Dear John ,In reply to U. S debate.... ?
there seems such a reluctance to discuss the merits of 'placebo' in forums
such as this ..
to acknowledge that 'placebo' was the thing that shifted someones physiology
forward towards health and well being is in my opinion a positive thing . It
is then probably beneficial to study how to enhance this effect as it is (in
my opinion) ubiquitous in the grey area of physical and neurophysical
medicine .
There are excellent chapters in the textbook of pain on placebo intervention
which make great reading .
Your reply seems to me to favour logical proven physical intervention for
physical pathology . This is probably what most people favour too but
unfortunately most conditions as Kevin suggests are 'grey' .
For a really good insight I have found David Butlers chapter in the NOI year
book the best essay yet on what we do, the complexites of the patient
therapist intervention and the complexities of neurophysiology/psychology
... Synthesising this information applying the subtle skills of hands on
hands off management is not a 'technicians' role but in my opinion requires
the intelligence and training of a graduate with clinical reasoning skills.
Applying a tool is just a small part of what I do . The ultrasound is in my
opinion inconsequential ( I haven't used it since I qualified) since many of
the things I have firm belief in may well prove to be 'placebo'. Another
startling application of placebo in the book I mentioned was the well known
internal mammory artery ligation v's a 'nick' in the pec major for treating
angina which had proven physiological measurable results....so if cutting
the pectoral muscle can have a substantial effect for a great number of
people with resting angina it seems quite important to discuss placebo
positively and not dismiss it altogether ?
However returning to the real world of physio it doesent stop me trying to
fathom out the mechanisms behind the 'techniques' I am interested in this
way I don't get sucked into the latest therapy claiming to have great
results . A great contribution to fathoming how things work or not is Eyal
Leddermanns Fundamentals of Manual Therapy which is a real departure from
most technique dominated approaches to Physical Intervention - I hope you
manage to get hold of it .
Thanks for the debate it is good to hear opinions from every direction !
Ian
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