Pay no attention!

[Barrett Dorko]

The denouement of that movie begins with the pulling back of the curtain. This is done, of course, by Toto, Dorothy’s instinct and the whole reason for that trip to Oz, according to me anyway.

Diane Jacobs' latest blog post should be read by everyone who normally reads Range of Motion and I get an average of 200 views in the first 18 hours anytime I post.

This bit of blogging has now grown close to 300 replies and 7000 views. All about a method I have never used (or intend to) and a theory that has increasingly been called into question.

Diane’s writing and the link in that article make the reasoning that precedes the needling even more suspect and I’d love to see someone defend it in light of this new evidence.

Let me add this: Abductive reasoning, explained in detail here, also precludes the possibility that things are as the purveyors of dry needling say they are. Once again, I’m not talking about the results they claim.

Remember the Wizard’s initial attempt to hide his true nature? He said, “Pay no attention!”

It didn’t work then and it’s not going to work now.

Over to you.

[rkathryn]

Yes, and the same can be said for the people who believe that since everything has to do with the mind and nervous system............we should all just use hypnotism since "it's all about the mind". (Which is actually going on in a discussion on a massage board for "evidence based" massage therapy.

How about some hypnotism & acupuncture......wait, don't steal my idea now!

The dry needling reminds me of a course I took called "Introduction to Structural Integration" (or really, a modern term for Rolfing). For those of you not familiar, Rolfing was developed by a woman named Ida Rolf who set up in Northern California in the 1940's to practice a type of very painful active engagement work to "loosen fascial restrictions" and "tissues" of the body. Anyway, in this class (before I met Norman Doidge, who led me to somasimple-- as well as the encouragement of a colleague from the East) the instructor was showing a technique to release the ankle. I inquired that wouldn't it be counter-productive to do this type of work on someone such as a ballet dancer who has hypermobile ankles and the instructor replied-- I'm working the bones of the ankle, not the ligaments. To which the student (who was the person being worked on) said, "yeah, he's working on the bones of my ankle, not anything else."

Shocked, I tell you, shocked. Too shocked to reply, "Oh, so you're accessing the bones of the ankle and completely bypassing the muscles, fascia, ligaments, (nerves) are you?"

Well, that's one of the many reasons I ended up here anyway.....

[proud]

Barrett,

Brilliant post. You really should copy/paste it over to Mikey's blog....

Wasn't sure where the reference to the wizard was going but...spot on.

Thanks for that.

[Barrett Dorko]

Thank you for the replies.

Referencing the wizard is always a good idea, and easy to do. For instance, when one of the brothers on Two and a Half Men couldn't find their perfectly awful mother a few years ago the other asked, "Have you asked the captain of the flying monkeys?"

Brilliant.

Linking this to Mike's blog is tricky. I'm hoping someone else will do it. Anyway, its "tone" is rather "negative."

Again, can anyone say in a simple fashion how abductive reasoning enters in here now?

[Diane]

Thanks for linking my blogpost Barrett.

[Barrett Dorko]

You're quite welcome.

It seems that though the regular contributors here cannot be said to always agree and that none of us is looking for a leader, we are (as they say on the reality shows) "a force to be reckoned with."

There's another line - the most common used on any of those shows: "I'm not here to make friends."

[Diane]

Blogpost, To sum up.

[Barrett Dorko]

Given the interest, and it is just about all that I can measure, this discussion seems to point toward a turning point in our profession's worldview. In fact, dry needling, to me, is the logical conclusion both in theory and practice to a mesodermal mind-set in relation to persistent pain.

No wonder we went there.

Any thoughts regarding abductive reasoning yet? I've my own statement about it prepared but will wait to post that.

[Barrett Dorko]

Thanks to Glen over at Mike's blog:

The video referenced above.

Glen, have you been here before? Who are you?

[proud]

Sorry..that is my first name. So...it's me.

[Diane]

Originally Posted by proud

Sorry..that is my first name. So...it's me.

Hey, hi Glen.

[advantage1]

"I'm a very good man, I'm just a very bad wizard"

I wonder if I'd be able to get some of my old ortho instructors to admit to being bad wizards? They would probably just look at me stunned and say that Rob is such a pain!

[Barrett Dorko]

Abductive reasoning follows the following pattern:

Some phenomena P is observed.

P would be explicable if H were true.

Hence there is reason to think that H is true.

From the link in the first post.

If muscular tissue were “lesioned” as proposed and if it were necessary to physically alter the peripheral tissue in the manner needling does, working on a rubber hand wouldn’t alter anything.

[John W]

Nice to meet you, Glen.

Barrett,
The dry needlers will, of course, discount the article utilizing the rubber hand illusion to explain the affects of acupuncture since they claim to be inserting their needles through the skin into muscle.

However, even their deductive reasoning from the muscle pain meme falls apart when it is pointed out how utterly implausible it is that a dry needle would never hit some kind of nervous tissue on its way into the muscle.

I just read through Diane's discussion with Arthur on her blog site, and to Diane's query about what exactly he thought he was poking, this was his answer:

You are right, of course, there are nerves and blood vessels that are hit with needling. Maybe one out of ten patients will have a very small drop of blood exit with the needle. Fewer still may bruise. If a nerve is hit there may be a second of nerve associated pain. The next pass of the needle generally misses a nerve. There are areas to avoid around neurovascular bundles.

That bolded statement is stunning in its utter lack of plausibility. Misses a nerve? Really??

I'm struck by the word of caution at the end of Arthur's statement-it's actually funny in an absurd kind of way in how it portrays a caricature of the nervous system. He seems to envision the human body like a game board with signs that read "Caution: Neurovascular bundle here!" and "Do not pass skin, do not collect pain relief for patient".

This would be a fun game to play if we weren't dealing with real people in real pain.

[Barrett Dorko]

This thread has had over 500 views in one day - easily a record, and on a Saturday no less.

Links to it have been retweeted from several other sites and Matheson's Rehab and Safety Daily made it their #1 story this morning.

Not a single word in opposition to its implications or conclusions.

The connection to the Wizard (in the movie, not the book) has become clearer to me. The line from the old America song, "Oz never did give nothing to the Tin Man that he didn't already have" keeps running through my head.

There'a also the issue of his escaping any responsibility and not answering questions after he bloviates for a while by floating away and claiming ignorance i.e. "I don't know how to run this thing!"

Anybody want to build upon that?

[Barrett Dorko]

Still no word from those now metaphorically "in the hot air baloon."

[John W]

Barrett,
I provided a link to your essay on abdutive reasoning in a post I made in a discussion thread for an online class I'm currently taking. The topic of the thread is "Online Exploration" based on an article by a young journalism graduate student, who is making recommendations to the instructors of today's college students.

I referenced your essay because I don't think this type of thinking is promoted in education in general, and certainly not in PT school. Yet, today's students are uniquely and amply equipped with tools for exploration and gaining useful knowledge through the internet.

There's so much knowledge available, yet so little reasoning being done to come up with creative solutions and better explanations. How would you promote abductive reasoning among these tech savvy students of today?

[Barrett Dorko]

You're right John. There's a great deal of difference between acquisition of knowledge and the reasoning that should precede its use.

I have found that abductive reasoning requires that the instructor ask questions. In short order you become Socratic. Then the class wants you to die.

I'm having trouble getting past that last part.

Since we wouldn't just die during the dry needling bit, those who were questioned simply decided to float away.