Jason Silvernail [moderator]

[Jason Silvernail]

I practice in an orthopedic and sports setting, providing referral and direct access care for a wide variety of acute and chronic neuromusculoskeletal complaints. I'm currently serving on active duty in the United States Army.

I'm interested in clinical teaching, the neuroscience of pain, manual therapy, and fitness/wellness practice in physical therapy. I like to openly challenge mainstream therapy concepts and practices and am committed to the use of best evidence and critical thought to advance the science of physical therapy and improve outcomes for our patients. I have a special interest in the theoretical basis for therapy practice. I also post on the Evidence in Motion Blog and the My PT Connect site.

I am a veteran of many online forums and listservs, as are the other moderators. You will see things discussed here that you will not see anywhere else. Many people here understand pain and the body in ways no one else does, directly as a result of their reading of relevant research in the fields of neuroscience and pain physiology. I can say with full certainty that my interaction with those here has completely changed the way I practice and reinvigorated my passion for therapy.

Welcome to Soma Simple!

"It isn't what you're able to do that requires your courage, but what you have come to understand and are willing to express."
-Barrett Dorko
"To speak or write in wrong terms means to think in wrong terms."
- GD Maitland (1924 - 2010)
“I'm not going to modulate my views based on someone else’s impression of what they should be.”
–PZ Myers
"...I confess that I prefer true but imperfect knowledge, even if it leaves much indetermined and unpredictable, to a pretence of exact knowledge that is likely to be false"
- FA Hayek
"If you mystify stuff for yourself or your students, that'll come back to haunt you..."
- Tony Blauer

[Jason Silvernail]

Foundational Threads:
Culture of SomaSimple
Moderator's Consensus on Pain
Cory Blickenstaff's Unified Theory for Physical Therapy and the Treatment of Pain
More Than Placebo
Enough is Enough
How to Debate Charitably
The Chestnut Challenge

Making this work in your practice.
Crossing the Chasm: Meso to Ecto
Biomechanical Aspects of Physical Therapy
Cory Blickenstaff's Patient Education Handouts
Oh My God I Got It
Using the Concept of Ideomotor Therapy...
My Pain Handouts

Discussions of particular treatments and methods.
Science or Marketing?
The Manipulation Solution
The Problem with OMPT
Fascial Contractility and Myofascial Trigger Points
Let's talk about ART
Spinal Manipulative Therapy: The Great Conversation
Myofascial Release: The Great Conversation
Postural Restoration

Things that really grind my gears
Terminology
Trainers playing doctor
"You're Arrogant"

Performance, strength training and conditioning.
Strength Training Progression Models
Let's Talk About Periodization
The Trouble with Crossfit
Deconstruction of "Z-Health"
Z-Health Part Two

Other reading outside of SomaSimple which references discussions here that you should check out:
Neil O'Connell at BodyinMind: Behavioral treatments for back pain
Lorimer Moseley at BodyinMind: Jointheads, Fasciaheads...
EBP, Deep Models, and Scientific Reasoning at EIM.
Craig Liebenson DC, Magic Brain Science, and Pain Management

Other threads
Why choose a physical therapist

Jason and Diane's Classic Feuds
More than placebo
Somethings been bugging me...
A deeper interaction

[Jason Silvernail]

Originally Posted by caro

I see a connection there to what I provide my clients as a massage therapist and have come to resent the condescension I perceive in my colleagues faces when I say : I provide relaxing massages, yes absolutely I do.

I forget those colleagues know not the hours and hours I have been spending this past year reading that which can give credence to my pet theory; that this crazy life people are leading is straining their nervous systems beyond what it was meant to take.( I take it personally and I shouldn't.) I've made some attempts at directing them towards SS and regularly post links and reading\viewing suggestions on my FB page, to no avail. We just aren't there yet as community here in Québec. And I haven't what it takes to stir up a fuss.

Were it not for SomaSimple, I would be unaware of the Neuromatrix, Patrick Wall, Butler, Moseley, Ramachandran, Sapolsky (who has played an enormous role in my reasoning.) Doidge, Neil Pearson, Simple Contact, DNM etc, etc, etc...

....

I don't buy the argument that SomaSimple is devoid of pertinent information nor that the tone here is difficult or confrontational. Yes, the ''atmosphere'' is strained at times and some threads have made me feel the way I felt when as a child, I heard my parents arguing. No one here makes any claims that these waters are easy to navigate. But.

People here ALWAYS give you the chance to explain yourself. They always give you the chance to reexamine your position and hash it out. They are not afraid to say they were full of shit when such is the case. They are not afraid of saying they were WRONG. And if they close the door in your face, you can be sure they gave you ample time to flesh out your thoughts and expose your theories.

Try finding that kind of place anywhere else.

I dare you.

Originally Posted by Alice Sanvito

It is frustrating the almost complete lack of rational thinking in my profession but there are, and have been, a few well-informed souls out there. I have sought them out and learned what I could from them. In the last few years those connections became unavailable and I've felt very isolated. This past year has been tremendous as I've made wonderful connections that have provided support, encouragement, revitalized my education, and given me a place to converse with people I trust whose heads are screwed on half straight.

In public, I try to remain as calm, polite, and informational as I am. In private, I'll express my frustration a little more bluntly. So, if you'll indulge me for a moment . . . It is endlessly frustrating to me, not only the lack of critical thinking in my profession but the deep ignorance and often unbelievable arrogance. It's stunning at times. (The most recent off-the-scale example - an MT on another forum suggested, in all seriousness, that a very sick person with a very resistant case of pneumonia, who is in an induced coma, be given intravenous hydrogen peroxide. I am not making this up.) It just makes me want to crawl into my hole, see what few clients who find me, and avoid the rest of my profession as much as I can.

And if I had to, I would. However, it's not healthy for me and it's not healthy for the greater good. We all, as one sort of manual therapist or another, do what we do because we want to be helpful in some way. The best way I know to do that is to continue to learn, to seek out those who also are learning, to do my best to maintain personal and intellectual integrity and find the company of those with similar values and interests.

I got into trouble the very first hour I started massage school when my teacher made an obvious and glaring error about basic molecular theory. Thinking she just misspoke, I said something and quickly learned that in this profession, people don't know basic science and don't like to be challenged. They find it quite annoying to bring up basic science or ask the most obvious rational questions. So, I've been annoying MTs since 1991. I try not to be too much of a jerk about it but at the same time, I just can't let blatant, glaring nonsense go by.

I hope to get more skillful and it seems recently I'm finding some outlets for getting the word out. This morning I got an invitation from the president of our state chapter AMTA to submit my recent article on energy work to the newsletter. That goes out in paper form to all our state members and in email form to members in four states. This, in my mind, is good news, that there's support for having a civilized discussion about an issue that is divisive and, in my mind, the most important issue in our profession - whether we are going to be professional and rational or continue to act as if reality were optional.

I thank all of you here for the encouragement and support. You are part of my growth. I'm honored and humbled to be in your company. Thanks from the bottom of my heart.

Originally Posted by keithp

I agree that everyone learns differently, but I would argue that to be a health professional who remains willfully ignorant of current concepts related to the care of their patients and is unwilling to adapt their own learning methods to provide better care for those patients needs to have their capacity for "caring" brought into question.

Originally Posted by keithp

I suppose that to me, there is a distinct difference between 1) To be concerned or interested and 2) To provide needed assistance or watchful supervision. The latter requires action while the former does not. When I think of "caring" and PT, I have traditionally thought that it was necessary to be both concerned (exhibit interest/empathy) and provide needed assistance. In as much, I would agree that to "care" (empathy) is a requisite in providing care (needed assistance) as a PT.

What I have difficulty with is the inconsistency in ANY therapist (the good or bad) who is working as a clinician charged with providing needed assistance and is oblivious to their own lack of effectiveness and refuses to seek out new/additional/pertinent information to provide beneficial care to their patient. The responsibility of the provision of "needed assistance" by a PT is not to simply "do anything". Instead, it is to do "something" with the intent of addressing the manifestation of that "thing" in the patient with which the PT empathizes with (i.e. Pain, inability to live independently, etc), based on the best information available to the clinician. The internet has altered forever what information is now become available to the clinician in question.

And that is where, to me, things get a bit dodgy...can the clinician who doesn't seek out information on the internet really be as empathetic as they think they are (or claim to be) if their outcomes are less than desirable? What do they really "care" about? Is the patient's response to treatment truly at the forefront of their decision making model? Do clinicians mistake sympathy for empathy? Would this allow the clinician to dissociate from their patients in such a way that a lack of desirable outcomes is not taken as a personal affront to everything they have learned about their own practice? There seems to be a fundamental incompatibility between being empathetic while simultaneously not seeking out a means by which professional growth is attainable. Maybe John is right when he says, "Fear with its partner ego are what invariably intercede between stagnating and growing."

The thing that is disturbing to me is the logical consequence of a scenario whereby a clinician's lack of motivations for professional growth are a direct reflection on their abilities to empathize with their patients, which I believe we all agree is (as Eric notes) a requisite to becoming a PT. Again, I believe this calls into question the capacity for such a clinician to care at all and makes me wonder how many PTs do not possess the requisite skills required to perform the job they are hired/licensed/trusted to do.