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Old 12-07-2017, 01:00 PM   #1
Barrett Dorko
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Many of the things I've thought about in the realm of therapy have gone nowhere. I've been thinking about them lately because I spend more time on social media (especially Facebook) than I did in the past. This is a function of my aging, which I can't seem to escape. Drat!

Anyway, this blog will be about the things I've read about or proposed in no particular order that don't seem reflected among those younger than I am. That includes almost all therapists. Those on social media are commonly more formally educated than I am.

I'll begin. I've long understood that "all pain is neurogenic," which sounds a lot more intelligent than it actually is. It means that I can cut my nails without any complaint of pain. Whole shops, an industry in fact, is devoted to this. There's probably a national convention of nail salons.

In any case, the treatment of painful complaint is not limited by this. It is thought to limit treatment.

If a complaint of pain is the end result of enough nociceptive firing to result in it, and that firing is neurogenic in nature, why has this phrase (to me it's a relatively simple fact) never caught on?
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Old 12-07-2017, 01:55 PM   #2
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If you want widespread acceptance of your ideas by colleagues and academics, you will have to give them what they really want. It's not about catchiness.
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Old 12-07-2017, 02:05 PM   #3
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EG,

What people want isn't always what is offered or learned. You'd think that science always revealed what was imagined by humans. That's advertising, not science.

I would certainly think that advertising is very powerful, but I'd prefer science. As Carl Sagan once said (paraphrased):

Quote:
I don't see things as I'd prefer them to be, but as they are.
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Old 12-07-2017, 02:12 PM   #4
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EG,

What people want isn't always what is offered or learned.
Right! So give them what they want and you'll find the widespread acceptance you desire.

Everyone wants the same thing- therapists and patients alike. Underlying all surface level desires and concerns is the universal need to find and be ones true self. SC utilizes this theme. SC has a practitioner adopt the attitude of: "just do whatever feels good and throw caution to the wind. Don't defend, don't protect, just move spontaneously and according to need. I'll support you in that". That's why it works (not due to tissues untwisting).

So if SC has a small uptake it's because it doesn't move practitioners in a way that feels good for them, or true for them. If you put aside theory and any concerns for the patient, how would you do treatment in a way which pleased you and you only? When you know this, compare it with what the patient wants and see if there's any overlap. Luckily there is, because as I said at the top, we all want the same things in life.

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Old 12-07-2017, 02:37 PM   #5
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EG,

You have no actual understanding of Simple Contact.
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Old 12-07-2017, 02:49 PM   #6
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EG,

You have no actual understanding of Simple Contact.
That's possible, but I'm a pretty good observer.

Have you ever tried just totally letting go, not thinking, not caring about outcome and just giving L5 a poke for 5 minutes then finishing treatment? It would be quite liberating for someone like you. Experiment and have fun with your own expression of therapy, rather than fitting it to the patient.

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Old 12-07-2017, 03:06 PM   #7
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EG,

You seem to be able to read another's mind and "know" what they're feeling.

I don't. I would contend that no one does.
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Old 12-07-2017, 03:08 PM   #8
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EG,

You seem to be able to read another's mind and "know" what they're feeling.

I don't. I would contend that no one does.
I know deep down that's a compliment (and I know you'll deny it, that's ok).

Thank you.
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Old 12-07-2017, 04:00 PM   #9
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Another example of being able to read another's mind.
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Old 12-07-2017, 06:59 PM   #10
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Honestly, reading this is like listening to the Trump administrations explanations of things. EG do you understand what Barrett knows about SC? If not, then I suggest you do some googling. You may be surprised to learn that Barrett Dorko is not the most common name.
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Old 12-07-2017, 08:19 PM   #11
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Mine is not a common name. In fact, I currently think that it's the only one on Google. Not that that is any recommendation however. Have I mentioned that my son works for them? Google I mean.

I wonder where my mother came up with the name of "Barrett." I would tell others that "it was an old boyfriend." Those who knew my mother probably guessed it wasn't true. She probably read it somewhere. I would also joke that my twin, named "Leah," was the undesirable sister of Rachel - which makes it biblical. That probably wasn't true either.

In any case, it's a strange name. I use it all the time.
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Old 13-07-2017, 12:05 AM   #12
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If the push-back on the "all pain is neurogenic" thing isn't forthcoming, I have another thing built on that - the origins of pain. There are four and I've written of them endlessly.

Many of the methods assigned to the therapy community (for painful complaints), if not all of them, ignore this.

And it has certainly been ignored.
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Old 13-07-2017, 12:39 AM   #13
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In any case, it's a strange name. I use it all the time.

How about the guy who pronounced it "barrette"
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Old 13-07-2017, 01:06 AM   #14
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Ken,

Well, I've heard that. I used to correct the speaker, realizing they hadn't seen that used for a first name before. Heck, they'd probably never saw it.

Up until I moved to Boston in '75 I was referred to as Barry, including my whole family. I decided then to use my entire name. Sometimes a person will call me "Barry". I tell them my name is Barrett, but always add, "Many who love me, call me Barry."
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Old 13-07-2017, 02:49 AM   #15
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EG,

As Carl Sagan once said (paraphrased):
I was very much like that too. It's an uncomfortable way to live. Our experience of the world is our own and cannot be shared or experienced by anyone else. We create our experience by adding meaning to a bunch of sensory inputs. There's no 'how-it-is-objectivity', there's only 'how-I-choose-to-interpret-it-subjectivity'.

If you entered the treatment room and decided (as per SC guidelines) to just do whatever felt right for you, and found yourself spontaneously dancing and singing, then so long as you shared your energy with the patient, he would do very well. What I'm saying is if you can do treatment in a way which is pleasing for you it will be maximally effective.

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Old 13-07-2017, 03:14 AM   #16
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EG,

Stop posting on this site.
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Old 13-07-2017, 04:02 AM   #17
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EG,

Stop posting on this site.
I'm not making fun of SC. I'm saying it's a great principle - very Rogersian. Why not apply it to everything... in particular, oneself? The dancing comment was only to illustrate the point. Dancing in the clinic might not go over very well, but maybe I'll try it one day. It would have to be spontaneous and true, not contrived - that's the key, is it not?

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Old 13-07-2017, 01:11 PM   #18
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I've also tried to introduce interpretation into the thoughts of therapists.

I used to do a bit that ended, "I can't treat her, she won't relax!" has always got a few bits of laughter, most of them uncomfortable.

I've suggested that every muscular contraction (both conscious and unconscious) begin with an isometric. This includes speech according to the speech therapists I've asked about it.

Anyway, what if therapists were to attempt to make it safe for those motions (it would, of course, include muscular activity) to express themselves?

The way many, many therapists act (and I'm not saying it doesn't "work" or their patients don't "love" them)as if the activity expressed by the patient is the enemy.

The best book I've read about this way of seeing natural processes in this way is Why We Get Sick.

Has anyone else read this?
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Old 14-07-2017, 01:22 AM   #19
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Want to propose something that really gets no traction? Try introducing the idea of chaos theory into touching the skin.

It's like suggesting that uncertainty is ever present when you touch another.

Imagine that.
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Old 14-07-2017, 06:21 AM   #20
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Want to propose something that really gets no traction? Try introducing the idea of chaos theory into touching the skin.
If it has merit, then introduce it. Don't worry about recognition (traction).
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Old 14-07-2017, 09:18 AM   #21
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If a complaint of pain is the end result of enough nociceptive firing to result in it, and that firing is neurogenic in nature, why has this phrase (to me it's a relatively simple fact) never caught on?
Denial maybe. For some reason, the idea of all pain stemming from fascia and myofascial trains seems to be more acceptable (at least to the general public, but therapists) than looking at it from the nervous system. To be honest, it was something I was probably aware of but didn’t give enough credit to until I came here and thought about it more deeply. In my mind, it actually ties together a lot of what I see and do, so I think it has actually made my approach much simpler.

Others may not see it that way.

Most therapists here (at least those who I trained with) are aware of the like of Butler and Moseley. They are aware of Explain Pain, and the advances in understanding pain and the nervous system, but there doesn’t seem to be that translation. These concepts tend to be put in the ‘Chronic Pain’ toolbox and are seen as a treatment tool or approach you use when you deal with people in persistent pain when you can come up with a specific causative structure.

I’ve heard more than one person say when I’ve mentioned Butler or Moseley, or something like graded exposure or pain as a CNS construct, “Oh yeah, that’s that chronic pain stuff”, as though it’s something they are aware of but never actually given any thought to. I’m not sure if that’s an issue with the dissemination of information or the way it is presented, but there seems to be a disconnect.

The idea that there is no muscle or joint pain, and that all pain is neurogenic appears to be resisted.

Is it a lack of understanding that has caused it not to catch on, or is it more conscious because acceptance of it would call into question all of those treatments focused on the tissues? Do people possibly see that it diminishes their own importance in the equation with patients and that makes them uncomfortable? I don't know.
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Old 14-07-2017, 09:32 AM   #22
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Anyway, what if therapists were to attempt to make it safe for those motions (it would, of course, include muscular activity) to express themselves?
Are you referring to creating an environment where that patient would find she is actually able to relax? I have a few times had patients, after I have finished working with them, say to me “I was expecting that to be more painful”. I think this is from previous experience.

I usually just smile in response.

Often they return more relaxed the next time I see them, even if I haven’t actually ‘done’ anything (that they would see anyway).

Quote:
I've also tried to introduce interpretation into the thoughts of therapists.
I find the question I should ask myself whenever a patient gives me a response is ‘why?’

Not ‘why have they said that?’, but ‘why is that the case?’ Why can’t that person relax?

I find it important to look at how I’m responding to them, rather than the other way around, and what influence this is having.

Maybe I've interpreted what you meant by 'interpretation' wrong. Please correct me if I have.

Quote:
The best book I've read about this way of seeing natural processes in this way is Why We Get Sick.

Has anyone else read this?
Not yet, though it’s on the list. I have just had a heap of books come in which I picked up from reading Cory’s ‘A Unified Theory for Physical Therapy and the Treatment of Pain’ thread, as well as Diane's DNM book which managed to make it's way over the ocean. I think if I try and get anymore now before I’ve ready that, my partner might raise her eyebrows, and think I just like stocking my shelves with unread books.
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Old 14-07-2017, 12:08 PM   #23
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Ben,

As always, I appreciate your writing here.

By interpretation I simply mean that an isometric precedes an isotonic, which customarily results in relaxation - the goal (or end-result) of most "effective" therapy. What has been called "therapy" by many is somehow achieving "relaxation" by various means. I have suggested that expressing without fear that it will be seen as something to be judged by others is important.

As I've said to many, "When I patient says 'Gardening relaxes me' (it doesn't relax me by the way), they are telling you that when they express themselves through their gardening that they begin to relax."

More soon.
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Old 14-07-2017, 01:11 PM   #24
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Ben,

Not living in Australia (where many insects and other things can kill you within five minutes), but Ohio, I have to been less watchful of the environment, unless I live in the Cuyahoga River (rim shot!), so I've been a little bit slow on the uptake, so to speak.

Raising in eyebrow (which you've mentioned) reminds me of how powerful is the environment and the culture around us. Stocking your shelves with books and your partner objecting (no matter how subtly) is an example of that. I'm often thinking of the example of how much I've been not allowed to do according to my practice act - not of not being allowed to know stuff.

Might it be that many things drive our behavior in directions that are less than optimal? Doesn't their ubiquity, invisibility and acceptance make such things more powerful? Isn't what is seen remarkably powerful?

My contention is that therapy has been driven by that which is seen and felt, not by the discoveries of science. It is no wonder that much of what has been proposed has made little or no progress.
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Old 14-07-2017, 02:26 PM   #25
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Might it be that many things drive our behavior in directions that are less than optimal? Doesn't their ubiquity, invisibility and acceptance make such things more powerful? Isn't what is seen remarkably powerful?

My contention is that therapy has been driven by that which is seen and felt, not by the discoveries of science. It is no wonder that much of what has been proposed has made little or no progress.
It's interesting to look at it like that. I suppose it can be looked at in a similar light to looking at an example you (or maybe it was someone else, I can't quite remember where I actually saw it so I might be messing it up a bit) used regarding ideomotion. I think it was something regarding sitting at a dinner party or social gathering for a long period, where the natural movement the body would unconsciously employ to limit the mechanical deformation of nervous tissue might be stymied by the social context.

Do we see this in the therapy world? Are those of us who end up here trying to remove ourselves from this context in order to allow for our own mental ideomotion and expression of therapeutic knowledge (or something to that effect)?

I like the point you make about therapy being driven by what is seen and felt. Is that what we see? People identifying what 'works' based purely off what they can see in their patients, or what their patients can feel, then creating a paradigm into which that treatment approach or modality fits. As this grows, the ubiquity you mention grows.

Why would a therapist explore the information presented here or in other forms, when what they see from colleagues all around then appears to take no notice of it? So their ability to move their mental muscles is limited by their environment and social context.

I now work by myself, but I can feel that from afar. All I have to do is receive the latest issue of our physio association magazine to see it.
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Old 14-07-2017, 02:40 PM   #26
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Ben,

Working without others around to affirm your confirmation biases tends to make you like this. I have blamed my personality variant. Perhaps that's convenient, but there you are. I tend to wonder about things and write and think a lot. I'm not a bad guy. I don't think so anyway.

Anyway, I'm human and an Ohioan, so that's something.

I'm old, and I don't know what time or day or year (rim shot!) it is where you live. Still, we're alike in many ways.
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