Barrett L. Dorko, P.T.

"She came finally to a small bed and laid down upon it. It was not too hard, and not too soft. It was just right. Very soon she fell fast asleep."

From "Goldilocks and the Three Bears"

          I don't often write of the specifics of technique. I'm convinced what we do should naturally follow a model of the body that we can explain and defend.

          It follows that your model's reaction to provocation would be a function of its make-up down to the cellular level. The qualities you assign to the tissues must be confirmed by adequate research. Without that, justifying technique by shrugging your shoulders and saying, "Hey, it works," is probably not a good idea. Especially if you are standing near me.

          I've long held a specific aversion to heavy pressure with the knuckles on tender body parts. The efficacy of this treatment must take a back seat to its rationale, especially since it is commonly painful. While defending this technique, although it seems to provide only a temporarily analgesia, a sports medicine therapist told me that her athletes need "quick results." I guess she thinks my factory workers, teachers, secretaries, and accountants are satisfied with less.

          The many techniques that comprise manual care are notorious for providing analgesia alone. If we don't effectively promote correction and a return to normal autonomic tone with our handling, well, that's just not good enough.

          Manual care that leads to correction and prolonged relief may come from many theoretical directions, but there is probably an aspect of its force that is common to all forms; it is enough to inform the body of its intent without being perceived as potentially harmful.

          When I demonstrate technique at a workshop, the location and direction of my force is easily described, but the students struggle with the degree of force used because it changes so frequently.

          O. Fred Donaldson speaks eloquently of touch in play therapy. "The skin becomes a barrier if touch is undertaken too harshly, and aside from the obvious, there are many subtle forms of intrusive touch."

          The force necessary to elicit self-correction (the type of manual care I personally employ) is not a constant, and it can be difficult to predict or describe. I am always searching for a response to pressure that includes unconscious motivation, warmth, and effortlessness. As long as these qualities grow, I'll stay where I am and I'll adjust the direction and amplitude of my pressure as the patient dictates.

          Ultimately I am seeking repose, but only as the end result of unique movement. My touch implies that. And from moment to moment, it changes with the patient. My patients taught me this. I don't think you can learn it at a workshop.

          Whoever built Baby Bear's bed created something Goldilocks simply couldn't resist. Sometimes therapy can provide a similar touch for those who need the rest.

Selected Reading

Donaldson O.F. Playing By Heart, Deerfield Beach, Fla: Health Communications Inc; 1993