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Re: Posture wars
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Re: Posture wars - October 18, 2003 9:39:00 AM
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PTupdate.com
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Joined: October 8, 2001
From: Pittsburgh, PA USA
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I tried very hard to get people within my own organization to attend a scheduled lecture by Barrett, but with no success. Barrett did kindly come to town and spend a morning talking with a group of us (only half of those who SAID they would come actually did), giving us a "sample platter" of what he does. I found it interesting and would like to learn more. He's obviously erudite and successful.
The Pittsburgh course was cancelled due to lack of participants, not an uncommon occurrence here in this town, where most of the PT's seem to know EVERYTHING.
We all have our own methods of treating, and I bet most of us are quite successful at what we do, compared to the average PT. I think we all skew our treatments in a manner that works, and is more appealing to us. Some people don't like ultrasound and don't even own a machine. I like it for some things, and even enjoy the one on one time with the patient. I feel they listen more and talk more during US than during a PT interview/evaluation. Kind of like a bartender! None of us should dismiss anothers practice skills and success based on what we know of them from this site. While someones treatment may not make sense to us, their successful outcomes may make tons of success to their community, physician base and payors.
I am VERY interested in what others do and how they do it, as I can always improve. My wife and I just had a PT over to the house today to provide massages (she does it on the side). She did some things that felt WONDERFUL, and I thought "so simple...why didn't I think of that?"
Barrett seems to have a business where he provides seminars and charges for them. That is fine, as it is his time, energy and expertise. If I was on the lecture circuit, I wouldn't give everything away, thus eliminating paying customers. However, I would like Barrett to provide some more appatizers!
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: Posture wars - October 18, 2003 12:27:00 PM
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coloradojulie
Posts: 413
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From: colorado usa
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I personally am not critcizing anyone...I am reacting however to being tossed into a group of lazy miss the point PTs because I am not willing to sort through philosophical/analogous essays. I suppose what I am offering Barrett is some constructive feedback regarding his teaching style, and expressing to him, as an educator that I personally and it seems like some here could use a different teaching approach. I am not asking for the entire weekend course, but as Duffy put it, an appetizer.
Some people need more personally relevant examples when learning and that is merely what I suggested. The best known PTs aren't reluctant to share something, because isn't it our goal in the end to further the profession as a whole? And isn't information sharing one way to that end?
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Re: Posture wars - October 18, 2003 8:45:00 PM
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Sam B
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This discussion is found elsewhere on this site, and I'd like to paste a very thorough reply from Nic Lucas, which I think is very relevant here.
--------------------------START-------------
"Firstly, who really believes in monocausality with regard to pain, especially spinal pain? If we make the hypothesis that posture is causally related to pain in some people, then we need to conduct prospective cohort studies of sufficient power to detect an association that is temporally related.
If we, as yet, have no valid way of determining those people in whom posture is clinically relevant, and those people in whom posture is not clinically relevant, then the results from any cohort study looking at causation between posture and pain will be diluted. Perhaps some people cope quite well with a scoliosis; perhaps others don’t? If both types are enrolled in a cohort study looking at the relationship between scoliosis and pain, yet are not recognized or sub-classified, then the results will be diluted.
Perhaps ‘poor’ posture is neither necessary nor sufficient, in and of itself, to produce spinal pain. This, however, is not proof that posture is not clinically relevant in some people.
There are many other variables that I presume have not been controlled for in cohort studies looking at backpacks and spinal pain. Please excuse me if the studies you refer to (but I haven’t seen) do control for these.
For example; in the studies that found a limited relationship between backpacks and spinal pain, did they also sub-classify the adolescents into groups according to the classification system proposed, and shown to be reliable by Sarhmann/Van Dillen, for example? Perhaps people who have a lumbar extension ‘give’ cope really well with backpacks, while those who have a flexion ‘give’ don’t, and are at higher risk of developing spinal pain? Note that I use the word 'risk' to correctly identify that the presence of a risk factor does not a pain make.
“You can’t rule out that which you haven’t considered” is a useful maxim in clinical epidemiology.
I agree with you that the general promotion and implementation of a standard recipe for backpacks and spinal pain is probably not supported by the literature. However, even without reading the research, I am dubious that it has unequivocally proven that posture does not have the potential to play a causal role in the development of spinal pain, and that it is not a worthwhile consideration in certain patients.
Are my suspicions accurate, or is the literature that compelling?
We could then talk about the aetiological time-frame. How long does a 'factor' have to be present for it to become a 'risk factor'? Have these studies looked at this also.
Perhaps we have two subjects enrolled in a cohort study. One is a girl who has had a slouched posture her whole life; has fallen off a horse and landed on her buttocks 11 times; is taller than average and has a tendency to have greater than normal flexion in her lumbar spine. She is now in highschool and has to carry a heavy backpack.
The other is of average height; has never had a fall onto the buttocks and has maintained reasonably good posture througout her life so far. She is also a dancer and has exercised regularly. Now she is also in highschool and has to carry a heavy backpack.
In this scenario, one subject has been exposed to the putative risk factor 'poor posture' for a greater period of time than the other. Further (since we don't really believe in monocausality) one has had potential spinal trauma, whilst the other has not. A fall onto the buttocks is enough to produce end-plate fractures in the lumbar spine and potentially initiate the process of internal disc disruption.
On the average, posture may not come out as an associated factor with pain, but this average result may mask the fact that in the first individual, posture may be clinically relevant. Did the studies you refer to take these type of considerations into account?"
---------------------------END--------------
I do not have the knowledge regarding statistical analysis/ epidemiology that Nic has, so Nic, I hope you will excuse me for posting your response here. I posted the whole reply, as not to misquote you! He shows great clarity in description of the multiple variables to be considered when studying factors associated with validity/ causation.
My own impression regarding the clinical presentation of postural problems relates to the pathology at hand. Posture that is habitual and able to be consciously controlled is somewhat different to "posturing" by a patient in response to/ or avoidance of pain. Static positioning of the spine/ spine neutral is simply immoblization of tissue.
Following trauma, it has been shown in studies ( unrelated to spinal pain) that reduction in GAG/ formation of early collagen crosslinks occurs in immobilized tissues following trauma. Immobilizing tissue is something that we never do as PT's for other parts of the body, but it seems acceptable to some in the case of spinal pain. The difficulty of course lies in the fact that spinal pain is multi-factorial, and a pathological tissue is not always identifiable. However, pattern reognition and clinical reasoning usually allows us to establish movements for patients that allow early motion/ regeneration of tissue/ co-ordination of movement patterns and so forth.
Perhaps the answer lies partly in our understanding of the nature and response of all tissue to movement, and the beneificial effects this has to the vascular/ neurological and collagenous tissues, following injury. If the body provides a "defense" (to quote Louis Gifford) in response to a perceived threat or painful event, then this defense is beneficial to the patients tissue, by placing themselves in a position of minimal tension, hence less peripheral nociceptive input. The "defense" should resolve, as the properties of the pathological tissue improve, or the ventral horn quitens down, due to peripheral or central changes in reponse to the perceived threat.
The idea of positioning a patient in our perception of a symmetrical spinal posture, may, at a tissue level be traumatic, invoke nociception, or be perceived by the individual as a greater threat, if the positive defense created by the individual to reduce pain is not enhanced by the therapist or patient.
There are many studies that show the changes to tissue with graded tension applied to them, indicating that a position of best defense created by the patient can be utilized, while applying appropriate dosed tensile force to traumatized tissues, to decrease the bodies need for a defense. Otherwise, we are leading a "defense" into a secondary" defect" ( Gifford again) as we have not taken repsonsibility for guiding/ facilitating/ observing changes in the original pathology, or perceived threat. Of course, these studies regarding immobilization were only in rabbits/ rhesus monkeys etc, following TRAUMA.
In the case of a patient with chronic pain it becomes far more complex, and this analogy become weaker, as clear peripheral nociceptive input does not always present clearly. Consider that minor chronic thoracic pain patient, who has pain reproduced say , with 10 mins of spinal flexion. Pattern recognition allows us to see that some deformation of tissue due to ischaemia/ creep/ hysteresis may be a factor. Corrective posturing in thoracic extension by the PT requires prolonged contraction of muscles already in defensive guarding, circulatory stasis, neural deformation, and then we add in immobilization of tissues recovering from repetitive micro-trauma, by telling the patient to sit up in a straight posture ( the body provides a defense of segmental posterior sagittal rotation/ extension, to prevent prolonged tensile stress, as an example)
Would it not be better to tell the patient to sit however is the most comfortable, but also be aware of moving their tissue defined upon evaluation as needing movement and stimulus, and dealing with any biopsychosocial issues at hand.
Static positioning seems to be contrary to to the way we treat every other part of the body, except the spine. Why is this? Is the tissue different? Is the bodies response to movement and stimulus different? No... it is not.
Defining a problematic posturing, during a functional movement seems relevant, but off the topic a little. Duffy brought up the example of the shoulder patient, with scapulae in protraction. The solution seems to be in defining the pathology, internal impingement of the cuff as an example and then possible contributing factors, such as glenoid positioning during external rotation, that may eventually lead to say, internal cuff impingement. If the patient has lost thoracic mobility, scapulothoracic mobility and hence cannot compensate to allow more external rotation at the shoulder, then a link between posturing during movement, or adaptive tissue changes over time(due to....?), preventing adequate posturing of the thoracic spine and scapula during shoulder rotation. This "seems" like a logical thought process to consider in defining problems with posturing. But, as Nic Lucas said, how do you perform studies that cover all these variables, without some dilution of the outcome findings due to individual variations that are significant, but "hidden within" the numbers/ statistics?
Maybe we should look more specifically at spinal function/ movement patterns during movements that require a more beneficail form of spinal posturing, and be specific about problems with spinal posturing that are being poorly compensated for elsewhere, rather than adapting spinal postures to a generically perceived "best position" which to this date has not been defined, or shown to actually exist.
Thanks for reading this lengthy post....I hope it helped put you to sleep.
A-propos, vis-a-vis,inexorably and concordantly time for bed.
Sincerely,
Sam Betts
( one of the least known PT's!...thank goodness)
[This message has been edited by Sam B (edited October 19, 2003).]
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Re: Posture wars - October 19, 2003 5:41:00 AM
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Diane
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From: Vancouver, B.C., Canada
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Sam, least known but never-the-less brilliant.
[IMG]http://www.rehabedge.com/forums/smile.gif[/IMG],
Diane
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Re: Posture wars - October 19, 2003 1:11:00 PM
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freetomove
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From: Nova Scotia, Canada
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I have never encountered a therapist who is willing to share his or her work as frequently, generously, honestly, and publicly as Barrett Dorko. He has written a book of essays full of clinical insights and practical suggestions. As most of you know, he writes relentlessly to make a point that many in the therapy community ignore, reject, or just don't get. I admire his persistence and I have also put forth enough effort to figure out what he is talking about and realize its value. I will try to approach this discussion from a different perspective.
First of all, for those of you reject a good story, I can only wonder how you can ever make sense of the patient in front of you. It is, after all, from their stories that we must extract those elements that are relevant for us to help them change. Sadly, I think we have lost a lot by trying to be too "objective" and "evidence-based." Regardless of how many journals we read or studies we perform, we are ultimately left alone with the patient before us. A little 'renaissance' wisdom would probably help us all. It has always been stories that have provided insight into the human condition. Let us not forget that in our rush to join the cult of scientism.
Having said that, Barrett is also one of the greatest proponents for scientific inquiry within our profession and has far greater familiarity with basic sciences and especially neurobiology than your average PT. He uses that information to inform his practice and is also willing to change his thinking if the evidence suggests such evolution.
Since this is beginning to sound like a Dorkite apologetics letter, allow me to turn to his treatment method and then to the topic at hand. I see Simple Contact not so much as a therapeutic approach, but as a way of approaching patients therapeutically. It is not so much a technique as a collection of principles that inform the treatment of a patient. He does not (and will not) tell us what to do, but rather how and why to do it. Here are some of the basics:
Pain results primarily from chemical irritation or mechanical deformation (even researchers and clinicians who focus on central sensitivity or representation of pain states acknowledge the importance of afferent input to generate and maintain the pain state...to his credit and contrary to those of you who think his work is psychoanalysis, Barrett has never let go of the peripheral aspects of the pain experience, while fully acknowledging central contributions)
The tissue most sensitive to mechanical deformation (and the tissue primarily responsible for pain) is the nervous system.
In order to reduce pain of this type, we need to reduce the mechanical deformation.
Movement is necessary to reduce mechanical deformation.
In the interest of self-protection the nervous system instinctively increases muscle tone to both protect and correct neural tension. This increased muscle tone (or underlying articular restrictions) which is often seen as the problem to be fixed or , at least, relaxed, actually offers a solution. The full expression of the movement a muscle is attempting to produce by contracting will help reduce mechanical deformation of neural tissue.
Since this movement is easily inhibited and we are generally encouraged to do so by cultural admonitions to remain still (not the least of which come from PTs), most people do not freely express this movement to the degree required. In addition to this cultural constraint, people are also affected by their understanding of pain...moving less when they should be moving more...and by notions of exercise that teach them they need to get stronger or to forcefully stretch, which generally do little to relieve pain.
Since this "movement" is already present in the patient before you in the form of isometric activity, what might be the best way to facilitate its expression?
Would it be telling them to sit up straight?
Maybe an aerobic workout on a treadmill?
Manipulation, which coerces the patient to move in the direction dictated by the therapist?
Or maybe gentle, non-coercive touch which increases the patient's awareness of internal processes and reflexively alters nervous system functioning, while at the same time respecting these internal processes enough to allow the person to move however their body wants to move at any given time???
How have we lost the ability to sense our instinctive corrective abillities. We all yawn and we occasionally stretch, but we rarely allow much spontaneous movement. If you look at babies, young children, and even animals move, you will see regular instinctive movement. To me, good posture is not conforming to some arbitray ideal that looks nice, but posture that changes, especially in response to signals of pain and stiffness. Ergonomic positioning in neutral may help temporarily by reducing tension on the nervous system, but ultimately confines someone to a little box of function where they will get tighter and tighter, eventually tolerating no departure at all from the imposed position. As Sam has mentioned, this is not what our tissues need to be healthy. We need regular movement through our full range of motion in order to have a healthy painfree spine. We need to be more aware of our bodies' signals and attempts to produce such movement. We need to help our patients change their stories.
Nick Matheson, PT
For further reading, I suggest some of the following: [URL=http://www.barrettdorko.com]www.barrettdorko.com[/URL] The essays are here.
The Sensitive Nervous System and Explain Pain by David Butler
Pain: The Science of Suffering by Patrick Wall
Adverse Neural Tension in the Central Nervous System by Alf Breig
Topical Issues in Pain (vols. 1-4), edited by Louis Gifford
Various articles by Michael Shacklock and Max Zusmann (see Medline)
Check out the site for the International Association for the Study of Pain
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Re: Posture wars - October 19, 2003 10:01:00 PM
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Tyler29
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Unlike SJ, I'm probably more than 50% idiot, which is probably why I couldn't find any publication by Barret on pubmed - I'm somewhat new to this site but does he only pose his views on his website and at con-ed? Has he ever subjected his treatment philosophy to peer-review? If he really has something to say that is worthwhile why not publish a case report to the PT journal or JOSPT or the AAOMPT journal, if his treatments are more manually based. Of course it is easier to get things into PT Advance or have your own website....
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Re: Posture wars - October 20, 2003 5:30:00 PM
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freetomove
Posts: 46
Joined: October 17, 2003
From: Nova Scotia, Canada
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SJ,
Thanks for your reply and questions. Interestingly, Oliver Sacks has said that he aspired to practice a "romantic neurology," by which he means a neurology that recovers the "I" or "who" (the patient's subjectivity) from the "it" or the "what" (the physiological condition). Although I have no reason to wonder, I can't help questioning if his ideas were always well accepted by his colleagues in neurology. Consider that your difficulties with some of Barrett's ideas may arise from your own biases arising from your immersion in ideas he is critiquing. Just a thought.
For those of you who think reflective writing is easy or that one's style may simply be too comfortable, I would suggest trying it yourself. There is little that requires more courage than writing one's private thoughts for public view. This turn (or return) to the subjective of both the patient and the therapist is a necessary one. Donald Schon, a well known adult educator, has written a book on the reflective practitioner and discusses the necessity of such action by experts leading their fields. He also acknowledges the importance of qualitative research, something that needs to become more acceptable in the current EBM craze.
In reply to your questions:
(1) The role of peripheral and central factors in individual cases is not determined by time, it is discerned by clinical reasoning based on the patient's history and the therapist's examination. Both peripheral and central factors play a role in ALL pain states. Someone could totally overreact to a mild injury and need to have central processing issues addressed even in a very acute stage. In general though, pain that persists beyond the period of time expected for healing likely involves more central processing issues.
(2) Yes, the body will react differently to different types of mechanical deformation. If a strong force is applied rapidly, tissue damage will likely occur and the resulting pain would be classified as nociceptive, not neurogenic pain. If such pathology is present, the well known stages of recovery are relevant; however, a large majority of PT patients simply do not fit into the categories we were taught in PT school. Many describe pain that crept up over time and has gradually worsened. Simple Contact is appropriate for treating neurogenic pain, not for pathology. Barret is very clear on this matter.
(3) I'm not exactly sure what you mean by the definition of neural tissue...it is tissue belonging to the nervous system. By full expression of movement, I mean removing the inhibition that keeps the muscle in a state of isometric contraction and allowing it to contract concentrically, thus producing movement. One of the things Patrick Wall realized is the motor cortex was active (evidence by MRIs) in patients with pain who were not moving. One can extrapolate that this activity would be present in the form of muscle tension.
(4) Have you ever had someone take your pulse? Did their gentle pressure make you aware of a process within your body that was previously below your conscious awareness? A noncoercive touch does not attempt to push the patient where the therapist wants him of her to go. Gentle deformation on the skin causes the opening of ion channels that result in depolarization of neural tissue Several authors have written of the skin as "the nervous system exposed"and both tissues arise from the same embryological level. Our knowledge of the skin is extremely poor considering it is the only tissue we actually handle all day long. Why do we assume that we can (or need to) push right through it to access deeper muscles or buried joints in order to alter a pain state?
(6) It easier to provide a "real life" example, but I hope you can see its clinical relevance. If I drive for several hours and get out of my car feeling stiff and sore, my natural instinct is to move, to stretch, to work out the kinks in a way that will make me feel more comfortable.
There are three categories of nonconsious movement: excitomotor (eg. breathing and swallowing), sensorimotor (eg. startle reflexes), and ideomotor (movement that follows thought). A large majority of our movement occurs nonconsciously or involuntarily, in spite of what we learned about the voluntary skeletal muscles. Think about when you first learned to drive; it likely required constant attention to each movement. Does it now? Or do you simply get in your car and suddenly arriveat point B without much attention to what you are doing? Since most of the muscle tension we deem problematic is nonconsiously bidden, does it not make sense that we need to look at this source for its resolution. What is it trying to do? I am arguing that it protects us by preventing us from moving in one direction and corrects us by attempting to move us in another.
Think about your example of a lateral shift. Consider tha tthose musclesmay "spasm" in an attempt to prevent movement in one direction and produce it in another. It is generally the patient's fear of pain that keeps them immobillized in one position. Attempts to coerce the patient to a straighter position do not respect the process that is taking place, directed by the central nervous system. For further discussion on this, check out Barrett's essay on Evolutionary Reasoning in which he makes excellent referece to a great article by Louis Gifford, cited by Sam in his post above.
I am very open to anyone's suggestions on a methodology for studying a patientsability to learn cognitively and kinesthetically, reduce inhibition related to fear and conditioning, and be willing to move instincitvely as needed to reduce mechanical deformation. This post is so long that my neck is getting sore...time for me to allow movement.
Nick Matheson, PT
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Re: Posture wars - October 20, 2003 8:07:00 PM
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mcap56
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From: New York, NY
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A few thoughts from Sam B's paste in.
Is the author contending that cohort studies have yet to prove an effect because we don't have a clinically relevant description of posture? That is an issue in and of itself. We can't even begin to study it if we can't define it. And how are we treating it if we have no meaningful definitions and distinctions?
Also, small effects in large size cohort studies, if anything, are exagerated and clinicians begin to mistake statistical significance for clinical significance.
I think we should all note that the EBPers such as myself aren't contending that there is no link, we are merely contending that one hasn't been proven. It's easy to poke holes in research and talk about the difficulties of doing a particular study. But with the majority of PTs out there holding a particular view that may be at least in part, flawed, a few studies would be in order.
From another post, I would like to point out that the importance of qualitative research is not ignored in EBP at all. In fact, it has it's own place on the heirarchy (may be between prospective cohort and case control studies but I am not sure). In any case, they are very, very important and can give us information that quantitative studies can't. If there are qualitative studies to be done on posture, go ahead. However, I don't see much of those either.
I teach patients that it is good to put themselves into the corrected or overcorrected position for small amounts of time throughout the day. This encourages movement, positional change, and may have some neurophysiological input that is therapeutic. But asking them to hold the "correct" posture is just silly. Far too many PTs treat this way.
I would also note that we are talking about structural posture. Awkward, dynamic working postures are clearly associated with pain.
Best,
mcap
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Re: Posture wars - October 21, 2003 8:40:00 PM
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coloradojulie
Posts: 413
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From: colorado usa
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Thanks above for a "jist" of simple contact. I must admit that some of it I agree with and seems to make sense. I agree with moving the spasming or protecting muscles into the direction they are trying to move the body part...dependent on the reaction and what it is a reaction to.
Is this something like barnes concept of unwinding? I don't know enough about it, but instead of stretching a muscle, release is accomplished in a shortened position...is that correct? I haven't taken any of the classes in this regard.
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Re: Posture wars - October 22, 2003 4:18:00 AM
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freetomove
Posts: 46
Joined: October 17, 2003
From: Nova Scotia, Canada
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Coloradojulie,
Thanks for your reply. I can understand why this process may sound somewhat like what Barnes espouses; however, there is nothing in my explanation that remotely resembles the kind of theory put forth by Barnes. His model of how the body works should be very foreign to anyone who has the least bit of physiological knowledge. I think the thing he is best at is marketing. Those glossy brochures sure look nice!
Now, I am not arguing here that myofascial release does not "work" and those who will use "whatever works" probably will not care for further distinctions. It is very important, however, that we combine empiricism with a deep model of physiological function that makes sense and is consistent with basic science, if that is indeed what we want our profession to be based on (which is our claim). That means, besides rejecting ludicrous propositions put forth by people like Barnes, we must also be willing to challenge some of the more traditional assumptions of our profession, such as what "good posture" actually is or how muscle tension originates and what its purpose may be.
Nick Matheson, PT
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Re: Posture wars - October 22, 2003 4:45:00 AM
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Shill
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From: Madison WI USA
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Here is some food for thought.
Breast reduction surgery drastically reduces back pain, in the brief lit review I just performed. How does this work? Does it decrease the magnitude of the "bad posture" stresses, or decrease the demand on the musculature that fights against the "bad posture"? If so, then posture does contribute to pain. Could this be (some of) the evidence we all seek? Hmmmmmm.....
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Re: Posture wars - October 22, 2003 7:52:00 PM
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chipomalley
Posts: 156
Joined: January 7, 2002
From: Baltimore, MD
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Nick, I hope you know how much I appreciate your descriptions of Simple Contact and your explanations of neurogenic pain processes. To those of you who don't know, I am in the Barrett camp but he knows I am also one of those mechanistic McKenzie students..how can this be? Am I keeping the ying and yang together with some kind of dubious credo? I dunno. I can tell you what I do know about movement and that is not going to be as well spelled out as Sam B. and others.
When one has a patient lie supine at rest in a comfortable and quiet room there is an opportunity to sense what processes are in effect within the patient. Now sensing is what many therapists have difficulty with. We have been trained to measure and gauge, to apply a force and to get a feel for the tissue or response. If a hand is placed in very light contact over the forehead, for example, there may at some change in the motor response of the patient with regard to neck motion. Similar motor responses can be seen in different directions by changing the input to the CNS by changing the contact areas. The movement that emerges, or that which is expressed is what I feel is the essence of ideomotor movement in that is not intentional therfore is not volitional and it is not passive since it is not directed by the therapist. It is what the patient needed to do, not what I decided they should do.
The fundamental nature of this movement is often related to unwinding in that ther tends to be a spiral or diagonal nature to many patterns. In my mind there is a strong correlation to what we know as PNF patterns. I have spent hours trying to put together what I understand about cerebral and cerebellar connections and peripheral input processes to work up a theory for the basis of this movement. If one looks at the spinal level, there is some value in the agonist/antagonist relationship and the very individual way this technique allows the patient to stretch in a unique way.
Moreover, it is the cultural influence that we put on ourselves and the rehab models that we hold onto that prevent us from reaching for this model of Simple Contact. Indeed, one can study the modern neurobiology of Shacklock and Gifford and see that the nerves rule the day and that we can't separate our peripheral and central processes altogether. One can read current texts and begin to believe that we are only touching the surface of understanding pain.
All I can say is that when I touch a patient with Simple Contact the patient may need to move in a certain way and when they are ready the agonists will reverse and the pattern may play itself out and there may come a change in autonomic state and in tone and often in the perception of pain. Many therapists are not aware that this movement is possible and are quite surprised when it is experienced as a patient or a subject. Thanks for letting me go on with this, its just that it had been a while since I came across such an ardent Barrett bashing..(ha)
Chip
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Re: Posture wars - October 23, 2003 8:04:00 PM
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chipomalley
Posts: 156
Joined: January 7, 2002
From: Baltimore, MD
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My phrase bashing was actually a tongue in cheek sort of way of putting it, I guess it worked phonetically for me! I will ask anyone who doesn't know what Simple Contact is to try the example I gave, perhaps on a friend or family member and then spend some time sensing movement and change in posture.
Chip
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