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RE: Does reading my posts make you stupid?

 
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RE: Does reading my posts make you stupid? - July 29, 2008 1:37:16 PM   
Sebastian Asselbergs

 

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So: I could well have been wrong about Barrett. If I was, my apologies to the Edge.

Diane WAS banned - I do not remember the the thread and date - but she was. And you are too funny: "very mean spirited to any chiropractor" - I can think of a few still posting here who have displayed that same particular behaviour. No foul language? No "kiss my *ss"?  Yet - banned....

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RE: Does reading my posts make you stupid? - July 29, 2008 2:05:21 PM   
proud

 

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Cory,

Thanks for engaging in this discussion.

I don't think I follow your interpretation of "the bridge". This just seems like a rambling mess to me:

quote:

But bridges can be used to cross lots of things, rivers, roads, other bridges.  Heck, there's no reason you couldn't use a bridge to just cross above a flat pasture if you wanted.  If you were to base your use of bridges on "successful outcomes," and your outcomes were based on what you presumed bridges were for: crossing to the other side, each instance would be a success.


I thought my suggestion was studying the 'science' of bridge building( science of why people are in pain in the first place) before actually building the bridge( attempting to get successful outcomes with those patients).

When you say:

quote:

is the bridge necessary in each circumstance?


Do you see how I don't follow?

I compared the study of bridge design to the study of pain.....while the actual building of the bridge was the outcome.

Certainly I would feel much safer on a bridge that I knew was built on a solid foundation of knowledge before the darn thing was erected. So I don't think we are far off with that reasoning.

My point was( yes...I'll just say it to avoid masquarading around.......Barrett does alot of studying but has never built that bridge...and does not appear to want to address or discuss this glaring deficiency in what he is teaching students). The mere mention of it is met with hostility.

I'm not sure the two are any better than each other. Taking a course from someone who claims great outcomes with a flawed theory( Barnes)....or someone who has a sound theory but no outcome data.....and no intention of gathering that data.



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RE: Does reading my posts make you stupid? - July 29, 2008 4:31:55 PM   
Sebastian Asselbergs

 

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There are outcome studies on MFR? I did not know that.  Or is it just a claim by Barnes?

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RE: Does reading my posts make you stupid? - July 29, 2008 4:38:56 PM   
SJBird55

 

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Both Diane and Dorko's theory has some components of a reasonable foundation, yes... I don't think it is completely solid though because it has a primarily peripheral focus which means it doesn't take into consideration the brain and the central component of pain... leaving a theory at movement and reducing deformations is too narrow of a focus, in my opinion.

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RE: Does reading my posts make you stupid? - July 29, 2008 5:00:59 PM   
proud

 

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quote:

ORIGINAL: Sebastian Asselbergs

There are outcome studies on MFR? I did not know that.  Or is it just a claim by Barnes?


Claims. I almost typed Mckenzie and definite outcomes studies....but did not have the heart( being certMDT in all). So what's worse? Taking a course from a guy who already claims that the disc model is conceptual and left it wide open to be deconstructed( and now it appears flawed) but regardless has some decent outcome/prognostic data. Assuming of course the instructors recognize the science going on. I'm not sure all are....

Or.... taking a course from someone who has proposed a treatment based on the science but makes no effort to produce data....

SJ made a good point I think that there are two ways to approach things. Perhaps Mckenzie is working backwards to arrive at the sound scientific rationale behind the treatment. And Diane is working from the opposite direction( I say Diane because I note that she is making attempts to gather data....and I think we have to respect the time it takes to do that sort of thing. ). Barrett on the other hand, is not working in any direction because he is comfortable with a sound theory and nothing else. And literally gets hostile when this gapping hole is talked about.  

Essentially 1( sound theory)+ 1( data)=2( ideal EBM). Choosing to ignore either one is just a bad idea and equally wrong.

Worse of course is someone with NO data....AND a flawed rationale( Barnes).

< Message edited by proud -- July 29, 2008 5:28:23 PM >

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RE: Does reading my posts make you stupid? - July 29, 2008 6:26:22 PM   
Kaden

 

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SJ,

Can you point me to some of Moseley's work you find most helpful in dealing with painful patients.  Having a better understanding of pain and how educating patients about this pain can help in recovery will hopefully be a focus on mine in the coming months as I find this a lacking piece of my clinical practice.

Your description of how you use his work sounds more my style, a more broad approach, short and to the point, and  without blaming specific nerves, etc.  Get the patient moving and move on from the pain aspect.  Seems like his work might be a nice place for me to start.

Thanks

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RE: Does reading my posts make you stupid? - July 29, 2008 6:39:08 PM   
TexasOrtho


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There is actually quite a lot of "evidence" (i.e. published reports) on myofascial pain.  Unfortunately it offers little useful direction as the methodologies of the studies are often oddly constructed.   I think it's a classic missrepresentation of evidence to benefit an agenda when someone simply says "there's lots of evidence" on a specific issue however.  Case in point,  there is still no unified understanding of what we call myofascial pain or myofascial trigger points, yet a huge number of well educated therapists poor time and money into perpetuating it.  They could end up being right but it certainly doesn't look that way from where I'm standing.

The McKenzie approach has both outcome studies and a plausable theoretical framework.  Despite this, it remains a controversial and sometimes contentious issue for those of us who treat spinal conditions.  It is standing the test of time (with some understandible criticism of course), because it continually tries to develop both the theoretical and objective basis.

Even with large amounts of evidence, questions still must be asked and answered without bias.  We all have bias of course, but peer reviewed evidence is our best way to reduce it's presence in our decision making. 

Here are a few interesting articles I discovered a few months ago.  I don't have the full text of the Marcus article, but I want to read it badly.

MARCUS, NORMAN MD The Horse Is Dead: Let Myofascial Pain Syndrome Rest in Peace. Pain Medicine. 9(4):466-468, May/June 2008.

Tough, Elizabeth A. MSc; White, Adrian R. MD; Richards, Suzanne PhD; Campbell, John MD Variability of Criteria Used to Diagnose Myofascial Trigger Point Pain Syndrome-Evidence From a Review of the Literature. Clinical Journal of Pain. 23(3):278-286, March/April 2007.

Niddam, David M. PhD * +; Chan, Rai-Chi MD ++ [S]; Lee, Si-Huei MD ++; Yeh, Tzu-Chen MD, PhD * [//]; Hsieh, Jen-Chuen MD, PhD * + [//] [P] Central Modulation of Pain Evoked From Myofascial Trigger Point. Clinical Journal of Pain. 23(5):440-448, June 2007.

_____________________________

Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
Movement Science Podcast and Blog

(in reply to proud)
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RE: Does reading my posts make you stupid? - July 29, 2008 8:00:51 PM   
Sebastian Asselbergs

 

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SJ, the brain is heavily involved in the theoretical model of Barrett's and Diane's concepts. And in the practical explanation of the effects.
Anything done in PT involves brain processes - THE place of interpretation of input and creation of output. The focus is on the nervous system: peripheral and central.   Or do you think that  peripheral changes in nerve deformations or corrective movement will not be processed centrally? (MDT? maybe?)

And proud, I agree that although a method may be effective, the underlying theory is essential to move our profession ahead  in real EBM fashion.

PS: Barrett's writing was going to be put in a "closed forum" - only to be read by those who would get an additional password AFTER first having to be scrutinized by Barrett. So he left.


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RE: Does reading my posts make you stupid? - July 29, 2008 10:25:02 PM   
SJBird55

 

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Bas, Diane supports skin stretching.  Unless she's changed her "theory," her intervention is focused on the skin in the periphery and focused on alleviating deformation of nerves.  Dorko argues for movement that alleviates the deformation.  Unless something has changed, both are focused on the periphery.  I've gone round and round with those two and they really do not address central, chemical, electrical, genetical (ha) or neuroplastical (ha) changes.  Both focus on "deformation" with no clue if anything is really "deformed."  They want to talk the "science" but don't even know if the "science" supports their theory.   (Outcomes is another weak area, but they can't even support that a "deformation" exists!)  Has "deformation" been seen to be present and seen to have been eliminated?  Nope.

As I said, only those Dorko chose to allow in his little area would have been allowed.  Dorko was the one complaining about those of us questioning.... he left.  Anyone can read his stuff over at SS but not everyone can post. 

Kaden:  http://www.fhs.usyd.edu.au/phy/publications/moseley_l.shtml

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RE: Does reading my posts make you stupid? - July 29, 2008 10:46:08 PM   
Tom Reeves DPT ATC

 

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THANK YOU SJ!!  I saw and read many of his posts when he was on RE and really did not get why this guy was held in such high regard.  He may be a really smart intellectual and so forth, but the dogmatic way he wrote/taught, reminded me of how some people talk about the subluxation theory.

< Message edited by Tom Reeves DPT ATC -- July 29, 2008 10:52:37 PM >

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RE: Does reading my posts make you stupid? - July 30, 2008 12:34:41 AM   
Hpsg

 

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An intervention is a "what" and a theory is a plausible "why." It shouldn't be possible to confuse the two, or conflate them (mash them together) as badly as sj appears to have.

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RE: Does reading my posts make you stupid? - July 30, 2008 1:09:33 AM   
SJBird55

 

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Moi?  confused?  LOL  Not really.  Skin stretching = intervention (a what); alleviating deformation = theory (a why)  No confusion on my part... who's confused?

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RE: Does reading my posts make you stupid? - July 30, 2008 1:38:32 AM   
TexasOrtho


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Just as there are very few flawless outcome studies, there are equally few flawless theories.  Secondly, evidence and theories are not static.  In fact, evidence often gives rise an evolution of theory.  For an interesting example, look at the development of gravitational theory dating from antiquity through quantum mechanics.  Even our germ theory has undergone modifications based on a more advanced study of immune function.

Health care isn't gravity and we are dealing with human suffering.  The endless pursuit of theory vs outcome can lead to analysis paralysis.  This is when a provider simply won't provide a specific treatment because the theoretical basis isn't water tight.  Can you imagine how many serendipitous medical innovations would have been silenced in the face of such an approach?  I'll give you a hint, look up the origins of quinine, x-rays, insulin, and the smallpox vaccine among many many others.  Their precise roles in diagnosis and therapy are still debated to this day...yet they continue to have clinical utility.

A more modern example is the questionable mechanisms surrounding statin therapy.  Statins are widely used and are arguably saving lives yet we don't fully understand why.  Should that preclude their use?  We also rely heavily on outcome studies to determine the appropriate use of anti hypertensives.  This in light of the fact we don't fully understand the mechanisms behind idiopathic hypertension.  And don't even start on cancer therapy...Should we halt the usage of these therapies until a group of great thinkers figures it all out?  If your answer is 'yes', maybe you should consider a philosophy degree.

Understanding the potential relationship between an outcome and a theory is critical, but most certainly not a prerequisite to being a good evidence-based provider.  We may provide the same measurable intervention on the same patient and get the same measurable outcome.  The fact you and I disagree over the precise mechanism of what went on can be figured out over a beer after the patient gets better.

< Message edited by TexasOrtho -- July 30, 2008 1:53:50 AM >


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Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
Movement Science Podcast and Blog

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RE: Does reading my posts make you stupid? - July 30, 2008 2:52:00 AM   
proud

 

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quote:

ORIGINAL: TexasOrtho

Just as there are very few flawless outcome studies, there are equally few flawless theories.  Secondly, evidence and theories are not static.  In fact, evidence often gives rise an evolution of theory.  For an interesting example, look at the development of gravitational theory dating from antiquity through quantum mechanics.  Even our germ theory has undergone modifications based on a more advanced study of immune function.

Health care isn't gravity and we are dealing with human suffering.  The endless pursuit of theory vs outcome can lead to analysis paralysis.  This is when a provider simply won't provide a specific treatment because the theoretical basis isn't water tight.  Can you imagine how many serendipitous medical innovations would have been silenced in the face of such an approach?  I'll give you a hint, look up the origins of quinine, x-rays, insulin, and the smallpox vaccine among many many others.  Their precise roles in diagnosis and therapy are still debated to this day...yet they continue to have clinical utility.

A more modern example is the questionable mechanisms surrounding statin therapy.  Statins are widely used and are arguably saving lives yet we don't fully understand why.  Should that preclude their use?  We also rely heavily on outcome studies to determine the appropriate use of anti hypertensives.  This in light of the fact we don't fully understand the mechanisms behind idiopathic hypertension.  And don't even start on cancer therapy...Should we halt the usage of these therapies until a group of great thinkers figures it all out?  If your answer is 'yes', maybe you should consider a philosophy degree.

Understanding the potential relationship between an outcome and a theory is critical, but most certainly not a prerequisite to being a good evidence-based provider.  We may provide the same measurable intervention on the same patient and get the same measurable outcome.  The fact you and I disagree over the precise mechanism of what went on can be figured out over a beer after the patient gets better.


Credit where it's due Rod. That was an excellent read with some excellent points I had never considered. 

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RE: Does reading my posts make you stupid? - July 30, 2008 3:38:58 AM   
BB

 

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Proud,
In my analogy the bridge is the solution, an intervention to a problem.  The river needing crossed, the problem needing a solution, is pain.  Do you see how asking the question "what is needed to cross this river?" is different from "what can we use this bridge for?" 

Rod,
quote:

Understanding the potential relationship between an outcome and a theory is critical, but most certainly not a prerequisite to being a good evidence-based provider. 


In absence of theory how would you proceed with a patient with anterior knee pain that did not fit the available outcome data and still be a good EBM provider?





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RE: Does reading my posts make you stupid? - July 30, 2008 3:50:37 AM   
TexasOrtho


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Cory, you really need to reread the portion of statment you quoted.  I never said or implied that an evidence based treatment could procede in the absence of theory.  Had I said this it would have of course been a contradiction.  I did however state that one could procede with a treatment without fully understanding "the relationships between an outcome and a theory". 

Something to consider about your last post Cory. You either misunderstood my statement OR you were angling to make a point of your own based on a missrepresentation of my post. I hate to say it, but I think you are too smart for it to be the former.

_____________________________

Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
Movement Science Podcast and Blog

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RE: Does reading my posts make you stupid? - July 30, 2008 3:59:10 AM   
BB

 

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You give me too much credit.  I see the difference in what you said and how I read it.   

I do feel you can be an effective (your patients get better and your treatments are supported) EBM provider without understanding the relationship with theory and outcome.  Good is a bit vague. 

Perhaps it would be useful to think about what the difference would be between this effective, yet non-understanding PT, and the same PT with undertanding present?


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RE: Does reading my posts make you stupid? - July 30, 2008 4:35:12 AM   
TexasOrtho


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Cory I really appreciate your acknowledgement and clarification on that point.  You asked if there would be a difference.  I could be wrong, but I think it would depend on who you ask.

To the patient? I doubt the patient really cares about the mechanisms as the outcomes would likely be similar.  This apathy is the patient's right of course, but is probably the reason sCAM-based treatments remain so popular - people don't care.  They just want to be better (and not pay a copay).  I could be biggest dumbass in the room (depending on the room of course), but if I provide the same intervention to the same patient with a less evolved sense of the theory behind it, the outcome is the same.  The patient walks away and thinks the provider was a genious.

To me? It means a lot. This is why I do try to understand the mechanisms behind what we do.  It's part of the reason many of us pursue board-certification, post-professional degrees, blog, etc...We want to know more.  We all know enough coming out of school to get-by, but for some reason we continue to look for better answers.  The fact that some disparage the manner in which others pursue the answers is a bit discouraging to me.

< Message edited by TexasOrtho -- July 30, 2008 5:04:12 AM >


_____________________________

Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
Movement Science Podcast and Blog

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Post #: 78
RE: Does reading my posts make you stupid? - July 30, 2008 5:08:54 AM   
BB

 

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My take:

To the patient:

While they may not care, it may affect thier outcome just the same.   Bone out of place thinking exemplifies that.  Let them assume a mechanism (and they will, even if they don't particularly care about it) at your own, or worse their own, peril.  What the patient thinks us (genius), while it will contribute to placebo effect, is not the outcome we are interested in, of course. 

For the therapist:

For one, when we find ourselves in the frequent position of being in front of a patient who doesn't fit any current outcome study (ie. there is no outcome data to guide your treatment) all that is left is theory.  In these situation the effective EBM therapist who understands the relationship between outcome and theory will be better equipped to proceed.  Not only that they will be more within the confines of EBM as most supported theory will still be guiding their treatment.

Follow up question:  What difference exists in clinical decision making between the effective non-understanding of theory PT, and the effective understanding one?

Cory


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RE: Does reading my posts make you stupid? - July 30, 2008 5:35:28 AM   
TexasOrtho


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quote:

ORIGINAL: BB

My take:

To the patient:

While they may not care, it may affect thier outcome just the same.   Bone out of place thinking exemplifies that.  Let them assume a mechanism (and they will, even if they don't particularly care about it) at your own, or worse their own, peril.  What the patient thinks us (genius), while it will contribute to placebo effect, is not the outcome we are interested in, of course. 



I tend to agree with this Cory and appreciate this to a greater degree since my visit with SS.  I am very careful about how I discuss mechanisms with the patients.  It's not easy and probably doesn't affect the short-term outcome, but I'd like to think it influences their long-term attitudes about MSK problems and their health in general.

quote:


For the therapist:

For one, when we find ourselves in the frequent position of being in front of a patient who doesn't fit any current outcome study (ie. there is no outcome data to guide your treatment) all that is left is theory.  In these situation the effective EBM therapist who understands the relationship between outcome and theory will be better equipped to proceed.  Not only that they will be more within the confines of EBM as most supported theory will still be guiding their treatment.


I couldn't have said this better...

quote:


Follow up question:  What difference exists in clinical decision making between the effective non-understanding of theory PT, and the effective understanding one?


I'd like to think there's a big difference otherwise I'm wasting my time with all this reading and writing!  I think clinical decision making is a reflection of one's understanding.  Heck it may just be exercise for my starving brain.

I think I'm going to sign off tonight.  I just finished writing 10 pages of case reports on the shoulder for my first course at TTU.  I'm tired and need a beer...good discussion Cory.  Hope to catch up later with it. 

_____________________________

Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
Movement Science Podcast and Blog

(in reply to BB)
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