Barrett L. Dorko, P.T.

          If I begin with the presumption that my patients experience pain secondary to a mechanical deforming of certain tissues, it's reasonable to further assume that some movement would relieve them. In fact, there's rarely evidence that anything else need be done.

          While this might sound remarkably basic to many of you, I've often found that the protocols of treatment typically offered those in pain offer either no movement, irrelevant movement, or movement that makes them worse. Perhaps this is why we're experiencing an epidemic of chronic pain in our culture.

          What I'm proposing here is that corrective and, therefore, pain-relieving motion has four characteristics that aren't commonly seen in therapeutic exercise. Maybe once we understand them, we can redesign our approach to care.


          Since this can only be the consequence of increased blood flow, it must represent an increase in parasympathetic tone. Neural irritation produces a sympathetic response, and we can reason that it is being reduced when the blood vessels dilate. I'm speaking here of a change in temperature that is almost immediate and felt by patient and therapist alike. It might appear anywhere within the body and rises and falls as treatment progresses.


          I've found that the movements that correct us are both active and instinctively driven. Freud said, "The essence of analysis is surprise," and I presume that since the answers to our problems lie in the unconscious, their expression is unexpected. In my experience, the movements we plan don't often help as we had hoped. This would also explain the failure of choreographed regimens or passive movement to relieve pain. If the motion necessary for relief must come from the patient, it is only likely to arise within an environment full of acceptance and faith in their inherent abilities. It is no wonder therapists rarely see it, given the typical environment the profession has created.


          When I speak aloud that which I had previously held in silence, the muscles of my throat and jaw will begin immediately to relax. In fact, I can't think of a way to more effectively reduce muscular tone than to fully express it isotonically. Even if the movement itself is painful, I know that this discomfort will not endure. Why shouldn't we view the skeletal muscles anywhere in the body with as much understanding as those that drive speech?


          Here I define effort as the force necessary to overcome our internal inclinations not to move. I've found that although the motions that correct us might be quite powerful at times, it takes more effort to hold ourselves from them than to reveal them fully. Here again the instinctive quality of the movement that I seek is apparent. In a culture that suppresses instinct in favor of cosmetic posturing, many socially acceptable positions will require effort to maintain, and they will keep us in pain.

          Well, there you have them. Now all you have to do is discover how your care can elicit these qualities of movement. I'd suggest you look for them within yourself first.