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RE: Mesoderm, ectoderm, etc

 
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RE: Mesoderm, ectoderm, etc - June 13, 2012 7:20:13 AM   
proud

 

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quote:

ORIGINAL: Chocco

Proud
Would my theory above be more acceptable to you If I replaced Physical with Peripheral and Emotional with Central as it is below?
quote:

ORIGINAL: Chocco

Generally I think when an injury happens it is traumatic both peripherally and centrally. Some injuries create more peripheral trauma, some more central. Some people have a more peripheral reaction and others more central. A person needs to address both the central and peripheral aspects of their injury. People that are more effective at dealing with central aspect of their injury are less likely to have chronic injuries conversely people that have difficulty dealing with central aspects of their injury tend to be more chronic. I think with chronic injuries it is important to address the peripheral and biomechanics as well as the central ( an advantage PTs have over Psychologists) even if it is just as a way to reassure the patient that they can perform a movement or task without without injury or symptoms. I don't completely rule out the fact that there can be underlying physical causes in chronic injuries although research suggests it's much less likely.



Well I find it less wrong that's for sure. Although I just don't think it's a matter of less of one and more of the other. The "central" aspects of which you refer are always the overpowering factor in any pain scenario.

I work in an acute care orthopeadic setting 2 hours out of my day (direct access in an emergency room type set up). I witness patients come in with obvious S&S of a grade 2-3 ankle inversion sprain and they literally walk into my office. They know something is not right based on the diffuse swelling and eccymosis....but the pain level is rated quite low and the non-antalgic gait pattern supports this. Then, on the same day, I might see a fellow with a very low grade inversion sprain. No swelling, no eccymosis. Can barely walk, tender to palpate practically everywhere. It's like they have been shot!

The pain experience is just not as simple as 80% peripheral/20% central or visa versa. It's ALWAYS the CNS that is involved and the brain deciedes ultimatley if; or how much pain you will experience.

A few points:

1) Nociception is neither required nor often sufficient to experience pain.
2) Amount of tissue damage does not = amount of pain.
3) Our ability to manually influence mature connective tissue in a manner that alters joint mobility or position in order to influence pain is near ZERO. Tooth fairy science. One of my main points here at RE is to drive this particular point home. Taking ortho courses where the main thrust of learning is specific manual therapy techniques in order to influence joints (specifically) needs to be removed from any Physiotherapy curriculum. It's anti-science or worse...psuedo-science and it's making our profession a laughing stock amongst the greater scientific and medical community.

Rant over.

< Message edited by proud -- June 13, 2012 7:22:54 AM >

(in reply to Chocco)
Post #: 121
RE: Mesoderm, ectoderm, etc - June 13, 2012 10:43:04 AM   
bgalindpt

 

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Just for devil's or insurance company advocate here for a second.

Say I am Blue Cross Blue Shield, and I totally buy into the theory about therapy encouraging pain free motion to reduce the over excitment of the brain in perceiving pain with motion. If I accept this, which I do not think too many people can argue against it 100%, then why would I pay a PT to do this when an ATC or personal trainer maybe able to do the same thing. I am not saying show me the money, but do you foresee the research moving therapists out of the way once the insurance companies dumb it down to their understanding?

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Post #: 122
RE: Mesoderm, ectoderm, etc - June 13, 2012 10:46:46 AM   
bgalindpt

 

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Also I totally 100% buy into your a few points. 100%. But, do you not believe that manual treatment:
1)can be part of the hands on factor that allows patients to experience joint mobility passively to then not fear it when they are actively performing it?
2)can be used in oscillating bones within the capsule to maybe change the brain's perception of capsular receptors not being a painful force but instead being a non noxious stimuli thereby allowing the active joint motion to no longer be perceived as a threat?

Therefore, if you did agree with 1 and 2, which I know you won't because you would hate ot agree with anyone, then why is manual so laughable?

Also, I have had great success in mobilization with movement. My working theory is that with external input into the joint, that I can influence the nueral recruitment and perception of joint spacing during movement to better allow proper perception of joint mechanics as a non noxious stimuli. why is this so worthless?

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Post #: 123
RE: Mesoderm, ectoderm, etc - June 13, 2012 11:17:31 AM   
Sebastian Asselbergs

 

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bga, if you check previous posts by proud and myself here, you will see that hands-on is a fine adjunct in therapy. The interpersonal, safe and gentle contact can greatly reduce the perception and patterns of "danger - do not move".
But, this
quote:

brain's perception of capsular receptors not being a painful force but instead being a non noxious stimuli
is a bit of a mish-mash of issues.
Firstly the conscious brain does not recognize "capsular receptors" - it just gets an input from the "critter brain" (the more primitive and very dominant part of the brain with regards to protection and defense) that "there's a problem, Houston - do something!".
Do not know what you mean by "painful force".

"Success" is claimed by every single "method". Each one. This is not useful data.

I challenge you to find the post where manual therapy is typified as "laughable" or "useless" or "worthless".

Repeat: It is NOT about the technique - it is about the underlying model and explanation .

(in reply to bgalindpt)
Post #: 124
RE: Mesoderm, ectoderm, etc - June 13, 2012 11:47:17 AM   
rwillcott

 

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bga,

Explaining manual therapy from a neurophysiological stand point is certainly not dumbing it down. As bas mentioned above it is about educating both PT's and patients about the underlying model and explanation of manual therapy. We are not moving bones to imporve motion or breaking up adhesions when perfroming manual therapy. Numerous studies show this. In fact one study on neck pain had an 'experienced manual therapist' chose which cervical segment to Rx based on their exam and gave another PT a random segment to treat. What do you think they found? The outcomes were the same. Therefore, why are we still obsessed with feeling tiny irrelevant movements of joints? What we should be more concerned with is why both groups had pain relief regardless of the specificity of the technique. Pain science tells us that there are many factors for these involving the CNS. Descending inhibtion from PAG, patient beliefs, past experiences, education etc.

We would never have to worry about ATC or personal trainer performing a PT's job. Explaining pain to a patient based on science is our job and most other professions haven't a clue. There are only a few PT's that are willing to take the time to sit down and actually read and think about what it is they are actually doing when treating a patient in pain.

(in reply to Sebastian Asselbergs)
Post #: 125
RE: Mesoderm, ectoderm, etc - June 13, 2012 11:51:10 AM   
proud

 

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quote:

ORIGINAL: TransientImage

Well, it does seem the majority of the so-called facts on "pain science" in this topic-thread are the personal conjectures of a handful of people (SomaSimple cult / cult of NOI) who have not worked through their bizarre theories with any scientific research, anyway.

There is not really a need to argue against the claims since these claims have not been validated in any objective manner to begin with.

This is sort of like the situation where the practicing pseudoscientist calls any other competing methodology pseudoscience. And the fear of "Cartesianism" is obsessive. All of these behaviors direct attention away perhaps from the incompetence of the source.

Returning to the topic, some theory based on ectoderm might sound authentic for a moment or two, but on closer examination, the ideas are about as valid as anyone else's opinion. Backing up one's claims with more personal claims or anecdotal experiences is entertaining but ultimately not scientifically so useful.


Precisely ZERO of what I am presenting here is my personal opinion or interpretation. Care to argue with some of the leaders in pain physiology Transient?

Be my guest...you'd lose.

(in reply to TransientImage)
Post #: 126
RE: Mesoderm, ectoderm, etc - June 13, 2012 11:53:24 AM   
rwillcott

 

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This is a great article explaining why we need to move away from our original explanation of manual therapy and motion paplation:

http://blog.evidenceinmotion.com/evidence/files/does_technique_matter.doc

(in reply to rwillcott)
Post #: 127
RE: Mesoderm, ectoderm, etc - June 13, 2012 12:01:18 PM   
proud

 

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quote:

ORIGINAL: rwillcott

Explaining pain to a patient based on science is our job and most other professions haven't a clue. There are only a few PT's that are willing to take the time to sit down and actually read and think about what it is they are actually doing when treating a patient in pain.


In fact this is exactly what SHOULD be differentiating the Physical Therapy profession from others. We are the only ones who hold a SCIENCE degree...at a masters or doctorate level.

S.C.I.E.N.C.E
 
I'd love to know where things went so awry in this profession to allow pseudo-science to creep in. I recall I read an editorial from Robin McKenzie once where he stated that once the science starts to reveal underlying mechanisms (this was 1984...he figured 20 years or so)....we would see some interesting things start to happen.

One of those "things" he predicted was that some professions (namely chiropractic would start to unravel and in order to survive they would transition to more of a wellness/defendable approach). His fear was that there will always be a market for pseudo-science, alternative approaches and that the Physical Therapy profession would jump in with both feet to fill the void.

I think the Canadian Orthopeadic stream of courses have done this.

What differentiates an expert? An expert has an understanding of mechanisms not techniques so much.

In fact, our ability to digest, accept and implement changes based on emerging science is the only thing that would result in our survival.

Keep convincing yourself that you can feel and specifically affect tiny inter-segmental joints and for sure you will be lumped in with everyone else who lays claim to magical treatments for pain...

< Message edited by proud -- June 13, 2012 12:45:51 PM >

(in reply to rwillcott)
Post #: 128
RE: Mesoderm, ectoderm, etc - June 13, 2012 12:17:08 PM   
rwillcott

 

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One error that was made in the PT profession in Canada was the manual therapy certification process. We have made this our 'holy grail' or Stanley Cup of orthopedic physiotherapy. I wouldn't have an issue with this if they were to change and adapt to the exciting and recent findings in manual therapy and pain science. However, they haven't. Their still teaching young grasshopper PTs to try and feel the nutations of the SI joint. Now we have a whole new crop of PTs thinking that until they achieve their highest level of manual therapy they won't be able to feel these tiny (insignifcant) motions of the spine and therefore not be able to help all of their patients. Think of all the patients in pain that won't get the proper Rx they deserve. Sad.

(in reply to proud)
Post #: 129
RE: Mesoderm, ectoderm, etc - June 13, 2012 12:18:33 PM   
proud

 

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Transient,

I could care less whether you read anything or not.

Good luck with things though....

(in reply to TransientImage)
Post #: 130
RE: Mesoderm, ectoderm, etc - June 13, 2012 12:22:50 PM   
rwillcott

 

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Tansientimage,

Have you read either "Pain-The Science of Suffering' by Patrick Wall or 'The Challenge of Pain' by Wall and Melzack? These two excellent books explain the science of pain and are in deed FACTS. Many of the concepts that are discusesed regarding the Rx of pain come from these authers and countless other brilliant scientists. Not just a few from somasimple. If you haven't read these books I would highly recommend you do so. If you have and still think its pseudoscience then I will suggest you call yourself a Physical Technician.

(in reply to rwillcott)
Post #: 131
RE: Mesoderm, ectoderm, etc - June 13, 2012 12:36:59 PM   
proud

 

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quote:

ORIGINAL: rwillcott

Tansientimage,

Have you read either "Pain-The Science of Suffering' by Patrick Wall or 'The Challenge of Pain' by Wall and Melzack? These two excellent books explain the science of pain and are in deed FACTS. Many of the concepts that are discusesed regarding the Rx of pain come from these authers and countless other brilliant scientists. Not just a few from somasimple. If you haven't read these books I would highly recommend you do so. If you have and still think its pseudoscience then I will suggest you call yourself a Physical Technician.


Transient is a chiropractor.

(in reply to rwillcott)
Post #: 132
RE: Mesoderm, ectoderm, etc - June 13, 2012 12:50:46 PM   
rwillcott

 

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Tansientimage,

Sorry I did not realize you were a chiropractor. Do you beleive in the subluxation theory and that these create pain and nerve interference?

(in reply to TransientImage)
Post #: 133
RE: Mesoderm, ectoderm, etc - June 13, 2012 1:28:07 PM   
rwillcott

 

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Perhaps if this divison if the CPA were to grow we would see more positive change in the profession:

http://www.physiotherapy.ca/public.asp?WCE=C=32%7CK=S228819%7CRefreshT=222515%7CRefreshS=Container%7CRefreshD=2225159

It is called the PAIN SCIENCE division

(in reply to rwillcott)
Post #: 134
RE: Mesoderm, ectoderm, etc - June 13, 2012 10:43:29 PM   
Sebastian Asselbergs

 

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Oh transient. So cute.
quote:

."cult leaders in pain physiology" = still amateur people with just their personal opinions and no research support or credentials.

So, Moseley, Butler, Shacklock, Ramachandran, Melzack, Wall are all names that you do not equate with good science? How about Bach-y-Rita? The compilation by Doidge?

Next one.
"No research emanates from SS". Wow. First: reallY?!? "research emanates"?!? It oozes out of some other source?
Then: Never knew it was a requirement to DO research before one can quote it or speak about it or integrate it. Most people in the world can not speak about science then.

I'd love to see the research that makes it in the good books of transient: maybe it is Palmer's? Or ....ummm. Darn - not getting much here....

(in reply to rwillcott)
Post #: 135
RE: Mesoderm, ectoderm, etc - June 14, 2012 12:12:06 AM   
Sheld505

 

Posts: 64
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quote:

One error that was made in the PT profession in Canada was the manual therapy certification process. We have made this our 'holy grail' or Stanley Cup of orthopedic physiotherapy. I wouldn't have an issue with this if they were to change and adapt to the exciting and recent findings in manual therapy and pain science. However, they haven't.


Playing devil's advocate here rwillcott and proud, but when is the last time either of you took a Canadian course? Weeks, months, years? You guys need to be fair here; neither of you KNOW that the Canadian system has not, or is not, adapting. I KNOW first-hand that the Canadian system is adapting and evolving. Yes, there are those who are very biomechanically-based; however, there are many who incorporate both specific MT, general MT, and pain science in their courses. The Canadian system is not as dogmatic as you guys make it out to be nor as "lost" or "archaic."

What makes the PT profession great is that there is room for differences in opinion and treatment. I've admitted before that I personally need to read more on recent pain science to better incorporate it into my everyday practice. Would it not behove you guys to revisit the Canadian system with some of the newer faculty and instructors? Change is on the way gentlemen....

< Message edited by Sheld505 -- June 14, 2012 12:18:49 AM >

(in reply to rwillcott)
Post #: 136
RE: Mesoderm, ectoderm, etc - June 14, 2012 7:48:12 AM   
proud

 

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quote:



quote:

One error that was made in the PT profession in Canada was the manual therapy certification process. We have made this our 'holy grail' or Stanley Cup of orthopedic physiotherapy. I wouldn't have an issue with this if they were to change and adapt to the exciting and recent findings in manual therapy and pain science. However, they haven't.


Playing devil's advocate here rwillcott and proud, but when is the last time either of you took a Canadian course? Weeks, months, years? You guys need to be fair here; neither of you KNOW that the Canadian system has not, or is not, adapting.



Sheld,

You a canucker?

Anyway, I have viewed copies of the most recent Level 3 upper and lower. Based on those as well as my discusions with recent attendee's....the "evolving" you speak of is more lip service than anything else as far as I can tell. Most of the instructors that taught when I did these things are still there...blowing sunshine.....


quote:

The Canadian system is not as dogmatic as you guys make it out to be nor as "lost" or "archaic."


Then the first thing they ought to do is change their manuals....

quote:

What makes the PT profession great is that there is room for differences in opinion and treatment


Nonsense and I've heard this before. Ask Child's,Flynn, Delitto, Cleland what they think of this wide swath of treatment options. It does not exist in most evolved professions. Eventually the crap is weeded out and we are left with what science tells we can....and cannot do.

"Room for differences in opinion" is precisely what is making the Physiotherapy professsion practically indistinquishable from any other purveyor of treatment for pain. Be it a chiropractor, athletic therapist, cranio-sacral therapist or...Riekki master.

Sure...opinion yes. But it darn well better be consistent with what pain physiology tells us. From what I see from those manuals...they are about as far away from reality as one can get. Chiropractic anyone????

quote:

. I've admitted before that I personally need to read more on recent pain science to better incorporate it into my everyday practice. Would it not behove you guys to revisit the Canadian system with some of the newer faculty and instructors? Change is on the way gentlemen....


Like I said...I've seen the most recent manuals. Talked to recent attendee's at the courses and have been an instructor for students who have drank the kool aid. I don't see much change. In fact...I think it's worse than ever.

< Message edited by proud -- June 14, 2012 8:49:29 AM >

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Post #: 137
RE: Mesoderm, ectoderm, etc - June 14, 2012 10:03:49 AM   
honker23

 

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I couldn't resist.......if we ask childs, flynn, and cleland to define a standard of care we are told to perfrom manipulations for everything these days.  To their credit, they aren't suggesting we are reducing subluxations and they acknowledge the neurophysiologic mechanisms, but it seems like the recent evidence has a strong manipulation focus to it.  I also have a problem with how they have attempted to create CPRs, not why, I hope to see this evolve with time.

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Post #: 138
RE: Mesoderm, ectoderm, etc - June 14, 2012 10:50:03 AM   
proud

 

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quote:

ORIGINAL: honker23

I couldn't resist.......if we ask childs, flynn, and cleland to define a standard of care we are told to perfrom manipulations for everything these days.  To their credit, they aren't suggesting we are reducing subluxations and they acknowledge the neurophysiologic mechanisms, but it seems like the recent evidence has a strong manipulation focus to it.  I also have a problem with how they have attempted to create CPRs, not why, I hope to see this evolve with time.


You are correct Honker. I did attend the manipalooza event in 2010 and the presentations where quite good. They had a presentation on practice variability and why it was not something to aspire towards. This is what I was talking about.

I couldn't have agreed more with them.

I certainly thought they were leaps and bounds ahead of any ortho division course I have ever attended not only on content....but also on presentation. These guys put on a great show.

I do however have problems with their focus on manipulation. I disagreed with them and their position on cervical manipulation. I felt they did not even skim the surface on the underlying mechanism's of manipulation.

These guys are quite good...but they too are in "business". They have something people want and are willing to sell it.

(in reply to honker23)
Post #: 139
RE: There is no pain science, there is only Neurology - June 14, 2012 10:59:58 AM   
proud

 

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quote:

Hi Sebastian,

Whomever conducted that erroneous datum that I have somehow become a chiropractor is likely a frequent source of misinformation


Alrighty then...what are you?

quote:

Palmer's work is a good read, however, because it presents as an example of tautology with aspects of internal logical consistency and features of established science but without the actual connection to reality. An excellent deceit, much like the self-deceit of theorists in "pain science."


Bold: Really?


quote:

Bach-y-Rita's work is compelling. It is built upon basis work done by Sherrington who postulated along with Cajal, that the knowledge of sensation is not the sensation itself, and these ideas led to the promulgation of the ubiquitous neuron doctrine.


Oh and I suppose he was also a pioneer in the work of neuroplasticity as well....

quote:

In fact, when we commute the subclassification of nociception to the general class of sensation, and that of pain to perception, and make those categories correspond to the anatomical presentation of peripheral conduits and cortical nuclear regions, we are essentially left with the work of Sherrington and Cajal. A century old construct re-packaged as new and improved by cultists whom have never stuck a needle electrode into a nerve cell to take a depolarization reading in their entire lives should not suggest that any original work was actually done.


I have re-read this several times and I just cannot figure out where you are going with this. Your writing reminds me an awful lot of a certain philosphical poster over at SS ( Melziavk...something or other)....

quote:

But we should redirect the discussion to ectoderm. Ectoderm does not exist in the adult organism. It cannot be treated in the adult organism. A more productive examination of the influence of "animal defense" in its relation to the existence of mechanical receptors and the perception of pain, with associations to the purpose of the existence of pain perception, and its neuropathic features, as you suggested earlier, may actually lead to a practical solution.



Again, a gobbled mess. You seem to be missing the point about using the term ectoderm.

< Message edited by proud -- June 14, 2012 11:01:38 AM >

(in reply to TransientImage)
Post #: 140
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