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RE: A problem arises...

 
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RE: A problem arises... - July 15, 2012 6:14:12 PM   
ginger

 

Posts: 1248
Joined: February 27, 2005
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Harper, , who knows, his skin may thicken, his mettle return, his thoughts and beliefs be sharpened by the Edge whetstone, only to return to bluff his way through another encounter with Bas and Proud.
________________________________________
Stay Ugly!( it's your best insurance )

_____________________________

Geoff Fisher
Physiotherapist

(in reply to HarperPT)
Post #: 61
RE: A problem arises... - July 15, 2012 6:28:42 PM   
HarperPT

 

Posts: 86
Status: offline
quote:

ORIGINAL: bgalindpt

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.


Great post!

Too bad it didn't come several years earlier before this once thriving forum was reduced to NOTHING by 3 or 4 ARROGANT members.

RIP RehabEdge.

_____________________________

Stay Hungry!

(in reply to bgalindpt)
Post #: 62
RE: A problem arises... - July 15, 2012 8:26:01 PM   
Niko

 

Posts: 137
Status: offline
I’m still here and I’m still smiling. Well, these discussions can be long and they are not a priority of mine.

Bgdpt . I apologize if I sounded offensive. I’m guilty of not taking people here too seriously. If we were all in the same room doing some Qi Qong together before the discussion started, we would have all been more easy-going and accepting.

Sebastian, what is your goal when you participate in this forum? It sounds that you already have your own formula in treating patients and refuse to deviate, and you already believe in a set “scientific” model that explains how the body works. When you are introduced to anything different, your underlying defense mechanics is a) you have tried everything and b) research study a b or c showed that it is garbage. Ginger, maybe doing some continuous mobilization on Sebastian’s spine will reduce his brain’s defense mechanism and help him be more positive and accepting?

No offence Sebastian, but maybe sometimes is a good idea to step aside and let the new professionals see things with a fresh perspective and more optimism. I can imagine why you prefer to live in negativity, it’s safer. If everything in our profession stops at where the current literature is suggesting, then why forums like this exist, lets just read the literature and go to bed. I believe that you have doubts about the literature yourself, you understand its limitations, you are not satisfy that you have grown enough or reached a plateau in your practice, and you are probably looking here for people like me to give you some insight or hope that not everything is black or white. Without somebody challenging your current believes you are only staying at a 360 degree circle. Deep inside you must know that we are long way to go from knowing exactly how every microsystem in the human body operates.

Re trigger points.
When you carefully palpate a muscle and identify a taut band with palpable nodule, and the patient experiences referred pain that does not match with dermatomal pattern, and this is the same pain that brought the patient to you, what is your scientific explanation other than palpating an active trigger point? What do you think about motor end plate dysfunction? Studies have shown correlation of motor end plate abnormalities and clinical presentations. Don’t you agree that pathophysiology of soft tissue problems can result from localized end plate dysfunction in combination with neuromuscular transmition problems? When you “deactivate” that point and pain is not felt anymore, motor function is improved, the patient does not need to take pain medications and moves on, how do you also explain that? I never talked about dry needling. You can deactivate a trigger point directly with any hands on soft tissue technique or indirectly through joint work, even if you don’t realize that you are doing it.

If you agree that passive modalities operate under the same physiological pathways, whatever that is, that means you agree that the specific technique used has little to do with any difference in functional outcomes. My point is that if one law governs everything, then you can’t just pick and choose what manual technique to believe in. You can choose what you enjoy doing and what works more for you, but that is a different thing. If you agree that passive modalities operate under the same physiological pathway, and then you deny that one specific technique works (including acupuncture and ultrasound), you must also deny everything else. You can still be a hands off practitioner and there is nothing wrong with that by the way. I’m not referring to muscle energy and PNF, and techniques where there is active patient involvement. I personally don’t care what you do as long as your patients get better.

quote:

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.....


You are saying here that the skin is the only thing that you can touch with absolute certainty on you patients. What does that even mean? Is there anything else to touch other than skin with any form of manual therapy? If you mobilize a joint, don’t you mobilize the skin as well? And if you only rely on skin changes why don’t just kinesio tape people and send them home? I find it hard to believe that you don’t ever mobilize a joint. It sounds to me again that you are trying to play it safe.

Finally, I believe that in helping people recover, especially those with chronic pain, requires a multidisciplinary approach. If I was a chronic pain patient I would prefer to be treated by a team of MDs, PTs, acupuncturists, chiropractors, psychologists. Well, I work with such a team, that’s why my ideas are just a bit different.

-Niko

(in reply to HarperPT)
Post #: 63
RE: A problem arises... - July 16, 2012 9:03:14 AM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
Niko: thank you for staying around.

I do take some offense to your suggestions that I am "negative" or choose "safer" approaches.
quote:

reached a plateau in your practice, and you are probably looking here for people like me to give you some insight or hope that not everything is black or white.

Sorry, I could not help but laugh out loud. Is that what you have read from my posts on this and other threads? I must say, that remark does not signify a solid understanding of the english language if that is what you conclude from my postings.....
About the "physiological pathways" please read again what I said. The little word "general" was included there.
There is a vast difference between hands-on neurophysiology and modality neurophsyiology. The grooming aspect alone makes careful manual contact more effective that any machine.

quote:

If you agree that passive modalities operate under the same physiological pathway, and then you deny that one specific technique works (including acupuncture and ultrasound), you must also deny everything else.


Oh my goodness. First of all - "general physiological similarities" - these include the patient's belief system, the practitioner's confidence, the familiarity or novelty of an input. I have never ever denied a technique can have good outcomes. Even MFR and CST have some evidence of good outcomes. But good outcomes do not support the underlying theory of the method!!

And trigger points;
quote:

Don’t you agree that pathophysiology of soft tissue problems can result from localized end plate dysfunction in combination with neuromuscular transmition problems?

A) is there any way to reliably test for the presence of this "pathophysiology"? Is there a reliable way to establish the causal relationship between trigger points and the patient's complaint?

quote:

When you “deactivate” that point and pain is not felt anymore, motor function is improved, the patient does not need to take pain medications and moves on, how do you also explain that?

Can you explain what "deactivate" means physiologically? If "pain is not felt anymore", it means that the patient's brain has changed its output of pain based on input from the periphery, your confidence, their previous beliefs, the novelty of the treatment, their understanding that there is a 'knot" responsible for their pain, etc etc. So far, it is impossible to suggest that you have "deactivated" anything. It is not about the method - it is about being accurate how we tell our patients what we are doing.

Why do you think I keep posting here?

It is because I am excited about the opportunities science is giving us to move out of modality land, out of crappy theories towards a more comprehensive understanding of the human we are treating. Do we know all there is? Heck, no.
I will say it again - the method is not as important as the the underlying understanding of what happens in therapeutic sessions. The understand of the processes should drive our methodology, not just short term outcomes.

quote:

I find it hard to believe that you don’t ever mobilize a joint.

Oh, I make joints move better for sure. But it is not because my hands somehow miraculously stretch capsule. It is because my hands provide - in context of the therapy session - an input that the nervous system in front of me processes and changes its output: both to the body, as well as to other areas of the brain (including its perceptual processes).

Your ideas are not that different - we see them here from time to time. I communicate with quite a few other PTs who work in multi-disciplinary pain teams (but not acupuncturists or chiros - but WITH OTs and SWs) - yet they can and do apply a more stringent standard of what is plausible in their therapies. It is a bit of a concern to me that you do not seem to know about pain being an output from the brain and that you think pain can come from tissues. I'd have hoped that in a chronic pain team they had heard oof the neuromatrix, Melzack, Ramachandran, Moseley, Thacker, Doidge and more.

Harper, Rehabedge is lucky to have a contributor like you. You makes everyone else look so good.

(in reply to Niko)
Post #: 64
RE: A problem arises... - July 18, 2012 11:53:18 PM   
Niko

 

Posts: 137
Status: offline
Rehab edge, you better send me a pay check for this..


quote:


There is a vast difference between hands-on neurophysiology and modality neurophsyiology.

What do you think is the difference? When you are doing ultrasound aren’t you also gently mobilizing soft tissue? How about electrical stim? The ultrasound wave or e stim is just a bonus that your hand does not transmit. I would say yes you have a point if you are doing deep tissue or manipulation/joint work. But since you only do gentle manual techniques/skin mobilization, then your argument here is not sound.

quote:

The grooming aspect alone makes careful manual contact more effective that any machine.

I assume that you refer to the positive psychological effect of human touch here. If this is the case then you are basically agreeing with my original statement that people need to be touched. Remember? You got upset because I said I do not need research to validate this. But your statement here also compares manual contact and machines, and I assume that you imply manual contact is always more effective? If yes then my answer to this is: yes and no. Some people, especially in western societies believe more to therapeutic equipment than therapeutic hands(remember that we talk about psychological factors). I would personally prefer to ultrasound my wrist strain first before having somebody move the soft tissue around it telling me I’m giving input to your body to cancel out the pain output in my brain kind of thing. In fact, when I treat my self from minor strains I only use modalities, sore the next day, symptoms gone the day after. I agree that manual care can offer many different positive experiences due to things like increased in release of neurotransmitters including dopamine, associated with reward and therefore endure of pain. However, I do not believe that equipment is useless. This is just another example of you being negative.

quote:


Oh my goodness. First of all - "general physiological similarities" - these include the patient's belief system, the practitioner's confidence, the familiarity or novelty of an input.

If you mean that these things affect physiological processes to some extend then I do agree. Never argued against that. It’s funny because it looks that you copied and pasted that sentence from a research article. I would go further and say: the practitioners clothes, the practitioners voice, the practitioners physique, the room decoration, temperature and lighting, backround music, etc. Now, that has nothing to do with my statement that you quoted. I said passive modalities operate under the same physiological pathway. The sensory nervous system is a huge part of it. Senses include touch, hearing, sight, smell and taste. I was referring to touch or the contact pressure with using your hand or a modality.

quote:


I have never ever denied a technique can have good outcomes. Even MFR and CST have some evidence of good outcomes. But good outcomes do not support the underlying theory of the method!!

Why do you say ‘even MFR and CTS’ like you don’t want to believe that these techniques work or that they should be last in the list of every PT. You said before that all you do is basically MFR and CTS. The fact that you take the word “release” away and explain it differently to patients does not make the technique more effective. Most patients care less if you think that you are releasing the fascia or if you are just providing some input to the nervous system. All they want is their money's worth and that is the end result.

quote:



A) is there any way to reliably test for the presence of this "pathophysiology"? Is there a reliable way to establish the causal relationship between trigger points and the patient's complaint?

There is good research that supports palpating a taut band can result in a twitch response or referred pain. Moreover, there is good electromyographic research demonstrating accelerated fatiguability and delayed relaxation in muscles with these palpaple taut bands versus without. This is worth noting dude.

quote:



Can you explain what "deactivate" means physiologically? If "pain is not felt anymore", it means that the patient's brain has changed its output of pain based on input from the periphery, your confidence, their previous beliefs, the novelty of the treatment, their understanding that there is a 'knot" responsible for their pain, etc etc. So far, it is impossible to suggest that you have "deactivated" anything. It is not about the method - it is about being accurate how we tell our patients what we are doing.

Deactivate is just a word to describe those 5 sentences plus more.

quote:


Why do you think I keep posting here?
It is because I am excited about the opportunities science is giving us to move out of modality land,

What do you do when you get a patient that is in a lot of pain, does not let you touch him/her, cannot tolerate exercise, and is telling you that has a positive experience with modalities in the past? Besides projecting to the patient your negativity that nothing works.

quote:


Oh, I make joints move better for sure. But it is not because my hands somehow miraculously stretch capsule.


Miraculously? Are you trashing the general idea of stretching soft tissues here? Very interesting. I recommend that you find an anatomy lab and work on some cadavers. That way you will realize that you can actually stretch a joint capsule and the joint can actually move more.

quote:


It is a bit of a concern to me that you do not seem to know about pain being an output from the brain and that you think pain can come from tissues.

I don’t disagree that pain is a sensation integrated in the brain. But what triggers it? You disagree that structural deviation/damage can trigger a pain response? If you cut your finger, isn’t’ there some structural damage as well as pain signals.


quote:


Harper, Rehabedge is lucky to have a contributor like you. You makes everyone else look so good.


Harper is a much better PT than me or you just because he is cool. you either have that quality or not. I would let Harper treat me any day over you that's for sure!

-Niko

(in reply to Sebastian Asselbergs)
Post #: 65
RE: A problem arises... - July 19, 2012 7:38:04 AM   
Sebastian Asselbergs

 

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

It’s funny because it looks that you copied and pasted that sentence from a research article.

Really.
Thank you for that. It means that my writing has improved. But no, that did come from me.

quote:

You said before that all you do is basically MFR and CTS.


No, I never said that. I said it LOOKS like. Because it is gentle manual techniques. CST and MFR have underpinning theories that are totally bogus and calling those gentle manual technique by those names implies that their explanatory model is valid. It is ONLY the hands-on part that LOOKS like them.

I thought my criticism of these methods was rather clear. But obviously not.

quote:

There is good research that supports palpating a taut band can result in a twitch response or referred pain. Moreover, there is good electromyographic research demonstrating accelerated fatiguability and delayed relaxation in muscles with these palpaple taut bands versus without. This is worth noting dude.

Again, this does NOT support that the findings are CAUSALLY related with the patient's complaint. read about "correlation" and "causation". Also suggest looking up "effect versus defect" in the exploration of the neurology of pain.

quote:

All they want is their money's worth and that is the end result.

And that remark appears to indicate you do not care HOW you accomplish that.

quote:

I recommend that you find an anatomy lab and work on some cadavers. That way you will realize that you can actually stretch a joint capsule and the joint can actually move more.


Oh my goodness. I recommend you stop assuming so much. I have worked in a cadaver lab. Probably before you could spell it.

If you want to suggest that working on a cadaver is the same as working on living tissue, please never treat me.

quote:

If you cut your finger, isn’t’ there some structural damage as well as pain signals.


And this one was the kicker. "pain signals"?!? From the finger? Really?
And what "pain nerves" and "pain sensors" have you been able to find in your anatomy labs or neurophysiology books? A hint: there are none. Zip. Zilch.
It astonishes me that for a person who is supposedly in a multidisciplinary pain team, you seem to have such paucity of understanding of modern pain sciences. "Pain signals", doesn't know the difference between correlation and causation, and this zinger:
quote:

I don’t disagree that pain is a sensation integrated in the brain.
A "sensation"? Really? Ever seen the IASP definition? Or any of the recent work by Moseley, Thacker and so forth?
Your definition is about 10 years out of date.

quote:

Harper is a much better PT than me or you just because he is cool.


Thanks for letting me know what you think is a good standard to measure the quality of a PT.

(in reply to Niko)
Post #: 66
RE: A problem arises... - July 19, 2012 8:39:53 AM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
just a bit of an addition:
quote:

If this is the case then you are basically agreeing with my original statement that people need to be touched. Remember? You got upset because I said I do not need research to validate this.

Yep. I fully agree that manual therapy is very useful. I also still find your statement - being a scientist and all - that you do not need validation quite disturbing.
quote:

I was referring to touch or the contact pressure with using your hand or a modality.

Then the "same physiological pathway" you talk about only refers to the input from the periphery. All the other influences (on which we both agree BTW!) on the effect of an input are the most important therapeutically.
We can not stop and say: "It doesn't matter what we do, it all uses the same pathway" or "it has the same effect". We MUST explain to the patient the most up-to-date and plausible, best supported MODEL for the things we do with them and why they work. If we simply say: "well, it works" and the patient thinks it was the US, or craniosacral rhythm or their qi was disturbed they will continue to think that their pain is caused by tissue "X" or "blocked energy" or "stuck cranial sutures" which will not help them self correct in future. That goes against my provincial standards of practice as far as using most up-to-date science and evidence.
It also creates pateint adherence to faulty explanatory models, leads the patient down a path of dependence on practitioners with a "special" technique or modality, to stay "healthy"

(in reply to Sebastian Asselbergs)
Post #: 67
RE: A problem arises... - July 19, 2012 6:27:16 PM   
rwillcott

 

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

We MUST explain to the patient the most up-to-date and plausible, best supported MODEL for the things we do with them and why they work. If we simply say: "well, it works" and the patient thinks it was the US, or craniosacral rhythm or their qi was disturbed they will continue to think that their pain is caused by tissue "X" or "blocked energy" or "stuck cranial sutures" which will not help them self correct in future. That goes against my provincial standards of practice as far as using most up-to-date science and evidence.
It also creates pateint adherence to faulty explanatory models, leads the patient down a path of dependence on practitioners with a "special" technique or modality, to stay "healthy"


Great post Seb and I think the above quote sums up how we should be treating patients. The following quote by niko on the other hand explains how we should not be treating patients:

quote:

Most patients care less if you think that you are releasing the fascia or if you are just providing some input to the nervous system. All they want is their money's worth and that is the end result.


This is why chronic pain is an epidemic.

(in reply to Sebastian Asselbergs)
Post #: 68
RE: A problem arises... - July 19, 2012 10:17:13 PM   
HarperPT

 

Posts: 86
Status: offline
Looks like Sebastian has met his match....once again.

I wonder when Honker23 will enter to help save the day?

WINK WINK

_____________________________

Stay Hungry!

(in reply to rwillcott)
Post #: 69
RE: A problem arises... - July 19, 2012 11:34:40 PM   
Niko

 

Posts: 137
Status: offline
Sebastian,

You failed to respond to my first question about modalities.

You failed to argue or provide any evidence that the grooming aspect of manual contact makes it more effective than machines.

Other than that:

quote:


No, I never said that. I said it LOOKS like. Because it is gentle manual techniques. CST and MFR have underpinning theories that are totally bogus and calling those gentle manual technique by those names implies that their explanatory model is valid. It is ONLY the hands-on part that LOOKS like them.

I thought my criticism of these methods was rather clear. But obviously not.


OK, we both agree that the hands on part itself has the same physiological effects, right? So if I tell the patient that I'm mobilizing the fascia (which I am) and you tell the patient that you are giving input to the nervous system (which you are), then what is the difference? As long as we are both convincing to the patient then there should not be a difference in outcomes based on these factors alone. I know that you don't buy into the initial theories of why these techniques work. Nobody asked you too. You are fixated with words. And is not even like I'm saying apples and you say oranges. It's like Im saying yellow apples and you are saying yellowish apples. It sounds like you suffer from OCD of some sort. The main therapeutic effect derives from the technique itself and not your mouth.

quote:


quote:

There is good research that supports palpating a taut band can result in a twitch response or referred pain. Moreover, there is good electromyographic research demonstrating accelerated fatiguability and delayed relaxation in muscles with these palpaple taut bands versus without. This is worth noting dude.

Again, this does NOT support that the findings are CAUSALLY related with the patient's complaint. read about "correlation" and "causation". Also suggest looking up "effect versus defect" in the exploration of the neurology of pain.


Again, all I said is that it is worth noting these studies, as well as the 100 years of research, and ongoing research on trigger points.

quote:


quote:

All they want is their money's worth and that is the end result.

And that remark appears to indicate you do not care HOW you accomplish that.


That remark is one that no sensible individual can argue with. It means that the main concern of the patient is to feel better. I said that this is the patient's main goal, or in other words, the health care consumer's goal. I always tell clients that they have the opportunity to get better in PT, but it is hard work. They don't always get better, and they don't always get their money's worth. They are paying to have an opportunity to get better. Now, how did you conclude from that sentence that I do not care how to accomplish that? I'm all about patient satisfaction.

quote:


quote:

I recommend that you find an anatomy lab and work on some cadavers. That way you will realize that you can actually stretch a joint capsule and the joint can actually move more.


Oh my goodness. I recommend you stop assuming so much. I have worked in a cadaver lab. Probably before you could spell it.

If you want to suggest that working on a cadaver is the same as working on living tissue, please never treat me.


working with a cadaver will take out of the equation the nervous system effects that you only believe in. Then you will realize that the concept of elasticity as a physical property does exist in any material including human tissue.
quote:


quote:

If you cut your finger, isn’t’ there some structural damage as well as pain signals.


And this one was the kicker. "pain signals"?!? From the finger? Really?
And what "pain nerves" and "pain sensors" have you been able to find in your anatomy labs or neurophysiology books? A hint: there are none. Zip. Zilch.
It astonishes me that for a person who is supposedly in a multidisciplinary pain team, you seem to have such paucity of understanding of modern pain sciences. "Pain signals", doesn't know the difference between correlation and causation, and this zinger:

quote:

I don’t disagree that pain is a sensation integrated in the brain.
A "sensation"? Really? Ever seen the IASP definition? Or any of the recent work by Moseley, Thacker and so forth?
Your definition is about 10 years out of date.


I was referring to nocioceptive pain due to peripheral nerve stimulation by a noxious stimuli. Afferent sensory axons. Yes, I have found those in the anatomy lab. Again, you are fixated with words.

quote:


quote:

Harper is a much better PT than me or you just because he is cool.


Thanks for letting me know what you think is a good standard to measure the quality of a PT.


you are welcome

quote:



Yep. I fully agree that manual therapy is very useful. I also still find your statement - being a scientist and all - that you do not need validation quite disturbing.


yea yea yea we 've heard that, you don't get to use that again because im still waiting for your evidence regarding the things you said about modalities and manual contact.

quote:


quote:

We MUST explain to the patient the most up-to-date and plausible, best supported MODEL for the things we do with them and why they work. If we simply say: "well, it works" and the patient thinks it was the US, or craniosacral rhythm or their qi was disturbed they will continue to think that their pain is caused by tissue "X" or "blocked energy" or "stuck cranial sutures" which will not help them self correct in future. That goes against my provincial standards of practice as far as using most up-to-date science and evidence.
It also creates pateint adherence to faulty explanatory models, leads the patient down a path of dependence on practitioners with a "special" technique or modality, to stay "healthy"

Sebastian, our outcomes will never change based on the evolution of explanatory models. And I don't disagree with what you said. I believe in "the best supported model" but how you interpret it is another story. Don't forget the many confounding variables in your own brain.

-Niko

edit: removed personal insult, my apologies to Sebastian

< Message edited by Niko -- January 1, 2014 8:58:32 PM >

(in reply to HarperPT)
Post #: 70
RE: A problem arises... - July 20, 2012 7:21:39 AM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
Thank you for that classy address with my last name. Geez, it is the first time that has ever been done.

And I have to follow your advice about how Harper apparently is the standard of PT to which I must measure myself.
Considering his last thoughtful post - I think I can try to regress to my behaviour when I was about 12. That should suffice to emulate Harper.

You talk about your preference to have your wrist US-ed versus an accurate explanation - and that what drives your practice choices. And you're a scientist.

quote:

So if I tell the patient that I'm mobilizing the fascia
As long as you believe you are doing this, I am wasting my time.

quote:

Sebastian, our outcomes will never change based on the evolution of explanatory models.

You obviously do not read any research that has shown how accurate patient education - explanatory models - can greatly improve resolution of problems and their recurrence.

I am done - I have had more productive debates with my third year university students.

I will await your next post - but not very anxiously.

< Message edited by Sebastian Asselbergs -- July 20, 2012 8:38:06 AM >

(in reply to Niko)
Post #: 71
RE: A problem arises... - July 20, 2012 8:53:29 AM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
there was so much to reply to, I forgot this:

quote:

I know that you don't buy into the initial theories of why these techniques work. Nobody asked you too. You are fixated with words.

"nobody asked" me to? My professional standards ask me to.
I am "fixated with words"? How old are you? 10?
Now accurate use of terminology and words is somehow something to snarl at derisively? Isn't accuracy in communication - especially in the limited form of written communication - vital to proper understanding? What communication about science do you know that uses terms and words loosely?

Here is what I was supposed to interpret from your words:
"I say Qi, but I don't really mean it.
I say fascia, but treating it is the same as treating skin.

I say pain signals, but I really mean nociceptive stimuli."

then:
quote:

Again, all I said is that it is worth noting these studies, as well as the 100 years of research, and ongoing research on trigger points.

No, you claimed good evidence for treating trigger points.
You never demonstrated any understanding of causation, correlation, prior plausibility, etc etc.

And you think you are doing just fine. I won't change that.
And you try to emulate Harper.
Our profession in is dire straits.

< Message edited by Sebastian Asselbergs -- July 20, 2012 10:23:24 AM >

(in reply to Sebastian Asselbergs)
Post #: 72
RE: A problem arises... - July 20, 2012 10:57:58 AM   
proud

 

Posts: 1834
Joined: March 23, 2006
Status: offline
Until there is a level playing field of understanding current neuroscience and what it informs us about what we can...and cannot do, discussions such as this are simply frustrating.

Niko, seriously...pick up some texts (Butler, Wall, melzcack), read some modern neuroscience or perhaps some papers from Thacker, Moseley, louw etc or some mechanistic insights from Bialosky, George perhaps?

Then come back for a visit to discuss things. If you do this...I gaurantee you that you will return with a better ability to engage is this discussion above calling someone an ASS.

Or alternatively..stay behind the science and embarress the profession.
You would not be the first to pick that route.

< Message edited by proud -- July 20, 2012 11:13:59 AM >

(in reply to Sebastian Asselbergs)
Post #: 73
RE: A problem arises... - July 20, 2012 4:54:18 PM   
Chocco

 

Posts: 188
Joined: September 6, 2006
Status: offline
Getting back to the original topic I think this article is more than relevant.

http://www.physicaltherapyjournal.com/content/91/5/790.full

Proud RWillcott and Bas If you haven't read it you'll probably will appreciate it.

(in reply to proud)
Post #: 74
RE: A problem arises... - July 21, 2012 3:56:44 AM   
Niko

 

Posts: 137
Status: offline
quote:

Thank you for that classy address with my last name. Geez, it is the first time that has ever been done.


common, that's nothing compared to your underlying offense tactics. sorry for being a bit raw if that's the issue

quote:


And I have to follow your advice about how Harper apparently is the standard of PT to which I must measure myself.
Considering his last thoughtful post - I think I can try to regress to my behaviour when I was about 12. That should suffice to emulate Harper.


Harper has a good point. And I'm also wondering what happened to honker 23.
quote:


You talk about your preference to have your wrist US-ed versus an accurate explanation - and that what drives your practice choices. And you're a scientist.


Accurate explanation does not exist. You mean the best supported model and your personal interpretation of it. I consider myself an artist more than a scientist. Putting me down as less of a scientist wont work. You don't have to act that insecure knowing that I have higher education than you.
quote:


quote:

So if I tell the patient that I'm mobilizing the fascia
As long as you believe you are doing this, I am wasting my time.

Fascia does exist, you can mobilize anything in the body including fascia. I did not say the word releasing the fascia if that's your concern.
quote:


quote:

Sebastian, our outcomes will never change based on the evolution of explanatory models.

You obviously do not read any research that has shown how accurate patient education - explanatory models - can greatly improve resolution of problems and their recurrence.


I agree and I'm a huge supporter of this. However, the main effect comes from the technique itself. A convincing explanation can maximize the outcome of the technique even if it is the wrong one. (before you criticize me on this remember, what we think we understand today might not hold true tomorrow) The explanation by itself without the technique won't do much.
quote:


I am done - I have had more productive debates with my third year university students.


I feel sorry for those folks, I hope that they will read my posts and realize that not everything has to be black or white.

quote:



quote:

I know that you don't buy into the initial theories of why these techniques work. Nobody asked you too. You are fixated with words.

"nobody asked" me to? My professional standards ask me to.
I am "fixated with words"? How old are you? 10?
Now accurate use of terminology and words is somehow something to snarl at derisively? Isn't accuracy in communication - especially in the limited form of written communication - vital to proper understanding? What communication about science do you know that uses terms and words loosely?

ok man, stop, breathe, relax and clear your mind, not everything has to be one way or the other, different concepts can co-exist harmonically even in science, appreciate that, step back and see the big picture.

quote:


Here is what I was supposed to interpret from your words:
"I say Qi, but I don't really mean it.
I say fascia, but treating it is the same as treating skin.

I say pain signals, but I really mean nociceptive stimuli."


This is how you interpret my words?
You can practice Qi Gong without believing in Qi like you can practice Yoga without believing in Hinduism or Buddhism. The concept of mindfulness was my main point.
I never try to project my faith to others, you either have faith or not. That's something personal.
With most manual therapy techniques you are mobilizing, or if it makes you feel better -moving in space and relative to other tissues, skin, fascia, muscles, bodily fluids.
I'm so sorry that I said pain signals and not nocioceptive stimuli, I did not mean to confuse you more, you already sound pretty confused.
quote:


then:
quote:

Again, all I said is that it is worth noting these studies, as well as the 100 years of research, and ongoing research on trigger points.

No, you claimed good evidence for treating trigger points.
You never demonstrated any understanding of causation, correlation, prior plausibility, etc etc.


If demonstrating understanding of anything is to agree with your own interpretation of literature then you are right.
quote:


And you think you are doing just fine. I won't change that.
And you try to emulate Harper.
Our profession in is dire straits.

don't worry about our profession, it's doing fine. especially when people like you take too much credit for doing nothing and get away with it.

Niko

< Message edited by Niko -- July 21, 2012 4:02:22 AM >

(in reply to Chocco)
Post #: 75
RE: A problem arises... - July 21, 2012 10:02:05 AM   
Sebastian Asselbergs

 

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

your underlying offense tactics.


My offense tactics?

quote:

You don't have to act that insecure knowing that I have higher education than you.


Oh my. Next: "my dad is stronger than yours!" yes, you are indeed emulating Harper.

quote:

ok man, stop, breathe, relax and clear your mind, not everything has to be one way or the other, different concepts can co-exist harmonically even in science, appreciate that, step back and see the big picture.
THIS is your response? That is all you have to say?

quote:

you already sound pretty confused

A classic case of "the ear of the beholder".

quote:

However, the main effect comes from the technique itself.

That is total crap. It comes form the patient's perceptions of what is happening and it comes form how the cognitive processes of the midbrain and cortex alter the pain perception and output to the body. That is where the explanation makes a huge difference! effect of treatment is altered by a different explanation of the treatment. But since you are much more interested in the art, I guess that aspect of science is not of interest to you.


quote:

Accurate explanation does not exist. You mean the best supported model and your personal interpretation of it
.
Umm, accurate does not mean "perfect". The best supported model is "accurate" versus the model of say" I am stretching your fascia". If you do not understand that distinction: read more and paint less.

quote:

especially when people like you take too much credit for doing nothing and get away with it.


"Doing nothing"? meaning what?

(in reply to Niko)
Post #: 76
RE: A problem arises... - July 21, 2012 11:01:23 AM   
proud

 

Posts: 1834
Joined: March 23, 2006
Status: offline
quote:

ORIGINAL: Sebastian Asselbergs

If you do not understand that distinction: read more and paint less.


I laughed out loud at that. Comically stated yet accurately defines Niko's input here.

Niko, you so fully mis-understand practically everything about how the human body works..and clearly you are unable to grasp what Sebastien is offering...it's painful to read.

As I stated above...read a bit....then come back. Seriously.

(in reply to Sebastian Asselbergs)
Post #: 77
RE: A problem arises... - July 21, 2012 12:40:41 PM   
HarperPT

 

Posts: 86
Status: offline
Great post Proud.

As I've stated before. It looks like being an "evidence based" therapist is more about insulting people then it is using evidence to back your claims.

_____________________________

Stay Hungry!

(in reply to proud)
Post #: 78
RE: A problem arises... - July 21, 2012 1:19:23 PM   
proud

 

Posts: 1834
Joined: March 23, 2006
Status: offline
quote:

ORIGINAL: HarperPT


As I've stated before. It looks like being an "evidence based" therapist is more about insulting people then it is using evidence to back your claims.


False.

I have refuted (with quotes from the literature) most everything hokey on this site for a couple of years now. That you choose to pass over it is no problem of mine.

As I've indicated on this very thread...Niko is in need of so much prep work prior to actually debating these things that it's not even worth the effort. I\ve respectfully invited him back however once he can dispute established physiological principles with something other than playing word games with someones name....

< Message edited by proud -- July 21, 2012 1:29:04 PM >

(in reply to HarperPT)
Post #: 79
RE: A problem arises... - July 21, 2012 1:51:44 PM   
Chocco

 

Posts: 188
Joined: September 6, 2006
Status: offline
Ok i will try to wring this back in again

Article on the original topic: http://www.physicaltherapyjournal.com/content/91/5/790.full -> same as the article I posted above

Some articles on manual therapy: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/?tool=pmcentrez
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172952/?tool=pmcentrez
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882554/?tool=pmcentrez

Take what you want from them but since we are all talking evidence it wouldn't hurt to throw some actual evidence into the conversation. There are a lot of good studies referenced in the first 2 articles.

< Message edited by Chocco -- July 21, 2012 1:53:51 PM >

(in reply to HarperPT)
Post #: 80
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