A PROCESS APPROACH IN MANUAL AND PHYSICAL THERAPIES BEYOND THE STRUCTURAL MODEL – FORUM 4

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Hi All
Warm welcome to CPDO at Home online live forum. Please feel free to ask any question regarding the Process Approach article. Remember that at the end of the session you can claim 1 CPD credit learning with other.

I would value your comments, thoughts or ideas for future online workshops. Are there particular topics that you felt were missing from the article and discussion?

[SR]

Hello!
And thank you so much for taking the time to organise and do this!

You state that research shows that there is no correlation between back pain and postural factors. I totally accept that.
BUT I am not sure what to do about my own personal experience that such a correlation does exist.

When I stand (or for that matter walk etc) in a certain way- I feel pain. I change my posture subtly (for example changing the degree of lumbar lordosis, and of course subsequently a whole load of other things then changes)- and the pain instantly goes away or is greatly diminished!

When I ask certain patients to explore the same ideas they often also have positive experiences- less, or no pain, more sense of freedom in movement etc.
What to do with this information?
Are you not working with/addressing postural factors at all?
Do you believe it is fair to claim that even though a certain posture does not necessarily cause back pain, once back pain is there, altering the posture can improve the symptoms?
(My approach is supporting patients to actively explore themselves what postural changes help them/make a difference to their symptoms).

[SR]

[SR]

I am not getting any updates…
Hoping I’m not the only one here, I will keep posting.

You write that obstacles are “often complex bio-psychosocial processes and
rarely structural or postural”. But what about the link between these two areas? Isn’t the point of osteopathy to use the body as the way in/access point to support positive change in the person?
If these obstacles are truly separate, wouldn’t that mean that we should refer most of our patients to non-manual therapists?!

[SR]

What is your opinion about using hands-on treatment to meet patient expectations?
What about the placebo effect of having been touched where it hurts? Do you consider this to have any value?

[SR]

I quite often get people who are not coming to me for recovery, but who simply adore having bodywork and want “treatment” so support their general health and well-being.
Do you ever work with patients who are asymptomatic? Could a Process Approach be used here too? What would it mean? Identifying and amplifying behavioural traits that are beneficial to general health?

[SR]

I know you don’t talk specifically about external vs internal focus in this article, but can I still ask you something about it?

I have done a rehabilitation course with you once, and I have your book so I am aware of your approach, which has been extremely useful for me!!
However, I am also very attracted to different types of movement therapy for example Body Mind Centering, Klein technique and active feldenkrais based exercises (e.g Todd Hardgrove’s work)

As I have so much respect for your opinion, I would love to know if you think there is any value internal focus type work, with the aim of affecting ‘cortical body maps’? Could it not be seen as part of a Process Approach, if the goal is to promote adaptation and/or alleviation of symptoms? For example for patients with fear behaviour? Or do you consider all exploration of movement which is not pedestrian or part of the individuals functional movement repertoire to be redundant? What about facilitating an individual to expand what they can feel/experience in their body and explore beyond their current movement vocabulary (if this is of interest to them)?

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=+=

[SR]

Hmm…either something is wrong here on my end, or I am all alone! All I can see is my own posts…

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Hi SR
For some reason I have just received your correspondance. give a few minutes to consider it (many questions:-))

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Re posture and pain while walking. You are taking an evasive posture to reduce the pain. If you sprained your ankle you would use the same strategy. However, your new posture is a protective strategy. Let me know if you are still there..

[SR]

I’ll be logging out in a minute if nothing happens

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You write that obstacles are “often complex bio-psychosocial processes and
rarely structural or postural”. But what about the link between these two areas? Isn’t the point of osteopathy to use the body as the way in/access point to support positive change in the person?
THERE IS NO LINK BETWEEN POSTURE AND DEVDLOPING LBP. IT HAS NEVER BEEN SHOWN
If these obstacles are truly separate, wouldn’t that mean that we should refer most of our patients to non-manual therapists?! OSTEOPATHY IS MORE THAN JUST TECHNIQUES. THESE CONSIDERATIONS WOULD BE INCLUDED IN THE OVERALL MANAGEMENT

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What is your opinion about using hands-on treatment to meet patient expectations?
VERY IMPORTANT
What about the placebo effect of having been touched where it hurts? Do you consider this to have any value?
THERE IS THE PLACEBO, BUT TOUCH IS BEYOND PLACEBO. IT IS HAS AN IMPORTANT ROLE IN HUMAN BEHAVIOUR AND WELL-BEING. HAVE A LOOK AT SECTION 3 IN MY BOOK SCIENCE AND PRACTICE OF MT…

[SR]

Hey :)
Great, thank you!! No stress.

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LET ME KNOW IF YOU ARE STILL THERE

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I quite often get people who are not coming to me for recovery, but who simply adore having bodywork and want “treatment” so support their general health and well-being.
YES, TOUCH HAS A VERY IMPORTANT ROLE IN SUPPORTING SELF REGULATION.
Do you ever work with patients who are asymptomatic? YES OCCASSIONALY Could a Process Approach be used here too? What would it mean? Identifying and amplifying behavioural traits that are beneficial to general health? YES, FOR SOME TOUCH AND CONTACT WITH ANOTHER PERSON IS VERY IMPORTANT FOR SELF-REGULATION

[SR]

Yes I am here! Sorry. Thank you for clarifying in your responses. However, as I only had a reply on two out of my five posts I thought maybe you were still writing. Technically this doesn’t seem to work very well for me… :( Can you see my other posts?

[SR]

just got another one

[SR]

Would you mind expanding a little on what you mean when you say self-regulation?

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As I have so much respect for your opinion, I would love to know if you think there is any value internal focus type work, with the aim of affecting ‘cortical body maps’? Could it not be seen as part of a Process Approach, if the goal is to promote adaptation and/or alleviation of symptoms? WHY NOT USE THE PERSON OWN MOVEMENT REPERTOIRE FOR THAT?
For example for patients with fear behaviour? Or do you consider all exploration of movement which is not pedestrian or part of the individuals functional movement repertoire to be redundant? AS A RECERATIONAL ACTIVITY IT IS FINE BUT FOR RECOVERY OF MOVEMENT OR ENHANCING HUMAN MOVEMENT PERFORMANCE IT IS LIKELY TO BE INEFFECTIVE. What about facilitating an individual to expand what they can feel/experience in their body and explore beyond their current movement vocabulary (if this is of interest to them)? IF OF INTEREST TO THE PERSON THAT’S FINE..

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SELF-REGULATION – ABILITY FOR SELF-CALMING / SOOTHING WITH ALL THE PHYSIOLOGICAL-BEHAVIOURAL-PSYCHOLOGICAL PROCESSES ASSOCIATED WITH IT. HAVE A LOOK AT SECTION 3 OF SCIENCE AND PRACTICE OF MT…

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We are approaching the end of this session. Thanks you for your contribution.
Don’t forget to download your Learning with Others certificate from here:

http://www.cpdoathome.com

There will another forum about this topic later this year, will inform you in advance.
Please let your colleagues know about this website.
Looking forward to meeting you future forums.
Regards
Eyal

[SR]

I think that as a practitioner who myself is so interested in different movement disciplines and have a lot of experience of these, it’s easy to forget that the patient may have no interest in such things.
And to make things overly complicated. It’s good to be reminded to keep things “simple” ie. not introduce unfamiliar movement concepts as this will be more of a hindrance than a help when it comes to movement recovery!

How do you go about finding out as much as you can about the persons own “movement repertoire”? I don’t have a large treatment room… do you ever get people to film themselves?

[SR]

Thank you!

[Author]

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