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Old 08-12-2012, 03:19 PM   #1
John W
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Default Game-Changer

Having arrived here at SomaSimple after struggling the better part of my career to read- let alone understand- all the small type in those neat little boxes of the Treatment-Based Classification System and then later the seemingly endless and overlapping lists of alignment faults in the Movement Impairment System, I was confused and exhausted.

At some point during that time I had read one of Barrett's essays about him and his dog Buckeye: the two of them walking and one of them responding behaviorally to his instinct- that would be Buckeye.

It occurred to me, What if the movement from pain is instinctual? Uh, oh- that might actually make some sense: limping, lateral shifts, “stiffness”. All of those neat and tidy algorithms and mal-alignment/movement clusters would be just big, fancy imaginative boondoggles. All the books, articles, RCTs examining these topics would be no more real than fairy dust, not to mention the fairy that sprinkles all that dust around.

Not only that, it would be a huge game-changer.

What was your game-changer?
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Old 08-12-2012, 03:35 PM   #2
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I can think of three sets of events that marked phases of change for me. Definite game changers, all.

1) Defense vs. Defect
2) These 2 papers from Quintner. (One and two is his article on pain models which I can't find at the moment.)
3) Nortin Hadler's amazing book on medicalization: The Last Well Person
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Old 08-12-2012, 03:39 PM   #3
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Mine was sitting in Butler's workshop and hearing about nerves, for what seemed like the first time in my life, and realizing what sensory capacity really meant, what the hideous yet completely liberating implications of that implied. Hideous in that world views (mine) had to change. Completely liberating in that world views (in general) had to change.
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Old 08-12-2012, 03:53 PM   #4
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Found the other Quintner article.

The game changer in it was the idea of the aporia of pain.

Also, here is one of my all time favorite threads where we discussed some implications of pain as an aporia and monism/dualism.

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Old 08-12-2012, 04:15 PM   #5
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For me, since I graduated in 2007 I always viewed PT, especially manual care, with a lot of skepticism. I read David Morris The Culture of Pain in 2008. That is when I learned that there was a whole lot more out there than just posture and movement.

It was not until I took a per diem job 1.5 years ago, that I got pushed out of my comfort zone (i.e. working in really horrible PT clinics) and needed another community. SS found me. It took until I met Diane at her DNM workshop did I finally reconcile the fact it was "okay" for me to be a manual therapist.

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Old 08-12-2012, 05:07 PM   #6
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1. Diane's insistence that nerves are behind -and only the beginning of- every perception.
2. Moseley's talk on pain perception. He is such a great presenter and this talk really super-charged my fascination with the neuroscience of pain.
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Old 08-12-2012, 05:22 PM   #7
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Quote:
Originally Posted by Milehigh View Post
For me, since I graduated in 2007 I always viewed PT, especially manual care, with a lot of skepticism. I read David Morris The Culture of Pain in 2008. That is when I learned that there was a whole lot more out there than just posture and movement.

It was not until I took a per diem job 1.5 years ago, that I got pushed out of my comfort zone (i.e. working in really horrible PT clinics) and needed another community. SS found me. It took until I met Diane at her DNM workshop did I finally reconcile the fact it was "okay" for me to be a manual therapist.

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[How great it is, that a new generation of HPSGs are developing themselves with their heads on straight, right from the start. ]
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Old 08-12-2012, 05:40 PM   #8
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Mostly on straight, while in PT school Sahrmann did help me abandon most of the OMPT. However, by the time I was done, and into my first year, I was kicking her to the curb as well. Even though it took me until I found SS, to really refine my language--which admittedly was a little sloppy with meso memes.

Now that those are gone, things are soooo much easier and sometimes harder

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Old 08-12-2012, 06:55 PM   #9
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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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Old 08-12-2012, 08:15 PM   #10
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Yea, Cory, that "aporia" paper gave me a huge headache.

However, "game-changers", in my view anyway, are often very subtle shifts in the emotional tide- some little nugget that lodges itself in the subconscious- that creates a definitive shift in thinking. Often, unlike an "ah ha" moment, you don't realize how important it was until much later.

This is why Barrett's writing is so important for our profession. We used to have Jules Rothstein to provide this unique kind of insight, but as far as I can tell, Barrett's writing's all we've got to MOVE people.

To change the game.


John Ware, PT, FAAOMPT

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Old 08-12-2012, 08:25 PM   #11
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Quote:
Originally Posted by BB View Post
1) Defense vs. Defect
+1

This changed EVERYTHING.

Respectfully,
Keith

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Old 08-12-2012, 08:35 PM   #12
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Quote:
Defense vs defect
This was very significant for me later in the game-change, but it all started in a flash with Butler in 1998.

His words just made so much sense in what I saw was a very boring world of muscle and joint therapy. The final musculoskeletal firng squad came with Barrett D in 2005.
Like Eric, I was dissatisfied with traditional muscle/joint therapy and was looking for change.

That makes all the difference - some PTs are quite happy with routine cookbook recipes.

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Old 08-12-2012, 11:05 PM   #13
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Barrett's relentless messages and Mel Siff's postings on PTHER (e-mail based discussion forum) - followed by a Butler course.
Barrett softened me up for Butler's teachings to make sense.
Then Diane.
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Old 09-12-2012, 01:45 AM   #14
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Like Eric, I need to give credit where it is due, and Shirley Sahrmann does deserve some credit for opening me up to a more hands-off less ostensibly operator-dominated mode of treatment.

It's one thing to think you can alter someone's mesoderm by having them do some precise and finely tuned movement, it's a whole other category to the nth degree of operator mentality to think that you can alter someone's mesoderm with your hands.

*********************************************************************

My son hit a bloop single into shallow right field this evening scoring the tying run. This came after I resigned as statistician because the head coach decided to bury him in the bottom of the line-up despite the fact that he's got the 2nd highest on-base percentage on the team at just under .500, which means that each time he comes up to bat, there's a 50% chance that he's going to get at least to 1st base, whether by getting a hit, a base on balls or getting hit by a pitch (he's 2nd on the team in that category as well, unfortunately.)

But he's not a big, strong kid and he doesn't hit with a lot of power like some of the other kids. He's a solid athlete but not flashy and doesn't like to draw attention to himself (don't know where he got that ). He kind of just blends in, does his job, hustles, gets too mad at himself when he makes a mistake (definitely know where he got that) and consistently contributes positively to the team. And for that he bats in the 9-hole (that's the very bottom of the batting order for you non-North Americans). This not only injures my son's confidence, but it also hurts the team. You want your players who get on base to get the most chances at the plate. Common sense, right?

Barrett Dorko consistently makes "base hits" (and not a rare "home run") with his writing at this site; yet, not nearly enough PTs take the opportunity to avail themselves of this tremendous resource. This rare talent is far too under-appreciated for its po"wer to change the game".

Scotty, a specimen of an athlete at 5'10" tall and 150lbs of pure muscle and also our ace pitcher, hit a batter who stole 2nd base and then gave up a 2-strike hit allowing the run to score from 2nd. Game over, we lose. Conner had a total of 3 at-bats in 2 games. He went 1 for 2 with a base on balls. He nearly legged out an infield hit to go 2 for 2 (his dad thinks he was safe, of course.

It's not always the stars who make the difference. It's not always the "stars" who are the stars.
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Old 09-12-2012, 03:37 AM   #15
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My game changer moment was really a series of moments that began with my leaving the 'nursery' that was my first place of employment following graduation. The clinic was/is very much aligned with diane lee's integrated model of joint function (form closure, force closure, motor control, psychology/emotions), although to their credit they did add a 5th component to the model- that being the client-therapist relationship. My boss used to say "If you cant connect with the patient you are screwed".

In that setting we all worked to a system of assessing form closure and force closure, using palpatory skills to determine if restrictions were local or global, or if there existed any segmental hypermobility and then treating with specific mobilization or stabilization interventions. I was immersed in it and althought I knew I couldnt feel specific hypermobility/hypomobility, i was certain that it was my skills that needed developing rather than the treatment model.

When I left this clinic and started in nyc, i was initially (quietly) skeptical, even cynical of my new workplace as the PTs there, who for the most part used trigger point therapy. That was/is the model that the owners filter down to new grads and other employees alike. I would think to myself "How the hell are you going to get anyone better if you dont get in their with your hands and determine what's moving and what's not moving? Squashing trigger points won't do anything to free up a locked facet joint!"

But to my surprise, I saw all these patients responding beautifully to trigger point therapy. That made it painfully obvious that there was something missing in both my former and current workplaces. The good results for each clinic create confirmation bias for those sheltered within it... but I couldnt help thinking that the good results in each clinic proved that the other clinic's model could not be right. Neither clinic's model could explain the good results in the other clinic. So I started hunting for better explanation and thankfully discovered SS, and the concept of defense vs defect.
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Old 09-12-2012, 06:52 AM   #16
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I am glad that I get to follow Patrick's post because he is the one that got me here. His facebook comment following a post regarding pain seriously confused the hell out of me. My first thoughts to his post were, "I know 100 different ways to mobilize the joints, soft tissues, ligaments, muscles, fascia, skin, and its interconnections...and this guy is telling me that it doesn't matter... what the hell, this guy either doesn't know anything at all or he knows something that I don't."

my ability to listen to him stems from something that happened my first year out of PT school in 2002...

It was my very first position as a staff therapist. There were three PTs working "together". My supervisor was McKenzie trained and our other PT was Maitland trained. There was constant disagreement about treatments regarding which method was better and which improved each specific patient. Fraud was even committed by documenting in the patient's chart that one method worked and other didn't made the patient worse, when in actuality the opposite was true. Then there was me, a moldable sponge taking in every bit of knowledge that was thrown at me. I didn't understand what the issue was so I took both McKenzie courses and Maitland courses. I learned that they were both right and both methods helped patients. But not all patients improved. So I kept searching for more answers. I knew that there was something more out there.

Every time I found a new method of treatment, I thought that I found the answer, but each was incomplete. This really stung my heart because I always felt that there was something more out there that I needed to learn because not all patients improved.

So today, its been about 2 or 3 months since I've been on SS. One huge thing that I learned is that the answer that I have been looking for will always be incomplete and I can be satisfied with that as long as I keep studying because I am slowly learning that pain is such a complicated, multidimensional, multi-organ/system process that we don't have all the answers yet.

Thanks again Patrick...

Rex
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Old 09-12-2012, 09:18 AM   #17
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I am a massage therapist by license, not a PT. My training started as you might imagine... how to give a good massage. But mixed in with that in the classes was the concept that you were doing something to the muscles. Softening them, releasing them. Oooh I thought as I soaked it up, I can do something to people to fix their muscles, the cause of their pain. I got decent results but not everyone improved.
I took more courses. Trigger point classes. Here I learned how to find those tender spots and release them. Aaah now I can find these points and fix them. I got decent results but not everyone improved.
Cranio sacral was next.... OOOhh bad head alignment and crappy pulse rhythms. I can fix this now, the cause of people's pain.
Rolfing... Fascia and alignment.
Posture Therapy... alignment
Erik Dalton... Firing patterns and fascia and alignement
ART.... muscles, stuck nerves, fasica
MAT.... inhibited muscles are allowing hyperfacilitation and therefore poor movement patterns.

I got decent results but not everyone improved. But through it all I kept thinking, every one of these modalities seems to presume that the body is terminally stupid and can't figure anything out without my well-paid-for hands and techniques. Not only that but it dawned on me that IF I actually could do that to someone's musculature I BETTER DAMN WELL NOT F%*$ IT UP!!!! What if I went too far with releasing someone's hamstring? What if I went past the point of proper ROM? What if I told someone to do a posture exercise 10 times too many, then they would start aligning the opposite way!!!!!! SOmething was always missing and it drove me nuts everytime I bumped up against that wall.

I even studied a guy named Stephen Kaufman. Pain Neutralization Techniques. He teaches DNM essentially but it is ALL mesoderm based. BEST results yet. Problem was again that his model fell apart with any scrutiny.

So I was stuck in the rut of paying for new techniques, helping a few people and then failing...again. Enter Diane Jacobs and the nervous system. BAAAAAAAAAAAMMMM. EVERYTHING CHANGED. Finally, a way of perceiving and interacting with a living system. WIth defense not defect. EVERYTHING CHANGED. I, as a person, have changed. I literally see life with new eyes as I witness not only bodies differently, I watch behavior with new eyes.

Alison Armstrong asks one simple question of those interested in her relationship work: What if no one is misbehaving!? Total game changer.

Nathan
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Old 09-12-2012, 03:28 PM   #18
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There have been many game changers in the past 10 years of my career. I had the pleasure of working with proud for the first 2 years of my career who forced me to think outside the box. I then began with reading at RehabEdge daily and then SS. This prepared me for a few game changers in my career. The saying 'When the student is ready, the teacher will appear' rings true.

One game changer that comes to mind was a patient with PFPS. He was a very knowledgable, pleasant fellow who had lots of questions about our treatment. One day as I was mobilizing his patella he asked me exactly what I was doing. I explained to him that I was mobilizing the lateral retinaculum since it was 'tight' and causing lateral tracking and tilt which was the cause of his knee pain. This was my standard explanation at that time even though in my mind I was struggling with this explanation based on my reading up to that point. Most patients just nod with approval thiking how smart I am to know this. Not this guy. He questioned my ability to stretch that tissue with my hands for such a short period. He was right and I was stumped. It's just he and I in a private room and I have to scramble for an explanation. I had a basic explanation based on pain science in my head but couldn't verbalize my thoughts since I was still stuck in the habit of using my old mesodermal explanations. I felt like I was fooling both him and myself. What a horrible feeling.

After that experience I vowed I would not allow myself to continue to promote these types of false explanatory models for people's pain.

The other was during a thoracic spine course. We were learing rib mobs and the instructor was teaching a Mulligan technique which involved a cranial glide of the lateral rib cage as the patient rotates. As we all perfomed the glide you could see everyone in the room sliding their partners skin approximately 2-3 inches cranially. I brought this to the attention of the instructor and a few others on the course. No one seems to know or care that it was the skin not the rib moving. I did.

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Old 09-12-2012, 11:46 PM   #19
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here as the softening up process, I knew I had found something but didn't understand the language and then NOI 2010

on came the lights,

ANdy
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Old 10-12-2012, 01:17 AM   #20
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Quote:
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After that experience I vowed I would not allow myself to continue to promote these types of false explanatory models for people's pain.
I share many of these experiences as well. I spent the first 7 years of my career chasing the magical hands of manual therapy that would allow me to be able to sense the subtle joint dysfunctions that, once detected, would relieve the patients pain. More courses equaled more frustration to the point I felt like an absolute failure and was in the process of applying to DO school at Michigan State (likely to be further disappointed by more biomechanical/mesodermal theory).

It always amazed me how passionate people would defend their models and theoretical constructs (like religion). I began to wonder what was in common with all of these methods who proposed such different models. I had seen them all get successes and failures. If you were a McKenzie PT it was all about the disc. If you were trained in MET it was all about the pelvis/SI, FRS, ERS...etc. If you were a Paris trained PT it was all about the facet. If you were Kaltenborn trained it was all straight plane strict biomechanical techniques that professed to be segmentally specific. At this time I began to come across David Butlers work and read his Sensitive Nervous System and then Explain Pain. It turned on a light bulb that regardless of what the theory of each system was, the nervous system was the common denominator. These systems had their contributions to our profession by giving us different options of how to move the mesoderm to elicit the desired ectodermal effect. Hopefully their theories and constructs will progress as our understanding of neuroscience progresses.

Around this time I worked one year in a chronic pain program which turned out to be a bunch of doctors whose motivation was how many needles could go into a spine or procedures could be performed for maximal reimbursement purposes. I saw patients with every procedure under the sun done to them who had become unrecognizable to their family due to the effects of the narcotics the doctors were prescribing them. PT and pain psychology was at best an afterthought. The PTs there were continuing with biomechanical treatments that did little to address the real problem yet occasionally would create a context to elicit a significant placebo response. Of course they attributed this to their biomechanical treatment. I felt like I was part of the problem and not the solution so I lasted less than a year there.

My time with EIM was the best thing for my career. First they did not ascribe to any theory or construct. They taught me to critically appraise research and not just go by the authors conclusions. They introduced me to more pain sciences and was taught the mechanisms of manual therapy by Steve George. I began reading more works of Melzack, Wall, Gifford, Shacklock, among others.

EIM also gave me the Maitland reasoning approach which, as I have stated in other posts, is a great reasoning system that de-emphasizes pathoanatomy and biomechanical theory. It is all about the patient and their signs and symptoms. We are taught to separate theory/research from the signs and symptoms that the patient demonstrates. I was taught to be a better clinical thinker and to evaluate my thinking and recognize the heuristical errors that are prevalent in clinical reasoning. Theory needed to fit the signs and symptoms that the patient demonstrated and neuroscience made a lot of the signs and symptoms I saw in treatment make much more sense then the earlier constructs I had to convince myself to believe.

I had found this forum earlier in my career, but was still in the process of trying to salvage the biomechanical constructs at the time and I was not ready. As I have been reading over the posts from the past years it seems like the discussions are answering the very questions I have had throughout my career as I have learned more about the neuroscience of what we do. I am thankful for the minds that are on here and feel lucky to be able to learn from them.

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Old 10-12-2012, 01:24 AM   #21
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Wow, great post Mark.
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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

"Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire
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Old 10-12-2012, 02:27 AM   #22
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They introduced me to more pain sciences and was taught the mechanisms of manual therapy by Steve George. I began reading more works of Melzack, Wall, Gifford, Shacklock, among others.
I sat in a roomful of Physical therapists yesterday, listening to Steven George. (perhaps there were some physical rehab technicians in the mix. I don't know.)

There were people of all ages, hence, I think it is fair to say, of different levels clinical experience. He really seemed pleased with people's questions. He said he really enjoys working with clinicians because the interaction really helps him in his research. George's evidence is quite compelling. Game changing compelling.

I know Frédéric probably told them about this place.

To better understand how you can about changing that game.

My game started changing via this Google search : What does Diane Jacobs think of trigger points?

(Good to see you are back Barrett.)
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Old 10-12-2012, 02:50 AM   #23
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I am not a PT or involved in the health care field in anyway. But I love this place so I have to contribute something. About 3 years ago I read The Brain That Changes Itself. I can't say how I found it, don't know, but I loved it. I think it marks a subtle shift in my thinking about anything body related. How to explain these changes people are making in the unchangeable realm of the brain? It tipped the scales in what I would read and research going forward.

I was preparing to teach a class workshop on the science of stretching and came across Paul Ingraham's article "Quite a stretch" and that destroyed just about every reason I was going to present in favour of stretching. I had to give the workshop anyway trying to fit this new information in and at one point a student asked "so what is the point of stretching?" I really had a lame answer at that point that rang hollow so I had to question everything I was saying all over. Paul said something about BIM on his site and there was Jason Silvernail's article on jointheads fasciaheads etc etc. That was hit, I had to follow that writer here. What a lucky break!
(And it was really good to see Barrett up there again)
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Old 10-12-2012, 03:02 AM   #24
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My game changer was very clear for me. I read a book about 20 years ago which had the scholastically imposing title "Kick Cold, Kick High, Kick Butt". It was written at a high school level but in it the author clearly explained that flexibility was almost completely a matter of the nerves and sensory processing. That what felt like "tight muscles" was in fact the brains response to a threat. As a demonstration of this he recommended something like a slump test, and then added the cervical flexion. He then asked, what muscle connects your neck and your hamstrings? The answer of course is none, and since none of the other joint angles moved and there was an increased feeling of "tightness" then obviously the joint angles weren't what was important nor was it a matter of the length of the muscle.

This opened my eyes to the whole idea of the neurological involvement in movement and sensation and thus performance. I wasn't interested in pain, and it still isn't all that interesting to me but that is what led me here. Actually I think it was an argument with Barrett on the Supertraining site that led me here but the interest was because of that little book.
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Old 10-12-2012, 11:12 AM   #25
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Like most I was stuck in the alchemy rut looking for the THE answer and investing huge amounts of energy and cash in all sorts of MET et al stuff that just confused me and destroyed what little confidence i had left. However it was 3 individuals who were my game changers and as John alluded they were subtle observations over time that slowly crept out of my subconscious 1 Gavin McCarthy he had the balls in 1997 to stand up in a department educational meeting and say he didnt buy this latest Core Stability evidence that squeezing your deep whatevers is going to cure backpain ( i was thinking the same but didnt have the guts to say it ) you could have tasted the tension, a room full of believers and one lone heretic- he was run out of town within a year 2 Ian Stevens (known to most of you) he joined our organisation approx 10 years ago, he didnt sound and look like everyone else ( which immediately interested me ) he came with an impressive clinical cv however he was a doubter - i observed them sharpening their knives- Ian though is made of stern stuff he has waged a long battle with the mechanists who still outnumber him dramatically but like all heroes he refuses to be trodden on and to date is still enriching our understanding 3 My wife ( a PT ) who was struck down with MS 7 years ago observing her battle has definately been a game changer, being so close and wound up in the struggle has changed the game- i remember early in the process i came home from work eager to find out what her physio home visit had gone like, we both chuckled when she produced the 4 point kneeling instructions, i asked if she found it helpful? no she replied but i enjoyed the company- a game changer indeed
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Old 10-12-2012, 01:14 PM   #26
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At a personal level - "I am not my thoughts." That was a big relief!

Professionally - as a student sitting in with an educator reflecting patients failure to improve back at them with blame and then in discussion after they would justify to me (and themselves) how the patient had done it wrong - not done enough, done too much, were too psychological or flawed 'heart-sinkers' anything to avoid personal responsibility for being unable to deliver approriate care. How in staff rooms PTs would cling to the teachings of gurus and how zealous they would be and how pack-like and tribal. Wow that is weird when you are the only one seeing it and you don't want to do it the one, true way. Having a lead clinician inexplicably relate everything to the SIJ. Another who would treat anything with a needle. Another who would needle and sit for twenty minutes, or traction and sit for twenty minutes, or PSWD and you guessed it - sit for twenty minutes - OK doing 'work' but not to that patients benefit, oh no.
So I was in the wilderness for so long then through the comments on the visceral manipulation thread on ScienceBasedMedicine I caught Diane's good sense and followed to her blog and then here. Safe now.
Kind thoughts,
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Old 10-12-2012, 01:50 PM   #27
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My arguments with Diane and Barrett.

All along I had a sense that what my orthopeadic mentors where teaching me was bunk (In my third year placement, I told a preceptor named Joel I thought he was nutters and largely ignored his biomechanical ramblings...nearly failed. He claimed I was inept. I would love to talk with him today....). But I could never fully understand why deep down I knew something was askew.

Anyway...at first I was angry with Barrett and Diane but soon realized that perhaps I should actually read what they have laid out.

Then I saw JohnW here and I knew everything would change.

I rambled a bit here but mostly read everything that was suggested (texts, articles etc). I was tedious in back referencing every link within a link.

Game changer: Recognizing NO ONE can teach you...you have to learn. And there is a BIG difference.

PS: Indeed advantage1 and I did work together and at the risk of sounding overly chummy...I think we helped each other along. Advantage1 was the first clinician I had encountered that actually invested the time to understand the why aspect of what we do. That was incredibly refreshing to me...especially after spending the better part of 5 years dazed and confused by ortho razzle dazzle....nonsense.
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Old 10-12-2012, 06:28 PM   #28
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There have been many conceptual shifts/changes in the game of understanding this thing we call pain for me. Many have been listed by others (defense/defect, origin vs cause, neurodynamics). But one other is when Adriaan at an Explain Pain course repeated something David said to him once: "you have to help patients understand this in the marrow of their bones". I thought to myself in order to get a patient to understand it that well, I need to understand it even better. And along with that came when Barrett talked about the difference between belief and understanding. I realized I had some work to do to understand this thing called pain.
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Old 10-12-2012, 07:44 PM   #29
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This is an important thread and could be made a sticky, because each poster so far is saying the same thing quite clearly:

You gotta UNDERSTAND what you are doing and WHY you are doing it instead of some off-field technique learned with Alice In Wonderland's guidance.

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Old 10-12-2012, 11:08 PM   #30
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As a new grad I heard some of therapists say " the longer" I treat patients, the more I treat my orthopedic patients neurologically, and my neurological patients orthopedically. I liked what they were saying, and though I didn't totally understand, I found myself ceasing to compartmentalize patients as "ortho", and "neuro". By about 15 years ago, I saw that the the more my younger co-workers saw patients, the more they tried to push them into the length/strength box, and the less they did anything that appealed to the patient's brain. This really frustrated me because I couldn't see the point of all this people getting muscles stretched, and doing straight plane exercises. Manual therapy seemed to be part of the answer, but the myofascial explanations coming out of my mouth sounded stupider and stupider. Muscle Energy became useful, but I could never keep the ups, and downs of all the joints straight, so I would usually resist what seemed to be resisted, and teach my patients pelvic clocks, and to explore motion.

When I went to Barrett's course, I realized that all of this stuff that sounded like nonsense to me made more sense in light of the brain.

For me the game changer was when I finally overcame my fear of internet enough to track down this web site, get some language, and start learning all of the stuff I should have learned in school, or in continuing ed. Isn't it aggravating that none of the time i log on Soma is considered "continuing ed", and yet it has been more valuable than most of the courses I've attended in the last 30 years?
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Old 26-03-2013, 12:04 AM   #31
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Quote:
Originally Posted by proud View Post

Game changer: Recognizing NO ONE can teach you...you have to learn. And there is a BIG difference.
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Old 16-06-2014, 10:27 AM   #32
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To get this thread going (because I think it's a good one):
My game-changer was this forum which I stumbled upon by accident some time ago. Having some decent success with the ectodermal approach right now, I have to admit that I know he game has changed - but I still don't fully understand the rules it is played by!
There's stuff to learn!

Quote:
Originally Posted by nari View Post
You gotta UNDERSTAND what you are doing and WHY you are doing it instead of some off-field technique learned with Alice In Wonderland's guidance.
That's the main issue I'm working on!
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Old 11-07-2014, 01:36 PM   #33
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1. Soma Simple has been a massive game changer for me.
2. The mantras - Hurt doesn't equal harm and Motion is lotion and Less is more.
3. My own experiences with pain and suffering.
4. Explain Pain
5. DNM and SC (always wanting to know more about these)
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Old 17-01-2015, 09:11 PM   #34
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Before begining PT school I questioned PTs teaching patients normal posture because what was normal? Everybody is different. Fast forward to 3rd year of PT school and John Ware gave a discussion on the neuromatrix which planted a seed. Luckily John was kind enough to let me observe how he treated a few patients and pointed me toward SS and Barrett's course which was refreshing because he encouraged us to think instead of 'here is what to do and do it because that's what I say/how its been done.'
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Old 17-01-2015, 10:52 PM   #35
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Michael,

What course did you attend?
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Old 18-01-2015, 04:19 AM   #36
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Michael was in Houston.


Sent from my iPhone using Tapatalk
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Old 06-02-2015, 12:21 AM   #37
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For me it was being at a lecture with David Butler several years ago. I had suffered from chronic neck pain for years. Fear avoidance and catastrophization had become my life. yet not one PT or MD (or myself for that matter) I went to at this time ever talked about this aspect of pain. I did not know the neuroscience behind pain and thought that every time I would have a flare up of intense pain it was "my fault". After being at that course and then having the pleasure of sitting down with David for a few hours a couple of days later my whole outlook on pain and my life changed. I read everything I could about the neuroscience behind pain and came here to Some Simple (I also met Barrett at David's lecture). Within a month my pain was 80% improved and now I rarely even think about it!
For me it was more than a game changer......it was a life changer.
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Old 06-02-2015, 02:55 AM   #38
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My game changer also came in the form of David Butler in 1990. His lectures made so much sense and he stressed to us to forget about machine that go ping... that stressed a lot of PTs who thought they worked well.

The second game changer was Barrett in 2005. I could not believe how simple it was to change so many presenting problems; not every time, but often enough to employ SC often in lieu of chatting while "working".

I always disliked orthopaedics (sooo boring!) and learning about pain led me to think I would like ortho better; I did, because I scrapped most of what I had learned at Uni. Yeehah! I almost, not quite, liked it, until I discovered TBIs and stroke and canned it completely.

Of course I was often silently accused of throwing out the baby with the bathwater.....but I just let them enjoy their angst.
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Old 06-02-2015, 03:16 AM   #39
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I was lucky with one of my teachers at physio school Ken Stopani, who started my interest in single malt whiskys and told me "You never step into the same river twice". I have been lucky to have many strong influences in my working life. Nowadays it tends to be the patients, neither of us are the same person at the end of the half hour.
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Old 06-02-2015, 03:28 AM   #40
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I had an on-set of low back pain for the first time in 2006. I was sent to a "low back pain specialist guru PT." I was told my SI joint was unstable with a posterior rotation on the right with an upslip of my ilium. Damn, amazing he knows that. I was given visuals of the joint, manipulated and special core exercises to realign myself. I was told to stop back squatting and participating in olympic lifting. The back pain continued for about 8 weeks without resolution. I was continually told I was unstable by the physical therapist. I became frustrated. I understood what I was told and logic told me to find a treatment that could 'stabilize' my unstable joint. I wanted back surgery with pins and rods. That'll fix me up real good.

Thank god it resolved and I didn't see a surgeon. Like back pain, I had a recurrence 3 months later. Enter new guru therapist (an FAAOMPT by the way). The same routine but now I was anteriorly rotated on the opposite side. "My god what's wrong with me?" More goofy exercises suggesting skill. It eventually resolved.

During this time I met a jerk over at the NSCA forums. His name was Jason Silvernail and he challenged that I had any of these SIJ problems. He gave me some things to read and suggested I go to a place called soma simple. He said something about a red pill….that was the start.

With that said, my game changer occurred when I first understood that I had cluster headaches. The worst pain I've ever experienced without tissue damage. A 100% central nervous driven pain. No tissue abnormality, no nociception, purely maladaptive, unhelpful pain.

A very real experience. So real I recall laying in my bed holding my head feeling as if an icepick was stabbing the front of my eye, pressure feeling as if my eyeball would pop while someone was taking a cattle prod to my brain and wanting to pull out the entire upper left teeth because that would be a more pleasant experience; then repeat this 3 times per day for a month.
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Old 06-02-2015, 10:21 AM   #41
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Finding this site and learning:

"Pain is an output of the brain"
"The muscles are a puppet of the brain"

I have some retroactive embarrassment regarding #2. Even in massage therapy school it's staring at you in the face, you just have to choose to look at it instead of the person going on about the thixotropic effect.

It's still bizarre on a daily basis. I can't talk about this stuff with 95% of clients because the context provided is on par with walking into a church and shouting "god doesn't exist, here are the papers to prove it" as it doesn't work. It's further bizarre in that so many otherwise brilliant doctors and surgeons haven't a clue about this stuff.

A bit off topic, I'm also fascinated when people who have been on this site for a while will have a little cognitive dissonance breakdown and post some version of "no really, I have this new conceptual toy which lets me put the neuro stuff back in the box...prove to me that the biomechanical model is wrong" and the folks who have been here forever go and do it for the 10,000th time without having a stroke.

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Old 06-02-2015, 08:01 PM   #42
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Strokes are never that far away.
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Old 06-02-2015, 09:36 PM   #43
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The game changer for me was developing chronic pain and subsequent loss of function. And then I found out that my colleagues were not interested in trying to help me--except the one that also had chronic pain. that was in the 80's.
RPG taught me to think globally.
CST taught me to be gentle. (Around 2000)
Barrett introduced me to SomaSimple a few years later when he taught in Moncton, NB
Diane used the phrase "mass hallucination."

Hook, line, and sinker.

Mary
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