An important and on-point comment from John Ware about the different mindsets in manual physical therapy of being an interactor or operator: Im afraid this argument boils down to a philosophical one in the end. That is, there are those, like ginger, who espouse an operator model of care, who acknowledge the finer points of the neurophysiology involved with manual therapies, the presence of CNS changes, like cortical smudging, the rationality of a neurodynamics perspective, etc. And then there are those, including the moderators at SomaSimple and other members here, who, to varying degrees, promote an interactor model of care. While we are in agreement with the ectodermal-operators on all of these finer points of the relevant neurophysiology, we dramatically depart course from them on how best to apply this knowledge to achieve enduring change in the patients pain problem. The key distinction here is that the interactor model doesnt stop at the individual patient; rather, it extends beyond the boundaries of just that individual to the culture within which that pain problem exists. For ultimately the problem of pain reflects glitches and defects in the culture, in particular the culture of health and medicine. I think the epidemiology literature relevant to chronic pain is strong evidence of this. The operators dont connect those dots, and I think thats a huge mistake. I think its driven by what most human failings are driving by: ego. The operator model of care completely ignores the influence their interventions have on the culture writ large. They are singularly devoted to the patient in front of them; but how can you divorce a patient with a persistent mechanical pain problem from the culture in which that problem developed? We know that the words we use are critically important in the meaning that patients ascribe to their condition- and where do these words come from? What gives them their meaning and power to influence our patients in such dramatic and often debilitating ways? The answer is the culture. Interactive physical therapy embraces the uncertainty that necessarily follows from moving with the uncertain fluctuating tide of cultural shifts, paying close attention to subtle changes in meaning and interpretation of what it means to be healthy. Operative physical therapy is static and pays little attention to what goes on beyond the walls of the treatment room, until some RCT comes along that forces them to swap out one of their beloved tools. Im reminded of the great Tsunami in Indonesia some years back. A few people noticed the strangeness of the extreme low tide, packed up and left. Most, however, reacted with a shrug and huh, thats kinda weird. Many of them drowned. Original post here: bit.ly/17C3PCA Thanks to Carol Lynn Chevrier for bringing it to my attention.
Posted on: Mon, 04 Nov 2013 17:43:31 +0000
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