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Re: Total motion release
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Re: Total motion release - August 14, 2006 1:29:00 AM
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SJBird55
Posts: 2293
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From: Michigan
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LMAO... there is a huge circle and arrow now that sometimes pops up over there on the left side when you log on... guess what it says? Just one guess? Yup... total motion release. Hmmm, I wonder about the timing of all these posts too.
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Re: Total motion release - August 14, 2006 4:28:00 AM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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Great comments by Drexey and Amy Bennett. As Amy stated, the principles behind TMR are there in the literature. Tom had just come up with (at the basic level of using TMR) 5 movements, that when done properly, have an effect on the body's myofascial and neuromuscular system, whereby tightness can be released, pain improved, and ROM and strength enhanced. Those who have not attended the course, and instead choose to rely on GOOGLE searches, are attempting to paint TMR as some voodoo treatment with no scientific basis. Once again, the testimonials from the website are mentioned and criticized. These are mad by PT's who have attended the course. Tom has not altered them in any way. The majority of these are the experiences PT's have had on themselves before they even talk to a patient about the movements. I personally have never had as dramatic a pain reduction with any tested/proven/researched PT modality.
There also seems to be a tremendous amount of murmur knocking someone for coming up with a treatment and then deciding to support his family by teaching a course on this. Sure he could just write about it and we could all try it out. Do we also think that the Jone's Institute should stop teaching Strain and Counterstrain and just write about it? What about Upledger and crainiosacral? Weiselfish and muscle energy? You benefit from going to the course and learning/practicing/questioning. Am I being illogical?
_____________________________
Eric Yarrington, PT, MPT, OCS
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Re: Total motion release - August 14, 2006 4:52:00 AM
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Bournephysio
Posts: 576
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From: Calgary
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Seriously, the more you guys post, the more this sounds like astroturfing. How would you know that "Tom has not altered them in any way"
Refresh my memory. What level of evidence is a testimonial?
The principles of TMR may be in the literature but they sure don't seem to be in this thread.
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Re: Total motion release - August 14, 2006 5:53:00 AM
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proud
Posts: 875
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Eric,
"Am I being illogical"
...yes, you are.
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Re: Total motion release - August 14, 2006 7:36:00 AM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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Bournephysio, Junction13, proud:
Wow, you guys are coming up with some interesting and condescending conspiracy theory with a lot of $.50 words abd abbreviations that I guess must be reserved for those "experienced" posters on this thread. I don't get the hostility. You have not read the comments and paid attention to those folks who have stated the research behind the concept of TMR. I agree that it should be researched. But, you seem to be dismissive on the basis of several unrelated things: the guy happended to attend Measurable Solutions that has some principles based on L. Ron Hubbard's management philosophies, the guy happens to be doing a service by teaching a course to others and God forbid, making a living. There is a difference between being scientific and self-righteous. Then again, aren't threads the perfect place to sit and preach in anonymity? Go to the course. Help your patients get better, start your own clinical trials, and keep questioning what we all do.
Clinical case example: As I stated, I saw a patient with a partially torn RC with 65 deg abduction. I have seen him for 5 visits. He is doing some tubing exercises and I also did some heat and stim once or twice. He is doing some arm movements, leg movements, and trunk movements based on TMR. He had resting pain prior to starting therapy. He now has full ROM and is able to keep himself pain free, play golf, and is independent.
I cannot "talk you through" TMR any better than I can talk you through strain and counterstrain.
Again, best of luck.
_____________________________
Eric Yarrington, PT, MPT, OCS
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Re: Total motion release - August 14, 2006 8:06:00 AM
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dfjpt
Posts: 238
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Eric, settle down, settle down..
There is no conspiracy theory, there is no personal attack, there is no nothing here. This site exists to promote the science side of PT (at least I thought it did once upon a time).
To become scientifically literate PTs must learn to be objective, including objective about their pet thing, whatever that thing may be. When you try to engage others in some technique, entice them to spend $ on a workshop, hopefully you will provide a foundation for your argument that will include, if not some sort of substantive and objectively measured track record of its usefulness, at least some sort of plausible science-based physiological mechanism, and not just sales, assertion, and a bunch of chiro-like testimonial. The clinical case you included is a good step.
I find the scientology connection very interesting; that particular group has infiltrated a lot of chiro cont-ed as well. In a general sense, I would not be happy to see PT in the US devolve similarly. In a personal sense, I would not want to spend my own cont-ed $ on something that I think could be used to support something I consider to be an expensive cult, or any religion for that matter. I consider checking out little things like this part of the responsibility of using a science or at least investigative approach to life.
There you have it. To attract people to your favorite thing, you'll have to become more science-based because you will be dealing with people whose mental blinkers are steadily disappearing as they become more and more scientifically literate.
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Re: Total motion release - August 14, 2006 8:19:00 AM
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Jeep
Posts: 353
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From: USA
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I am curious. How do you(PTs) evaluate seminars/techiques?
From reading here for some time, I am getting very mixed messages that are extremely confusing. From what I have observed, the same standard is not being applied universally to all. Maybe it has to do with the personality of the promoter? The personality of the "believers"?
For example:
This thread is largely trashing TMR. Yet I have observed other techniques advocated here that have no more "evidence" than TMR. This site(RE) is a virtual bombardment of techniques and seminars that charge $$$$, yet TMR is being admonished for not being free?
For example I will use a technique I have seen promoted here: Simple Contact. I have seen no RCTS on this. The "developer" or the name shows up on no pubMed searches. And what from the advertisements, promotions, and web site, there is no more information on what it "IS" than is on the TMR site. However, unlike the TMR site, the Simple contact home page devotes a good deal of space trashing other techniques, and linking to other trashing sites....a big red flag in my book. I did not observe any such trashing on the TMR site. That alone, IMO, puts TMR on a higher integrity rating. The SC site, LIKE the TMR site, contained testamonials, "tangential references", and other dubious promotional jargon. Yet only the TMR site has been trashed for that. What criteria is used to ascertain why it is OK for one, but not another? Both technique peddlers charge for their seminars..............
This is not an enodorsement, or a trashing of either technique(however, if one's technique was so wonderful, why would trashing others on their site be necessary?, ie. "this one" only looks good if you can make others appear bad? Is it unable to stand on it's own merits? That left a very questionable and negative impression.....).
So, in closing, as per my example......when the two sites are juxtaposed, I am failing to see why TMR is getting singled out.
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Re: Total motion release - August 14, 2006 8:36:00 AM
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proud
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Yes, the quality of this site lies in the fact that posters seem to have a grasp of how to read and understand research. And why that is so vital in today's healthcare environment.
This thread is an example of what needs to be fixed internally within our own profession. This type of "seminar" should not be attended by any Physiotherapist who values themselves a professional.
The frustration stems from the fact that unfortunately the entire Physical Therapy profession gets painted by the same brush. Too many of these guys is not healthy( ask the Chiro's what practicing with complete disregard for the literature has done for them).
By the way Jeep...I agree with you. Hopefully you can separate the real from the "unreal". I am sure you do that within your own professsion.
I can speak for myself. I take courses that have scientific foundation on which to build the techniques( see Childs or APTEI.com). I read the research and make my choices from that. It's responsible to both my profession and the patients that I treat.
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Re: Total motion release - August 14, 2006 10:58:00 AM
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dfjpt
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Hyperbole that uses words like "trash" and "bash" tend to silence rather than draw out comparisons and differentiation between a carefully developed and argued science-based approach versus a try-it-you'll-like-it,-it's-great approach.
In the former, comparisons are necessary/required. In the latter they are avoided. You can't rule out what you haven't considered, and in science (and that includes PT if it ever hopes to belong to the big kid's science club) hypotheses are set up to be knocked over.
A careful workshop provider will have already done most of the knocking over work, so as not to mislead anyone. That's the difference, Jeep et al.
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Re: Total motion release - August 14, 2006 12:27:00 PM
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Sean Weatherston
Posts: 102
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From: Idaho
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Jeep and others:
I've been an RE member/lurker for about the same amount of time as you- and I have seen many a thread on here that went right after the lack of published evidence about Simple Contact. At least with SC, the idea of neuromodulation was bantied about as a theory for why it was effective.
I just don't see that type of discussion here with TMR. I don't have any problem with anyone making $$ by teaching courses. I can tell you that before I'm going to spend and CE money, I want to see some research/theory/hypotheses on why it works. And what's wrong with seeing a bit of a preview? Sure sways my decision at the movie theater :)
Sean
_____________________________
Sean Weatherston, PT, OCS, CSCS
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Re: Total motion release - August 14, 2006 12:37:00 PM
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nari
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From: Australia
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Sean,
Well said. There is always a great deal of reading that is available on SC/ideomotion and there always has been - but it takes some effort to read about neuroscience if one is starting from scratch. It is not something to be learned by reading a couple of abstracts.
If a course such as TMR appears with only testimonials about its wonderful results, and no references, no hypotheses - well,anyone can espouse a technique because it seems to work but with no hint of why it works. Testimonials are a sign of salesmanship and nothing else. They do not sit at all well with a professional approach. A lack of background knowledge behind a course renders it little more than a fly-by-nighter.
Trouble is, it captures those who don't care about the learning process and just want another tool to play with.
Nari
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Re: Total motion release - August 14, 2006 1:34:00 PM
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proud
Posts: 875
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Excellent Nari: "trouble is, it captures those who don't care about the learning process and just want another tool to play with"...
However when patients are involved, we owe them more...much more.
Again, I have said it before and I will say it again...just because a client appears to get better in the duration of their sessions at your clinic, does not mean you "fixed" them. Check the long term outcome. After all, the recurance rate is the true measure of how succesful your treatment was.
Ever watch Benny Hin(?sp)...How do you think those people did in the long run...huh Tom?
If he is so convinced his "system" works, then produce the evidence. How hard is that?
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Re: Total motion release - August 14, 2006 2:13:00 PM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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Junction13:
I did not know that I was presenting a case study, but here goes:
"His shoulder range limitation to 65 degrees of abduction is due to what influence?" Poor humeral head control due to supraspinatus weakness causing impingement. He also has some pec restrictions causing a relatively protracted shoulder.
"Did he injure his shoulder or was it insidious onset?" Insidious onset, chronic.
"Did he originally have pain with daily activity in addition to resting pain?" Pain was mainly reported with sitting or resting and did not affect normal ADL except reaching laterally or with quick, forceful movements.
"Is the limitation the same in supine versus standing; No
is it due to muscular weakness or incoordination? Weakness
Is there a neural traction aspect of range limitation? None on exam
Is there inflammation? One could infer from diagnostic testing, but not palpable or observed on eval
Why did you have him do "tubing exercises"? Is it to strengthen his supraspinatus? Yes, he also has some infraspinatus weakness.
Does it improve his shoulder muscular mechanical sequencing? Along with strengthening, I am using it for neurore-ed as you suggest.
Why are you applying heat or "stim"? Stim to what -- trapezii, rotator cuff, biceps? Pain reilef via interferential current to posterior cuff. This was performed on one visit onely.
"What is the influence of having him do arm movements? What is your rationale for having him do unspecified generic arm movements? Is that therapeutic or particularly skilled?" This is where TMR enters the picture. Again, the one of the basic principles of the movements relates to principles seen in counterstrain or other indirect stretching/release techniques. As far as "generic" movements, this presumes no thought on my part. Iam sure that you would agree that myofascial restrictions in the pecs/lats/subscap are often seen in patients with RC dysfunction. Some of the TMR movements allow for an indirect release of these restrictions. They just happened to be more effective, in this case, then pec stretching, soft tissue/joint manual techniques. And, the result was immediate. And the patient was able to take it home and begin using it the first day.
"Why would he move his legs to improve a shoulder motion restriction?" If you asked him he would say because it works. That is the patient's perspective. And, for what it is worth, it was the leg/hip opposite his dysfunctional shoulder. I'll leave that to further discussion. Listen, I don't have all of the answers as to the effectiveness and reasons why the technique works. But, it is safe, reproducable, the patient can do implement it for a variety of conditions, and it works.
Are you asking this because you see it as an impossibility or because you want my opinion?
"What exactly do you think you did that restored his shoulder ROM to full range?" Myofascial restrictions beig released. I see the same efect in patient's with whom I use counterstrain. As with some manual techniques, there still has to be prorprioceptive retraining, if you will, to help the body stay in the new "normal" state.
"Was he not stretching before activity?" Yes he was. But, I am sure that we would all agee that stretching tight muscles does not always relax or release tight muscles.
"Was he not independent before he came into see you?" Not with pain relief or all ADL - that is why he sought medical atention and why his surgeon sent him to PT. Do you mean another thing by "independent"?
Were golfing activities the mechanism of injury? No, nor were they painful.
"How can you know if he would not have recovered fully without TMR?" I don't. But isn't that the beauty of our profession? We have at our disposal a lot of techniques/approaches to solve the myriad of problems we see in our patients. We see patellofemoral pain and we don't just treat the quads with VMO specfic exercises. We look at glute medius function, static and dynamic patella tracking, iliopsoas flexibility, foot posture, etc.. Then we treat the causes of the symptom (knee pain). But doesn't this make research more difficult? How do we find the best treatment for patellofemoral pain when there are so many potential intrinsic and extrinsic factors that we may have to treat? Do we stop researching? Of course not. If we do more than one exercise, modality, manual technique, taping, etc., do we eer truly know which treatment "fixed" the problem.
TMR deserves to be researched. What you seem to be doing is trying to discredit somethng that you do not know enough about because you cannot find it through GOOGLE. I think that there are enough testmonials and clinical examples on this site to encourage TMR research.
Sorry about the lengthy reply, but I hope that I answered your questions.
_____________________________
Eric Yarrington, PT, MPT, OCS
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Re: Total motion release - August 14, 2006 2:41:00 PM
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proud
Posts: 875
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Eric,
Now...here is a thought. How about explaning one of the "techniques"
Run us through one example of what you might do using TMR. You know, when Mulligan explains a technique in text, we can all understand what was done to try it for ourselves( For example the headache SNAG).
Simple: Let us in for a sneak technique peak. Give us an example of what you might do for Plantar fasciits. Can you do that?
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Re: Total motion release - August 14, 2006 4:04:00 PM
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Drexey
Posts: 4
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From: St. Petersburg Florida
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Ok, here are a few brief case studies which I promised to write and post. This will not be a short course in TMR or a defense of it. I am very comfortable using the technique as it is very similar to techniques I was using before – Adverse Neural Tension, PNF, strain counterstain, and bits and pieces of myriad other courses over the years. The difference is the organization of materials. First, let me clarify and explain several variables:
1. I went to the course and was impressed with the simplicity of the technique and decided to use it on EVERY patient that I saw at the St. Petersburg Free Clinic for the next two months to see if it really worked as well as demonstrated in the course – between 6/4/06 and 8/4/06 I saw 31 patients. Of that 31, 4 were discharged (by me) after not returning after 1 or 2 visits and not returning phone calls, 17 have discharged themselves with at least 80% decrease in pain and improved function (their definition of pain reduction and function – not mine). Of the remaining 10, 5 are still active patients and the other 5 have been called to see how they are doing and if they want to come back in.
2. since I am not accountable to any payer and there is no charge for treatment, my goal for every patient is “reduce pain, improve function”.
3. for the same reason, the patient is the person who determines when the goal is met – they can come for PT as many times as they wish and we mutually decide discharge date knowing that they can return if their problem (or another) returns.
4. to determine what their pain level is at the moment I ask them, I use the Wong-Baker FACES Pain Rating Scale with words in both English and Spanish. The patient alone determines whether their pain has been reduced when they repeat a previously painful movement pattern.
5. the majority of patients are working and unable to afford insurance. Some have unreported workers’ comp injuries but do not wish to risk termination. Problems are fairly evenly split between chronic and acute. The population I see are between 18 – 64 years old and all are living below federal poverty levels, some are on the street.
6. and most important – I strongly believe that most problems we see in PT are caused by lack of flexibility and this, I think, is why this technique works. It provides a method to quickly scan the major joints and soft tissues of the body (the nutty-named “Fab 5”) and look for imbalance comparing left and right sides. It is nothing that you and I don’t already do – and flexibility is certainly not controversial. During the acute phase of an injury the person begins compensatory movement to protect the injured part and move away from the pain. Doesn’t take long for tissues to begin shortening on one side and lengthening on the other and then additional dysfunction begins to set in.
Case study #1 – Brenda, 45 yo with history of 2 RC surgeries (7/04 and 7/05) secondary to WC injury R shoulder in 7/04. This had been settled a year ago and she was able to work until recently when the entire R UE and cervical area became painful. She rated her pain 70/100. She also noted cervical spasm and pain in the R hand. She carried R shoulder high with arm in flexed, IR and “protected” position. AROM severely limited; PROM flexion 100*, abd 85*, IR 40*, ER 10*. Anterior R sh complex very shortened. I assessed Brenda using those “Fab 5” exercises and settled on using the “arm raise” and “trunk rotation” for treatment since the patient was unable to discern any difference in movement patterns between left and right sides on the other 3 exercises. Using rotation to the non-painful side, the patient was able to decrease pain from 70/100 to 40/100. This was followed by arm raise exercise on the non painful side during which she further decreased her pain from 40/100 to 0/100 with full pain free, functional movement (AROM flexion/ abd 160*, full IR and ER rot). Brenda was given a HEP of flexion and trunk rotation and told to continue these until AROM was full. Brenda was told to call if ROM not full and pain free in a week. Assessment: I think that Brenda’s pain and decreased function were secondary to postural mal alignment of the R sh girdle which was corrected with an organized system utilizing a combination of PNF, contract relax and active movement of the co contractors of the opposite side.
Case study # 2 Joan 29 yo homemaker who walks in with antalgic gait and toe touch on the R. Rates her pain 80/100 and says it began without injury approximately 6 weeks ago. Has seen the Free Clinic podiatrist twice, one injection and no pain relief except after complete NWB rest. Pain returns upon standing. R dorsi flexion lacks 10* to neutral with MTJ stiffness. Tested in all 5 exercises with biggest differences in side to side movement on toe reach (basically an unsupported short squat on one leg with the opposite leg reaching forward), lunge (one legged short squat) and leg raise (sitting straight leg raise). The arm raise and trunk rotation showed no differences in side to side comparison. After doing the toe reach twice on the left leg, her pain reduced from 80/100 to 0/100. She was discharged with a HEP of those 3 exercises to do and told to return to PT if the pain returned.
By the way, it is the patient who makes all determination in differences between movement patterns comparing side to side; all determination of pain reduction (or increase) and all determination of whether the movement pattern has improved. The technique is completely patient driven which is what makes it so successful – “Gee, that exercise reduced my pain and I move better. Maybe I’ll continue doing it as directed.”
Hopes this helps explain the technique some. Sorry it is so long.
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Re: Total motion release - August 14, 2006 5:18:00 PM
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proud
Posts: 875
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Drexey,
With respect. I am not sold.
And it might be a good thing you don't charge. In fact, if anyone wants to use this stuff...go ahead but just don't call it Physiotherapy until you can back it up please. Period.
Otherwise, those with established credability within the medical community will asociate you with me. That I am not happy about.
I am still waiting for a good explanation of the technique. Your "arm elevation with trunk rotation" just does not convince me of anything at all. It just seems like PNF.
Ever heard of Benny Hin?
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Re: Total motion release - August 15, 2006 2:53:00 AM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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proud:
Active ROM into end range and sustain the hold. If this does not explain it to you, and Drexey's comments and studies do not help, I'm certain that nothing will hlep you to want to understand. If I am not familiar with the technique and I read Drexey's comments, I understand both the basis and have a general idea of the technique. I really wish you luck and hope you find your answers. That is, if you are truly interested in learning about the technique vs. finding the one certain thing you can use to bash and finally dismiss it. In the meantime, we'll continue getting our patient's better in a safe, sound manner.
_____________________________
Eric Yarrington, PT, MPT, OCS
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Re: Total motion release - August 15, 2006 5:19:00 AM
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gerry
Posts: 235
Joined: July 6, 1999
From: Montgomery, AL, USA
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Drexey,
Thanks very much for your post. I appreciate the effort and time you spent putting those thoughts together. Your explanations were concrete and specific. More importantly to me, the tone of your writing is helpful. It gives me at least an idea of what TMR is about. Before your post, I was thinking there must be some sort of form everyone had to sign when taking this course promising not to tell others anything specific about the techniques.
Perhaps the one comment of yours that I appreciated the most was calling the "Fab-5" nutty-named. I have trouble giving serious consideration when "cutsie" type of names like those are used.
Thanks again.
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Re: Total motion release - August 15, 2006 5:23:00 AM
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Drexey
Posts: 4
Joined: August 12, 2006
From: St. Petersburg Florida
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proud,
You are the reason I rarely post comments on PT websites. You and several others asked for more specific examples in case studies using TMR which I did my best to provide. Just what are you so "proud" of - your sarcastic "wit" and ability to ridicule? I will not respond to your comments but wish you well in your chosen profession and sincerely hope that after 45 years you too have the satisfaction of knowing that you did your best for your patients everyday.
Peace
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Re: Total motion release - August 15, 2006 6:02:00 AM
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PainFree
Posts: 83
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Everyone, thanks for your time in giving us some examples of TMR. I, for one, enjoyed the comments of everyone with the sole exception of Proud.
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