Announcement

Collapse
No announcement yet.

Evidence based PT a crisis in movement

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • #46
    Evan,

    Not sure what you're getting at. You asked for an example and I provided a very recent and real example.
    As far as definining "pain science," I'm not sure I have a good one. I'm not even sure that's the correct phrase to use. Dichotomizing the study of pain and terming it "pain science" and separating that from the scientfic process may be a fool's errand. Diane's reference and link to Joe's post is a good one and I'd tend to agree with him. Pain is such a complex, fascinating inter-play of nearly infinite combinations of factors past, present, and future that cannot simply be limited to "BPS." Anyway, that's why I come here; to learn. I'd be interested in other's thoughts.
    Always learning.

    Comment


    • #47
      Patient didn't have any c/o neck pain. His pain was thoracic and lumbar after ejection and purely lumbar during the course of recovery.
      So, a guy comes into the ER w/ complaints of trunk and low back pain after getting ejected from a vehicle, and his thoracic and lumbar spine aren't imaged? I'm incredulous. Now that's a gross failure on the part of the ER physician. That history alone would have stopped my examination cold, and I would've told the patient to come back after he had a full series of spinal films. No need to even do detailed subjective interview or assess psychosocial factors.
      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


      • #48
        Usually it's women's complaints of pain that are ignored..
        Anyway, the other side of the issue is that imaging itself can also be iatrogenically noceboic.
        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


        • #49
          Diane,
          If someone arrives in the ED with a primary complaint of spinal pain after being ejected from a vehicle at moderate speed, radiographs of the region should be performed to clear the very thing that was found nearly 6 weeks later. I would not be concerned about nocebo in this context.
          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


          • #50
            I agree.
            In fact, I recall a guy I treated soon after graduating. He had been thrown from a car, had neck pain. No one believed him when he said his neck hurt and his arms felt weak. He had been drinking, which back in the day, lowered peoples' credibility, it seems. Anyway, he was admitted, but no one stabilized his neck or even xrayed him until he couldn't lift his arms at all. He had become a quadriplegic while under medical care. The alcohol interfered with the natural spasm factor which might have kept his neck more stable. Or maybe it wouldn't have..

            I recall another guy (one I didn't treat, heard a story about him from his friend), a mountain climber. He fell and knew he had broken his neck. He was stable though. Very fit. He walked for two days, even crossing a river as I recall, to reach a hospital. He walked in, said, I fell and broke my neck - could you xray me please? They kinda laughed, but did do an xray, then sent him home. He wasn't home very long when the phone rang and it was the hospital, saying, um, could you please return ASAP? You have a cervical spinal fracture. He had surgery, went on a frame for 6 weeks.

            Things do go amiss in health care.

            On the other hand we have people having the most invasive kinds of surgery for pain that has lasted months and years. Then they still have pain afterward.
            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


            • #51
              Sheld, I just I don’t understand how you concluded that the student dismissed pathology in the name of “pain science”.

              I asked Roger Kerry for his definition, I think my comment awaits for moderation.
              -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
              The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

              Comment


              • #52
                I am surprised, proud, that you are so opposed to the posting.

                I grant you that I too am a bit confused re: Dr Lee - but the talk that is linked (which I have not listened to) seems to be applicable as it relates to EBP, not the TRingApproach. And who is to say that his remarks re: complicated systems is not a dig directly at her approach? Maybe they have serious debates over the validity of her approach over drinks? I don't know, and I don't intend to read too much into it.

                And sure, there is a pain-science straw-man, but I found a HUGE portion of his posting (overall) to be a nice rant, a rant against a bunch of BS that he sees, reads about or fears in clinics, twitter, his classrooms (prof and ContEd, I believe), etc.

                This is better than 99% of the stuff out there, IMO.

                Respectfully,
                Keith
                Blog: Keith's Korner
                Twitter: @18mmPT

                Comment


                • #53
                  Keith,
                  I think Kerry's association with LJ Lee in this context damages his credibility, particularly when he's going around preaching to people about dumping complicated classification schemes.

                  Evan,
                  It's one thing to speak at the same conference as someone who holds a view that is anathema to your position and entirely something else to collaborate with that person on an EBP presentation at one of the most prominent international conferences attended by PTs in the world.

                  At the very least it's politically tin-eared.

                  I'm less interested in what he has to say.
                  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


                  • #54
                    John, I agree that there are differences in the above scenarios, but I think that there is still room for disagreement to also take place in the second scenario, especially when it comes to “inventing complex and unnecessary classification and diagnostic systems.” Perhaps his definition of "complex and unnecessary" is different than mine or yours. Or perhaps his recent blog post represents his current view of things which is not necessarily the same as before. Who knows.
                    -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                    The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                    Comment


                    • #55
                      Originally posted by keithp View Post
                      I am surprised, proud, that you are so opposed to the posting.

                      I grant you that I too am a bit confused re: Dr Lee - but the talk that is linked (which I have not listened to) seems to be applicable as it relates to EBP, not the TRingApproach. And who is to say that his remarks re: complicated systems is not a dig directly at her approach? Maybe they have serious debates over the validity of her approach over drinks? I don't know, and I don't intend to read too much into it.

                      And sure, there is a pain-science straw-man, but I found a HUGE portion of his posting (overall) to be a nice rant, a rant against a bunch of BS that he sees, reads about or fears in clinics, twitter, his classrooms (prof and ContEd, I believe), etc.

                      This is better than 99% of the stuff out there, IMO.

                      Respectfully,
                      Keith
                      Keith,

                      It wasn't so much that I didn't like it, but rather I didn't find it overly profound or provided anything particularily thought provoking...at least for me.

                      Plus (and this is the biggy), I felt he missed the mark completely by associating pain science with guruism. As Joe Brence stated...pain science is science.

                      He made it appear that those that apply science to practice somehow become less competent as clinicians and diagnosticians.

                      I thought he was way off the mark there.

                      And then throw in the ring folks and my eyebrows raised further.

                      Indeed, he is likely a great fellow, smart and has a better grasp than most...but I just found the piece a bit fluffy. That's all.

                      Comment


                      • #56
                        Originally posted by proud View Post
                        Plus (and this is the biggy), I felt he missed the mark completely by associating pain science with guruism.
                        Perhaps he has the same take on it as I do. There is nothing I could object to in what they publish, it's the behaviour on the platform, which is neither clever or amusing. Prof Kerry is both.
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • #57
                          Proud,

                          I tend to agree with you and John . I felt there is a prevalant attitude by some people that pain science = psychology and distress and the avoidance of actually assessing people 'physically' ...
                          Perhaps in some cases its a dig at the popularisation by some Australian researchers in particular --a move to emphasise central sensitisation over 'peripheral pathology perhaps.
                          Louis Gifford who probably started the whole physiotherapy knowledge base and integration of pain science into practice was truly integrated --recognising and describing inflammatory , oncology and other red flag issue but putting them into context. Its this contextural unawareness ,partiularly in mainstream practice and education that is the problem ...emphasising the 'thoracic ring' in manual therapy rather being skilled to be able to emphasise fearless movement in meaningful contexts for example.... Simple therapy approaches with more complex understanding of pain and disability is the way to go ...Brief interactions with a good knoledge base is the way to go ...employing complex but often delusional manual therapy reasoning leads to many more 'treatment' sessions, big waiting lists and more likelyhood of prolonged suffering. I did agree with much of Kerry's article however --the need for simplicity , integration of the humanities into educatiion and practice , becoming more humane and humane etc etc ...However , the links ANdy provided were eyebrow raising and you cant have your cake and eat it but maybe you can !?

                          Comment


                          • #58
                            you cant have your cake and eat it but maybe you can !?
                            Many here seem to think that Eyal Lederman is OK marketing the material he does.
                            Jo Bowyer
                            Chartered Physiotherapist Registered Osteopath.
                            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                            Comment


                            • #59
                              point taken Jo ...

                              I think that Eyals writing and the approaches he takes are excellent but I dont agree with some of the other course running alongside this ..however this is what pays and all these courses fill up (the more integated ones not so much) ........I can't comment thats what seems to pay the bills ?
                              Like you I stay out of it all and I know your ethics are strong in the direction you want to practice --as a result you probably earn a great deal less than you could .........?

                              Comment


                              • #60
                                I agree that there are differences in the above scenarios, but I think that there is still room for disagreement to also take place in the second scenario, especially when it comes to “inventing complex and unnecessary classification and diagnostic systems.” Perhaps his definition of "complex and unnecessary" is different than mine or yours. Or perhaps his recent blog post represents his current view of things which is not necessarily the same as before. Who knows.
                                Evan,
                                Differences might be that Lee is Canadian and Kerry is British, or that Lee likes to have a blue background on her slides and Kerry prefers gray. I'm not talking about "differences", I'm talking about inconsistencies and apparent hypocrisy. I think we all agree that the thoracic ring stuff is a bunch of malarkey.

                                If in fact he has changed his mind recently, and this more recent piece is his attempt at a sort of "mea culpa", well then he should've acknowledged that he was taken in by the bright lights and big city of mesodoom. He didn't do that. He scolded the profession and directed us to change our behavior. Well, what about you, Roger?

                                He should lead by example. If he thinks he screwed up by hitching his wagon to the thoracic ring star, then he should have owned it.

                                Perhaps he has the same take on it as I do. There is nothing I could object to in what they publish, it's the behaviour on the platform, which is neither clever or amusing
                                Jo, who are "they" that you're referring to? I think both David Butler and Lorimer Moseley are both clever and amusing in their public presentations, but in very different ways. So is Adriaan Louw, but also in a different way but with a South African instead of Oz accent. I don't think it's helpful or fair to make broad brush criticisms like Kerry does in this piece. Kerry's statement, "We no longer need ‘institutes’ and ‘organisations’ of pain science" is entirely unuseful in its generality. What is he referring to? The IASP, The Canadian Physiotherapy Association's Pain Science Division? The Orthopedic Section's Pain SIG? Adriaan's group has called itself the "International Spine and Pain Institute" for at least 10 years. Should he re-name his organization because Roger Kerry says we no longer need institutes and organizations of pain science?

                                I'm not a big fan of the term "institute"- it has a faintly sterile, pompous ring to it, in my opinion. Several of the OMPT fellowship programs in North America refer to themselves as "institutes". Maybe that's why Adriaan named his organization what he did in order to compete with the OMPT programs. I don't know.

                                For someone who seems so tin-eared when it comes to politics, Kerry certainly seems to have no trouble exploiting a political position to increase his profile while at the same time criticizing others for doing the same thing. Neither clever or amusing in my opinion.
                                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

                                Working...
                                X