Barrett L. Dorko, P.T.
Persistent problems with painful movement can be resolved with care that reduces the mechanical deformation inherent to the system while simultaneously increasing the body's tolerance for the normal stress of living. Doing just one of these, or doing them in sequence seems not to work especially well, hence the number of therapists I see in trouble.
In order to move toward a method of management that addresses both the essential anatomic lesion and the physiologic consequences of trauma, we need a greater understanding of processes commonly ignored in a typical manual therapy course.
In Waking the Tiger by Peter Levine, (North Atlantic Books 1997) the author contends that the persistent pain that follows some traumatic events is due to the constant increased sympathetic support that remains despite the passing of the event itself.
This is not exactly new knowledge. After studying manipulative care designed to relieve pain for over thirty years, the physiologist Irvin Korr concluded that, "its most significant effect was the reduction of sympathetic hyperactivity and its pathogenic pain-producing influences." 1
I will discuss the care and movement necessary to achieve this in my next column, but here I want to address our approach to the incident of trauma itself.
Levine uses the myth of Medusa to illustrate his experience with the kinds of care that directly and dramatically engage the patient's memory of the event that led to their current circumstance. Or, at least, what they think happened.
In the myth, Perseus is determined to bring back Medusa's head as a gift for his king. Since anyone looking directly into the face of the monster is immediately turned to stone, he is advised by Athena to avoid this by using his shield and thus is successful in his quest.
I have heard countless stories of techniques that require an emotive response on the part of the patient in order to completely resolve the problem, and I am troubled by this.
When physical therapists enter the realm of psychology and counseling, they are asking for trouble. It has also been my experience that if I believe a patient must do something specific in order to improve, I will, however subtly, request it, and most patients will comply.
The meaning of the Medusa myth is clear. To directly face an event that is full of fear and powerful emotion is most likely to produce the immobility, the "turning to stone" that the trauma originally created. Better to approach the memory obliquely, symbolically, gently and with our "shield" of understanding held high.
It has been well established that the memory we have of any event is little more than a mysterious combination of truth and fiction designed to make sense of our current feelings. Any "recovered" memory is unreliable. 2
But if the consequences of trauma must be engaged, how are we to deal with the memory of trauma itself? And how can the therapist accompany the patient through to the completion of our naturally occurring physiologic response?
That's the subject of the final installment of this trilogy; "Take Wing."
for it next week.
2) Loftus, Elizabeth The Myth of Repressed Memory (St. Martins Press 1996)