Butler's Latest

Barrett L. Dorko, P.T.

Last year I counted the books lining the walls of my office. I found over 500 and I know I’ve gotten quite a few more since. I like books. Perhaps I don’t actually have to tell you that. I’m certain that some of this obsessive collecting is in an effort to find just the right book. I mean the truly magical one with all the answers, and I actually find this book every few years.

Well, I just found it again. It’s David Butler’s “The Sensitive Nervous System.”

For me, the subject of neural dysfunction evokes memories of a dinner I had with the late David Lamb in the early 80s. He was one of the founders of manual therapy education in North America, my mentor and my friend. He asked me if I had ever read the work of Alf Breig, a Swedish neurosurgeon who had published a book about the consequences of neural tension. I hadn’t, but I got the book and, I must admit, I fell in love. No, I didn’t fall for Dr. Breig, I fell for the idea of neurogenic pain that didn’t necessarily include compression or pathology. I felt immediately that such a thing could explain most of what my patients said and displayed each day and had an essay published about this in the now defunct “PT Forum” in October of ’85. To my knowledge, this was the first thing written about the subject for the therapy community by a therapist.

In 1991 Churchill Livingston published Butler’s “Mobilisation of the Nervous System” and I felt then that it was one of those “all the answers” books that crowd me into the center of my small office. I have held it up before all of my classes since, imploring them to buy it, study it and let it lead them toward greater understanding and more effective care. I don’t know that I was all that good a salesman, but I see that David has certainly been a popular teacher during the past decade, so I might have generated some bit of interest in the subject. I doubt that many of my students actually fell in love with the concepts as I had. You know what it’s like when you’re in love; you do not see the thing itself with the clarity or objectivity that others might possess. On the other hand, you appreciate things about it that others cannot see. I tended to gloss over that dearth of data and basic science that neural tension needed for it to be considered a legitimate and common essential diagnosis, but I had absolute faith in its potential.

With the publication of this book Butler solves the problem of scientific imprimatur by adding more references than you could ever ask for, and these are used with precision and common sense. Beyond that, he weaves a narrative of clinical reasoning and management that matches what we know to be true and biologically plausible on a molecular level. It is difficult to make the connection between what is invisible to the clinician and how those processes might become manifest in the patient, but Butler does again and again.

I don’t feel that explaining the contents of this book would be possible or even useful here. I’m hoping that it is sufficient to say that it demonstrates how powerful the phrase “all pain is neurogenic” can be once the therapist understands the complexity of the system and how they might sort out historical details that make sense only in light of that knowledge. The light is in this book, and when read thoroughly, more about every patient in pain begins to make sense. If you’re looking for help with management and examination there are ample strategies here. If you want the common sense of a skilled clinician, it is here too.

Consider what Butler says in the midst of his discussion of neurologic exam: “The fact that most clinicians think that they are going to sample the nervous system may be restrictive. In fact the nervous system is going to sample you the clinician, and your performance.” Now that’s not the kind of insight you’re going to find many places for the cost of a book and your effort to study it, and I feel everybody dealing with patients in pain can appreciate that. When and if this text becomes required reading in our university programs we will have made some real progress as a profession. I think that each of us should own it today, and not wait for the academics to catch up. Our patients need us to know this now.

The book is “The Sensitive Nervous System” by David Butler (Noigroup Publications 2000)

To order this book in North America call 800-367-7393 or email optp@optp.com