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Old 08-03-2011, 07:43 AM   #1
Ben Sabo
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Hello everyone,

I"m a personal trainer and pretty much stumbled upon this site looking for some discussion on Eyal Lederman's Myth of Core Stability article. Well, I found that here and a lot more about MFR and ectodermalism, just to name a couple other topics that have caught my attention. I've subsequently removed Anatomy Trains from the top of my to-buy list and replaced it with Explain Pain.

A very large part of my job is coaching movement, and taking an interest in physical therapy was just a natural course in my desire to help clients move better and understand their limitations to movement. I want to do whatever I can in this regard, but also be able to refer out to a PT when necessary. Placing confidence in a therapist isn't easy when you're not really sure what to look for, however, and I've spent considerable time trying to figure out what I should be looking for!

In the meantime, I've gotten caught up a bit with corrective exercise, even if not to the extreme that is sometimes promoted. I've looked at corrective exercise as a way to regress certain movements to a level the client can perform, and to avoid injury. I've read a few threads on here with reference to posture not being a precursor to pain, and how there isn't "good" or "bad" posture, and I would like some clarification on that. If anyone reading this can point me to relevant discussions, articles or studies, I will gladly follow up on it.

Anyway, I'm glad I found this forum and I just wanted to introduce myself before I start poking around and asking questions. I'm a bit of a skeptic and I question everything, but I want to learn and this seems like a place to do that.
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Old 08-03-2011, 07:57 AM   #2
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You're welcome, Ben.
You may read this one for example:
Postural Restoration
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Old 08-03-2011, 12:55 PM   #3
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Ben, welcome here.
May I say that I find it very interesting how smoothly you have self-corrected your paradigms from Myers to Butler? I find that very impressive.
Especially in your profession, which is almost as full of myths as ours!

Happy to see you here.
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Old 08-03-2011, 03:46 PM   #4
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Welcome, Ben. Skepticism is good and you will find that here. Another thread of interest to help you sort through the theory why some PT works, even corrective exercise sometimes, go here.
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Old 08-03-2011, 04:18 PM   #5
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Hi Ben, welcome to somasimple.
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Old 09-03-2011, 08:23 PM   #6
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Thank you all, for the welcoming comments.

@ Bernard and Kory - thanks for those links. I'll finish reading them through as soon as I have more time, sometime this week.

@ Bas - my entire life has been one correction after another, maybe I'm actually getting good at something.
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Old 09-03-2011, 09:25 PM   #7
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Quote:
I've subsequently removed Anatomy Trains from the top of my to-buy list and replaced it with Explain Pain.
Ahhh...these are the moments I live for. I'd feel even better if you removed it from your to-buy list altogether, but 'tis enough, t'will serve.

Welcome, Ben.
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Old 11-03-2011, 09:13 AM   #8
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Hi John,

If it makes you feel any better, after finishing The Great Conversation thread, I'm not harboring any belief that fascial manipulation will improve mobility or release trigger points. I was highlighting the fact that Anatomy Trains was literally at the top of my list before finding this site, but that didn't mean it was moved to the #2 spot. Any remaining interest in reading fascial lit would be for informational purposes, if that ever seems to be a worthwhile use of my time.

I am interested in the similarity in technique between MFR and the "ectodermal" methods. And for my immediate application, what does that mean for foam rolling? I'm sure that questions like that will be answered as I read the material here. I've only been on SomaSimple for 1 week, so I have some catching up to do, which I don't think I can accomplish without compromising my sleep requirements.
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Old 11-03-2011, 01:10 PM   #9
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Ben, those are good questions that should occupy anyone's mind who applies any manual contact with patients.

Think skin and its plethora of connections straight to the brain;
think about the fact that skin is kinaesthetically a HUGE player:
think about the grooming instinct and response of primates (brain);
think about the thoughtfulness and attention of the one touching the other (brain);
think about the personal and complete attention given to a pain complaint (so rare in medicine and thus outstanding in its attention getting)- (brain);
think about the oxygenation of small nerves in the cutis and subcutis, and what gentle manual contact can do to their blood and oxygen supply and thus their level of threat input to the brain;
think of the effect of relaxing under the gentle hands of another and what it does to breathing (very important little issue too!) and general tension (brain) ;
think about....

Is your head hurting yet? Seriously, without my second cup of Java, I probably forgot about a few equally important ones...

But the gist is that we have seen discussion here on every single one of the above issues and their effect on pain modulation and relief. Note how much the brain and skin are in that list.

You will have a blast - especially with what I perceive to be a good attitude for having your existing notions thoroughly shaken.
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Old 11-03-2011, 03:29 PM   #10
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Quote:
Originally Posted by Ben Sabo View Post
I've only been on SomaSimple for 1 week, so I have some catching up to do, which I don't think I can accomplish without compromising my sleep requirements.
Tell me about it! They caught me too...hook, line and sinker. I used to try and get to bed for 10 for a good night's sleep, but now I'm glued to the screen until usually after 11pm! There's just so much to take in
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Old 12-03-2011, 03:13 AM   #11
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Hi Ben,

I didn't even want to mention that I had been looking into Myer's work and workshops.

Your a brave soul.

I'll agree with Jenny, after I have found this site sleep has been in trouble
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Old 15-03-2011, 06:59 AM   #12
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@ Bas,

It will definitely be challenging to "un-learn" some things, but the basic principle that you must go through the skin and/or the brain couldn't be any easier to accept. It helps that it's presented with such remarkable clarity and precision on this forum. Why is everyone else trying to manipulate the nervous system through mesodermal structures? How do we get deceived into thinking in such a meso-centric fashion? So, yes, my head may hurt, but it's more like a hunger pain. I'm starving for knowledge and I want to know it all.

@ JennyMack and byronselorme,


I've already put in a couple nights past 3am and it's almost 2am now, let me know if you have any suggestions for practicing self-control.

@ Everyone,

I still have to read the thread Kory linked here, but I've gone through the Postural Restoration thread Bernard shared with me. That was straightforward enough, from the SomaSimple side of the discussion, anyway. Postural "imbalances" and asymmetries are not reliable indicators of soft tissue pathology and will not predict pain. Did I get that right?

I thought a comment that Barrett made in the Altering the Ideal thread provided a good perspective on posture:

Quote:
Better posture in the classic sense pleases the therapist much more than it does the patient.
This still raises a question for me, though. I'm not even sure I've properly formulated it yet, but here it is: Any given posture might not produce pain when sedentary, or during light activity, but what happens when a more demanding task is attempted in a biomechanically inefficient position? In the Biomechanical Aspects of Physical Therapy thread, Jason Silvernail refers to performance training as "a totally different world," and I have no argument there. However, to what extent can (or cannot) postural habits predispose one to injury, even in the non-athletic population?

That's where I'm at right now. I hope I'm not asking questions prematurely, when the answers will be obvious after I read (or re-read) "just one more thread."
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Old 25-03-2011, 07:34 AM   #13
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My last post must not have been interesting enough, or maybe not intelligent enough? to illicit a response. If I sound like I'm stubbornly holding onto mesodermal dogma, please let me know, anyone.

I've been geared to think that improving posture (for example, excessive kyphosis at the t-spine) will improve quality of movement. Now I'm of the opinion that it's the other way around, that improving quality of movement will result in better posture. Am I misguided to be looking for a correlation? Maybe I should clarify that I'm speaking in terms of postural efficiency, not some static, classical "ideal" of posture.

Thanks again to those who provided the links above, nudging me in the right direction.

Explain Pain is officially on it's way, as well as Pain: The Science of Suffering by Patrick Wall and Somatics by Thomas Hanna. I've also put Zebras...Ulcers by Sapolsky on the list (that had caught my eye before, but I had forgotten about it). At this point, I'm not sure what I'll read after that, so I'm open to recommendations.
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Old 25-03-2011, 12:06 PM   #14
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Ben, I do not think your post was uninteresting at all.

My personal reason for not responding is that answers to this question have been batted around, diiscussed and picked at for a few years in different forums - numerous times.
Just laziness on my part in other words.

The question about posture possibly predisposing one to injury is a valid one. In a general population, establishing this link is nigh impossible.
There is such a huge set of variables determining biomechanical stresses, that when combined with the virtually limitless number of ways that a nervous system can intepret and process input and output, we end up with no linear connection between posture and pain.

There are very, very few people who hold a posture for longer than a few minutes. So, how would a "better posture" work in that context anyway?

I have found it more appropriate to focus on helping the patient develop awareness of comfort and correction when needed, no matter what posture they may assume.

With regards to books - excellent list you made there! One of my other favourites to recommend to patients is "The brain that changes itself" by Norman Doidge - not expensive at all, and chock-full of very good, interesting and well-presented info, and references.
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Old 25-03-2011, 12:18 PM   #15
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Hi Ben

I, like you, am finding LOTS to learn here! If you're accumulating a book collection one I am currently devouring is Barrett's "Shallow Dive". I was determined to take it in small chunks but still found myself gobbling it up.

Tony
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Old 25-03-2011, 11:28 PM   #16
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I'd also recommend The Brain that Changes Itself.

Re posture: No-one is going to hold the ideal mechanical posture (which we were all trained to do) for more than several minutes. Even if we were able to maintain it, there is no evidence it would resolve any pain issues. It developed via a very mechanical obedience to the way the skeleton and discs looked on XR, probably.

Movement is the key, and it seems that as long as you move around while sitting or standing, even if only the feet, knees or forearms are moving (fidgeting, in other words), it keeps the brain happier.

Society has a big input here; a 'fidgety' person is believed to be anxious and tense. According to the maxim 'motion is lotion' this belief is misleading. The movement can be quite small and discreet, such as ankle flexing or finger tapping.
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Old 26-03-2011, 12:05 AM   #17
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Again, the image of a poker player becomes useful if we're looking for a good metaphor.

In fact, the pain experienced by those who sit as still as they can is hardly a metaphor in any sense.
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Old 28-03-2011, 01:53 AM   #18
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"The brain that changes itself" is one of my favourite books of all time. It reignited my interest in the neurosciences.

Regarding excessive kyphosis. In Yoga there are a lot of schools of thought that focus on improved posture. But the question remains, if that person is experiencing no pain, messing with things that may or may not improve things but may make things worse is a dicey way to approach clients in our kinds of fields. Like the notion of "fixing" clients that are broken using our "knowledge" of the "correct" posture.

It is so hard to actually see what the spine should look like from the outside as well as determine the best way to obtain optimal, whatever that is, that the inner experience like Bas says the awareness is a much better tool that allows clients to be in control.

I have spent too many years trying to correct clients posture. It is ridiculous to think that 2 - 3 hours of my work per week will compensate for the rest of the time they spend with themselves.

I will be interested to hear what you think about Explain Pain. We are approaching this book from similar fields (more or less) and I expect to receive my copy in the next week or so as well.

I have to say I have become quickly overwhelmed by the amount of books referenced here. I don't know where everyone gets the time to read them all.

Byron
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Old 28-04-2011, 07:06 PM   #19
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Well, it has been busy lately but I intended on replying much sooner than this. Thank you for the recommendation, Bas (and everyone else) for The Brain that Changes Itself. It's saved in my Amazon cart for my next order.


Byron - Like you, I wish I had more time to read everything, nevermind to write so prolifically. After reading Explain Pain, I think I'm better equipped to deal with clients who present with what I will call the "nuisance" level of chronic pain. Even though I've been able to work around painful issues before, it was only at the expense of reinforcing a fear of pain and movement. Of course, I didn't realize what I was doing. What I really need is a local PT with an understanding of modern neuroscience who I can refer out to. (If anyone is in NJ or knows of someone here, and you feel inclined to reach out, please do so!)

As I feel comfortable with my level of understanding, I've made some attempts to apply what I'm learning about the nervous system. For example, instead of "stretching" tight muscles, I'm more concerned with getting them to relax. I'm now looking at restricted mobility as a loss of motor control rather than dysfunction of the joints and muscles. It's been as simple as slowing down some movements to focus on body awareness as well as emphasizing breathing, and I've had positive results so far. (Does that sound a little like yoga to you?) A few of my tougher clients (not in pain) who were making slow progress are noticeably more relaxed and mobile. It's awesome.

I know that I'm just scratching the surface here and I expect to make plenty of future adjustments in my training, but I think this is a good start.


Tony - I've been reading some of Barrett's essays already, so thank you for the suggestion. I see that you joined 4-1/2 years ago. Is that any indication of how long it should take to catch up with the knowledge base on SS? That wouldn't surprise me.


nari, Bas & Barrett - It's apparent that a lot of trainers and coaches (and PT's) expect the "mechanical obedience" that nari spoke of, and I see how I was sucked into that mentality a bit. What seemed like a practical consideration to prevent pain and injury, (and maybe an attempt to force the client to remember a certain position so they don't have to re-learn it next session?) now seems like the means for developing a false dependency. If it's impossible to maintain the "perfect" posture for more than a few minutes at a time, then you have a potential client/patient for life, right? Not unlike the chiro who recommends frequent "adjustments."


Barrett - I remember your example of the poker player from the Postural Restoration thread. I hope you don't mind if I use that when discussing posture with clients.


Bas - I think I know what you mean about choosing not to respond, but I wouldn't accuse any of the regularly contributing members on SS of laziness! If these topics have been discussed many times before, then I understand the desire to avoid redundancy. I don't expect to be spoonfed either, which is why I've been keeping my comments in the intro thread.
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Old 28-04-2011, 07:27 PM   #20
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Quote:
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Tony - I've been reading some of Barrett's essays already, so thank you for the suggestion. I see that you joined 4-1/2 years ago. Is that any indication of how long it should take to catch up with the knowledge base on SS? That wouldn't surprise me.

Nah won't take you that long...Even though I signed up that long ago I mostly just lurked a bit here and there til late last year when I 'got serious' so to speak
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Old 29-04-2011, 02:27 AM   #21
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Hey Ben,

That's awesome that you are changing your approach with clients. I bet you will have loads of fun with the challenge and creative aspects you can now employ. I watch a trainer at a local gym training his clients and I see a babysitter who seems dead inside. He repeats the same phrases, does the same routines, and probably has to train way to many people in a day to earn a decent wage.

I wonder if you have read Anoop's article. I think he has done an excellent job of explaining what he has learned about pain and how he applied it. I have to say I was secretly jealous that he had written it so well. At least with Jason Silvernail you can say "Well of course he understands it but what about us laypeople?"

I thoroughly enjoyed Explain Pain. My only critique was that it is such a flimsy book I am afraid it won't last. I have gone through it and referred to it and it already looks like it is 2 years old. I also thought Painful Yarns was hilarious. It is so refreshing to see humour used to help the learning process. Have you read ...Zebras don't get ulcers yet? I just ordered it myself.
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Old 05-05-2011, 06:49 AM   #22
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Funny that I just stumbled on this (literally, I have no idea how this website works and I'm pretty confused), I have been thinking about posture a lot lately. I am in PT school, and while I have a tremendous amount of respect for my faculty and the program... I'm just not buying everything they are selling. We are getting hammered on posture- this is bad, that's bad, DON'T ever do this, look for patients who do this... but something isn't right. It doesn't add up. The human body is so dynamic, and then add to that the sports that we train ourselves for- I refuse to believe that aligning yourself to a plumb line will solve all of your problems. Recently, I got called out for having really low values for all neck ROM (flexion, extension, rotation, and side bending.) My teacher was sure that I must have a lot of headaches and neck pain... nope. A massive car accident?... no.TMJ problems then? None. Trouble sleeping? Not at all. So WHY would I try to "fix" those ranges, as suggested, with stretching exercises? I plan to formulate my theories on this more accurately in the future, but right now, I'm left with a general sense of unease and frustration about the whole posture concept.
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Old 05-05-2011, 08:07 AM   #23
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Hi Clark,

Please feel welcome to start a thread in the welcome forum and introduce yourself if you would like. Many people have raised to concerns you have and there are some good threads to help you. As you can see from this thread, there is support for those who have questions about what they are learning or have learned.

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Old 05-05-2011, 08:13 AM   #24
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Hey Clark. Check out The Problem with OMPT and Crossing the Chasm. My guess is that you'll find anything that Jason's written to be your 'cup o tea.'

Congrats on the skepticism. If you can make it through PT school with it intact you'll be in good shape.
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Old 05-05-2011, 11:32 AM   #25
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Clark,

I'm not a gambler in any sense but I'd bet that if you were to invite any of the faculty you respect so much to come here they wouldn't do it.

Someday, the absolute absence of participation in the neurobiologic revolution by anyone in the academic community will have to be explained. We're all waiting.

Welcome.
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Old 05-05-2011, 04:02 PM   #26
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Hi Clark! Welcome to the world behind the mirror in Alice Through the Looking Glass. Sounds like you aren't quite all the way through it yet. Make sure to leave a trail of smooth white stones behind you so you can find your way back out, and keep one larger rock in your backpack just in case you need to chuck it at that mirror and break it, to get back out once you graduate.

Here is a link to the welcome forum (you're already in it, but you are on someone else's intro thread). Please feel free to start your own. Then we can welcome you all over again. Also, you can practice starting a thread of your own!
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Old 05-05-2011, 09:20 PM   #27
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Thanks for the shout Cory.
Clark I just finished a manual therapy Fellowship and the faculty there said nothing about the old Kendall posture-pain mythology and in fact actively criticized it. Static posture is of little use though you can make a case that for mechanical pain problems some degree of postural education (eg hip position for neural tension) has a role. Just not the role found in "posture and pain".
Welcome to Soma and hope you'll join us in the welcome forum.
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Old 06-05-2011, 06:03 PM   #28
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Tony - I was being semi-facetious about a timeframe, but I can't wait to see where I'm at one year from now. I'm making up for some lost time!

Byron - Yes, I did see Anoop's article, and I didn't mind reading it again. It's nice to see that other trainers are embracing modern pain science. I wouldn't have expected that article to show up on the blog that it did, and it will be interesting to see how much further attention gets generated from that.

Currently, I'm going through Explain Pain for the second time, as well as reading Somatics. When I start Science of Suffering, I'll place my next order which includes Zebras and Brain That Changes Itself. I try to maintain a policy of reading books I already own before ordering new ones, otherwise things get out of hand. What I'll be looking for next is the book that basically expands on everything in Explain Pain.

Regarding the flimsy construction, I'd love to make Explain Pain a "coffee table" type of book, but yeah it would get destroyed that way. I've learned the hard way not to open it unless it's first laid down on a flat surface.

Clark - We are approaching this site from different angles, but I know what you mean about "something not being right." Even in my limited experience, it was very clear that "corrective" exercise was effective sometimes, or at least it seemed to work, but other times it wouldn't accomplish anything. Why is that? I guess if you're willing to ask those questions honestly, you'll learn a lot from SomaSimple.
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Old 06-05-2011, 08:34 PM   #29
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Ben,

I know others have heard me describe this before but I like it so much I'll repeat it here.

I ask my classes about using traditional methods and then say like Dr. Phil, "How's that workin' for ya?" We agree that, at times, it can really help.

"But," I say, "isn't there a lot of luck involved? Is it a good idea to walk up to your next patient in the waiting room and say, "Do you feel lucky today?"

That last bit should be done in your best Clint Eastwood voice.
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Old 07-05-2011, 01:26 AM   #30
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I like that Barrett.

Do you feel lucky punk?

You know with all the PC type mamsy pambsy stuff around, that kind of stick may actually get you a line up. Kind of like the soup natzi and "No soup for you!"

@ Ben. I would like to say that I read every book I own before I buy another one, but that just doesn't work for me. I find that I have my library filled with books that I get halfway through and then lose interest or can't follow. Then I end up changing my perspective later and finish it or retire it. I go a lot easy on myself now about having to finish "everything" I start. I have been over zealous with that in the past.

I am pulling out of "The Sensitive Nervous System" right now. It looks like a great book, but it is a few steps (maybe several hundred) beyond my abilities. Sapolsky's is a much easier read and may help me make the leap in a few weeks.

Out of interest. The Teaching Company has two lecture series by Sapolsky. If you can't read sometimes it is really great to listen. plus the author can put their emphasis in better when they are speaking. I think Barrett and Diane should get a lecture series on their about pain. I would get it for sure.

But hey, we all have to find our own way that we learn don't we. Watch this awesome video from Sir Ken Robinson on education. I just love it!!!!

Man we live in an exciting time. Even though Barrett is dead.
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Old 07-05-2011, 05:54 AM   #31
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Byron, where else do you get to talk to dead people and live to tell?
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Old 07-05-2011, 01:19 PM   #32
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I hope everyone here understands that in the parlance of Soma Simple "dead" is a relative term.

The more "dead" you are the more you write and post. You also read a lot.

This is why the people I work with are so "undead." Ironically, this is what zombies are often called and we discussed this at some length in this thread in '07.
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Old 07-05-2011, 06:29 PM   #33
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I'll like to add a comment about transitioning between a "mesodermist" to an "exctodermist". I feel strongly that it is important to keep a skeptic attitude while learning about neuroscience and its application to clinical care, if you do not want to make the same mistake twice. Neuroscience theories are very attractive to us because it is making sense of a world that was previously discordant using a bio-mechanical perspective. A lot of great experts and published research have helped creating a clearer picture of the neuroscience 's impact;However, its it is important to remember that these are just theories and a lot of its clinical applications have not yet been tested rigorously.
I think you have to take a step back and appreciate the complexity of the human body and not rush to feel the void of a crumbling bio-mechanical approach with a "sexier" neurophysiological approach without challenging its proper application and place in clinical care.
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Old 07-05-2011, 06:44 PM   #34
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ahboncainri, that ship sailed long ago around here, sorry to have to inform you.
No one is saying that the complexity of the human body isn't appreciated. All we are saying is that our education taught us to look at the body through a telescope instead of a micropscope, and to make matters worse, entirely through the wrong end.
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Old 07-05-2011, 07:58 PM   #35
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I am well aware that you (and most of the members on this site) have reached a higher level of enlightenment that I have. Your 12,623 posts are a proof of that.
My previous post was an attempt to relate what Ben is going through with my personal experience as it come to joining this site and discovering the wealth of information available . When I first discover this site I was delighted to discover that I was not the only one challenging the bio-mechanical approach of patient's care and started to accept as absolute truth the information discussed in the forum.
I think this was because my belief in the bio-mechanical approach was shattered and my survival instinct was looking for another perspective to fill the void and make sense of my professional world.
I am now attempting to temper my enthusiasm, and remember that a lot of the information presented are coming from theories (very enticing theory with very good preliminary supporting evidence) for which a lot more research need to be completed before being perceived as fact or clinical truth.
I have been fooled once and I do not want to be fooled again.
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Old 07-05-2011, 08:01 PM   #36
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I am well aware that you (and most of the members on this site) have reached a higher level of enlightenment that I have. Your 12,623 posts are a proof of that.
My previous post was an attempt to relate what Ben is going through with my personal experience as it come to joining this site and discovering the wealth of information available . When I first discover this site I was delighted to discover that I was not the only one challenging the bio-mechanical approach of patient's care and started to accept as absolute truth the information discussed in the forum.
I think this was because my belief in the bio-mechanical approach was shattered and my survival instinct was looking for another perspective to fill the void and make sense of my professional world.
I am now attempting to temper my enthusiasm, and remember that a lot of the information presented are coming from theories (very enticing theory with very good preliminary supporting evidence) for which a lot more research need to be completed before being perceived as fact or clinical truth.
I have been fooled once and I do not want to be fooled again.
OK, I see your point, and applaud your caution. I'm in line right behind you with the whole "more studies need to be done" idea. However, I would hope in future studies different questions are asked, examined, and measurements framed in a new light. At least, that's what I hope my own research endeavors, pitiful though they are, might help do.
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Old 07-05-2011, 08:39 PM   #37
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We understand that in science all knowledge is provisional. "Facts" and "truth" are always suspect - some more than others.
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Old 07-05-2011, 11:40 PM   #38
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When mesodermalism dies under it's own weight of irrationality, you won't find members here hoisting a golden calf to honor the new reign of the one true explanation for all pain, or mawkishly celebrating, like some youngsters did across the U.S. with the recent demise of Bin Laden.

Barrett just surmised how it's not only what theories and ideas we espouse and promote here, but how we go about doing that. Here at Soma Simple, we do that skeptically. And it's not as though this is a revelation that skepticism is a necessary attribute for the clinical scientist, which all of us should strive to be lest we degrade into charlatanism.

This is how we're supposed to seek and advance our understanding of the natural world through scientific discovery. Always questioning, always taking out Occam's BS meter and cranking it up as high as it'll go to detect the slightest bit of excess- watching the needle closely as it flips from "making sense" to "sense-making" to a full out "BS alert".

These days, I get a bit uncomfortable when I start thinking I know the best way to treat patients in pain. BSS (Before Soma Simple), I fought against feelings of uncertainty and not "knowing" the best intervention for any given patient. Now I not only have a much deeper and more accurate explanatory model to work with, but rather than resist feelings of uncertainty, I cherish them knowing that this is the only way I will grow as a therapist and that the profession will advance scientifically.
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Old 08-05-2011, 01:46 PM   #39
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John W - That is the kind of thing that has earned so much of my respect on on SS. Well Said.
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Old 08-05-2011, 05:04 PM   #40
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Thanks Bryon.

If it's certainty in your daily work that you're looking for, then I think you have two options: 1) accept a theory that provides a false sense of proficiency and skill or 2) choose a profession where at least relative certainty is attainable, like engineering or accounting.

If you want to feel certain and "skillful" in your provision of therapy, then I think you have the wrong set of expectations, and you don't really understand therapy for pain.
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Old 08-05-2011, 06:36 PM   #41
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Thanks Bryon.

If it's certainty in your daily work that you're looking for, then I think you have two options: 1) accept a theory that provides a false sense of proficiency and skill or 2) choose a profession where at least relative certainty is attainable, like engineering or accounting.

If you want to feel certain and "skillful" in your provision of therapy, then I think you have the wrong set of expectations, and you don't really understand therapy for pain.
The catch 22 is, that because of how the human brain is set up, it responds placeboically to displays of confidence on the part of a caregiver. All the expectation and trust and hope pathways are activated by way of the therapeutic interaction and without these, there is much reduced chance of success of a given intervention. Sux. See "The Patient's Brain" thread for more about this.
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Old 10-05-2011, 03:37 AM   #42
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Quote:
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Thanks Bryon.

If it's certainty in your daily work that you're looking for, then I think you have two options: 1) accept a theory that provides a false sense of proficiency and skill or 2) choose a profession where at least relative certainty is attainable, like engineering or accounting.

If you want to feel certain and "skillful" in your provision of therapy, then I think you have the wrong set of expectations, and you don't really understand therapy for pain.
Actually John, I am a Mechanical Engineer by day. I think if any profession can't tolerate uncertainty they are doomed. An Engineer that can't tolerate uncertainty will never, ever venture into projects that are any different than what they have completed in the past. The physics may be certain but whether you can acquire the funds, time, and acquire the additional skills that are almost always needed to do anything new or different you will be left to recalculate the mundane in a cubicle. Or head some company as a guru that no one questions. Sounds somewhat familiar doesn't it.

I think thinking requires embracing uncertainty?
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Old 08-05-2011, 06:53 PM   #43
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John,

I agree.

Understanding the nature of the painful experience is so far removed from the education our colleagues have gotten that we can't expect much from any of them within shouting distance of it. On top of that, they finally become aware of the fact that its pervasive presence in any clinical setting forces them to make a choice between ignoring it (which usually means not believing the patient) or trying to acquire some way of treating it.

Did you notice how understanding is left out there?

So, they wait for a brochure to arrive announcing a nearby workshop full of promises, testimonials and shortcuts instructed by a person they've never heard of (this is easy because they've never heard of anybody) and sign up if the company pays the freight and gives them a paid day off to get their requisite CEUs.

My classes were full of these students, and I always struggled to find a way toward their desire to embrace theory - to understand. I found that becoming an entertainer was my only way through the day.

Recently a colleague suffering from "sciatica" broke down and asked me what I thought. I spoke for a couple of minutes about what she knew from the previous week's experience and she visibly relaxed, stopped squirming, and began to move ideomotorically. I never touched her.

Sensing an opening I said quietly, "You're better than you were five minutes ago, aren't you?"

She immediately made a face, looked at another PTA (who thinks I'm an idiot) and they began to laugh.

I entered again, this time far more forcefully than they've ever seen me. I used a clenched fist on the table. "That's the problem with your care," I said. "You want me to tell you want to do, not suggest how you might think. You want immediate, total relief. You want a faith healer, and your understanding of the problem doesn't concern you. Now, do you feel better or not?"

Because of my tone the laughter had completely disappeared. They seemed stunned.

She thought for a moment, shifted in her chair and said, "Yes."

I left. I can't get their schoolgirl laughter and attitudes out of my head. And I can't figure out how I'm supposed to teach this to people like that.
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Old 08-05-2011, 07:03 PM   #44
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Thanks a lot for the replies which help me clarifies my thougts. I think it all comes back to our brain having for primary purpose survival. It has been discussed in previous threads the reasons why beliefs resist to change. I think it is adding to the threat level when you not only change a belief (away from bio mechanical approach) but replace it with a framework that does not promote certainty.
I know it is the right way to go but it does not make it less challenging.
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Old 08-05-2011, 08:36 PM   #45
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Of course, I say all of this just having tested 2nd year DPT students in a practical skills check-off last week. I'm not in charge of this class, and moreover I realize that the current accrediting body requires that students become proficient in certain skills that have very little to do with providing actual therapy.

This is our quandary in the present scheme of things. It's a real mess and logarithmically more frustrating than my previous vain search for certainty.

I'm reminded of those times I'd go fishing as a kid down in the Missouri River bottoms and find myself confronted with a massive knot in my line. Always having limited extra line available, I'd be forced to spend what seemed like hours trying to undo the knot, while cussing under breath as my cousin would be hauling in one big fat catfish or bluegill after the other. What I really needed were two things: better equipment (or better understanding of how to take care of the equipment I had) and more extra line, not better skill at undoing knots. Like the "knot" of pain, trying to undo it by becoming more proficient at untangling knots is the wrong approach. If we just understood pain better, we wouldn't be wasting all this time and effort trying to undo it from the periphery; yet, this is precisely what current therapies for pain attempt to do- and with very limited success, mind you.

Unfortunately, we don't have someone next to us hauling in the fish as we fumble with our knots. It's more like the scene Barrett describes, where our colleagues engage in this game of make-believe therapy accompanied by a lot of giggling and banter interspersed with some occasional firm pronouncements on posture and strength in order to establish some semblance of authority over the patient. Nauseating stuff really.

Ironically, we've contributed to a massive knot in our education and clinical practice by willingly playing this silly game of make-believe. We've spent so much time learning methods for "undoing knots" in patients and then lavished so much praise, honor and respect upon those who've designed the methods of undoing the knots, that we've virtually neglected the "equipment" with which we're working.

This will require a Great Undoing, I'm afraid.
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Old 26-05-2011, 08:00 PM   #46
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I realize I'm probably not encouraging much in the way of future replies when I'm taking so long to respond on my own thread, but it's been a busy year so far and will most likely continue that way for a while. I enjoy reading everyone's input and I just have a few comments:

I seem to remember a recommended reading list in a SS thread somewhere, but I can't find it again. Does anyone know what I'm talking about, or am I imagining that?

One more note on Anatomy Trains: As I was deleting it from my Amazon cart, the word 'meridians' caught my eye. I checked the online preview and sure enough, fascial meridians are compared to acupuncture meridians. My exposure to MFR was limited to foam-rolling, but if I knew that ancient Chinese astrology was part of the equation, then that would have set off some serious red flags right there. I don't know if that's a recent addition to the MFR construct, but it's not even that important at this point.


Byron - Yes, of course, The Sensitive Nervous System. That would seem to be the next logical step for me. What has you hung up in there, are there a lot of medical terms? I don't mind having to perform some supporting research to understand the text, but I also appreciate the heads up!

Also, I'm not familiar with Ken Robinson, but the assembly line analogy of our education system is spot on.


ahboncairi - Your concern is a valid one, but I don't think you can replace true skepticism of one paradigm with credulity toward another. The reason I'm even here on SS is because I was looking for some answers that weren't previously explained to my satisfaction by the biomechanical model. Of course, I now have a lot of new questions, but I prefer the admission of uncertainty to a false sense of security. And it was mind-blowing to see some "mesodermal fantasies" completely demolished. I agree, the adjustment is challenging, but I think it's a positive development that you are demanding stronger evidence for this new model, and I'm with you 100% on that.


Barrett
- Since I've started reading through various threads here, I can't help but to be reminded of the main characters in The Fountainhead and Atlas Shrugged. Whether you agree with Ayn Rand's philosophy or not is irrelevant, as I'm more interested in her underlying theme of integrity.

I wish I had time to re-read both books and find the best quotes, but this one will do. From Part 4, chapter 18 of The Fountainhead:

Quote:
...all learning is only the exchange of material. No man [or woman] can give another the capacity to think.
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Old 26-05-2011, 10:39 PM   #47
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Hi Ben,
Quote:
I seem to remember a recommended reading list in a SS thread somewhere, but I can't find it again
It might have been the reading list in Moderators' Current Consensus on Pain. Karen is pretty good at making lists, so it might have been one of hers, or it might have been the one to do with MFR.
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Old 27-05-2011, 12:09 AM   #48
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Diane,

Yes, the 'Moderators Current Consensus' thread must have been the one. I remember seeing research articles listed as well. Thank you!
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Old 29-05-2011, 04:03 PM   #49
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Hi Ben,

Regarding "The sensitive nervous system". It wasn't the medical terminology. I have read plenty of that before.

It may be that I was overwhelmed with other tasks at the time and the book is quite technical in nature. Not being a therapist of any kind, I have no future application of the concepts so that leaves me with lower motivation to memorize certain aspects that Butler is talking about.

I am absolutley spell bound by "Why Zebras...." Sapolsky is an excellent writer.
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Old 29-05-2011, 04:19 PM   #50
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Quote:
Originally Posted by byronselorme View Post
I am absolutley spell bound by "Why Zebras...." Sapolsky is an excellent writer.
He's also an excellent speaker. Link to an entire uni course he taught last year, 25 lectures, 36 hours.

I listened to this thing while I did other things, or else just watched. It's great. I plan to (sometime before I die) listen to it way more carefully and take notes.
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"Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

“Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

“If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

"In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

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