Barrett L. Dorko, P.T.


I read the book The Perfect Storm by Sebastian Junger (Harper Torch 1997) recently and was reminded of times in the past when I tried to use the ocean as a metaphor for the body. I thought I’d use a few quotes from the book and elsewhere to do this again. 

A boat’s motion can be thought of as an instantaneous integration of every force acting upon it at a given moment, and the motion of a boat in a storm is so chaotic as to be almost without pattern. Billy would just keep his bow pointed into the worst of it and hope he doesn’t get blindsided by a freak wave. 

The passage above reminded me of patients I’ve seen who struggle to tell me how and when they might have begun to experience their symptoms. They’ve often ended up in my office after totally confounding their previous caregivers, especially if that person takes great store in a detailed history and believes that some specific incident is necessary for acute pain to begin. Even the patient is likely to say, “Can you tell me just what exactly is was that I did?” Often, I don’t think I can. The physical forces and other more subtle physiologic influences that vary regularly in many directions as we live our lives cannot be completely accounted for. When a “storm” of these occur it’s not possible to say which is the most important one or to know how they all interact. At best, they can just face it and hope nothing completely uncommon sneaks up on them. Another line comes to mind that describes an attitude that some patient’s might find useful when in the middle of an acute attack: 

In a sense, Billy’s no longer at the helm, the conditions are, and all he can do is react. If danger can be seen in terms of narrowing ranges of choices, Billy Tyne’s choices have just ratcheted down a notch. 

Feldenkrais describes in his writing how a reduction of movement choices will result in the kind of inefficient and painful conditions we often see. Gently and thoughtfully discovering the movements that are now painless and possible is the main thrust of his work. The reference to “no longer being at the helm” reminds me of the unconsciously generated movement I personally promote. Although it is certainly active movement, the patient’s sense is of being driven by forces that they don’t direct in the usual way, and, in fact, they don’t. “Reacting” to our desire to move in this ideomotor fashion is akin to allowing the “storm” direct us. My faith in this attitude and movement has been reinforced by the reduction in sympathetic tone that typically accompanies it. 

All waves, no matter how huge, start out as rough spots-cat’s paw’s-on the surface of the water. They give the wind some purchase on an otherwise glassy sea. Unfortunately for mariners, the total amount of wave energy in a storm doesn’t rise linearly with wind speed, but to its fourth power. 

I like this description of how large things are initially nurtured by small events or circumstances we wouldn’t ordinarily notice. In the diagnosis of Complex Regional Pain Syndrome there is the phrase, “pain disproportional to the inciting event.” It’s used to describe a situation that seems to have its origins in things that begin small but then grow in an exponential fashion if the conditions remain just right. Nervous irritation can grow like this, and unless we understand that, a lot of perfectly legitimate patients will be thought of a “symptom amplifiers” when they really aren’t at all. 

This is from K. C. Cole in The Universe and the Teacup: The Mathematics of Truth and Beauty; A scientific prediction is less like a weather forecast than a train of thought. Predictions are guideposts along the way to understanding, not goalposts. What science is about is how and why, not where and when. 

And from The Perfect Storm; These aren’t mistakes so much as an inability to see into the future. 

Each day I am asked to predict the future and, given what I do, that’s understandable. If I were always dealing with frank and testable lesions of the connective tissue, I’d probably be pretty good at telling people when recovery might occur. But the nervous system has a way of defying our efforts to predict how it will respond to mechanical provocation. It lacks a linear relationship to this, I think, because of its geometry, which is fractal. I can’t see into the future when nervous irritation is the primary problem, so I’m forced to move ahead steadily with methods that I’m certain will move the patient’s physiological state in the right direction, at least. I focus on breathing, a less mechanically stressful resting posture, and I encourage movements that warm and soften the body. Not very dramatic I admit, but it’s the safest way to go. 

Water is the only element that offers more resistance the harder you hit it. 

Think about this the next time you are tempted to use heavy, concentrated pressure on someone else’s watery body. 

Finally, I want to add here one of my favorite lines from an obscure novel I once saw in a bookstore. It is something I try to remember whenever I begin to think I can control the ocean that is my patient. It’s from The Gold Bug Variations by Richard Powers; Science is not about control. It is about cultivating a perpetual condition of wonder in the face of something that forever grows one step richer and subtler than our latest theory about it. It is about reverence, not mastery.