As it appeared
in Worldwide Spine January 2002
I am a 1973 graduate of the Ohio State University with a bachelorís
degree. Very early in my career I
took all of Stan Parisí workshops and was the first therapist hired to work at
his clinic in Atlanta and teach courses on joint mobilization.
For four years I was immersed in the world of manual therapy, spending
time with many of the finest practitioners in North America and teaching with a
number of them. I became interested
in less coercive methods of management, opened a private practice in Ohio, and
began to employ increasingly gentle technique while studying what I could find
on the nature of pain and how it might change with movement.
What I came to understand and actually do in the clinic was formed by my
personal experience and endless reading. Iíve
been very active on the Internet for several years and have found it is possible
to learn a great deal there from some of the finest clinicians, researchers, and
academicians around the world. In
1985 I began to write for the first time and Iíve never really stopped.
I found that I was most comfortable writing essays on a variety of topics
related to life in the clinic. Slack
Inc. published my book Shallow Dive in 1995.
With the demise of much of the print media during the past couple of
years Iíve switched to writing for a few web sites and leading discussions on
clinical problems and various aspects of the research literature.
course do you teach?
A. My course is entitled Simple Contact:
Manual Management for People in Pain. This
presentation may or may not include demonstration and/or hands-on work.
I speak specifically about spinal pain and how I treat that each day but
also talk a great deal about pain in general.
Q. What is unique to your course?
What does your course provide that others do not?
A. I teach a method of handling that is very unlike anything
I ever learned in school or in the many courses on manipulation I once
participated in. The premise of
this work is that movement designed specifically to correct the mechanical
deformation responsible for pain will emerge from the patient in an instinctive
and effortless manner. This
activity, described in the vast literature on the subject, is called ideomotor,
and it accounts for most of the spontaneous recovery we hear our patients
describe every day. Understanding
its presence, purpose, and nature has allowed me to develop a manual technique
that promotes its emergence. Beyond
that, I emphasize what I call the Ďdeep modelĒ of bodily function. This includes an examination of the most reliable literature
concerning the neurobiology and physiology related to pain.
I maintain that our technique should arise from our familiarity with the
deep model, not that we should do something now that seems to work and come up
with some tortured explanation later when pressed for it.
I say to my classes, ďWhat I have is not a skill so much as it is an
understanding, and you can have the same. Skillful
movement toward correction and pain relief belongs to the patient, not the
therapist. Ideally, the therapist facilitates awareness and
understanding and then steps back in order to witness recovery.Ē This is very different from the powerful coercion ordinarily
taught in manual care.
Q. What type of participant would benefit from the course?
Iíve never been anything other than a clinician in an outpatient
orthopedic setting, so those PTís are the ones I relate to most readily.
Iíve had many PTAs tell me that the the course truly helped them
understand more about what they might do manually without potentially hurting
anyone, so I feel it is by no means beyond their skill level or ability to
understand. I feel any professional
attempting to understand the patient in pain will benefit from a lot of the
reading I suggest and provide.
Q. What is the length of the course (number of CEUs)?
A. This varies, Iíve done lectures lasting no more
than an hour but have a full workshop extending to 14 hours, all approved by the
Ohio board for CEUs.
Q. Will the students be able to directly apply what is learned
to their clinical setting?
A. Yes, immediately.
Please describe your teaching
I feel that preparation and
honesty are vitally important. I
donít pretend to be something Iím not and I never teach things I donít do
and understand myself each and every day. I
made a commitment long ago to learn whatever I was able about manual care and
use that knowledge to make sense of what I saw and heard in my clinic.
This is a lifelong task and has required a good deal of sacrifice to say
nothing of how it has at times placed me at odds with my peers, teachers, and
referral sources. I was never
trained as an educator but I feel that my passion for the work, my attention to
detail, and my absolute commitment to science as the source of our knowledge is
something my students can sense and benefit from.
People often pay a good deal for a workshop.
I think they should get all that I can give them about what I do and why,
given the time available. I donít
promise them the really good stuff at some future course after theyíve spent
more money. They deserve it now.
Q. Do you base your course work on any particular research or
I have been strongly influenced by the literature on neurobiology
beginning with Irvin Korrís earliest work with the osteopaths in the 1950s.
Alf Breigís text regarding neural tension and its consequences sent me
searching for more on the subject, and I found all kinds of excellent thinking
and research reading through Elvey, Shacklock and Butler.
All of these resources have led me to others too numerous to mention.
I felt a strong attachment to Bobath very early in my career and
subsequently to Feldenkrais. Ultimately,
I became a therapist with a profound respect for the central and peripheral
processes of neurology while clinically managing spinal pain.
This goes a long way toward explaining the nature of my method and
philosophy. I feel that the purely
orthopedic model is inadequate when it comes to understanding these problems.
I try to expand upon it rather than simply say that itís entirely
Q. What books are included on the recommended reading list
for your course?
A. Aside from the newer texts on neurogenic pain such as Butlerís The Sensitive Nervous System and Topical Issues in Pain volumes I and 2 edited by Gifford, I try to point my students toward work they wonít hear of elsewhere but that Iíve found very useful in the clinic. I like all of Oliver Sacks work for his wonderfully human understanding of medical science. I recommend Captured by Aliens by Joel Achenbach for its explanation of the scientific community and how it progresses. Iím a big fan of Carl Sagan and his fellow skeptics no matter what they might write. Wall's Pain: The Science of Suffering and Spitzís Nonconscious Movements are essential for anyone hoping to better understand what Simple Contact seeks to do and why my approach makes sense. Many, many more books come to mind and though I might mention others when I speak that have truly changed me, this list is what I think of first.
Barrett L. Dorko may be
contacted at 330-929-1119 Fax