Barrett L. Dorko, P.T.
for me, is a visceral act. By that I mean that I feel its effects through my torso, and not just in the muscles of my hand. I sense another relevant line of prose or poetry rise toward the surface from places deep within me, and the ink from my pen lands like a wave on the shore. It can't be stopped, and no two waves are ever quite the same.
Now, I know that this is a rather romantic view of what I do each week on this page, and that a few of you are already beginning to lose interest because it sounds like, once again, I've stepped away from the hard science of movement into the realm of metaphor. I know where descriptions of this sort can lead, but hang in there. You are the ones that will probably find what you're looking for this week.
The tendency of our patients to move or rest in unique ways is of great interest to many in our community. They work hard to explain these things with theories of muscular imbalance, fascial tightness and aberrant joint mechanics. Many suggest, reasonably, that our muscular set, mediated by the brain through the intrafusal fibers, is a consequence of past experience in combination with current thought. Since our remembrance of things past can also evoke emotions, these are thought to play a role as well.
There is in orthopedics a conceit that I don't see in internal medicine. It is that we feel we should be able to test adequately enough to determine the problem before we proceed with care. What is "wrong" should be visible in some way, or at least it should leave a large, clear track on the surface. Treatment proceeds only after this is found and interpreted.
But if I were to go to an internist with a transient discomfort in my gut, he or she wouldn't know precisely what was wrong before they advised or medicated me. Their final diagnosis would follow my response to conservative care, not precede it. This is common and perfectly acceptable.
In our community, there remains the impression that we can always know with precision what is wrong if we just test people enough, but I wonder about this.
I often read that therapists will interpret the postures, movements or even the gestures of their patients very specifically, as if they could somehow see into the past of another, and judge what is most important to them. It is very like the notion that we can always know what is wrong by viewing the surface of the patient, and just as misleading.
Such a view does not honor the unique and unpredictable nature of individual human beings, it only elevates the therapist to the position of mind-reader.
Elizabeth Behnke Ph.D., the coordinator of "The Study Project in Phenomenology of the Body"* writes of "ghost gestures" that may persistently "haunt" our bodies. They arise from a vast array of sources and may echo well beyond a task, an instruction or a deep-seated desire. They are present both in an effort to display something or to hide something. Sorting this out in the course of therapy seems a remarkably daunting task to me. I'd rather practice in a fashion that gives the patient permission to explore their own motion, and interpret it in their own way, and I do.
My urge to place myself in a writing mode is, to me, as physically compelling as it is intellectually necessary for my mental health. I'm convinced that without a regular dose of this creative movement, I would suffer the pain of persistent muscular tension, of movement unrequited. I see this in my patients, and I suggest they let the movement they want to emerge completely.
Maybe in therapy they can do this without fear of judgement or of another's analysis, but that is unlikely given most therapist's desire to control and appear all-knowing.
don't know what I'm going to write about tomorrow. I'm just going to let the next wave rise and fall. It will be on this page next week.