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RE: A problem arises... - July 21, 2012 2:38:21 PM   
proud

 

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quote:

ORIGINAL: Chocco

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.


Yes, I forgot to thank you for those Chocco. I have referenced them (full text I think) on several threads throughout Rehabedge.

What are your thoughts on these Chocco. I'm not certain what your take is in posting these?

(in reply to Chocco)
Post #: 81
RE: A problem arises... - July 21, 2012 8:46:05 PM   
HarperPT

 

Posts: 86
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quote:

ORIGINAL: proud

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....


I find it ironic that you use insults while attempting to show that my statement that you insult people is FALSE.

Let me guess, if I was an "evidence based" therapist I would understand your logic?

_____________________________

Stay Hungry!

(in reply to proud)
Post #: 82
RE: A problem arises... - July 21, 2012 10:02:58 PM   
Niko

 

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Chocco,

Thank you for saving the day. Those manual therapy articles support many of the things that I've been arguing with Sebastian. The irony is that I did not want to use literature to prove anything, but after all it seems that it might be the only way that I can reach my friend Sebastian.

Just briefly:
The first article suggests,
"Conclusion: The mechanisms behind the clinical effectiveness of MT are not established". Based on this alone, Sebastian, you saying that your interpretation of the best supported model of why manual therapy works is more accurate than anyone else's is a scientifically invalid statement.

Moreover,
"Specifically, this model suggests that a mechanical force from MT initiates a cascade of neurophysiological responses from the peripheral and central nervous system which are then responsible for the clinical outcomes."
Sebastian, a mechanical force from MT initiates the neurophysiological responses, not you telling the patient what you think is happening. That mechanical force can be mobilizing a joint, a fascia, stretching a nerve or a muscle etc etc.

The second article suggests,
"We are not suggesting manual therapists include known sham or ineffective interventions in their clinical practice, but take steps to maximize placebo responses to reduce pain".
I've been saying this all along. A convincing explanation will maximize outcomes whether is true or false. whether you say that you are mobilizing skin, fascia, fluid, or just giving input to the nervous system. It does not even matter who's ideas are closest to the truth, simply because as the first article suggest , we have not established yet the mechanism behind the clinical effectiveness of MT.

The third article suggests,
"A standardised programme of manual therapy and home exercise did not confer additional immediate benefits for pain and function compared with a realistic placebo treatment that controlled for therapists’ contact in middle aged to older adults with chronic rotator cuff disease".

The placebo group perceived that it was treated by therapeutic equipment. This finding supports my previous point that hands on treatments are not always more effective than modalities at the psychological level. Sebastian, remember what I said, people, especially in western societies believe more in therapeutic equipment than therapeutic hands. The findings of this study in combination with the suggestions of the second study cannot rule out the usefulness of modalities in influencing the brain processes related to pain. It would be interesting to see the results if the ultrasound was active and not inactive. I'm still waiting for you to show me literature that supports your statement: "The grooming aspect alone makes careful manual contact more effective that any machine".

Harper, I've been ignoring Proud this whole time and he keeps coming back desperately trying to insert himself in the conversation by mentioning my name. Go figure.

(in reply to HarperPT)
Post #: 83
RE: A problem arises... - July 21, 2012 11:19:06 PM   
Sebastian Asselbergs

 

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You are hilarious, Niko.
You have not understood or learned a darn thing from this whole discussion. Not. a. thing.
That's OK though. I really do wish you well.

If you know how to use a search function, you can check some previous virtually endless back-and-forths here. Saves me having to repeat myself forever and ever.

(in reply to Niko)
Post #: 84
RE: A problem arises... - July 22, 2012 12:43:00 AM   
HarperPT

 

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quote:

ORIGINAL: Sebastian Asselbergs

You are hilarious, Niko.
You have not understood or learned a darn thing from this whole discussion. Not. a. thing.
That's OK though. I really do wish you well.

If you know how to use a search function, you can check some previous virtually endless back-and-forths here. Saves me having to repeat myself forever and ever.


Instead of being so rude why don't you just answer his question?

_____________________________

Stay Hungry!

(in reply to Sebastian Asselbergs)
Post #: 85
RE: A problem arises... - July 22, 2012 10:00:31 AM   
rwillcott

 

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Sebastian you are a very patient man. Most would have walked away by this stage. This thread reminds me of a wonderful post that Barrett Dorko made at SomaSimple:

quote:

Are you certain about that?

Yea.

Okay, thanks for telling me. If that’s the case I won’t put any effort into altering what you think.

What do you mean?

I mean that your feeling of certainty about this is known to rise from the same neuronal processes that produce emotions another cannot change.

But aren’t you supposed to try?

I used to, but now we know that certainty and similar states of ‘knowing what we know’ come from involuntary brain functions that, like love and anger, function independently of reason.

So, you’re saying that I’m acting unreasonably?

No, I’m saying that reason isn’t at the forefront of your thinking. That doesn’t make you a bad person; it just means that you’re human. When you’re certain about something evidence to the contrary doesn’t really make any difference. Ever try to talk someone else out of being in love? Doesn’t work.

So I guess we’ll just agree to disagree.

Not really. I’m approaching this issue from the standpoint of rational and dispassionate logic with an eye on the evidence I consider worthy. You’re going with your gut while depending upon the reliability of your senses and a worldview that I consider skewed. I’m saying you’re wrong but because of the certainty you say you have I’m not going to spend any time trying to reason with you. I’m not agreeing with anything, I’m just walking away.
__________________
Barrett L. Dorko P.T.
www.barrettdorko.com

(in reply to HarperPT)
Post #: 86
RE: A problem arises... - July 22, 2012 11:13:43 AM   
SJBird55

 

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Aside from the personal attacks, both Niko & Bas have valid points. Whatever theory is finally created will include all the aspects that both of them are mentioning.

Better outcomes seem to occur the stronger the therapeutic alliance. That's actually scary - makes me wonder what the heck do we do? Yet, at the same time, literature doesn't support positive outcomes for episodes of care with 50% or greater of passive modalities. The treatment based classification system fails for patients with subacute or chronic back pain. The brain changes within 2 weeks after an acute onset of low back pain and can remained changed for an extended period of time.

Whatever the theory, it isn't going to be simple. The bulk of our research is quantitative in nature... Quantitative can only tell one part of the story. We are just beginning to explore the needed qualitative part. The most encompassing theory will merge the known quantitative pieces with qualitative information on the practitioner with qualitative information on the patient. Multi-specialty input will help create the explanatory model for a defined patient population.

Keep having the debates & discussions. At this monent in time, no one knows the true model/theory. It's still being shaped.

< Message edited by SJBird55 -- July 22, 2012 11:15:41 AM >

(in reply to rwillcott)
Post #: 87
RE: A problem arises... - July 22, 2012 5:04:50 PM   
Niko

 

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Sjbird,

From everything that I've read in this forum so far your post makes the most sense. You sound open minded and positive, and you are able to step back and see the big picture. I like that and thanks for your input.
Sebastian's general support of neurophysiology makes a lot of sense too and I have never disagreed with his main point "the patient's brain has changed its output of pain based on input from the periphery". What I've been trying to say is that this is just a small piece of the puzzle and does not necessarily rule out other existing mechanisms as the comprehensive model in the article above suggests. I've been also fighting his general negativity for things like: therapeutic equipment is useless, Qi Gong is useless, acupuncture is useless,we should ignore the many years of research on trigger points, the initial theories of why MT works are "total crap" and the list goes on and on. That's all. He failed to successfully support any of his claims with or without evidence from current literature. Him saying that I should go back to review his 2000 posts to find the answer is just verifying that he has no answer. I did not mean to put Sebastian into a checkmate position or attack his self esteem. And I'm sorry if I did Sebastian. This is just a forum. I came here to learn from others including you. But if you cannot prove my arguments as unsound then just say that you disagree and respect my own interpretation of things. All we can really say in this forum is" this is what I did and this is what I recognized" or for the strictly evidence based people "this is what literature a b or c suggests". We just share ideas and knowledge, nothing more than that. I cannot take any insult from here as personal but I admit that it can be a bummer when it happens.

Love,

Niko

(in reply to SJBird55)
Post #: 88
RE: A problem arises... - July 22, 2012 7:28:50 PM   
Niko

 

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Mr, proud,

This is what you just posted but then deleted and not sure why:

quote:


Sj..I can't figure for the life of me where it is that you see Niko as presenting anything credible whatsoever.

As you know SJ, we (as in you and I) generally see eye to eye on most things. This one...not so much.

I mean, Niko is the same person that came up with these gems:

quote:

Talking about science, it is mathematically impossible for you to be more effective than me if you only do half of what I do.


So his version of science based practice would be then...the more you do the better. I spotted the frog right there.

quote:

none of the pioneers of PT had research to back up their practice. They were all open minded people who went beyond what research at their time had to offer.


Of course our pioneers had it largely wrong. But let's just ignore that shall we. Let'a all be open minded shall we?

quote:

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.


So he posts a link to a article so full of holes he then had to retreat and claim he posted it to prove another point.

< Message edited by proud -- July 22, 2012 6:34:30 PM >

(in reply to SJBird55)


Proud, help me understand you. First you state this:
quote:



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.


Then you don't keep your word and you come back asking for my attention. In doing so, you provide nothing to the discussion but insults. Let me know if there is anything that I can do for you to help you become a better person or a better PT. Otherwise, don't worry about me or anybody else in this forum. We are all doing fine without your negative input.

My statements that you include here are partial sentences that have nothing to do with my main arguments in this thread. And I did not say that I'm perfect. And I admit that I'm growing as these discussions evolve. If you want to make a comment regarding my recent post that sums up a lot of things, or the post before that regarding the literature that Chocco provided, then you are welcome. If you are here just in need of attention then get a life man. You have not provided anything constructive to this thread at all.

take care,
Niko

(in reply to Niko)
Post #: 89
RE: A problem arises... - July 22, 2012 8:00:38 PM   
proud

 

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I deleted it because it's a pointless venture. I am actually a little embarressed that I participated at all. That of course is not a re-traction of my thoughts about your inputs here Niko. That fact that SJ (whom I respect as a fellow blogger) saw valid points between your countless insults struck me as odd...and it compelled me to write something.

I have always been willing to engage in debate here at Rehabedge and often times it's very constructive. Unfortunately, I find your style of debate extremely immature and unprofessional.

I'm actually dissappointed that "Rehabedge" has allowed you to continue to degrade the professionalism of this site. Rehabedge does indeed give some leeway with "back and forths" and it's part of the reason I kind of like it. But really....there has to come a point where unprofessional conduct will get you banned.

No question in my mind Niko...your conduct is purposefully antagonizing, immature and unprofessional. At least you have some decent things to add between the insults and antagonistic remarks. I think some decent discussions could have taken place had you refrained from the juvenile remarks. The fact that Harper hasn't been banned it an absolute joke.

Not my site so...whatever.

< Message edited by proud -- July 22, 2012 8:06:57 PM >

(in reply to Niko)
Post #: 90
RE: A problem arises... - July 22, 2012 9:20:30 PM   
SJBird55

 

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Joined: May 11, 2004
From: Michigan
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In post 83, Niko discussed post 81. Good stuff in 81 that should make us think.

(in reply to proud)
Post #: 91
RE: A problem arises... - July 22, 2012 10:28:05 PM   
HarperPT

 

Posts: 86
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quote:

ORIGINAL: proud

I deleted it because it's a pointless venture. I am actually a little embarressed that I participated at all. That of course is not a re-traction of my thoughts about your inputs here Niko. That fact that SJ (whom I respect as a fellow blogger) saw valid points between your countless insults struck me as odd...and it compelled me to write something.

I have always been willing to engage in debate here at Rehabedge and often times it's very constructive. Unfortunately, I find your style of debate extremely immature and unprofessional.

I'm actually dissappointed that "Rehabedge" has allowed you to continue to degrade the professionalism of this site. Rehabedge does indeed give some leeway with "back and forths" and it's part of the reason I kind of like it. But really....there has to come a point where unprofessional conduct will get you banned.

No question in my mind Niko...your conduct is purposefully antagonizing, immature and unprofessional. At least you have some decent things to add between the insults and antagonistic remarks. I think some decent discussions could have taken place had you refrained from the juvenile remarks. The fact that Harper hasn't been banned it an absolute joke.

Not my site so...whatever.


Thats funny.....you seem to be the one hurling all the insults. In fact, you did the same thing to me when I didn't agree with you. And now you're trying to get me banned?

Science isn't about banning and censoring things Proud.

_____________________________

Stay Hungry!

(in reply to proud)
Post #: 92
RE: A problem arises... - July 22, 2012 10:50:15 PM   
Niko

 

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proud,
I will tell you something similar of what I told Sebastian when he appeared to be emotionally overwhelmed. Stop thinking for a second, focus on your breathing, bring yourself to the present moment, allow all the muscles in your body to relax, don't fight or struggle, whenever a feeling comes up recognize it, just enjoy breathing in and out, enjoy being alive, smile, light smile can relax all the muscles in your face, accept yourself as you are, then open your heart and accept others...

Again, if there is anything I can do for you let me know.

Harper, when I say I believe that you are the best PT in this forum I mean it.

Niko

(in reply to proud)
Post #: 93
RE: A problem arises... - July 22, 2012 11:00:19 PM   
honker23

 

Posts: 217
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Gone on a family vacation to the northwoods and now I am a Bas clone...funny.
I still am waiting for evidence of Qi, cranial sutures moving about, fascia released non surgically.
When you have a viral infection, do you want an antibiotic or a sugar pill, pay for them, get better in 7 days, and say it "worked" or would you like like a doc to say you have viral infection that should resolve in 7-10 days on its own, I am sure you don't have a more serious medical condition that I can treat.
The therapeutic effect should not be a free pass to exploit it under the guise of some crazy theory (see subluxation).

(in reply to HarperPT)
Post #: 94
RE: A problem arises... - July 23, 2012 12:01:35 AM   
Niko

 

Posts: 137
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quote:

Gone on a family vacation to the northwoods and now I am a Bas clone...funny.

ok man sure
quote:


I still am waiting for evidence of Qi, cranial sutures moving about, fascia released non surgically.


I never stated that I'm certain that any of the things that you mention here actually happen. what's you definition of myofascia release? I think your definition is different than mine because you compare it which surgical incisions. my definition is more moving the fascia in space relative to the rest of the soft tissue.All I said is that Im mobilizing (moving in space but not necessarily relative to other tissues) the fascia not releasing it. In fact, nobody can be certain if these things happen or not until research proves otherwise. Until then, you are welcome to believe whatever you want and I'll do the same. I'm confident that there is not strong evidence to suggest release of the fascia does not occur as myofascia release is still a billing code. If you have one in mind please share.I suggest that you read the first MT article Chocco provided.

quote:


When you have a viral infection, do you want an antibiotic or a sugar pill, pay for them, get better in 7 days, and say it "worked" or would you like like a doc to say you have viral infection that should resolve in 7-10 days on its own, I am sure you don't have a more serious medical condition that I can treat.


Give me an example specific to physical therapy so we are exactly on the same page.
quote:


The therapeutic effect should not be a free pass to exploit it under the guise of some crazy theory (see subluxation).


Until the exact mechanism of effectiveness of manual therapy is clearly established then I disagree that any theory is completely crazy. If you ask about my opinion yes I m not convinced that every aspect of the sublaxation theory is true, but my opinion is not objective right? if there is such a thing as objectivity.

Niko

(in reply to honker23)
Post #: 95
RE: A problem arises... - July 23, 2012 12:43:23 AM   
HarperPT

 

Posts: 86
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quote:

ORIGINAL: Niko

Harper, when I say I believe that you are the best PT in this forum I mean it.




Thanks Niko! You're not too shabby either!

_____________________________

Stay Hungry!

(in reply to Niko)
Post #: 96
RE: A problem arises... - July 23, 2012 7:00:18 AM   
Chocco

 

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Joined: September 6, 2006
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quote:

ORIGINAL: SJBird55

Keep having the debates & discussions. At this monent in time, no one knows the true model/theory. It's still being shaped.


I agree completely.

I wish the original point of this thread didn't get lost because I think it was an important one.

Proud, I am not ignoring you.  I will get back to your question when I get some time after work to day. I have a lot to say on the topic particularly on the first article and don't have the time to get into it now.


(in reply to SJBird55)
Post #: 97
RE: A problem arises... - July 23, 2012 1:30:23 PM   
SJBird55

 

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The first article was a really good one too, Chocco. I love seeing how researchers evolve. Delitto is evolving. And, we as clinicians need to evolve.

I can't get support from researchers to do an odd quantitative/qualitative study - a study that somehow includes quantitative info WITH a little qualitative info. So... in my opinion, it isn't enough to just use standardized outcome measures to get a score. It is hugely relevant to also analyze a patient's responses AND use the responses to drive our interventions, in particular our conversations and education. If we believe psychosocial factors impact outcomes and also are part of a theory of how manual therapy is effective, we have begin to use the information for more than "demographics." Why aren't we doing this? I truly believe we can actually create the desired response shifts in patients by not only knowing the psychosocial factors, but also attempting to address them. As we address them, I have a feeling a neurobiological or neurophysiological response occurs.

And, seriously.. Bas is Bas. He doesn't need to come online and pretend to be various different posters. I will vouch for him and his character - he wouldn't "clone" himself...

(in reply to Chocco)
Post #: 98
RE: A problem arises... - July 23, 2012 9:03:20 PM   
Chocco

 

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To me the Foster /Delitto article is one of the better articles written in recent years. They described a major issue ( lack of psychosocial interventions in physical therapy), discussed some potential reasons for the issue and potential opportunities to help resolve the issue. A couple of key points for entry level therapists was that most schools don't address the psychosocial aspect of pain adequately. Even when it is addressed it is often lost to the more heavily stressed biochemical model for pain/ injury. We ask our PT students to learn a wide range of information and schools are responsible for exposing students to the many different environments within PT. However as we learn more through evidence based PT the schools need to better adjust their curriculum to support it. I think the APTA missed the boat when they didn't add a Pain course to their DPT and tDPT programs. If the APTA and like organizations are serious about supporting evidence based PT they should also include more/some questions on the certification tests. This would help to reinforce the importance of topics such as the psychosocial aspects of pain and schools would be forced to educate their students more on the topic. In general it would better for students to demonstrate that they know and understand the current concepts in Physical therapy instead of memorizing information that they probably won't use again and even if they did they could easily look up. I had 3 questions on my test for postural drainage. I have worked in PT for 10 years including assisting in a pulmonary rehab program for 3 years and not once did I have to do postural drainage.
Another key in the article I feel is that even when schools do educate students in current best evidence base practice they are sent to do their affiliation/ internships with instructors that don't reinforce those same principles. In most cases students are placed with whomever will take them. My last student came to me after an affiliation with a Cranio-sacral therapist. He learned all about cranio-sacral therapy and that was about it. He came to our facility unprepared and behind where he should be in his professional development. I don't know what the answer is but there has to be a better way to educate/screen clinical instructors prior to schools placing them.

(in reply to SJBird55)
Post #: 99
RE: A problem arises... - July 24, 2012 6:46:03 AM   
Sebastian Asselbergs

 

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Chocco, good post.
I'd like to see "science-based" education - "evidence-based" is part of that. And you are right about clinical instructors. In my time as faculty at U of T way back in the 90's, that was already a hot issue. It hasn't changed alas. Too much focus on protocols and cook-book PT and not enough focus on independent and critical thinking.

(in reply to Chocco)
Post #: 100
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