OMPT, neurodynamics, osteopathy, needles or no needles, massage.

    I think it might be worthwhile to list out what components defensible therapy approach should have based on what we now know about pain processing.
    It seems to me that it consists of:
    -the neuromatrix is being considered as central when pain is the issue being treated
    -we are explaining and modifying our approach based on neuroscience as an explanatory model, not other outdated paradigms of human function
    -we are adhering to the principles of therapy promulgated by Barrett (eg patient must be able to self-treat)
    -we attempt to approach all 6 domains of input and output

    I think if any of us are doing all of these, we have a defensible approach. What does the group say?
    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


    • #77
      How sure can we be that the correction of a specific deformation or inflammation, which define the abnormal neurodynamic, is the direct consequence of some specific handling?
      Eric Matheson, PT

      Comment


      • #78
        I don't think we can be very sure at all. I just don't think we should give up trying to do helpful things outside of the brain.
        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


        • #79
          Amazing discussion.

          Reading Eric's question I'm reminded of the original work in chaos theory begun many years ago. Google sensitive dependence on initial conditions or fractal or butterfly effect or read The Nonlinear Being at the bottom of the list of essays here and you'll see that we will always wonder about the specific or predictable effects or our intervention when dealing with neurogenic problems. No so much with the mesoderm.

          Is it any wonder so many therapists run from the patient in pain?

          I especially like was has been said about the corrective movement not necessarily being painless, and that Butler has concluded this as well.
          Barrett L. Dorko

          Comment


          • #80
            Eric,

            That's a very difficult thing to be sure of.

            In terms of our discussion of treatment models here, we have two options: we propose, based on our best understanding, that a peripheral component is likely to be involved in a pain response, that the peripheral component is amenable to change via some specific active or passive input, and that treatment which aims to include the provision of such an input is reasonable; or we propose that the presence or absence of a peripheral component to a pain response is irrelevant, that alterations in central processing are the only mechanisms responsible for pain reduction, and that manual treatment with the intent to do anything other than effect cognitive/evaluative change is superfluous.
            Last edited by Luke Rickards; 18-07-2009, 04:26 PM.
            Luke Rickards
            Osteopath

            Comment


            • #81
              Originally posted by Jason Silvernail View Post
              Diane-
              So my understanding of post 73 is that you have acknowledged that there is a role for examination and treatment of the periphery then?
              Or are you still saying that all peripheral treatment is irrelevant?

              I don't think I EVER said that peripheral treatment was irrelevant. I questioned constructs, and forcefully reject certain KINDS of treatments that my own nervous system finds objectionable, but I do not think I ever said peripheral treatment was irrelevant. Show me where I said that. On the contrary, it gives us another way into the brain, access to the brain's kinesthetic cortex.

              I think the apparent chasm of communication and understanding stems from how far I have shifted to mostly a brain-centric view of a patient (body as blob under the brain rather than brain as blob on top of the body - Nari).

              From a brain's perspective, it doesn't matter what sort of monkeying around is happening out in the periphery, or how earnestly some therapist has learned their moves and treasures the associated construct - what matters is, does the brain accept it as sufficient, necessary, and so on, to make a change in output? A change favorable to the "I"-illusion it also maintains?

              From a manual therapy profession's manual therapy perspective, anyone in it will hotly defend things like constructs, tooth fairy science to prop them up, the endless (and likely quite futile) search for the holy grail of specific effect, etc etc. etc. I get that, But I also don't care a whole lot anymore about any of it. Maybe I'm jaded. I think moving body parts into positions and sitting outside on the skin and imagining the bits of nerves and interacting with them and imagining all sorts of things happening throughout the nervous system I'm visiting with, is quite sufficient, and is all that is necessary, to produce pretty much all the same stuff that others think they actually do, to a "body." And any tooth fairy science I am involved in will reflect that. I hope.

              I think if your over-arching point is that we need to pay close attention to the brain and what neuroscience is telling us about pain processes, and consider in all that we do, I agree. But that doesn't strike me as new. If you're saying, as I understood it before, that all peripheral treatment constructs are irrelevant and the central changes are all that matter, then I disagree.
              Seriously, what do you think I mean when I talk about human primate social grooming? I'm talking about physical contact, and I even said that I think constructs are necessary, as a social application. For the forebrain. But not for the hindbrain. Is that more clear?

              I think one can practice from many different paradigms and still make sense from a Neuromatrix point of view - DNM, ideomotion, OMPT, neurodynamics, osteopathy, needles or no needles, massage.
              Anything "makes sense" if you swallow enough of the koolaid that comes with it.

              I think it might be worthwhile to list out what components defensible therapy approach should have based on what we now know about pain processing.
              It seems to me that it consists of:
              -the neuromatrix is being considered as central when pain is the issue being treated
              -we are explaining and modifying our approach based on neuroscience as an explanatory model, not other outdated paradigms of human function
              -we are adhering to the principles of therapy promulgated by Barrett (eg patient must be able to self-treat)
              -we attempt to approach all 6 domains of input and output

              I think if any of us are doing all of these, we have a defensible approach. What does the group say?
              I concur completely. :clap1:
              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


              • #82
                That's true Diane, you haven't said peripheral treatment is irrelevant. Unless I am mistaken though, you have said that the particular features of all peripheral treatment other than, I suppose, conveying a sense of therapeutic ritual are irrelevant.
                Last edited by Luke Rickards; 18-07-2009, 03:58 PM.
                Luke Rickards
                Osteopath

                Comment


                • #83
                  I think that Luke is correct here. Perhaps this thread is large enough to contain a discussion of ritual itself.

                  My understanding is that the difference between ritual and ceremony is that the latter is observed while the former invites participation. Perhaps this is the not so easily seen distinction between methods that address the neuromatrix effectively (ending in a placebo response) and those that don't.
                  Barrett L. Dorko

                  Comment


                  • #84
                    In terms of our discussion of treatment models here, we have two options: we propose, based on our best understanding, that a peripheral component is likely to be involved in a pain response, that the peripheral component is amenable to change via some specific active or passive input, and that treatment which aims to include the provision of such an input is reasonable; or we propose that the presence or absence of a peripheral component to a pain response is irrelevant, that alterations in central processing are the only mechanisms responsible for pain reduction, and that manual treatment with the intent to do anything other than effect cognitive/evaluative change is superfluous.
                    I think it is important to emphasize that these represent the options or categories that patients may be in rather than competing models of (possible) reality. That is, for a given patient, either option may represent the reality of the situation. And for some patients, it could be both/and.
                    "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                    Comment


                    • #85
                      Originally posted by Luke Rickards View Post
                      That's true Diane, you haven't said peripheral treatment is irrelevant. Unless I am mistaken though, you have said that the particular features of all peripheral treatment other than, I suppose, conveying a sense of therapeutic ritual are irrelevant.
                      I thought I made it abundantly clear that I think that physical contact is important, specifically to the hindbrain and to the kinesthetic cortex.

                      I don't think I brought up the term therapeutic "ritual" in this thread.
                      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
                        Jon,

                        You are correct. Though the models may be seen as competing where one 'reality' is significantly more likely than the other.
                        Luke Rickards
                        Osteopath

                        Comment


                        • #87
                          Diane,

                          You did make that clear. You also said that the features of that physical contact are not important because therapeutic responses are the result of placebo mechanisms. Placebo responses usually refer to those directly related to the contextual elements of therapy (the social ritual) and the patient's interpretation of their meaning.
                          Last edited by Luke Rickards; 18-07-2009, 05:06 PM.
                          Luke Rickards
                          Osteopath

                          Comment


                          • #88
                            Originally posted by Luke Rickards View Post
                            Diane,

                            You did make that clear. You also said that the features of that physical contact are not important because therapeutic responses are the result of placebo mechanisms. Placebo responses usually refer to those directly related to the contextual elements of therapy (the social ritual) and the patient's interpretation of their meaning.
                            I thought I was quite clear that I was taking about placebo response, in the Patrick Wall sense, necessary for pain resolution and for setting neuroplasticity into a preferable direction.
                            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


                            • #89
                              Originally posted by Diane View Post
                              Originally Posted by Luke Rickards View Post
                              Diane,

                              You did make that clear. You also said that the features of that physical contact are not important because therapeutic responses are the result of placebo mechanisms. Placebo responses usually refer to those directly related to the contextual elements of therapy (the social ritual) and the patient's interpretation of their meaning.
                              I thought I was quite clear that I was taking about placebo response, in the Patrick Wall sense, necessary for pain resolution and for setting neuroplasticity into a preferable direction.
                              I thought it was clear that I linked placebo RESPONSE as defined by Wall into a need for manual physical contact by a therapist.

                              The only punches that are being thrown here are to do with people being too overly wedded to their favorite treatment constructs, which the hindbrain and kinesthetic cortex could not care less about, and whose perspective I'm trying to represent fairly, because they, their receptivity, and their spreading effect out to the rest of the brain, are usually ignored.
                              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


                              • #90
                                Wall; The Science of Suffering (his final publication): page 133.
                                Culture, Learning, and Expectation

                                The placebo response is the fulfillment of an expectation.
                                That's the sense that I am referring to.
                                Luke Rickards
                                Osteopath

                                Comment

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