The Tracker

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.