Barrett L. Dorko, P.T.

          It is reasonable to assume that people in pain from mechanical deformation search for the movement that might relieve them. In fact, nothing less will do if there is to be any prolonged relief. This search is the underlying fundamental issue of each visit to the therapist, and when it remains unaddressed, therapy is often no more than palliative.

          There is an ancient joke about a man searching for his keys outside although he lost them in his house. "The light's better out here," he says. When I speak of corrective, pain-relieving movement, we must consider both its origin and its manifestation. Its origin, of course, is the brain. And it seems obvious that for many of our patients with chronically painful problems, the corrective movement that begins there has a very difficult time emerging. It also seems that it must "leak" out a bit at a time and thus account for the spontaneous recovery that is so common in recurrently painful problems. When asked what they did that seemed to produce relief, patients are typically clueless. "It just went away," they say. Since pain is not an entity but rather a way of being, it makes no sense to speak of it in this way. Instead, we should acknowledge the fact that we alter our behavior when we feel better and therapy should be about discovering that alteration and amplifying it.

          Since the behavior that relieves pain is so often difficult to recreate with ease, we might assume that it begins in a place whose expression is ordinarily restricted. This would not be the familiar realm of the cortex whose manifestation is seen in the posturing and posing we use to perform our jobs and relate to others. If the cortex could fix us, chronic pain wouldn't be epidemic. Movements that relieve us begin "deeper' in the brain, in those centers more closely associated with instinct and preservation. These regions are likely to produce movements that are not considered perfectly appropriate in polite society. Though effortless, they might be briefly painful and, being unconsciously driven, they are constantly surprising to all concerned. It doesn't sound like the kind of thing any of us would be willing to do given the constraints of our culture, and it certainly isn't the kind of movement encouraged in a physical therapy environment.

          This being the case, both patients and therapists act much like the man searching for his keys. They prefer the clarity, precision and control of cortically directed movement. And although these movements fail quite often to provide much in the way of prolonged and profound relief, at least it's light out there, so to speak, and they don't have to deal with the darkness inside their own home.

          But if the keys aren't there, all the searching in the world won't reveal them. Eventually, we have to go into the place that uniquely expresses us (like our own homes typically do) and find our keys there. Sometimes, it seems that the lost items find us if we pause quietly long enough near to them. I find that this is the case with corrective movement, and it is what I encourage my patients to do.

          In Gail Sher's book One Continuous Mistake; Four Noble Truths for Writers (Penguin 1999), she addresses the individual nature of writing and the notion that our best work can only be known to us, not taught us by another. She says, "What is the best way to write? Each of us has to discover her own way by writing. Writing teaches writing. No one can tell you your own secret."

          I see our best way of moving toward relief in much the same way. Where we have to go is our own secret, and no one else can lead us there. In the end, the keys are in our own house. Dark or not, we must look for them there.