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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 31, 2008 4:09:55 PM   
Jon Newman

 

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Hi Tom,

I get it.  So what would you tell this person?

(in reply to Tom Reeves DPT ATC)
Post #: 101
RE: Does reading my posts make you stupid? - July 31, 2008 7:06:51 PM   
PTupdate.com


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I am not sure how Tom will answer, and I get the feeling based on Jon's reply, that this topic may spin off into the posture versus no posture discussion, as I have seen some of the members of SS challenge the "posture police" line of thinking.

For what it's worth, I would personally use my own body to show how my cervical ROM is drastically reduced when slouched, and painful at end range too.  I'd display my major loss of shoulder ROM, the fact that my left index finger tingles when slouched, my jaw pops open due to the altered pull of the neck musculature, and I lose about 40% of my shoulder strength when muscle tested.  I use the analogy of driving with 10lbs of air in the tires, improper wheel balance, a hung up caliper, and an out of balance wheel.

A good explanation, even if wrong or based on poor methodolgy (such as the old MDT thoughts) can go a long way in the outcomes of the patient, even before intervention occurs.

_____________________________

John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com

(in reply to Jon Newman)
Post #: 102
RE: Does reading my posts make you stupid? - July 31, 2008 7:55:46 PM   
Bournephysio

 

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Diane, thanks for clarifying you're theory but SJ is right. You have just replaced one weak link with another. Here is a question for you. What part of your theory do you think is most likely to be wrong? What study would you do in an effort to prove your theory wrong?

Rod, thanks.

Bonez, I agree with much of your post. IF Diane's stretching technique works I suspect that it is neuromodulatory in nature. My point is that there is no solid evidence that there is significant neuromodulation happening with her technique and that link is required (that or the hypoxic link path or another unknown path) but not sufficient to determine that her skin stretching technique works based on theory alone.

(in reply to Tom Reeves DPT ATC)
Post #: 103
RE: Does reading my posts make you stupid? - July 31, 2008 10:08:52 PM   
proud

 

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One of the better, most productive and educational discussions I have seen in a while. I wonder why?

Could it be that Diane, Rod, SJ, Jon, Cory etc have all participated with respectful, well thought out comments aimed at enhancing our understanding of how things work...or if they work.

Excellent and a shining example of why all viewpoints should be discussed in one place. The key is keeping those dam knickers from getting twisted. I also would like to see Diane back here

< Message edited by proud -- July 31, 2008 10:14:17 PM >

(in reply to Bournephysio)
Post #: 104
RE: Does reading my posts make you stupid? - July 31, 2008 10:51:04 PM   
bobmfrptx

 

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This is all fascinating...quite a nice discussion.
It is my understanding diane feels the nerve gets entrapped in its own neural tunnel.  See this thread on SS to read her words.  http://www.somasimple.com/forums/showthread.php?p=56215#post56215

McKenzie when he was early in his extension theories tore my meniscus by violently hyperextending my knee in standing during his course in Westminster MD in 1983 or so...  had I known he was going to do that.geez.
His work in progress resulted in my knee surgery.
I still utilize Barnes handling and have had great results in a variety of conditions.  Proud an arm pull and cross hand releases have worked wonders for some tough epicondylitis patients.  Different theory than diane, slightly different application...same outcome???
I will continue to enjoy my reading here.
bob

(in reply to proud)
Post #: 105
RE: Does reading my posts make you stupid? - July 31, 2008 11:06:50 PM   
Tom Reeves DPT ATC

 

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Jon and John,

Yes Duffy, I would go off on nearly the same diatribe that you said,  I use phrases like I will give you $5 for every second you can hold a gallon of milk straight out in 90 dgrees of shoulder flexion with your elbow straight, if you agree to give me $1 for every second I can hold it with my elbow bent to 90 degrees.  Stuff like that makes sense to the patient.  (analogy is your head weighs the same as a gallon of milk yada yada yada)

I have seen the threads poo pooing the whole posture thing and I don't buy their arguements.  In my practice posture contributes to dozens of diagnoses that I see all of the time,  In fact, if posture were globally perfect, people lifted like they should, and had good balance, and there were no leg length discrepancies, (here we go again) I would be left treating people in car accidents.

(in reply to bobmfrptx)
Post #: 106
RE: Does reading my posts make you stupid? - August 1, 2008 12:45:32 AM   
Hpsg

 

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This is for Bourne, who commented/asked:
quote:

Diane, thanks for clarifying you're theory but SJ is right. You have just replaced one weak link with another. Here is a question for you. What part of your theory do you think is most likely to be wrong? What study would you do in an effort to prove your theory wrong?

Diane says:
quote:

Hi Doug, how's it going? Have you ferreted out all the secrets cartilage holds yet?

1. Perhaps you could explain what you mean by "Diane?s theories on ectoderm are almost completely riddled with weak or nonexistent links."
I merely sifted through the body and mentally screened out all the large (and almost surely innocent) chunks of inconsequential mesodermal derivative, about 98% of the body's tissue, all that is non-neuronal/non-neurally/ and after that first release of cells into the space between ectoderm and ectoderm, non-ectodermally derived. So I'm not sure what seems "weak" about that. It's not even "theory", it's substantiated embryology. Basic science.

2. Re: "freeing of nerves," please see above.

3. Perhaps you would be so kind as to clarify this: "thanks for clarifying you're theory but SJ is right. You have just replaced one weak link with another." I'm just not following.

4. " Here is a question for you. What part of your theory do you think is most likely to be wrong?"
Don't know yet. It's still developing. But so far I think it (by being based entirely on nervous system function) outperforms any other pain theory/treatment construct I've ever heard of, including that "pain" comes from joints (out of place), or from fascia (too tight), or from bones (out of place)...

5. "What study would you do in an effort to prove your theory wrong?"
Don't know yet. I carry Occam's chainsaw with me everywhere I go, and apply as needed to whatever impasse blocks my path to understanding what it is I do or separates my ideas from already-vetted, already- established, current-as-possible neuroscientific theories. That's all I can do for the time being. Feel free, however, to point out what you see as "weak" or "wrong" and I'll be glad to supply what basis I can for having included it.


< Message edited by Hpsg -- August 1, 2008 12:50:29 AM >

(in reply to Tom Reeves DPT ATC)
Post #: 107
RE: Does reading my posts make you stupid? - August 1, 2008 1:03:42 AM   
TexasOrtho


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quote:


1. Perhaps you could explain what you mean by "Diane?s theories on ectoderm are almost completely riddled with weak or nonexistent links."
I merely sifted through the body and mentally screened out all the large (and almost surely innocent) chunks of inconsequential mesodermal derivative, about 98% of the body's tissue, all that is non-neuronal/non-neurally/ and after that first release of cells into the space between ectoderm and ectoderm, non-ectodermally derived. So I'm not sure what seems "weak" about that. It's not even "theory", it's substantiated embryology. Basic science.


This is where your theory drifts into an uncessesary tangent Diane and presents a potential weak link as Doug describes, IMO.  You "screened out" a vital link in the chain at least in my setting.  I completely understand that damaged connective tissue doesn't always correlate well with the patients perception of what occurs.  However, there are a great many cases where there is a strong connection between the degree of tissue damage and the patient's experience.  I know you work with many patients with persistent pain syndromes where your theory may apply more robustly.  However being on the more acute end of the management spectrum, I assure you there are relationships between connective tissue damage and nociception.  The primal issue I have with this aspect ofyour theory is that it isn't neccessarily wrong, just incomplete. 

This is one of the prerequisites of a sound theory.  Doug mentions another: fallability.  Here is the list I've utilized in the past courtesy of my close dead friend, Carl Sagan:

-Wherever possible there must be independent confirmation of the facts.
-Encourage substantive debate on the evidence by knowledgeable proponents of all points of view. Arguments from authority carry little weight (in science there are no "authorities").
-Spin more than one hypothesis - don't simply run with the first idea that caught your fancy.
-Try not to get overly attached to a hypothesis just because it's yours.
-Quantify, wherever possible.
-If there is a chain of argument every link in the chain must work.
-"Occam's razor" - if there are two hypothesis that explain the data equally well choose the simpler.
-Ask whether the hypothesis can, at least in principle, be falsified (shown to be false by some unambiguous test). In other words, it is testable? Can others duplicate the experiment and get the same result?

< Message edited by TexasOrtho -- August 1, 2008 1:55:34 AM >


_____________________________

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

(in reply to Hpsg)
Post #: 108
RE: Does reading my posts make you stupid? - August 1, 2008 2:35:50 AM   
SJBird55

 

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Diane... just respond without all the quote crap - that huge white box is a visual irritant and actually causes a headache.  Quit playing games and acting as though you aren't posting - it's getting a little old.

(in reply to TexasOrtho)
Post #: 109
RE: Does reading my posts make you stupid? - August 1, 2008 3:22:53 AM   
Hpsg

 

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TO said:
quote:

I completely understand that damaged connective tissue doesn't always correlate well with the patients perception of what occurs. However, there are a great many cases where there is a strong connection between the degree of tissue damage and the patient's experience. I know you work with many patients with persistent pain syndromes where your theory may apply more robustly. However being on the more acute end of the management spectrum, I assure you there are relationships between connective tissue damage and nociception.


Here is Diane's response:
quote:

Deja vu? We've been through this. Mesoderm can't communicate injury. It needs a line, and that line is a neural connection. This is well demonstrated by the example provided by people, children, who are born with no nociceptive capacity and usually die young from horrible injuries they couldn't feel happening. Their mesoderm works fine - muscles/ bones/ etc. form properly and are hooked up with motor output, but they have no "incoming." It's called congenital insensitivity to pain; another version is congenital indifference to pain. If mesoderm had anything to do with signalling anything, these people would not exist. Their disorder is genetic and has to do with the signalling system, i.e., the nervous system.


< Message edited by Hpsg -- August 1, 2008 3:27:04 AM >

(in reply to SJBird55)
Post #: 110
RE: Does reading my posts make you stupid? - August 1, 2008 3:46:10 AM   
TexasOrtho


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Diane if you don't stop quoting yourself, I'm going to start referring to you as Chris Gaines. 

Right we have been through this discussion before Diane.  Unfortunately, you just spent 98% of your response referencing a syndrome that is incredibly rare.  I typically see things that are...well common.  By common, I mean circumstances where there is a connection between tissue damage and the resulting nociception.    

To illustrate my example, it is unlikely a female basketball player would spontaneously develop lateral ankle pain, swelling, and the inability to bear weight though the LE in the absence of a connective tissue injury associated with a lateral ankle sprain.  I'm no neurologist, but I don't think I could generalize this clinical scenario to someone with a congenital insensitivity to pain.  I am prepared to be wrong so here we go.

Can you explain how your theory explains and would address the above clinical case?  Not to sound too sarcastic, but a lateral ankle sprain is a bit more common in my neck of the woods than congenital insensitivity to pain.  I think if we can begin to generalize your theory to encompass a broader spectrum of clinical presentations, you might have fewer people asking "Where's the beef?".

I will offer up a sincere admission here:  Since meeting Diane I have identified many more dysfunctions of peripheral nerves and their cutaneous branches this year than I ever had before and it has helped my management of pain tremendously.  I think elements of this theory are sound, but there is so much more that can be drawn from the well. 

By the way Diane.  Shouldn't it actually be called a congenital insensitivity to nociception? Can you really have an insensitivity to pain?  Seems like you'd need to be missing a brain for that to occur.  See I do pay attention.

< Message edited by TexasOrtho -- August 1, 2008 3:56:33 AM >


_____________________________

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

(in reply to Hpsg)
Post #: 111
RE: Does reading my posts make you stupid? - August 1, 2008 4:26:50 AM   
Hpsg

 

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TO,
quote:

it is unlikely a female basketball player would spontaneously develop lateral ankle pain, swelling, and the inability to bear weight though the LE in the absence of a connective tissue injury associated with a lateral ankle sprain. I'm no neurologist, but I don't think I could generalize this clinical scenario to someone with a congenital insensitivity to pain. I am prepared to be wrong so here we go.

Can you explain how your theory explains and would address the above clinical case?


Diane says (large font):
quote:

Yes, this is common. The injury has become a nociceptive driver. But "common" doesn't account for variables, like the congenital insensitivity to pain. So one can't accept the theory that every case of pain had to be preceeded by an injury. "Nociception is not necessary or sufficient to cause pain." And apparently, as in the example I provided, pain isn't possible without nociception.

The point here is that an ankle sprain pain would be impossible without nociceptive fibers from ankle to cord, capable of doing a job. The ankle doesn't produce the pain. It gets injured, but it is innocent in pain production, as is all mesoderm. The neural fibers IN the mesoderm that also get injured are the complainers.

quote:

Unfortunately, you just spent 98% of your response referencing a syndrome that is incredibly rare.


quote:

(Would you have been more happy with 97%?)
It's not "unfortunately" IMO... Just because it's rare (and many nervous system syndromes are) doesn't mean they are irrelevant or that they can be learned from or that theories cannot be coaxed out of their existence or that you can rule it out.
In fact, Occam's Chainsaw is needed to cut out all the false hypotheses that do nothing to account for variables such as these - to rule them out you have to account for them first. How would a pain theory based on "Importance of Mesoderm" (IOM) or "Mesoderm First Always" (MFA) account for a variable like this? I doubt it could but I'm open to hearing one.

Remember, Occams Razor is for cutting away all the hypotheses that do NOT account for all the variables.


quote:

Shouldn't it actually be called a congenital insensitivity to nociception?

quote:

I think so.
quote:

Can you really have an insensitivity to pain?
quote:

It seems so - in that case it's called Congenital Indifference to Pain. People with this can feel something they agree is "pain," but they don't care. It can't bother them. Their threshold is not merely high, it's like it's nonexistent.

(in reply to TexasOrtho)
Post #: 112
RE: Does reading my posts make you stupid? - August 1, 2008 4:26:50 AM   
Bournephysio

 

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Hi Diane,

Things are going well. Pretty hectic, I'm trying to get a bunch of data together for a conference next week. I'm still working on the secrets of cartilage. In fact, I'm off to Montreal before the end of the year to study cartilage regeneration.

I'll get to your points in time (need to get my presentation done). I did want to quickly respond to one comment though:
"Mesoderm can't communicate injury."
It can and does. It does need a line to communicate and eventually that has to be through the nervous system. For example cartilage communicates with the synovium via the synovial fluid. I suspect chondrocytes communicate directly to the nerves in the synovium as well as indirectly through the synoviocytes.

Doug

(in reply to TexasOrtho)
Post #: 113
RE: Does reading my posts make you stupid? - August 1, 2008 5:26:46 AM   
TexasOrtho


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Diane. I'm trying not to have a congenital indifference to your latest posting style (enlarged quoted font).  Now it seems like you are yelling with a speech impediment.  So be it...

You said the injury "has become the nociceptive driver".  Without realizing it you just made my point that their is a primacy to the injury itself and therefore warrants more attention than your theory provides.  Without addressing all the other clinical sequelae of an ankle sprain such as limited dorsiflexion, the fact we acknowledged the paitents pain does little to resolve the problem.  We may disagree on this point, but the absence of pain does not indicate the problem is resolved.  Residual deficits can and often do persist and must be addressed.  Again, I see your theory as complimentary rather than a substitute for our current perspective on issues like this.

I have a young lady with a distal radius and ulnar fracture (8 weeks out).  Prolonged immobilization.  Significant loss of motion into pronation and wrist extension and VERY little pain.  There is a significant limitation in DRUJ and radiocarpal accessory movement again with no pain and VERY firm end-feels compared to the other wrist.  Today we performed very vanilla DRUJ mobilizations resulting in significant increase in pronation.  Can you explain how or if a skin-based treatment could have accomplished the same thing?

You can choose to keep quoting Diane if you choose, but you should realize we are attempting a legitimite dialogue with you.  We are also advocating your transparent participation as "Diane" in the discussion.  It might be nice to reciprocate.  If you can't, so be it.  This thread will exist long after it ends and others will see how the discourse proceeded.  I have nothing to hide from my interaction on SS and neither should you over here.  We're all adults here...show us what you've got.

< Message edited by TexasOrtho -- August 1, 2008 5:32:26 AM >


_____________________________

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

(in reply to Bournephysio)
Post #: 114
RE: Does reading my posts make you stupid? - August 1, 2008 6:44:42 AM   
BB

 

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Doug,

quote:

Pain science would not be very helpful on its own if there weren?t rcts validating its use in patient populations.


How does the RCT change the content of the pain science?  An RCT only confirms or refutes the phenomenon.  It doesn't add to it or take away from its content or usefulness.  It only describes its effect.  New question:  What does an RCT provide us?

Also, Rod, I'm still curious as to your answer to my last question.

I hope my quote didn't give you a headache.

Cory

(in reply to Tom Reeves DPT ATC)
Post #: 115
RE: Does reading my posts make you stupid? - August 1, 2008 12:38:51 PM   
TexasOrtho


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You are right Cory...The fact they don't add or take away from content makes them pretty worthless. It's a pretty convenient attitude given the current state of evidence.  There are no quality clinical studies so there must be no need for them right?  I get it...the theory is impervious to questioning which might lead to its modification. 

The purpose of an RCT isn't to change the content of a pain or any other science.  If that's what you think, I may have discovered the problem. The purpose is to reveal measurable observations which may lead to a refinement of the theory. This could include a change or it could lend support for the status quo.  The bottom line is we wouldn't be able to make credible modifications without these measurable observations most of us recognize as evidence

Incidentally, there have been nearly 90 randomized clinical trials in the Journal of Pain over the last 13 years.  They don't add or take away from our understanding, so please feel free to disregard them.  I'll inform the editor of your declaration and I'm sure he/she will get right on it.

Help me out. I could have sworn I answered your last question back on post #79.  If not, please remind me what your next question was.  I never said the quotes are giving me a headache.  You must be at your old tricks of misreading my posts again.   

< Message edited by TexasOrtho -- August 1, 2008 12:56:06 PM >


_____________________________

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

(in reply to BB)
Post #: 116
RE: Does reading my posts make you stupid? - August 1, 2008 2:48:05 PM   
Jon Newman

 

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Luke and I were discussing some of the notions about theory and practice being discussed here.   For example, in relation to thoughts such as these expressed by Sj--

quote:

Moseley has completely changed treatment for soldiers returning from Iraq with amputations by his work with the mirror box. I believe the Army has a large study occurring on mirror therapy for the soldiers. Moseley has published work on education and chronic pain. I use his work all the time with patients. Just last week, I had a guy with chronic low back pain and radiculopathy attend physical therapy - the physiatrist checked the box "fair" potential. I'm thinking... ugggh.... Off work for over a month, severe pain, radiating pain, inability to maintain any position of any length of time, allodynia - yep, had failure all over it. But.. I took a deep breath and put Moseley's work into action. NOT all of it, I just do what I think is needed by the patient AND I spoke about some research on the low back, incorporated a version of the slump test, incorporated some lumbar stretching into rotation and a bit of directional preference --Sj


--Luke had some insights that he gave me permission to reproduce here.

quote:

Mirror therapy was invented by Ramachandran and was the product of applied theory. A recent Topical Review on mirror therapy published by Moseley et al in PAIN states, "the overwhelming majority of positive data comes from anecdotal reports". So, this "complete change in treatment for soldiers" (if this is actually true), is essentially based almost entirely on theory and anecdote.

Moseley's outcome study on pain education included only one measure that most of us would consider relevant to our the bulk of our patients -the RMDQ. A clinically significant change in disability scores was not found in this study. So, the effectiveness of this intervention for pain and disability, is essentially based almost entirely on theory and anecdote.

Personally, I am comfortable with the use of both of these interventions, but not because of the outcomes evidence base. I am comfortable with other interventions lacking such an evidence base for the same reasons. This doesn't mean I think stasis of this situation is satisfactory.

The final comments may be reflecting a common misunderstanding regarding the applicability of evidence. It is surprising how frequently researchers, in both diagnostic accuracy and outcome studies, fail to include subject populations representative of the average PT patient, practitioners representative of the average practitioner, or both. Unless you and your patients 'fit' the study design the data will not be relevant to your practice. The seeming comfort with modifying a treatment on which a study's data refers to is another concern for those interested in evidence-based practice. You can't "put Moseley's work into action (but) NOT all of it", "incorporate a version of the slump test", and use "a bit of directional preference" and still claim to be applying the evidence base. As soon as you fall outside of the characteristics of the practitioners used in a study (education, experience, body strength for some techniques, etc), your patient's characteristics were not represented in the study population, or you alter the intervention in any way, you are firmly in the territory of applying theory in your practice rather than evidence; that is, the theory that 'close enough', or 'a little bit similar to', equals 'exactly the same as'. Such an assumption regarding the transferability of research data is not likely to be valid.


Please discuss.

< Message edited by Jon Newman -- August 1, 2008 3:16:22 PM >

(in reply to Jon Newman)
Post #: 117
RE: Does reading my posts make you stupid? - August 1, 2008 3:00:39 PM   
Hpsg

 

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To TO:
quote:

You said the injury "has become the nociceptive driver". Without realizing it you just made my point that their is a primacy to the injury itself and therefore warrants more attention than your theory provides.


Diane says:
quote:

After a couple years have gone by, I doubt it requires any attention whatsoever. Limited dorsiflexion? I'd pay some close attention to the superficial peroneal nerve, but that's it.


She said something else, indicating she was getting tired of this thread. I won't repeat what she said. It had to do with cults and kissing a----.

To Doug:
quote:

"Mesoderm can't communicate injury."
It can and does. It does need a line to communicate and eventually that has to be through the nervous system. For example cartilage communicates with the synovium via the synovial fluid. I suspect chondrocytes communicate directly to the nerves in the synovium as well as indirectly through the synoviocytes.


Diane says,
quote:

Thanks Doug. Yes, little mesodermal derivative cells can talk to each other, but the message does not travel far, won't be heard by the organism as a whole. Neurons are needed for that. There are only three neurons spanning the distance between big toe and sensory association cortex. Glia aside, if a neuron soma were blown up to be the size of a tennis ball, the axon would be a half mile long and the width of a garden hose (Nolte). That's some serious signalling span. Even so, if there is a greater threat facing the organism as a whole in that moment, the message coming up from the chondrocytes via neurons will be ignored completely. The microglia in the cord will take full note however.

(in reply to TexasOrtho)
Post #: 118
RE: Does reading my posts make you stupid? - August 1, 2008 3:04:10 PM   
TexasOrtho


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Nice...

_____________________________

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

(in reply to Hpsg)
Post #: 119
RE: Does reading my posts make you stupid? - August 1, 2008 3:52:45 PM   
SJBird55

 

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Why doesn't Luke just come and talk for himself.  These quotes from "others" is irritating. 

With regard to mirror therapy, it isn't based on theory and anectote: 

A randomized sham-controlled trial of mirror therapy for lower limb phantom pain demonstrates efficacy of mirror therapy . 
European Journal of Pain , Volume 11 , Issue 1 , Pages 206 - 207
P . Tsao , B . Chan , R . Witt , R . Howard , A . Charrow , A . McGee , P . Pasquina , K . Heilman


http://www.physiotherapy.asn.au/AJP/48-4/AustJPhysiotherv48i4Moseley.pdf 
This work and the discussion suggests single interventions are less effective and it is wiser to have some type of multimodal approach to the care provided for chronic back pain.  I will admit that I am not as familiar with the RMQD as I am the ODI or the tool I prefer to use (the spinal functional index), but since this study does compare the single interventions alone, Luke is absolutely correct that education alone might not be the perfect choice in provision of care.  It does appear to me that including education as a component of the care is beneficial.  I honestly don't believe that 4 one hour sessions are required to reap the gain of education.  Moseley's work DOES support more than just education alone.

Definitely... one can do a version of the slump test - the particular patient I was mentioning in no way could do the slump test as described due to both the amount of allodynia present AND his system's lack of tolerance.  There are times one needs to apply common sense, ya know?  And definitely, a patient can also be a candidate for directional preference - both his symptoms and his response to directional preference indicated he was a candidate for directional preference.  Because of the amount of fear this guy had, he wasn't a candidate for manipulation.  Yeah, I do apply evidence.  I may not be MDT certified... I may not be Moseley... but none of us are ever going to be like any of the researchers.  Those of us that read the literature translate that evidence into practice every day.  Is every piece of literature perfect?   No  Is every single patient a complete representation within the literature?  Nope.  what you are suggesting, Luke, is that because the literature isn't perfect and our populations don't perfectly match literature and we may not always be as qualitifed or trained as the clinicians performing in the methods section of literature, we're doomed if we try to incorporate evidence.  That's a false assumption.   

    Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain . 
    European Journal of Pain , Volume 8 , Issue 1 , Pages 39 - 45
    G . Moseley

This work nicely addresses what we are up against with patients with chronic low back pain.

Luke is probably referring to the below work:  A Randomized Controlled Trial of Intensive Neurophysiology Education in Chronic Low Back Pain.  Original Article Clinical Journal of Pain. 20(5):324-330, September/October 2004.
Moseley, G. Lorimer PhD *+++; Nicholas, Michael K. PhD ++; Hodges, Paul W. PhD *  This particular study is really cool and even though not some big RCT gives nice insight and pause to think about what we say, how we say it and how a patient perceives what they are told by others.http://blog.evidenceinmotion.com/evidence/files/moseley_2005_aust_j_physiotherapy_widespread_brain_activity_during_abdominal_task_reduced_after_pain_education.pdf I would like to politely request that posters just speak for themselves.  All the quoting and copying and pasting going on is ridiculously childish.  IF someone believes he or she has something relevant to say and wants to be heard, then that someone should just post.  Could a few of you quit the nonsense?  It is ridiculous. 

(in reply to Hpsg)
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