Barrett L. Dorko, P.T.

Perseus cut off the head of Medusa, and from her neck flew Pegasus, the winged horse.
From "Perseus and the Heroes of Argolis" (The Larousse Encyclopedia of Mythology)

          I'm not always a popular figure with a certain segment of the physical therapy establishment. This is because I regularly criticize the theories of typical therapy. I don't do this without citing research appropriately, but my words sting, and I suppose that I would feel the same.

          My main conflict with traditional practice is obvious at the moment of manual contact. It is precisely then that my ideas about how to proceed culminate in a kind of handling foreign to my colleagues, and, in my experience, entirely new to my patients as well.

          In Waking the Tiger by Peter Levine (North Atlantic Books 1997) it is suggested that the human reaction to trauma is often arrested before the physiologic response is complete. Thus we are left in a state of heightened sympathetic tone characterized by cooling, rigidity, increased sweat gland activity, upper respiratory breathing and general nervous facilitation. This makes it easy for any mechanical deforming of the body to become symptomatic.

          Traditionally, manual care attempts to promote pain relief and relaxation with technique that includes some kind of coercion. It is thought that through some combination of pressure designed to stretch connective tissue and/or inhibit muscular activity that alignment and normal mobility will be restored. Theoretically, this leads to pain relief and a warmer, more pliable body.

          I'm of the opinion that when forces from the outside accomplish this, that there is more luck involved than we ordinarily admit, and I'm not comfortable with that.

          Levine is a psychologist, and, of course, his care includes more verbal communication than my own. As he describes a typical session, you can see that he understands the importance of subtle nuance in tone of voice or facial expression. It is evident that he watches his client's posturing as they speak, and interprets that which is unconsciously and instinctively driven as helpful.

          I think that such motions are corrective of the mechanical deformation responsible for their pain. Because they are accompanied by a reduction in sympathetic tone, I reason that the organ changing is the nervous tissue itself. There is no evidence that fascial planes are being "released," whatever that means, or that connective tissue is being stretched or modified in any significant way. Such problems, if they exist at all, would never account for the symptoms normally reported by my patients. Since I see no reason to assume that fascia needs stretching, I don't employ the manual force necessary to accomplish that, and this is evident in the unusual nature of my technique. I call it "simple contact."

          Let me complete this trilogy of essays about Levine's insightful work and its connection to manual care by recounting something I heard in an interview with the actress, Ruby Dee, concerning a new production. At its end, the interviewer said, "Break a leg," to which Ms. Dee responded, "Oh no. Now we say 'Take wing.'"

          I was struck by the simple power of this phrase, and how it conveyed the message my handling seeks to impart.

          Medusa's myth speaks to us of how we might safely deal with trauma, and, finally, how to let fly the instinctive movement of correction that we know can restore a normal and healthy physiologic state. This is symbolized by the appearance of Pegasus.

          Understanding this, and letting it influence your handling will move you away from the therapy establishment, and your popularity will suffer.

          But your patients will take wing.