Simple Contact-The Basic Premise

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.