Dear Mel, thanks for this nice analisises of the therapeutical field.
Although this one sounds a little bit desparate. I love reading your
writings and I suppose you love writing them, As you are very well present
at the physio-mailbase.

The understanding of this, very often simplified matter, lies in fact that
we (therapists) love simple solutions, straight forward koncepts and often
forget that the body follows it's own interconnected rules. Single input,
multiple output, Multiple input, Chaotic output.

I suppose that in making our understanding of the basic mechanismn better,
and in building up a modular understanding of the human body, we first need
to define Axioma (like in Mathematics; basic and fixed definitions) which we
than can use in explaining why all therapies have their effect.

The axiomas probably are parameter and observation based,

e.g: if the the skin is stimulated with an object that has a temperatur
(parameter) difference to the skin of more than X° the body will withdraw in
a reflex (observation).

Hypothesis: There are mechnism within the body that register Temperatur
differences and can very fast active mechanism that are able to avoid
further Contact.

Knowledge: there are temperatur-selective sensors in the skin that can
activate under certain circustances a reflex-bow to the muscles that are
able to withdraw from the object automatically.

Most therapies build on observations due to creative experiment and find
their explanation (hypothesis) in currently present knowledge. Combined
parameter-influenced observations may lead to new therapie concepts merely
speculating about the mechanisms. Best example ist the melzack and wall
paintheorie that works without the hypothesis being able to be proved.

We should be able to combine both worlds: Reduce therapies to their original
observations, look for simularities, discuss openminded the possible
mechinism behind the observations, collect the newest research and try to
use this knowledge for structured experimentation again to produce new
observations.

Why don't we try to create our axioma and describe the basic mechanismn that
makes therapy work, or not. Any ideas how to put this into a structured
undertaking.

Sincerey yours,

Marco Schuurmans Stekhoven

----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, October 02, 2000 1:29 PM
Subject: Treating Musculoskeletal Problems


> If any one thing that characterises the resolution of musculoskeletal pain
> and dysfunction, it is the large number of different approaches which
enjoy
> some measure of success.  It has never been established that there is
> definitely one best method of treating problems of the back, shoulder,
legs,
> arms, yet the claims of many qualified and 'informal' therapists suggest
that
> they alone have developed methods that are far better than any others.  In
> fact, some of these therapists use such a mixture of different methods,
that,
> given sufficient time, effort and psychological stroking, they have to
> produce some progress.
>
> Some of these therapists, especially those with informal or self-awarded
> 'credentials', spend an inordinate amount of time applying an extensive
> collage of  muscle and other tests borrowed from physical therapy,
> chiropractic and elsewhere.  These tests are by no means universally
accepted
> or corroborated by science.  They are often applied in static postures and
> assessed by palpation, finger pressure or home-made combinations of string
> and putty, but they seem to create an aura of thoroughness, scientific
> precision and reproducibility that impresses clients into parting with
tidy
> sums of money.  The fact that research has shown something like one third
of
> all such strategies to work because of a placebo effect ensures that there
> will always be a significant number of satisfied clients to perpetuate
some
> healing myths.
>
> At the opposite end of the scale, there are some therapists and even
> individuals who never bother to rely on any therapists, who simply
advocate a
> rather generalised exercise, stretching and lifestyle regime in many cases
of
> musculoskeletal disorder.  They apply few if any tests, advise clients to
> work within sensible ranges of exercise intensity, modified by basic
> perceptions of pain and effort - and lo and behold, they, too enjoy a very
> significant degree of success!
>
> This leads us to question if most functional tests, other than basic
> palpatory assessments and those reported by the client in normal
"functional'
> activities, generally are a waste of time in the treatment of most
> musculoskeletal disorders (excluding fractures, pathological disorders and
> serious medical conditions).   Are these static muscle tests for
identifying
> "weak", "unfiring", "imbalanced" and "lazy" transversus abdominis, rotator
> cuff, multifidus, piriformis, psoas and other 'key' muscles generally
> redundant or do they play an essential role in treating musculoskeletal
> problems?  Do exercises based upon such "muscle testing" methods
definitely
> enjoy a greater level of success than very general regimes based upon a
> thorough classical medical 'interrogation' of the client?
>
> Dr Mel C Siff
> Denver, USA
> [log in to unmask]
> http://www.egroups.com/group/supertraining
>



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