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Old 09-01-2011, 01:08 AM   #101
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(*And I am not suggesting that this is the sole source of pain, I am fully aware that the brain can output pain without any apparent nociceptive input*).
Not "apparent", no nociceptive input at all. Those pesky meanings of words...

Jen, have you read much about the neuromatrix theory, including Explain Pain? I think if you delve deeper into some of the literature on it that you'll understand why phrases like "the brain can output pain without any apparent nociceptive input" and "the sole source of pain" are confusing and inaccurate.

When I hear phrases like this from someone who has recently studied the McKenzie approach and apparently become quite proficient with it, I'm concerned that this method has not adequately embraced current pain science, and therefore continues to promote inaccuracies and unhelpful concepts.
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Old 09-01-2011, 01:09 AM   #102
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If he had acted on the then current neuroscience instead of promoting his "method" all over the world and handing out "Bronze Ladies" to people, then I'd have a lot more respect for what he's [McKenzie's] done.
I feel that he is concerned with the nervous system. He suggests that the structures which obstruct movement in the derangement syndrome are all structures which are highly innervated. To abolish pain we must reduce the compromise of these structures. Certainly it may be too simplistic in thinking that these sources of neural compromise are simply within or around the joints as opposed to being anywhere within the system, but again, that's what I'm trying to get at with this thread. Repeated movements do more than just move a joint, they affect every tissue that is involved with the movement.

And as far as promoting his method and the Bronze Ladies go, can you really blame him? Research is what is needed to further validate or refute his theories, why would he not encourage this? Are you opposed to Butler and NOI teaching their courses all around the world? And Barrett Dorko, shame on you for teaching simple contact. How dare they!!!! Um, obviously not!

And I'm pretty sure I've read many times on SomaSimple that you'd love to see more people leave the standard ranks of PT and come join "Fortress PT", well if people are unaware that such a place exists then how are they ever going to get there?
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Old 09-01-2011, 01:14 AM   #103
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And I'm pretty sure I've read many times on SomaSimple that you'd love to see more people leave the standard ranks of PT and come join "Fortress PT", well if people are unaware that such a place exists then how are they ever going to get there?
No no, wrongo.
Somasimple is anti-Fortress PT.
Fortress PT = standard ranks.
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Old 09-01-2011, 01:17 AM   #104
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He suggests that the structures which obstruct movement in the derangement syndrome are all structures which are highly innervated.
Is this for both spinal and peripheral joints? What are some examples of these highly innervated structures?
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Old 09-01-2011, 01:17 AM   #105
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Argh, semantics!! Okay, there can be pain with no nociceptive input. But you can't tell me that this is always the case. The success (for lack of a better word) of McKenzie I feel is more in the presence of pain originating from nociceptive input.

The reason I began looking for something different and found SomaSimple was because I don't know what to do in the case of a few clients I now have with chronic pain who have been through physio after physio with no success. I don't doubt these are cases of central sensitization.
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Old 09-01-2011, 01:18 AM   #106
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No no, wrongo.
Somasimple is anti-Fortress PT.
Fortress PT = standard ranks.
Lol, forgive me, I knew there was something about a fortress
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Old 09-01-2011, 01:21 AM   #107
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But you can't tell me that this is always the case.
Correct, it is not the case. To be precise you would describe pain in such instances as nociceptive pain, defined by the IASP as pain arising from activation of nociceptors.
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Old 09-01-2011, 01:24 AM   #108
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He suggests that the structures which obstruct movement in the derangement syndrome are all structures which are highly innervated. To abolish pain we must reduce the compromise of these structures.
This suggests that he is still under the spell of the specificity theory of pain, aka Cartesian or Descartes theory of pain, 400 years old, recently eclipsed (dates vary but at least 1997 if not a couple decades back) by Melzack's neuromatrix model, the latest version of the patternicity theory of pain.

It sounds like he is still assuming "pain" comes one way, in from the periphery. Au contraire. It has a lot of processing to go through before the brain decides if (mere) nociception will become a pain perception. Further to that, nociception is neither sufficient nor necessary for pain.

In other words, structures have nothing to do with pain no matter how thickly nociceptively innervated they may be.

Someone can have horrible x-ray changes and no pain.
Someone can have horrible pain and look just fine on xray. Or MRI.

He still has way more company than we do - like every orthopedic surgeon in the world nearly. Every chiropractor, every ginger, every physiatrist, every massager except maybe Karen, every fascialista... every Sahrmannite, every postural reconstructionist, every core stabillizer, every stretch'n strengthener, except for Jason maybe and Anoop, every Rolfer except maybe Todd Hargrove.. you get the idea?

So, the whole deal here, and why people sound a bit skeptical, perhaps, about your wonderful thing you like, is that they have moved past the whole tissue-based miasma of "this or that thingy in the body is what is the "culprit" and here I can fix that with my handy-dandy-conceptual tool kit I just learned", mentality.

Make sense?
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Old 09-01-2011, 01:35 AM   #109
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Is this for both spinal and peripheral joints? What are some examples of these highly innervated structures?
In the spine these would be the annulus itself, a significant disc bulge that does impinge an exiting nerve root, and meniscoids within the facet joints to name a few.

In the extremities these may be fat pads, meniscoids, a labral tear or meniscal tear to name a few.
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Old 09-01-2011, 01:36 AM   #110
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I don't doubt these are cases of central sensitization.
Jen,
Check out this article on recognizing central sensitization.
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Old 09-01-2011, 01:49 AM   #111
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Originally Posted by Diane View Post
This suggests that he is still under the spell of the specificity theory of pain, aka Cartesian or Descartes theory of pain, 400 years old, recently eclipsed (dates vary but at least 1997 if not a couple decades back) by Melzack's neuromatrix model, the latest version of the patternicity theory of pain.

It sounds like he is still assuming "pain" comes one way, in from the periphery. Au contraire. It has a lot of processing to go through before the brain decides if (mere) nociception will become a pain perception. Further to that, nociception is neither sufficient nor necessary for pain.

In other words, structures have nothing to do with pain no matter how thickly nociceptively innervated they may be.

Someone can have horrible x-ray changes and no pain.
Someone can have horrible pain and look just fine on xray. Or MRI.
Actually he talks about central sensitization, this fits into his "Other" category along with systemic/red flag stuff where there is no clear mechanical pattern to pain.

And he is a firm believer that you should never treat the image (ie. x-ray/MRI/whatever). In fact in the latest course I took which began to address the extremities they discussed Sir Astley Cooper's engravings which are just phenomenal to me. Some of these show hip and shoulder dislocations that were never reduced, and essentially formed new joints as these people went on to live pain-free lives with continued function (albeit altered). And one where the femur emerges into the pelvic cavity, but life goes on.

I can't find a good image yet, but I'll keep googling...or will try and scan one from my book when I can get a chance. Very cool stuff to see!
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Old 09-01-2011, 02:03 AM   #112
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Actually he talks about central sensitization, this fits into his "Other" category along with systemic/red flag stuff where there is no clear mechanical pattern to pain.

And he is a firm believer that you should never treat the image (ie. x-ray/MRI/whatever). In fact in the latest course I took which began to address the extremities they discussed Sir Astley Cooper's engravings which are just phenomenal to me. Some of these show hip and shoulder dislocations that were never reduced, and essentially formed new joints as these people went on to live pain-free lives with continued function (albeit altered). And one where the femur emerges into the pelvic cavity, but life goes on.

I can't find a good image yet, but I'll keep googling...or will try and scan one from my book when I can get a chance. Very cool stuff to see!
So, how does that jive with your other post,
Quote:
In the spine these would be the annulus itself, a significant disc bulge that does impinge an exiting nerve root, and meniscoids within the facet joints to name a few.

In the extremities these may be fat pads, meniscoids, a labral tear or meniscal tear to name a few.
How are these seemingly incompatible situations/ trajectories of thought reconciled?
Just asking.
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Old 09-01-2011, 02:09 AM   #113
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Warning: Less than nice comment ahead.

I think that JennyMack's conflicted ideas about what McKenzie and his system proposes is a direct result of their lack of understanding of a deep model defended by the evidence and an obsession with protocols, results and confirmation bias.

I've been watching that happen within their community for years.
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Old 09-01-2011, 02:15 PM   #114
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So, how does that jive with your other post,

How are these seemingly incompatible situations/ trajectories of thought reconciled?
Just asking.
Hi Diane, I can't say I understand this question. Do you mind expanding for me?

And for the other issue, I was defending McKenzie himself, whereas my other post was my personal beliefs about what is happening with these repeated movements towards a directional preference. Yes my beliefs are based on McKenzie concepts, but I am by no means a McKenzie robot.
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Old 09-01-2011, 02:19 PM   #115
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Warning: Less than nice comment ahead.

I think that JennyMack's conflicted ideas about what McKenzie and his system proposes is a direct result of their lack of understanding of a deep model defended by the evidence and an obsession with protocols, results and confirmation bias.

I've been watching that happen within their community for years.
Lol, thanks for the warning, but I didn't really find any offense in that. And I would agree. That's what my whole post is about, that I don't necessarily agree with the theory behind the method, but that I do like using the assessment and treatment methods. I wanted to discuss here what others thoughts were on why a few repeated movements in a particular direction would be sufficient to abolish pain.
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Old 09-01-2011, 02:54 PM   #116
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Melzack's model offers us numerous explanations, if not always solid and immediate evidence, for why movement may result in a reduction of painful output.

Reduce threat; reduce pain. Reduce deformity; reduce pain. Reduce ischemia; reduce pain. These are just a few of the methods we might employ in order to reach our goal, but they are my favorites, and, I feel, the ones most congruent with my individual way of practicing.

I have suggested that movement might accomplish all three rapidly and that the movement should not only be active (McKenzie's bent) but instinctive as well. Most therapists do not care for the loss of control inherent to ideomotion however.

I have also noticed that "preferential movement" in this case might not immediately reduce discomfort or alter its location. Without question, the movement of sensitized nervous tissue in any direction might temporarily increase pain. Surely we're all familiar with the immediate consequences of movement toward correction that is unwelcomed but required for eventual relief. This isn't common, nor is it uncommon, nor is it entirely predictable. This is where the characteristics of correction become especially useful.

What McKenzie's system does is ignore the power of ideomotion and confine the therapist to a set of rules that produces a rigid approach more restrictive than they might realize and, consequently, permission to "blame" tissue disruption for a problem it also acknowledges may lead to no problems at all. How convenient!

Obviously, at least in JennyMack's experience, it doesn't speak to the astoundingly important effect of ischemia in the nervous tissue.

All this makes my head spin, but it helps to write about it without someone interrupting to say things like, "My patients got better with me when no one else could help them" or "My patients love me" or Robin McKenzie is a genius" or "The McKenzie Institute is changing" or "[insert your own non sequitur here]".
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Old 09-01-2011, 03:53 PM   #117
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Please click one of the Quick Reply icons in the posts above to activate Quick Reply.

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Old 09-01-2011, 03:58 PM   #118
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When the directional preference is found a number of things may potentially be done, and I chose whatever seems most appropriate for that particular client. The possible treatment may be:
1) Repeated movements towards the directional preference. The aim is to progressively move towards end-range, but without moving through pain. Hey sounds a lot like a neural mobilization exercise doesn't it?!? On each repetition the client is typically able to move further than the one before, and often by 10 they are able to reach the end range of the movement without pain. These movements may be active or passive and may be done with or without overpressure (which may be provided by the client themselves or by myself).
2) Sustaining the position of comfort until pain is abolished. This is often done by the client assuming the position and passively relaxing into that position or in some cases I may assist in holding them in the position of comfort.
Dear Jenny Mack:
Great thread you have written about your approach (Mckenzie). I liked so much your presentation. Felicitations.
I liked your concern with the welfare of the patients. I shared your joy with the good results in your patients with mechanical pain.
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Old 09-01-2011, 04:12 PM   #119
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Okay, here we go.

The term "mechanical pain" troubles me. It is not a simplification of anything - it is simplistic.

All pain is neurogenic. At times, it may have mechanical deformation within its origin. Other origins may also be contributing - or not.

If the patient can alter their pain with position or use - I said "alter," not "abolish" - there's every reason to think that movement may help. According to many, instinctive movement (active and unconsciously generated) would be something to consider here.

Well, "many" might be a bit of an overstatement.

When will the manual and physical therapy communties, especially leaders like Paris, McKenzie and Butler, consider this?
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Old 09-01-2011, 04:29 PM   #120
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Melzack's model offers us numerous explanations, if not always solid and immediate evidence, for why movement may result in a reduction of painful output.

Reduce threat; reduce pain. Reduce deformity; reduce pain. Reduce ischemia;reduce pain. These are just a few of the methods we might employ in order to reach our goal, but they are my favorites, and, I feel, the ones most congruent with my individual way of practicing.

Thank you for this, Barrett. I really like this. As I'm reading here and learning more about brain/nerves it's been a bit overwhelming but that is a very clinically helpful simplification for me!
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Old 09-01-2011, 04:36 PM   #121
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You're welcome Tony.

I really think, well, hope, what I've said is defendable.

Anybody who knows this stuff better than I have a problem with it? I want it put through the wringer.
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Old 09-01-2011, 06:10 PM   #122
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Anybody who knows this stuff better than I have a problem with it? I want it put through the wringer.
You're in the right place for that.
I think Mechanical Pain is accurate enough to keep - it speaks accurately enough to origin and is understandable to the wider medical community.
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Old 09-01-2011, 08:09 PM   #123
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I very much like your post 116 Barrett. It's crisp and clear. "Mechanical pain" covers an awful lot of territory, includes vascular considerations as well as neural, and yes it does leave the situation a bit too porous for my taste, allowing a lot of mesodermalism to sit there in smug comfort, but it'll do probably, until we can get the ectodermal explanations wrestled into something a bit more elegant and less gangly.
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Old 09-01-2011, 08:35 PM   #124
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"Mechanical pain", to me, means nociceptive pain in which relevant nociceptive neurons (those with mechanoreceptors) have been activated (activated meaning mechanically deformed to the degree which results in action potentials in the nociceptive neuron).
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Old 09-01-2011, 08:43 PM   #125
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I really don't think mechanical and chemical pain can be easily separated. I don't even think they are valid categories, really. There is pain that is as a result of not moving around enough, or moving too much, that will go away if you lay down or change position. But it's still pain, and it's because of ratcheted up (biochemical) spinal processing or failure of descending modulation to (biochemically) modulate successfully (if it lasts past a few days or weeks).
Then there is the range of pathophysiological kinds of pain that can shade over top of that - CRPS, neuropathic, fibromyalgic, chronic inflammatory all to do with central sensitization run amok and descending systems that don't have clever ways of automatically getting back into control.
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Old 09-01-2011, 08:43 PM   #126
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In other words, structures have nothing to do with pain no matter how thickly nociceptively innervated they may be.
Diane,
I think this is a bit of a strong statement. I can think of many exemples where what is happening to a structure has something to do with pain.

Although pain can happen without nociception, it surely often happens in the presence of it. Injured tissues which are richly nociceptively innervated have a higher likelyhood of triggering a train of nociception coming from free nerve endings embeded in them and thus, have a higher likelyhood of playing a role in the perception of pain by the individual.

Surely, it is not the tissue itself that generates the pain, but what happens to that tissue can either mechancally or chemically stimulate a free nerve ending, send a nociceptive signal which may or may not translate in pain once it reaches the brain.
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Old 09-01-2011, 08:45 PM   #127
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Fred, I think it has everything to do with how you define pain. Remember it does not = nociception. And the brain can make it in the absence of nociception. So there you go. Neuromatrix trumps labelled line/mesoderm. Ultimately. Not that there isn't a large overlap on the Venn diagram.
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Old 09-01-2011, 08:48 PM   #128
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I don't like mechanical pain so much either. there are pain that are influenced by mechanical factors or events but yet, they might not have anything mechanical in the mechanism making the pain subsist.

We could simply say mechanically influenced pain. I think it's less commiting then mechanical pain.
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Old 09-01-2011, 08:54 PM   #129
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Surely that the neuromatrix trumps the mesoderm.

But an absence of tissue would result in no pain in some situations. So tissues do play a role, simply by the fact of being there, innervated with a brain that craves for info coming from them.

I'm sure if you take away all nociceptive input from an individual you would surely reduce the risk of the daily aches that person would feel. But then again, maybe not. Phantom pain is a good exemple of the opposite.

But broken bones do often translates into pain.
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Old 09-01-2011, 09:07 PM   #130
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Perhaps there is a difference between a mechanical origin of pain and a mechanical solution to pain.
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Old 09-01-2011, 09:15 PM   #131
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Jon,

Yes.
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Old 09-01-2011, 09:18 PM   #132
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Remember [pain] does not = nociception. And the brain can make it in the absence of nociception.
If I understand properly, that's why it's considered a mechanical origin and not a mechanical cause.
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Old 09-01-2011, 09:27 PM   #133
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Jon's got it. Various methods may result in a "trick" that always appears the same, thus the method is not the trick.

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Bars and walls do not a prison make - but they sure do help.
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Nociception does not equal pain - but it sure does help.
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Old 10-01-2011, 03:31 AM   #134
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I have suggested that movement might accomplish all three rapidly and that the movement should not only be active (McKenzie's bent)
#1 - McKenzie exercises are by no means always active. They may be active or passive as well as loaded, unloaded, or semi-loaded.

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I have also noticed that "preferential movement" in this case might not immediately reduce discomfort or alter its location
#2 - You clearly don't understand the concept since a movement in the directional preference can only be deemed such if it reduces either the intensity or location of pain, if not both, and if not abolishing pain all together.

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What McKenzie's system does is ignore the power of ideomotion and confine the therapist to a set of rules that produces a rigid approach more restrictive than they might realize...
#3 - There are no rules. I take the clients history, from which it can often be evident which movements they prefer and which provoke pain. From there I decide which movements I want to test, in which order, in which position, and by no means do I feel compelled that I must test all movements. Sometimes from the history you can go right to the movement that indeed turns out to be the directional preference and the client is pain-free. Sometimes depending on the client's irritability it can be useful to do a few movements in the provocative direction to educate them on the role of their positions and movements which contribute to pain, which is then followed by movements in the reductive direction.

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...permission to "blame" tissue disruption for a problem it also acknowledges may lead to no problems at all. How convenient!
#4 - Can you elaborate? Are you referring to the older model where disc bulges were attributed as the cause of problems?

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Obviously, at least in JennyMack's experience, it doesn't speak to the astoundingly important effect of ischemia in the nervous tissue.
#5 - Can you inform me as to how you reached this conclusion?

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The term "mechanical pain" troubles me. It is not a simplification of anything - it is simplistic.
#6 - This is in reference to pain that can be modified by movement, as in there is a mechanical component to the pain, it responds (either favorably or not) to movement. This is not the same as stating that the pain is of mesodermal origin, just that it is affected by movement. I think I've stated enough times by now that I am fully aware that all pain is neurogenic. And I am aware that there are sources of pain which are not affected by movements, and I have not specifically addressed these here since I am specifically talking about pain which can be altered by movement (ie. mechanical pain)!

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If the patient can alter their pain with position or use - I said "alter," not "abolish" - there's every reason to think that movement may help. According to many, instinctive movement (active and unconsciously generated) would be something to consider here...When will the manual and physical therapy communties, especially leaders like Paris, McKenzie and Butler, consider this?
#7 - Hmm, well obviously repeated movements such as those with MDT would be something to consider here too! Why do you expect these other camps to consider ideomotion when you (in my opinion) don't seem to consider any of these others?
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Old 10-01-2011, 03:43 AM   #135
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What do you mean I don't "seem" to consider these? In years past I've actually taught all of this stuff.

You "seem" not to have any idea who you're talking to.
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Old 10-01-2011, 03:54 AM   #136
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I really don't think mechanical and chemical pain can be easily separated. I don't even think they are valid categories, really. There is pain that is as a result of not moving around enough, or moving too much, that will go away if you lay down or change position. But it's still pain, and it's because of ratcheted up (biochemical) spinal processing or failure of descending modulation to (biochemically) modulate successfully (if it lasts past a few days or weeks).
Then there is the range of pathophysiological kinds of pain that can shade over top of that - CRPS, neuropathic, fibromyalgic, chronic inflammatory all to do with central sensitization run amok and descending systems that don't have clever ways of automatically getting back into control.
From my understanding, the separation goes like this:

Mechanical pain
- Is typically not constant, but may be if the person adopts a position which constantly compromises the neurovascular structures
- Pain can be altered by movement (some may reduce and some may provoke)

Chemical pain
- Is constant
- Present during the acute phase of healing when there is sufficient damage to tissues
- May be associated with swelling, redness, heat, tenderness
- Movement (in any direction) is likely to provoke symptoms

Both of these are sources of nociceptive input, so maybe the terminology should change to mechanical or chemical nociception. Aside from these are of course still the central sensitized states, etc.
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Old 10-01-2011, 03:58 AM   #137
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Barrett, again it would appear to me that you don't consider at the very least McKenzie anyways, that's the impression I get.

And what about my other questions?

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You "seem" not to have any idea who you're talking to.
No offense, but I think it is this type of statement that people are referring to as "arrogant" with respect to the Silence of Others thread.
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Old 10-01-2011, 04:21 AM   #138
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Jenny, it is no more arrogant as your assumption
Quote:
when you (in my opinion) don't seem to consider any of these others?
You have no idea what the writers here have done.
This should make you a bit more careful in your assumptions. I would have responded the same way.
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Old 10-01-2011, 04:49 AM   #139
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Mechanical pain
- Is typically not constant, but may be if the person adopts a position which constantly compromises the neurovascular structures
- Pain can be altered by movement (some may reduce and some may provoke)

Chemical pain
- Is constant
- Present during the acute phase of healing when there is sufficient damage to tissues
- May be associated with swelling, redness, heat, tenderness
- Movement (in any direction) is likely to provoke symptoms
Jenny, do you think your understanding of the above issues concerning pain might not be really accurate? I find it somewhat vague and too discriminating.

Most of us here have investigated over the years many different concepts of pain presentation and stick with the one which best fits the current knowledge as described by researchers such as Lorimer Moseley and others.
In a nutshell, pain is pain.

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Old 10-01-2011, 04:53 AM   #140
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No offense, but I think it is this type of statement that people are referring to as "arrogant" with respect to the Silence of Others thread.
Jen,
Barrett studied, worked and taught with people like Stanley Paris back in the days of manual physical therapy's rise in the profession. All of these different schools began their ascension decades ago and Barrett was in the thick of it. As the science evolved, thus did Barrett, whereas the others, like Paris, McKenzie and Grimsby went on to establish educational programs that have now become, in my view, an intractable barrier to growth of the profession.

Only relatively recently has McKenzie begun to change his tune and downplay the role of peripheral structures in persistent pain problems, and this may be because several of his countrymen- Butler, Shacklock and Moseley (and even Geoff Maitland)- have eclipsed him with respect to accurate descriptions of how pain actually works.

On balance, I think the overly peripheral/tissue-based emphasis of the MDT approach as well as those of the other contemporaries that I mentioned above have been an impediment to our growth as a profession and our ability to help the patients who need us most. Those would include the patients that you cited as your motivation for coming here. They are the ones that suffer the most, by far cost the most and continue to to be misled and mis-treated the most by our "modern" medical systems.

I made the same mistake about Barrett when I first rammed horns with him a few years back. Then, I realized that it's not Barrett's responsibility to continually remind me or anyone else where's he's been or what he's done. There's an extensive written record of that which I highly recommend you take a look at. In addition to the myriad threads where this comes up at Soma Simple, you can read his essays here.
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Old 10-01-2011, 05:07 AM   #141
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i don't think Jenny's brief descriptions of mechanical vs chemical pain is too far off.
The MDT books explain this topic rather well.
We all acknowledge things are multifactorial, but there are elements of good history taking and Barrett's Five Questions in there.

I'll disagree with her contention that there are no rules. In fact there are strictly prescribed means of examining and progressing things. This doesn't mean they are wrong, and shortcuts are common when you understand the method.
If indeed the primary problem is mechanical in origin there's no reason to think that an organized and progressive mechanical exam can't find useful ways to treat it. The Long et al study showed that pretty well, I think.
I don't think its complete, and neither would a lot of MDT folks, but that doesn't mean choreography isn't sometimes a useful way to approach things.
I've had my share of successes using this model of care as well.
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Old 10-01-2011, 05:09 AM   #142
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Jen
I'll have to add after reading Bas's post that if you knew how presumptuous your comment about what Barrett or anyone else here has considered was, I think you'd be embarrassed.

It reminds me of when my kids (11 and 8) tell me that I don't know what it's like to [insert uncomfortable childhood event or circumstance that all kids have to go through here].

But they're little kids who don't and shouldn't really have much perspective yet. You're a professional.

I'm going to give you some advice that someone had probably recommended one way or the other to me: step back from the keyboard, go back and read several of the recommended readings in the "Current Consensus on Pain" thread, several of Barrett's essays and Jason Silvernail's threads "The Problem with OMPT" and "Crossing the Chasm from Meso to Ecto" here at SS.

I'd link them, but I'm worn out.
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Old 10-01-2011, 05:10 AM   #143
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Quote:
Originally Posted by JennyMacK View Post
From my understanding, the separation goes like this:

Mechanical pain
- Is typically not constant, but may be if the person adopts a position which constantly compromises the neurovascular structures
- Pain can be altered by movement (some may reduce and some may provoke)

Chemical pain
- Is constant
- Present during the acute phase of healing when there is sufficient damage to tissues
- May be associated with swelling, redness, heat, tenderness
- Movement (in any direction) is likely to provoke symptoms

Both of these are sources of nociceptive input, so maybe the terminology should change to mechanical or chemical nociception. Aside from these are of course still the central sensitized states, etc.
I've made the same groupings and think it works as a rule of thumb but doesn't help much when more than one origin is contributing or sensitization has occurred.
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Old 10-01-2011, 11:53 AM   #144
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The so-called “older model where disc bulges were attributed as the cause of problems” is the only one the vast majority of McKenzie’s adherents know about. Add that to your exclaiming repeatedly about ischemia as if it were a very recent revelation on your part and I can only conclude they don’t teach any of this at the McKenzie courses.

I’ve never had the impact many others in our community have had despite the fact that I “grew up” with several and preceded others. I’m no psychic, but I’m pretty sure I never will.

There’s a “law” floating around in my head, perhaps not yet fully formed:

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In the end, you will be seen one of two ways; saint and schlub.

You are neither.
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Old 10-01-2011, 01:24 PM   #145
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(...) On balance, I think the overly peripheral/tissue-based emphasis of the MDT approach (...)
I took MDT courses in Germany, so maybe there is an other emphasis in teaching, but all in all it should be the same.

So I'm wondering, where do you see that "tissue-based emphasis" in MDT ?
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Old 10-01-2011, 01:25 PM   #146
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Jenny, do you think your understanding of the above issues concerning pain might not be really accurate? I find it somewhat vague and too discriminating.

Most of us here have investigated over the years many different concepts of pain presentation and stick with the one which best fits the current knowledge as described by researchers such as Lorimer Moseley and others.
In a nutshell, pain is pain.

Nari
Yes, I agree that pain is pain. All pain is neurogenic. All pain comes from the brain. But in some cases this pain can be attributed to nociceptive input, and in those cases that pain may possibly be mechanical (ie. mechanical deformation of neural tissues by pressure or tension) or it may be chemical or it may be thermal etc.

And certainly I am not suggesting this is necessarily accurate, I began my post saying that "this is my understanding". Do you disagree that mechanical factors can alter the nervous system? And by that I by no means mean that mesoderm is causing the pain!!
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Old 10-01-2011, 01:43 PM   #147
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Jenny, the problem is that we can NOT with any certainty determine in most of our patients whether the mechanical factors are the crucial part in the creation of pain.

Do not stop being successful with your patients (!) but realize that your professional and personal attitude, your attention to the patient's complaint, your confidence, the patient's expectations and previous experiences, and the movement initiated are ALL influential in pain reduction. (or creation!)
In many cases so much so, that attributing the relief to a particular "approach" or "restoration" of vascular supply is simply conjecture.

There is no doubt that ischemia plays a role - but to what extent? And in which nerves?
The skin? The connective tissue grommet holes for nerves ? The annular ligament branches?
After all, the perception of pain and its location are NOT an "objective" bit of data - it is a virtual body representation of a myriad of inputs and outputs into and from the brain.
Even if restoration of the movement of a certain limb restores well-being, it may have absolutely nothing to do with the origins of that pain.
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Old 10-01-2011, 02:10 PM   #148
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I apologize for appearing arrogant or presumptuous, and it's true Barrett I suppose I don't know you who are since I've only just heard of you when I joined SomaSimple. But if you're interested in getting more people to be interested in what you do, you may want to approach them in a different way than "Do you know who I am?". And John W I am not embarrassed by my presumptuousness. I stated what I felt, how it appeared to me. And from what I've been reading lately, I am not the only one who get's this impression. Barret, I do appreciate what you've done with this site, and I am here to learn!

I realize that nociception is not the sole means of pain production, but in my practice I would say that it falls in the majority. Again I am able to help a majority of my clients, and I have sought help from this site for about 10% of the clientele that I have taken over that have persistent pain. But the majority are mechanical responders, so I will by no means be dismissing my MDT.

The whole point of my thread is to try and incorporate a nervous system based explanation into the McKenzie method. Does it have to be all or none? If I have a system that works for me but that I don't necessarily agree with the full theory, can I not try and incorporate my own reasoning?

I have spent an unbelievable amount of time reading through many threads on this forum, and certainly all the ones that suggest in your post John W. I have never been so attached to a computer in my life. This forum has absolutely captivated me and has definitely begun to change my perspective. I do appreciate the techniques that are used here, but I also will continue and use MDT for the clients who respond well to it. I stated that Barrett did not consider these other camps, because it is my impression from all that I have read that he is anti-McKenzie. So please correct me if I'm wrong. But if this is the case, then I would say my original statement holds true, and that maybe there should be more consideration for these other methods.

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Originally Posted by Barrett Dorko View Post
The so-called “older model where disc bulges were attributed as the cause of problems” is the only one the vast majority of McKenzie’s adherents know about.
I feel this is a little presumptuous itself. And I would have to disagree. But I think I'm realizing that we will have to continue to disagree on this McKenzie stuff, and I'm okay with that.

Jason, I have never felt at any point through my McKenzie training that there were any particular rules to follow. Again, just my perspective. But I do agree that the better you understand the method the more effective the method is. There are unfortunately many clinicians out there claiming to use "McKenzie exercises", but if you don't know how/when/where to use them then treatment will most likely fail. And what gets me is that I don't really think you could call anything a McKenzie exercise...they're all just movements or exercises that have been done for ages, just assessed and applied in a different way.
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Old 10-01-2011, 02:24 PM   #149
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I stated that Barrett did not consider these other camps, because it is my impression from all that I have read that he is anti-McKenzie. So please correct me if I'm wrong. But if this is the case, then I would say my original statement holds true, and that maybe there should be more consideration for these other methods.
I'm under the impression that Barrett has, in fact, carefully considered other models.
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Old 10-01-2011, 02:36 PM   #150
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The whole point of my thread is to try and incorporate a nervous system based explanation into the McKenzie method.
The nervous system IS the explanation for the McKenzie method - and all others.
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