|
|
RE: Neck Pain
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
RE: Neck Pain - February 29, 2008 7:20:28 PM
|
|
|
Kaden
Posts: 243
Joined: June 17, 2007
Status: offline
|
Bob,
Good points. I do think some of your statements bring up the question of when is preventitive care good and when does it border on excessive. For me there would need to be better evidence of which individuals with LLD will eventually develop compensations in other parts of the chain.
It is one thing to acknowledge that a "norm" can lead to biomechanical faults and it is quite another to assume they all will and we must treat these in a preventitive nature. The former at least makes us aware of remote causes of biomechanical pain while the latter leads to excessive expensive treatment to patients lacking in clinical evidence.
|
|
|
|
|
RE: Neck Pain - February 29, 2008 7:37:14 PM
|
|
|
bobmfrptx
Posts: 39
Joined: December 12, 2006
Status: offline
|
kaden
Agreed. Determining the latter is the rub.
|
|
|
|
|
RE: Neck Pain - February 29, 2008 10:07:59 PM
|
|
|
steve
Posts: 448
Joined: May 14, 2003
From: victoria, bc Canada
Status: offline
|
Quoting Bob
The question is when will it become a problem. Degenerative changes associated with compensatory mechanisms of the body likely will occur if not abolished by allowing the client to return to as near a physiological state of rest posture as possible. Walking on an unlevel base with the body reading S2 as COG will lead ot head tilt, via optical righting, and mid foot collapse due to the bodies attempt to level the pelvis and S2.
We can manually correct these conditions via gentle handling techniques designed to restore proper neurodynamics or let the medical doctors read studies like this:
http://www.newsmax.com/health/Acupuncture_Back_Pain/2007/09/25/35438.html
and lose our referral base.
Quite the interesting perspective - the reason we as a profession are so frequently disregarded with respect to our interventions is the rampant use of multiple unreliable assessments and using these findings to guide treatment interventions that supposedly fix problems that have an unknown contribution to pathology. Throw in huge variations in practice patterns across therapists and then have them participate in a study like the one you quote and our treatment effect is invariably little to none. To argue that the treatment philosiphies you suggest would help our image within the medical world is questionable at best.
I can understand the appeal of these theoretical models you are using - they provide a nice package to understand why patients have pain and provide a nice easy way to "Fix" that pain. I would even argue that for a subgroup of the individuals that you treat they are effective but probably not because of the rational that they are applied. The truth of the matter is we are so far from understanding the pathology and the multifactorial contributions to the vast majority of our patients pain experience that using the system you propose is laughable and in all likelihood contributes to increasing unwarranted fear avoidance beliefs given a pathological posture diagnosis.
Whats next - checking the level of the testicles?
Steve
|
|
|
|
|
RE: Neck Pain - March 1, 2008 11:18:31 AM
|
|
|
bobmfrptx
Posts: 39
Joined: December 12, 2006
Status: offline
|
quote:
ORIGINAL: steve
Quoting Bob
Quite the interesting perspective - the reason we as a profession are so frequently disregarded with respect to our interventions is the rampant use of multiple unreliable assessments and using these findings to guide treatment interventions that supposedly fix problems that have an unknown contribution to pathology. ..........
I can understand the appeal of these theoretical models you are using - they provide a nice package to understand why patients have pain and provide a nice easy way to "Fix" that pain. I would even argue that for a subgroup of the individuals that you treat they are effective but probably not because of the rational that they are applied.
Whats next - checking the level of the testicles?
Steve
Steve...
Do not include me in ....the we as a profession speech.....Shake and bake exercise approaches to a neuromuscular proprioception problem which generally substitutes for authentic physical therapy is not what I do.
I have been treating clients for over 26 years...the last 21 with the approach I use now....I am well regarded in the region in which I practice... I have a waiting list of 30 days. My referral base is across the state. In fact clients drive over 140 miles to see me, not because it s me, but rather that as you rightly speculate...the methods I use work.
The rationale is based on form follows function and the adverse neural tension leads to associated postural changes and biomechanical compensatory faults which lead ultimately to the typical wear and tear problems we blame on aging. I do not fix anyone!!! I provide an environment that allows the body return to homeostasis via its own inherent corrective mechanism thru movement and increased awareness of the bodies protective bracing patterns.
As for testicles....mine are hanging right out there if you wish to check.
Bob
|
|
|
|
|
RE: Neck Pain - March 1, 2008 12:14:10 PM
|
|
|
Crevidence
Posts: 138
Joined: November 16, 2007
Status: offline
|
Bob,
You will not win an argument with steve. He applies logic and reason.
Who is this Rocabado master you serve?
|
|
|
|
|
RE: Neck Pain - March 1, 2008 1:50:01 PM
|
|
|
Crevidence
Posts: 138
Joined: November 16, 2007
Status: offline
|
quote:
ORIGINAL: Kaden
Remember, it may be the norm but it could also be pathological.
My thoughts regarding the normal comment:
Why don't physicians cut off freckles in pt.’s with skin cancer? Freckle=normal discolored brown spot on skin.
Example:
Pt. has a normal discolored brown spot on skin (not falling into ABCDE rule)
Pt.’s with normal discolored brown spot of skin may have cancer
Pt. may have cancer
That doesn’t seem like a sound way to approach a normal discolored brown spot on the skin for a physician, let alone possibly cut the freckle off.
A normal discolored brown spot (freckle) could be likened to other normal clinical presentations. Perhaps even the presence of a normal leg length discrepancy.
A freckle could have cancer cells. A normal LLD could maybe, possibly, potentially contribute to neck pain.
LLD Example:
My pt. has a normal leg length discrepancy (say <10mm)
Pt.’s with normal leg length discrepancies may have neck pain
Therefore my pt. may have neck pain
This does not seem sound. The LLD pt. may have neck pain but people with attached earlobes or a normal Q angle may also have neck pain.
Conversely another example:
My pt. has neck pain
Pt.'s with neck pain may have normal leg length discrepancies
Therefore my pt. may have a normal leg length discrepancy.
This is interesting because a lot of people have normal leg length discrepancies. Does this mean I should treat it for neck pain? Some PT’s certainly feel using the above LLD example, they should give pt.'s a heel lift for these normal leg length discrepancies in regard to neck pain (even if only in certain instances). You could replace any malady for neck pain and it will look much more ridiculous.
Maybe there are appropriate times to use a heel lift instead of pretending we see very small differences in leg length and they may be meaningful. Most have probably seen some benefits of a heel lift in the clinic. Maybe there will be a time when we can evolve and intelligently use the heel lift for pt.’s with normal LLD. I am sure a long time ago some physicians cut freckles off for fear of cancer?
Example:
My pt. has characteristics that fall into a validated clinical prediction rule for neck pain (this could possibly include level of testicles)
Pt.’s falling into this rule will likely benefit from a heel lift
My pt. will likely benefit from a heel lift for his neck pain
This seems like a sound intelligent way to approach neck pain. I don't think it is worth investigating for neck pain, but back pain may be a better bet. Am I missing anything? Are there holes in the logic?
|
|
|
|
|
RE: Neck Pain - March 1, 2008 2:52:05 PM
|
|
|
bobmfrptx
Posts: 39
Joined: December 12, 2006
Status: offline
|
You have never heard of Mariano Rocabado? http://www.bodylogicaustralia.com.au/brochure/rocabado.pdf
I do not serve him I serve but One.
I am not trying to win an arguement, I am way beyond that...I'll keep cleaning up after collegues like Steve, removing heel lifts, I use them maybe one in one hundred clients, and restoring real people to real painfree function for a long long time and cost effectively I may add.
http://en.wikipedia.org/wiki/Linear_logic
Applying linear logic to a dynamic living being is only one of your percieved realities which you believe you can control.
Those of you who say it can't be done do not bother us who are doing it.
|
|
|
|
|
RE: Neck Pain - March 1, 2008 3:11:55 PM
|
|
|
Sebastian Asselbergs
Posts: 1061
Joined: September 29, 1999
From: Barrie, Canada
Status: online
|
Bob, you seem to always get stuck in this -Look how effective my approach is- mode. Did anyone dispute your effectiveness here.... Talk about the underlying model to explain why your hands-on approach could be so effective. The problem is here, you need to use scientifically plausible models. Otherwise all we have is a lot of unverifiable anecdotes. And self-congratulatory blather.
Mariano Rocabado is but a PT who teaches his ideas. And YES, before you ask: I took courses from him. A long time ago.
_____________________________
Mundi vult decipi
|
|
|
|
|
RE: Neck Pain - March 1, 2008 3:20:25 PM
|
|
|
bobmfrptx
Posts: 39
Joined: December 12, 2006
Status: offline
|
Bas,
I did mention the under lying model...neural tension, biomechanical shifts secondary to protection of the body...reflexive changes to maintain homeostasis....I thought you would like these...they are based in the neuro end of things.......
On SS Diane just used an arguement to try to lengthen a limb to see what other trophic changes occur due to the nervous systems response to freedom....less pain away from the site....
Am I wrong here?
Bob
|
|
|
|
|
RE: Neck Pain - March 1, 2008 7:03:53 PM
|
|
|
Crevidence
Posts: 138
Joined: November 16, 2007
Status: offline
|
quote:
ORIGINAL: bobmfrptx
Applying linear logic to a dynamic living being is only one of your percieved realities which you believe you can control.
Help me to understand a bit of your reality in regard to treatment.
When would you treat a LLD in regards to neck pain? What are the criteria you use to determine this?
Is the criteria faith based? Are the criteria testable? Are the measures reliable? Is it grounded in reality?
Reality= That which exists objectively.
Faith=Acceptance of ideals, beliefs, etc., which are not necessarily demonstrable through experimentation or reason
Edit: I did not use linear logic. That is very basic philisophical logic and I feel demonstrates correct thinking.
< Message edited by Crevidence -- March 1, 2008 10:01:45 PM >
|
|
|
|
|
RE: Neck Pain - March 2, 2008 12:16:51 AM
|
|
|
Sebastian Asselbergs
Posts: 1061
Joined: September 29, 1999
From: Barrie, Canada
Status: online
|
Bob please don't equate your treating the "whole body" with what Diane or anyone else does. She certainly does not go looking for LLD - either above or below the equator....
This gem really goes against everything we have been talking about at SS: "the adverse neural tension leads to associated postural changes and biomechanical compensatory faults which lead ultimately to the typical wear and tear problems we blame on aging. "
For the rest - see Crevidence's post - succinct and to the point......
_____________________________
Mundi vult decipi
|
|
|
|
|
RE: Neck Pain - March 2, 2008 1:17:32 AM
|
|
|
steve
Posts: 448
Joined: May 14, 2003
From: victoria, bc Canada
Status: offline
|
Bob,
I'm really not interested in arguing whos patient list is the longest and who can do the better job fixing people up... Therapists are busy for reasons other than getting people better, perhaps the best example of this is one of the chiropractors who boast seeing up to 400 patients per day. Sadly, the type of care you advocate will likely appeal and be effective with that same 9% of the population who are interested in getting chiropractic care.
My problem with the "I do it because it works" faulty logic system is three fold:
1) It relies on experiential learning, which, although valuable, has significant issues with recall bias. Much of the practice patterns are based on guru teaching with faulty theoretical rationale.
2) Discards, ignores and fails to incorporate the use of evidence into practice because it conflicts with the clinicians theoretical held beliefs creating a clinician who is providing less than optimal care and unwilling to change practice patterns.
3) It reflects poorly on the rest of us who are attempting to give our profession increasing credibility as the MSK provider of choice within the medical community as opposed to being a fringe alternative medicine provider.
|
|
|
|
|
RE: Neck Pain - March 2, 2008 10:19:39 PM
|
|
|
proud
Posts: 844
Joined: March 22, 2006
Status: offline
|
"Bob" is the poster child for all that is wrong with this potentially great profession. It's why we struggle as a profession.
Luckily, I work in an environment working closely with Physicians, orthopeadic surgeons etc so they see the difference in ability to communicate between and evidence based Physiotherapist and various alternative providers. They appreciate when I tell them to take a picture of a hip because one of the tests I just performed has high specificity for intra-articular pathology and I quote the research. They get that.
Unfortunately third party payors see "bob" as represetative of our profession and say..."...what is the difference between a PT, a massuer and the local chiro offering Vax-d and thermal scans...."
When will our own professional regulators create an action file on this stuff? Perhaps once our professional association removes adds for John Barns seminars from association magazines? Geesh...
Is that a direct enough " we as a profession" speech for you "bob"?
< Message edited by proud -- March 3, 2008 10:50:16 PM >
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.172
|
Printable Version
