Excellent discussion. Great to see the mutual respect between you both. For me the thing that stands out the most is the estimated accuracy (Adam 10-20%, Mark 70-80%) of structural source of nociception from Ax findings, despite hearing that both seem to have reasonably similar objective methods of Lx spine assessment. Would be interesting to hear more about the specifics i.e. what collections/patterns of symptoms may relate to specific structures?
Mark reminds me a lot of my teachers in physio school who were sitting on their pedestal and weren’t ready to change their mind because they have been doing it for X amount of years.
@@docblue8081 Except Adam tends to be right most of the time, if not all of the time, as his views generally line up with what the wider body of evidence suggests.
Sorry but to me Mark seems mostly frustrated by his points not being immediately accepted by everyone, but questioned instead, and I actually found Adam to be relatively calm and much more reasonable during most of the conversation. They both make some fair points. I think Adam's more right about the uncertainty we have to admit to be dealing with relating to (back) pain. The only one being really calm was Rob though, haha, and the end was quite peaceful. Interesting discussion anyway, thanks for providing the platform and sharing it with us!
Repeated comments of 'in my experience' really highlight a problematic eminence-based approach. This podcast really demonstrates overconfidence and over-precision cognitive biases amongst clinicians. There also seems to be ignorance to the endless list of reasons why anecdotal observations in clinical practice cannot be taken as cause-and-effect, as well as just how much symptom presentation across the plurality of medicine has significant uncertainty when it comes to exact biological causation.
I have contemplated this for some time... Why can individuals reshape the idea that pain isn't pain when the cause is not something dangerous? I appreciated your question there Rob... brain freeze and pain while touching cold? Very true that it is a warning sign of potential danger and not tissue pathology... BUT it is still painful! Which proves your point, pain can present without damage, thus using pain to determine damage is not wholly accurate. BUT, because Mark can determine the cause as not tissue pathology, then it isn't PAIN? And that is why pain and tissue damage argument always leads (in the acute environment) to "We just haven't found it (the cause) yet". Stuart McGill said something similar at one point, that we just have searched deep enough for the mechanical cause. I wish there could be some reflection here to see that what matters is the conceptualization of the pain you are feeling. If you see that it is safe like in example of brain freeze, then you loss focus on it and go about your day. But when you don't know the cause or assume it is damage then all things and behavior changes.
I love biomechanics, pathoanatomy and mechanical diagnosis. Although, I cannot understand how a clinician "with 50 years of experience" keeps talking and treating as if pain neuroscience and research papers that go against biomechanics and pathoanatomy biases don't exist. I do not belittle Dr Mark, it's just really weird for someone with his clinical and research experience to talk and act that manner. Great podcast though. Hope many more similar to come.
I feel so sorry for Adam and all other clinicians who have to deal with stubborn individuals incapable of changing their minds in light of new information.
Mark is frustratingly bad at presenting his own point in a consistent manner. He waffles back and forth on his statements, talks down to Adam, sets up strawmen in order to “be right” in his unwinnable argument, and is generally acting as the stereotypical “old practitioner” who believes what he’s always done to whatever effect is better than any new, clinical evidence would support.
I don't buy this "just stay calm". It's such an easy out for someone who's lost the argument. "Oh well you got all het up" is not a refutation of an argument.
interesting discusiion i like Adam, but he need to show more respect to another speaker and do not interrupt. Host should pay more attention on culture of discussion.
Pain without nociception. What about the story of the man who had a nail go through his boot, was sedated in order to remove it only to find that the nail had passed between his toes?
Laslet speaks more from clinical experience and Adam speaks from possible scientifically proofed evidence.That tells us about the complexity of back pain.Both of them are right.Laslet experienced that from many years of practice and adam is following more scientifically approved hypothesis.Thats what this debate tells us in my opinion
Completely disagree. Laslett has a strong research background as well as clinical experience. It is very obvious that Laslett is the only expert on LBP of the two
the way adam loses his temper is quite a turnoff. As much as he argues that Mark is unwilling to listen, it also demonstrates his inability to accept other schools of thought
I've met Mark while in NZ he is such a nice person!
An interesting discussion - nice to have a discussion where people can disagree respectfully
Good job staying fairly composed Adam, greg must have taught you some tricks after his lockett talk
Thanks for listening!
Excellent discussion. Great to see the mutual respect between you both. For me the thing that stands out the most is the estimated accuracy (Adam 10-20%, Mark 70-80%) of structural source of nociception from Ax findings, despite hearing that both seem to have reasonably similar objective methods of Lx spine assessment. Would be interesting to hear more about the specifics i.e. what collections/patterns of symptoms may relate to specific structures?
Kindly invite Stu Mc Gill for this kind of debate in the future..maybe stu vs adam/greg :)
@@Speedstrengthtv haha. 100% disagree
@@Speedstrengthtv really? I was thinking the other way around :)
Check out episode 021 of the podcast, McGill was on that one!
Mark reminds me a lot of my teachers in physio school who were sitting on their pedestal and weren’t ready to change their mind because they have been doing it for X amount of years.
Well Adam also gives this point every time when someone disagrees..
@@docblue8081 Except Adam tends to be right most of the time, if not all of the time, as his views generally line up with what the wider body of evidence suggests.
Can we have a debate between Adam and Jeff cavalier please
Excellent content. We need more of these!
I agree. We have a whole back catalogue of podcast episodes with many fantastic guests. Including previous episodes with both of these two chaps
@@thebackpainpodcast5061 great. These live debates are very good because you can evaluate the arguments easily.
@@thebackpainpodcast5061is this podcast active anymore
Wow! Looking forward for such contents in future too!
More to come!
Sorry but to me Mark seems mostly frustrated by his points not being immediately accepted by everyone, but questioned instead, and I actually found Adam to be relatively calm and much more reasonable during most of the conversation. They both make some fair points. I think Adam's more right about the uncertainty we have to admit to be dealing with relating to (back) pain.
The only one being really calm was Rob though, haha, and the end was quite peaceful.
Interesting discussion anyway, thanks for providing the platform and sharing it with us!
I'm so happy to be a physiotherapist right know 🙌
“The art of medicine consists in amusing the patient, while nature cures the disease”-Voltaire
Thanks for the debate!!
Repeated comments of 'in my experience' really highlight a problematic eminence-based approach. This podcast really demonstrates overconfidence and over-precision cognitive biases amongst clinicians. There also seems to be ignorance to the endless list of reasons why anecdotal observations in clinical practice cannot be taken as cause-and-effect, as well as just how much symptom presentation across the plurality of medicine has significant uncertainty when it comes to exact biological causation.
Great podcast! 🙌
Quality debate!
I have contemplated this for some time... Why can individuals reshape the idea that pain isn't pain when the cause is not something dangerous? I appreciated your question there Rob... brain freeze and pain while touching cold? Very true that it is a warning sign of potential danger and not tissue pathology... BUT it is still painful! Which proves your point, pain can present without damage, thus using pain to determine damage is not wholly accurate. BUT, because Mark can determine the cause as not tissue pathology, then it isn't PAIN? And that is why pain and tissue damage argument always leads (in the acute environment) to "We just haven't found it (the cause) yet". Stuart McGill said something similar at one point, that we just have searched deep enough for the mechanical cause. I wish there could be some reflection here to see that what matters is the conceptualization of the pain you are feeling. If you see that it is safe like in example of brain freeze, then you loss focus on it and go about your day. But when you don't know the cause or assume it is damage then all things and behavior changes.
Nice video. How about an interview with stuart mcgill ?
Already done, check out episode 21 of the podcast!
I love biomechanics, pathoanatomy and mechanical diagnosis. Although, I cannot understand how a clinician "with 50 years of experience" keeps talking and treating as if pain neuroscience and research papers that go against biomechanics and pathoanatomy biases don't exist. I do not belittle Dr Mark, it's just really weird for someone with his clinical and research experience to talk and act that manner. Great podcast though. Hope many more similar to come.
These are excellent
👏 nice podcast..
Thanks for listening
Hey, Love your videos and tips. ❤️ Yan
Put timestamps :)
fantastic podcast nonetheless
I feel so sorry for Adam and all other clinicians who have to deal with stubborn individuals incapable of changing their minds in light of new information.
Mark is frustratingly bad at presenting his own point in a consistent manner. He waffles back and forth on his statements, talks down to Adam, sets up strawmen in order to “be right” in his unwinnable argument, and is generally acting as the stereotypical “old practitioner” who believes what he’s always done to whatever effect is better than any new, clinical evidence would support.
Same impression I had...
Adam you are a wise man but try not to be so emotional. Calmness always win. Peace and thanks for the podcast!
I don't buy this "just stay calm". It's such an easy out for someone who's lost the argument. "Oh well you got all het up" is not a refutation of an argument.
interesting discusiion i like Adam, but he need to show more respect to another speaker and do not interrupt.
Host should pay more attention on culture of discussion.
Pain without nociception. What about the story of the man who had a nail go through his boot, was sedated in order to remove it only to find that the nail had passed between his toes?
I think Lorimer Mosely should have been in on this...
not sure what y'all on about how 'composed' adam was but he lost it a few times during this interview
Sorry, but Mark is Spot on!
Laslet speaks more from clinical experience and Adam speaks from possible scientifically proofed evidence.That tells us about the complexity of back pain.Both of them are right.Laslet experienced that from many years of practice and adam is following more scientifically approved hypothesis.Thats what this debate tells us in my opinion
Completely disagree. Laslett has a strong research background as well as clinical experience. It is very obvious that Laslett is the only expert on LBP of the two
the way adam loses his temper is quite a turnoff. As much as he argues that Mark is unwilling to listen, it also demonstrates his inability to accept other schools of thought
Adam did very great! i think Mark is to old for this XD
Are you kidding??? Mark was all over Adam in terms of experience and knowledge of the evidence.
@@darrellflinn7183 this was not a comment on knowledge or who is right, but rather on the way of communicating with each other
If the annulus of the disc was injured, flexion would have hurt.