About pain in D.C.

[Barrett Dorko]

After I attend the APTA convention in Washington D.C. in June I’m to do a full day’s workshop in that area for the strength, conditioning and athletic training community at a facility yet to be determined. It will take place on Saturday, June 11.

This isn’t a lock yet but I’d really, really like to get it organized. It will happen with enough interest. For my part, I’d love some suggestions from those gathered here about what they’d want from the day given their place in the field of healthcare.

For information and to be put on the mailing list please write Dave Westerman at evolveperformance@yahoo.com Be sure to put Barrett Dorko Seminar in the subject line.

In the meantime, perhaps we can discuss the things that most interest you about the patient/client experiencing pain, how to understand that and what you can do to help.

[Jason Silvernail]

Barrett-
I'll be in that area at an Army course then and I'd love to attend.

[Barrett Dorko]

Jason,

Great. Please write Dave.

[thrill96]

Dave and I are coordinating this. It'll be great to meet you both.

Will

[Barrett Dorko]

This is the first I've heard of this.

I'd love to hear more about who you actually are. Have you started a thread about that?

[thrill96]

Barrett,

I have posted a few times before, yes.

Dave and I both work in the DC area and we chatted about this a week or so ago. We are working to get a few other folks in our area involved to come to hear you speak.

Will

[Diane]

@Barrett, you can go to a person's profile page and look for the posts they've made.
Here is Thrill's (Will's) intro thread. He has a blog and makes videos. Here's a thread about that.

[Jason Silvernail]

Will-
Any idea on where it will be located?
Very much looking forward to attending!

[thrill96]

Originally Posted by Jason Silvernail

Will-
Any idea on where it will be located?
Very much looking forward to attending!

Jason,

I think right now we are gauging interest before go to the next step. I spoke with Dave yesterday and a few people had already emailed him which is great. As we start to nail down details, I will post them here.

Thanks,

Will

[Barrett Dorko]

Will,

I'm sorry I didn't remember you. I should have, but my aging brain (not yet aged, just aging) seems unable to sort through screenames that have no relation to an actual person.

For what it's worth, I'll be tweeting about this and posting to Facebook as well. This community may be unused to an ectodermal approach to the issue of painful problems but I feel that a carefully designed program will demonstrate how it can make everyone's job both more sensible and simpler.

Jason knows what I'm talking about and having him in the room will enhance this to a phenomenal degree.

[Nick]

Connect worlds...how approrpriate pain management creates the adaptability to allow people to engage in other health-promoting behaviors. And how those in the "performance" community might consider changing their programs to avoid provoking pain. This includes reducing those things that challenge adapatability, namely (1) sustained positions (2) repetitive motions, and (3) force. IMO, it's all about connecting creative and productive movements. Both have a role, but creative movement is almost entirely eliminated and discouraged from the productive world of performance enhancement.

At the same time, be sure to justify their worldview with a nod to the importance of productive activity and the meat and bones of the body. Just help them realize it is the ectoderm that makes it all possible and balancing it with creative movement makes their efforts far more successful in the long term...aiming for a lot less casualties along the side of the road.

[Jon Newman]

Nick! It's good to "hear" your voice. Welcome back.

[Barrett Dorko]

I agree. Nick's experience with this aspect of care far exceeds most and anything he has to say about it I'd love to hear.

[Barrett Dorko]

I've been thinking. Nick makes the point that "approrpriate pain management creates the adaptability to allow people to engage in other health-promoting behaviors."

Too often people are helped to change without any consideration for their adaptability, thus the words said with almost mantra-like effect, "I'd really like to work out but I'm in too much pain. Exercise makes it worse."

If there were some way of reducing the patient's/client's tendency to threaten their nervous tissue with movement we'd probably see less of this situation. We'd have to turn the typical progression of training around though. We'd have to ask people to spend some time mobilizing their nervous tissue and training their brains before too much effort overcame their adaptive potential.

I see this in the SNFs (read nursing homes) where I work all the time. I understand the emphasis on walking, but I hold off on that effort and accomplishment until the nervous system indicates it's ready. My colleagues rarely understand that, but they could.

There are ways of determining adaptive potential if not precisely predicting outcome, and that's what this workshop is about.

[tonyf315]

I think there will be a nice market for the idea of bringing neuro concepts to a fitness/athletic audience. I just started working with a lady who has longstanding on/off pain in her hip/leg exacerbated by playing recreational tennis, which she loves and wants badly to get back to. She asked at her 1st follow-up about learning "warm-ups" which I used as an opportunity to introduce the idea of re-programming that notion to doing movements before playing as a way of "waking up" her nervous system and turning down the threat alarms. She *seemed* interested in this idea...

[Barrett Dorko]

Tony,

I love your enthusiasm. You need to get out more.

I asked a fella who works in my department today, a serious weight lifter, what he thought of when I say “Someone I know started lifting weights and now they hurt.”

He said, “If they use the proper technique they won’t injure themselves.” End of conversation.

This same guy will interrupt if I’m speaking to another staff member actually interested in some information: “Don’t get him started.”

I can only conclude on the basis of this and a few other conversations that the community I’m about to speak to equates injury with pain and “proper” technique will result in prevention and avoidance of injury/pain.

How common do you suppose this is and how might you introduce some alternate ideas?

Of course, I mean ideas that have some backing in the neuroscience community.

[EvolvePerformance]

I'm thinking this course should be a success. Between the different disciplines possibly attending, it will have a nice diversity.

Details on the location are TBA. Hopefully have a registration form out soon once the details are finalized.

thanks
David Westerman
EvolvePerformance@yahoo.com

[smith]

To me; the amount of type 2 muscle that you can develop is determined by how successful you are mobilizing the nerve. The limitation is the nerve.

I'm planning to be there unless I'm a victim of school cutbacks. I'll make a sign "will work for food or conference."

[zimney3pt]

I have been continuing to think about novel movements, which I think some could considered the opposite of proper technique.

In football for example you have a set play to run. Proper technique would be to run the play exactly as it is drawn on the chalk board. Unfortunately the other team doesn't always do as you want them to do. So you have to practice multiple variations to the original play, and continually work on them so all players can adjust their specific role based on others as they have to change to make the play work. This constant adjustment I see as novel movements.

If your goal is simply to squat a lot of weight, then doing proper technique works real well. The weights don't have much of a brain and always follow simple laws of physics, no psychosocial issues to deal with. When we move around in life, physics is a part of what we have to deal with, but there is a lot more. So if I am using weight lifting as a tool to create a better athlete, doesn't it seem logical to explore novel movements out this proper technique at times. Yes, not very wise to load the body as much, but get it to experience new movements so during the game it has a large movement repertoire to pull from to complete the task at hand.

I think getting strong is important, but eventually it has diminishing returns as you move up the ladder. We eventually have to ask how strong is strong enough to play a sport (obviously the athlete that squats the most is not always the best athlete)? When does the ability to move and be able to pull from various movement strategies more important?

There is a difference between a weight lifter and an athlete. Much of that is an athletes ability to have novel movements to pull from when needed.

[Jason Silvernail]

There's been a lot of attention in the fitness community about "joint mobility work" and foam rolling etc as prep for strength and conditioning work.
Bringing some neuroscience to that topic, Barrett, could be a course in and of itself.

David-
Sounds great. Will look for registration information soon.

[Barrett Dorko]

“Joint mobility”?

It’s as if we invite people over for dinner and they drive right past the house and go to The Golden Corral.

Okay, well, maybe that’s not the best analogy but it’s the one that comes to mind.

As I said somewhere, “When we get to the skin we should come to a screeching halt.”

There’s enough there to consider and work with long before we imagine we can permanently elongate the connective tissue with our hands.

Which we can’t.

[Ken Jakalski]

Hi Barrett!

I asked a fella who works in my department today, a serious weight lifter, what he thought of when I say “Someone I know started lifting weights and now they hurt.”

He said, “If they use the proper technique they won’t injure themselves.” End of conversation.

This is the approach almost all coaches in my environment have come to accept.

I can only conclude on the basis of this and a few other conversations that the community I’m about to speak to equates injury with pain and “proper” technique will result in prevention and avoidance of injury/pain.

This is what our coaches hear quite consistently.

[Barrett Dorko]

Ken,

I thought this was pretty common. The challenge will be to get people to consider something else without asking them to alter their current method too much.

Our tolerance for change is addressed in the Gradient thread which begins with this quote:

There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things.

Machiavelli

[TexasOrtho]

Barrett. I'm not sure what I could actually do to help from a distance. If I can offer how I've come to see strength and conditioning within the context of neuroscience, feel free to contact me. I've done a lot of thinking about this lately and have some fresh (at least to me) thoughts on my mind about it.

[Barrett Dorko]

Thanks Rod.

The course planning is moving ahead. Please use the contact info provided to get a better idea of what we're doing. Will is working on CEUs and Dave has a registration form on his web site. I'm on an unfamiliar computer and cannot link as I normally do.

Anybody have any ideas about how we might use the APTA convention the previous few days to promote this?

Anoop's wonderful piece about pain referenced in The Performance Lab is something I carry with me these days. After reading it several times I've concluded that what needs to be emphasized is what he calls the "top down approach" to both our understanding and treatment of painful problems. This would obviate much of our immediate concern (which may not be entirely correct) about injury. It explains why "hurt equals harm" needs to be questioned carefully in light of what we now know.

This emphasis eliminates nothing from the other salient points, but I feel it makes what I'm trying to teach simpler. I'm always for that.

If someone else here can provide the links unavailable to me today please feel free.

[zimney3pt]

I think referrencing the Central Governor Theory that has been discussed on SS here. Timothy D. Noakes has other articles published on it. May be helpful to draw links just like the theory draws attention away from the peripheral fatigue to central governor; just as we need to be aware of "top down approach" as well as "bottom up". Thus being careful with "hurt equals harm".

I don't know how well this theory has ben accepted in the athletic ehnacement community, as I don't work in that environment. It may serve to help or make things worse.

[Ken Jakalski]

Hi Kory!

I don't know how well this theory has ben accepted in the athletic ehnacement community, as I don't work in that environment. It may serve to help or make things worse.

That is an excellent point! Dr. Noakes is highly respected in the running community, and his work, The Lore of Running is considered by many to be the distance runner's "bible." Somewhat of a legend in South Africa, he has a strong following, and continues to draw world-wide attention.

One of the arguments from the research community is that Noakes's hypothesis--that maximal oxygen uptake is limited by a central nervous command--has not revealed any compelling research based corroboration.

In a counterpoint that appeared in the Journal of Applied Physiology a while back, Dr. Bjorn Ekblom noted the following: "It is the suggestor's absolute duty to go on and prove the theory in practical experiments in one way or another. But except for re-evaluations of earlier studies, TN [Noakes]has not fulfilled this obligation so far."

[EvolvePerformance]

Here's the link to sign up for Barrett's workshop: http://evolveandperform.com/seminars/

This course is for everyone in the health field.

Email me at evolveperformance@yahoo.com if you have any further questions.

[garydiny]

Barrett,

Here is a link to 2 studies on ACL injuries and changes in the CNS. They maybe pertinent discussion point or subtopics when talking with Strength and contintioning "professionals"

May get them thinking beyond ligaments and muscles and more at the "top down approach" to things.

Hope it is useful.

Gary

[Barrett Dorko]

Gary,

These are both wonderful additions to our understanding of "top down" mechanisms often misunderstood or ignored by our communities. I'm always struck by how well Feldenkrais understood this despite the fact that when he passed away in '84 the neuroscience wasn't near to confirming his observations.

It is no wonder that his work was considered purely intuitive at the time and thus "controversial" and "fringy." I feel certain that what he proposed be done in the case of dysfunction and/or pain could be easily defended by a neuroscientist today. Unless I'm missing something, this hasn't been done very effectively. Shouldn't the PT schools be leading the way here?

Instead, we remain saddled with Kendall's notions about the direct relation between posture and strength, strength and pain, manual muscle testing and her version of reality - all deeply flawed.

D.C. is an opportunity to break the school's grip on our thinking. I can't help but think that it's too bad we are obliged to do this without the support from the academic community that research and a passion for the work deserves.

I know it's been referred to as "the neurobiologic revolution" and I like the phrase, but I sense very little movement on the front lines. After all, the brain was discovered in 1652 by Thomas Willis but the NFL didn't do much about head injuries until very recently.

Don't you think that means something?

[Jason Silvernail]

Just reserved my spot!
Looking forward to it!

[Barrett Dorko]

A few weeks ago I was offered the opportunity to answer some questions from an interviewer for his pod cast. I sent ahead as much information as I dared and suggested he read some of the threads on Soma Simple as well.

Two weeks later we made our first attempt.

“Are you a PT?” he asked.

I knew this was trouble. On two subsequent attempts he seemed to know even less. Fortunately, every recording was plagued by technical difficulties and I didn’t bother to schedule a fourth.

Now I’m on the verge of actually doing another, and I think the timing is pretty good. I can tell you as well that the man interviewing me really knows who he’s talking to. When it happens, I’ll be sure to announce it here.

In the meantime, if you want to listen to about 20 minutes of my speaking a couple of years ago, consider visiting Rod Henderson’s site here.

[Barrett Dorko]

I recently read through this thread again after a brief correspondence with an old friend. The thread’s about how we got to this point in our careers, or, imagine how we got here. He contributed the following:

The seeds of my eventual demise were planted in 1987. I purchased a cassette of a workshop (debate, actually) on neck and low back pain between the legendary Duane Saunders and The Destroyer. (here Gary is referring to me, and it’s Great Destroyer BTW) I was hooked. I began a snail mail correspondence with Barrett, and finally attended his course. It was all downhill from there. The last time we met for dinner, I was in such a state of decrepitude that he had to read the menu to me.

This is Gary Shapiro. PT, home health care provider, some kind of advanced tai chi belt-holder, writer, farsighted and sometimes forgetful and, as I said, friend.

He’s coming to the class in D.C. and though he refers to this as “going to the well” (that’s me again. I can’t seem to get the Great Destroyer name to catch on), I know his presence will lend a great deal to the gathering.

Gary, remember to bring your glasses. I’ve a few new things to show you.

[Bas Asselbergs]

Barrett, try: "the Dead Destroyer".

[Barrett Dorko]

Bas,

I love the alliteration, of course. But, this name may require more explanation than I like to give. I mean, Superman, didn't need any.

See where I'm going with that?

[Bas Asselbergs]

Yeah, only those with a strong background in Seinfeld will have chance understanding that one.

"Supra-orbitus" doesn't quite do it either, does it?

[Barrett Dorko]

Will Stewart has set up an interview to be broadcast on Thursday this week. Find it here and consider tuning in.

This is one way to find out that I don't have a high-pitched, squeeky voice.

[gary s]

This is Gary Shapiro. PT, home health care provider, some kind of advanced tai chi belt-holder, writer, farsighted and sometimes forgetful and, as I said, friend.


That was nice Barrett. You neglected mention one of my other bonafides(got that from
Deadwood)--former Capt, USAF. SAC KC 135 naviguessor.

[Barrett Dorko]

Gary,

Can't wait to see you, and you're right, I forgot to mention that naviguesser part. Similarly, I often forget to tell people that I was the president of the Westlake High School Marching Demons. Perhaps I'm unconsciously trying not to overwhelm them.

Check out the interview Will and I are doing tomorrow. I'll try to get your name in there somehow.

[gary s]

Barrett,
It's nice to see that you're still at the top of your game.

[John W]

Barrett,
It's nice to see that you're still at the top of your game.

Yeah, Gary, around here, one can be at the top of his game while being at the bottom of his grave.

Cool trick, huh?

[Jon Newman]

Gary,

It's good to hear you chime in. I thought of you when I found this link from a Roger Ebert tweet.

Yuen Woo Ping Picks His Five Favorite Fight Scenes

Have fun in D.C.

[gary s]

Originally Posted by John W

Yeah, Gary, around here, one can be at the top of his game while being at the bottom of his grave.

Cool trick, huh?

John,
All I can say is "Amen, bruddah"

[Barrett Dorko]

I actually own this book and keep it near all the others I use for class.

Now I know why.