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Re: Total motion release
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Re: Total motion release - August 11, 2006 6:48:00 AM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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What is this manual therapy supported by the literature? It's easy to say it is supported, but which maneuvers? How do you account for the difference in manual therapy between me, you, and others? Rehab is supported, but which exercises specifically?
The total motion release mentioned at the start of this thread, is it just another method to apply rehab or manual therapy? If so, then I dont see why it could be so far out that it might work well.
Then again, maybe total motion release is a little far out. I know nothing about it.
Speaking of US, it is one of the methods I use on occassion when other things dont seem to provide relief. I know you will say the best current evidence says it doesnt do much, but I find it to work well in many cases. If I were to follow EBP very strictly, as it seems you do, many of my patients would miss out on the benefit (even if it is short term pain relief to help them through the acute stage).
Ok, I'm rambling again, but I guess to sum up my feelings on EBP - I think to follow it strictly and to give RCT's too much weight hinders one's ability to treat individual patients. If we follow the evidence strictly, when those methods fail, then what do you do? Discharge them and tell them there is no solution to their problem?
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Re: Total motion release - August 11, 2006 7:47:00 AM
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steve
Posts: 452
Joined: May 14, 2003
From: victoria, bc Canada
Status: online
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Buddy,
I think you are misinterpreting EBP. The ideology is that we start with whatever has the most evidence to back its use - ie. RCT but it may simply be a case study in some areas of rehab. If that doesn't work, its ok to move on to other, less proven methods of treatment but it would be misleading and potentially harmful to patients (Ie. you have a subluxed vertebra, your spinal fluid is not pulsing properly etc) to explain the theory behind them as factual to patients.
The problem I have with the TMR as described is not the therapy (From the very vague description given it moves away from pain, patient independence and control); which may be just pretty packaging on things we already do but rather the way it is presented - A cure all with miraculous results and vague descriptions of the actual treatment. I believe Shill's previous response is a great representation of how the evidence based practicioners mind should work.
dfjpt's post is probably the most telling, I hope she doesn't google my name!
Steve
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Re: Total motion release - August 11, 2006 7:50:00 AM
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steve
Posts: 452
Joined: May 14, 2003
From: victoria, bc Canada
Status: online
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Junction,
All you need now is some scantily clad people in the background, some poor camera work and 30 minutes late at night and you have the makings of a great infomercial
steve
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Re: Total motion release - August 11, 2006 7:51:00 AM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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Ok, I see. Keeping things in context, it is good to be critical. I guess I was more responding to all of the replies to "show me the evidence". Looking back at some of the claims made by the company, I think we do need to question them.
Then again, how many seminar's are sold by saying "this might be an ok way to help some of your patients."
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Re: Total motion release - August 11, 2006 8:06:00 AM
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proud
Posts: 868
Joined: March 22, 2006
Status: offline
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Buddy T Dc,
Well as for US...I bet if you did not even turn on the machine but sat there and moved the sound head around for 5-6 mins( without the patient knowing)...you would get the same effect. It's called placebo. One of the most misunderstood and utilized tools by those uninformed.
Just because someone leaves your clinic saying they " feel better" does not make it so...in the true sense.
As I have stated before, going to a masseuse can make you feel better...but the actual long term benefit and outcome is horrible(when used as a sole treatment).
You at least need to be able to identify supporting literature to justify your claims.
As for Total motion release...okay perhaps it is just a new term for techniques already being used.
But good lord, when someone comes on here and claims they use it on 90% of their patients...you just gotta wonder where their acedemic training came from...don't you think?
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Re: Total motion release - August 11, 2006 9:59:00 AM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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I also use ice or heat on 90% on my patients, therapeutic exercise on 90% of my patients, some form of manual therapy on 90% of my patients. Not sure where the hostility is coming from. I know that they claims sound outrageous. I felt the same way before I attended the course. It sounded like too good to be true, snake-oil, insert your favorite cliche. Those claims are written after the first and second days of the course, after attendees experience the treatment on themselves and observe it on others.
As far as the placebo effect, I mentioned previously that I evaled a patient with a partially torn RC and approx 65 deg abduction. I had him do some of the exercises, not telling him anything more that I want to see if you have tightness in other areas that may effect your shoulder - he then was able to fully abduct. He wanted to make sure that he could do the exercises at home.
I view TMR as a new treatment with a lot of clinical evidence that is begging for research. But, it will take people like those of you being critical (some rightly so, so with a bit too much ignorance and arrogance)on this thread to attend the course and begin some clinical trials, etc.
Safe to say, the principles are grounded in things that we already do. Tom doesn't give away everything on the web site. Neither does Kevin Wilk, etc. when they are teaching a course.
I am disappointed by the "paid endorsement" comments. If you have been a PT for a number of years, do yourself a favor and take a look at this course and the concepts. Tom is well read and passionate about PT.
Best of luck.
_____________________________
Eric Yarrington, PT, MPT, OCS
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Re: Total motion release - August 11, 2006 2:52:00 PM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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I am familiar with the placebo effect.
What you are telling me is you think that US has no physiological effects beyond the placebo effect?
I'll agree that for a majority of patient US will give little to no statistical benefit, but in certain situations, it can be useful.
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Re: Total motion release - August 11, 2006 5:08:00 PM
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dfjpt
Posts: 238
Joined: April 9, 2006
Status: offline
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[QUOTE]Tom is well read and passionate about PT.[/QUOTE]Passionate about PT or passionate about all the $ he is making from a multi-level workshop series? Seriously, google his name plus scientology.
(No worries Steve.)
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Re: Total motion release - August 12, 2006 9:51:00 AM
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tucker
Posts: 182
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From: Texas
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Apparently passionate about making $$$...and the Church of Scientology...Interesting find dfjpt.
If he was passionate about contributing to the field of PT, he would have published his results allowing therapists to reproduce the treatments.. instead of having to pay him.
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Re: Total motion release - August 12, 2006 11:20:00 AM
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dfjpt
Posts: 238
Joined: April 9, 2006
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Tucker, exactly my point.
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Re: Total motion release - August 12, 2006 12:01:00 PM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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Steve, proud, Tucker and dfjpt said it all.
Someone who is secretive about resources, references and support for a course's validity is nothing more than a vendor of expensive cobra skin clothing and a way to fund their particular institution.
Nari
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Re: Total motion release - August 12, 2006 7:09:00 PM
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Amy Bennett
Posts: 8
Joined: August 9, 2006
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I don't care if he's a Scientologist, as long as I can learn something clinical from him. I've also taken courses from Christians, Buddhists, and atheists, so what's the point of dwelling on that? His religious beliefs are not something he mentions in the course. Some of you, never having been to his course, still find yourselves capable of criticizing the "validity" of the techniques. Your criticism is equally as invalid as you presume his information to be. In fact, the bases of his treatment approach have significant support in the neuroscience/neurophysiology literature. Try reading the "Neurophysiology of pain and pain modulation" and "Exercise and pain" chapters in the book Pain: A Textbook for Therapists. Try reading the chapter on myofascial realease in Philip Greenman's book. Or just read the huge number of articles about how arresting inappropriate proprioceptive activity results in pain relief and improved ROM and balances synergistic and antagonistic muscle forces.. Or how active motion can reorder neural activity to and from the CNS and alter facilitation of the spinal motor neuron pool, producing changes in muscle spasm and nociceptor activity. Or go to a functional exercise course like Gary Gray's or "When the Foot Hits the Ground" and learn how dysfunctions often occur as a result of an injury in a remote area. All of this can reasonably be used to inform clinical reasoning regarding the use of TMR.
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Re: Total motion release - August 12, 2006 10:31:00 PM
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goodlooks58
Posts: 417
Joined: October 21, 2002
From: CA
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OK...now anyone who took the TMR course (with the permission from Tom) gave us an example of how would you treat e.g. a frozen shoulder. Letting out one technique is not going to be detrimental to the TMR business of getting PTs sign-up for the seminar. Give us a treatment technique which everyone in this group is willing to try out on their patients and then we can all come back and report our outcomes. Is this OK? This is better than arguing about the placebo effects and EPB. Placebo effects have been clearly noted in chronic pain therapy.
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Re: Total motion release - August 13, 2006 1:45:00 AM
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SJBird55
Posts: 2286
Joined: May 10, 2004
From: Michigan
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Tom's website and that message board are filled with catchy jargon. Good - you of course HAVE to do the Fab 5! In 10 minutes after the Fab 4, the patient will have have made 80% improvement. LMAO
What the heck is this Fab 5 crap?
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Re: Total motion release - August 13, 2006 6:25:00 AM
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Drexey
Posts: 4
Joined: August 12, 2006
From: St. Petersburg Florida
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I have been reading your comments with great interest and find them fascinating with some very ignorant comments tossed in. Let’s address that first. To disparage a technique because of some one’s religion is the bottom of the pit. Being from Pinellas County in Florida I am certainly not a fan of Scientology but what does that have to do with anything. Isn’t this website for intellectual discussion rather than mud slinging – let’s rise above that. There’s enough hatred out there without us adding to it.
I am a retired PT (graduated ’61) who has taken a minimum of 2 major courses a year since the late 70’s. I’ve been a teacher, owned a private practice, been an independent contractor – you get the picture. I learned the Rood Technique from Margaret, therapeutic exercise from Ms. Worthingham, PNF from Maggie Knott, Cyriax from Dr. Cyriax, McKenzie from himself, Adverse Neural Tension in1994 from NOI and I am still learning. How many of these people published their results before teaching their techniques? And I have never seen any of these courses advertised for free. When I started receiving ads from TMR I was initially skeptical but Tom Dalonzo-Baker is a promoter in the style of Keith Blankenship and eventually I read more and wound up taking the course. I took it because, since my retirement, I’ve volunteered 40 hours a month at St. Petersburg Free Clinic. I see patients every 45 minutes and over 50% of my patients each week are new referrals, often not fluent in English. I was interested in TMR because it looked like I might be able to do a better job for my patients. The simplicity of the method knocked my socks off. I realized that TMR incorporated many methods which we have utilized since the beginning of our profession but they are organized in a different manner to simplify and make more user friendly. Tom has built on Bobath’s methods utilizing the “good side”, Barrett Dorko’s Simple Contact, David Butler, Upledger, Barnes, McKenzie, Rocabado – he has pulled a lot of things together and put them in a very teachable system. It’s a compilation of things you already know but in a different format. You smack your head and have an “ah ha” moment halfway through the course! I have corresponded with Tom since the course and urged him to document what he is doing and he will be starting that very soon. I, too, look forward to that.
In the meantime, I began using TMR on all my patients at the Free Clinic in April. I document carefully and have followed every patient for 4 months. I have translated materials into Spanish and simplified the pain scale and rating systems as I do not have a “typical” patient load – many people live on the street, speak languages other than English and Spanish, are out on work release or in drug rehab or are working 3 jobs and don’t have time to do a lengthy exercise program to say nothing of having to take time off to come to PT. My patient problems have included TBI, CP, LBP, CTS, bone spurs, strains, sprains and everything in between. After 4 months I can tell you this – the majority of my patients are discharged pain and problem free after 2 or 3 visits and with the tools to take care of themselves should the problem re-occur. I can teach TMR on the front steps of the clinic, across the street in the field, or in my tiny PT room. I still use US, laser and iontophoresis when appropriate but, boy oh boy, have I changed the way I do PT. I am able to see more patients each week, decrease the number of visits and – most importantly – teach them to control their pain quickly and efficiently. I can not explain 100% how this works but that is for you folks to do – where would PT be if we did not continuing learning and trying out new techniques. I am more than willing to share my running documentation with anyone who wishes it.
I must add a final observation – I have noticed a growing educational elitism at APTA meetings and on various websites that I look at. While healthy skepticism is good, let’s not get in the habit of calling everything which we personally do not utilize in our practice “quackery”. Check it out for yourself and keep learning. It’s good for you and our profession.
Peace.
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Re: Total motion release - August 13, 2006 7:16:00 AM
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proud
Posts: 868
Joined: March 22, 2006
Status: offline
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Guys it's simple,
If you take this course despite your claims of "using it on 90% of patients"...you do not have a grasp of where the stakeholders in healthcare delivery will be, and are, taking us. Thank goodness for the likes of Childs, Jull, Hides, Richardson, Flynn etc...
"Ignorance" generally means uninformed. Those who have voiced their concern with peers taking this course are not the ignorant ones. Trust me.
As a professional, I take offense to individuals who so clearly lack an understanding of what it means to practice within the EBM model. Unfortuantely if we have too many blind followers...we all get painted with that same brush. It is frustrating.
If you want an example of how a course should be presented, then I suggest you check out APTEI.com...all referenced material with a library available so that you may use the referenced material and see for yourself...then take the course to learn more. Or the courses presented by Childs are another example.
I have no problem taking a course from these guys if they study their tecqniques first and can produce some systematic data...then put on a course. Until then, these are examples of who should be eliminated from being allowed to bill under the umbrella 'Physical Therapy."
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Re: Total motion release - August 13, 2006 12:03:00 PM
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Drexey
Posts: 4
Joined: August 12, 2006
From: St. Petersburg Florida
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Good idea - I will write up a couple of brief case studies this week and post them. By the way, proud, my comment about "ignorance" was directed at the mudslinging and inuendo at Tom's choice of religion, not at people who choose to take or not take a course. Personally, I don't care whether anyone takes the course in TMR or not. I was responding because I do have the luxury of treating in whatever manner I wish with no time or financial constraints. I work for free and the patients are not charged for services. I use the method that gets the best and quickest results - simple as that.
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Re: Total motion release - August 13, 2006 1:45:00 PM
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youlimey
Posts: 1
Joined: August 12, 2006
Status: offline
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I just came across this dialogue and I'd like to make a comment. The best post so far has been from Drexey. It's such a shame that this discussion has turned into professionals slagging off other professionals, it's really a waste of time and energy to do that. Exchange of ideas, constructive suggestions and shared clinical experiences make looging on to these forums worthwhile. People who have an axe to grind should do it elsewhere. Billions of dollars are spent on alternative approaches every year by the public (maybe some on PT). This is driven by consumers and we need to give the public credit in choosing who they go to see, and who they continue to see, and who they recommend to family and friends. RCT's have aplace ina big picture , they are not the be all and end all. Why do people like Drexey continue to go to cont ed? Probably because any therapist worth their weight knows we do not fully understand how the complexities of the human body interact, especially when confronted with dysfunction. All credit to anybody out there is doing innovative stuff, all credit to the practioners who attend those courses and continue to inspire the innovators. If you do not wish to attend this course, don't. But don't discourage other people from investigating options and please don't drag us all into yet another negative environment, there's enough of that around already.
For the record, I've done the TMR course, it's very interesting stuff. Tom has an invitation to go to his clinic and see him use it on his patients. He obviously stands by his work. I've done a lot of courses through the years and have a very sound clinical base to now investigate other possibilities outside of "my model of the world". It's eye opening actually and very interesting how many approaches have common ground. Don't waste your time on this web-site being negative, I don't think that's good use of your time, you could always buy a book and investigate other ideas, it certainly isn't good use of my time reading your comments. It's not my role to convince you that the way I spent my continue ed money has your blessing. Let's lift this discussion above it's present level.
Thank you for your time
Stuart
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Re: Total motion release - August 13, 2006 4:19:00 PM
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rwillcott
Posts: 342
Joined: March 20, 2006
From: Canada
Status: offline
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Well said Junction 13! "Kumbaya double-speak" -Classic! I'll have to remeber that.
Rob
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Re: Total motion release - August 13, 2006 5:51:00 PM
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tucker
Posts: 182
Joined: May 24, 2003
From: Texas
Status: offline
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LMAO Junction! I was also getting that feeling of an ebay auction where one bids up their own item by logging in as different buyers...who have no prior feedback. Let's hope that is not the case here.
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