The human mind is most at home somewhere between perfect
order and perfect chaos. Creativity thrives on a balance of the fluid and the
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practices long outdated, yet doesn’t require we abandon our scientific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.