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AlexanderEgebak

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AlexanderEgebak last won the day on July 2 2018

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About AlexanderEgebak

  • Birthday 01/23/1993

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  1. I agree that there is too much emphasis on the physical mechanisms of what exactly is going on. The clinical phenomenon of a 'release' is real, of course, you only need to see a few examples of it happening. As you have done. However, what is seen by eyes, felt by hands and experienced via perception is not evidence to what is actually going on beneath your hands; in the skin, muscles, fascia, bones and the nervous system. The inherint risk of a post hoc, ergo prompter hoc-fallacy is even higher through a confirmation bias where many instances of the same phenomenon is happening and the same conclusion is being drawn. The burden of proof lies with the ones claiming that fascial release is happening through a mechanical mechanism. And given the force needed to seperate fascia, I believe it is an extraordinary claim to say that hands can mechanically seperate fascia when 1) hands are not able to produce much force, and 2) the force is being applied to and absorbed by many of the underlying structures. Extraordinary require extraordinary evidence, and I will refer to Hitchen's Razor: 'What can be asserted without evidence can also be dismissed without evidence'. I find the neurobiological explanation much more plausible with the absence of any actual evidence @Jim Pickles I am not being entirely dismissive about the point about seperation vs elongation of fascia. But I still see it as unlikely. It could be interesting to have an ultrasound device scanning mid-release although that does not do much to confirm the hypothesis anyway, I guess.
  2. On the topic of dropping strength training sessions I feel like I need to drop an entire strength/hypertrophy cycle before I can make progress with stretching. My usual work goes on the lines of 4 months of hypertrophy --> 3 months strength --> 3 months skill. During hypertrophy I can maintain flexibility easily with minimal time investment but I cannot make any progress. During strength I can make a little progress in selected focus areas. During skill I can make 3x the progress of a strength cycle; my body simply is not battered and broken every day which is the natural response to high volume intensity training. Time is not the issue here but the level of mental fatigue and inflammation of the body certainly is for me. At least that is what I am thinking.
  3. As a physiotherapist? I am not working full time yet because I still attend education but other than that I love it! Physiotherapy school is in Denmark not that up to date with research and physiology but we learn decent hands on skills and people skills which I utilize in my work. Luckily, with this profession there is a multitude of ways you can go - you can draw from psychology, medical education, personal training, coaching and massage therapy to make up your own practice. You are not bound by what you learn in school - and thank god for that! What I loved during the introductory course which was basically a standard massage school certificate was the exploration of touch. It may sound wrong but if you are a very physical and touchy person you can share that interest with other through examination and treatment relevant to massage studies. We quickly moved onwards from that though.
  4. I practice massage so I guess I am I am also studying physiotherapy and have a keen interest in pain science.
  5. I dont think you follow me completely. Maybe you should do a litterature search and read the studies conducted on massage. There are two kinds of studies that informs us of the placebo effect of massage. 1) The studies that compare massage with "natural cause". Which means doing nothing and let time use its healing powers on pain. It seems that for long term pain problems massage is having a very little effect compared to doing nothing. 2) Massage where specific techniques are being compared. When special techniques, for instance targeting specific tissues, going with a certain flow or grap etc. works no better than each other for a homogenized population it seems like there is no specific effect in the type of touch (or sensation being applied) - or it does not matter that much. From that you can conclude massage has no specific effects and that long term effects on their own are inefficient. But massage falls into a category of touch modalities along with manipulations, mobilizations og guided movements that may have a short term touch specific effect. Not proven, but in my opinion likely. But not long term. You are only partly in control of the placebo effect. Genetics, personality traits, socioeconomics etc. are part of outcomes, and one has little to no control of those whatsoever. But beliefs, expectations, experiences and context you can control. I disagree, a skeptical patient just needs a more patient approach. Though in my experience hardly anybody who comes FOR a massage is skeptical OF a massage. But they might have issues with certain techniques etc. I have never said that massage therapy is not effective. If that was what you read from my post, then you need to read again. I am skeptical of why it is effective and how it is effective. Science is good at measuring outcomes, but not effects of treatments. The results for long term pain are of high quality and perfectly valid. But science is not good saying THIS EXACT THING HAPPENS. I suspect we will never be sure of the effects of massage. We only know what it doesnt. Qualitative research might provide context to proposed placebo effects but there are limits.
  6. I think I need to clarify what placebo is first. In short terms, placebo is positive none-specific effects of a given intervention that is heavily reliant on what meaning an individual places upon the intervention and the context. Massage is not "a placebo". Massage just have not had any specific scientifically proven effects. Touch is a "placebo effect" due to the fact that it is not specific to a massage, and it cannot be quantified how big/small the effect is. Massage cannot heal injuries either though part of the placebo effect is a pain dampening response. Massage is usually claimed to increase blood flow to an area but that only happens superficially to the skin to my knowledge. Massage can be both effective and ineffective. It really depends on the individual being given the massage and the provider. If it is not a persistent pain problem massage is generally more helpful. If the provider understands to create a calming atmosphere, looks good, dresses appropriately, has a nice room for treatment, calms the patient through talking, listening and addresses concerns… If the person believes touch will help them, if they expect a good result due to prior experiences, if their are "touch-deprived"... These are all parameters for how good a result a massage will have - transferred from placebo research. If you sort these out, you will have good results, and your patients will see you as empathic. Massage school is generally about learning techniques and basic anatomy which is good but you will being thrown into some dogmas if you are not skeptical of the information that you are given. The most important about a massage is in my opinion learning to feel the response of the patients; that will let you know the optimal pressure, the optimal placement of your hands, the optimal technique just for them. Focusing on the muscle knots, targeting specific muscles, specific techniques if just a waste of time of the patient is not in on it.
  7. The thing is; there is no scientifically proven effects of massage. Essentially, when compared to a placebo, massage works no better for pain treatment. There is a huge evidence base for that. So when people feel better after a massage the effects must be none-specific, and this is me hypothesizing the possible effects. If you read Dan Moorman's "The Meaning Response" about the placebo effect it will make sense. Otherwise, there is a whole ton a litterature out there on the placebo effect. About different types of massage; this is a big topic, and controversial. As therapists we like to believe that a certain result we attain is due to a certain effect. The classic example is myofascial release where it is being hypothesized that by the applied force of our hands it is possible to break fascial adhesions. This has 1) not been proven to happen, 2) is not scientifically plausible due to force resistance of collagen tissue (and lucky for that because otherwise our whole body would be a bubbly mess if hands only could break collagen), and 3) all structures around the targeted one will absorb force application; the net force produced by the hands will spread out. The possible specific effect of myofascial release, though not proven, is that the lateral static stretch applied to the skin will trigger a reflex through stimulation of Puccini corpuscles that are small receptor organs in the skin. I can expand on the whole "touch thing" too and why theories suggest massage would provide relaxation as an effect.
  8. The effects of massage is mostly "none-specific". The effects are derived from a relaxation response due to touch, expectations and it can be conditioned. The is essentially and classically called placebo. The hypothesis by neuroscientists right now is that this lowers the threat level of the brain and lessens pain, tension and autonomous responses associated with danger. This favors relaxation.
  9. I agree with the others about the sensationalism. Removing tension is complex but not complicated. Complex in that many factors play a role for why the muscles are being excited. Not complicated in that reducing muscle tension is "all about" reducing muscle spindle activity to prevent resting tension. Muscles are by default being excited by an area of the brain but that area of the brain can be suppressed by higher brain layers. Learning how to intimately feel, control and relax a certain area will have a profound effect on conscious relaxation. Passively-induced sensory input through touch like massage, nuzzling, mobilizations or manipulations can aid that greatly. In the end it is all about "cutting the wire", not literally, but consciously to a tense area. Everyone is 100% relaxed and is able to be bend freely within their structural limitations while being unconscious. And there is a reason why cognitive interventions in some cases can create large leaps in flexibility (not saying not flexibility equals tension, they are different, but still the CNS controls both phenomena). And then there is "feeling tense" and "palpable tension" but that discussion is muddy.
  10. I get all your points and partially agree with them. It is troublesome. I am a 20$ member so I get to see the majority of the good stuff, definitively worth it in my opinion. But yes, they have chosen a commercial model and you mostly only get half the information with a free account. The article itself is very well written, and I would still suggest to sign up with a free account to just read that article. There is some new information, but the true value lies in how Josh presents how flexibility works and what you can do about it.
  11. Joshua wrote an article about the general concepts of stretching. I thought it might interest some of you guys. https://www.labcoatfitness.com/articles/a-general-approach-to-the-difficult-to-release-tight-muscle
  12. Long term overdue-sit Lab Coat Fitness with old gymnastic bodies members Joshua Naterman, Cole Dano and Yaad Mohammad at the steering wheel. They have already put up some interesting articles, and, although basic, might be interesting for those of you who do handstand balancing, body weight training and is interested in nutrition. www.labcoatfitness.com I am in contact with Joshua and know a little of what to come, and these guys are definitely going to be worth following!
  13. Great article. I think I have a slight nerve entrapment in my right leg due to involuntary shaking of my leg after reaching max pike depth but it slightly releases after a few sets. The sensation is also closer to the calves than the hamstrings.
  14. One aspect to the placebo-effect worth noting: It is also a conditioned response. The expectations to an intervention can be greatly enhanced by former exposure. I like this post by Jarod Hall: https://www.facebook.com/drjarodhalldpt/photos/a.741226812748092/966337000237071/?type=3&theater I am more inclined to say that placebo effect of most interventions accounts for 80-90% of the effect because the explanation models of most interventions have been proven wrong. Take for instance fascial release which cannot be deformed by hands on treatment. Something happens, clearly, placebo, and then to some extent reflex activation/inhibition and gate control with sensory information competing for second neuron transmission and in the end competing for cognitive realisation. But fascial release in general works no better as a stand alone treatment for pain than other interventions, mostly, and works no better or only a little better than placebo in high quality evidence. I disagree about placebo having no side effects. It has been demonstrated that you can get addicted to the placebo effect - you can simply get withdrawal symptoms from a placebo! And if we go down the rabbit hole I would claim that "placebo" is being used to justify the use of ineffective standalone treatment modalities (as proven by science) and acts as a way of withholding patients from a more active strategy. Hardly, passive placebo treatments are not designed around providing self-efficacy and a locus of control. Essentially, the placebo effect can become a long term nocebo effect if utilized improperly. First of all a treatment modality should be chosen based on the largest possible specific effect, and then you can try to enhance the non-specific effects (placebo - or meaning responses) - disregarding the ethical discussion about patient deception here. The only exception to this rule should be if you clinically reason that the placebo effect of a certain treatment would be very large for a patient. Then doing this modality and then transittioning to a more active strategy would be both clinically sound and help you build a therapeutic alliance with the patient otherwise hard-to-gain. That is why I am both for and against placebo treatments. In the world of physical therapy the justification of placebo is that "it works" - but does it really work? Would they have gotten better without any treatment? Any considerations for regression to the mean? Would a more active strategy have worked long term instead of just short term? Any nocebic expressions from the clinician? Usually this mentality is due to a lack of trust in whether the patient even can get better which also reflects a lack of knowledge about what pain essentially is. Which is a huge problem. But placebo treatments results in short term relief and gets patients back which in turns gets the clinician money. And therefore the clinician thinks he is being helpful because people come back for pain relief, and the people that dont come back are "cured". I like the term "outcome measures measures outcome, not intervention". Most people make the logic mistake of A intervention results in B outcome due to a lack of critical thinking. All this creates a nocebic behavior with the patient, and some patients will get worse and go elsewhere for a treatment. That always happens. I disagree about the evidence for acupuncture providing pain relief. High quality randomised control trials state that it works as well as placebo. Tooth picks also work as well as needles, and it does not matter where you stick the needles. I can find the evidence of that for you if interested. It is really an interesting study that you mention. Can you find it? Reminds of the study on Wim Hof's apprentices who where able to direct their immune system towards the injection of a virus. There is so much new stuff about placebo going on now. I will probably write my thesis on the specific and none-specific effects of a certain treatment and comment on the relevance of distinguishing between the two in the clinic
  15. That is just a short summary though. You need to dig deeper into the rabbit hole later but it might suffice for now. This is also my opinion, not Kit's, though I believe we are close on this one
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