Barrett L. Dorko, P.T.
If manual care is to
have a significant and enduring effect on painful problems it must lead to a
reduction in the mechanical deformation responsible for the pain.
Sounds simple enough, wouldnít you say? But most of us
know that determining precisely what the relevant mechanical problem is and then
intervening effectively and safely is not a simple matter, and if the history of
manual medicine has taught us anything, itís that for the same complaint of
pain any patient might find as many methods of management as they can
practitioners, and that this variety of care doesnít guarantee a lasting
result. Itís been my experience that some of this care is capable of making
them feel worse.
Yet we keep looking for another technique that might
ďworkĒ for a certain diagnosis and continuing education courses that promise
the participant that they will be instructed in methods that reduce anotherís
pain are well attended by those anxious to learn a new skill. This makes sense
to me and Iíve been to a few of these courses myself over the years. In fact,
Iíd like to offer you the same here today, but thereís a catch. Today I want
to talk about the underlying nature of many painful problems and propose that
this dictates a manual approach to care not often considered. I want to make the
relevant tissue come alive in a way that enhances your respect for its
sensitivity and inherent capacity for change. I want to introduce you to
literature that supports my interpretation of what we see and hear in the clinic
and, most importantly, convince you with hard science that Simple
Contact is a reasonable, safe and effective method of manual care. I want to
do that before we even begin to handle each other, and I believe I can.
Let me add something to the first statement I made above;
Any method of care
that reduces persistently high sympathetic tone will assist in pain management.
I think this is pretty safe to say given what we know of
the effects of increased sympathetic tone and its relation to pain. In relation
to the issue of manual care, the bodyís response to coercion comes to mind.
With the exception of Simple Contact,
virtually all methods of handling include at least some direction, force and
intended result imparted by the therapistís effort toward the patient. Iím
not suggesting that this never generates the sort of movement desired or that
the result isnít appropriate. What I want to emphasize is the common response
any painful system is likely to have when it is moved passively. The unknown
nature of that movementís speed, duration, range and potential effect is
scary, and is not likely to reduce the sympathetic support already present.
Handling that does not evoke a fearful response simply because it poses no
threat, and, in fact, implies acceptance and trust, the kind of handling Simple Contact requires, is naturally more likely to reduce
sympathetic tone. We will discuss what a patient like that would begin to sound
and feel like.