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Low achievers

 
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Low achievers - July 27, 2015 7:53:48 PM   
ginger

 

Posts: 1247
Joined: February 27, 2005
Status: offline
quote:

-The more I read and learn about pain, the further away from manual therapy, modalities or other methods defined as 'treatment' I get…

-The more I read and learn about pain, the less equipped I feel when attempting to help people suffering from it.

-I have no idea what normal means or why it matters when speaking of human movement, posture and symmetry.

-I don't understand the term 'movement specialist' (see above). To me movement is your fingerprint.

-The more I read and learn about pain, the more I see continuing education courses and pseudoscience continuing. If context, expectation and other factors are so important in the modulation of pain, tissue targeting courses will continue.

-Any intervention going through skin is equal to the next if provided in the right context. This is why learning 'new' techniques doesn't make sense to me

-I have yet to fix or cure anyone, and I have no intentions to do so in the future.


I have lifted this from a thread found on the somasimple site, entitled , "pot pourri" which I find disturbing on many levels.
There follows page after page of reflections on , mostly, that therapists on this site maintain it is not possible to render therapy such that patients are "fixed".
By this it becomes clear that many therapists, are so poorly equipped , trained and skilled to not be able to resolve with manual therapy,
a range of common MSK problems. Pain problems afflicting their patients.
These therapists go on to say that because they are not able to resolve pain problems with hands on methods, that no one else can either.

I find this sad. I'm not sure wether to be sadder for their patients. I have found this attitude mostly in my discussions with non Australian physios.
Those whose training had not included spinal mobilisation, or where what training they had received had been of limited extent or quality.
I have written this on the RE site mostly because I know that my posts here will not be interfered with.
It is clear that the managers of the Soma site don't take kindly to opinion that differs from their own. This is such a pity.
More so because it is only through alternate opinions and experiences being discussed that these sad attitudes toward treatment and more importantly outcomes ,
can be improved.
MSK treatments are , in my experience and understanding, relatively simple, straight forward arrangements, leading in most cases to fairly swift resolution of MSK pain,
once the common source of nociception is found and resolved. This is, in the vast majority of cases, a simple issue of turning off spinal protective behaviour.
To suggest that the kind of resolutions I and many of my colleagues participate in daily are not possible, strains my gall sometimes to breaking point.

Physiotherapists can be the leading edge of practical, safe, effective provision of manual therapy that works. To set out , as these posters do, with sails limp,
eyes downcast their hopes and their therapeutic bars set low, is the saddest thing I've read in a long tme.

< Message edited by ginger -- July 27, 2015 8:02:14 PM >


_____________________________

Geoff Fisher
Physiotherapist
Post #: 1
RE: Low achievers - August 22, 2015 6:18:40 PM   
ginger

 

Posts: 1247
Joined: February 27, 2005
Status: offline
quote:

So,

"1. What is wrong with me? Don't know exactly.

2. How long will it take? Don't know exactly.

3. What can I do about it? Put cold/heat/nothing on it and move.

4. What can you do about it? Here is a plan of care, please pay the receptionist.

We should be honest about this. Too many practitioners try to give patients the impression that we can do more than we can, thereby shooting the manual therapy professions in the foot. "


this piece again lifted from pot pourri.

this poster seems to be actually celebrating her complete lack of skill and ability in both the understanding of MSK pain problems and their solutions.

She goes on

"
quote:

Fishing guides might tell their fishers that "there's no fish in the river, it's too cold, too high/low/dirty and that they'd have been better off going to to the pictures." and still have people desperate for their services on the off chance that something wonderful might happen.

Patients appreciate authenticity, I have learned a great deal from fishing guides (and fencing coaches) about how to get the best from and for those who employ me. "

One can only surmise that her employer knew as little as she.

Tragic, but a common thread on the somasimple site. Like moths to the flame it appears that those who can't, like to congregate with others who don't know how and find solace together.
__________________

< Message edited by ginger -- September 10, 2015 6:58:56 PM >


_____________________________

Geoff Fisher
Physiotherapist

(in reply to ginger)
Post #: 2
RE: Low achievers - September 8, 2015 2:50:10 AM   
ginger

 

Posts: 1247
Joined: February 27, 2005
Status: offline
quote:

I think I finally get it. It is the claim that we can fix pain that is the abomination. We cannot know what the cause of pain is. How could we possibly claim to have a technique that fixes it. Surgery included. The very claim that XYZ can fix your pain or that you can be pain free is the problem. It's a problem for two reasons 1) it makes you think that there IS a solution for pain. What happens if you don't get out of pain? It makes you wrong, unhelpable, non participatory in the wrong ways. 2) the claim that my muscle imbalance fixing program (or....) fixes pain sets up a client for a potential failure. What if they don't get out of pain? Who failed who? Did the technique fail? Did the client not do it right? And even if it does fix the person they become unnecessarily and possible destructively focused on muscle imbalances. This can set up at the least an obsession with muscles and worst a hypervilgilance that could perpetuate cognitive components of sensitization.
The proper approach is through the truth of uncertainty. This allows us to provide movement, touch and reassurance so that blood, tissue, nerves and joints are mobilized, somatic maps are challenged, and personal and social aspects are pressed positively and daringly toward greater function.



more of the same " if I can't get good results no one can" dilemma.
Using methods in any way related to "muscle imbalance" or even thinking this way is a sure fire way to failure .
The odd thing about this site (Somasimple) is that it encourages this kind of irrational thinking.
The main body of regular posters maintain that all manual therapies are essentially the same, and that the product of any therapy is likely to be the same whichever method one uses.
Clearly these people are using poor methods. worse, seem unable to grasp the difference between those methods with a strong likelihood of failure and those with an equally strong likelihood of success. Page after page of " you can't this and you can't that. Not just sad, but testimony to the decline in standards I witness amongst new grads generally.
More on this vexing subject soon.
Sigh.

_____________________________

Geoff Fisher
Physiotherapist

(in reply to ginger)
Post #: 3
RE: Low achievers - September 11, 2015 3:01:02 PM   
SpokanePT

 

Posts: 133
From: http://www.accelerationdeerpark.com
Status: offline
Geoff, while I don't fully agree with your continuous mobilization technique and philosophy, I can appreciate that we can change how the system works. I can't understand how therapists can look at a patient with obvious movement dysfunction and state that they can't change that situation with any number of techniques from joint mobilization, myofascial release, strain/counterstrain, muscle energy, or continuous mobilization. If we can't do that, then what exactly are we doing?

_____________________________

Acceleration Physical Therapy in Spokane WA Acceleration Physical Therapy in Deer Park WA

(in reply to ginger)
Post #: 4
RE: Low achievers - September 12, 2015 4:22:03 AM   
ginger

 

Posts: 1247
Joined: February 27, 2005
Status: offline
I'm sure the proliferation of wanky methods of various types has swollen the wallets of many a promoter of BS methods, but unfortunately has had other more serious consequences. Notably, a sense within the ranks of some who have tried and failed with woo woo to believe that all manual therapies are similarly weak . I can understand this trend, but to throw up one's hands and dump the treatment baby with the bathwater is foolish to say the least.

_____________________________

Geoff Fisher
Physiotherapist

(in reply to SpokanePT)
Post #: 5
RE: Low achievers - September 15, 2015 5:55:11 AM   
ginger

 

Posts: 1247
Joined: February 27, 2005
Status: offline
another seeker led astray by SS

quote:

My short duration in rehabilitation could be summed up easily:
Phase 1: Soma simple Student (SPT)
Phase 2: Evidence Based Manual Physical Therapist (2 years)
Phase 3: Neuroscience education and exercise based physical therapist (3 years)
Phase 4: Physical Reality Rehabilitationist (Current)


he goes on to say

quote:

The list goes on and on but it turns out the reality of the situation is this: pain is unavoidable


agree, more or less, however,,,

quote:

I am only a physical therapist. I (we) cannot change or alter body parts. I (we) cannot fix or cure someone's pain. I (we) can improve important qualities of tissues and one's life.


only a physical therapist, and clearly one whose treatment options don't include manual therapies that work.
Much of the blame for this young therapist's inability to resolve pain issues must lie with his school, made worse by those whose posts at SS have reinforced the message that looking for better methods is a waste of time.
Once again it is patients who suffer and our profession that is diluted and reduced by these non performers.

_____________________________

Geoff Fisher
Physiotherapist

(in reply to ginger)
Post #: 6
RE: Low achievers - September 30, 2015 12:21:59 PM   
jesspt

 

Posts: 182
Joined: April 4, 2007
From: Illinois
Status: offline
quote:

ORIGINAL: SpokanePT

Geoff, while I don't fully agree with your continuous mobilization technique and philosophy, I can appreciate that we can change how the system works. I can't understand how therapists can look at a patient with obvious movement dysfunction and state that they can't change that situation with any number of techniques from joint mobilization, myofascial release, strain/counterstrain, muscle energy, or continuous mobilization. If we can't do that, then what exactly are we doing?


But you're discussing "mvement dysfunction" and Geoff is talking about patients in pain. Those are not the same thing.

_____________________________

Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy

(in reply to SpokanePT)
Post #: 7
RE: Low achievers - September 30, 2015 12:28:58 PM   
jesspt

 

Posts: 182
Joined: April 4, 2007
From: Illinois
Status: offline
quote:

ORIGINAL: ginger

quote:

I think I finally get it. It is the claim that we can fix pain that is the abomination. We cannot know what the cause of pain is. How could we possibly claim to have a technique that fixes it. Surgery included. The very claim that XYZ can fix your pain or that you can be pain free is the problem. It's a problem for two reasons 1) it makes you think that there IS a solution for pain. What happens if you don't get out of pain? It makes you wrong, unhelpable, non participatory in the wrong ways. 2) the claim that my muscle imbalance fixing program (or....) fixes pain sets up a client for a potential failure. What if they don't get out of pain? Who failed who? Did the technique fail? Did the client not do it right? And even if it does fix the person they become unnecessarily and possible destructively focused on muscle imbalances. This can set up at the least an obsession with muscles and worst a hypervilgilance that could perpetuate cognitive components of sensitization.
The proper approach is through the truth of uncertainty. This allows us to provide movement, touch and reassurance so that blood, tissue, nerves and joints are mobilized, somatic maps are challenged, and personal and social aspects are pressed positively and daringly toward greater function.



more of the same " if I can't get good results no one can" dilemma.
Using methods in any way related to "muscle imbalance" or even thinking this way is a sure fire way to failure .
The odd thing about this site (Somasimple) is that it encourages this kind of irrational thinking.
The main body of regular posters maintain that all manual therapies are essentially the same, and that the product of any therapy is likely to be the same whichever method one uses.
Clearly these people are using poor methods. worse, seem unable to grasp the difference between those methods with a strong likelihood of failure and those with an equally strong likelihood of success. Page after page of " you can't this and you can't that. Not just sad, but testimony to the decline in standards I witness amongst new grads generally.
More on this vexing subject soon.
Sigh.


But Geoff, do you look at "muscle imbalances"? And if so, do you think they are the result of spinal protective behavior? And if your answer is yes, why look for them at all? Just CM for everybody in the area of their spine that corresponds to the region where the patient percieves their pain.

Also, how do you determine or differentiate between those methods with a strong likelihood of failure or an equally strong likelihood of success?

_____________________________

Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy

(in reply to ginger)
Post #: 8
RE: Low achievers - October 1, 2015 3:41:56 AM   
ginger

 

Posts: 1247
Joined: February 27, 2005
Status: offline
Hi Jess,
The idea that muscles need to be "balanced" is a problem in the first place. How would you know if they were or were not balanced.?
Sorting out pain , altered sensation, altered patterns of recruitment and altered sympathetic nerve activity is best done by addressing the state of nerves.
By consideration of the likely involvement of spinal activity and it's impact on nerves at and near the spine first, I usually discover and resolve these issues quickly and with long term benefit.
The method that I find achieves best and quickest resolution of spinal tonic and other protective activity is CM.
Any approach ( to MSK solutions)that does not first resolve the prospect of referred events from the spine will be a failure most of the time.
Cheers

_____________________________

Geoff Fisher
Physiotherapist

(in reply to jesspt)
Post #: 9
RE: Low achievers - October 2, 2015 6:15:22 PM   
SpokanePT

 

Posts: 133
From: http://www.accelerationdeerpark.com
Status: offline
Jess-
I would make the argument that biomechanical dysfunction in the form of restriction, weakness, and poor coordination are the reason that tissues become irritable in the first place. Resolving movement dysfunction through any number of techniques is spreads the force from one irritable site to the whole quarter, whether upper or lower. In the case of shoulder impingement, resolving thoracic restriction, rib restriction, and scapulothoracic restriction and improving dynamic stability of the whole upper quarter through neuromuscular re-education, we can take stress off of the rotator cuff. I would argue that taking stress from that structure and spreading it throughout the upper quarter is why that structure calms down.

_____________________________

Acceleration Physical Therapy in Spokane WA Acceleration Physical Therapy in Deer Park WA

(in reply to ginger)
Post #: 10
RE: Low achievers - October 6, 2015 12:00:52 PM   
Tom Reeves DPT ATC

 

Posts: 1166
Joined: March 15, 2006
Status: offline
quote:

ORIGINAL: SpokanePT

Jess-
I would make the argument that biomechanical dysfunction in the form of restriction, weakness, and poor coordination are the reason that tissues become irritable in the first place. Resolving movement dysfunction through any number of techniques is spreads the force from one irritable site to the whole quarter, whether upper or lower. In the case of shoulder impingement, resolving thoracic restriction, rib restriction, and scapulothoracic restriction and improving dynamic stability of the whole upper quarter through neuromuscular re-education, we can take stress off of the rotator cuff. I would argue that taking stress from that structure and spreading it throughout the upper quarter is why that structure calms down.



Love this response. at SS they would not allow such heresy.

(in reply to SpokanePT)
Post #: 11
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