The Third Way

Barrett L. Dorko, P.T.



The human mind is most at home somewhere between perfect order and perfect chaos. Creativity thrives on a balance of the fluid and the firm. 

Chet Raymo in Skeptics and True Believers 

If you practice as a physical therapist these days you often have two choices. You can stick to a fairly rigid protocol of methods that have been institutionalized in our educational system, or you can go off into the realm of “alternative” medicine that is all the rage in the media and the continuing education community. The former carries the burden of theory that has not consistently been proven correct, and the latter, theory that is often simply not testable. 

In his book Skeptics and True Believers (Walker and Company 1998) physicist Chet Raymo describes a strong reductionist view of physical law and compares it to the view of those who see things in a way that is far more complex and unpredictable. He likens the simplest explanation of any phenomenon to the number 1, and the complex view to the number 5. Somewhere in between, he says, the human mind dwells most comfortably, its perceptions and knowledge wavering between that which it is sure of (planetary movement, for instance), and that which it strains to understand and predict. The turbulent flow of fluids is a good example of that. 

As a therapist who commonly treats painful problems, I often find myself confronted with problems in my patients that are either predictable in their presentation and recovery, such as a post-operative shoulder, or as unpredictable as the weather. I’d place a lot of spinal pain in that second group. 

The therapist that chooses traditional protocols of care might enjoy a great deal of success with connective tissue problems that follow the fairly simple rules governing healing and restoration of function. But when pain exists in the absence of obvious tissue disruption and the patient does not respond to rest, I’ve seen a tendency in our community to leap at anything in the way of treatment that promises it will “work,” despite the questionable nature of its theory. If they think that this is the only choice they have, I suppose I can understand why they do this, given what I know about the pressures of the clinic. 

What I’m proposing here is that there is yet another way of practicing that doesn’t confine us to the ineffective traditions of practices long outdated, yet doesn’t require we abandon our scientific heritage. I call it “The Third Way,” and I describe it as a practice that never justifies its existence because it “works” (whatever that may mean), but, instead, continually strives to make sense of its methods and conclusions by strictly adhering to whatever physical law or physiological process is known to be relevant. 

In an era where the term “evidence based” has come to mean that what you’re doing actually changes things as you propose, I’m using the term to refer to the evidence that what you’re doing makes sense and is relevant to the problem you’re trying to solve. Continuously answering these questions of reasonableness and relevance moves the practitioner away from the certainty (albeit unfounded) of traditional practice while at the same time restricting what they do and propose is happening. In The Third Way of practice whatever you do or think must be defensible from a scientific point of view. 

It is the movement, metaphorically, from the reductionist’s “1” toward the alternative practitioner’s “5.” I suppose you could say I stop about “3” (coincidentally), and my mind is comfortable there.