Barrett L. Dorko, P.T.

"Come and listen to my story 'bout a man named Jed..."

In the U.S., it is not possible to say these words without a certain rhythm and tune. This is how the legendary country western duo of Flatt and Scruggs began each episode of "The Beverly Hillbillies," a popular weekly T.V. series from the late sixties that continues in re-runs today.

Briefly, it was the story of a poor family, the Clampetts, from deep in the hills of Appalachia that discovered oil on their land, became fabulously wealthy and relocated to a mansion in a posh suburb of Los Angeles. The comedic tension arises from the Clampett's profound lack of sophistication in the midst of wealth and modern convenience. The patriarch is an honest and personable man named Jed.

Like anyone else in the practice of manual care, I began my career hoping to acquire skills that would transform the shape and sensation of my patients in a certain way. Toward that end I devoured the writings of many caregivers that claimed to have discovered methods of handling the human body that were effective for the relief of pain. These techniques were almost without exception dependent upon the judicious application of force through the skin in an effort to stretch structures thought to be adhered or shortened for a variety of reasons. Occasionally, techniques of direct pressure were proposed to alter muscular activity by altering blood flow or manipulating the activity within the intrafusal fibers. These methods were for the most part gentler in nature, but were no less coercive. That is to say that the therapist's hand applied an agenda, a judgement of the current activity beneath it, and an effort to alter that activity in a certain direction.

I not only read of these techniques, I learned them, had them applied on myself, applied them on patients and taught them. Certainly I did this in greater depth with some techniques than with others. My point is that I am by no means a novice when it comes to manual care.

I'd like to return to Jed and his family for a moment:

The Clampett's Beverly Hills mansion had a beautiful set of chimes attached to the doorbell. During the first few episodes they'd be somewhere in the house and suddenly hear what they came to call " that music." They'd all look up at the ceiling in wonderment, trying to figure out where it was coming from, and why.

In about the eighth episode Jed says, "You know what I betcha? Pretty soon somebody's gonna be knockin' on the front door. Because every time I hear that music, after a couple of minutes, somebody comes knockin' on the door!"

As I moved unsteadily through the forest of manual technique toward the spot I currently occupy, I noticed that methods generally fell into two categories; those that relied on mechanical effect and those that relied on nervous stimulation secondary to manual deformation of the skin.

I know that both of these effects were inevitable with handling, but that the dominance of mechanical effect grew with force while reflexive effect decreased as pressure increased.

This wasn't my idea, it's physiologic law. You could look it up.

Evidently, Jed Clampett, for all his good sense, honesty and country wisdom, never discovered the nature of the electricity in his own home. Maybe be never looked behind the walls and saw the wires. Maybe he never read a book. I guess he never rang his own doorbell.

A major problem with the use of mechanical pressure to change systems is the fact that that energy is dispersed rather rapidly. In a house like the Clampett's, no matter how hard you knock on the door, nobody's going to hear it much beyond the foyer. Now, if the problems in the body that we need to alter mechanically are that near to the door of the skin, pushing on it would probably be good enough.

But when was the last time you saw someone with a spinal problem or anatomical lesion within reach of heavy pressure from the surface? I stopped pushing because I wasn't strong enough to get to the involved tissue.

If Jed had taken the time to investigate the power and potential of the electrical activity within the walls of his home, he would not have been surprised to hear the effects of some pressure on his doorbell, even if he was clear back by the pool, or, as the Clampetts called it, "the cement pond."

When the therapy community decides to investigate the potential of reflexive effect i.e. that which is mediated by the connections of the nervous system, I feel they will discover that there is a way of promoting change and awareness that far exceeds the mechanical. Until then, many of us will wander about like Jed; benign, full of honest goodwill and steady effort.

And when we go visiting, we always knock, ignoring the doorbell. But these homes are big, and we often walk away, disappointed and unheard.