How do you know when you've encountered a guru?

A colleague recently expressed some frustrations they were having in their clinical setting with a culture of 'gurism', essentially the tendency among some PTs to cling to individuals who advocate often miraculous sounding treatment approaches with no credible evidence to support their approach. I thought it would be useful to share my response because we all encounter gurism from time to time. So, I have pasted my response below. I have removed names because our blog readers are a highly intellectual bunch who can figure it out for themselves based on the criteria I outline below (no, I am not asking that we post names in the comments, but if it comes up, so be it).

Response:

I used to spend time criticizing and exposing gurus, but I rarely do now, primarily because it only provides them a credible platform on which to further make their case. Gurus only have an audience if someone is willing to listen. Here are a few ways to identify a guru:

1) Most gurus have all the classic traits of a great salesman - personable, charming, engaging, charismatic, persuasive, etc. They are generally people that you would enjoy being around, have dinner with, etc. If you're captivated by their every word, beware…they may be a guru.

2) Their ideas are almost always extreme, typically built on having found the cure for all pain. The treatment approaches frequently sound miraculous in nature. One really practical way to know if you've found a guru is to count the number of exclamation marks in their course descriptions. When you see lots of them, you may have a guru on your hands.

3) Gurus can also be identified by their use of proprietary language. They tend to even create their own vocabulary. When you see words that are only associated with this 1 particular camp, you have found yourself a guru.

4) Invariably, they position themselves as the expert, with us lowly ones as the ‘students’. They like to think of us as their protégé who must spend years and years in training to rise to their level of expertise, and, of course, fork out thousands of dollars along the way. In other words, when you think of a certain treatment approach and someone’s personal name immediately comes to mind…you have likely found a guru.

5) And science? Don’t go there. They almost never have credible clinical research, although they will masquerade around with plenty of basic science and theoretical work as ‘evidence’ for their approaches. In fact, you will often hear a guru offer the excuse that their ideas cannot be readily subjected to the scientific method for any number of audaciously arrogant reasons (ie, only in my hands, too metaphysical for scientific research, etc.).

So, anytime I see or hear about individuals like this, I personally try to ignore them. Ok, I confess - sometimes I can’t resist. I have ranted about a few gurus on the blog. However, I am confident that they will become an increasing fringe in a growing doctoral profession that will leave them behind. For the same reason that the chiropractic profession is very worried about where we’re headed as a profession (DPT, direct access, EBP, etc.), so should the gurus. Yes, there will always remain a gullible element of our profession that is attracted to these approaches. However, the effort required to shift their thinking to a more evidence-based paradigm is extremely difficult. The cost-benefit analysis is typically not in our favor. We adults have a hard time shifting gears if we’ve been led astray. Rather than spending time worrying about them, we should focus our energies on those willing to listen and who are in the various stages of ‘getting it’. Students graduating from our programs today are more and more skeptical of gurus and often know them by name before they even graudate. The professionalization of physical therapy continues to grow, causing me to be extremely optimistic about the future of our profession! That’s why my favorite groups to speak with are students. You have a real opportunity to shape thinking for a career.

Now, back to the real issue of how you confront gurism in your own practice. The best thing we can do with gurus (or students of gurus) who have found their way into our organization is to slowly ‘move them out to pasture’. We can (and should) still treat them with respect, be nice, etc. However, we should not promote them to positions of authority and certainly never place them in positions where they have influence over clinical education. By all means, please do not let them be clinical instructors or mentors for students or junior therapists! It is not ok to rationalize based on the desire to have students view ‘different approaches’. This is an absurd argument but one that is often made. We want students to see less variability in practice patterns, not more! As employers or clinic directors who make decisions about clinical education, we should refuse to waste employers’ money on fringe courses. This is completely irresponsible and a waste of time. And please don’t fall for the ‘but the course was approved for CEUs’ as evidence of a course’s legitimacy. The continuing education approval system in virtually every state that requires CEUs is utterly broken and a mere non dues revenue cash cow. We need the AMA model, but it won’t likely happen though because of state association's resistance to losing a source of revenue. I will stop before I digress too much. We have blogged about this topic a fair amount.

The one place I see for ‘guruism’ is for patients with the most chronic pain conditions. There are certainly patients who do not benefit from physical therapy and who for multiple reasons might benefit from alternative treatments. I take no issue with consumers spending their own money to seek whatever type of care they wish. Hey, it’s the American way. However, please, please don’t call this ‘physical therapy’ if you’re the one providing this care.

This is more than you asked for, but I thought it might provoke some thoughts in this area.

John

Comments

[Tim Flynn]

John an excellent post on a recurrent topic. In my current clinical setting I see individuals whose complaints are approximately 90% chronic and musculoskeletal in nature. If after applying current best evidence (for example manipulation, exercise, and cognitive-behavioral type approaches for chronic LBP) and not achieving clinically meaningful change I will discuss with the patient and if in agreement I may try additional approaches that could be labeled "alternative." I do some intervention techniques where I place my hands on the patient's skull and lower ribcage/upper diaphragm, etc. These are when viewed pretty standard soft tissue and tender point type work (albeit lacking evidence). I think the "story" is what makes it alternative. It is when we create fancy/bogus stories about rhythyms and viscera that we now become alternative. I would say that even worse is if we actually propagate the stories/myths surrounding these techniques such as I am releasing your x organ (i.e. kidney, liver, etc.). In this instance you can make a reasonable argument that we are treating outside our scope of practice.

I am occassionally asked that since I occassionally do these things why aren't you regularly teaching them? My response is simple. Teach and practice the evidence first. If patients actually got the evidence based treatment during the acute phase would we have the same level of chronicity? As new treatment and evidence emerges perhaps we will see some of these alternative therapies have demonstrated effectiveness. Then we should rapidly adopt them into our clinical skill set.

I sound like a broken record ("White Stripes" to be exact) but we don't need more stories. Lets gets some published case studies, case series, and trials using these techniques and see if they work or not. If they work, the story really doesn't matter...if they don't... move on.

Tim

[David Penn]

John and Tim make excellent points regarding how to spot Gurus but also when it would be appropriate to explore alternative methods ( non-validated ) that may indeed get at the root of a cognitive dysfunction or a belief system that gets the patient from the disability mind set or the need to hold onto their pain to a more active approach.

My whole motivation for seeking the DPT after more than a decade of CEU courses is that there was no consistency in what I was learning. Schools of thought could be all over the map and the only way to really feel comfortable with a treatment strategy would be to continue with the same group ( ala McKenzie) or Michigan State Univerisity's CME ( which by the way are great in terms of anatomy review and quality instructors). Some of these courses were so detailed and complex in their biomechanical model that you lost your efficiency in your treatment and likley the confidence that your patient had because you had to look at a match book to figure out sacral torsions.

That being said, how does the group feel about the McKenzie model. Well researched in many respects but many therapists get caught up in this whirl wind dictum. I get confused when I'm told that the McKenzie model does not implicate a painful structure during the eval yet later details how the pressures on the disc are changed based on posiitions of extension as the basis for treatment. ( not direct from Dr. McKenzie, but a McKenzie course part A)

The bottom line at the end of the day would be this. Have I prioritized my treatments based on the latest best evidence, clinical experience and patient centered values? If yes and the patient is not better in the anticipated amount of time then I am obligated to look for alternative treatments that in my experience have worked or refer to someone who has more expertise than I in this area.

My 5 cents worth........

[Jon Newman]

The word guru is an interesting word. Webster’s 3rd international dictionary defines guru a number of ways:

A personal religious teacher and spiritual guide in Hinduism

A person who acts as one’s teacher and guide in matters of fundamental intellectual concern

The second definition actually sounds like it would be nice to have. In fact, I like that definition better than the one provided for the word “mentor” (a close, trusted, and experienced counselor or guide) which sort of sounds life coachy to me. A reasonable substitute to describe the things being proposed in this blog entry might be the word “grifter” and I believe if we ignore PT grifters we place our profession in peril. Perhaps promotion of sound theory would make it more difficult for grifters to exist.

A few more thoughts:

--In WI, someone may call whatever it is they are doing “physical therapy” if they are a physical therapist and are doing the following

1. Examining, evaluating, or testing individuals with mechanical, physiological, or developmental impairments, functional limitations related to physical movement and mobility, disabilities, or other movement–related health conditions, in order to determine a diagnosis, prognosis, or plan of therapeutic intervention or to assess the ongoing effects of intervention.
2. Alleviating impairments or functional limitations by instructing patients or designing, implementing, or modifying therapeutic interventions.
3. Reducing the risk of injury, impairment, functional limitation, or disability, including by promoting or maintaining fitness, health, or quality of life in all age populations.

It seems that a process defines PT more than a limited number of interventions despite what insurers think.

--Our profession will eventually leave most of us behind including Kendall, Paris, McKenzie, insert your name here, etc. If you don’t think so, you just might be a “guru”.

[ryan]

purpose of physical evidence?

[ryanryan]

im going to searching purpose of physical evidence but how will i get them because the page is not available everytime that im searching...........

[Cory Blickenstaff]

I would like to add a few more comments to the points originally raised by John. Great topic by the way!

Points 3 and 4 are, I think, often related. A newly created language attempts to create an image of "this is something like you've not seen before, and therefore can't get anywhere else." Once that image is created they are able to follow with "and since you can't get it anywhere else, you better start at step one of the 23 step training schedule. Better take out a loan also."

Tim mentioned that if as long as the intervention works in a way that is identifiable by research, who cares about the story of why it works. Would a study, demonstrating effectiveness of an intervention, which also happens to be explained by some form unsound theory, really benefit us in any way other than justifying reimbursement? It seems to me that such an ommision of sound theory would only function to continue to divide our clinical reasoning. Something that is already done quite enough by the various gurus, not to mention institutes and other method certifying groups.

This highlights what I think is scary about point 5. We could very well find that these interventions can be proven to be effective through outcome studies. The unsound theory and newly invented languages, etc. suddenly become more justified and get passed along with the stamp of evidence approval. Now we've just perpetuated a problem (but now we can justify billing for it).

In the latest "PT magazine" several FAPTs commented on where the profession will be in future. The very first one mentioned the integration of energy based interventions. I couldn't have been more dissapointed. I think this highlights the dangerous ground we are treading on with guruism, as well as lack of sound theory, the combination of which divides us through the stories we tell. As Tim said, we don't need more stories.

Cory

[David Poulter]

Great Commnets from John and Tim. I'm a recovering cult member. Which is by definition the group that the Guru controls.

I sense that John has some emotional issues, as do I when we think and talk about Gurus.

I have come to believe that people basically need to belong and hence are easy pery. Being part of a recognized group offers us many conforts and even professional recognition, whether deserved or not.

My approach to all this has become a bit tongue in check.

I counldn't help thinking of Jeff Foxworhty whilst reading the listings. So I apologize in advance but....

You may be a GURU if.......

* Your name is similar to a famous fast food chain, a free shot in golf, a place to keep cattle and hay, the capital of France,a man servent to the British lord, or you were just born in the southern hemisphere.

* The governement "centralizes" and you write to them for royalties.

* You think Fascia is innocent and hence should all be released.

* You think a compact disc is the source of back pain.

*You claim to have invented extension (which would make you older than dirt itself)

And finally no one can do it better, without you, or differently than you, for your word is the word and nothing else matters.

PS I'm still taking the medication, but it seems to be wearing off.

In closing I want to paraphrase one of your great leaders Abe Lincoln, he said:

" No man shall benefit from another doing for him what he can and should do for himself."

I hope he was talking about THINKING.

[Selena Horner]

The guru thing is interesting. When the majority of those in our profession are not involved or members of our professional association, I wonder what kind of stuff the majority in our profession receive/read. If all one sees/reads is continuing education course material from organizations that bought one's name because one has a PT license, then one will be very current on the various course offerings and continuing education options. Toss on top of that the simple fact that generally speaking, one rates one's success or lack of success in treating patients via past experience/memory. One's memory is obviously tainted and generally not completely accurate, right? So, one will generally remember those awesome successes and one will remember those huge failures. (I also think that sometimes in the clinic, one has a slew of patients that respond well and progress well and then sometimes one gets a handful of patients all within the same time period that just don't respond or progress as would be anticipated and that just mentally brings one down.) Since one generally does not have data to substantiate one's memory, then obviously there may be some inaccurate assumptions regarding success and failure. Toss in that there may be many professionals that truly believe that every patient encounter should be a positive, successful experience with great outcomes. That's a LOT of stress to put on oneself. So one maybe begins to have something kind of like low self-esteem issues. Now, where would the majority of failures reside? If I were to guess, I'd choose spinal issues or non-resolving pain issues. So, what do the guru's do... they find their victims (and David has excellent points too about human nature - the belonging thing). There is a prestige in spending a lot of time and money to better oneself to acquire additonal letters and sometimes this moves one up the clinical ladder. It also probably sets one apart from others and within the little work environment, increases the chance of others seeking clinical advice from one OR becoming the "specialist" with some type of patient. So, one feels more important, one got a boost to one's self-esteem and one belongs to a new special group that extends into a bigger community than just the little work environment. Hmmm... what was forgotten though? Well, again, there is no data to substantiate the the clinican actually became successful with patients, so I'd be willing to wager that at some point down the road the clinicican again falls prey. The cycle begins again...

How can the cycle be broken?
1) Quit relying solely on memory.
2) Firmly believe that every patient may not have a completely sucessful outcome.

[Mark Armstrong]

My thoughts--We are part of a hands-on profession that needs human modeling for learning hands-on skills. Gurus take advantage of the human element but take it to the extreme degree--they get the learner to believe in the Guru, believe in the "approach" and believe (it is like a religion with light coming down from the sky). This complicates things for PTs in the long run as we all may agree.
It is more valuable for us as individuals to do the hard work of evidence collection but still remember to choose a few good human models who can teach us that we can do the hands-on aspects of our profession. In my daily practice I do benefit from remembering human modeling of skills but I really get excited when I practice with disregard for Gurus. Their memory is fading the longer I practice. Guru memory loss may be a great sign of aging (or should we say maturing)for the individual PT and the PT profession.

[Weston Lindsay]

Following the teaching of guru's as it is connoted above, leads to dangerous potential misconception. Tim, correct me if I'm wrong, but does this statement apply to what you were saying? "In a court of law, the lack of evidence is not evidence against." However, when we have a plethora of evidence for a given treatment, why would you pull out and use something that has not been substantiated?

My second point, I frequently talk to collegues and even patients about the "guru's" that I have learned from and continue to learn from. I suppose that I use the term as Jon defined it, "A person who acts as one’s teacher and guide in matters of fundamental intellectual concern." These folks are those who have either left the position of following this or that belief for promoting those that can be justified by the growing mountain of evidence. Those like the creators and perpetuators of this blog, those who teach in our schools who put stong emphasis in using the evidence to guide our clinical decision making, those who really are not doing it to make a name for themselves or make a clinic load of money, and those who take the time to amass clinical data to contribute to our knowledge. My kudos to you who are my mentors in evidence based practice. Someday I hope to lead as you do.

[Britt Smith]

Interesting discussion above. David Penn, I have an interesting case that might be along your thoughts. I have a patient who was involved in an MVA 10 days ago. I have seen her recently for ankle stiffness and pain secondary to a sprain. She was casted for 6 weeks because she has Ehlers-Danlos syndrome. Anyway, she came it with in a soft collar all AROMs of her neck limited to < 30 degrees (rotations < 20 degrees) and pain in her right shoulder, neck and low back. She was a physician assistant the next Monday. He wrote a prescription for PT and said, "I want the PT to do McKenzie method with you, that's what worked for me" and he said he would refer her to a McKenzie trained PT if she didn't improve in my care. Now, what does this PA know about anything McKenzie except the PT told him the method was McKenzie (including intermittent mechanic traction for his c-spine radioculopathy)?
I don't know what McKenzie says these days about WAD patient? I heard McKenzie speak in 1983, so I haven't followed his take on neck pain patients, but I haven't seen a boat load of evidence for treatment of neck pain.
I keep fairly well abreast of the evidence and I've heard Jull speak on Rx/eval of WAD patients, with sound evidence.
I'm not blaming McKenzie or accusing of guru-ism, but this situation is fascinating because somehow I'm to imply treatment by invoking the name "McKENZIE".
Britt
PS. She has had 5 surgeries to her shoulders (2 on the right). She has preferred direction of flexion and peripheralization of pain with backbending and shift correction (anterolateral leg pain to the foreleg right). Her neck flexion has improved in 1 session to 55 degrees with gentle manual therapy, but rotation remain < 20 degrees.
I am encouraging gentle pain-free ROM periodically.

[james smith]

Not to be trite, but I think you are on to something with this GPR i.e. the guru prediction rule. it must be why after 20 years of searching sometimes quite far for knowledge that i have never been quite able to committ myself entirely to any one school of thought. I think it is a brave stance to put it out there for all to consider.

[Rob Landel]

Throwing gas on the fire:

Some of our guru heros of the past have presented treatment approaches that have worked well, subsequently being substantiated by research evidence. It just turns out that their initial hypotheses as to *why* the approach worked were wrong. Isn't it the responsibility of the keen observer to record observations, and of the curious to try to understand them? So if at some point in time someone notices that putting tape on a patella significantly reduces anterior knee pain and allows increased function, and teaches that observation to others, is that person to be marginalized because the original hypotheses as to why it works were later proven wrong? Or if someone states that spinal extension that centralizes pain works because the disk protrusion is reduced, when it is later shown that the disk doesn't reduce, should we ignore the initial observation?

Don't observations such as these, and the hypotheses generated as a result, serve a purpose: to stimulate thought and research to test the hypotheses?

So, I would argue that gurus have a place in this world.

Beyond that, I agree with Jon Newman: grifters, who masquerade as gurus, should be marginalized by ignoring them.

After that, the real culprits are the blind followers; unfortunately, there's one born every minute.

A quote for the day:

The whole problem with the world is that fools and fanatics are always so certain of themselves, but wiser people so full of doubts.

Bertrand Russell

Rob L

[John Ware]

I had an interesting thing happen in the clinic on Friday that pertains to this discussion. I decided to tape a pt's scapula, but I needed an extra pair of hands to apply the tape while I held the scapula. The young women who held the scapula is starting PT school this fall. After applying the tape where I instructed her, She commented, "That's cool, McConnell taping for the shoulder." My flip response was, "No, that's 'Ware taping' for the shoulder." Not even in PT school yet, and this young future PT is already indoctrinated. Actually the technique I used was a modification of a technique used by Helen Host, PT and published as a case study in PTJ in the early 90's. I think this is before Jenny McConnell started taping shoulders, or at least teaching con ed courses on it (though someone will correct me if I'm wrong.) Isn't there a movement in medicine to get away from using names to describe diseases and interventions in favor of more clinically and scientifically appropriate identifiers? I think you may be a guru if your name is attached to anything scientific other than an element on the periodic chart.
John

[Drsilk]

Great topic....right on target. By the way, I have patented ROM and MMT!. I heard that they were both available and i have been doing them with my hands for years with almost magical results for getting some almost objective data! ...talk about what the world needs now!!! For Those of you that would liked to continue to do these highly advanced techniques...please send your royality checks to............Seminars coming soon to a city/state/exotoc location near you!!!!!

Tom

[Greg Specht]

I have taken courses with some of the charlatans, it goes with any profession.

I first learned about McConnell taping from Jenny herself in 1991. I was a new grad and she was such a charismatic speaker, so passionate about her subject matter that the room was filled with PTs eager to learn something new. In the pre-EBP, dark ages of the PT world I returned home, and foolishly thought I would once and for all solve the puzzle of my PF pain. Despite not having done a lit search, I shaved and taped my kneecap (with duct tape) just how Jenny had suggested. I ran 3 pain-free miles that day and would use taping along with some other techniques she suggested to eliminate my PF pain. ‘McConnell’ taping worked for me.

I applaud the EIM team for being such strong proponents of EBP and think that we need to strive to use treatments for which we can find evidence of effectiveness. So of course, always start by treating patients ‘by the book’. But when those EB/traditional treatments are not effective, that is when the great therapist will shine. They get creative and find a way to get the patient better. If we don’t eventually help a patient, we should be sure to have tried everything that is within our scope of practice to do so.

If a patient doesn't realize a satisfactory outcome at our clinic, we consider it our duty to refer them out and if they do get help somewhere else, hopefully we have been a part of the process and learned something new.

I especially encourage new grads to be creative and open to new ideas and treatments, while remaining skeptical of everything, even well done research. To do otherwise would be akin to following the advice of the U.S. Patent Commissioner who in 1899 said "Everything that can be invented, has been invented."

Greg

[mark boncser]

As usual this an interesting topic. I disagree with most of the tone of the blog however. Do I have follow gurus? Yeah I do. The funny thing is when I have actually talked to a guru (ie Maitland, Grieve,Kaltenborn etc) they don't call themselves guru and are very humble people. During my time in Australia I did not meet anyone who meets the description of guru as expressed on this blog other than Nick Bogduk who in my opinion is just a real jerk. We should never follow anything blindly but many of what you guys are calling gurus have been giants in our field. I think we see further because we stand on the shoulders of giants. Before we slam the giants we should consider what they have contributed to our field.

[John Ware]

Most of those that we, as a profession, have annointed as "gurus" probably cringe when they're referred to as such. I don't think this blog has been directed at them personally, or has attempted to minimize their accomplishments and contributions to the field. I think this blog has been directed primarily at the grifters that Jon referred to early in the thread.
However, I do think we should get away from the use of people's names to surmise a theorectical construct. A person's name is not descriptive at all of what your doing, for one thing, and it tends to elevate the person to "guru-hood" whether they intended it or not. Furthermore, as the techniques are modified and elucidated by research- and often made better by others-the original name tends to stick. Within the field, we know what we're talking about when we say "Sarhmann exercises" or "McConnell taping" or "McKenzie protocol," but what about our referral sources and patients? I know Shirley Sahrmann prefers that her theory be referred to as what it is-Movement Balance Theory- not who pioneered it.
John

[Greg Specht]

The reason that a person's name is often used to describe a specific process, technique or theory is for clarity and convenience. Every profession does as such and I really don't see a problem with it. It is the reason that we describe some of the special tests that we perform by using the last name of the individual who popularized the test. You all know what Ober's test is, or should I use another name.

Inevitably, when a new theory is floated out into a body of professionals, the person who is sticking their neck out in front of their profession is going to have their name attached to the idea. When the theory becomes so well known and embedded in a profession, so as to become common knowledge, the name it is no longer used descriptively (i.e. Cyriax).

Put another way, if you mentioned to a colleague that you were using progressive lumbar extension exercises with a patient based on their directional preference, 20 years ago, they may or may not have known what theoretical construct you were working from. They may have even thought you were nuts. By saying that you were using the McKenzie protocol, they either knew what you were talking about, or if they didn’t you could say, “yeah, this is new, but it works, you should take a ‘McKenzie’ course!”. But as time moves forward, the former is becoming more appropriate as the ideas espoused by McKenzie become embedded into our profession.

I agree with Mark when he says that we 'stand on the shoulders of giants', we should be happy that they pushed our profession forward and maybe even thank them from time to time by using their name to describe something that we are doing.

Greg

[John Ware]

Greg:
I think you may be making my point for me with your inclusion of special orthopedic tests, which I wasn't really talking about, i.e. a special test is not a theoretical construct, rather it's a discrete test. However, the use of people's names to describe special tests is very often confusing. Which version of Ober's test are you referring to? As described by Kendall or by Magee? There are so many variations of this test, that the term "Ober" doesn't really refer to anything in particular. I recently saw in a research article reference to the modified-modified Schober Test. What?? I had to go back to an article written over 20 years ago to find out what the original Schober Test was. As a famous radio talk show host has said, "Words mean things." What does a person's name mean?
By the way, I wish that when I started doing this 12 years ago my colleagues had referred to McKenzie extension exercises exactly as you succinctly described in you comment. It would have saved me a little money.
John

[Rob Landel]

What's In A Name?

The other day, just as I was about to apply the Childs Rule to determine if I should perform the Cibulka Slam, I looked out the window just in time to see a leaf fall to the ground, following Newton's Law of Universal Gravitation. Before carefully applying Newton's Three (yes, all three!) Laws of Motion whilst performing the technique, I decided to change the viscoelastic properties of the tissues, utilizing the WLF (Williams Landel Ferry) equation (Look it up!), by changing the temperature constant using ultrasound. Since the sound head was constantly moving, I carefully factored in the Doppler effect in determing dosage. (By the way, had I decided to use light therapy, I would have determined the amount of energy imparted using Planck's constant). I then assesed the outcome using the Oswestry (OK, OK, it's not named after a person, but...), the Schober test for sagittal plane range of motion, and the Lorren Goniometer for ROM.

That whole process, by the way, is the Landel Algorithm for Understanding Good tHerapy. You have my permission to pass it on.

Rob L

[John Ware]

Rob,
I'm confused. Which version of the Schober test did you use? Oh, and did you use the original Oswestry or the modified Oswestry? Did you actually write in your note that you performed a "Cibulka Slam" on your patient?
On a more serious note. As far as making names changes to equations and laws of physics that have existed for centuries-that may be a bit of a stretch-but I'm open to it. You may not be aware of this, but there are discussions going on as we speak in the standards committee of AAOMPT and IFOMPT to improve and standardize nomenclature for spinal mobilization techniques in order to avoid terms like "Cibulka slam," "lumbar roll" and "dog" technique. I've been using the CPR for lumbar manipulation for nearly two years and I've never heard anyone refer to it as the "Childs Rule"-thankfully. Furthermore, when I speak with referral sources about the CPR, that's what I call it! I've been doing this for 12 years, I did an 18 month residency, and I have never heard of a Lorren goniometer. Maybe that's a regional term.
John

[Rob Landel]

The "Lorren Goniometer" refers to Tom's post on this topic on July 23, wherin he patented ROM and MMT.

One last quote on Guru-ism:

Conceit spoils the finest genius. There is not much danger that real talent or goodness will be overlooked long; even if it is, the consciousness of possessing and using it well should satisfy one, and the great charm of all power is modesty.
--Louisa May Alcott

Yours, with tongue firmly planted in cheek,

Rob L

[Lono]

Give please. Your world is made of your memories, and your memories are given to you by your world. The whispering voice of happenstance is always in our ears. 'This is the world. This is the way things are. Look. Pay attention. Remember.'
I am from East and , too, and now am writing in English, please tell me right I wrote the following sentence: "Find the cheapest flights and airline ticket prices on bookingbuddy."

Waiting for a reply :p, Lono.

[Aideseecrek]

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