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

Online CPD course videos for manual and physical therapists Forums MEET THE RESEARCHER A PROCESS APPROACH IN MANUAL AND PHYSICAL THERAPIES BEYOND THE STRUCTURAL MODEL – FORUM

This topic contains 35 replies, has 6 voices, and was last updated by  [email protected] 2 years, 3 months ago.

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  • #967

    Please feel free to add your thoughts (counter arguments are welcome), references and links.
    Eyal

  • #1098

    luciferbox
    Participant

    (with tongue firmly in cheek) Is osteopathy just a ‘glorified cuddle’ then? ;)

  • #1100

    Hi all and welcome.. at the end of the forum I will provide you with a link to download your certificate of attendance (1.5 CPD credits learning with others)..
    Please feel free to share your thoughts

  • #1101

    To luciferbox
    This glorified cuddle is consistently underestimated in manual therapies. There has been extensive research about the physiology and necessity of touch in infant development (animals and humans). These mechanisms are at work throughout the life cycle. Touch intention plays an important role in the therapeutic relationship and potentially recuperation. Have a look at my book The Science and Practice of Manual Therapy. Section 3 deals specifically with the therapeutic aspects of touch.
    However it’s not all about touch effects (affects?). All manual techniques have a physiological effect of some kind. However, how strong or how long these effects last is another matter.

    • #1105

      luciferbox
      Participant

      I may have joked in my first post, but I never underestimate the importance of therapeutic touch, not when you realise that at 7 weeks intrauterine life the ability to respond to ‘touch’ is present!

  • #1102

    osteosam
    Participant

    Very interesting read. I bang on about exercise being of little value if not functional or relevant to real life but can definitely see where many of the conventional rehab exercises I prescribe could be replaced by more truly ‘functional’ ones relevant to an individuals daily activities.
    My mind gets stuck though at the thought of not needing to address structural obstacles as well as implementing more process oriented activities…

  • #1103

    luciferbox
    Participant

    I read the article in my lunch, then spent the afternoon telling my patients that my structural treatment was just opening a window of opportunity for themselves to continue their ‘healing process’ before they next see me! They liked that idea a lot. Not sure that’s exactly what the article was referring to, but it helped them understand a little more. So for that, big thanks!

  • #1104

    John A. Ibbetson
    Participant

    MT techniques?

  • #1106

    Ostesam
    Have a look at the fall of the structural model article (in the CPD Resources section). It is difficult to name a known condition which is caused by a postural related structural obstacle

  • #1107

    lumac108
    Participant

    The power of touch is evident in the lack of satisfaction patients feel when they have ‘hands-off’ therapy. I feel compliance and perception of change, from the patients perspective is always greatly enhanced when some form of manual therapy is combined with advice / exercise etc.

  • #1108

    John
    can you expand yor question about manual therapy (MT)

  • #1109

    lumac
    I agree. Human seek physical safe, comforting contact that help self regulation. Patient that are given hands-off treatment are not engaged in the management in the same way. Of course some patients prefer just exercise.

  • #1110

    Sploutarchou
    Participant

    I agree with the idea that PSB factors may not be able to explain why someone suffers with LBP – the body has a great capacity for adaptation. I’m interested to know what Eyal thinks about when there are several PSB factors present concurrently whether there is point at which the biological reserve is used up and symptoms develop?

  • #1111

    Touch is part of the patient’s narrative of recovery

  • #1112

    Sploutarchou
    I would think these PSB changes would have to be quite extreme to influence health. So, if they are too small they don’t matter, because of the body/person’s reserve capacity. However, If they are too large they would be outside the remit of a physical therapist as we are unlikely to be able to change them..??

  • #1113

    Another problem is that by focusing on PBS factors we are pathologising normality/variablity!

  • #1114

    What is a normal posture? What is the reference point?

  • #1115

    luciferbox
    Participant

    Do you think this type of approach would be better for treating chronic pain conditions such as FM? The published research would appear to suggest that the structural manual therapy approach to treating FM is not as good as the physical exercise and empowerment route, and so to me it would seem to be a better approach….

  • #1116

    Ask a simple question – by which process is a patient with FM likely to recover?

    • #1120

      luciferbox
      Participant

      With regards to FM, I certainly wasn’t referring to recovery, just some kind of amelioration in symptoms, be that that reduced pain or improved functioning.

  • #1117

    lumac108
    Participant

    rather than saying the structural model is defunct, is it not a case of the process approach ‘absorbing’ the structural model into a wider and more holistic model? surely, some MT seek to help facilitate adaptive change as well as alleviation of symptoms and that by helping the patient to relate these changes in symptoms with functional and psychological process we help to repair and recovery?

  • #1118

    osteosam
    Participant

    Definitely theres a gap between structural approach and what a vast amount of patients need to gain a full resolution… I am currently treating a client with a very stubborn chronic shoulder. Structural approaches have gotten him so far, but will certainly sit down with him and work out a more process approach as we seem to have hit that stagnation stage. Definitely will broaden the approach I take in these sorts of cases particularly.
    In general, as discussed above I feel the power of touch along with the power of simply ‘being heard’ plays such a huge huge role in what we achieve. All great food for thought, so to speak.

  • #1119

    Once we can name this process we can co-create with the patient the environment that can support it?

    • #1125

      lumac108
      Participant

      Yeah i see what you mean……the structural model is very limited in that respect. i like the point about recovery being largely an automatic process. but like in the case of Tendon pain, this is mostly a failed recovery/ repair and there are definetly things we can do that we can use to help ‘restart’ or ‘unstick’ this failed healing response, which undoubtedly include MT. but without understanding all of the process involved, we will not complete the rehabilitation.

  • #1121

    osteosam
    Participant

    With FM (and other similarly chronic conditions also) does a heck of a lot of a patients state not come down to how in control of their progress (or perhaps lack thereof) they feel? Process approach I’d imagine in that case is simply a case of empowering the patient within their limitations, whether pain or function are technically improving or not?

  • #1122

    luciferbox
    Participant

    Ah I see what you mean. Now that really is one to think about! Especially when so many ‘processes’ are at play in this condition!

  • #1123

    Lumac108
    A structural model can be integrated within a process approach. Personally, I feel that the structural model has run its course and is now impeding progress in MT professions.
    Interestingly, some recovery processes are autonomous. For example, repair. It could still take place in a person in coma. Of course, psychology and behaviour have important influences on the recovery processes. But for that we don’t really need a structural model.. ??

  • #1124

    John A. Ibbetson
    Participant

    MT ( manual therapy ? – general hands-on) or should we go back to MT (manipulative therapy ? – implying skilled more specific hands-on interventions). I wonder if patients or their nervous systems (maybe parasympathetic – sympathetic sensorimotor – not structural/biomechanical) do know somehow the difference.

  • #1126

    osteosam
    Participant

    Very true. I had a patient recently whose symptoms presented very much like an acute rib dysfunction might. Structurally there was some very mild ‘stuff’ worth working on, but I strongly feel it was the discussing the grief and stress she’d been under for many years, culminating in recent significant health issues, and allowing her to feel she could physically move through the pain she felt without risk to either MSk or systemic health that made the difference. In hindsight I suppose it was a process approach of sorts involving gradually introducing her previously normal ADL’s which got her moving through that pain which resolved as she went. Fear was a huge factor in it all, which all the structural approach in the world would never make a dent in.

  • #1127

    luciferbox
    The advantage of a process approach is that it seeks to identify what can positively help the patient recover; taking the focus away from the pathology. Imagine a patient with an acute disc problem. If we think about the pathology, the pressure on the nerve, etc it impedes us therapeutically. However, if we think how it will recover, say by repair primarily, we can readily identify the environment which will support this process..

  • #1128

    osteosam
    Participant

    But then yep… what of the cases where the repair process has gone askew and become a chronic presentation as mentioned by lumac. Can that be expected to change without some good breaking down of aberrent tissue? Wouldn’t we then end up like it appears many exercise based Physios seem to be where patients are diligently following a graded exercise program but their body is doing the movements all arseways due to structural restriction/dysfunction? Arseways being highly technical and proper terminology of course :)

  • #1129

    Osteosam
    Yes you see that a lot in clinic. Many chronic neck patients have no history of neck trauma, structural deviations or remarkable imaging findings. Treatment that encompasses the psychosocial dimension seems to produce better long term results. Touch is used for its supportive, comforting, self-regulation function.

  • #1130

    osteosam
    Participant

    And heck, in those cases patients tend to feel so warm and fuzzy by the time they leave i’ve literally gotten some osteopathic hugs ;)

  • #1131

    It’s almost time to finish. That was a great session. Very enjoyable and thought provoking. Thank you all for participating
    Next forum is next week on proprioception
    Don’t forget to download you certificate of attendance from here:

    Kind regards
    Eyal

  • #1132

    osteosam
    Participant

    Thank you for your time and a thought provoking article Eyal.

  • #1133

    By the way, there will another free process approach forum on 10 Sept, Please spread the word
    Thanks
    eyal

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