Graded exposé

By Timothy Cocks Education for all 31 Aug 2016

What’s in a title?

In my life time, for better or for worse we have become more and more “politically correct”. Is it really so terrible to call an old fashioned black board a black board. Air stewards have become flight attendants and janitors convenience technicians. Health and safety also ties us up in knots so that we might now have to wear protective goggles to play good old fashioned English conkers! I only know, in my karate training, whilst free fighting if we don our gum shields for safety, noses get broken. 

So where is my grumpy old man ranting taking me?

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We seem to have a problem with the title “graded exposure”, a new term for an age old concept. Maybe we don’t have all the research to support graded exposure but, under its age old title of “progressive exercise” nothing is new. When a weight lifter slowly increases the load, the runner the distance, the gymnast the difficulty we don’t seem to struggle with the idea of intrinsic increase in adversity. Even Maitland had his 3 triple minus techniques which led progressively to grade 5 triple pluses. 

“Fuck it up or totally cure it!”

Within the Royal Army Medical Corps (RAMC) we spent hours learning the art of taking the patient, with the post-fracture limp from early to late stage recovery exercises before confidently handing them back to the Remedial Gymnast – a highly skilled, medically trained professional group sadly missed. 

You wouldn’t see it today but we even had provocative knee classes where suspect meniscal tears were taken to the top end of the training spectrum – the patient kicking old fashioned leather medicine balls with the instep whilst we blocked the ball when they kicked – The surgeons prescription was “fuck it up totally or cure it”! Many were cured!!! Equally before the days of MRIs we were encouraged to “Get tough” with sciatica where a prolapse was suspected. Again the surgeon requesting a clear situation through manipulation treatment, of totally herniating the disc so surgery was clear cut, or as was often the case curing the patient. I’ll leave you to hypothesise how the cure came about and whether you would consider this approach today! 

More transparent, not mystical

Graded exposure is nothing more and nothing less than it says on the tin, good old fashioned progressive exercise, but now including the mind and spirit as well as the body. Today’s knowledge has just made it easier not harder, more transparent and not mystical, more credible and not less believable.

Enjoy what we have at our fingertips and don’t be frightened off by the new title. 

-David Bolton

London

David Bolton, MCSP MMACP MSOM, has over 40 years of clinical experience in the field of neuromusculoskeletal medicine and is a long time NOI faculty member. At Limbus in Chelsea Harbour, David specialises in treating difficult pain states with a biopsychosocial treatment philosophy.

 

LAST CHANCE TO GET ON AN AUSTRALIAN EXPLAIN PAIN OR GRADED MOTOR IMAGERY COURSE with david butler FOR 2016

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Gold Coast 30 September – 2 October Explain Pain and Graded Motor Imagery **FULL**

Perth 15 – 17 October Explain Pain and Graded Motor Imagery

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WE’RE PACKING UP EP3 AND TAKING IN ON THE ROAD IN THE USA

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EP3 events have sold out three years running in Australia, and we are super excited to be bringing this unique format to the United States in late 2016 with Lorimer Moseley, Mark Jensen, David Butler, and few NOI surprises.

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To register your interest, contact NOI USA:

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