Saturday, February 09, 2008

Eternal Struggles I

It's rare that I side with my orthopaedically-minded colleagues on anything much. I have an issue with their generalized lack of acknowledgment of the importance of nervous system considerations and apparent lack of interest in pain theory or pain treatment. They are the consummate "All-you-have-to-DO-is" people. They want to DO, not think (at least they don't want to be forced to think very hard...)

To them, it's easy you see, all body pain comes from joints. To tackle any perceived problem be it motor dysfunction or pain, "all-you-have-to-DO-is"... find the suspect joint and apply pressure to it in such a way that you passively move the joint surfaces upon each other and voilá, movement improves, pain leaves. Simple as that. Formulaic. Except for when it doesn't work out so easy, pain is not only not alleviated but even worsened by this cavalier approach. Pain is always the patient's problem, you see, never the practitioners'..

This is generally true of chiropractic as well - that segment which presumes to believe it is evidence-based.

This is what I like to refer to as training wheel mentality - intellectually neotenous dependence on a simplistic model that has been around so long and is so well-established that it will never come of age. Passed along and down through the ages mostly by workshops and various "schools" by manual therapy gurus in a direct transmission sort of way, this set of only-slightly-varied (and expensive to learn) ideas and behaviors has been a cash cow and a never-never land that the old boys of manual therapy (who, like Peter Pan, never grew up past these training-wheel ideas) created long, long ago - it has been perpetuated as an integrated meme-plex, the underpinnings of which are seldom examined and rarely if ever updated.

But I have digressed terribly. This post was not intended to be about my life-long allergic response to orthopaedic mentality. Let me begin again.


Once in awhile, politics make strange bedfellows: Jason Silvernail started a thread on Evidence in Motion, a strong PT group weblog that promotes an orthopaedic approach to everything, "evidence-based" (in an ortho sort of way at least...)

Jason's thread exposes and shines a spotlight on a major blight on science within PT itself, namely the teaching empire that was built by John F. Barnes, successful over a number of decades now. Barnes borrowed a technique from osteopathy called myofascial release, and conflated into it his own interpretation of Oschman's strange ideas on "energy medicine". Read Harriet Hall's deconstructive review of the book "Energy Medicine", by James Oschman. Barnes also added in his own approach to "repressed memories" which he claims are "trapped in fascia" both of which he believes he can "release" by changing (yes, physically changing from a gel to a solute) fascia from outside the patient's body, with his hands, using some sort of mentally applied quantum physics possibly, while encouraging his patients to "remember" their buried emotional traumas. Practicing this would be bad enough, but he teaches this. He makes money selling this set of interwoven ideas to human primate social groomers who feel inadequate and want more information. His ideas take root in vulnerable minds and he gains a "following" of practitioners in whom it would seem he has not encouraged any critical clinical thinking - in fact it would appear that he actively discourages such a thing. He claims his version of MFR has scientific rationale - but it seems like just the same old "energy medicine" stuff to me.

"When two opposite points of view are expressed with equal intensity, the truth does not necessarily lie exactly halfway between them. It is possible for one side to be simply wrong." - Michael Shermer, "Wronger than Wrong", Sci Am 2006

I'm all for a good sound deconstruction of this Barnes approach that seems to have all but taken over PT, but for the (skeptical, bless their socks) ortho people. For one thing, it would be wonderful if someday careful hands-on work with the outer layers of people's bodies was not automatically assumed by the ortho people in the PT profession to directly fall into this category of what I hope to show is pseudo/anti-science. It would also be better for patients if my profession had taken steps to counter all crazy thinking like this, thinking that came into it holus-bolus along with soft tissue techniques and should have been decisively countered at the time, but wasn't. Never too late though. The time has come. Neuroscience has provided a much saner foundation on which to base treatment constructs.

It remains to be seen, however, if the profession is in good enough shape to take this reclamation job on. Apparently Carol Davis, a friend, someone who would appear to be a "disciple" of J.F. Barnes, and vibrational energist, teaches physical therapy students at U. of Miami and has written her own book called "Complementary Therapies In Rehabilitation". It contains every pseudo-and anti-scientific idea that ever came along with any of these therapies. Davis, according to her bio (see bottom of page) has been the recipient of an award by the APTA, which represents the American branch of the PT profession at a national level.

Here is her public letter to "John":

"Dear John:
I have been reading about the “new” science - the latest hypotheses concerning the effects of quantum physics on our mind/body - and I have come to recognize the central role that fascia plays in the process of health and healing and balance. What I have read from James Oschman’s work in Energy Medicine and Lynne McTaggert’s book, The Field, from a bioenergetic perspective, health is now being viewed as a balance of flows throughout the body that insures homeostasis through adequate immune response, endocrine function and other functions. According to Oschmsn,this balance seems to result from the flow of photons (sub atomic particles of light) all throughout the mind/body over the “living crystal matrix” of fascia. And fascia, the fascial web, actually is the superconductor of vibration, of energy flow. So it makes sense that myofascial release is the key to treating fascial restrictions that interfere with the conduction of the energy, the vibration of energy, of photons, that is responsible for health.
You say that, in proper treatment, myofascial release, by way of the piezoelectric effect from the pressure of the hands on the body, transforms potential energy into kinetic energy, and the polyglycoid ground substance of the fascia becomes less solid, more fluid. This hydrates the fascial cells, and the cells the fascia surrounds, so that they can vibrate once again for their own healing. So that they can conduct flow to the rest of the body/mind. Like taking your foot off the garden hose so the water can flow, the fascia “plumps up” again and the DNA of the cells it surrounds once again can vibrate off photons to regulate the cell it is within and also to communicate with other cells by way of photon or “light information” for the benefit of the entire being.
Fascia is central to the health of the living being, and myofascial release is the therapy that releases stuck fascia, and the energy that it has encapsulated, so that the person is free to move and think again without restrictions. This is a phenonmenal breakthrough in understanding the mechanism of action of the benefits of myofascial release. I have summarized this science in one chapter of the next edition (the third edition) of my book: Complementary Therapies in Rehabilitation, Evidence for Efficacy in Therapy, Prevention and Wellness. It is published by SLACK. Inc. and will be available mid 2008 from Janet Kahn, a well known leader in massage therapy, has a chapter on massage in it, and your chapter on myofascial release has the most updated research available.
John, here is my question — how does a myofascial release therapist best prepare oneself to do this work that is so critical for balance? Myofascial release is more than mechanical massage. As mfr therapists, we are vibrating for the health and balance of another, as well. How do we get our vibrations to be therapeutic for the good of our patients and clients?"

In case the reader missed that last sentence:
"As mfr therapists, we are vibrating for the health and balance of another, as well. How do we get our vibrations to be therapeutic for the good of our patients and clients?"
How indeed. Wronger than wrong.

The national PT associations in countries are not set up to "police" the members of the profession to the extent that would be required to rootle out all this weird pseudoscientific thinking. Their job is to keep the profession glued together organizationally, give it some sort of public face, provide support to special interest groups within it. The only "quality control" exerted on the product (at least in Canada) is a set of standards to which the PT schools (all of which are based in universities and affiliated with medical schools) must adhere and an academic level which graduates must attain.

I have no idea what goes on at U. of Miami, but to allow this sort of,.. um, education to proceed unchecked within a university setting suggests to me that someone who should be awake and aware of what PT professors are transmitting must be sleeping at the wheel.

It looks like it will be up to individuals to protest all this craziness. I'm taking a blog stand today, with this post, against craziness in PT. See the new list to the right, of sites that debunk quackery. There is as yet no official site to name, expose and denounce quackery specific to PT, but this could change. Meanwhile, we'll see how the winds blow.


Unknown said...

I like this quote from the wikipedia article on pseudoscience that you linked in your post:

Pseudosciences have been characterised by the use of vague, exaggerated or untestable claims, over-reliance on confirmation rather than refutation, lack of openness to testing by other experts, and a lack of progress in theory development.

I might use the following terms to describe the basic scientific method:


It seems that pseudoscientists want to skip the hard work of fulling developing hypotheses and doing the necessary work to test them. They skip straight from speculation to theory and practice.
It would be nice if that worked consistently, but it doesn't.

This is a problem across the board, but particularly seems to plague medical science.

I believe there is a place for subscientific knowledge (that rose smells nice), scientific knowledge, and suprascientifc knowledge (love is good). However, I see no place for pseudoscientific knowledge.

Bravo for refusing to accomodate it.

Diane Jacobs said...

Thank you for your comment Kent. I agree with pretty much everything you said, except I side with Michael Shermer who says science is a "verb"/process more than it's a "noun"/knowledge base.

Unknown said...

Oh my gosh! I'm so happy to hear other people see what I see two. There is a lot of quackery and massage therapy as well. Hopefully, less and less people will fall for the quackery and become more medically and science-based.