Barrett L. Dorko, P.T.


            It seemed to me that a couple of days floating down a river in West Virginia would be different enough from my clinical work to qualify it as a vacation. I was wrong. 

            There’s a recurring debate in physical therapy about whether we have been overwhelmed by technology

or not. I distinctly recall it from school over 20 years ago.  Back then some of my instructors were only trying to protect and preserve the integrity of massage. 

            My day on the river was spent in a rubber raft; no rudder and no motor.  Either we moved it or the river did.  Considering the rocks and the rapids, I can’t imagine that any engine would survive the trip unless it powered the boat a few feet above the water. 

            The thing about the use of machinery to relieve pain or resolve dysfunction can be confusing and divisive but only if we do not distinguish between examination and treatment.   The body is literally a format, like a compact disk though far more complex.  It needs many reading mechanisms to view and interpret its multiple messages and, being animated, its way of being can change in a moment.  Using a machine to examine someone is a good idea as long as we remember the limitations of the device.  We shouldn’t forget that human beings can see things in others that will forever be invisible to any machine. 

            Floating down the river, I was struck by the timeless quality of the day.  Without my watch the “current” events (pun intended) were intensified because they all involved “body time.”  This is wonderfully described in Alan Lightman’s novel Einstein’s Dreams (Warner 1993); “(Body time) is not predetermined, it makes up its mind as it goes along.”  While in body time, we listen to our heartbeats and feel the rhythms of our moods and desires.  Time such as this struggles forward when we are stressed and it darts across our vision when we are receiving praise.  Body time encourages us to obey our inclinations, not to order them. 

            In my experience, truly effective manual care induces in the patients a sense of their internal activity that defies measurement in seconds or minutes.  It is most likely to reveal processes and movements that are best described by their naturally occurring quality, not their speed.  The timers we set while applying mechanical modalities might provide a measure of safety, but they are largely irrelevant to change.  Lightman suggests that where mechanical and body time meet we are uneasy and that we are more content when we are allowed to follow our own currents without feeling the gaze of a nearby clock.  Obviously, machines will not induce the feeling we want once we’ve set the timer.  I always remove my watch to handle others.  Maybe that’s more symbolic than practical. 

            The river on that day had two distinct elements -- water and rocks.  The stability of one is in stark contrast to the nature of the other.  I noticed that the guide could always tell me where the rocks would be, and their effect on the raft (and me) was consistent.  The water was another matter, and a recent rainstorm or the opening of some gate in a distant dam could change our movement through it in unexpected ways.  When dealing with this aspect of the river “feeling” our way through with vigilance and some respect for its changeable nature was always best. 

            Perhaps we can effectively separate anatomy into those parts that are inert and linear and those that flow, change and defy easy measurement.  The former might respond well to therapeutic machinery and the latter would probably prefer a human hand upon them, responding to their unique needs.  Similarly, on the river I can push the rocks in order to alter their position, but I can only flow with the water. 

            Each day into my office walks something that defies my efforts to assign it consistent qualities of shape or strength or response to provocation.  On some level each patient is a river. Effective and safe navigation requires both our hands and the technology offered us.  Which modality we choose depends on where the river and the therapist  happen to meet.