Barrett L. Dorko, P.T.
Always this fire
If it remains unlit,
The body fills with a dense smoke
from "Out on the Ocean" by David Whyte
begin each day in my office with a presumption that what
I've found is unusual in manual care, but very common to ordinary
I presume that my patients are always pursuing correction, improvement and homeostasis, and that there is a movement or physiologic change within them that will help if it is simply amplified and allowed to express itself.
I didn't learn this in school. Like everyone else in physical therapy, I was taught that it was my job to determine what was wrong, not what was right. Every asymmetry, every bit of tenderness, all of the deviations from some ideal were to be considered possible contributors to the patient's complaint. We were taught that our observational skill, once acquired, would actually grant us a kind of reverse clairvoyance that allowed us to say things like: "...he has an unstable segment brought about by many years of asymmetrical weight bearing due to his left frontal plane asymmetry." I actually got this description of a new patient in the mail from another therapist.
I'm not sure that this therapist is necessarily wrong, it's just that he seems to think that asymmetrical posture will lead to predictable consequences and that what is seen on the surface is sufficient to accurately reveal internal activity. And while that might be true of inanimate objects, humans, if not all animals, tend toward less certain reactions to mechanical stress. Often they react as would a mound of gelatin to the tipping of the plate. At least, this is what I've seen in all my years of looking.
I don't dislike this uncertainty, I just live with it. I have come to appreciate that it's what keeps me awake at work. I think perfectly predictable responses to handling would bore me.
The poem at the beginning of this column refers to the classic image of creative processes as a fire carried within. You can find references to this symbol throughout the classic literature of many cultures, and mankind's fascination with fire extends beyond its practical use to a sense that it somehow lives. There's a speech about this by Robert DeNiro in the movie "Backdraft."
I feel the movement that corrects us and relieves our pain is also creative, and it also seems to have a life of its own. Within people with persistent pain of mechanical origin, perhaps it is only glowing, like some embers deprived of enough oxygen to ignite the available fuel.
Following this image, I would approach it carefully, and breathe on it gently. I would understand that since it is uniquely creative, I have to accept it willingly, as I would a picture brought to me by a small child. How easy it is to snuff the creativity of another.
The implications of this thinking for manual technique seem clear to me, although so much of what we learn implies that we can coerce correction with force and proceed to "fix" what we think we see wrong on the surface.
The next time you sense the patient resisting your manual methods, consider how difficult it would be to know and then match the creative act of another. When this fire is only glowing, breathe on it gently, and then just watch it grow.