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Dear Julie I think what I am saying is that there is a degree of uncertainty in our testing and treatment procedures. Because of this if we keep an open mind we are more likely to individualise our sessions with our patients and believe what they tell us. A small amount of uncertainty is healthy, too much counter productive. I believe the best measures of change and outcome are movement, function and the patients self assessment of their symptomology. Does this help ? Warm Regards Kevin Reese PT UK i -----Original Message----- From: [log in to unmask] <[log in to unmask]> To: [log in to unmask] <[log in to unmask]> Date: 31 October 1999 16:48 Subject: Re: Piriformis stretch >Hi Kevin > >Well I was having trouble accepting your excellent points of contention until >I read that you hypothesize and appear to treat on the principles of >uncertainty. I was getting of the opinion that you were implying that you >were inplyingwe dont really know WHAT we are doing. I dare say it is >extremely dangerous to treat in that manner and the scientific among us would >not TREAT unless they knew what results they were planning to achieve from a >specific manuever. > >I myself have very little faith in the research evidence that has been shown >in manual therapy treament. I think there are too many variables that we are >unable to measure at this point. In addtiont what we DO measure is much >more GROSS in function than what we actually are doing. ( e.g, after >mobiliaztion we would measure RANGE OF MOTION. ) On the other hand, as >therapists in the U.S. these days the standards our treatment is measured by >is even GROSSER. " does the patient " ' feel better' , can they return to >their previous level of function?" > >I guess I had the feeling that since you felt that there were so many >variaibles in our treatment techniques and in the results, you were not >assessing your patients. I think that when we approach a specific injury with >a specific type of treatment (eg a "muscle strain" with a counterstrain >type of approach that we ARE treating Tender points. If this hypothesis does >not work, then we must try a differnt approach with a different system and >be, as I was once taught "more than a one horse dog and pony show" . I do >strongly feel that we MUST approach the body through a system and that if we >treat the problem with the correct system we as therapistscan begin to >correctly CLASSIFY symptoms ( rather than diagnose or assess) that are >found in specific systems. We can then more effectively treat with the >correct system. > >Is this what you have been saying? > >Julie > > %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%