WOODY AND ME
Barrett L. Dorko, P.T.
I came through Ohio State at the peak of Woody Hayes' career
and although I feel it really shouldn't be necessary, I guess I
should explain that he was their football coach.
Anyway, the Buckeyes had a string of fine teams known for a
grinding ground game that was fundamental, predictable and largely
unstoppable. When asked why he didn't pass the ball Woody would
always reply, "When you throw a pass three things can happen, and
two of them are bad".
The diagnosis of reflex sympathetic dystrophy syndrome (RSDS)
is something I see occasionally and I've listened to a few
clinicians speak of their extensive experience treating this in
specialty clinics. The basic message is this: "We don't know why
some people get this and others don't. We don't know which modality
(blocks, electrical stim, exercise, biofeedback and many more) to
begin treatment with. And we don't know if any form of intervention
will make the patient better, worse or have no appreciable affect".
Listening to this, I've come away feeling toward modality care
for this problem precisely the same way Woody felt about throwing
Like Coach Hayes, I would describe myself as quite
conservative in my approach to this game. To me, this means
providing potentially harmless care and remaining rooted in the
basic sciences and the laws of physics. Difficult clinical problems
no longer tempt me to wander down the pathways of so-called
"alternative" approaches where anecdotal evidence is used to
justify theories that make no sense.
Seated in front of me at a recent RSDS course was a young,
lean P.T. and athletic trainer in obvious discomfort. After about a
half hour she was literally grasping the left side of her head with
her right hand and passively sidebending her cervical region to the
right while actively depressing the left scapula. Clearly she was
trying to acquire some length where she felt shortened and painful.
She admitted to me that this really did not relieve her and that
any sitting quickly brought on symptoms.
What I found interesting about her were two simple things; her
dress and her breathing pattern.
In a warm room she wore three layers including a coat fully
buttoned, and I saw her shoulders rise with every inhalation.
I began to think about how this situation was fundamentally
different than the severe cases of RSDS including the allodynia and
trophic changes displayed on the screen during class. I don't think
it was. I say this because the literature on autonomic function
makes it clear that the sympathetics are highly involved in the
ordinary flow of body reactions. It also is evident that the
instinct of fear when unacknowledged will maintain sympathetic flow
beyond its required time. Until that is dealt with it will keep us
rigid and cold. The young lady in front of me is not yet in the
throes of RSDS, but an insult to such a system, even a mild one,
could tip her into the cycle of more obvious dysfunction. It would
be like watching a shade of pink become a shade of red.
It seems that modality care, especially in its more exotic
forms, is as risky as taking a football and throwing it where the
opposition might catch it.
I prefer a running game. By that I mean I grind it out with an
insistence on regular, deep diaphragmatic breathing, external
rotation and abduction of the hips to induce neural slackness, and
movements requested by the patient instinctively that elicit
This isn't fancy or dramatic but it is guaranteed to move the
patient in the right direction and it is very difficult for the
patient's illness to defend against.
I think Woody would have liked it.
"Sustained Sympathicotonia" by Irvin Korr in NEUROBIOLOGIC
MECHANISMS IN MANIPULATIVE THERAPY (Plenum Press)
"Persistent Pain and Underlying Processes" and "A Simple Test of
Autonomic Balance" by Barrett L. Dorko, P.T. (copies available from