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Old 14-03-2017, 04:28 PM   #1
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Default Top 5 most influential

Alright everyone. Who are your top 5 most influential people that are driving things away from the bio-patho-anatomical model our profession has been stuck in?

I'm not necessarily talking about people who produce good stuff...but folks who are willing to lay it out there. Mine:

1) Neil O'Connell

2) Peter O'sullivan

3) Lorimer Moseley

4) Adam Meakins

5) The crew at Soma Simple
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Old 14-03-2017, 04:44 PM   #2
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1. Lorimer Moseley
2. David Butler
3. Michael Shacklock
4. Neil Pearson
5. Barrett Dorko
6. Diane Jacobs
7. Jason Silvernail

aha! I cheated and put 7 instead of 5!
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Old 14-03-2017, 04:57 PM   #3
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Quote:
Originally Posted by gilbert View Post
1. Lorimer Moseley
2. David Butler
3. Michael Shacklock
4. Neil Pearson
5. Barrett Dorko
6. Diane Jacobs
7. Jason Silvernail

aha! I cheated and put 7 instead of 5!
Good ones.

Do you think David Butler is willing to "lay it out there"?
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Old 14-03-2017, 05:12 PM   #4
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Butler wears crazy shirts and I wear a tie.

He's also funnier.

"Laying it out there" is an interesting perspective. I've embraced my place as a curmudgeon and admitted I'm a cynic. I'm also from Ohio, so don't have much of an accent. Not much I can do about that.
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Old 14-03-2017, 05:54 PM   #5
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Quote:
Originally Posted by Barrett Dorko View Post
Butler wears crazy shirts and I wear a tie.

He's also funnier.

"Laying it out there" is an interesting perspective. I've embraced my place as a curmudgeon and admitted I'm a cynic. I'm also from Ohio, so don't have much of an accent. Not much I can do about that.
By "interesting perspective" I wonder what that means Barrett?

"Laying it out there" to my mind means not being afraid to ruffle feathers a bit.

Butler is smart as a whip and people like and appreciate his courses for sure.

But I get the distinct sense that they attend his course...find him entertaining...and then go about trying to find a way to square peg/round hole their pet treatments AROUND what he taught.
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Old 14-03-2017, 06:12 PM   #6
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I think that Butler was promoting a BPS/pain science approach long before it was as 'acceptable' as now (notice I didn't say 'popular'). So yes, I think he knows how to ruffle feathers a bit.
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Old 14-03-2017, 07:39 PM   #7
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Well, David Butler did ask his PT colleagues this provocative question:
Quote:
Are you ignoring the brain on purpose?
So, it's apparent to me that he's not averse to ruffling feathers.

On the other hand, stylistically, he's got a distinctive way of spreading the BPS approach to care. He's developed a penchant for learning/education theory, and this seems to have a a strong influence on how provocative he chooses to be with PTs. The theory he seems to espouse can be summed up by the dictum: "repetitio est mater studiorum" or "repetition is the mother of learning."

Since hearing that quoted by Father Don Murphy at Rockhurst College in my freshman theology course, I've often wondered Who or what is the "father of learning?" After giving this much thought and listening to Barrett for the last 13 years or so, I've concluded that he's a cynical, tie-wearing curmudgeon from Ohio.
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Old 14-03-2017, 08:31 PM   #8
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John,

True, I like learning a lot. Maybe that's why I watch so much TV.

It's also why I never work in the yard or drive without something to listen to.

It seems to be why I didn't like small talk, or get invited to parties.

Uh-oh.
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Old 14-03-2017, 09:09 PM   #9
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Quote:
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John,

True, I like learning a lot.
Boy did you ever choose the wrong profession then.

It's potentially the only profession I can think of where learning/understanding is directly related to a steady loss of income.
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Old 14-03-2017, 09:13 PM   #10
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Let's face it, Barrett, you wouldn't be caught dead in a pastel-colored tie, much less pants. There's a certain femininity to Butler's approach, which is fine- indispensable even, and it's reflected in his presentation. There's a calm, nurturing, non-threatening patience to that method, which many are attracted to.

I'm not so much- at least not in the context of practicing physical therapy. I would liken the profession to being a bit of a spoiled adolescent, whom mom has ineffectually tried to cajole and negotiate with in an attempt to convey the errors of its ways. That hasn't quite sunk in, now, has it?

Some might think this means being loud, intimidating and blustery. For those who think that's what I mean, then watch Greg Lehman interact with his sweet little daughters as only a father can.

PT needs a little less Yin and decidedly more Yang.
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Old 14-03-2017, 09:16 PM   #11
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proud,

Hey, I thought I was the most cynical person here. As I've said, understanding, learning about stuff and asking questions will get you punched. I'm lucky because of my size and apparent toughness. The tie has always helped too.

I can't remember telling anybody at work that I was in the marching band. Please don't tell anyone.
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Old 15-03-2017, 12:31 AM   #12
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Quote:
Originally Posted by proud View Post

5) The crew at Soma Simple
Sweet! I made the list!

Erik Meira
Neil O'Connell.
John Quintner
Edzard Ernst
Harriet Hall and the SBM crew
Ian Harris (doctor skeptic)
Norton Hadler

These are some in your face types....I like that....
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Old 15-03-2017, 12:52 AM   #13
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And Mark Rippetoe...

start at 6 minutes...ouch!

https://www.youtube.com/watch?v=nueZnMtp37s
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Old 15-03-2017, 01:21 AM   #14
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Quote:
Originally Posted by Johnny_Nada View Post
And Mark Rippetoe...

start at 6 minutes...ouch!

https://www.youtube.com/watch?v=nueZnMtp37s
Except he seems to replace one bunch of horse $$$ for his own bunch...

I have a problem with that.

On a blog someone asked him about chronic back pain and this is his response:

Quote:
sympathize, because I have had similar back pain over the past 20 years. The thing that has made the most difference for me is that about 4 years ago I began diligently stretching my hamstrings every time I train. I have used back extensions, reverse hypers, and deadlifts all successfully to rehab this problem, but since I have been stretching my hamstrings I can get my back in the correct position to lift with much greater reliability, and have had FAR less trouble than I used to have with my back. Hip flexors are NOT the trouble -- if your hamstrings are tight you cannot get into proper lumbar extension. Give it a try, and you'll know in a couple of weeks.
Uh...

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Old 15-03-2017, 01:28 AM   #15
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Plus he seems to think strength and pain relate:

https://pjmedia.com/lifestyle/2016/1...ck-strength/2/
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Old 15-03-2017, 01:46 AM   #16
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I know he's full of his own doctrine/dogma. But at least he does say some things that should make PT's think about what they do.
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Old 15-03-2017, 02:08 AM   #17
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Johnny,

That's anecdote. It doesn't count as a rational defense.
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Old 15-03-2017, 02:16 AM   #18
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Barrett,

I agree, but Rip isn't trying to defend himself on rehab. The original post was about people willing to lay it out there. Rip does that, and doesn't pull punches. At least folks from his team are moving in the right direction...

http://startingstrength.com/article/...ches-and-pains
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Old 15-03-2017, 02:23 AM   #19
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He's influential sure. That doesn't make him right.
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Old 15-03-2017, 02:37 AM   #20
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Quote:
Originally Posted by Johnny_Nada View Post
Barrett,

I agree, but Rip isn't trying to defend himself on rehab. The original post was about people willing to lay it out there. Rip does that, and doesn't pull punches. At least folks from his team are moving in the right direction...

http://startingstrength.com/article/...ches-and-pains

Yep. He lays it out there for sure.

But I'm talking about influential (defensibly and positively) as well.

This guy just seems to say things for the sake of saying something....and comes off uneducated in the process.

Tonnes of those around and I discount them rapidly.
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Old 15-03-2017, 02:40 AM   #21
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Quote:
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Barrett,

I agree, but Rip isn't trying to defend himself on rehab. The original post was about people willing to lay it out there. Rip does that, and doesn't pull punches. At least folks from his team are moving in the right direction...

http://startingstrength.com/article/...ches-and-pains
Johnny,

That is a good article. But does not appear written by Rippetoe?
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Old 15-03-2017, 03:25 AM   #22
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Proud,

"From his team." Austin baraki is part of the starting strength group. He's a physician.
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Old 15-03-2017, 10:46 AM   #23
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From an exercise, nutrition perspective:

Brad Schoenfeld
Bret Contreras
Chris Beardsley
Greg Nuckols
Anoop Balachandran
Dan John
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Old 17-03-2017, 03:28 PM   #24
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My list

1. Somasimplers
2. Louis Gifford
3. Bronnie Thompson
4. Lorimer Mosely
5. John Quintner
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Old 18-03-2017, 02:02 PM   #25
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1. Barrett Dorko
2. David Butler
3. Lorimer Moseley
4. Jules Rothstein
5. Nortin Hadler
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Old 18-03-2017, 07:55 PM   #26
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Interesting to see everyone's list.

I am a bit perplexed by the choice of Butler...even though I would never deny his contributions.

The thing for me is this: Butler has been around now for 15 years (I recall taking a course of his that was "full").

His influence could have been great.

Yet here we are....15 years latter and seemingly worse off that we were before. And if you think that's exaggerated....reflect on the explosion of TDN, FMA screening and manipulation.

I just think somehow Butler has avoided ruffling feather in a manner that I think quite frankly needs to happen.
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Old 19-03-2017, 04:37 PM   #27
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proud,

Well, "Ruffling feathers" is problematic. Butler has done a remarkable thing by writing a few books and getting his doctorate. He has filled his courses, and that's no small thing. He's been beaten by TDN, manipulation and FMA no doubt, but I'm bigger and stronger. I understand that's genetic, but it's something. I'm also older. He's also referred to me as a "relic," but I wrote that this was a cultural thing. Neither of us anticipated the loss of science or reasoning, but David doesn't write of this much, if at all. I write of this sort of thing all the time.

David didn't grow up in the midst of American football either. He grew up where the Koala Bear is the national symbol (rim shot!).

I write of power a lot. For one thing, David has had to endure a lot of time on a plane, while I grew up in "The greatest location in the nation" (Cleveland) and I've flown from there. So there's that.

I used to joke that I was only several years ahead of Butler "because I read Breig's book before he did," but he never embraced ideomotion or neural tension. He wrote when Wall died, and I've only written of him. We differ, but each has added their bit to understanding pain in their way.
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Old 19-03-2017, 06:08 PM   #28
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proud,

Well, "Ruffling feathers" is problematic. Butler has done a remarkable thing by writing a few books and getting his doctorate. He has filled his courses, and that's no small thing. He's been beaten by TDN, manipulation and FMA no doubt, but I'm bigger and stronger. I understand that's genetic, but it's something. I'm also older. He's also referred to me as a "relic," but I wrote that this was a cultural thing. Neither of us anticipated the loss of science or reasoning, but David doesn't write of this much, if at all. I write of this sort of thing all the time.

David didn't grow up in the midst of American football either. He grew up where the Koala Bear is the national symbol (rim shot!).

I write of power a lot. For one thing, David has had to endure a lot of time on a plane, while I grew up in "The greatest location in the nation" (Cleveland) and I've flown from there. So there's that.

I used to joke that I was only several years ahead of Butler "because I read Breig's book before he did," but he never embraced ideomotion or neural tension. He wrote when Wall died, and I've only written of him. We differ, but each has added their bit to understanding pain in their way.
I suppose I prefer the directness of yourself and folks like Adam Meakins.

The treatment of painful conditions is so wrought with anti-science that those who have made the effort to expose the under-belly....I think have an obligation to call bullshit.

I do not believe I have ever heard or read Butler swear.

He's either got great control or he's comfortable watching this mess continue to unfold despite his massive contributions.

MY opinion.
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Old 19-03-2017, 06:31 PM   #29
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John W,

Thanks for mentioning Jules Rothstein. He was before my time. I've been reading some of his writings lately. They are quite enjoyable. I think he would have liked this place. i also think the current direction of PT would have given him much to write about....
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Old 19-03-2017, 06:34 PM   #30
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proud,

He's called it "ultra-bullshit" in the past, and I remember thinking "he won't get away with that." I didn't swear during lecture time but I did say "hell" several times. I heard about that.

When I wasn't lecturing, I chose my words from my own emotion, I guess.

In my experience, Butler has done a remarkable thing. He was a great running back, but he didn't run around a much larger defensive lineman in some cases - if you get my reference.

Of course, I actually wrote him in 1990 and he allowed me to attend his course in Chicago for free a few years later.
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Old 19-03-2017, 08:41 PM   #31
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proud,

He's called it "ultra-bullshit" in the past, and I remember thinking "he won't get away with that." I didn't swear during lecture time but I did say "hell" several times. I heard about that.

When I wasn't lecturing, I chose my words from my own emotion, I guess.

In my experience, Butler has done a remarkable thing. He was a great running back, but he didn't run around a much larger defensive lineman in some cases - if you get my reference.

Of course, I actually wrote him in 1990 and he allowed me to attend his course in Chicago for free a few years later.
If I get the reference...how about posting on say.....a site like EIM and asking them about their alliance with Kintecore....

That's what I am talking about.
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Old 19-03-2017, 09:36 PM   #32
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proud,
I'm telling you that Butler has become a theoretician on learning theory, and that's where I think he's run aground as far as advancing clinical practice in PT. This doesn't diminish his contributions in advancing the concept of the abnormal neurodynamic. These are very important.

I'm disappointed, but not all that surprised, that he's joined the crowd in taking what I suppose those in academic circles would consider the more "respectable" and "polite" approach to changing the way PTs approach the patient with a primary complaint of pain. This desire to win the "Miss Congeniality" prize among PT academics makes me vomit a little in my mouth when I witness it. I still feel some faint nausea when I think back on the time I spent there. There's a profound lack of intellectual courage in PT academia, with a precious few exceptions.

I find Adam Meakins refreshing in a "guys bullshitting in the locker room" sort of way. But, it may be that he's over-compensating just a bit, at times. He's, in a sense, the anti-Butler.
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Old 19-03-2017, 09:52 PM   #33
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And, Barrett, Aussie PTs over the age of 50 who wear green pants are allowed to utter "bullshit" in public approximately six times per year, but only one of those can be at an international conferance.

Jules Rothstein didn't need to use profanity. He was that good.

You're welcome, Johnny.
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Old 20-03-2017, 01:15 AM   #34
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proud,

All that can be said, by me anyway, I've said. I've asked and even acted nice. Against my better self (whatever that once was), I've been utterly defeated. Finding people who were unused to thinking, reasoning, reading and arguing has been fairly easy, no matter how well educated.

Firms like the one mentioned invented a condition and came up with a way of treating it.

It's over, as far as I'm concerned.
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Old 20-03-2017, 01:30 AM   #35
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Well perhaps I'm delusional but I believe if we had a few more "curmudgeons" rather than the typical kumbaya approach...we may see some changes.

I recently engaged Adriane Louw over at EIM and was somewhat astounded (in a negative way) by what he had to say. Despite my desire to just tell him I thought he was way off (he was at least from my vantage point)...I was intimidated by his academic profile and chose to dis-engage at his apparent behest (he apparently is too busy with research to engage in blogs and "would not be returning"...)

That's a problem going forward I'd say.

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Old 20-03-2017, 04:12 PM   #36
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The longer I practice I have come to observe that there are those interested in health business and those interested in health care. Those running health businesses would like to have a bunch of robots that don't think or question, and stick to the unit generating treatments of the day. Numbers up, processes "work" = success to some. Those in health care, often think, read, reflect to improve their patients' care. This often flies in the face of health business so the road gets tougher and tougher. Most get beat into submission and give up questioning and conform and our patients get worse. I think this "business" flows over into academia as well and contributes to some of this.
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Old 20-03-2017, 07:05 PM   #37
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Proud,

I read Adriaan's responses.

I don't really know what to say, other than that I am disappointed.
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Old 20-03-2017, 08:12 PM   #38
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Quote:
Originally Posted by Mikal Solstad View Post
Proud,

I read Adriaan's responses.

I don't really know what to say, other than that I am disappointed.
Yes, I was really quite flabbergasted by some of his responses. It almost seemed like he lacked any insight whatsoever.

Like his comment about a work-out that "hurts so good"...as if that somehow is comparable to a persistent pain scenario.

Honestly, I expected more from someone of such esteem.

Edit: Having stated the above, I am aware that social media is not everyone's "gig" and I think Adriaan is on the older side so perhaps his comfort level with that sort of engagement rendered his points less effective than had we been sitting side by side. I just have to imagine his knowledge base is far better than what was conveyed over at EIM.

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Old 20-03-2017, 08:23 PM   #39
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Boy, that response from Adriaan at the EIM blog was downright petulant. Very disappointing to see him resort to that kind of condescension. I hope all the appearances at international conferences and cocktail parties with the intelligentsia aren't going to his head.
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Old 21-03-2017, 01:09 AM   #40
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As the other poster on that thread questioning and being critical of dry needling I was almost offended by the way Adriaan played the "ivory tower" card. Good to know what he thinks of clinicians.
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Old 21-03-2017, 01:07 PM   #41
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proud, Adriaan is younger than I am. And thus younger than Barrett (rim shot).
I thoroughly enjoyed talking with Adriaan about NTE and the research on that - gained some very valuable information.

I did not like the inclusion of the suggestion "do whatever works" - which seems to be the basis for his rather lazy response to you in that comment thread. Very disappointed as well.
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Old 21-03-2017, 02:06 PM   #42
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When I first saw Adriaan's picture I was guessing he wouldn't please everybody. Of course, I've been wrong before. As long as I predict things, this will occasionally happen.

I think that doing whatever works is remarkably powerful. It doesn't make any sense, but that makes it no less powerful.

To use a sports analogy, just because a player (that values a certain size) doesn't play well, that makes them no less the weight or height they were born to have. This is where conditioning and training have a role. The combination of nature and nurture reveals itself in sport. Adriaan Lowe probably shouldn't have revealed himself so clearly.

Never have made such a mistake, I really can't relate.
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Old 21-03-2017, 02:53 PM   #43
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A similar kind of thing happened at a CSM conference a few years back in Chicago. Kathleen Sluka, a renowned pain researcher here in the US, did a presentation that included video of a clinical interaction with a patient who had persistent low back pain. The only thing I can remember from that presentation was her instructions to the patient. She asked this poor woman, who was obviously in some discomfort and anxious, to "bend over as far you can" and after she did, she then asked her if she could bend over any farther. This is when Cory Blickenstaff and I looked at each other in dismay. How could a therapist who is so knowledgeable about pain ask someone who is obviously in pain to perform a movement that is sure to increase their pain? Where is the disconnect?

To be clear, I don't think Adriaan would have given the same verbal commands to this patient as part of his clinical reasoning process. But his willingness to do "whatever works", even if it increases pain- or a produces the proverbial "good hurt"- is hardly distinguishable from what Dr. Sluka did. Is it not?

Whatever it is, it's not therapy.
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Old 21-03-2017, 04:03 PM   #44
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If you give researchers a task to "prove" with a financial incentive to "prove" it, you end up with biased researchers. Another pitfall, in my opinion, is trying to prove an intervention's efficacy AFTER claiming it's effectiveness. This leads researchers on a hunt for why it "works" and inevitably you end up back at the non-specific neurophysiologic processes that occur with all interventions. Then they move the goalposts and claim said intervention "works" like all others, it's safe (nobody died yet), so just pay us to teach you and start using it!

I wish they started by proving trigger points exist, cause pain, consistently show up in response to specific environments, needles consistently and exclusively modify the environment proven to cause trigger points, etc etc....

The primary questions should be: Is this a necessary intervention? Do other less invasive similar interventions exist? Does this promote dependency or self-efficacy?

If you answer those questions honestly, you can't subscribe to the TDN intervention.

Patient expectations shouldn't be the get out of jail card either. This frustrates me. If a patient demands DN, I would expect any PT to be able to explain the literature shows ischemic compression is equally as effective and safer. Or when a pt want their neck cracked, we should be able to explain gentle mobilizations are equally as effective and don't carry risks like stroke and death.

If I remember correctly, I believe a review of manual therapy interventions for LBP tried to quantify the gain attributable to the specific effects of the intervention, and came up with 3%. So lets quit spending time and money on the 3% and start actually helping people.
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Old 21-03-2017, 05:32 PM   #45
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Quote:
the literature shows ischemic compression is equally as effective
Isn't that weird, because the pro MTP people hypothesize that TP's are caused by hypoxia/ischaemia.

Another primary question could be: is it a low value service type of intervention (if yes, don't bother)
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Old 21-03-2017, 06:43 PM   #46
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Quote:
Originally Posted by John W View Post
A similar kind of thing happened at a CSM conference a few years back in Chicago. Kathleen Sluka, a renowned pain researcher here in the US, did a presentation that included video of a clinical interaction with a patient who had persistent low back pain. The only thing I can remember from that presentation was her instructions to the patient. She asked this poor woman, who was obviously in some discomfort and anxious, to "bend over as far you can" and after she did, she then asked her if she could bend over any farther. This is when Cory Blickenstaff and I looked at each other in dismay. How could a therapist who is so knowledgeable about pain ask someone who is obviously in pain to perform a movement that is sure to increase their pain? Where is the disconnect?

To be clear, I don't think Adriaan would have given the same verbal commands to this patient as part of his clinical reasoning process. But his willingness to do "whatever works", even if it increases pain- or a produces the proverbial "good hurt"- is hardly distinguishable from what Dr. Sluka did. Is it not?

Whatever it is, it's not therapy.
She has obviously never watched Peter O'Sullivan in action.
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Old 21-03-2017, 07:59 PM   #47
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I'd like to see this notion of the so-called "good hurt" get deconstructed. To start, isn't such a thing based on an assumption that patients always tell us the truth? Even if they did, since when did we become lie detectors?

Detection is vitally important to what we do, but discerning the truthfulness of what our patients report to us falls well outside our practice scope and, in my experience, is exhausting and fruitless.
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Old 21-03-2017, 08:55 PM   #48
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Quote:
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I'd like to see this notion of the so-called "good hurt" get deconstructed. To start, isn't such a thing based on an assumption that patients always tell us the truth? Even if they did, since when did we become lie detectors?

Detection is vitally important to what we do, but discerning the truthfulness of what our patients report to us falls well outside our practice scope and, in my experience, is exhausting and fruitless.
Yes this notion of "hurting so good" is yet another dumb dumb movement our profession has taken up.

Some (like seemingly over at EIM) kinda understand that it's just playing with pathways....yet somehow find a way to bend their own stunned treatments around it.

Others....just think the DNIC outcome was an actual appropriate treatment response (like eradicating the mythical trigger point for example)

Either way it displays a profound lack of insight in my estimation.
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Old 21-03-2017, 10:25 PM   #49
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I was surprised by Adriaan's response. Maybe the aggressive nature of debates on this site has desensitized me a bit, but I didn't think proud came off overly aggressive. Adriaan is a really smart guy too, I can't believe that he totally buys his own response. I wonder if he so strongly identifies with and/or is so invested in manual therapy and PT interventions that he has a hard time separating criticism of the interventions from criticism of himself.

The big question I have with regards to therapy is how to reconcile the need for promoting self-efficacy and patient empowerment with the cultural need to have something "done" to address a problem. The problem with discussions like the one on EIM is that it becomes clear that we, as a profession, are not ready to have that discussion. We spend far too much time trying to rationalize low value interventions rather than trying to develop a rational course of care.

A rational course of care could include manual therapy or some passive intervention of some sort, but we need to be willing to question those things and have discussions on them. Right now we suck at that.
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Old 22-03-2017, 01:16 AM   #50
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"It hurts good" tends to be confusing for a number of reasons. It reveals more about the person's knowledge trying to defend a method of "treatment" with this.

It's easily deconstructed.
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