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RE: A problem arises... - July 11, 2012 7:03:39 AM   
Sebastian Asselbergs

 

Posts: 2293
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Niko, PLEASE understand that my outcomes have only gotten BETTER with no acupuncture or other woo-therapies. Where on earth did you see me write that I "ignore all those people who need my help"?!? You made a few conclusions based on assumptions. That is called very, very poor science. AND insulting.

Scientifically speaking, outcomes research is basic, easy, and fraught with problems. Did you read the link I provided above? It really addresses much of what is poor in today's strictly outcome-focused therapy.

quote:

The first thing I learned in PT school is how to critically think and challenge current literature.
Apparently not. There is a Science Blog (http://www.sciencebasedmedicine.org/) that helps compile research references and comments on CAM. It would behoove you to explore some of their acupuncture and Qi Gong posts.

Lastly, you have not addressed my last point in my previous post #36.
Glad I could make you happy, although that was not my intent. My intent is to show you that WHAT you do is not under any criticism here. It is HOW you explain it to yourself and patients - it is WHY it works - it is HOW you understand human neurophysiology to work.

Because the info is out there.....And you do not even have to give up the feeling of practicing "art" in PT.

(in reply to Niko)
Post #: 41
RE: A problem arises... - July 11, 2012 3:12:58 PM   
HarperPT

 

Posts: 86
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In your "post #36" you list some techniques that therapists should not use because they are not backed by science. What techniques do you use?

< Message edited by HarperPT -- July 11, 2012 4:05:02 PM >


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Post #: 42
RE: A problem arises... - July 11, 2012 9:55:06 PM   
Sebastian Asselbergs

 

Posts: 2293
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From: Barrie, Canada
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Gentle manual techniques.
Good science of the very large role of skin as kinesthetic sensory organ, its direct neurological route to the brain - and it is the only thing I can touch with absolute certainty on my patients.
Looks very much like some MFR or cranial osteopathic techniques. BUT: with none of their garbage explanatory models though.....

(in reply to HarperPT)
Post #: 43
RE: A problem arises... - July 11, 2012 9:58:26 PM   
Niko

 

Posts: 137
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quote:

Niko, PLEASE understand that my outcomes have only gotten BETTER with no acupuncture or other woo-therapies.


Really? I did not want to do this but here you go. A research study that proves you wrong and proves that acupuncture is more effective than exercise and the placebo for rotator cuff tendonitis. Sorry for making you look like a fool but you should have seen it coming.
http://www.ncbi.nlm.nih.gov/pubmed/19644905

quote:

“Where on earth did you see me write that I "ignore all those people who need my help"?!? You made a few conclusions based on assumptions.


According to the research article above I did not make assumptions, I was right.

quote:

That is called very, very poor science. AND insulting”.


Sebastian, the world is a mirror. The faults you see in others are your own. You enter this discussion thinking that you are absolutely right but you are proven wrong. And now you are mad?


quote:

Scientifically speaking, outcomes research is basic, easy, and fraught with problems. Did you read the link I provided above? It really addresses much of what is poor in today's strictly outcome-focused therapy.


I did not ask you for a research article of why science is important. I think three degrees in science from leading research universities have taught me that already, I’m just curious how many do you have?

quote:

Lastly, you have not addressed my last point in my previous post #36.

Whats post # 36? You have over 2000 posts here dude! Maybe you should be spending more time with your daughter.

(in reply to Sebastian Asselbergs)
Post #: 44
RE: A problem arises... - July 11, 2012 10:34:34 PM   
HarperPT

 

Posts: 86
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quote:

ORIGINAL: Sebastian Asselbergs

Gentle manual techniques.
Good science of the very large role of skin as kinesthetic sensory organ, its direct neurological route to the brain - and it is the only thing I can touch with absolute certainty on my patients.
Looks very much like some MFR or cranial osteopathic techniques. BUT: with none of their garbage explanatory models though.....


Fair enough!

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Post #: 45
RE: A problem arises... - July 11, 2012 10:44:52 PM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
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quote:

quote:

Niko, PLEASE understand that my outcomes have only gotten BETTER with no acupuncture or other woo-therapies.


Really? I did not want to do this but here you go. A research study that proves you wrong and proves that acupuncture is more effective than exercise and the placebo for rotator cuff tendonitis. Sorry for making you look like a fool but you should have seen it coming.
http://www.ncbi.nlm.nih.gov/pubmed/19644905


Silly me. If you read what I said carefully, you would have seen my outcomes have IMPROVED after dropping acupuncture. And you come back with a silly study showing naturopathy (including acupuncture) is better than:
quote:

The PE intervention group received passive, active-assisted, and active range of motion exercises and matched placebo.
OVER 12 WEEKS!
Duh, I could have told them before the study. Who the hell treats rotator cuff tendinitis like that?
First off: this study does NOT show improved outcomes for acupuncture at all!. Again: you have three - THREE - degrees in science?
Second: this study has nothing to do with MY outcomes. That is because YOU assumed I did not treat those people looking for acupuncture; wrong. I did treat them, differently - with success.
The paper proves you were right about my outcomes?!? Three degrees in science?!?
Finally, the paper abstract does not say anything about long term outcomes. VERY poor study.

Have you seen the papers that show positive outcomes for MFR? For scam-arthroscopies? Should we run out and "do " those as treatment?

quote:

Whats post # 36?
Post #36 in this thread, genius. Oh well, I guess I must really explain in small detail for some readers. Three degrees.....


quote:

Sebastian, the world is a mirror. The faults you see in others are your own.

Thanks for making me laugh.
Maybe you SHOULD read that link - maybe you should read the materials I provided you with.

Niko, I know it is very unlikely that you will understand what I am trying to make clear to you. That's OK. It takes a big effort - for those who even want to.
Keep practicing the way you do -I really don't care about you.

I do care about the crap in our profession, and some of your posts made reference to crap-treatments. We will not even see eye-to-eye on those.
I reserve the right to express my disdain for such blatant disregard for fundamental scientific principles.


Three degrees....

(in reply to Niko)
Post #: 46
RE: A problem arises... - July 11, 2012 10:50:00 PM   
HarperPT

 

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Niko,

Check your messages, I sent you a PM.

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Post #: 47
RE: A problem arises... - July 11, 2012 11:40:47 PM   
honker23

 

Posts: 217
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Does qi exist? Do specific meridians exist? Can you move cranial sutures? Can you release fascia non-surgically?

(in reply to HarperPT)
Post #: 48
RE: A problem arises... - July 12, 2012 7:36:08 AM   
proud

 

Posts: 1834
Joined: March 23, 2006
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Oye...Seb and others.

I spotted the frog quite early as this thread rambled on. Good for you guys for debating with a fellow whose primary reason for engaging here is to play the role of antagonist. Takes more energy than I am willing to throw out.

Niko brings forward an absolutely absurd research article (which I'm suspecting he/she did not even read in it's entirety, which I have by the way) and rally's some preposterous argument around it that somehow he/she is the one who truly understands scientific literature...when in fact the very presentation of the article proved the opposite.

I enjoy my exchanges with many on here whom I often hold an opposing position, as they provide good and coherent viewpoints that stimulate healthy debate(Tom at times, Spokane at times etc).

I've no time for nonsense antagonsim and this is what it appears to be coming from Niko. I am aware that many many PT's are out to lunch when it comes to their beliefs and inability or unwillingness to read the literature...but Niko seems over the top in this regard so...last post from me RE: Niko.

< Message edited by proud -- July 12, 2012 7:45:17 AM >

(in reply to honker23)
Post #: 49
RE: A problem arises... - July 12, 2012 8:02:19 AM   
JSPT

 

Posts: 440
Joined: April 20, 2005
From: Michigan
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Look, I don't want to beep my own horn, but I have 3 degrees in art (since we're talking about the art of PT). The following drawing is one I made to prove this. Its good, because I have 3 degrees in art, and there is no way its possible that earning a degree doesn't make everything I turn out true art. There is no way I spent all that money on a degree and didn't understand what art is.

Again, here is my proof. It is how I picture all of us having this discussion.

(in reply to proud)
Post #: 50
RE: A problem arises... - July 12, 2012 9:29:23 AM   
Sebastian Asselbergs

 

Posts: 2293
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From: Barrie, Canada
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JSPT; thanks for that artwork. It did its job and lifted my spirits.

(in reply to JSPT)
Post #: 51
RE: A problem arises... - July 12, 2012 6:40:39 PM   
ginger

 

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Joined: February 27, 2005
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Wow JS, you're a legend, so ( put on frenchy accent) ow you say, mannifeeeka , tres bon.

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Physiotherapist

(in reply to Sebastian Asselbergs)
Post #: 52
RE: A problem arises... - July 12, 2012 10:48:59 PM   
Niko

 

Posts: 137
Status: offline
HarperPT, Thanks for the PM. You have a very good point brother, it makes total sense.

JSPT, good job, that is funny indeed I admit it.

Sebastian!
Look at you going against a published research article! I’m proud of you again, you continue demonstrating progress. Slow but steady. This article was a trap and you have fallen for it. You finally realize my point of opposing to current/limited evidence. Like you think you understand many problems with this research article, there are many more that you don't understand with others that essentially created what we call today PT science.

So far you learned to appreciate the art of the profession and that a research article does not necessarily reveal the truth due to study errors/biases and many confounding variables.

However, you are still failing to understand or successfully argue against any of my other points
- “the scientific principles of exercise physiology apply to any therapeutic movement and not just traditional exercise protocols”.

- the concept of mindfulness and its therapeutic effects in patient care, whether through Gi Gong, Yoga or just lying down.

- physical, emotional, mental and spiritual health interdependence

- all passive treatments act through the same physiological pathway (sensory nervous system) whether is manipulation, mobilization, soft tissue work, acupuncture or even ultrasound.

Finally, I have one more point to make regarding acupuncture. Not even about the meridian theory but regarding trigger points. Saying that acupuncture does not work at all is basically challenging all of Janet Travell's work. Are you up for that?

Let's see if you continue to show progress/make a fool of yourself.

Proud, you are like Donny in Big Lebowski. http://www.youtube.com/watch?v=OCLBjjffrek

Honker23, what are you? You sound like Sebastian’s backup voice. Maybe you are the same person? !



-Niko

(in reply to ginger)
Post #: 53
RE: A problem arises... - July 13, 2012 7:21:28 AM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
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Aha, Niko. Nice try: post a terribel article to support your point - get exposed for a lack of scientific know-how, and then pretend it was your goal all along. A little transparent maybe, but a nice try nonetheless.
Three degrees in science? really?

quote:

So far you learned to appreciate the art of the profession

Sorry Niko - you cannot take credit for that - learned that about 29 years ago. This slightly predates this "discussion".


Wriggle away from acupuncture to dry needling eh?
Travell? Really? I do not have to "go against" her. "Trigger points" have had their time in the sun - check this easy to read critique: http://saveyourself.ca/articles/trigger-point-doubts.php
I know that there are hot proponents of "dry needling" - Jan Dommerholt is one who deserves respect for his work, buit has yet to be able to demonstrate with any conclusive certainty that there is more value to sticking needles in skin and soft tissue, than gentle hands-on as part of a session.
So trigger points? Not of importance and haven't looked, palpated for them for about 12 years now. Oh, before you worry about my patients not getting trigger point therapy - they do just as well with much less. AND they understand why.

You say I did not argue or understand the following points?!? This shows that you indeed have poor reading skills. Because I mostly agree with them. Good god, you really do not have a clue what I written about for years on Rehabedge, do you?

quote:

- “the scientific principles of exercise physiology apply to any therapeutic movement and not just traditional exercise protocols”.

- the concept of mindfulness and its therapeutic effects in patient care, whether through Gi Gong, Yoga or just lying down.

- physical, emotional, mental and spiritual health interdependence

- all passive treatments act through the same physiological pathway (sensory nervous system) whether is manipulation, mobilization, soft tissue work, acupuncture or even ultrasound.


One thing I must caution you against: the first point is a bit shakey - too much generalization: metabolic physiology varies widely from just slow motion to fast and resistive for instance. The common physiology is the neurophysiology.

quote:

Honker23, what are you? You sound like Sebastian’s backup voice. Maybe you are the same person? !


Ah, another deflection. No, Niko, we are definetely NOT the same person. it might be a bit disconcerting that two different people may have the same questions about some of your points.
But try to think about them - honkers' questions are of importance in the practice of physiotherapy. They should make PTs think about the deeper model of science underlying therapy (without losing the "art" don't worry) and should help get rid of the fallacious explanations of what causes pain and what fixes it.

You almost had it there in that list of four points, but not quite fully. It is all about the neurophsyiology, but you seem to be leaving the human brain and its perceptions too low on the list.

Keep at it, padawan.

(in reply to Niko)
Post #: 54
RE: A problem arises... - July 13, 2012 9:56:10 AM   
rwillcott

 

Posts: 1123
Joined: March 21, 2006
From: Canada
Status: offline
Niko,

I find it odd that you are setting so called traps for people. Since you like to post youtube links of who people remind you of I though this pertained to you:

http://www.youtube.com/watch?v=PqcWpYBSWWY

(in reply to Sebastian Asselbergs)
Post #: 55
RE: A problem arises... - July 13, 2012 10:41:41 AM   
bgalindpt

 

Posts: 101
From: boynton beach, fl
Status: offline
right about now, with the base level this has gotten to, like many others that result in two stubborn bulls posturing around one another, if I were and advertiser on here I'd start pulling my money back. What about some professionalism on everyone's behalf. Agree to disagree, agree to have good debates but not ones that result in eruditious soliloquy of why you need to feel smarter than the next chap. Remember, there are kids watching, and we do not want to turn off an entire forum over 1 or 2 posts per month. I said it before, there are probably people with great discussion topics afraid to post because of the level of patronizing and bullying that goes on. Please, do keep it fierce but keep it nice, it will benefit all of us.

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Post #: 56
RE: A problem arises... - July 13, 2012 11:27:32 AM   
JSPT

 

Posts: 440
Joined: April 20, 2005
From: Michigan
Status: offline
bgalindpt-

Well that's no fun.

I think if you read the forum, posts like this are rare, but they probably get more hits. In fact, I bet the number of page views goes way up when people are mixing it up. The natural evolution of this type of thread seems to be:

initial thought-->respectful counter-thought-->reasonable back/forth-->getting down to the ideology of 2 (or more) immovable objects-->entertaining/ridiculous comment(s) because the technical discussion is over-->someone gives up and we all move on in a week.

That is also reflective of the internet in general, I suppose.

I actually mentioned to Bas that, speaking for myself, I'm responding for the general audience more than I am to the actual poster. I have no illusions about changing Niko's mind. Frankly, I won't sway his opinion, nor he mine. If he gets his patients better, great. But I hope that some of the larger points we are making about the direction of the profession are not lost on others, especially those new grads out there.

I first came here as lurker looking for clinical pearls about 7-8 years ago as a new grad. It took me a couple years of watching to not be afraid to speak up. Whether or not you contribute, you can learn a lot by following the discussion, just like in class. You've usually got a handful that ask/answer questions, and the rest are passive observers.

Regardless, I appreciate the reminder to not deviate too far from spirited discussion. Past experience tells me that if any serious mud or personal attacks start flying, the thread will be killed.

(in reply to bgalindpt)
Post #: 57
RE: A problem arises... - July 13, 2012 12:23:49 PM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
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bgalindpt, "Bullying"?
quote:

Agree to disagree, agree to have good debates but not ones that result in eruditious soliloquy of why you need to feel smarter than the next chap.


Ironic choice of words there.

A) "feel smarter than the next chap" - this is a diagnosis based on too little info.
B) " good debates" are defined in different ways.
However, fierce discussions are found in many science debates. If you want a tea-party with bone china and raised pinkies, you may have to ban, say, at least four or five people from the Edge. Including me.

(in reply to JSPT)
Post #: 58
RE: A problem arises... - July 13, 2012 6:02:51 PM   
Tom Reeves DPT ATC

 

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The way I look at it, if you can't defend your position you shouldn't be in the profession. Bas and Proud have argued fiercely with me on several topics. I think that largely, our treatment sessions would probably look the same if there was a mute button. I am not as fluent as they probably are but I am working on it.

Strong opinions should be based on plausible science. The plausible science needs to be tested to see if it is, in Mythbuster terms, confirmed, busted, or plausible. Sometimes the research doesn't prove or disprove things, it only raises more questions. but sometimes it does.

If people can't listen to another opinion and alter their perceptions, then they are dogmatists and that is not how we should act or what our profession should be.

I have had my eyes opened by some of these discussions that have challenged some professional core beliefs that I have had. I hope that I have made at least a few people say "hmmm" in a good way.

My practice is tweaked every day.

Don't be afraid of the discussion. Don't be afraid to challenge what you think you know. Heck, before I ever heard of the neuromatrix or really thought concretely about chronic pain, I had been already addressing many of the concepts intuitively. The discussions here have only served to solidify some of those intuitions. I have certainly modified the way I speak with my patients and especially with those chronic pain people. I am seeing patterns that have always been there but have been below my personal radar.

Por ejemplo: Why is it that some people always seem to be being treated for something? Why do they have back pain, then plantar fasciitis, then adhesive capsulitis, then patello-femoral syndrome, then headaches?

Because many of us fail to adequately treat the brain.

My disputes with Bas and Proud, I think are mostly about details and in my view possibly a matter of their relative dismissal of orthopedic/biomechanical aspects of our practice. The more I read and talk, and debate though, the less of a disagreement I think we have.

I have been beaten up plenty but I've never felt bullied on this site.

Those that are feeling bullied probably need to re-read their posts and ask themselves " did my post sound like something written by a scientist or a philosopher?"

have a nice weekend.

< Message edited by Tom Reeves DPT ATC -- July 13, 2012 6:05:54 PM >

(in reply to Sebastian Asselbergs)
Post #: 59
RE: A problem arises... - July 15, 2012 3:29:33 PM   
HarperPT

 

Posts: 86
Status: offline
Congratulations guys! It looks like you've driven off the first new member you've had here in months.

To quote rwillicott,

LMFAO!!!!!

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Post #: 60
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