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RE: Mesoderm, ectoderm, etc

 
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RE: Mesoderm, ectoderm, etc - June 4, 2012 1:13:34 AM   
ginger

 

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Proud, TRansient's post resonates with me and my agreement signifies just that.
As to your other query, mate, we've been over this stuff so many times, I don't think another time will help you that much.
Making claims that one's treatment is more ecto/neuro than another is to miss the point entirely about effectiveness and the way the body works. It serves to hint at the dominant role of the nervous system, while , on SS anyway, making no sense at all from a practical problem solving perspective. Often it is a ploy used to attract attention away from posters' complete lack of manual therapy ability, while attempting to embellish their self percieved connections to published theorists.
I'm much more likely to give credit to problem solvers than divisionists.

_____________________________

Geoff Fisher
Physiotherapist

(in reply to proud)
Post #: 41
RE: Mesoderm, ectoderm, etc - June 4, 2012 6:54:00 AM   
Sebastian Asselbergs

 

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Funny you say that Geoff.
I dare you to to find someone who says their "treatment is more ecto".

You just - again - demonstrated your lack of understanding that it is not about the treatment where the terms ecto and dermo are bandied about.
It. Refers. To. The. Explanation. Of. The. Therapeutic. Interaction. And. Effects.


Bird, the terms are just that. They indicate a change of focus in the whole "why" of effectiveness of therapy.
This:
quote:

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.


is all neurophysiological. More "ecto" that "dermo".

Why is there a designation in PT for "neuro", "ortho", "geriatric" or "sports"? Indicates a focus. Do you suggest that that is divisive too?

(in reply to ginger)
Post #: 42
RE: Mesoderm, ectoderm, etc - June 4, 2012 11:21:44 AM   
Chocco

 

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quote:

is all neurophysiological. More "ecto" that "dermo".

Why is there a designation in PT for "neuro", "ortho", "geriatric" or "sports"? Indicates a focus. Do you suggest that that is divisive too?


Apples to Oranges
The designation in PT for "neuro, "ortho" etc. is more a reflection of the patient population and not a reflection of a theoretical model. I don't however think that we should practice as a strictly ortho, neuro etc. therapist. The best ortho therapists I know have atleast a good working knowledege of the current concepts of the neuro, geriatric and sports world. Same could be said for neuro and so on.

My concern with the "ecto" vs. "meso" is that we ( Physical Therapists) seem to be building a theoretical model that isolates one system of the body from another. I think it has value in guiding reseach and building understanding but a lot of times results in incorrect information to the patient. I don't mind the discussion of "Why" in fact I find it interesting, but if therapists are taking these theories back to their patients then we will probably end up in the same boat 5- 10 years down the road. I think we would be better serving our patients to educate them on more solid principles and leave theory to the theorists.

(in reply to Sebastian Asselbergs)
Post #: 43
RE: Mesoderm, ectoderm, etc - June 4, 2012 12:01:39 PM   
proud

 

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quote:

ORIGINAL: Chocco

I think we would be better serving our patients to educate them on more solid principles and leave theory to the theorists.


I am assuming then you see the science of pain is more theory than say...weak Tra is a source of LBP?

I'm confused Chocco...what do you consider "solid principles" and what do you consider "theory".

I am wondering if there is some irony in this comment of yours in that what you think and what is true are opposite.

In other words...I agree wholeheartedly that we should educate on what we know and leave the theory behind....

Guess which one has "solid principles". Hint (it's not Ginger....).

< Message edited by proud -- June 4, 2012 12:10:44 PM >

(in reply to Chocco)
Post #: 44
RE: Mesoderm, ectoderm, etc - June 4, 2012 12:23:56 PM   
Sebastian Asselbergs

 

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quote:


. is more a reflection of the patient population and not a reflection of a theoretical model.


Apples and apples. It is a reflection of a theoretical model indeed. Nothing divisive about it. just like the PT specialties. It shows a difference.

quote:

we ( Physical Therapists) seem to be building a theoretical model that isolates one system of the body from another.

Yep, it has happened for many years. The "meso" explanation has had a looooong run of it. Time to shift the focus.
NOT "isolate".
That keeps popping up as if I am trying to ignore or discard the "meat".

Sigh.

The only way, and I mean the ONLY way we can be effective in human therapeutic interaction is via the nervous system's processing of input.
That is all that is meant by "ecto".
Is it often mentioned? Hell, yes. It needs it because for too long it has been mainly ignored in PT.

< Message edited by Sebastian Asselbergs -- June 4, 2012 12:26:33 PM >

(in reply to proud)
Post #: 45
RE: Mesoderm, ectoderm, etc - June 4, 2012 1:21:14 PM   
Sebastian Asselbergs

 

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Transient, I tend to engage in the odd "bickering" in the hope that the idea of the neuromatrix and "pain as an output from the brain" become more common in as many PTs' and pratitioners' minds.
I do that on Facebook, Twitter and SomaSimple as well as here (and proud pulls more than his weight here).

We're probably too much individualistic to get a real "communal effort", although in Canada we have managed to create a very good "Pain Sciences Division" of the National Association where a strong group of PTs and PhDs is trying to change things. The small struggles and debates I am involved on the 'net are little practice runs for me, to learn where and what the opposition to a different and more plausible theoretical model really is.

I share your feeling of sadness about the state of many practioners. And some of the DPTs I have encountered are not any different.

(in reply to TransientImage)
Post #: 46
RE: Mesoderm, ectoderm, etc - June 4, 2012 8:39:25 PM   
ginger

 

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Bas , the kind of mindset changes you and Proud ( and I and others ) allude to when we moan about the lack of awareness of the role of the nervous system ARE happening. Take a look at the themes considererd and the style of response from this site back, say, seven years. There has been a continual change in favour of notions thought radical back then.
The idea of protective responses/behaviour for one. When I first brought this theme to the attention of posters here, it was met with howls of disapproval and consternation. Lately I see the protective behaviour theme has been taken up even by those who howled the loudest.
Ideas take time to become familiar, people who attend the tasks of their professional lives have a considerable investment in belief, though they may well argue their own objectivity. I think the use of polarising identities ( ecto /meso), no matter the good intention, creates division and rancour rather than cooperation and good will. We are all in this together.

_____________________________

Geoff Fisher
Physiotherapist

(in reply to Sebastian Asselbergs)
Post #: 47
RE: Mesoderm, ectoderm, etc - June 5, 2012 6:46:12 AM   
SJBird55

 

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Ecto and meso really aren't helpful unless one wants to get into a shouting match of who is more right...

Biopsychosocial... neurophysiological and there is another term (too early to pull the word out of my head) are more appropriate terms. These kind of terms are the ones you'll see in research papers... these terms are the language of scientists across a wide range of specialties.

What we are learning is that our educational system that focused only on the biomedical model has failed us (collective us that includes all medical providers) in certain situations. What we are learning is that to practice optimally, we also need to implement the concepts of biopsychosocial and understand the neurophysiological affects of our interactions be it verbal, nonverbal and manual.

(in reply to ginger)
Post #: 48
RE: Mesoderm, ectoderm, etc - June 5, 2012 7:14:39 AM   
Sebastian Asselbergs

 

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Ok so let's call it "neuropsychosocial" to indicate the move away from "biomedical". You don't think there's shouting over this? Dream on.

They are just labels to indicate a shift in focus. just. like. ecto. and. meso.

Anyone has the right to dislike words. No problem. But to assign a "more divisive" or "polarizing" label to words is simply your own dislike entering the picture.
NPS (neuropsychosocial) and BM (biomedical) do exactly the same.
Oh, yeah: scientific language.
Should we stop saying "skin" and call it "cutaneous tissues" from now on?
Should we stop saying "warm" and call it "an increase in the tissue temperature"?

Come on folks. Your dislike for the folks who use "ecto and meso" is showing.

(in reply to SJBird55)
Post #: 49
RE: Mesoderm, ectoderm, etc - June 5, 2012 9:03:57 AM   
honker23

 

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My continued problem is not with the people, it's with the treatments. My question has not been answered by proud yet, maybe bas wants to take it. Why do treatments like SC, DNM, KTape not get scutinized and deconstructed to the level others do. Is it because they are "ecto" type treatments? So are we suggesting that any treatment that contacts skin and educates is defensible? Do we not want to find the best treatment that maximizes outcomes in the shortest amount of time?

(in reply to Sebastian Asselbergs)
Post #: 50
RE: Mesoderm, ectoderm, etc - June 5, 2012 9:25:02 AM   
proud

 

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quote:

ORIGINAL: honker23

My continued problem is not with the people, it's with the treatments. My question has not been answered by proud yet, maybe bas wants to take it. Why do treatments like SC, DNM, KTape not get scutinized and deconstructed to the level others do. Is it because they are "ecto" type treatments? So are we suggesting that any treatment that contacts skin and educates is defensible? Do we not want to find the best treatment that maximizes outcomes in the shortest amount of time?


Indeed it was. Post #39 over on the "answers for Proud" thread.

The problem Honker is your questions is actually a very good one. But in order to understand "why"
various treatments are more accepted...you are going to have to do a fair amount of reading on the placebo response (not inert), pain neurophysiology, etc etc.

Also, with a bit of reading at SS, you will see that the treatment approaches are exteremely varied (some use Mulligan, some use a more neurodynamic approach, some access the system via the skin, some utilize ideomotion, some use primarily education and basic movement).

You will also see regulars like Jason Silvernail and Diane disagree on the role of coerced manual therapy versus skin.

Lot's of disasgreement there actaully about how best to treat. But I'm willing to bet the "outcomes" are essentially the same. But I'm afraid "outcome measures" might be a slighly misleading adventure when it comes to painful conditions. But that's a topic for another discussion I think.

What is not in dispute is the underlying mechanisms, the explanatory model. All consistent.

Over on that thread I asked why you thought cranial sacral therapy "works" for some. Did you answer that (I cannot recall).

< Message edited by proud -- June 5, 2012 9:28:57 AM >

(in reply to honker23)
Post #: 51
RE: Mesoderm, ectoderm, etc - June 5, 2012 9:48:14 AM   
honker23

 

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I think I did in post 42.
So, do you think all approaches that you listed will provide the same results if the context, beliefs, expectations are the same....i.e. pt is greeted by a confident caring practitioner referred by their best friend, pt believes the treatment will work, therapist believes it will work, pt expects to be better in 4 weeks?

I want to know which approach is best, maybe this can't be answered.

(in reply to proud)
Post #: 52
RE: Mesoderm, ectoderm, etc - June 5, 2012 11:12:15 AM   
proud

 

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quote:

ORIGINAL: honker23

I think I did in post 42.
So, do you think all approaches that you listed will provide the same results if the context, beliefs, expectations are the same....i.e. pt is greeted by a confident caring practitioner referred by their best friend, pt believes the treatment will work, therapist believes it will work, pt expects to be better in 4 weeks?

I want to know which approach is best, maybe this can't be answered.


Warning: the following is off the cuff:

Probably about right. Although I suspect there are conditions where manual therapy directed "the right way" (ie...specific) would be better regardless of all those variables you listed above. I don't know what those are by the way...I only make my best guess. So long as the treatment does not add fuel to the fire by adding more nociceptive input...although even that is an exercise in intrigue as often a painful treatment that fires off the DNIC (diffuse noxious inhibitory controls) results in a good outcome (somehow I guess if the patient really believes they must hurt to get better....that sometimes works). Makes you wonder huh?

But by far and away those variables play the largest role I think.

Remember...we are talking about in the short term here (which is what is typically measured by those in the bean counting industry). This obsession with short term outcomes is a real problem...It should be recurrence rates and return rates for healthcare utilization for any subsequent painful condition that should ideally be measured.

So ya...Angela has neck pain and sees a cranio-sacral therapist who she "believes in" (subsequent descending inhibition, reduction of threat etc) and viola....pain comes under control.

Angela is dumber than a post with regards to how pain works....but for this epsiode anyway...better. Lower extremity functional scale says so right?

The more I can sell a treatment, appear confident, provide a novel concept and all that crap....so long as the patient buys what I'm sellin'....all those areas of the brain responsible for downregulating threat will light up...pain will reduce.

Treatment...worked (as measured by those outcome measure tools).

< Message edited by proud -- June 5, 2012 11:48:33 AM >

(in reply to honker23)
Post #: 53
RE: Mesoderm, ectoderm, etc - June 5, 2012 12:08:40 PM   
honker23

 

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Agreed.
What would your perfect outcome tool be?

(in reply to proud)
Post #: 54
RE: Mesoderm, ectoderm, etc - June 5, 2012 1:23:13 PM   
proud

 

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quote:

ORIGINAL: honker23

Agreed.
What would your perfect outcome tool be?


Well Healthcare expenditure and utilization has been looked at in studies:

Like this one:

http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinternmed.2011.1662


So there is likely a way to have a look at this data for painful conditions as well. Frankly, I think third party payers should ask this question: "If a patient see's you...how likely is it that they access medical care for ANYTHING MSK in the next year, two, three etc"

Much better marker of success of any intervention I think. SJ (if you are reading)...what do you think?

By the way....I'm sure cranio-sacral therapists have very high patient satisfaction rates. Afterall...they were the only practioner who finally figured out that the source of their problem was those dam sticky cranial sutures!!!!!

< Message edited by proud -- June 5, 2012 1:42:10 PM >

(in reply to honker23)
Post #: 55
RE: Mesoderm, ectoderm, etc - June 5, 2012 2:06:44 PM   
Tom Reeves DPT ATC

 

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So if the short term outcome is based upon the patient's beliefs, and you successfully convince them that your mechanical intervention is going to be effective, how is that any different than convincing them that movement is good, and they are experiencing hurt, not harm? Aren't both outcomes the same with this logic?

On the other hand, if there was a mechanical nociceptive trigger, and it happens to be mechanical, hasn't the mechanical therapist (or one with some mechanical influences) actually had more impact on the patient for the long term?

e.g. crappy foot control, valgus knee, tender plica - describe this to the patient, help them improve foot control, stretch tight things etc . . . their nociception goes away AND their pain goes away.

If they are convinced, that works on the central. If you remove or manage the peripheral nociception, you have helped them prevent recurrence.

(in reply to proud)
Post #: 56
RE: Mesoderm, ectoderm, etc - June 5, 2012 2:57:49 PM   
proud

 

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quote:


So if the short term outcome is based upon the patient's beliefs, and you successfully convince them that your mechanical intervention is going to be effective, how is that any different than convincing them that movement is good, and they are experiencing hurt, not harm? Aren't both outcomes the same with this logic?


Uhmm...yes? If I'm understanding the question correctly.


quote:

On the other hand, if there was a mechanical nociceptive trigger, and it happens to be mechanical, hasn't the mechanical therapist (or one with some mechanical influences) actually had more impact on the patient for the long term?


Yes...and I said so above. But currently, we have no way to determine with any (and I mean any) degree of certainty that "it happens to be mechanical"

quote:

e.g. crappy foot control, valgus knee, tender plica - describe this to the patient, help them improve foot control, stretch tight things etc . . . their nociception goes away AND their pain goes away.


Really? And you are sure that is the only factor in the reduction of pain? None of what you mentioned above has ever been demonstrated to have a casual relationship with pain (aside from a valgus knee...but even the literature on that is marginal at best).

quote:

If they are convinced, that works on the central.


yep.


quote:

 If you remove or manage the peripheral nociception, you have helped them prevent recurrence.


Really?

How about I put it to you this way (with an alternative explanation for effects):

1) Patient comes in with oh...let's say right sided LBP
2) I assess them and tell them that they lack foot control on the right and have a varus calcaneus. Also, a leg length discrepency requiring a 1/4" heel lift on the left. All this is the driver of the LBP.
3) I convince the patient that motion control footwear, a valgus wedge and a heel lift will help is the source (underling "driver" of the pain).
4) Patient believes all this and subsequently has cortical changes that downregulate the threat...pain dissipates.
5) Patient returns to his Physician 6 months latter with...oh....shoulder pain. Patient feels that his leg length issues must be "working their way up the chain"....
6) cycle of mis-information about how and why people experience pain continues. Does this not explain why we have a virtual epidemic of painful conditions in an otherwise developed world?

* This is how mis-represenation of how pain works can negatively impact things.

Tom...you cannot say with any degree of certainty that a pelvic rotation, or poor foot mechanics has caused pain. Telling a patient this is pretty much as close as you can get to bold face lying.

(in reply to Tom Reeves DPT ATC)
Post #: 57
RE: Mesoderm, ectoderm, etc - June 5, 2012 3:22:35 PM   
Tom Reeves DPT ATC

 

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Careful there Proud. don't call me a liar.

I am saying that excessive mechanical deformation can cause nociception. You and others have said that nociception can be a driver for people to develop pain. Diane on SS said its not pain until seconds, minutes, days, or weeks later.

I can and do reduce nociception with mechanical interventions.

The way you describe things, you could work an entire day and not do anything but talk to your patient because the meat doesn't matter at all, for any reason, ever.

No, I cannot say that pain is caused by X. Just like I cannot say that lung cancer is caused by smoking. I just know that I have a lower chance of getting lung cancer by not smoking.

(in reply to proud)
Post #: 58
RE: Mesoderm, ectoderm, etc - June 5, 2012 7:11:49 PM   
proud

 

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quote:

I can and do reduce nociception with mechanical interventions


Or you reduce pain...

quote:

The way you describe things, you could work an entire day and not do anything but talk to your patient because the meat doesn't matter at all, for any reason, ever.


I spend my day doing I bet much the same things you do (minus the cement goloshes). I do manual techniques that seem to reduce pain and improve movement...all the while informing patients how and why they might be experiencing less pain. I'd love to ramp up expectation with fancy explanations and absurd correlations....but I have to remain truthful and ethical. Otherwise...I'm just another charleton amongst the thousands and thousands of them out there slinging pure BS.

No thanks...I let science inform my practice.

Often though....after a really good discussion with my patients...I don't touch them. No need.

quote:

No, I cannot say that pain is caused by X. Just like I cannot say that lung cancer is caused by smoking. I just know that I have a lower chance of getting lung cancer by not smoking.


Try again. The smoking/lung cancer causation is well established in the literature...

SI joint pain---->-poor foot control----cement golosh----->reduce nociception.....ya....not so much.

< Message edited by proud -- June 5, 2012 7:25:14 PM >

(in reply to Tom Reeves DPT ATC)
Post #: 59
RE: Mesoderm, ectoderm, etc - June 5, 2012 10:14:33 PM   
Tom Reeves DPT ATC

 

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quote:

Try again. The smoking/lung cancer causation is well established in the literature...


Sure but everyone who smokes doesn't get lung cancer and everyone with lung cancer didn't smoke.

Smoking certainly is a strong risk factor and to avoid lung cancer, my best bet is to not be a smoker.

Poorly controlled feet are a risk factor for knee pain. (OK nociception)

I can pluck a plica and it is painful. I can palpate just next to it and it is not. explain that to me. Why does the CNS pick on that one particular structure to be "the" pain in the patient's words? Why is the rest of the medial knee joint capsule NOT sore? Its funny that the CNS presents with pain in such similar mechanical environments.

< Message edited by Tom Reeves DPT ATC -- June 5, 2012 10:16:34 PM >

(in reply to proud)
Post #: 60
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