Barrett L. Dorko, P.T.
Cindy came to see me last week because her father's cousin is
married to my son's soccer coach.
I can't always trace the path people take to my office, but,
as in this case, it is often best described as a series of
misunderstandings and coincidences.
Since a fairly mild car accident over a month ago, Cindy has
had a pain about the lower thoracic region that spread down and to
the right. She cannot sit comfortably and sleeping is very
difficult. She's cold, breathing shallowly and holds both hips in
internal rotation and adduction.
Carl Sagan writes in his latest book, "The Demon-Haunted World;
Science as a Candle in the Dark," of the !Kung tribesmen in the Kalahari
Desert. He describes their observations and reasoning when
confronted with the tracks of their prey.
The !Kung carry in their heads a knowledge of gait patterns
related to speed and injury that they relate directly to the track.
They also note the position of the tracks in relation to the
available shade and at what time of day the sun's position would
have produced a cooler path. Knowing that all animals seek this,
they can easily determine how recently they passed by.
These hunters do not evoke the animal "spirits." They don't
seek wisdom from some invisible realm replete with superstition and
magical incantation. They are in the strictest sense using
scientific method. They understand that erosion of the track is a
product of time, material and weather. Astronomers calculating the
age of craters on the moon use the same reasoning.
Cindy's mother tells me that an x-ray and bone scan have been
found negative and that the orthopedist has ordered an MRI for
early the next morning. She also comments that this pain has
reduced her daughter to tears several times and made it impossible
for her to play golf. Cindy is the only female member of her high
school team and is considered a rising star locally.
Cindy's athletic status afforded her immediate attention in a
sports medicine clinic where she was instructed in strengthening
exercises for her right latissimus dorsi and posterior deltoid. I
guess the therapist there feels that the origins of pain have
something to do with muscular strength. I've never seen a
correlation or read a study indicating such a thing. Maybe this
other therapist has.
In any case, she worsened considerably and when repetitive
applications of ultrasound altered her symptoms in no way
whatsoever, her mother remembered that some therapist had been very
helpful to her husband's cousin's son for a similarly difficult
problem a couple of years earlier. It was me.
Now that I've followed Cindy's migration to my office, I can
begin to use my powers of observation and knowledge of the body's
behavior to track the origins of her pain.
It seems simple to me:
- She can immediately alter her pain with movement, therefore
the problem is mainly mechanical and not chemical.
- She's sympathetic dominant so this is clearly a neural
rather than a muscular irritation.
- Her resting posture promotes neural tautness.
As a tracker/therapist I have to see what is no longer
visible. By that I mean I have to know the consequences of
previous events and appropriately interpret the evident processes
that remain beyond the traumatic onset of pain.
A little external rotation of the hips, an alteration in the
breathing pattern, some spontaneous correction in response to
gentle handling and Cindy feels fine. Not bad for three visits.
I can't see the future nearly so well as I can the past and
present, but I'm betting Cindy will be fine. I try to remember
that it isn't the job of science to make us sure of things, but
only to make sense of things.
The next set of tracks that walks into my office will teach me
a little more.