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  • VIS Trigger point logic: Shifting the burden of proof fallacy

    I looked here for this, couldn't find it, found it elsewhere (Fred's blog), and bringing it here and sticking it to the top so I don't lose it again. Bernard made it ages ago.



    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

  • #2
    Here is the latest response by Quintner and Cohen to Dommerholt and Gerwin.
    They address these points in detail (excerpts):
    1. The question of bias:
    The very nature of an opinion piece that questions dogma is one of bias. Why would we go to the trouble of articulating our views if we had not come to the conclusion that “the
    conventional wisdom” has been found wanting? If by “bias”, Dommerholt and Gerwin imply that our fundamental rejection of the “trigger point” construct means that we ignore studies that uncritically accept it, then we wear that as a badge of epistemological courage.
    Pain medicine still has much established bias; until the Enlightenment, Medicine itself was similarly full of bias, of explanatory models based on myth, mystery and mendacity. So-called bias in the present context really refers to a way of looking at the world, or the German word Weltanschauung. For example, theists and non-theists interpret
    the world differently depending on their bias. The question remains, which view is closer to the truth?
    My bold.

    2. With what do they in fact disagree?

    We invite the reader to examine these statements by Dommerholt and Gerwin, and to identify how these authors disagree with us:
    - “In spite of years of research into the nature of myofascial pain and significant gains especially during the last decade, several aspects remain elusive and are not
    well understood. A distinct mechanistic understanding of this disorder does not yet exist.”
    - “We acknowledge that there has not been a study to demonstrate the minimal essential features of the TrP needed to identify it for diagnosis and treatment
    purposes.”
    - “... there has never been a credible anatomic pathology associated with myofascial TrPs.”
    - “We agree that there are few outcome studies of good quality and although some studies showed reduction in pain scores and pressure pain thresholds, the literature has neither convincingly supported or refuted the effectiveness of some invasive and non-invasive modalities beyond placebo.
    - “We agree with Quintner et al. that studies of the efficacy of TrP interventions have shown such marked statistical heterogeneity that it can be difficult to evaluate outcomes.”

    Yet Dommerholt and Gerwin upbraid us for not “...providing any alternative studies specifically done on the pain phenomena that is attributed to TrPs.”
    One wonders why they D&G pursue with such vigor the flogging of a horse that is not only dead, it has been decomposed for decades, given that there is so much else out there to explain pain that is so 'less wrong'.





    3. How scientific inquiry works:
    Dommerholt and Gerwin are critical of our use of “theory” and “hypothesis” and claim that we have used them in a non-scientific manner:
    “Scientific inquiry commonly starts with observations, followed by the development of hypotheses, which through experiments are confirmed, modifies, or refuted. Through repeated experimental testing of the hypothesis it is continually refined until a theoretical basis can be constructed that addresses different aspects of the hypothesis. The end goal of the process is to construct a scientific theory. Few, if any, phenomena in medicine have reached the stage of scientific theory, including the existing TrP hypothesis.”
    As we do not agree with that formulation of method, let us return to basics.
    A theory is an explanation for a set of observations. The explanatory power of a theory varies directly as its degree of support from different lines of evidence. The theory of myofascial pain seeks to explain the phenomena of pain and tenderness in apparently normal soft musculoskeletal tissue by invoking the hypothesis that “trigger points” exist in “myofascial” tissues. These “trigger points” are said to be the origin of nociception that is experienced as pain.
    That hypothesis has been tested time and time again, along the lines of “If there are trigger points, then x, y, or z will be found or will happen.” This is the logical construct: “If P, then Q”. However, no evidence (x, y, z) that supports the existence of trigger points has been found e experimentally, empirically, or predictively. The logical inference is: Not Q, therefore not P. As such P, the hypothesis, is rejected. The hypothesis is now seen to have been only a conjecture. As myofascial pain theory is fundamentally based on that hypothesis, it too must be rejected.
    However, Dommerholt and Gerwin (and indeed others) adhere to the logical positivist approach of seeking to confirm a hypothesis by repeated observations (and interpretations)
    based on the assumption that the theory is correct. They support using the hypothesis beyond the intended purpose of generating testable ideas, to directly inform treatment. Then, in a classical circular reasoning process, they ascribe largely anecdotal positive treatment effects as confirmation of the hypothesis. This is patently wrong.

    By contrast, we argue that this approach continues to treat the conjecture as if it were true. But if the fundamental tenet of a theory is flawed - that is, it is shown to be only conjecture - then no amount of data can rectify this. The proposition, “All swans are white” is not confirmed by repeated observations of white swans: it is refuted by the observation of a black swan. We adhere to the Popperian view that, despite substantial research efforts there is no credible evidence either that “trigger points” exist or that “myofascial tissue” is the primary origin of nociception. Therefore the theory that generated
    this hypothesis is faulty and should be rejected.
    In summary, observations lead to theory. Hypotheses are deduced from theory. Refutation of (the claims made by) a hypothesis should lead to modification of the theory. In this way, even cherished theories can be contested. According to this argument, perhaps we should have advanced our alternative explanatory model for the phenomena in question as a theory rather than a hypothesis.
    The theory is that the phenomena reflect altered central nociception. A deduction from this theory is the hypothesis that pain and hypersensitivity may arise secondary to altered functions of nociceptive axons in response to a variety of factors, such as mechanical insult leading to inflammation. It is up to the pain community to test this hypothesis.
    Dommerholt and Gerwin have extensively reiterated arguments based on a false premise. We are not persuaded that we have made scientific or logical errors in our thesis. It is time to shine the light of critical inquiry elsewhere in pursuit of explanations for these clinical phenomena.
    My bolds.

    So, instead of this...


    Or this...


    ... we can have this:
    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


    • #3
      Find the original here. LINK
      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


      • #4
        Quintner's theory argument, line by line:

        1. A theory is an explanation for a set of observations.
        See definition for scientific theory.

        2. The explanatory power of a theory varies directly as its degree of support from different lines of evidence.
        3. The theory of myofascial pain seeks to explain the phenomena of pain and tenderness in apparently normal soft musculoskeletal tissue by invoking the hypothesis that “trigger points” exist in “myofascial” tissues.
        4. These “trigger points” are said to be the origin of nociception that is experienced as pain.
        5. That hypothesis has been tested time and time again, along the lines of “If there are trigger points, then x, y, or z will be found or will happen.”
        6. This is the logical construct: “If P, then Q”.
        7. However, no evidence (x, y, z) that supports the existence of trigger points has been found e experimentally, empirically, or predictively.
        8. The logical inference is: Not Q, therefore not P.
        9. As such P, the hypothesis, is rejected.
        10. The hypothesis is now seen to have been only a conjecture.
        11. As myofascial pain theory is fundamentally based on that hypothesis, it too must be rejected.
        12. However, Dommerholt and Gerwin (and indeed others) adhere to the logical positivist approach of seeking to confirm a hypothesis by repeated observations (and interpretations) based on the assumption that the theory is correct.
        13. They support using the hypothesis beyond the intended purpose of generating testable ideas, to directly inform treatment.
        14.Then, in a classical circular reasoning process, they ascribe largely anecdotal positive treatment effects as confirmation of the hypothesis. This is patently wrong.
        15. By contrast, we argue that this approach continues to treat the conjecture as if it were true.
        16. But if the fundamental tenet of a theory is flawed - that is, it is shown to be only conjecture - then no amount of data can rectify this.
        17. The proposition, “All swans are white” is not confirmed by repeated observations of white swans: it is refuted by the observation of a black swan.
        18. We adhere to the Popperian view that, despite substantial research efforts there is no credible evidence either that “trigger points” exist or that “myofascial tissue” is the primary origin of nociception.
        19. Therefore the theory that generated this hypothesis is faulty and should be rejected.
        20. In summary, observations lead to theory.
        21. Hypotheses are deduced from theory.
        22. Refutation of (the claims made by) a hypothesis should lead to modification of the theory.
        23. In this way, even cherished theories can be contested.
        24. According to this argument, perhaps we should have advanced our alternative explanatory model for the phenomena in question as a theory rather than a hypothesis.
        25. The theory is that the phenomena reflect altered central nociception.
        26. A deduction from this theory is the hypothesis that pain and hypersensitivity may arise secondary to altered functions of nociceptive axons in response to a variety of factors, such as mechanical insult leading to inflammation.
        27. It is up to the pain community to test this hypothesis.
        28. Dommerholt and Gerwin have extensively reiterated arguments based on a false premise.
        29. We are not persuaded that we have made scientific or logical errors in our thesis.
        30. It is time to shine the light of critical inquiry elsewhere in pursuit of explanations for these clinical phenomena.
        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


        • #5
          However, Dommerholt and Gerwin (and indeed others) adhere to the logical positivist approach of seeking to confirm a hypothesis by repeated observations (and interpretations) based on the assumption that the theory is correct.
          I just had an "aha!" moment reading this.

          I just had this mental flash: what would it be like if everyone woke up tomorrow morning and they had all totally forgotten any concept of trigger points and were starting from scratch, without any preconceived ideas about what was causing pain?

          I think, probably, at one time, in the course of trying to figure out why people had certain kinds of pain, that Travell and whoever . . . there obviously was a time *before* they had adopted this idea that they were in a place of not knowing, of inquiry. Unfortunately, they got an idea in their heads about what it was and stopped there, assumed the idea was correct, and quit asking the right questions. And here it is a few decades down the road and it's been adopted by MTs, PTs, DCs. MDs, and who knows who else?

          I do hope that it won't take 350 years to undo this like it did with Descartes. Apparently even in his time there were those who questioned his explanation for pain, and even then phantom limb pain was known and there were those who saw some flaws in his explanation.

          I have accepted the problem of the Travell explanation for awhile now, but at that moment, laid out like that, it sunk in just a little deeper. It's really not much different than, say, acupuncturists accepting the concept of meridians. It's classic Cargo Cult/Tooth Fairy science. And here, all those years I was studying TPs, I thought it was science-based. Well, it was the best information available to me at the time. Fortunately, I have better information now.

          Thanks.
          Last edited by Alice Sanvito; 26-05-2015, 09:10 AM.

          Comment


          • #6
            The whole problem with this, is that an observation did NOT lead to a scientific process, but scientific methodology was used to try and confirm the importance of the observation - NOT the plausibility of it.

            Thus circular reasoning entered the game.

            More and more TrPs were observed, and their manipulation/needling/spraying had an effect on the pain perception, thereby validating the notion that they were responsible for pain.

            Travell fell woefully short in her actual scientific explorations......
            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


            • #7
              It's obvious to me that Travell promoted method, not premise.

              No wonder her enduring popularity.

              Method first and foremost is the subject of today's blog post.

              Quintner has pointed out the flaws in her thinking, what there was of it. I don't wonder why so many oppose him.
              Barrett L. Dorko

              Comment


              • #8
                Originally posted by Alice Sanvito View Post
                I just had an "aha!" moment reading this.

                I just had this mental flash: what would it be like if everyone woke up tomorrow morning and they had all totally forgotten any concept of trigger points and were starting from scratch, without any preconceived ideas about what was causing pain?

                Yes...
                Alas, I'm sure that logical positivism regarding trigger point conceptual hallucination is just the tip of the iceberg though.
                I think even more than it's a thinking rut, it might be a personality type.
                I think it underpins all operator treatment models, especially the classic joint-based ortho ones.
                Lots of surgical procedures too.
                Only recently did a surgeon who performed knee arthroscopies for a living decide to objectively study the procedure, and realized, to his horror maybe, that his results were no better than placebo.
                I think logical positivism is the foundation of most if not all human primate social grooming professions. Heck, most professions that exist, period. Anybody need a plumber (to fix an actual object, e.g. a toilet)? A lawyer (to work through a legal issue, i.e., a reification/objectification of a human encounter)? A corporate lawyer (to work through an issue between two pretend people, i.e. "corporations")?

                Triggerpoints and the efforts to "study" them as a "thing" are just the lowhanging fruit of logical positivism, easy to shoot at. They are attached, though, to an entire tree, filled with fruit that is harder to see and shoot, housing lots of crazy birds, and which has a vast root system that is thoroughly emergent from human capacity to speak in language, i.e., entrenched symbolism.

                It seems humans can't do anything without objectifying it first, pretending that unicorns are horses (real).
                I do not know what can be done with human conceptual foible. But trying to conduct science from that standpoint does seem like a major fool's errand.
                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


                • #9
                  Only recently did a surgeon who performed knee arthroscopies for a living decide to objectively study the procedure, and realized, to his horror maybe, that his results were no better than placebo.
                  Yes, a scary discovery in and of itself but more frightening, what more is there like this? Fascinating to think about if one is willing to think about it. Most seem not to want to, have knee-jerk reactions. Too much work, too threatening. I have no idea what to think of some of this, but I'm content to wait and see and not jump to any conclusions.

                  Comment


                  • #10
                    http://www.sciencedirect.com/science...40673600712293

                    FIBROSITIS.
                    BY E. B. CLAYTON, M.B. CAMB., DIRECTOR OF THE DEPARTMENT OF PHYSIOTHERAPY, KING’S COLLEGE HOSPITAL; ° AND J. L. LIVINGSTONE, M.D., M.R.C.P. LoND.., JUNIOR PHYSICIAN TO THE HOSPITAL.

                    FIBROSITIS is an inflammation of the fibrous sheath and supporting structure of muscles and nerves, the ligaments of joints, fasciae, and tendons. Thickenings have been removed and examined microscopically by Stockman. Essentially it is the white fibrous tissue that shows change. At first there is a sero-fibrinous exudate without much cellular reaction ; no organisms have been demonstrated on culture. Later, the oedema is absorbed and there is fibroblastic proliferation ; the veins and arteries show much endarteritis and nerve fibrils show thickening of their sheaths. The condition goes on to the formation of a small area of dense white fibrous tissue and the surrounding vessels are thickened.
                    Similar lesions are produced by injecting various organisms intravenously into animals, and it is more than possible that the lesions in man are produced. by circulating organisms becoming arrested in capillaries where the circulation is poor. Recent investigations show that bacterisemia (e.g., B. coli orstaphylococci) may occur without definite illness. There is no specific cause, and the various aetiological factors are as follows.

                    1. Focal; Clinicians are well aware that acute fibrositis may follow acute tonsillitis, sinusitis,. tooth abscess, colitis, prostatitis, influenza, and similar infective conditions ; it is also well known that a certain proportion of cases recover permanently when a septic focus is suitably treated.

                    2. Trauma and strain are common antecedents of fibrositis ; rupture of capillaries and muscle-fibres is followed by exudation and fibrosis. Many different forms of injury can either cause or light up quiescent. fibrositis ; a slight muscle strain in a person subject to fibrositis may cause an acute attack. A girl practising back-hand top-spin strokes at tennis frequently missed the ball; she developed a painful thickening in the supinator brevis muscle. The. so-called " tennis elbow " has a tender spot over the origin of the extensor muscles of the wrist and fingers from the external condyle of the humerus. Many of these cases are due to fibrositis. But the same spot may become painful and tender from lifting heavy weights such as a full watering-can when gardening.
                    Acute fibrositis can develop in the scar formed by the healing of a muscle or ligament which has been torn. This explains some of the cases of persistent pain after an injury to the back muscles or to a joint. A fracture is occasionally the cause of fibrositis. Painful thickenings may develop round the shoulder joint, in the palmar fascia, and on a flexor tendon of a finger after a Colles’ fracture. Again, certain patients develop stiff joints after a fracture while others do not. Sometimes every joint in the limb is stiff though the fracture is through the shaft of the bone and the anatomical result is good. Full movements may not be recovered for several months and sometimes there is permanent limitation of movement, especially in the finger-joints, which become contracted. In many of these cases there is no sign of arthritis, and no effusion. It seems that there is probably fibrositis of the ligaments of the joints. This may be due to poor circulation in the arm in a patient with a septic focus, the poor circulation being caused by the injury and the lack of movement of the limb from the use of a splint.
                    Fibrositis was the previous term for 'fibromyalgia'. The publication date was 28.06.30 before antibiotics were much available. In those days 'fibrous bands' rather than trigger points were of interest. Clayton wrote the first edition of the electrotherapy book I used as a student.

                    Some of this resonates more with me than present day ideas about trigger points.
                    Last edited by Jo Bowyer; 26-05-2015, 06:30 PM. Reason: punctuation
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • #11
                      Funny cartoon Diane. Here is what transpired today in my office:

                      I printed the cartoon fo rmy own amusement. I mistakenly left it on my desk and a colleague stumbled accross it. Conversation went like this:

                      Colleague: Is that cartoon suppossed to be funny?

                      Me: Yes.

                      Colleague: How?

                      Me: Well...it's funny because in the bottom portion of the cartoon, the person is anable to show the baseball to prove it and get's angry instead. Kind of like how people who subscribe to the trigger point treatment philosphy react.

                      Colleague: I still don't get it. Do you want me to show you a trigger point? They are so easy to find. Have you read Travell's book for example?

                      Me: Uhmmm....are you aware that their work is essentially....oh...never mind.....I've got a patient....

                      Comment


                      • #12
                        I totally know what you mean.
                        The profession is FULL of logical positivists.
                        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


                        • #13
                          Ces deux gars vraiment mignon, je l'aime.

                          étui Samsung galaxy s6 edge

                          http://www.accesamsung.com/product-c...naturel-2.html
                          Last edited by Doraexo; 12-06-2015, 09:17 AM.

                          Comment


                          • #14
                            Hi Doraexo,
                            Would you please introduce yourself in the welcome forum?
                            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

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