??? Conversations with an Osteopath

[Diane]

I don't think he was being aggressive. I think he felt his dopamine slipping away, so he felt obliged to retreat to the illusory safety of his elaborately constructed belief system, which is so unwieldy he can't take it anywhere. Like an eel in a cave. If it were truly useful he could go roaming all over the place with it and be able to defend it on any turf at all, effortlessly. Like a shark. Whose teeth are made of actual science.

It seemed to me he was being stiffly polite but not abusive.
The fact he won't consider his own story at this point means he's precontemplative about learning how to use Occam's razor on himself.
He is closer to it, now that Byron has had at him.

[Bas Asselbergs]

Byron, congrats on your impressive patience with this one.
He did fall back on accusing the critic instead of considering the critique itself. The little dance steps around " your level of knowledge" and so forth are indicators of you getting a bit too close for comfort. And thus, the old warhorse of "science doesn't know everything" is trotted out.

You got too close.

[byronselorme]

Thank you guys.

I didn't miss the fact that his words were only cloaked with niceness. It is surprising how the psychology of the whole thing developed. I know lots of people who know way more than I do about many things who would reply very differently to my questions.

And I liked the Karate vs Massage analogy too. I thought "hey this is a good one" .
I do wonder what he would have attacked if I had left that out though.
Like I said. I consider it practice and it was good for that at least. Eventually, as Diane puts it, pooh will be flung.

[Diane]

Originally Posted by byronselorme

Like I said. I consider it practice and it was good for that at least. Eventually, as Diane puts it, pooh will be flung.

There always is. Pooh shields up!

[amacs]

Hey - leave Pooh alone!!

[byronselorme]

All apologies to Pooh anDY.

By the way. I always love reading your quote

"Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it." A.A.Milne

The unassuming way in which Milne causes me to take that different perspective. I only hope that I can find a way to do that in conversation.

[Barrett Dorko]

Winnie the Pooh P.T.

[byronselorme]

Hey cool! I read the Tao of Pooh a long time ago. I'll have to pull that out again.

This stood out for me

In fact, when traditional manual care is augmented with the common cultural admonitions to appear a certain way, there is little room left for the acceptance, quiet contemplation and introspective discovery that typifies natural processes.

[John W]

For the record, I'm for a strict delineation between poo and pooh.

[byronselorme]

I forwarded Jason's recent video by Will on Crossing the Chasm to my friend. I was happy to hear his reply.

Hi Byron,

Thank you for the video! Jason has a good perspective, I think. I can say I probably don't think enough in terms of neuroscience when I am attempting to treat somatic dysfunction. It is an adjustment I think I need to make as I try to take that next step.

I have been wondering how you were doing, and how your search for answers is progressing. Nikki and I have been exploring the possibilities with social media to interact with the world, and to discuss osteopathy and athletic therapy. One of the points made by a few social media experts is that you must learn to interact in a positive way with people who don't see things the way you do, and to take criticism gracefully. I must apologize for being oversensitive. It is a difficult point in one's career to get close to the end of your studies and realize that it will take decades before developing a true understanding of what is actually happening during treatment. I have to get used to not having all of the answers, and to somehow be okay with that! (not easy)

I have been a chronic pain sufferer as well. I have had pain around the thoracic spine every day since 2002, and I have been looking for answers. It was one of the reasons I moved in my current career direction. I hoped the process would help me find the key. Nothing I have found so far has corrected the situation. Although there has been improvement with ongoing osteopathic treatment, the pain is still there.

I have long abandoned the idea that there is a magic spinal adjustment that will fix things, or a magic stretch that will suddenly set things free. There is obviously a deeper issue here. There is clearly myofascial dysfunction, but the question in my mind is "what is driving it?" The fact that I can have it treated (eg. massage) to reduce the myofascial tension, only to watch it re-create itself within 2-3 days tells me the nervous system is driving this pattern to meet its own ends. But what ends?

I have had patients like me, and they are the ones I feel for the most. The ones with upper thoracic pain following a car accident have been the most difficult. Sometimes I will see results, but I would not say I've seen a dramatic or permanent change. Increasingly I am wondering, "what is driving this?"

My understanding of neuroscience needs to mature. I know the founder of the Osteopathy college has gone very far in that direction. He goes into detail about the neurological processes involved in pain perception and how it affects treatment for the pain itself, but his courses on that topic are post-grad, so I won't be going there for a few years. I wouldn't be ready for it at this point anyway. My hands have a long way to go yet.

So will osteopathy give me the answers I am looking for? I don't know yet. Even if it does, it will probably be another 10-20 years before I begin to understand it all, and maybe a lot longer than that.

As for the thoracic spine pain, I think it will be there for some time. Perhaps it was originally a somatic dysfunction, that is now so deeply ingrained in the nervous system that somatic treatment isn't quite reaching it. Perhaps it has been neurological from the very beginning and that drove the somatic dysfunction (and continues to).

It actually might be a good thing that you and I see things so differently. Maybe if we both keep turning over different rocks, then one of us will find a solution. Maybe the solution will come because of collaboration at some point.

I certainly hope one of us figures out the problem! Pain free would be nice, for a change.

Thanks Byron!

I replied to him with this. I think I have explained my current level of understanding pretty clearly.

I am very impressed by the maturity in this email you sent. It is indeed very interesting that we are both suffering similar pain issues for almost the same amount of time.
Also, I am sure I still have plenty of things to learn about how to express my ideas and to disagree with someone else who has dissimilar views from my own in a constructive way.


I think it is what we do afterwards that shows who we are.


I am currently working with a PT in Hamilton who is conversant in the current neuroscience surrounding pain. We are working with the following ideas:


1) Pain is an output from the brain.
2) Pain is a bio-psychosocial phenomena.
3) Chronic pain leads to neuroplastic changes that need a steady consistent and gentle approach to instigate positive rewiring.
4) The nervous system is highly sensitized with chronic pain.
5) Addressing oxygen restrictions to cutaneous nerves by gentle manual manipulation can aid in teaching the nervous system to down-regulate the threat.
6) In chronic non-cancer related pain, tissue damage and joint displacement is highly unlikely to be related to the pain experience.
7) There is some evidence that lateral differentiation isn't as well defined in someone who are suffering chronic pain
8) A graded exposure approach of slowly increasing the ability to differentiate sides of the body (left / right) moving to a mirror therapy approach then a gradual increase in desired activity has shown to be effective and promising
9) A resolution phase has been subverted in the normal Withdraw - Guard - Resolve response to real or perceived injury.
10) Resolution can also be suppressed by certain cultural restrictions (ideas of posture, sitting still, muscle imbalances etc)
11) Finding environments and therapeutic situations that invite this resolution phase can also aid in pain reduction.



I have a target of being ready for some hard labour in the fall (roofing) and I hope that following this approach for that period of time will prove successful. If yes I will definitely let you know.


There is an interesting program on youtube by BBC called "The secret world of pain" There are a couple errors (minor) regarding pain being Perceived by the brain (it's not, it is produced by it) and another talking about pain pathways (again pain is produced by the brain so pain doesn't travel up a pathway to ring a bell in the brain as previously thought). But overall it is quite good.


It is in 4 parts, here is part 1



I really have to follow the science about the most recent pain research carefully. It all points to CNS and the interpretations of the brain about the perceived threat.


We'll see how it goes. I am hopeful

Byron

[Bas Asselbergs]

Great to see that therapy-work developing with yourself Byron!

[Barrett Dorko]

Byron, This line:

My hands have a long way to go yet.

was, to me, the most powerful in the letter and the one used to justify both ends of the "training" spectrum - the absence of progress in understanding from the student's end and the volume of courses (and repeats) proposed by those getting paid to teach.

Please let me know what I might use of this conversation in a future blog post.

[byronselorme]

Hi Barrett,

I know that he has many things he says in here that need clean up, I left it aside since I thought he had made such a positive step forward. The hand comment stood out for me too.

I have deliberately kept his name and location out of these posts so that it may be used for any discussion. I would be more than happy to have you use it. Thank you for asking.

[Barrett Dorko]

Thanks Byron.

I doubt there's anything more powerful than this "skill" thing to keep others from feeling they can't succeed without time passing and money spent.

Isn't it funny that people running "games of skill" on midways at every carnival know this? They should be called "games that require a little practice, but not much."

Naw, not very catchy.

[SMEGC]

Oh dear, I'm rather embarrassed to call myself an osteopath after reading all of that.

The brainwashing does run deep in the cranio and visceral crowd.

[Ken Jakalski]

What is interesting is the tactics that I see being employed to undermine my position without directly facing the points I am making. I know everyone else here has had endless experience with this but I have not had much.

In a recent visit to Paul Ingraham's site, I came across the following regarding his ongoing battles with some of the fascia folk:

"There is a novel theme in the most recent batch of cranky email (other than spelling mistakes and missing the point): a few readers have criticized me for an imaginary lack of “practical” experience. It’s not unusual for people to fixate on my qualifications instead of the subject matter, but this recent emphasis on clinical experience is a fresh twist."

The take home message for me is that many of us either have been-- or eventually will be--experiencing this same kind of undermining.