Barrett L. Dorko, P.T.
To be nobody-but-yourself in a world which is doing its best, night and day, to make you everybody else - means to fight the hardest battle which any human being can fight; and never stop fighting E.E. Cummings
my essay "Origins" I emphasized that mechanical
deformation was the origin of most of the pain we might help with
I consider this a deceptively simple idea because it makes no mention of why movement hurts at some times and not at others, or how a comfortable, static position can become painful.
What I didn't mention was the element of adaptive potential. This quality of autonomic flow and balance determines how much deformation is possible without pain. For me, a large adaptive potential is displayed by competitive swimmers. Their fluid tone allows them to painlessly tolerate repetitive, forceful, prolonged, and acute deformation. My patients are usually at the other end of the autonomic spectrum.
Simply put, sympathetic dominance decreases our tolerance for mechanical tension and parasympathetic dominance increases it.
Much of what we call physical therapy boils down to movement that both decreases mechanical tension and sympathetic tone. It is clear that the primary tissue capable of changing us autonomically in this way is the nervous tissue itself.
For a long time now I've been convinced that for all my attempts to sense dysfunction through means of examination, I still can't tell a patient which movement will take them out of the twist they've uniquely acquired. One day I simply stopped coercing them manually and discovered this: Everybody is unconsciously attempting to reduce their neural tension by means both subtle and obvious. This attempt to move is concurrent with life, but ordinarily we have no sense of it, do not fully express it, and are typically taught to distrust it. The movement may contain a rhythmic quality at times, but other than that it is wholly characterized by its effortlessness and spontaneity.
This movement is least likely to be expressed in situations where we tend to pose, posture, or feel concerned about the judgment of others. In other words, just about everywhere.
The movement needed to reduce neural tension is the expression of desire. That is, it comes from each of us uniquely, personally, and intensely. It can't be taught or choreographed because it is instinctive, primal, and unpredictable. It is done in an effort to please no one but yourself.
Our culture does not encourage the authentic expression of unconscious desire outside the institutions of art, and there it is only tolerated among those with a "gift".
All that most of my patients really need to do is what they want to do. If I can somehow give them an environment that makes it safe to express that, they soften and feel much better.
The real struggle begins when they walk out the door and face a culture that demands something else.