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RE: manual therapy courses - February 7, 2012 5:12:58 PM   
Sheld505

 

Posts: 64
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Proud,

In regards do your question #1) The way I look at things is this: Does a joint move like it should? Too much? Too little? Is it possible that too much movement or too little movement can cause pain? I'm well aware of the studies re: inter-rater reliability with palpation. I think the problem with palpation in general is that there are too many schools of thought, ways of grading, etc, so we have a hodgepodge of different rating systems for joint motion. But yes, I'm aware. I do it one way all the time and that improves intra-rater reliability, no? #2) Yes, but this is not the basis of approach #3) I don't disagree with your reference. You've provided evidence that non-specific treatment works. I would hope you treat the region involved though, say chicago roll for lumbar pain and not a t-spine manip. There are numeous case studies out there that support specific treatments too. I have examples of clinical scenarios that have worked for me. As far as MRI, I'm not worried about that unless red and yellow flags are present. When patients ask me if I've seen their MRI or want to see it, 99% of time I say no.
In regards to your answers to my questions #1) I just wanted to see it in writing that you do manual therapy. I think it's important that the OP know that manual therapy forms a .good basis for anything. I guess I would ask you why Mulligan and not Paris or NAIOMT or Maitland or EIM? Better outcomes? I'm really just wondering. In my case, I do a lot of manual therapy and therapeutic exercise, a lot less detailed in regards to pain. #2) Agree. #3)Fair enough. #4) Also, fair enough.
Seems like we agree for the most part. And I thank you for the references. As I stated earlier, I'd consider myself novice in terms of years practiced. If I thought there is only one approach, I would not have gone through USA and then gone through NAIOMT.NAIOMT does sound like it has evolved since your experience. After these discussions, I realize that I need to dig a little deeper with Butler and Moseley. I think manual therapy has a definite place in PT and is here to stay, general or specific or whatever. Having a good understanding of biomechanics has served me well. Having a better understanding of pain seems like it has served you well and I'll continue my studies.
Anyway, thanks again.

(in reply to proud)
Post #: 21
RE: manual therapy courses - February 7, 2012 5:47:33 PM   
proud

 

Posts: 1834
Joined: March 23, 2006
Status: offline
It's a good discussion. Let's continue:

quote:

Does a joint move like it should?


How should it move? That's not even defined. I have been practicing for 15 years, trained in manual therapy and I have placed my hands on literally thousands of patients... and joints just do not "move as they should". Some people with virtually no "joint play" have no pain and visa versa.

quote:

I do it one way all the time and that improves intra-rater reliability, no?


Yes it does but even the systematic reviews on intra-rater reliability range from extremely poor to moderate (Hujbrets 2002 is one example). Regardless of the huge problem with reliability...that is literally the least of my concerns with the notion of attempting to localize stiff or hypermobile segments. The importance of these findings lack validity and should be abandoned as model for basing any treatment approach.

quote:

Yes, but this is not the basis of approach


In reference to my question about NAIOMT teaching the PIVM/PAIV stuff. So I'll take that as a yes...with some caveats thrown in. Regardless, the foundation of NAIOMT is to teach the student grasshopper how to feel mythical creatures (and charge thousands of dollars in the process).

quote:

There are numeous case studies out there that support specific treatments too.


Yes, and there are numerous case studies that demonstrate that myofascial release and cranio-sacral therapy "work". Are you going to tell me that sutures in the skull can be mobilized with energy fields now? I am not sure what you are saying with this.

quote:

I guess I would ask you why Mulligan and not Paris or NAIOMT or Maitland or EIM? Better outcomes?


Now this is the meat and potatoes of this discussion I think. I stated I utilize spinal manipulation (sparingly...). I attended the manipalooza in 2010 with John Childs, Josh Cleland...the EIM crew.

I DO NOT utilize AT ALL what I was extensively taught in my ortho manual therapy courses here in Canada (PIPVM's PAIVM's...Hogworts school of wizardry). My experieence with Jim Meadows is he teaches/taught that stuff and as such...NOPE...no NAIOMT please....

Better outcomes? Ahhhhh...outcomes. Love this one. Probably not actually. Likely about the same overall I'd bet. But I can defend what I do using movement based manual therapy such as Mulligan/McKenzie or utilizing the concept expoused by Tim Flynn at EIM (manip and move on...no need for specificity). It's all about neuro-modulatory party tricks which likely has sub-groups for which some things work better for certain people (although this is likely more linked to beliefs and expectations rather than anything specific....that's just my opinion by the way....based on what I have read).

Education forms the foundation of my treatments with manual therapy secondary...once the patient understands a bit what is happening from a physiology perspective....

< Message edited by proud -- February 7, 2012 6:02:02 PM >

(in reply to Sheld505)
Post #: 22
RE: manual therapy courses - February 7, 2012 8:28:24 PM   
Sheld505

 

Posts: 64
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Proud,
I gotta laugh b/c I have strong and vocal disdain for cranio-sacral. There is CS "therapist" where I practice who treats post-surgical patients and doesn't even touch the affected joint. We end up seeing her "results" in our clinic. Also, a little off-topic, but I had CI trained in CS once who complained to my school b/c I told her I was not interested in something that has never been shown to exist or that is scientifically measurable.
Anyway, I understand the concept of general vs. specific. And I would say I do more general MT than specific. My example of the patient with the "kink" is one where I've used a specific technique at that segment and that patient walked out with full AROM. Also, what are your thoughts on a patient s/p ankle fx who's been in a CAM and has loss of AROM/PROM and no pain. Would you use MWM to increase DF? Are you opposed to a targeted/specific grade 5 at the affected joint? Is there not joint "stiffness" present? Do you ever use general spinal stabilization programs in patients with LBP? Specific programs? Do you think it's really a good idea to "manip and move on?" Is that approach somewhat similar to the other profession?
If it weren't for your manual therapy training, would you be where you are today? Has it been beneficial to your practice? Can you fault a newer PT for exploring? What I've come away with from our discussion is a dose of humility (thank you), a better understanding of yours and others (Sebastian, RWillcott) views and practice, and a desire to delve deeper into pain with NOI. I was in the same boat as the OP, coming from SNF to what I really wanted to do (out-patient ortho) despite the pay-cut, and the manual techniques have served me well; I still have learning to do apparently.
Thanks.

(in reply to proud)
Post #: 23
RE: manual therapy courses - February 7, 2012 9:09:37 PM   
proud

 

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Joined: March 23, 2006
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Sheld505,

You ask really good questions and I do have my answers in my head. However after a night of driving my girls to "brownies" and "sparks" and then cooking super and then getting the kids lunches ready for the next day....after seeing 15 patients...I...am.....cooked....

I'll chime in tomorrow with my two cents.

Agree with you regarding the frustration with that Cranio-sacral stuff by the way.....we have a fellow Physiotherapist in town performing that stuff and it irks me to no end.

(in reply to Sheld505)
Post #: 24
RE: manual therapy courses - February 8, 2012 10:44:09 AM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
Sheld, I can not speak for proud (he does such a good job himself), but I need to answer this:
quote:

Do you think it's really a good idea to "manip and move on?" Is that approach somewhat similar to the other profession?

Yes, it can be interpreted that way. however, it is my experience that the other profession is not very heavy on the education of pain sciences and self-care......(much like many PTs - even those who do not manipulate).

Absolutely no fault for exploring - and you already have a head start on me when I was in your situation at the start of my career. However, the money I could have saved....
Are the detailed manual ortho-skills I accumulated over the years a waste at this time? YES!
However: they helped me establish a faithful following of patients and paid many bills - now I am faced with re-teaching my "old" patients a new model....
I am positive that my palpation skills have improved since I dropped almost all manipulation from my manual techniques.

Moving away from the "operator" model to an "interactor" model has greatly benefitted my patients. And they keep referring others (always good for the bottom-line!)

(in reply to proud)
Post #: 25
RE: manual therapy courses - February 8, 2012 11:00:10 AM   
proud

 

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Joined: March 23, 2006
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quote:

Also, what are your thoughts on a patient s/p ankle fx who's been in a CAM and has loss of AROM/PROM and no pain. Would you use MWM to increase DF?


This represents something different than pain ( as you said...no pain). Yes....I would and do use Mulligan MWM

quote:

Are you opposed to a targeted/specific grade 5 at the affected joint?


I am not opposed to cavitating the talo-cural joint if that's what you mean. Although I don't do it anymore...no need generally. Recently Cleland et al included it in a study for plantar-fascitis but I find general mobilizations and neural mobilizations works rather well for this group.

quote:

Is there not joint "stiffness" present?


In this case you described...yes.

quote:

Do you ever use general spinal stabilization programs in patients with LBP?


This is a more difficult question but I will answer this way: NO.

This speaks to it:

http://www.cpdo.net/myth_of_core_stability.doc

This along with the emerging science pretty much indicates that targeted lumbar stabilization is largely a myth and we are essentially changing perceptions and addressing some cortical processes instead.

So no...none of this Tra/multifidus mumbo jumbo.

quote:

Do you think it's really a good idea to "manip and move on?" Is that approach somewhat similar to the other profession?


Why not? This apprach is the exact opposite of "the other profession". I do not convince a patient they require this, I do not advocate for further aligments or even that anything required anligment. I explain the purpose of the manipulation is to obtain a neuro-modulatory effect (using the Ctr-Alt-Del analogy). Most of the time I tell my patients they do not require this at all but there are times when I utilize it based primarily on my "best-practice" experiences and nothing else.

I make sure the patient knows the underlying mechanism and certainly they leave the clinic knowing that I do not think it's a requirement for their care at all. This is important.

quote:

If it weren't for your manual therapy training, would you be where you are today? Has it been beneficial to your practice?


Well this is a tough one. I might actually be ahead had I avoided certain Canadian ortho courses that lead to a certification from Hogworts.

But perhaps I required this kind of nonsense to force myself to think about things deeper.  

quote:

the manual techniques have served me well;


Myself also. But the underlying mechanism of what we are doing with manual therapy is what is changing.

< Message edited by proud -- February 8, 2012 11:03:31 AM >

(in reply to proud)
Post #: 26
RE: manual therapy courses - February 9, 2012 10:21:41 AM   
jesspt

 

Posts: 182
Joined: April 4, 2007
From: Illinois
Status: offline
quote:

ORIGINAL: proud

It's a good discussion. Let's continue:



quote:

I do it one way all the time and that improves intra-rater reliability, no?




In reference to my question about NAIOMT teaching the PIVM/PAIV stuff. So I'll take that as a yes...with some caveats thrown in. Regardless, the foundation of NAIOMT is to teach the student grasshopper how to feel mythical creatures (and charge thousands of dollars in the process).




I DO NOT utilize AT ALL what I was extensively taught in my ortho manual therapy courses here in Canada (PIPVM's PAIVM's...Hogworts school of wizardry). My experieence with Jim Meadows is he teaches/taught that stuff and as such...NOPE...no NAIOMT please....

Better outcomes? Ahhhhh...outcomes. Love this one. Probably not actually. Likely about the same overall I'd bet. But I can defend what I do using movement based manual therapy such as Mulligan/McKenzie or utilizing the concept expoused by Tim Flynn at EIM (manip and move on...no need for specificity). It's all about neuro-modulatory party tricks which likely has sub-groups for which some things work better for certain people (although this is likely more linked to beliefs and expectations rather than anything specific....that's just my opinion by the way....based on what I have read).

Education forms the foundation of my treatments with manual therapy secondary...once the patient understands a bit what is happening from a physiology perspective....


Proud,

My experience with Jim Meadows has been similar. As of two years ago, PIVMs, PIAVMs were a large part of the treatment paradigm, although from my understanding, there is considerable variability in course content based on who is instructing the course. As of that time, NAIOMT did not have a consistent course "manual" that all instructors used.

Also, Meadows uses what he describes as the "Phase-Transition" model, and he stresses that it is only a model, meaning that it is helpful in explaining what he sees in the clinic, but likely does not accurately describe what is going on in vivo. I'll attach a newsletter where he describes his approach in another post.

_____________________________

Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy

(in reply to proud)
Post #: 27
RE: manual therapy courses - February 9, 2012 10:26:14 AM   
jesspt

 

Posts: 182
Joined: April 4, 2007
From: Illinois
Status: offline
http://swodeam.com/newsletter/

This link will take you to Jim's newsletter page on his web site. Newsletter number 3 described his Phase Transition approach.

I couldn't figure out how to directly attach the PDF.

_____________________________

Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy

(in reply to jesspt)
Post #: 28
RE: manual therapy courses - February 9, 2012 2:05:28 PM   
proud

 

Posts: 1834
Joined: March 23, 2006
Status: offline
Yep....that's Jim Meadows.

Cognitive dissonance <....click.

Perhaps considering the mounting evidence that even some of the original spinal stabilizations researches now acknowledge (Hides I think) should be considered in Jim's "model"....

(in reply to jesspt)
Post #: 29
RE: manual therapy courses - March 7, 2012 12:17:50 AM   
ajoe

 

Posts: 9
Joined: March 6, 2007
Status: offline
stacejannel

Your lack of input is understandable. This endless debate is often times the result of a forum such as this. Back to the question to which you asked. I have been to a number of the mentioned courses discussed [ad nauseum] and I agree they all have value, however I seem to personally enjoy far less "canned" courses.

To keep things simple and to the point [i like simple]

The CervicoThoracic Complex - William Hanney, PT, PhD, ATC through Therapy Network Seminars
Very sharp guy and the course was organized, evidence based and focused on treating the person and not the parts.
https://www.tnseminars.com/home/courses/CERVICAL





It doesn't appear that there are too many dates scheduled for this year but he is teaching a Core Stabilization course which he mentioned at the course I attended in New Jersey which I plan on taking this year as well.

https://www.tnseminars.com/home/courses/core

Best of luck to you in your transition and don't be put off by the trail of dialogue you started. All part of this great forum.

(in reply to stacejannel)
Post #: 30
RE: manual therapy courses - March 9, 2012 1:11:25 PM   
grifffdog

 

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Joined: July 22, 2008
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Reading above discussion ,I could not resist this.


False dilemma From Wikipedia, the free encyclopedia (Redirected from Fallacy of the excluded middle)
Jump to: navigation, search A false dilemma (also called false dichotomy, the either-or fallacy, fallacy of false choice, black-and-white thinking, or the fallacy of exhaustive hypotheses) is a type of logical fallacy that involves a situation in which only two alternatives are considered, when in fact there are additional options (sometimes shades of grey between the extremes). For example, "It wasn't medicine that cured Ms. X, so it must have been a miracle."

False dilemma can arise intentionally, when fallacy is used in an attempt to force a choice (such as, in some contexts, the assertion that "if you are not with us, you are against us"). But the fallacy can also arise simply by accidental omission of additional options rather than by deliberate deception (e.g., "I thought we were friends, but all my friends were at my apartment last night and you weren't there").[citation needed]

In the community of philosophers and scholars, many believe that "unless a distinction can be made rigorous and precise it isn't really a distinction."[1] An exception is analytic philosopher John Searle, who called it an incorrect assumption which produces false dichotomies.[2] Searle insists that "it is a condition of the adequacy of a precise theory of an indeterminate phenomenon that it should precisely characterize that phenomenon as indeterminate; and a distinction is no less a distinction for allowing for a family of related, marginal, diverging cases."[2] Similarly, when two options are presented, they are often, though not always, two extreme points on some spectrum of possibilities; this can lend credence to the larger argument by giving the impression that the options are" mutually exclusive", even though they need not be.[citation needed] Furthermore, the options in false dichotomies are typically presented as being"collectively exhaustive", in which case the fallacy can be overcome, or at least weakened, by considering other possibilities, or perhaps by considering a whole spectrum of possibilities, as in fuzzy logic.[citation needed]



[edit] Examples[edit] Morton's ForkMorton's Fork, a choice between two equally unpleasant options, is often a false dilemma. The phrase originates from an argument for taxing English nobles:

"Either the nobles of this country appear wealthy, in which case they can be taxed for good; or they appear poor, in which case they are living frugally and must have immense savings, which can be taxed for good."[3]
This is a false dilemma and a catch-22, because it fails to allow for the possibility that some members of the nobility may in fact lack liquid assets as well as the probability that those who appear poor also lack liquid assets.

[edit] False choiceThe presentation of a false choice often reflects a deliberate attempt to eliminate the middle ground on an issue. Eldridge Cleaver used such a quotation during his 1968 presidential campaign: "You're either part of the solution or part of the problem."[4] Another example would be the former US president George W. Bush stating that the world had a choice to make; "Either you are with us, or you are with the terrorists."[5] A common argument against noise pollution laws involves a false choice. It might be argued that in New York City noise should not be regulated, because if it were, the city would drastically change in a negative way. This argument involves assuming that, for example, a bar must be shut down for it to not cause disturbing levels of noise after midnight. This ignores the fact that the bar could simply lower its noise levels, and/or install more soundproof structural elements to keep the noise from excessively transmitting onto others' properties.

[edit] Black-and-white thinkingSee also: Splitting (psychology)
In psychology, a related phenomenon to the false dilemma is black-and-white thinking. Many people routinely engage in black-and-white thinking, an example of which is someone who labels other people as all good or all bad.[6]

[edit] Falsum in uno, falsum in omnibusThe Latin phrase falsum in uno, falsum in omnibus which, roughly translated, means "false in one thing, false in everything", is fallacious in so far as someone found to be wrong about one thing, is presumed to be wrong about some other thing entirely.[7] Arising in Roman courts, this principle meant that if a witness was proved false in some parts of his testimony, any further statements were also regarded as false unless they were independently corroborated. Falsus is thus a fallacy of logic. The description that an initial false statement is a prelude to the making of more false statements is false, however, even one false premise will suffice to disprove an argument. This is a special case of the associatory fallacy.

It must be noted that falsum in uno, falsum in omnibus status as a logical fallacy is independent of whether it is wise or unwise to use as a legal rule, with witnesses testifying in courts being held for perjury if part of their statements are false.

(in reply to ajoe)
Post #: 31
RE: manual therapy courses - March 14, 2012 8:19:56 AM   
stacejannel

 

Posts: 10
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Thanks for the useful input, ajoe, much appreciated. I'll bookmark the site and see if any of their classes come a little closer to home for me. Thanks again.

(in reply to grifffdog)
Post #: 32
RE: manual therapy courses - May 15, 2012 3:55:34 PM   
ptim

 

Posts: 97
Joined: September 27, 2006
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McKenzie Method, you'll get the extremities on part c and d now

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Post #: 33
RE: manual therapy courses - October 11, 2012 11:12:16 AM   
stpowers

 

Posts: 2
Status: offline
Hello All,

I am a Physical Therapist and i am here to be a part of this discussion forum. Hoping that it might be very helpful one to all the members here.

Regards,
Stephanie Powers.
----
Click pta training chicago | physical therapy assistant chicago

(in reply to proud)
Post #: 34
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