SomaSimple Discussion Lists  

Go Back   SomaSimple Discussion Lists > Physiotherapy / Physical Therapy / Manual Therapy / Bodywork > General Discussion
Albums Quiz PubMed Gray's Anatomy Tags Online Journals Statistics

Notices

General Discussion this forum is opened to all registered users of somasimple

Reply
 
Thread Tools Display Modes
Old 21-11-2008, 08:14 PM   #1
Jon Newman
Enjoy a moment of whimsy
 
Jon Newman's Avatar
 
Join Date: Dec 2005
Posts: 9,015
Default Questions to Steven George

Steven George presented at a few lectures at this year's AAOMPT conference. See here for some review of that material.

The purpose of this thread is to provide you the opportunity to ask questions you would like to see being asked in the upcoming interview. I'll add some links to his work for those unfamiliar with it.

For those that are familiar with his work, the mic is now open.

And thanks to Eric M. for the idea that is this thread.
__________________
"I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

Last edited by Jon Newman; 21-11-2008 at 10:27 PM.
Jon Newman is offline   Reply With Quote
Old 21-11-2008, 08:39 PM   #2
Jason Silvernail
Clinician and Researcher
 
Jason Silvernail's Avatar
 
Join Date: Dec 2005
Location: United States
Age: 43
Posts: 4,360
Default

Dr George-
You've been an investigator in studies looking at the neurophysiological effects of thrust manipulation. Many of us who are looking away from a biomechanical rationale and toward a neurophysiologic explanation for the effects of manual therapy draw on your literature for support.
1. What do you think the most plausible mechanism(s) are for the effects of manual therapy in general and thrust manipulation in particular? Specifically, do you feel the results point to a neurophysiologic and/or reflexive effect, rather than the traditional view of a biomechanical or positional effect?
2. What has your experience with the manual therapy community been like, given that it is still largely based on a strict biomechanical assessment and treatment construct?
3. Do you feel there is value in teaching manual therapy through the traditional methods of palpatory diagnosis and treatment?
__________________
Jason Silvernail DPT, DSc, FAAOMPT
Board-Certified in Orthopedic Physical Therapy
Fellowship-Trained in Orthopedic Manual Therapy

Certified Strength and Conditioning Specialist


The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
Jason Silvernail is offline   Reply With Quote
Old 21-11-2008, 11:21 PM   #3
Jon Newman
Enjoy a moment of whimsy
 
Jon Newman's Avatar
 
Join Date: Dec 2005
Posts: 9,015
Default

Great questions Jason. I should note that not every question that gets asked here will be addressed but it gives us a flavor for what people want to know about. Feel free to chime in with "what he said" type posts.

I promised a link to Steven George's work. There's not just a couple of things to post so let's see if this works

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22George%20SZ%22[Author]&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPan el.Pubmed_RVAbstractPlus

If not, I encourage you to mosey on over to PubMed and do a search on your own.
__________________
"I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

Last edited by Jon Newman; 21-11-2008 at 11:24 PM.
Jon Newman is offline   Reply With Quote
Old 21-11-2008, 11:57 PM   #4
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Can anyone get George's reply to Flynn's editorial here. I might have a question on this, among others coming up.
__________________
Luke Rickards
Osteopath
Luke Rickards is offline   Reply With Quote
Old 22-11-2008, 12:30 AM   #5
BB
Null-A
 
BB's Avatar
 
Join Date: Mar 2004
Location: Vancouver, WA
Posts: 3,815
Default

Here it is.
BB is offline   Reply With Quote
Old 22-11-2008, 12:48 AM   #6
EricM
Null-A
 
Join Date: Mar 2005
Location: Nanaimo, BC
Age: 43
Posts: 1,809
Default

Some general questions from my random question generator:
  • I’d like to know what sparked his interest in studying the neurophysiological effects of manual therapy? Was there an 'aha' moment for him?
  • Are there any significant persons who have influenced his thinking and work?
  • Has his study of neurophysiology led him to change the way he practices in any way?
  • Is he satisfied with the level of pain neurophysiology currently being taught in entry level degree programs? If not, what more needs to be done?
  • Crystal ball time. How does he envision physiotherapy for the treatment of pain 50 years from now?
__________________
Eric Matheson, PT
EricM is offline   Reply With Quote
Old 22-11-2008, 12:50 AM   #7
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Quote:
1. What do you think the most plausible mechanism(s) are for the effects of manual therapy in general and thrust manipulation in particular? Specifically, do you feel the results point to a neurophysiologic and/or reflexive effect, rather than the traditional view of a biomechanical or positional effect?
Jason,

George seems to have given his answer to this question pretty clearly in his publications. Perhaps we could take it one step further and discuss exactly which neurophysiological mechanisms he would put his money on - non-specific, descending inhibitory, autonomic, peripheral/neurodynamic - and why.
__________________
Luke Rickards
Osteopath

Last edited by Luke Rickards; 22-11-2008 at 01:11 AM.
Luke Rickards is offline   Reply With Quote
Old 22-11-2008, 02:03 PM   #8
Jason Silvernail
Clinician and Researcher
 
Jason Silvernail's Avatar
 
Join Date: Dec 2005
Location: United States
Age: 43
Posts: 4,360
Default

Luke-
Thanks and I'm aware of that - but I'm sure most people aren't and felt that would give him a good opportunity to talk freely about the concept in general. Though perhaps I wasn't giving our SomaSimple crew enough credit. In any case, I like your question better.
Also I felt his response to my original question would be something I could point to in future discussions or blog posts, which makes me look like a shallow opportunist, but there you have it.
__________________
Jason Silvernail DPT, DSc, FAAOMPT
Board-Certified in Orthopedic Physical Therapy
Fellowship-Trained in Orthopedic Manual Therapy

Certified Strength and Conditioning Specialist


The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
Jason Silvernail is offline   Reply With Quote
Old 22-11-2008, 02:20 PM   #9
Jon Newman
Enjoy a moment of whimsy
 
Jon Newman's Avatar
 
Join Date: Dec 2005
Posts: 9,015
Default

Hey, a lot of people make their living on shallow opportunism so don't knock it.

This whole thread is about throwing questions out there. Steven George will check out this thread as well as Cory (who will be conducting the final interview) and the curiosity expressed here, in whatever form it is expressed, will help form the basis of the interview. Some of the questions may be taken verbatim, some won't be addressed at all but all of them will help focus the interview. Since we're doing this for readers here and not for the purposes of a private conversation over beer we desire your input in whatever form it comes.

I think it is clear that mechanisms will need to be addressed.

I'll add my question--Based on the proposed mechanisms (whatever they are, and I'm assuming there is more than one); is thrust manipulation a necessary condition for improvement of the pains it is typically employed to reduce? I realize that while something isn't necessary it does not exclude the possibility that it is the best. I just want to explore first principles.

Brainstorm on.

Also, I think the little conversation such that is occurring with Luke and Jason is also helpful. It can help tease out devilish details that deserve attention.

Keep it up.
__________________
"I did a small amount of web-based research, and what I found is disturbing"--Bob Morris
Jon Newman is offline   Reply With Quote
Old 22-11-2008, 02:54 PM   #10
Barrett Dorko
Writer and Clinician
 
Barrett Dorko's Avatar
 
Join Date: Nov 2005
Location: Cuyahoga Falls, Ohio
Age: 65
Posts: 23,531
Default

Jon,

Your evocation of "first principles" immediately brought to my mind a line from The Silence of the Lambs. Okay, I admit I have a rather strange mind, but who doesn't?

Seated in his cage, Hannibal Lecter tells the FBI agent in search of a serial killer to attend to "first principles" and references this to a Roman philosopher whose name kind of escapes me but I think it's probably Heraclitus. He says, "Attend to first principles Clarise... Simplicity."
Later I realized that he was giving her a clue in the form of the name of a popular sewing machine, but I digress.

My point is this: If Dr. George has demonstrated in some way that it is the neurologic effect we seek, wouldn't that simplify manual technique in an effort to achieve our goals? And simplify it in a massive way?
__________________
Barrett L. Dorko

Last edited by Barrett Dorko; 22-11-2008 at 04:56 PM.
Barrett Dorko is offline   Reply With Quote
Old 22-11-2008, 05:37 PM   #11
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Jason,

I didn't mean to suggest that it wouldn't be useful for the extended readership here for him to answer that question. I just thought that going into it a little deeper, while we have the opportunity, would implicitly answer your question as well as direct him to the more technical details we tend to discuss quite frequently here.
__________________
Luke Rickards
Osteopath
Luke Rickards is offline   Reply With Quote
Old 22-11-2008, 05:58 PM   #12
Diane
Human Primate Social Groomer and Neuroelastician
 
Diane's Avatar
 
Join Date: Mar 2004
Location: Weyburn Sask.
Posts: 25,392
Default

(Luke, perhaps you have no idea how EX-plicit things are going to have to get, in general.. for there to be any real.. let's say, "progress" in manual therapy constructs )
__________________
Diane
www.dermoneuromodulation.com
SensibleSolutionsPhysiotherapy
HumanAntiGravitySuit blog
Neurotonics PT Teamblog
Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
Canadian Physiotherapy Association Pain Science Division Facebook page
@PainPhysiosCan
WCPT PhysiotherapyPainNetwork on Facebook
@WCPTPTPN
Neuroscience and Pain Science for Manual PTs Facebook page

@dfjpt
SomaSimple on Facebook
@somasimple

"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

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
Diane is offline   Reply With Quote
Old 22-11-2008, 05:59 PM   #13
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

(Thanks for the reminder, Diane )
__________________
Luke Rickards
Osteopath
Luke Rickards is offline   Reply With Quote
Old 22-11-2008, 06:28 PM   #14
John W
"Mean Poopy-Pants" Club Founding Member
 
John W's Avatar
 
Join Date: Sep 2006
Location: Mandeville, LA
Age: 52
Posts: 7,493
Default

Here's a question that's been gnawing at me a bit for some time:

Way back in 1984, Clifford Woolf published an article which showed that C-afferent stimulation of muscle nociceptors resulted in an up to 3-fold prolonged flexor reflex response (20-30 minutes) compared to skin C-afferents via the sural nerve in rats (10 minutes).

Could this explain a mechanism underlying the benefits of manipulation for acute episodes of LBP where muscle C-fiber afferents are firing wildly?

Quote:
Title:
Muscle but not cutaneous C-afferent input produces prolonged increases in the excitability of the flexion reflex in the rat.
Author(s):
Wall PD; Woolf CJ
Source:
The Journal Of Physiology [J Physiol] 1984 Nov; Vol. 356, pp. 443-58.
Publication Type:
In Vitro; Journal Article; Research Support, Non-U.S. Gov't
Language:
English
Journal Information:
Country of Publication: ENGLAND NLM ID: 0266262 Publication Model: Print Cited Medium: Print ISSN: 0022-3751 (Print) NLM ISO Abbreviation: J. Physiol. (Lond.) Subsets: MEDLINE
MeSH Terms:
Joints/*innervation
Muscles/*innervation
Nerve Fibers/*physiology
Neurons, Afferent/*physiology
Reflex/*physiology
Skin/*innervation
Animals; Axons/physiology; Evoked Potentials; Motor Neurons/physiology; Rats; Rats, Inbred Strains; Sural Nerve/physiology; Time Factors
Abstract:
Stimulation of cutaneous afferent fibres in the sural nerve and muscle afferent fibres in the gastrocnemius-soleus nerve at a strength that excites C axons produces a delayed and long-lasting burst of activity in posterior biceps femoris/semitendinosus flexor motoneurones. Following a 20 s stimulation at 1 Hz to the sural nerve the flexor motoneurones continue to fire for 20 s while a similar stimulus to gastrocnemius-soleus nerve results in an after-discharge lasting three times longer. Using stimuli to the sural and gastrocnemius-soleus nerves as conditioning stimuli (20 s, 1 Hz) changes in the excitability of the flexor reflex were measured by recording the discharge evoked by a test sural nerve stimulus or by a standard pinch to the ipsilateral and contralateral toes. Prior to any conditioning stimulus the flexor reflex remained stable for prolonged periods. Conditioning stimuli at strengths that activated large myelinated afferent fibres only, or large and small myelinated afferent fibres, failed to produce more than a very transient alteration in the reflex excitability. Conditioning stimuli at C-fibre strength to the sural nerve produced a marked increase in the excitability of the reflex for 10 min. C-fibre strength gastrocnemius-soleus nerve conditioning stimuli resulted in a similar increase in excitability followed by a second phase of facilitation peaking at 20-30 min and lasting for up to 90 min. The afferent barrage initiated by cutting the sural and gastrocnemius-soleus nerves resulted in similar patterns of reflex excitability increases with the muscle nerve resulting in a more prolonged effect than the cutaneous nerve. The results show that a brief C-afferent fibre input into the spinal cord can produce a prolonged increase in the excitability of the flexion reflex and that muscle C-afferent fibres evoke longer-lasting changes than cutaneous C fibres. The differences in the time course of the post-conditioning effects may be related to the well-described differences in the sensory consequences of injury to skin versus deep tissue.

© 2008 EBSCO Industries, Inc. All rights reserved.
EBSCO Publishing Green Initiatives
__________________
John Ware, PT
Fellow of the American Academy of Orthopedic Manual Physical Therapists
"Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
“If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
be carried on to success.” -The Analects of Confucius, Book 13, Verse 3
John W is offline   Reply With Quote
Old 22-11-2008, 07:01 PM   #15
Jason Silvernail
Clinician and Researcher
 
Jason Silvernail's Avatar
 
Join Date: Dec 2005
Location: United States
Age: 43
Posts: 4,360
Default

Quote:
Originally Posted by Luke Rickards View Post
Jason,

I didn't mean to suggest that it wouldn't be useful for the extended readership here for him to answer that question. I just thought that going into it a little deeper, while we have the opportunity, would implicitly answer your question as well as direct him to the more technical details we tend to discuss quite frequently here.
Luke-
Totally agree, and of course you're right. Going deeper would be what we want Dr George to do, as it would necessitate covering what are, to us anyway, the more superficial issues I brought up.
__________________
Jason Silvernail DPT, DSc, FAAOMPT
Board-Certified in Orthopedic Physical Therapy
Fellowship-Trained in Orthopedic Manual Therapy

Certified Strength and Conditioning Specialist


The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
Jason Silvernail is offline   Reply With Quote
Old 22-11-2008, 07:10 PM   #16
Diane
Human Primate Social Groomer and Neuroelastician
 
Diane's Avatar
 
Join Date: Mar 2004
Location: Weyburn Sask.
Posts: 25,392
Default

Quote:
Going deeper would be what we want Dr George to do, as it would necessitate covering what are, to us anyway, the more superficial issues I brought up.
In stark contrast to "covering up"..
__________________
Diane
www.dermoneuromodulation.com
SensibleSolutionsPhysiotherapy
HumanAntiGravitySuit blog
Neurotonics PT Teamblog
Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
Canadian Physiotherapy Association Pain Science Division Facebook page
@PainPhysiosCan
WCPT PhysiotherapyPainNetwork on Facebook
@WCPTPTPN
Neuroscience and Pain Science for Manual PTs Facebook page

@dfjpt
SomaSimple on Facebook
@somasimple

"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

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
Diane is offline   Reply With Quote
Old 22-11-2008, 07:31 PM   #17
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

George's research seems to have a particular focus of manual therapy mechanisms and fear-avoidance. Perhaps it would interesting to ask whether the therapeutic aims of manual therapy and of challenging fear-avoidance behaviours are exclusive or if there is some crossover.
__________________
Luke Rickards
Osteopath
Luke Rickards is offline   Reply With Quote
Old 22-11-2008, 07:36 PM   #18
Jon Newman
Enjoy a moment of whimsy
 
Jon Newman's Avatar
 
Join Date: Dec 2005
Posts: 9,015
Default

Quote:
Perhaps it would interesting to ask whether the therapeutic aims of manual therapy and challenge fear-avoidance behaviours are exclusive or if there is some crossover.
It's been suggested (someplace on RE long ago) that perhaps one of the benefits of thrust manipulation is that it sends a strong disconfirmation that the spine is a delicate object in need of protection.

Is that the type of thing you're referring to Luke?
__________________
"I did a small amount of web-based research, and what I found is disturbing"--Bob Morris
Jon Newman is offline   Reply With Quote
Old 22-11-2008, 07:37 PM   #19
Nick
Null-A
 
Nick's Avatar
 
Join Date: Dec 2005
Location: Bedford, Nova Scotia
Posts: 718
Default

Is there significance to the end-range application of thrust manipulation or non-thrust mobilization considered important in some approaches?
__________________
Nick Matheson, PT
Strengthen Your Health
Nick is offline   Reply With Quote
Old 22-11-2008, 07:40 PM   #20
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Perhaps Jon. Although I would hope the reasoning would be a little more sophisticated than the suggestion given in the RE thread. I was thinking more in terms of modulatory mechanisms - maybe something to do with central modulation and descending inhibition.
__________________
Luke Rickards
Osteopath
Luke Rickards is offline   Reply With Quote
Old 22-11-2008, 07:46 PM   #21
Barrett Dorko
Writer and Clinician
 
Barrett Dorko's Avatar
 
Join Date: Nov 2005
Location: Cuyahoga Falls, Ohio
Age: 65
Posts: 23,531
Default

Jon,

I think I remember this and would imagine that every movement, passive or active, is a potential lesson and may create a deeply embedded pattern in the brain. I also imagine that context has a lot to do with the effectiveness of the embedding. I'm certain Norman Doidge would agree.

I also have the impression that for similar reasons "jiggling" a limb or torso passively though briefly after some deformation has been reduced is a good idea. I've been doing that for years, for whatever that's worth.
__________________
Barrett L. Dorko
Barrett Dorko is offline   Reply With Quote
Old 22-11-2008, 07:46 PM   #22
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Quote:
If Dr. George has demonstrated in some way that it is the neurologic effect we seek, wouldn't that simplify manual technique in an effort to achieve our goals? And simplify it in a massive way?
Barrett,

It looks like George would agree with that-
Quote:
...manual therapy studies ([S]to[/S]) support the clinical effectiveness of regional interdependence; however, the accuracy and specificity of manual therapy components have been questioned in prior studies. Given these concerns with manual therapy, its lack of precision may make it difficult to identify and treat specific impairments, whether at a primary or remote site.
Neurophysiological effects are associated with manual therapy and are not necessarily specific to the region of application.
__________________
Luke Rickards
Osteopath
Luke Rickards is offline   Reply With Quote
Old 22-11-2008, 07:48 PM   #23
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Quote:
I also have the impression that for similar reasons "jiggling" a limb or torso passively though briefly after some deformation has been reduced is a good idea.
Barrett,

Eyal Lederman has some interesting ideas on a plausible mechanism for this observation.
__________________
Luke Rickards
Osteopath
Luke Rickards is offline   Reply With Quote
Old 22-11-2008, 07:50 PM   #24
Barrett Dorko
Writer and Clinician
 
Barrett Dorko's Avatar
 
Join Date: Nov 2005
Location: Cuyahoga Falls, Ohio
Age: 65
Posts: 23,531
Default

Luke,

I recognize the name but can't recall what he wrote or where. Please don't tell anybody I said this.

Got any references?
__________________
Barrett L. Dorko
Barrett Dorko is offline   Reply With Quote
Old 22-11-2008, 07:54 PM   #25
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Hi Barrett,

He wrote "The myth of core stability" and we have discussed his main textbook here before (link to reviews).

I'll dig up what you are looking for on 'jiggling'.
__________________
Luke Rickards
Osteopath

Last edited by Luke Rickards; 22-11-2008 at 07:56 PM.
Luke Rickards is offline   Reply With Quote
Old 22-11-2008, 08:42 PM   #26
kongen
Senior Member
 
Join Date: Jul 2006
Location: Sweden
Age: 42
Posts: 564
Default

Quote:
Originally Posted by Luke Rickards View Post
I'll dig up what you are looking for on 'jiggling'.
Luke, are you referring to "harmonic technique", or is that something different..?

E Lederman 2000 Harmonic technique: supporting joint repair. OMT News 2000/3:4-6 (Belgium)

Harmonic Technique is a group of manual techniques whereby the practitioner induces continuous rhythmic movement in different areas of the patient's body. This tends to create pendular movements within the natural resonant frequency of the body. Different areas of the body have different patterns and frequencies of oscillation. Harmonic Technique have been developed and researched at the British School of Osteopathy and described extensively by Lederman (1999). The clinical rational for using such techniques has become more evident over the last three decades due to extensive studies that have demonstrated the importance of passive motion for joint repair. This article will examine this relationship between passive motion and its possible therapeutic value.
__________________
Anders.
"There is nothing so practical as a good theory." -Kurt Lewin
kongen is offline   Reply With Quote
Old 22-11-2008, 08:56 PM   #27
Barrett Dorko
Writer and Clinician
 
Barrett Dorko's Avatar
 
Join Date: Nov 2005
Location: Cuyahoga Falls, Ohio
Age: 65
Posts: 23,531
Default

Anders,

I think your reference is perfect for this. My personal experience with similar technique was during attendance at a workshop regarding The Trager Approach from Betty Fuller many years ago. She was Trager's #1 student.

Of course, they had no rational explanation for the effect of the movement. Now we do.
__________________
Barrett L. Dorko
Barrett Dorko is offline   Reply With Quote
Old 22-11-2008, 11:55 PM   #28
Jon Newman
Enjoy a moment of whimsy
 
Jon Newman's Avatar
 
Join Date: Dec 2005
Posts: 9,015
Default

I thought the experiential modifying effect of jiggling had to do with stimulating A-beta fibers. Is there more to it? Maybe someone has access to kongen's reference? Someone (Luke?) had suggested we do an interview with Lederman and I think it's a great idea. We'll have to look into that. If someone does have a digitial copy they can upload please carry this part of the conversation on in the new thread so as not to distract too much from the purposes of this thread.

Luke,

I've been thinking about the fear-avoidance behavior and manual therapy overlap. Fear-avoidance behaviors are usually said to flow from fear-avoidance beliefs. The neurological correlates of belief are just recently being investigated. At least I think that's right. If the research is indeed as young as I perceive it to be then it may not be possible to have more sophisticated reasoning at this time. We may be left to describe what we observe in terms of "disconfirmation" or "dissonance" or "consonance" or the like.

That said, George's presentation did demonstrate that negative expectation had a negating effect on pain inhibition (or more properly, temporal summation of thermal stimuli) following SMT. This was accomplished through the creation of a fear or threat. As Barrett pointed out, context matters and perhaps the overlap, if there is one, of thrust manipulation and fear-avoidance boils down to an act consonance with a patient's (new or pre-exisitng) belief. Of course this assumes that we have a belief in belief as per Dennett.

I'll make a slight reversal on my previous post about disconfirmation. It could be that disconfirmation of a fear avoidance belief could resolve as surprise or as dissonance. Good luck and be prepared for the dissonant.

I should ask if I have even understood your question. I may be addressing something that you did not ask. I've been known to do that.
__________________
"I did a small amount of web-based research, and what I found is disturbing"--Bob Morris
Jon Newman is offline   Reply With Quote
Old 23-11-2008, 02:29 AM   #29
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Quote:
That said, George's presentation did demonstrate that negative expectation had a negating effect on pain inhibition (or more properly, temporal summation of thermal stimuli) following SMT. This was accomplished through the creation of a fear or threat. As Barrett pointed out, context matters and perhaps the overlap, if there is one, of thrust manipulation and fear-avoidance boils down to an act consonance with a patient's (new or pre-exisitng) belief.
Jon,

I think these are exactly the kind of issues we should take the opportunity to ask George about.

There is also additional complexity here that could be considered. For example, when I met met Tamar Pincus at the Congress on Pain this year she talked about the difficulty in considering fear and avoidance as consistently interlinked, ie it is possible to be fearful but not avoidant, or avoidant but not fearful. It appears that a few of George's papers have also considered aspects of the model relating this differentiation.
__________________
Luke Rickards
Osteopath

Last edited by Luke Rickards; 23-11-2008 at 02:43 AM.
Luke Rickards is offline   Reply With Quote
Old 23-11-2008, 02:44 AM   #30
Jon Newman
Enjoy a moment of whimsy
 
Jon Newman's Avatar
 
Join Date: Dec 2005
Posts: 9,015
Default

Tamar Pincus is another good suggestion for an interview.

I expressed a similar research interest when I applied to grad school. Apparently I misaimed my applications (among other things.)
__________________
"I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

Last edited by Jon Newman; 23-11-2008 at 02:48 AM.
Jon Newman is offline   Reply With Quote
Old 23-11-2008, 04:42 AM   #31
John W
"Mean Poopy-Pants" Club Founding Member
 
John W's Avatar
 
Join Date: Sep 2006
Location: Mandeville, LA
Age: 52
Posts: 7,493
Default

Luke,
Were you and Pincus discussing the link between avoidance and fear within the context of persistent pain exclusively?

I've always thought that fear preceded the avoidance behavior, and comes down to a matter of degree and proportionality to the original injury. After an acute injury, such "fear" of movement is prudent, or adaptive, to allow tissue healing. When excessive and overly cautious immobility persists after healing has occured is when the risk of a persistent pain state increases, and then the behavior has become mal-adaptive or "fear-avoidant". In my rather simple brain, this makes sense because the anticipation of movement is associated with pain, so one avoids moving.

With a little education, a safe environment to move, some warm hands interacting with a trepidatious and disheveled nervous system, the therapist creates an environment capable of evoking corrective, necessary movement.
__________________
John Ware, PT
Fellow of the American Academy of Orthopedic Manual Physical Therapists
"Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
“If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
be carried on to success.” -The Analects of Confucius, Book 13, Verse 3
John W is offline   Reply With Quote
Old 23-11-2008, 05:10 PM   #32
Jon Newman
Enjoy a moment of whimsy
 
Jon Newman's Avatar
 
Join Date: Dec 2005
Posts: 9,015
Default

Possible question:

Much of what seems important in the resolution of pain requires an understanding of knowledge areas outside of biomechanics yet PTs seem to express a reluctance to formally embrace anything outside the realm of biomechanics or pathophysiology. As best as I can tell such reluctance stems from a concern that such knowledge is outside their scope of practice. Do think this a valid concern?
__________________
"I did a small amount of web-based research, and what I found is disturbing"--Bob Morris
Jon Newman is offline   Reply With Quote
Old 23-11-2008, 11:09 PM   #33
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Hi John,

Yes, persistent LBP in fact.

Quote:
When excessive and overly cautious immobility persists after healing has occured is when the risk of a persistent pain state increases, and then the behavior has become mal-adaptive or "fear-avoidant". In my rather simple brain, this makes sense because the anticipation of movement is associated with pain, so one avoids moving.
Your explanation is consistent with the fear-avoidance model. The argument Pincus was making was that avoidance itself isn't necessarily always the product of negative affect (fear/anxiety). People may simply avoid movements beyond a certain intensity of pain, or due to some cognitive construct.
__________________
Luke Rickards
Osteopath
Luke Rickards is offline   Reply With Quote
Old 23-11-2008, 11:13 PM   #34
Jason Silvernail
Clinician and Researcher
 
Jason Silvernail's Avatar
 
Join Date: Dec 2005
Location: United States
Age: 43
Posts: 4,360
Default

Quote:
Originally Posted by Jon Newman View Post
Possible question:

Much of what seems important in the resolution of pain requires an understanding of knowledge areas outside of biomechanics yet PTs seem to express a reluctance to formally embrace anything outside the realm of biomechanics or pathophysiology. As best as I can tell such reluctance stems from a concern that such knowledge is outside their scope of practice. Do think this a valid concern?
Jon-
Great question. Would love to hear his response!
__________________
Jason Silvernail DPT, DSc, FAAOMPT
Board-Certified in Orthopedic Physical Therapy
Fellowship-Trained in Orthopedic Manual Therapy

Certified Strength and Conditioning Specialist


The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
Jason Silvernail is offline   Reply With Quote
Old 24-11-2008, 12:11 AM   #35
Jon Newman
Enjoy a moment of whimsy
 
Jon Newman's Avatar
 
Join Date: Dec 2005
Posts: 9,015
Default

Quote:
Do think this a valid concern?--me
I myself do not.
__________________
"I did a small amount of web-based research, and what I found is disturbing"--Bob Morris
Jon Newman is offline   Reply With Quote
Old 24-11-2008, 01:14 AM   #36
Jon Newman
Enjoy a moment of whimsy
 
Jon Newman's Avatar
 
Join Date: Dec 2005
Posts: 9,015
Default

Maybe rather than fear-avoidance the proper framework should be approach-avoidance. For instance check out the work of this group.

Pain, presumably, would be negative feedback for most folks.
__________________
"I did a small amount of web-based research, and what I found is disturbing"--Bob Morris
Jon Newman is offline   Reply With Quote
Old 24-11-2008, 01:25 AM   #37
John W
"Mean Poopy-Pants" Club Founding Member
 
John W's Avatar
 
Join Date: Sep 2006
Location: Mandeville, LA
Age: 52
Posts: 7,493
Default

Quote:
People may simply avoid movements beyond a certain intensity of pain,
Wouldn't fear/anxiety provide the motivation for this? What else would?

Quote:
...or due to some cognitive construct.
I'm assuming you mean an erroneous or ill-formed cognition, which again would have fear (due to an inaccurate idea) as the underlying source.

But, then, if the individual benefits in some way from this avoidance state, i.e. worker's compensation, attention from family and/or health care providers, then their ignorance can become a state of bliss, can't it? But only for a short while until they've immobilized themselves into a real mess of a persistent pain state.
__________________
John Ware, PT
Fellow of the American Academy of Orthopedic Manual Physical Therapists
"Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
“If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

Last edited by John W; 24-11-2008 at 01:28 AM.
John W is offline   Reply With Quote
Old 24-11-2008, 03:24 AM   #38
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Quote:
Wouldn't fear/anxiety provide the motivation for this? What else would?
A motivation, certainly. I'd like to know more about why you think it is the only possible one.
__________________
Luke Rickards
Osteopath
Luke Rickards is offline   Reply With Quote
Old 24-11-2008, 04:47 AM   #39
John W
"Mean Poopy-Pants" Club Founding Member
 
John W's Avatar
 
Join Date: Sep 2006
Location: Mandeville, LA
Age: 52
Posts: 7,493
Default

Quote:
I'd like to know more about why you think it is the only possible one.
If we're talking about acute LBP, for instance, and someone avoids moving beyond a certain intensity of pain because they trust that their pain output is an accurate representation of tissue damage, and to move beyond that point would worsen the tissue damage, then they are acting out of appropriate levels of caution. But, this is still a degree of fear. It's an adaptive, appropriate level of fear, but fear nonetheless. Fear is not necessarily mal-adaptive.

There are less pejorative words than fearful, such as cautious and careful, that are merely degrees of fear. I wonder if Dr. George could help us make a distinction on a physiological level the difference between mal-adaptive fear-avoidance and appropriate caution following an acute injury. Maybe also we should consider using the term that Jon proposes, "approach-avoidance," which is more specific to the problem, and makes fewer assumptions about the level of "fear" the patient is exhibiting.
__________________
John Ware, PT
Fellow of the American Academy of Orthopedic Manual Physical Therapists
"Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
“If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
be carried on to success.” -The Analects of Confucius, Book 13, Verse 3
John W is offline   Reply With Quote
Old 24-11-2008, 02:43 PM   #40
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Hi John,

Quote:
someone avoids moving beyond a certain intensity of pain because they trust that their pain output is an accurate representation of tissue damage, and to move beyond that point would worsen the tissue damage
In my experience, limited movement behaviours are more commonly associated with concerns about the reason for the pain ie the unknown, rather than a self-diagnosis as specific as tissue damage.

Here is a review that I'm sure will interest you. Following this quote from the discussion are a few paragraphs discussing the alternatives.

Pincus et al. 2006-
Quote:
While we agree that many patients reduce their levels of daily activities, including work, and that this reduction in activity is an important factor in recovery and therefore warrants further investigation, the findings from the present review and from other work (53) suggest that there may be other pathways to reduced activity.
__________________
Luke Rickards
Osteopath

Last edited by Luke Rickards; 24-11-2008 at 02:50 PM.
Luke Rickards is offline   Reply With Quote
Old 24-11-2008, 05:15 PM   #41
John W
"Mean Poopy-Pants" Club Founding Member
 
John W's Avatar
 
Join Date: Sep 2006
Location: Mandeville, LA
Age: 52
Posts: 7,493
Default

Luke,
Thanks for providing Pincus' review.

After reading it, though, I'm not sure that the average clinician makes a distinction between depression/distress and fear. It seems that the distinction is a temporal one- that eventually a specific fear could lead to a more general sense of distress/impending doom and depression. However, this is likely an important distinction to make in designing a treatment program, and screening for depression prior to initiating treatment may help in that regard.

With respect to the the authors' second proposed model of social-beliefs approach, I can see where this type of avoidance can get really complicated. We've all had that patient who was being coddled by a spouse or parent, and therefore had little incentive to get moving. I made reference to this within the worker's comp. setting where the system can be coddling in a sense, which along with providing diagnostic imaging and labels that tend to exacerbate fear and the fear of returning to a specific job (which the Pincus review suggested may be qualitatively distinct from general fear-avoidance), results in poorer outcomes.

Perhaps a term to describe this latter group could be "victim-avoidance." This term more accurately reflects a response to an external locus where perpetrator(s) against that patient's best interests foster the avoidance behavior.

I don't see any reason why victim- and fear-avoidant conditions couldn't co-exist. In fact, they would probably be very happy together.
__________________
John Ware, PT
Fellow of the American Academy of Orthopedic Manual Physical Therapists
"Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
“If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
be carried on to success.” -The Analects of Confucius, Book 13, Verse 3
John W is offline   Reply With Quote
Old 24-11-2008, 06:19 PM   #42
Luke Rickards
Null-A
 
Luke Rickards's Avatar
 
Join Date: Oct 2004
Location: Adelaide
Age: 42
Posts: 2,540
Default

Cory,

Has there been sufficient input here so far in order for you to get started?
__________________
Luke Rickards
Osteopath
Luke Rickards is offline   Reply With Quote
Old 24-11-2008, 06:29 PM   #43
BB
Null-A
 
BB's Avatar
 
Join Date: Mar 2004
Location: Vancouver, WA
Posts: 3,815
Default

Yes. Great stuff so far. I intend to try to incorporate as much of this into the interview as I can.
BB is offline   Reply With Quote
Old 22-01-2013, 09:33 PM   #44
Diane
Human Primate Social Groomer and Neuroelastician
 
Diane's Avatar
 
Join Date: Mar 2004
Location: Weyburn Sask.
Posts: 25,392
Default

This is an old thread (RIP Jon Newman..) but it's about Steven George, so I wanted to attach this recent interview with him, here. He is now the recipient of a pain science award, from IASP.
Good for him!

I like that recovered biomechanists are receiving awards for pain science. It's a glimpse of hope!
__________________
Diane
www.dermoneuromodulation.com
SensibleSolutionsPhysiotherapy
HumanAntiGravitySuit blog
Neurotonics PT Teamblog
Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
Canadian Physiotherapy Association Pain Science Division Facebook page
@PainPhysiosCan
WCPT PhysiotherapyPainNetwork on Facebook
@WCPTPTPN
Neuroscience and Pain Science for Manual PTs Facebook page

@dfjpt
SomaSimple on Facebook
@somasimple

"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

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
Diane is offline   Reply With Quote
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Forum Jump

Similar Threads
Thread Thread Starter Forum Replies Last Post
Five Questions Barrett Dorko Barrett's Forums 170 08-08-2010 06:50 AM
Cross Country 77 - George and Me Barrett Dorko The News from Cuyahoga Falls 6 28-05-2007 11:58 AM
Questions to Michael Barrett Dorko CHOICES: Perspectives on the Future of PT 29 18-08-2006 12:17 AM


All times are GMT +2. The time now is 10:49 AM.


Powered by vBulletin® Version 3.8.11
Copyright ©2000 - 2017, vBulletin Solutions Inc.
SomaSimple 2004 - 2017