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Old 05-07-2010, 10:41 PM   #1
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Default Giving offense

Yesterday being July 4th I saw that the musical 1776 was being broadcast so I watched a bit.

In the scene depicting the vehement debate surrounding the final wording of the Declaration many proposed a softening of the language so as to avoid repercussions. Exasperated, one supporter of the original document says:

Quote:
This is a revolution; we’re going to have to offend somebody.
I recently read again the Where’s the Revolution? thread and started thinking about how much has happened to alter our theory but how little has changed in the way of practice.

As was said, we have to offend somebody.
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Old 06-07-2010, 01:59 PM   #2
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The EIM people haven’t actually changed the method (coercion), they’ve just amplified it in a manner many find personally empowering and sexy. Surely they know that theory and mechanism has been altered drastically by advances in neuroscience, and, I think they’ve acknowledged this.

Still, they act as if offended.

No wonder they’ve become the darlings of the APTA, not an organization deeply steeped in the science based dictum of prior plausibility.

Revolutions are supposed to be about moving forward, not the other way.
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Old 06-07-2010, 05:02 PM   #3
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Maybe PT has served its purpose, lived its lifespan, is past its due date, and, like any biological organism (multi-cellular) or cultural organism (society), it is going to die. Maybe it is supposed to.

Human primate social grooming will live on forever, however, as long as there are humans; most of it remains hidden in a cloud of woo/unthink like an octopus hides in a cloud of ink to make a getaway if happened upon.

We (who had this crazy idea that being a PT meant being scientific in purpose) are trying to examine the octopus starting with removal of ink glands (ironically by using a lot of our own digital ink) - it seems to not like this very much.
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Old 06-07-2010, 05:46 PM   #4
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PT is still relatively young. It's litterature base is still in it's infancy and the quality of that litterature is often poor to moderate.

There seem to be a desire to play with science's rules yet remains a tendency to cling to old folkloric traditions.

I think as our research base gets wealthier, it will be shown that many of what's been traditionnaly done has either no or little effectiveness compared to inert/placebo treatments.

Maybe some actual and novel approaches will get good enough results to keep the profession alive in its actual form (reimbursment, referals,...). Nevertheless, we are still left with our bare hands (or other non or nearly non-invasive modalities) trying to influence complexes synaptic and chemical reactions. What are the odds we succeed ?
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Old 06-07-2010, 05:49 PM   #5
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I mean aside than by boosting any context related positive expectancy ?
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Old 06-07-2010, 07:04 PM   #6
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Maybe some actual and novel approaches will get good enough results to keep the profession alive in its actual form (reimbursment, referals,...). Nevertheless, we are still left with our bare hands (or other non or nearly non-invasive modalities) trying to influence complexes synaptic and chemical reactions. What are the odds we succeed ?
I think we differ in opinion here Frederic.

In actual fact....the origins of our great little profession had things somewhat correct: Movement and directing people away from impairment and disability.

Somehow, we've evolved into a "trade" wherein the main goal appears to be generating revenue, providing techniques that appear to the general public to be "specialized" and therefore worthy...

If the profession can get onside with science-based approaches, I can see us getting back to our roots with more powerful tools.

Providing patients with sound, science based explanations for why they have pain. And as such, a means to cope, move forward and transition AWAY from being impaired. Towards MOVEMENT and MOBILITY. No fancy stabilization programs, no specific manipulation, no....bunk.

Unfortunetly we have fallen prey to trying to compete with various other woo woo practioners( Chiro's, Acupuncturists etc). When we should have simply stuck to our roots( movement, mobility, education etc).

I see our role as crucial...if we could just move away from all the WOO WOO.

Afterall....this is how our profession came to be. And it added value.

We can have a HUGE positive impact on patients lives if we choose the correct course and avoid the pitfall of becoming placebo dispensors making people "feel" better for the moment...but more stupid and impaired long term.

This site seems to get that.

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Old 06-07-2010, 07:15 PM   #7
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proud,

Wonderful post.
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Old 06-07-2010, 07:40 PM   #8
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proud, I agree. I wonder what your take is on all the motor control/ movement impairment stuff being promoted out there these days. Do you think it's going to help or hurt? Do you think it moves the profession in the right direction or closer to the edge of the cliff?
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Old 06-07-2010, 08:11 PM   #9
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proud, I agree. I wonder what your take is on all the motor control/ movement impairment stuff being promoted out there these days. Do you think it's going to help or hurt? Do you think it moves the profession in the right direction or closer to the edge of the cliff?
Are you talking about Shirley Sahrman stuff? Tra/multifidus stuff?

If yes..then I would absolutely say this is a giant step backwards for our profession.
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Old 06-07-2010, 08:40 PM   #10
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This sort of comment is exactly what I'm referring to.

We see it as courageous, they see it as impertinent, ignorant and offensive.
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Old 06-07-2010, 08:50 PM   #11
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Quote:
Maybe PT has served its purpose, lived its lifespan, is past its due date, and, like any biological organism (multi-cellular) or cultural organism (society), it is going to die. Maybe it is supposed to.
How about this for the title of an essay/editorial: Is Physical Therapy Dead- Or Am I?: Musings of a Science-Based PT

I am actually writing this post as I watch my colleague attempt to get his patient to contract her lower trapezius during a complex prone arm lift maneuver with a pulley in one hand and a dumbbell in the other.

I think she's about 16 years old with neck pain. I envision her at 36 having a cervical fusion due to chronic neck pain and cervical radiculopathy.
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Old 06-07-2010, 09:25 PM   #12
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John, I hope you write that! I want to read it.

proud, I agree.

Barrett,
Quote:
We see it as courageous, they see it as impertinent, ignorant and offensive.
You forgot to include "inconsequential."
Let's see if we can make them wrong about that.
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Old 06-07-2010, 10:54 PM   #13
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Proud,

Don't get me wrong. I think an intervention à la explain pain is warranted in many cases of persistant pain and even if it is borderline with cognitive behavioral therapy we (PT) (at least I) can have some good results with that. I've read some research showing the result were comparable with other type of (woo) therapies. Although more in line with science it might not necessarily be more effective. This is still to be determined. Just to be clear, with equal outcomes, a good rational is always what should prevail.

My point is that, we need to envision the possibility that manual therapies are obtaining pain relief by nothing else than a strong, calculated and augmented placebo response (A complex response from the brain in response to the entirety of our interventions). There is nothing wrong with that (or is it?). But the potential scope of our action in such cases is somewhat limited. If pain is the main complaint and nothing pathological resides behind it then we stand a chance.

Otherwise, we might have a limited potential of truly influencing the condition.

Do you think research will ultimatly find a particularly effective way of reliably and repetetively treat typical epicondylgia, for instance, with manual therapies ?

I think actual research in PT is trying to find the optimal technic or combinaison of actions to obtain a very good effectiveness in treating back pain for instance (which might be the wrong way to go). Maybe with the tools we have (our hands and words) we have a limited scope of effectiveness regardless of our understanding of science. We need to envision this possibility. I am not saying that we can't be more effective with sound scientific rationals (I think we are) but simply, that even with this knowledge our impact may have a ceiling effect since hands and words, regardless of what they do, have a limited potential (yet present) to act on a chemical level.

Maybe I sound a bit pessimistic but until being proven wrong with overwhelming scientific data to the contrary this is my null hypothesis. So if PT gets the facelift it desperatly needs, I think I should loose a good part of my caseload with it. (less people will need PT, for less appointments per week and for less time).

Pardon my pessimism, maybe it's just a phase.
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Old 06-07-2010, 11:37 PM   #14
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Quote:
Maybe PT has served its purpose
Now there is a truly radical idea. I must admit to not being one I have thought about before. At least not in those terms.

I had to visit a local outpatients dept. this afternoon and as I wandered in through the car park to the glass fronted building, I was pondering the many changes that are happening to the public sector (NHS) workforce due to the "cuts" being imposed. Many here are quick to point the finger at the public sector and declaim the difference with the (profit making) private sector. I was struck by the thought that the building oozed business, money kind of business, it could have been any kind of business. It looked and felt much the same. Is this a trade in the sense of economic trade, marketing, buying and selling services, making money for the people within. It and the generic healthcare we, market and sell healthcare to an ever hungry for health, public. I did feel rather uncomfortable particularly when I noted that the neighbouring building was the physio dept which was even bigger and newer!

What am I peddling?

regards

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Old 07-07-2010, 02:20 AM   #15
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Proud,

So if PT gets the facelift it desperatly needs, I think I should loose a good part of my caseload with it. (less people will need PT, for less appointments per week and for less time).
Absol-freakin'-lutely...

I've often postulated that perhaps 50% of all patients "in" Physiotherpy actually have any potential( I use that word for a reason) to benefit.

50%...that's it.

And of those 50%....half of those only need basic education, guidance and motivation.

Very few require the 20+ sessions I see billed almost as if simply because that's the payors limit!

Get rid of third party payment for CST, MFR, acupuncture, ear candelling, joint jammin' or whatever the heck else this profession has chosen to dip it's dumbass nose into....and the cream should rise to the top.

Unfortunatley this current healthcare system is broken when it comes to treating things of the NMSK variety. It's consumer driven by ignorance and predatory pseudo clinicians all too willing to vulge of the unsuspecting victim (the patient).

I still say when healtcare costs reach unsustainable levels we will see more scrutiny appied to what get's paid for....better hope you can substantiate what you do with sound scientific principles.

And "success" will not be measured by points on some scale like the RMQ or Oswestry. It will be measured by how much YOU saved the healthcare system in long term costs. This is how the PT profession came to be really.....we were supposed to get people moving and out of the expensive hospital beds faster....thus reducing cost.

Oh and thanks Barrett for the positive feedback on my thoughts on our profession.

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Old 07-07-2010, 04:06 AM   #16
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John suggests:

Quote:
How about this for the title of an essay/editorial: Is Physical Therapy Dead- Or Am I?: Musings of a Science-Based PT
Wouldn't this write itself?

I want to read it, help with the writing, whatever.
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Old 07-07-2010, 04:58 AM   #17
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I think it would be a good name for a new group blog. Hint hint.
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Old 07-07-2010, 05:16 AM   #18
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proud, I agree. I wonder what your take is on all the motor control/ movement impairment stuff being promoted out there these days. Do you think it's going to help or hurt? Do you think it moves the profession in the right direction or closer to the edge of the cliff?
I think motor control along the lines of somatic education is vital. The problem is the majority of what's promoted tries to fix defects/impairments instead of using movement to initiate a felt sense and increased body awareness. In general terms the former is about aesthetics and the latter is about refreshing the body schema and getting the peripheral nerves moving.
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Old 07-07-2010, 05:22 AM   #19
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I agree Reg.
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Old 07-07-2010, 05:30 AM   #20
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Quote:
I think motor control along the lines of somatic education is vital.
Assuming you mean vital to the resolution of pain, then I'm wondering what kind of motor control-based somatic education you recommend. If the "motor control" required for pain resolution necessitates instinctual actions, then how do you suggest the therapist educate the patient to achieve this?
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Old 07-07-2010, 05:49 AM   #21
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proud,

I agree wholeheartedly, my fear is related to teh following...

Quote:
I still say when healtcare costs reach unsustainable levels we will see more scrutiny appied to what get's paid for....better hope you can substantiate what you do with sound scientific principles.

And "success" will not be measured by points on some scale like the RMQ or Oswestry. It will be measured by how much YOU saved the healthcare system in long term costs. This is how the PT profession came to be really.....we were supposed to get people moving and out of the expensive hospital beds faster....thus reducing cost.
Just who is going to be in the position of deciding what those "sound scientific princilpes" are...APTA, MD, insurance companies, case managers, claims reviewers, academic institutions, state regulators. Frankly, I have very little faith in any of the above being able to determine what would really constitute sound scientific principles from woo woo stuff.

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Old 07-07-2010, 07:12 AM   #22
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Assuming you mean vital to the resolution of pain, then I'm wondering what kind of motor control-based somatic education you recommend. If the "motor control" required for pain resolution necessitates instinctual actions, then how do you suggest the therapist educate the patient to achieve this?

Yes, vital for pain resolution and potentially a whole lot more. Without movement there?s no true sense of embodiment.

As for education it varies from imagery, breathing, choreographed movements, and gentle hands on work (similar to Diane?s skin stretching) to elicit the 3rd stage of Wall?s instinctive movement output.
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Old 07-07-2010, 04:53 PM   #23
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What do you mean by "true sense of embodiment?"

Does this have something to do with internal locus of control/self-efficacy?
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Old 07-07-2010, 08:20 PM   #24
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What do you mean by "true sense of embodiment?"

Does this have something to do with internal locus of control/self-efficacy?
Embodiment as a subjective feeling of self awareness from experiencing the world around you, especially through your felt sense. At first blush it seems possible to self embodied with either an internal or external locus of control. What are your thoughts on the matter?
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Old 07-07-2010, 08:26 PM   #25
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My thoughts are that it sounds kind of wooey at first blush.

After your explanation, I'm just more confused about what it actually means.
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Old 07-07-2010, 11:24 PM   #26
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My thoughts are that it sounds kind of wooey at first blush.
To each their own.

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After your explanation, I'm just more confused about what it actually means.
How's this, John -- feeling physical sensations (awareness) through movement organizes the body schema and moves one towards embodiment.

A more intriguing idea, at least to me, is looking at Wall's 3rd stage of instinctive movement in relation to embodiment. I remember reading that the corrective process occurs when a restriction or inadequacy in a movement is encountered. Can instinctive movement occur without awareness? If not, then it can be stated that the process of moving towards embodiment is corrective and as stated previously this can be achieved through imagery, breathing, choreographed movements, and gentle hands on work (SC, DNM, or whatever else).
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Old 07-07-2010, 11:43 PM   #27
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I'm with regnalt (forgot your actual name, again) on this.

It's a difficult concept to convey by word alone but he's done well. Our behavior is driven to a large extent by context, and when that context includes an awareness of our internal processes, motivations and instincts we can express it with greater authenticity.

I likeI authenticity but understand the word "authentic" is showing up with increasing frequency among the MFR crowd. Give them a chance and they'll mutate this like they have a few other words and concepts.

When they do, I'll be forced to respond as I have to their ideas in the past: Ick.
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Old 08-07-2010, 04:00 PM   #28
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I think I'm having a semantical problem with your initial explanation, Reg. When I look back at your first clarification post, I'm trying to conceive of what the lack of embodiment, or a lack of a "felt sense" would feel like. Would this manifest itself as feeling physically out of control, numb, discoordinated, disconnected to one's environment? Might it feel uncomfortable or painful even? I'm just trying to make practical sense out of a vague term. When you referred to being "self embodied" I was trying to figure out what other kind of embodiment could there possibly be, short of an Invasion of the Body Snatchers scenario.

Barrett's explanation of behavior being driven by context helps. Then, embodiment is one's felt sense within the current contextual reality. Have I got that right? If so, that make sense to me, and I can see how gaining awareness of ones body schema can lead towards achieving this.

Would it also be accurate to say that feeling "self-embodied" is a state of feeling comfortable in one's skin?

How then, if one has achieve an authentic "felt sense," could they not possess an internal locus of control? Those two states seem to be mutually inclusive.
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Old 08-07-2010, 04:26 PM   #29
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I can understand John's issue with the word "embodied" being used as if everyone knew exactly what it meant and there was complete scientific definition and agreement - the word has been taken over a lot by wooers. It's almost become a screwed-up word already.

Some thoughts:

1. With all the info and informed consideration coming out these days from neurophilosophers the calibre of the Churchlands, it's starting to look like the whole language of first person singular may require a revamp soon. Specifically who is the "I" that "feels" "embodied"? That's a bit of a pokey question, though, and I (the "I"-illusion program my brain runs when it is awake) realize(s) that.

2. It might be helpful if we were to start with what things "feel" like as/when dis-embodied. People doing rubber-hand work in Switzerland are studying this, as is Moseley. The locus of body ownership can shift dramatically to the body of a mannequin so convincingly that threatening the mannequin with a blow from a hammer will create precise autonomic response in a person that is identical to that which would be elicited by the same threat to one's actual body.

3. The best book on understanding what the difference (between how embodied and disembodied feels) is, is still, IMO, Blakeslee's book, The Body has a Mind of its Own from a couple years ago.
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Old 08-07-2010, 05:21 PM   #30
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Choosing something from this wiki link might begin to add some semantic clarity.
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Old 08-07-2010, 06:42 PM   #31
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'In actual fact....the origins of our great little profession had things somewhat correct: Movement and directing people away from impairment and disability.

Somehow, we've evolved into a "trade" wherein the main goal appears to be generating revenue, providing techniques that appear to the general public to be "specialized" and therefore worthy...

If the profession can get onside with science-based approaches, I can see us getting back to our roots with more powerful tools.

Providing patients with sound, science based explanations for why they have pain. And as such, a means to cope, move forward and transition AWAY from being impaired. Towards MOVEMENT and MOBILITY. No fancy stabilization programs, no specific manipulation, no....bunk.

Unfortunetly we have fallen prey to trying to compete with various other woo woo practioners( Chiro's, Acupuncturists etc). When we should have simply stuck to our roots( movement, mobility, education etc).'

Proud you seem to have hit the nail on the head , an excellent summary of the situation we are in............it seems like a world wide trend with 'mavericks' looking at the emporer and saying yes this bloke is really naked .......
As many did I leapt around after graduation leaping from thing to thing enthusiasically believing all this guru led stuff but really doubting my back to front logic ...looking for evidence for techniques, procedures and the usual obsession with the 'mechanical body'. Its pain behaviour , physiology, therapeutic interaction/communication we are dealing with . As I have got more knowledge of the above and also got an awareness of social,cultural and psychological issues therapeutic techniques are not very important in the general scheme of things. What is important is your summary --making things simple restoring confidence and making goals individually relevant ......... some evidence here see 1 on this link to Lorimers review on influence on the motor coretex http://bodyinmind.com.au/up-close-an...m-the-experts/
The embdoiment issues are really interesting and as John summarised 'Then, embodiment is one's felt sense within the current contextual reality'. It is easy to write this down but harder to do it or feel it ........
I think many people have no idea of the 'lived body' or intereoception (see Bud Craig) and as John described graphically this often leads to strange practices like trying to turn people who are often anxious and fearful into weight lifters (with no obvious reason as to why they are doing this..... Education via the easily digested Sandra Blakeslee book should sort this out but for some reason this does not seem to be that popular ...
Embodiment may sound woo but Philosophers such as Merleau Ponty's work are being integrated into modern neuroscience (that's my understanding at least)
http://www.thegreenfuse.org/embodiment/definition.htm

Its seems to me that the deeper the understanding of physiology and pain/behaviour than the simpler things (intervention wise) are but contextural and educational information has to be more nuanced and relevant to the individual person .
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Old 08-07-2010, 08:12 PM   #32
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That's quite good, ian. I'm glad you chimed in.

I particularly like how you describe that it's the context that requires individualization. It seems the myriad techniques that have come about in order for us to "individualize" treatment have achieved the exact opposite. That is, we are asked to identify the best techniques and/or exercise regimen for some discrete biomechanical diagnosis that doesn't exist. We end up having a toolbox full of techniques and choreography that are often chosen based on this illusion.

When patients improve, it's probably because we've-intuitively or accidentally- modified the ritual to fit the context, not because we've chosen the right "dosage" of manual therapy and exercise.

Many patients of course don't improve.
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Old 08-07-2010, 11:02 PM   #33
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I keep thinking of the Maitland mantra: Make the features fit.

To me, that has always indicated that a PT looks for signs and symptoms which fit certain known diagnoses and ignore anything else.

Maybe that's not accurate, but it would mean that
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Many patients of course don't improve.
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Old 09-07-2010, 01:58 AM   #34
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Making features fit is Maitland's term for Abductive Reasoning.
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Old 09-07-2010, 07:51 AM   #35
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Would it also be accurate to say that feeling "self-embodied" is a state of feeling comfortable in one's skin?
Off the top of my head I do think it's possible for a person to feel "comfortable in their own skin" while disembodied and with a smudged body schema. The non-scientific phrase to explain such an event is sensory-motor amnesia.
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Old 09-07-2010, 08:10 AM   #36
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That's quite good, ian. I'm glad you chimed in.

I particularly like how you describe that it's the context that requires individualization. It seems the myriad techniques that have come about in order for us to "individualize" treatment have achieved the exact opposite. That is, we are asked to identify the best techniques and/or exercise regimen for some discrete biomechanical diagnosis that doesn't exist. We end up having a toolbox full of techniques and choreography that are often chosen based on this illusion.
In many situations the context doesn't need to be individualized, but altered in a general manner.
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Old 09-07-2010, 04:09 PM   #37
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Quote:
In many situations the context doesn't need to be individualized, but altered in a general manner.
For instance?

Quote:
Off the top of my head I do think it's possible for a person to feel "comfortable in their own skin" while disembodied and with a smudged body schema. The non-scientific phrase to explain such an event is sensory-motor amnesia.
Isn't sensory-motor amnesia (SMA) Hanna's explanation for the development of mechanically- originating musculoskeletal pain? If a consequence of SMA is persistent motor output that suppresses instinctual movement, then the patient would experience pain and a smudged body schema.

However, and I haven't read Hanna's book, but based on my limited understanding of SMA, as long as instinctual movement isn't unduly suppressed, then it's a normal function of the CNS to improve efficiency/reduce cortical workload.

So, does SMA always result in a smudged body schema and disembodiment?
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Old 11-07-2010, 11:41 PM   #38
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For instance?
Is the context for SC individualized? For instance, my hands-on interactions are often nothing more than holding a client?s foot/ankle, no matter where the pain happens to be located. Are you implying that the moment I touch my client the context is individualized? If so, any cookie cutter bodywork or physical therapy session has individualized context, right?



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Isn't sensory-motor amnesia (SMA) Hanna's explanation for the development of mechanically- originating musculoskeletal pain? If a consequence of SMA is persistent motor output that suppresses instinctual movement, then the patient would experience pain and a smudged body schema. However, and I haven't read Hanna's book, but based on my limited understanding of SMA, as long as instinctual movement isn't unduly suppressed, then it's a normal function of the CNS to improve efficiency/reduce cortical workload.
Hanna based SMA largely on Selye?s GAS. The musculoskeletal impairments are a window to the arousal state of the nervous system. At which point Hanna veered off into his own classifications of reflexive output patterns.


The following is my interpretation and it's not based on Somatics.

At times people hold their bodies in a particular posture as part of a stalled instinctive motor output. This doesn?t necessarily mean they?re still in pain, but simply aren?t aware that their still posturing. The pain output is initiated again if, for whatever reason, they reach the limits of their adaptive capacity.

On the flipside bodies can adapt without the initial pain output. For example, people sit at their computers all day and their nervous systems change resting posture to maximize efficiency for survival. I?d consider this an increased sympathetic response and not corrective, per se.

In both possibilities people have SMA, and not pain, until a threshold of personal tolerance is violated.

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So, does SMA always result in a smudged body schema and disembodiment?

The concept of SMA is heavily influenced by proprioceptive and kinesthetic blind spots ? so, SMA results in a smudged body schema. After further reflection the concept of disembodiment isn't as defined...at least to me. It can be part of SMA but at the same time people have "out of body experiences" that have little to do with what we're discussing.

Very interesting discourse, John.
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Old 11-07-2010, 11:46 PM   #39
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Hi Reg, can you tell me what the acronym (Selye's) GAS stands for?

(Not something he put in his car, I'm sure..)
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Old 11-07-2010, 11:53 PM   #40
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Hi Reg, can you tell me what the acronym (Selye's) GAS stands for?

(Not something he put in his car, I'm sure..)
General Adaptation Syndrome.
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Old 12-07-2010, 12:50 AM   #41
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General Adaptation Syndrome.
I read it ages ago but I'm pretty sure that Robert Sapolsky's (excellent) book "Why Zebra's don't get ulcers" has a good amount of information on GAS.

From memory Sapolsky lauds Seyles work as being ground-breaking but points out that recent research has shown that the bodies stress response doesn't work in the way that Seyle postulated in his GAS theory.
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Old 12-07-2010, 01:51 AM   #42
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On the flipside bodies can adapt without the initial pain output. For example, people sit at their computers all day and their nervous systems change resting posture to maximize efficiency for survival. I’d consider this an increased sympathetic response and not corrective, per se.
Why do you consider adapting to your environment an increased sympathetic response?
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Old 12-07-2010, 01:54 AM   #43
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From memory Sapolsky lauds Seyles work as being ground-breaking but points out that recent research has shown that the bodies stress response doesn't work in the way that Seyle postulated in his GAS theory.
Do you have any links/references for the recent research you could provide here?
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Old 12-07-2010, 02:11 AM   #44
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Do you have any links/references for the recent research you could provide here?
Sorry no but Sapolsky's book is well worth a read. One of the most interesting books on health i've ever read.

I think Sapolsky's take on the issue is that the GAS as described by Seyle includes an 'exhaustion' phase when the hormones secreted during the stress response are depleted and therefore we have no defense against the stressor and hence get sick.

Sapolsky counters by saying that this hormonal depletion is a very rare scenario and that far more commonly the stress hormones stay at high levels and hence actually the stress-response itself becomes the damaging agent.
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Old 12-07-2010, 11:30 AM   #45
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Is the context for SC individualized? For instance, my hands-on interactions are often nothing more than holding a client’s foot/ankle, no matter where the pain happens to be located. Are you implying that the moment I touch my client the context is individualized? If so, any cookie cutter bodywork or physical therapy session has individualized context, right?



Hanna based SMA largely on Selye’s GAS. The musculoskeletal impairments are a window to the arousal state of the nervous system. At which point Hanna veered off into his own classifications of reflexive output patterns.

The following is my interpretation and it's not based on Somatics.

At times people hold their bodies in a particular posture as part of a stalled instinctive motor output. This doesn’t necessarily mean they’re still in pain, but simply aren’t aware that their still posturing. The pain output is initiated again if, for whatever reason, they reach the limits of their adaptive capacity.

On the flipside bodies can adapt without the initial pain output. For example, people sit at their computers all day and their nervous systems change resting posture to maximize efficiency for survival. I’d consider this an increased sympathetic response and not corrective, per se.

In both possibilities people have SMA, and not pain, until a threshold of personal tolerance is violated.


The concept of SMA is heavily influenced by proprioceptive and kinesthetic blind spots – so, SMA results in a smudged body schema. After further reflection the concept of disembodiment isn't as defined...at least to me. It can be part of SMA but at the same time people have "out of body experiences" that have little to do with what we're discussing.

Very interesting discourse, John.
Very interesting, indeed! Thanks for the clarity of your thoughts, Regnalt. I really enjoyed this post.
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Old 12-07-2010, 02:46 PM   #46
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Sorry no but Sapolsky's book is well worth a read.
I've long known about his Zebras book but I've never read it. I'm picking it up at our library today. Thanks for the tip.
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Old 12-07-2010, 06:06 PM   #47
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I agree that anything by Sapolsky is worth reading. Be sure to pick up the most recent edition of the zebra book.
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Old 12-07-2010, 07:58 PM   #48
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I picked up the third edition--it's the one our library had.
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Old 12-07-2010, 09:16 PM   #49
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Default culture driven disorders

I posted this on the fibromyalgia topic on SOS thread . As the PDF can be obtained readily from this link I enclose it here......http://fyam.dsam.dk/files/8/artikel2.pdf
It may be read alongside Sapolsky perhaps . Certainly the topic is worth considering and its similar to the views of Hadler . The conclusions are worth reading too and are relevant in daily practice - at least the kind of practice I have always been in.
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Old 12-07-2010, 09:17 PM   #50
ian s
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Default wrong place...

Sorry ! meant to press the new thread topic button instead of new post......
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