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The Performance Lab A place to discuss the role of physical exercise on health in diseased and non-diseased states.

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Old 18-11-2010, 06:21 PM   #1
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Default How do we get "length"

The process of developing movement through a required ROM has been something that I have been contemplating a bit lately. The idea that stretching "lengthens" a muscle in the setting of a gym or clinic is one I really haven't been able to buy into. From the little I have read on the subject the majority of any changes that occur are going to be directly due to a change in the nervous system. In the absence of pain and the interest of moving more efficiently in sports I think that some form of training that targets increased ROM is advisable. This is an area I have largely taken for granted in the past but decided I will put a little time into looking into it over the next few weeks. The impetus was provided when I was talking with a good friend about various things and he mentioned using static stretching at the end of his patients session. I inquired why and after a bit of though the answer seemed to be because thats what you do. He and I discussed this a bit and moved on but I wanted to get a bit further into the topic. A few years back static stretching was largely looked at as a bad idea due to some evidence showing it reduced power output, however the consensus seems to be that as long as a proper dynamic warm-up is performed afterwards any CNS depression that came about from the static stretching is largely resolved. A few idea I am interested in are those pertaining to how do we get length, and how do we get it to stick. Some common techniques in the fitness industry include static stretching, dynamic stretching or mobility, AIS/PNF/Contract relax stretching, foam rolling, and etc.

This is pretty much just a ramble to think "out loud" but I would be interested in any thoughts or opinions. If the nervous system is what dictates our limits in movement then what methods are going to communicate the idea that we need a bit more length in certain movements?
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Old 18-11-2010, 06:50 PM   #2
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This thread may help a little.
http://www.somasimple.com/forums/showthread.php?t=7027
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Old 18-11-2010, 07:09 PM   #3
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Quote:
The impetus was provided when I was talking with a good friend about various things and he mentioned using static stretching at the end of his patients session. I inquired why and after a bit of though the answer seemed to be because thats what you do.
And that's what you do because that's what you can get paid for as you complete your notes, check your FB page, call your spouse to remind them to pick up the kids, text your friends about the best happy hour deal after work, etc.

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He and I discussed this a bit and moved on but I wanted to get a bit further into the topic.
Yeah, don't expect to get too far with this conversation in the modern-day PT clinic. It's the taboo subject that invariably degenerates into a discussion about the ethical use of support staff.

What about the ethics of providing care that actually works?
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Old 18-11-2010, 11:32 PM   #4
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To add 'length' to a muscle we would have to add sarcomeres, right?
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Old 18-11-2010, 11:48 PM   #5
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To add 'length' to a muscle we would have to add sarcomeres, right?
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Old 19-11-2010, 12:14 AM   #6
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Originally Posted by mrupe82 View Post
To add 'length' to a muscle we would have to add sarcomeres, right?
Exactly. Which is why I put the word length in quotations. It just happens to be the term most often used for discussing this area. There are many better terms available.

Understanding that it is the nervous system that is allowing for any gains in ROM where do these various form of flexibility fit? I recently saw someone (who is relatively well known in certain S&C circles) state something to the effect that he knew his muscle was being stretched because he felt the stretch in the muscles belly. I guess a better question might be why has the brain decided that this motion is no longer required? The way I learned was that these were protective mechanisms, and adding motion to a movement without also working on stability through the new movement was going to set you up for an injury.

I purchased awareness though movement but have not had the opportunity to read it yet.
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Old 19-11-2010, 12:48 AM   #7
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Mr. Dorko used the word lengthening as oppossed to stretching.
"Doesn't "lengthening" work? It implies what you seek and suggests the desired outcome will ensue." I admit this is different than adding length if one wants to get picky since words mean something here.



As did Bas Asselberg "I really LIKE "lengthening" as an alternate for "stretching". Really like it."

Also, why does it need to alleviate pain? Why can't it be do benefit ambulation? Toe walking secondary to tight gastrocs presents balance and conservation of joint problems.
So I should use feldenkrais movements for my hemi patients to increase "length" of the gastroc soleus groups. Sure seems functional albeit impossible. Mirror therapy may help more.
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Old 18-11-2010, 11:52 PM   #8
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Feldenkrais.
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Old 19-11-2010, 12:10 AM   #9
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Scot - great ramble.

Quote:
what methods are going to communicate the idea that we need a bit more length in certain movements?
Any method that helps the human do this in a way that can be done independently.

That is - as long as it has been properly established that lengthening is required to help the patient's pain complaint.
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Old 19-11-2010, 12:27 AM   #10
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Quote:
Originally Posted by Bas Asselbergs View Post
Scot - great ramble.


Any method that helps the human do this in a way that can be done independently.

That is - as long as it has been properly established that lengthening is required to help the patient's pain complaint.
Hey Bas, I am thinking along the lines of someone who needs an increased ROM for sports performance. For instance in golf, there are certain movements that if a golfer is unable to perform them, he/she will have certain swing faults associated with it. So I am assuming this is in a state where increased ROM is required. From what I understand limited ROM doesn't necessarily = pain.
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Old 19-11-2010, 12:34 AM   #11
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Don't read the book, just watch some videos on YouTube.
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Old 19-11-2010, 12:44 AM   #12
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Thanks Barrett, I will do that.
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Old 19-11-2010, 01:25 AM   #13
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To my knowledge there is no such thing as "a Feldenkrais movement."
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Old 19-11-2010, 01:37 AM   #14
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Then can you explain your one word answer in a complete sentence?
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Old 19-11-2010, 02:11 AM   #15
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I'm into brevity, and anybody willing to Google a little doesn't need any more from me.
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Old 19-11-2010, 04:41 AM   #16
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Quote:
Also, why does it need to alleviate pain?
Deb, the point was not that it needs to alleviate pain; the point was that most often in physiotherapy, stretching serves as a treatment for some supposed "tightness" that is somehow related to a painful condition. My answer was just aimed at that - in my eyes - completely overblown notion.


Quote:
Toe walking secondary to tight gastrocs presents balance and conservation of joint problems.
Why would that type of ambulation be a problem?

Scot, your point is well taken. If body mechanics limit performance, pain is not a main concern.
For those, yoga, ta'i chi, feldenkrais, self-directed classic stretches - they all serve the purpose as long as it matches the person's style and expectations.
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Old 19-11-2010, 12:46 PM   #17
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Have you ever worked with an elderly soul who couldnt ambulate with heel strike secondary to contractures? It is like walking in high heels without the heels being present. Try that Bas and see what problems it could present for octogenarians who need to get from the bed to the bathroom or down the hall to dinner. Could you ambulate llike that all day?
Barrett NUTS brief enough?
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Old 19-11-2010, 12:54 PM   #18
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Have you ever worked with an elderly soul who couldnt ambulate with heel strike secondary to contractures? It is like walking in high heels without the heels being present. Try that Bas and see what problems it could present for octogenarians who need to get from the bed to the bathroom or down the hall to dinner. Could you ambulate llike that all day?
I would wonder what the person's system (as in nervous system) was trying to defend itself from, not what kind of defect (contracture) s/he had.

Defense, not defect.

("Dfs-not-dfct" is a Big Idea that Barrett brought here several years ago. I don't know if he originated it, but he certainly brought it here and shared it. )
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Old 19-11-2010, 12:55 PM   #19
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Can someone tell me what NUTS stands for?
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Old 19-11-2010, 12:59 PM   #20
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Usually Diane the patients body is "protecting" from lack of movement and proper care. The tissues seem to shrink from being left alone in bed for months. In your world it would be related to some tunnel syndrome because the nerves were not allowed to glide and slide properly and this led to their stagnation (read hypoxia) and protection withdrawl.
That is why I write neuromuscular mobilization techniques to lengthen and restore mobility to the ankle.
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Old 19-11-2010, 12:50 PM   #21
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Quote:
NUTS brief enough?
Certainly. It tells me what I need to know.
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Old 19-11-2010, 12:55 PM   #22
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Hopefully you googled it and knew that this is what I was refferring to.

http://www.thedropzone.org/europe/bulge/kinnard.html
Enjoy your day doing what you do to promote the changes you desire one person at a time. (believe it or not things do change positively that way)
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Old 19-11-2010, 01:01 PM   #23
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Quote:
Originally Posted by norton View Post
Hopefully you googled it and knew that this is what I was refferring to.

http://www.thedropzone.org/europe/bulge/kinnard.html
Enjoy your day doing what you do to promote the changes you desire one person at a time. (believe it or not things do change positively that way)
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Thanks for the link. I would have never found that. I'd have tried guessing a hypothetical "Not-undertake-transfer-safely", or something else nursing-homey, and would have wondered why the tortured acronym.
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Old 19-11-2010, 01:08 PM   #24
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I certainly do remember working with patients like that. I was a green PT just out of school, and couldn't usually get anywhere with the (um...) "contractures." Plus I would have a long list of patients to "get through" before lunch time. I'd have been grateful for someone like Barrett to show me ways to deal with such problems even if it was just sharing a magician trick or two.

Looking back to 40 years ago, I don't know how our profession continues to do this, to crank out new baby PTs, convinced they've obtained a great education, who have worked hard to complete an academic training, and are cranked out knowing exactly all the wrong way to deal with everything based on HPSG treatment concepts that are exactly backwards.
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Old 19-11-2010, 12:59 PM   #25
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Thanks for that clarification, Deb. No, I have never worked with such a patient even though in the past I was responsible for treratment of 78 geriatric patients in a psych hospital. A limited perspective of course. My present perspective is that of a general outpatient private clinic practitioner - and thus also limited.

What tissue are you stretching in that patient? How is the proper length accomplished for an improved gait? Are the changes neurologically driven (reduced excitation of motor-units) or accomplished by tissue "getting longer"?
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Old 19-11-2010, 01:03 PM   #26
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Bas,
See above. and also see the referenced thread way above. We have been thru this already.
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Old 19-11-2010, 01:04 PM   #27
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Ok Deb. "We've been thru this already"?

I did not need the link: I knew what "nuts" stood for.

Fine.
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Old 19-11-2010, 01:09 PM   #28
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no Bas,
the link to the thread way above. Not NUTS! We discussed why we use lengthening not stretching because it is virtually impossible to STRETCH any tissue manually and actually gain length. See what I write as I am performing the procedure.
Seems like you are so used to defending your positions you miss those times when people actually are agreeing with you.
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Old 19-11-2010, 06:39 PM   #29
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Hey Deb, thanks for that original link. I missed that thread in my searches on the site. Also I had completely forgotten the NUTS line. I actually read a book on that battle a long time ago.

I assume it is fairly safe to say that any changes seen in length due to something done in an hour session is strictly a change in the nervous system. I am not sure how much the fact that a muscle has been "warmed up" is due to actual mechanical features or changes in the nervous system. Whatever the "special" method being used they are all some form of PNF stretching and all bring about the measured changes in length through a similar series of events. If this is so, then its less about what you do and more about doing it if a need has been determined. Unless of course one method has a more logical base for the results it produces when compared to another. Am I thinking correctly here?

So in the case of the static stretching at the end of the workout, if flexibility is something needed (and not in a "he has back pain so his hamstrings must be tight" way) static stretching at the end of what has been done is a defensible position.

I am attaching a paper written by Gray Cook on static stretching.
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File Type: doc Why Not Stretch.doc (39.0 KB, 26 views)
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Old 19-11-2010, 06:56 PM   #30
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Static stretching at the end of a session should be more focused on feeling the new available ROM with the intention of remapping the brain and its awareness of motion without nocioceptive signals being elicited. I agree it is all proprioception and awareness.
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Old 19-11-2010, 08:30 PM   #31
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I understood that a passive drill such as static stretching doesn't do this as well as actually moving through the new movement patterns. Something like yoga or feldenkrais.
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Old 19-11-2010, 08:35 PM   #32
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Is it just me or does anyone else see what role the response "Nuts" places me in?

I'm supposed to explain a man's lifelong work in a single post?

I am done with this conversation.
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Old 19-11-2010, 09:18 PM   #33
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Do you see where your responses place me?
Do you care?

That may be one of the problems Mr. Dorko. Completing something and sticking with it. You can be a grouchy old bear can't you.

Why is it so hard for you to just write one or two sentences on how you believe Feldenkrais can add length? Pretty simple request I feel.
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Old 19-11-2010, 09:41 PM   #34
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Mr. Dorko,

Since you are finished with this conversations I will give it a go - and hope you will reply.

First and foremost - Deb is seeking adwice and guidance. As far as I know, you are currently working with "older people" and I am sure that you have gained a lot of experience over the last couple of years in the field of geriatrics. You, of all, know what Feldekrais is, how and why...... Cut her (Deb) some slack and guide her in the right direction. Share your thoughts (you are good at it).

Right now I find you quite grumpy and sensitive (It does not bother me - quite the opposite actually).

Try a for once
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Old 19-11-2010, 09:52 PM   #35
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Jan, the word "nuts" addressed to Barrett places him in the role of the Germans in Belgium in WWII. The background of that story is well-known (see above link). This is not exactly a love-in generating move, is it?

With regards to sharing info - I'd say that he is one of the most sharing people here - and has been for a long time.

I am going to cut him some slack!
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Old 19-11-2010, 10:15 PM   #36
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I agree - he is sharing and have (together with a couple of others here) changed my view and practice.
A know my history (including the WWs). (Smiling) But to take it personal in that manner???? (Barret is not that big - nor important) Please, let humans be humans - grooming or not!

If this site want to guide their participants in the right direction - do it right by using what you know best; scince-based guiding!
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Old 19-11-2010, 10:23 PM   #37
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Deb,

In Barrett's own words:

"Imagine being desperate to speak but fearful of doing so. A common consequence of this
situation will be an isometric contraction of the muscles that drive speech. Humans are capable of suppressing the isotonic contraction of these muscles for prolonged periods,
perhaps indefinitely, and will do so if fearful that their speech is in some way unsafe, unacceptable or harmful to others. Some people speak anyway. In many cultures the permission to speak freely and to verbally express ourselves in an authentic manner is recognized as an essential aspect of mental health. We encourage it, make laws to protect it and, if necessary, train professionals to recognize and elicit it from those who need to do this in order to resolve psychological issues."

Mayhaps he is attempting ideomotion on you?

I found his paper from which I quote the clearest as to simple contact. There may be others, I have not finished the tome.
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Old 19-11-2010, 10:53 PM   #38
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Quote:
This is pretty much just a ramble to think "out loud" but I would be interested in any thoughts or opinions. If the nervous system is what dictates our limits in movement then what methods are going to communicate the idea that we need a bit more length in certain movements?
A ballerina, a guy doing wind sprints, a baby reaching for a toy, a ninety year old lady getting into bed. The thing they all have in common is their conscious decision to over ride their neuromatrix and perform the movement to the maximum extent of their physical ability. The brain might say otherwise and stop the ninety year old lady with a sharp pain in her shoulder, the baby might shrink down and cry in frustration, the runner might pull up with a cramp, the ballerina might succumb to fatigue after practicing all day.

The neuromatrix, genetics, autonomic nervous system, local and systemic immune response, and endocrine function all determine length and limits to movement. The function you are applying your body to during the activity could be considered training, learning or living.

Talk about motor control Why doesn't that guy just fall over? He has to imaging every movement every waking moment of the rest of his life. His ideomotor faculty is still functioning with a major component of motor control missing; proprioception.

My understanding of the intent of Feldenkrais is, it is non threatening movement as is ideomotor activity.

Pain does not equal damage. Pain = Threat


Quote:
Nothing Simple - Ten Steps to Understanding Manual and Movement Therapies for Pain


1. Pain is a category of complex experiences, not a single sensation produced by a single stimulus.

2. Nociception (warning signals from body tissues) is neither necessary nor sufficient to produce pain. In other words, pain can occur in the absence of tissue damage.

3. A pain experience may be induced or amplified by both actual and potential threats.

4. A pain experience may involve a composite of sensory, motor, autonomic, endocrine, immune, cognitive, affective and behavioural components. Context and meaning are paramount in determining the eventual output response.

5. The brain maps peripheral and central neural processing into each of these components at multiple levels. Therapeutic input at a single level may be sufficient to resolve a threat response.

6. Manual and movement therapies may affect peripheral and central neural processes at various stages:
- transduction of nociception at peripheral sensory receptors
- transmission of nociception in the peripheral nervous system
- transmission of nociception in the central nervous system
- processing and modulation in the brain

7. Therapies that are most likely to be successful are those that address unhelpful cognitions and fear concerning the meaning of pain, introduce movement in a non-threatening internal and external context, and/or convince the brain that the threat has been resolved.

8. The corrective physiological mechanisms responsible for resolution are inherent. A therapist need only provide an appropriate environment for their expression.

9. Tissue length, form or symmetry are poor predictors of pain. The forces applied during common manual treatments for pain generally lack the necessary magnitude and specificity to achieve enduring changes in tissue length, form or symmetry. Where such mechanical effects are possible, the clinical relevance to pain is yet to be established. The predominant effects of manual therapy may be more plausibly regarded as the result of reflexive neurophysiological responses.

10. Conditioning for the purposes of fitness and function or to promote general circulation or exercise-induced analgesia can be performed concurrently but points 6 and 9 above should remain salient.
Karen

Last edited by Karen L; 19-11-2010 at 11:13 PM.
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Old 19-11-2010, 11:45 PM   #39
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Quote:
Originally Posted by Karen L View Post
Pain = Threat
Hi Karen,

I agree with most of what you said but I'm going to take the opportunity to disagree with the Pain = threat idea.

In the consensus you reference it states this about threat:

"A pain experience may be induced or amplified by both actual and potential threats."

It does not equate pain and threat. While I think it's common to feel a sense of threat of some sort when in pain, I think it is also common to feel a sense of threat in the absence of pain.
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Old 19-01-2011, 12:09 PM   #40
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Karen L
Thanks for offering this quote
"Nothing Simple - Ten Steps to Understanding Manual and Movement Therapies for Pain"

I find all of these ten paragraphs fit neatly with my own concepts of there being a spinal protective behaviour. I couldn't quite make out where these came from though and by whom. Can you help?
Cheers
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Old 20-11-2010, 12:34 AM   #41
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Thanks Jon, I was struggling with that. Every person will approach a painful threshold differently and how they communicate adaptation to that new position will probably depend on their imagination. I try to remember "pain has an element of blank" the person training etc. is using the principles of neuroplasticity to alter ability. Pain is part of the neuroplastic process for better or worse.

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Old 20-11-2010, 01:31 AM   #42
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Quote:
Originally Posted by Karen L View Post
Thanks Jon, I was struggling with that. Every person will approach a painful threshold differently and how they communicate adaptation to that new position will probably depend on their imagination. I try to remember "pain has an element of blank" the person training etc. is using the principles of neuroplasticity to alter ability. Pain is part of the neuroplastic process for better or worse.

Karen
You're welcome Karen. People are welcome and encouraged to do the same with me. Taking the influence of threat one step further, perhaps it's more commonly a neuroelastic process rather than a neuroplastic process, assuming threats are sufficiently infrequent and short duration.
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Old 20-11-2010, 02:39 AM   #43
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Jon

Lorimer Moseley states that "pain can be conceptualised as a conscious correlate of the implicit perception that tissue is in danger" ie: a threat, real or perceived

I have found that way of looking at it very useful
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Old 20-11-2010, 02:48 AM   #44
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Hi all,

It's quite interesting to see that there are quite a few people who haven't been deconstructed even when they have read something or conributed something here. Why is that??

I reckon I can feel Norton's feel......

When Barrett said "Don't read the book, just watch some videos on YouTube", I really want to know what he really wants to say? Good or not? what arguments he holds on?

When he said 'Is it just me or does anyone else see what role the response "Nuts" places me in? I'm supposed to explain a man's lifelong work in a single post? I am done with this conversation. " Yeah, even with few years of seriously learning English, I can really understand what "NUTS" mean.....but why he has to give up the conversation?

From my Taiwanese perspectives, I can really see western people (no offense) like to critically argue over things. I really appreciate that because that way does help to make things or this forum's standpoints clearly as well as help me to reflect what I have learned. But why do "only few" people like to share what they think or how they might progress their treatment when the real case is presented (see Impairment and pain: can that R shoulder pattern be corrected?? )or when people here are asked to share how they exame their clients (Mesodermal exam question... )??

Still confused and am struggling.....

Weni
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Old 20-11-2010, 03:05 AM   #45
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Thanks Gilbert. Here is a link where you can download (for free) an article in which Moseley unpacks that idea a bit more.

(We probably have the article here someplace at SS also.)
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Old 20-11-2010, 03:17 AM   #46
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Here and here are some short references to the idea of "implicit perception." (links to Nature articles)
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Old 20-11-2010, 05:58 PM   #47
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Quote:
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Here and here are some short references to the idea of "implicit perception." (links to Nature articles)
Also, read the See What I'm Saying thread.
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Old 12-01-2011, 05:56 AM   #48
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Good article I found somewhere and finally read. May have found it here. There is also a clarification posted that can be found here. http://ptjournal.apta.org/content/90....full.pdf+html

While this seems to reinforce the view that it is merely sensory feedback that gives us the added comfortable ROM, what mechanism would be used to actually shift the length/tension curve. The authors do not seem to think we really know from what I gathered. My next thought would be does it matter?

Link to Paper
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Old 19-01-2011, 03:05 AM   #49
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I just received the book Strength & Conditioning: biological principles and practical applications and just began looking at the section on stretching Some statements I have enjoyed so far.

"Confusing the picture of flexibility... even more are a few publications attributing the mechanisms and effects of stretching to fanciful ideas... [then they list various quotations taken from a number of books on flexibility that are preaching fascia etc]... "for instance science has recently classified a third nervous system... called the enteric nervous system... similarly there is mounting evidence for independent roles played by the connective tissue system... all the cells get this mechanical message of movement as it undulates and reverberates through the facial network at the speed of light..." (Frederick and Frederick, 2006)

The authors respond " there is little to be gained by these types of statements... [explanation of what the enteric system is] Of course there is a great deal of financial incentive to present pseudoscientific information as fact in order to gain a competitive advantage in the marketplace and to constantly use “name dropping” rather than data and peer -reviewed studies to establish a market niche. this approach is called “cargo cult science” by the late Richard Feynman... the basic idea is that pseudoscientific treatments often include scientific terms from other fields used incorrectly, along with some of the trappings of science without the evidence or substance. There are plenty of unanswered questions concerning flexibility without resorting to fringe areas and fanciful ideas.”

I rather liked this and think I may enjoy this book. The term Cargo cult science is a new one for me but good.
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Old 19-01-2011, 12:30 PM   #50
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Since when is protection painful?
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