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RE: Mesoderm, ectoderm, etc

 
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RE: Mesoderm, ectoderm, etc - May 25, 2012 11:36:57 AM   
Tom Reeves DPT ATC

 

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yup but improving. He is lifting, playing baseball. Only pain is the final few degrees of a wide gripped heavy bench rep, or having to adjust the bat at the last minute radially when swinging. He has some pain with RD and overpressure which changes with ulnar glide carpal mobs. (meso meso meso with some ecto flavoring)

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RE: Mesoderm, ectoderm, etc - May 25, 2012 7:46:36 PM   
Chocco

 

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LBDPT- I wouldn't concern yourself too much with any of "derm" stuff. As much as some people want to think they know what is going on the truth is nobody actually knows exactly what is happening at that level. It's all theory. If you want help your patients the best way possible (in my opinion) I would use the most recent evidence based THERAPY. Science itself is nothing more than assumptions based on observations. Example: If we do something 100 times and it works 95 of those 100 times then we can assume that its an effective treatment for that condition. Most of the time studies will then take that assumption and then apply it to a pre-conceived theory. I used to think you need to know why something is going on to treat it effectively, but the more I practice and the more I try to stay up to date with the most recent research the more I realize that the theory changes all the time. Theory that people are talking about now will be modified, disproved or improved and 5 and 10 years from now won't look/sound anything like it does today. Focus on "Evidence Based" techniques, exercises and other treatments. Evidence based treatment isn't all studies. Remember part of evidence based therapy is based on your own personal experience with doing techniques after all your ability/inability to perform techniques will effect your outcomes. If you want info on evidence based treatments for orthopedic conditions try the Clinical Practice Guidelines on the Orthopedic section of the APTA website ( no you don't need to be a member to get to them). The CPGs will give you good info but remember that all patients are individuals and should be treated as such. Finally I will leave you with the advice I have taped above my desk. "Use past experiences to aid you in future experiences not bias them" meaning just because something worked with one person doesn't mean it will work with everyone but knowing that it can help could be the key to helping someone in the future.
Then again that's just my theory

(in reply to LBDPT)
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RE: Mesoderm, ectoderm, etc - May 25, 2012 11:27:16 PM   
Tom Reeves DPT ATC

 

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wait for it . . .

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RE: Mesoderm, ectoderm, etc - May 26, 2012 6:11:12 AM   
proud

 

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quote:

ORIGINAL: Tom Reeves DPT ATC

wait for it . . .


Hey Tom...why don't you break down all that's wrong in that post? Presumably you follow a neuroscience approach so that should be quite easy for you.

I will say this...if there is a treatment that works 95 times out of 100 I've yet to see or hear of it.

And all I will also say is this is a typical response I hear from the majority of Physical therapists...and likley why our profession struggles to distinguish itself as truly expert.

I still utilize the buzz word "evidence based therapy" but always with an eye on the science behind the why...the "why" drives my practice.

Here's the deal:

Professionals spend more time learning principles than they do techniques; technicians spend more time learning techniques than they do principles.

I can't nail this one home any harder. The local massuesse who does cranio-sacral therapy spends NO time trying to understand why. The guru who taught him/her already told him/her how it works. And rest assurred...they DO get good outcomes. And it is certainly not because they move cranial sutures now is it? The specific flavour of myofascial release by the bearded guy we all see in ads "get's results"....but it's not from releasing emotional demons from within the fascia though is it?

Re-imbursement rates follow suit: professional vs technician. Third party payors know we haven't advanced past the technician title despite our shiney degrees.

Where I work (government)....if you can screw in a nail or match a red electrical wire to a yellow wire... you get paid about the same as a Physical Therapist.

Obviously that's wrong but in part, I know why....

< Message edited by proud -- May 26, 2012 7:01:26 AM >

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RE: Mesoderm, ectoderm, etc - May 26, 2012 12:25:36 PM   
honker23

 

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If someone can screw in a nail, they should get paid well! Just giving you a hard time proud!

I couldn't agree with you more on the distinction between technicians and professionals. However, our profession isn't the only one with this problem. Many surgeons still think along the lines of a technician and get PAID well.

Science based medicine has to be the big brother keeping EBM in line. Evidence is mostly about who paid for the study and how they crunched the numbers. EBM should be set up to test treatments that all have sound scientific rationale, hopefully showing us which technique is best. Maybe that makes no sense, but thats how I view literature.

I think about ecto and meso in this way. The smoke detector in my house goes off if there is smoke or if there is internal problems (battery dead or an electrical short). I don't know which one caused it, but if I check on the room and find no smoke/fire I assume it is internal (central or ecto driven) If I check the room and find a fire, I assume it is external (peripheral or meso driven) Right or wrong...as a PT I try to identify a treatable peripheral cause setting off the fire alarm first and if I can't, then assume something central is driving the alarm and treat with different techniques. This is where I see science and evidence helping us out. Showing us reliable methods to detect peripheral drivers vs central drivers AND giving us evidence to support our treatment methods.

(in reply to proud)
Post #: 25
RE: Mesoderm, ectoderm, etc - May 26, 2012 8:53:00 PM   
rwillcott

 

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What do you tell your patient who tells you "my back pain is becaue of a joint that is out ofplace in my spine?" If you agree with them and then perfrom PIVMS and stability tests of the lumbar spine and confirm this then you would be wrong. You will be telling the patient a lie. You will be practising is a very irresponsible way since the evidence tells us this is not correct. This is a clear example of how professionals should understand the principles rather than the technique. As a professional we are obligated to educate this patient and explain that a joint is not out of place. A technician would simply agree with patient and try to put the joint back into place. Now the patient has confirmation in their bogus belief that their spine is out of place. A nocebo effect. This will then lead to reoccurennce of back pain for the rest of their life. All because of what we said was wrong.

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RE: Mesoderm, ectoderm, etc - May 27, 2012 10:09:38 AM   
honker23

 

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Is the patient's brain ever right?

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RE: Mesoderm, ectoderm, etc - May 27, 2012 10:21:57 PM   
rwillcott

 

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There's no way to answer the question of whether a patients brain is ever right. Keep in mind though that a patients report of pan is not just based on tissue damage. It is based on their past experience, beliefs, society etc. So if they belief that their is a joint out of place in their spine and Uncle Joe hurt his back and was never the same and are experiencing chronic pain then I guess in this case their brain is wrong.

What is even more wrong is for a health professional to confirm the patient's false belief that a joint is out of place is the cause of their pain.

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RE: Mesoderm, ectoderm, etc - May 29, 2012 10:33:13 AM   
honker23

 

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I would contend that our job as a medical team is to determine if the brain is right or not.
"My leg feels broken" We need to determine if it's broken or not to optimize treatment.
"My back is subluxed" "can you feel your legs and wiggle your toes?" "You back is not subluxed...move"

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Post #: 29
RE: Mesoderm, ectoderm, etc - May 29, 2012 4:32:47 PM   
Sebastian Asselbergs

 

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You are talking about sensations and experience, analogies and metaphors that patients use.

I agree that we have to offer a more likely, plausible and accurate explanation for their complaint.

In our north american culture, the patient's brain has been bombarded so much with bogus explanations that yes, their brains are often "wrong".

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RE: Mesoderm, ectoderm, etc - May 29, 2012 7:43:25 PM   
Chocco

 

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First off let me apologize for any harshness in my tone when writing my previous post as it was more due to frustration as that was the second time writing that post after the first one was deleted

Second, I was trying to convey (admittedly poorly) is that I don't like the whole mesoderm vs. ectoderm idea. I think principles are important as they are the basis for what we do. It's the theory of what is going on the we need to be careful to not latch onto because It will be different 5 or 10 years from now then it is now. I think Chiropractors face a dilemma right know because their Clinical Doctorate is based on an (in my opinion) atiquated theory of subluxations. I think we benefit from being more fluid and adapt our theories to represent changes in evidence.  

I brought up the CPGs because I feel the APTA has made strides in pointing therapists in the right direction by weeding out innefective treatments/ ideas and promoting more effective treatments and principles without trying to pidgeon hole the profession into one theory of what is going on and so endothermists and mesothermists can grow together following the research instead of drawing lines in the sand.

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RE: Mesoderm, ectoderm, etc - May 29, 2012 8:05:05 PM   
proud

 

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quote:

ORIGINAL: Chocco

First off let me apologize for any harshness in my tone when writing my previous post as it was more due to frustration as that was the second time writing that post after the first one was deleted

Second, I was trying to convey (admittedly poorly) is that I don't like the whole mesoderm vs. ectoderm idea. I think principles are important as they are the basis for what we do. It's the theory of what is going on the we need to be careful to not latch onto because It will be different 5 or 10 years from now then it is now. I think Chiropractors face a dilemma right know because their Clinical Doctorate is based on an (in my opinion) atiquated theory of subluxations. I think we benefit from being more fluid and adapt our theories to represent changes in evidence.  

I brought up the CPGs because I feel the APTA has made strides in pointing therapists in the right direction by weeding out innefective treatments/ ideas and promoting more effective treatments and principles without trying to pidgeon hole the profession into one theory of what is going on and so endothermists and mesothermists can grow together following the research instead of drawing lines in the sand.


I appreciate this chocco.

I highly recommend reading through this thread (linked below) to understand why it absolutely is important to understand the distinction between meso and ecto. It impacts greater on how we proceed I think:

http://www.somasimple.com/forums/showthread.php?t=13008

(in reply to Chocco)
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RE: Mesoderm, ectoderm, etc - May 30, 2012 11:14:37 AM   
LBDPT

 

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Chocco,
Forgive the lateness.. thank you for your reply. LBDPT

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Post #: 33
RE: Mesoderm, ectoderm, etc - June 1, 2012 2:47:33 AM   
ginger

 

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Brilliant Transient, agree with knobs on.

_____________________________

Geoff Fisher
Physiotherapist

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Post #: 34
RE: Mesoderm, ectoderm, etc - June 1, 2012 7:15:17 AM   
proud

 

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quote:

ORIGINAL: TransientImage


Some clinicians give explanations of treatment describing interventions on embryological structures that no longer exist.


Really? Who are these "some clinicians" that work on embryologocal structures?

I know those that describe how they work based on the most sound science we have available to us today (ie the most plausible manner in which we affect change within our patients).

Ginger,

What do you agree with? I'm never quite sure with you these days. One moment you nod your head in agreement to the role of the CNS, expectation, ritual and all things non specific...then on the other claim complete specific effects by repetatively jabbing your thumbs into someones back...

I haven't a clue what Transient is babbling on about there. Are you a chiropractor Transient? I seem to recall this being the case.

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Post #: 35
RE: Mesoderm, ectoderm, etc - June 1, 2012 1:45:05 PM   
proud

 

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quote:

ORIGINAL: TransientImage

I am actually an ectopractor.

And how dare you call me a mere chiropractor.

When my regular Activator device is rusty or lost somewhere behind the sofa cushions, I whip out my improved EctoActivator apparatus and effect change -- directo on the ecto.

I also work on my clients by describing a sound scientific basis related to their protoplasm.

Protoplasm happens to be one of the most well known plasms available to us today.

Therefore, I am also a practitioner of protodermiotherapy.


Was this an answer to my question?

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Post #: 36
RE: Mesoderm, ectoderm, etc - June 1, 2012 2:28:52 PM   
proud

 

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Admittedly funny though....

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RE: Mesoderm, ectoderm, etc - June 1, 2012 5:16:50 PM   
SJBird55

 

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I agree... using those two terms is just plain ridiculous. The more we know about pain, the more complex it becomes. Placebo, culture, expectations, perceptions, immune system, the brain, past experiences and current interpretation of a situation perceived as painful all have a role. Then we have mirror box therapy and some huge cool machine that create what appears to be distorted appendages that relieve discomfort/pain. And... the opposite, we can create a situation where a person can believe a fake hand is theirs and will feel pain if it is stabbed. We also have to recognize the impact the clinician's belief system, the clinician's words and the clinician's behavior plays in the patient's pain experience too.

Choosing to talk about "derm" and creating 2 camps of clinicians is SO missing the boat when it comes to pain science and treating people who are experiencing pain.

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Post #: 38
RE: Mesoderm, ectoderm, etc - June 1, 2012 5:43:32 PM   
proud

 

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quote:

ORIGINAL: SJBird55

I agree... using those two terms is just plain ridiculous. The more we know about pain, the more complex it becomes. Placebo, culture, expectations, perceptions, immune system, the brain, past experiences and current interpretation of a situation perceived as painful all have a role. Then we have mirror box therapy and some huge cool machine that create what appears to be distorted appendages that relieve discomfort/pain. And... the opposite, we can create a situation where a person can believe a fake hand is theirs and will feel pain if it is stabbed. We also have to recognize the impact the clinician's belief system, the clinician's words and the clinician's behavior plays in the patient's pain experience too.

Choosing to talk about "derm" and creating 2 camps of clinicians is SO missing the boat when it comes to pain science and treating people who are experiencing pain.


I agree SJ. I will say this though....I suppose it's a way to get the majority of PT's who still think there are labelled lines between tight hamstring, counternutation...and pain (or some fanatasy of the like)...to think differently.

That's to say that when we come across what we believe to be tight hamstrings...that there is other "non meaty" things that are at play.

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RE: Mesoderm, ectoderm, etc - June 1, 2012 10:33:14 PM   
rwillcott

 

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I don't think we should get too hung up on the terms ectoderm and mesoderm. Its just a way to begin discussion that there is more to treating pain then manual therapy applied to muscle and joints. There's a nervous system that we are effecting with our treatments that seems to have been ignored. Anytime you can get a PT to think about this nervous system and how it effects pain its a good thing since our treatment of muscle and joints has its limitations. I find it fascinating and exciting to know that a joint mobilization has very little to do with the specific direction. Studies show that non-specific manual techniques have the same effect. Also, studies show that an 'expert' manual therapist does NOT have better outcomes than a new grad. Unfortuanetly there are many within the PT profession that have obtained their black belts in manual therapy and have spent thousands of dollars to feel superior to others in the profession. Finding out that your specific techniques are not necessary would be a hard pill to swallow. However, its not about us now is it. Its about our patients that are being fed this BS biomedical explanation for their pain. These leads to more harm than good and is furthering the disability of patients. I liken ectoderm vs. mesoderm to biomedical vs biopsychosocial.

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