Evolution in Manual Care

[Diane]

Copied from noigroup, by permission from Yves, the author:
Hi folks:

Having read David and Lorimers manual on Explain Pain, and having come to understand that the most important contribution that I can do for my patient is to make sure that they do not feel threatened.

the psychologist listens and talks to you so that you do not feel threatened, physchiatrist can medicate you so that you cannot perceive the threat, the hairdresser will touch your hair and scalp and listen to you and talk about what you are most interested so that a relationship is established, therefore that bad hair cut is no longer threatening and therefore no longer painful.

I use to be a very rigid manual therapist during the 70s and 80s, then nerves where discovered in the 90s, but we simply yanked the heck out of them and some 5 hours later, the patient was worse then ever.

Then we have come to realize that the brain is somehow part of this nerve thing, and now we are treating the brain more then ever, just like the psychologist, psychiatrist, and hairdresser, ie. do not threaten the patient, and they will move away from their pain.

I would like to thank NOI for the bood Explain Pain who has made it very clear that as long as the patient's unconsious brain is feeling threatened,they will respond with pain.

I would like to thank Barrett Dorko for having come to Nanaimo and help me understand that the only person who can influence the patient to move away from their sympathetically driven muscle activity is the patient themselves.

I work with WCB patients and now we run a chronic pain progrram, and both groups are fear centered people, for all kinds of reasons.

Who ever can validate their fears, ie. the psychologist, whoever can medicate them to experience no fear, antidepressants from the psychiatrist, and who ever can touch them so that this experience is not a fearfull one, the hair dresser, and who ever can allow them to move without threat or fear, thanks Barrett, and who ever can explain to the patient why they are fear full, ( thanks David and Lorimer) .......all parties involved will permit the patient to move on in their life with less pain..

I will place a patient's neck in my hands, and my carreer flashes through my mind. In the 70s I would Cyriax the neck, in the 80s I Maitland the neck, in the 90s I muscle energy, strain-counterstrain then neck, in the late 90s and early 2000 I did slides and glides, and now I help them find activities that they can do for themselves to reduce the joint guarding about the cervical joints.

Out of the blue, it just came to mind, has any body assess a neck before and after the patient has smoked a joint? or even had an orgasm for that matter? I bet they feel no pain, and the cervical joint will move quite unrestricted, because again, we have reduced their threat of being hurt.

finnally I am becoming more viscerally reactive to the word exercise. Which thanks to Barrett's enlightenment, simply means imposed culture from me onto my patient. I have this crush hand patient who will move pegs from A to B because I have asked him to do so, but refuses to take some sand paper and help his neigbour smooth out the edges of his wooden toy truck that he is making in our work shop. I think it is because then if he were to do some thing creative, then he would have to take ownership of his hand, and not keep it at distance from his body like a radio antenna. doing a creative activity with your hands will free the brain from focusing and getting frustrated with a stiff hand to shift focus on the project, and then the hand will spontaneously do what it has to to get the job done, and I did not have to impose my will on him.

So I think I am regressing in my way of working, the more I can play, be it with stroke patients,orthopaedics or WCB, the more the patient and I can have fun, laugh, cry some times, the less fear they will have and them they might take a chance with you.

With whom ever the patient takes a chance with because they feel the least threatened, then that practionner will get the credit, when the real credit should go to the patient who decides to take that leap in faith.

Have a great day, hug your moms, they may not be around much longer.

yves

Well, just a few thoughts.

[ian s]

He made the shifts which medical people expect patients do all the time but seldom do -----great personal account.

[Barrett Dorko]

I’ve been thinking about Yves’ post the past couple of days. First of all, my prominence there is certainly gratifying though I feel I simply made something that he already knew clearer to him. I realize that this might be a big deal at times.

Diane’s evocation of evolution makes me wonder if each of us might try to trace our current method back to those moments or prolonged experiences that formed us in ways that have endured. I’ve been thinking of the earliest one for me and thought I’d mention it here.

In the fall of 1970 I walked into the office/living quarters of a man named Richard Maxwell. Dick had been rendered a quadriplegic in 1963 and I was just the latest of a series of personal attendants he had hired to get him up each morning. The job was this: Arrive at 5:30AM seven days a week. Complete bed bath, dress in a suit and tie. Pay; $25/week.

I did this for three years. Eventually I wrote this: All the manual care I provided for three years was passive range. Each day I handled limbs that could not be consciously moved or normally sensed their being moved. Still, this part of Dick had a way of being alive that was simply more subtle than my own. Unless moved with a certain care and respect they would object violently with spasm that would preclude further movement until their voice was heeded…The skills we acquire in life are not always chosen. They are often the end result of what we had to do in order to get by. If we are lucky, the very skill we inadvertently acquire may help us later on and perhaps even shape a significant portion of our chosen work.

Though I spent a little time watching both Bobath and Feldenkrais work, and a lot of time watching Paris and Kaltenborn and Grimsby work (teaching with them), when I handle people today I know that the skills and sensibilities I acquired handling Dick form the basis of what I do manually. I did it with no real understanding of course, but I did it because I had to – and it taught me enough.

Anybody else with a sense of what drove them to do what they ended up doing?

[Bas]

My experience is far removed from yours, Barrett. I was wrestled into moving away, by you, from using passive motion; this was aided by a mild, hard to define dissatisfaction with what I was doing. This dissatisfaction made me dart out to all kinds of theories, ideas, gurus and courses. Many battles later, I was dragged, grumpy and annoyed, into the present state of my mind. The grumpiness and annoyance have long since disappeared. All I need to do is make time to get a SC course.....

[christophb]

I worked in an inner city hospital in Milwaukee, WI for 4 years right after graduation. 80% of my clients were Medicaid/workers comp and had their "condition" for greater than a year while being treated (without success) with medication. All had many things to worry about (living in a very unsafe area of Milwaukee, poor nutrition, no exercise, poor social support etc) other than doing their exercises or sitting up straight. All the manual therapy I attempted was for the most part ineffective. So of course I thought if I knew more techniques I would get better results. Eventually I came to realize that my interaction with the clients and seeing them beyond their "problems" (physically/socially) was the most important part of our interaction. It was amazing to see how my manual therapy improved when I later switched clinics.

Chris

[Diane]

This work was always something I wanted to do, but I took a meandering path to get here. The big "kaTHUMP!" that landed me finally on the right track was after I'd been a PT for 12 years already, being a good but grumpy cog-in-a-wheel hospital PT with a few forays out into working for private practitioners whose only concern was bottom line... (not a great experience).

It was 1983, and a new workshop came to town, "muscle energy for the lumbar spine and pelvis", taught by this odd bird called an osteopathic physician. I'd never heard of osteopathy before, but I loved the handling I learned, very interactive and non-coercive. I was sold on manual therapy, finally. Moved out west and shadowed the guy for a long time, learned a lot more. It was he who insisted about 6 years ago, that people buy computers and start finding out about life... The rest is history. I've noticed that my mind actually works better since hanging out with you lot.

[Luke Rickards]

Ever since I was a young teenager I have had a strong sense and fascination with the idea that knowledge/education and one's consequent choices were an important part of maintaining one's health and, more importantly, that in the right environment (internal and external) we have the ability to self-correct. This idea and my environment at the time led me towards the study of CAM. Then I started practicing and very quickly realised that I actually new nothing about how we work - and I am equally driven to know how things work.

So I ended up in a lecture room with Nic Lucas standing out the front, and with great enthusiasm, sharing his incredible knowledge of the nervous system. Congnitive dissonance set in as I realised that the esoteria in my mind could be replaced with what I was learning, but still osteopathy was only giving lip service (and ideas that didn't fit with what Nic was teaching - read: cranial) as to how one goes about encourgaing self-correction. Then during one lecture Nic introduced the concept of ideomotion and wrote Barrett's website on the board, suggesting we all check it out. I think I was the only one who bothered, and I was hooked.