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Too much “me”?

By Timothy Cocks Physio world 10 Oct 2014

From the number of people reading it, Wouter Ramboer’s last post on noijam had people thinking. It kept Wouter thinking too…

The recent blog Hit me with music kept me thinking. Something as simple as music can have a big impact on behaviour and emotions – it can alter our very experience of a situation. So how does the entire context in which we propose to test exercise regime A vs exercise regime B affect the outcome?

When we read papers about chronic pain, we see that no ‘intervention’ is superior to the other – or the differences are rather small and non significant. It seems that no matter what specific exercise is put into the regime the results are more or less the same – short term outcomes of slight improvement. Long term improvements? Not really, and often drop-outs along the way.

Perhaps we should we take it from another perspective? When researchers/physios test their exercises on the painful population, they impose their strict regimes and protocols – intensity, duration, timeframes, and so on. I understand that this is necessary and important from a research perspective, but, what if we considered what patients want, what their goals are, and let them control the regime in some part? What do they like – the same ‘core’ exercises over and over again in a clinical environment? Or fun, novel activities at home, or in the park, with their favourite music playing? What about meaningful movements building on what *they* need in daily life, be it work related or for their hobbies?

Is there too much of the therapist; too much “I” and too much “me” in the research regimes?

Wouter Ramboer, PT, Belgium.

-Tim Cocks


  1. Hi all,

    I reckon it depends on the client.

    Lately I’ve been altering my views slightly to incorporate two broads groups of CP clients:

    1) those with a single specific negative belief about pain and structural integrity of the affected body part, and
    2) those with multiple negative beliefs relating to every aspect of life (as well as the painful body part).

    My experience is that the first group respond very well to explain pain and suggestion, and that second group don’t respond at all.

    If a person has a heap of negative beliefs, then they will have low self-esteem. Low self-esteem is just a belief that “I am bad/useless/worthless”. This belief will undermine and negate all attempts from others to help. It has to. To accept and integrate help, one has to first believe one is worth it.

    So in this group, I think a very non-directive approach is good. There’s a guy on somasimple whose treatment is basically “move however you feel you want to move, and I’ll move with you”, and this has a built-in acceptance and non-judgment incorporated. I think this is what you’re getting at wouter. It’s the allowing and non-directive tone which gives the client a feeling of power and worthiness. One might just as easily say “draw whatever picture you want” or “speak/sing/rant however you want”, because it’s the *expression of self without fear of judgment* which is the important aspect. It gives freedom. Freedom to be oneself is the ultimate cure for negativity.

    Today I had a woman with multiple severe medical conditions and a frozen shoulder on top of it all. Her life story was about pleasing others, never saying ‘no’ and not paying attention to her own needs/wants. I told her that the most healthy people I have ever met were quite self-centered. I said such people go about much of their life thinking “how can I feel better than this?”, then they alter their thoughts or behaviours in a way which brings more comfort/pleasure/ease. She liked this. Her whole energy changed. It gave her permission to be herself and do what she wanted.

    I had another client this morning who was the opposite of this – very positive young guy with good energy, but a single negative belief about his back (3 weeks duration and not improving). In this case I was very directive. I was the one who was in control. I was the expert and I was in charge. He liked it. It worked.


  2. Nice post and the line ” Meaningful movements ” is what it’s all about. What ever makes your heart sing is good…..

  3. Sometimes it’s not just about former education and biases, sometimes it’s all about the ego of some therapists. They love to say: “I told you so, you’ll get better”, “hear that?, that’s the sound of your vertebrae going back to it’s normal position, cool isn’t it”…

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