Barrett L.
Dorko, P.T.
Try not. Do or do not. There is no try.
Yoda
Touching another can be done in many ways. Traditional
manual therapy seems to be mainly about coercing tissue in one direction or
another. Whether that’s done with great force or gently, slowly or rapidly, I
don’t really think it makes a whole lot of difference.
Of course, my colleagues in the manual therapy community
might consider this heresy. But there isn’t much in the literature that
indicates manual intervention is all that effective, much less necessary for
recovery from painful problems. More heresy, I know.
So if I don’t think that manual care is all that
important, why do I refer to myself as someone who does it? Well, I should
explain that I think that movement is the thing that generates relief,
and I’m convinced that the movement most likely to help must come from the
patient, not the therapist. In short, it’s an active movement, not a
passive one. It’s been my experience that touching another with my hands is an
excellent way of eliciting that active movement, thus my respect for handling of
some sort and my self-description as a manual therapist.
We can split active movement into that which is consciously
and unconsciously driven. It’s the latter that we ordinarily inhibit in an
effort to control our appearance or hide the expression of what it is we’re
thinking. Since touching another need not include the usual admonitions to
change or move as directed, it is perfectly possible to handle another with an
attitude that accepts and thus amplifies what the “touchee” is already
doing. That is, what they’re doing unconsciously.
I realize that what I’m describing here does not include
a protocol of some sort or a specific sequence of technique. Instead, I’m
offering some ideas about what to consider before touching begins. Some
consideration of what the materials to be altered actually consist of and what
they might already be doing is essential if technique is to be effective in the
way we want it to be. This is especially true if you want your force not to
exceed what is necessary.
The quote from Yoda above describes something about Simple
Contact that is not common to traditional manual therapy. It is that the
clinician should not “try” to examine or coerce the tissues in some fashion
that reveals the system’s deficits or ability to go where the therapist wants
it. Instead, Simple Contact seeks only to enhance the patient’s
awareness of their desire to move, however subtly. It manages this by
giving the already ongoing movement something to resound against. Think of your
own heartbeat. It is unlikely that you are at this moment aware of it, but
anything placed lightly on your chest wall could easily make you so. Whatever is
placed there should not try to interfere with the beat as it is naturally
occurring or changing. It should, in fact, resonate i.e. go along with the
cycles of movement. This shift from something that the movement resounds against
to something it resonates with is perhaps the only technically difficult
thing about the technique of Simple Contact itself.
In my experience, this is not all that difficult. But it
does require a clear understanding of the materials handled and the activity
present within them. When ideomotor activity is expected (it should be in any
living person) and when the therapist understands what it takes to depolarize
nervous tissue secondary to touch, no trying to elicit movement is
necessary, and, in fact, any trying may divert the patient from the
necessary task. As soon as the therapist tries to get something, the
patient’s sense of that (and it is always acute) elicits either a cooperative
or protective stance. Neither is likely to help much.
So, consider what Yoda tells us, and let your hands flow wherever the person you’re touching takes you. When you are doing that, you’ll see what I mean.