In praise of recliners I

[Barrett Dorko]

During his second inaugural speech George Bush used the word freedom (or words meaning the same thing) 49 times (see this. Richie Havens made up a song with this word as its primary lyric while on the stage at Woodstock and most people of a certain age remember this, including me. Mel Gibson screamed the word while dying in Braveheart. Remember that?

Years ago I read something David Butler wrote about neurologic freedom and it caught my attention. He didn't define it, but I felt that this would mean that permission from within and opportunity from without would conspire to permit correction. It seemed to be a consequence of context, and, as a therapist, this was one of the things I might control.

In what ways do we seek such a context?

[Barrett Dorko]

I worked in a department where a large treatment platform went completely unused and there were no plinths (treatment tables) available.

I started using the mat with a number of patients and soon the director was approached with complaints about my way of practicing. Not a single therapist had said a thing to me.

[ste5e]

The chairs in our treatment room are really cheap. Thin padding - a harsh enviroment for anyone to sit and be attentive or relaxed. But it does give me a chance to do the Lorimer Moseley tm "There's DANGER in your bottom!" bit. Even with a slightly dodgy Aussie accent
From adversity - opportunity!
Steve

[Barrett Dorko]

Steve, Excellent idea.

[Ken Jakalski]

Hi Barrett!

Onthe notion of conspiring to commit corrrection: Here's another of Mel's insights on posture. It's one that you directly responded to several years back. I think several of the points listed below are things you've recently discussed.

"1. Structural or observed symmetry all too often is regarded as the optimal and safest end state for allhumans. The body very typically is an asymmetric system which displays a level of plasticity and adaptability that is not always as homeostatically "perfect" as seems to be implied by many posture police.


2. Posture often is regarded as something that is invariant and should not vary to any noticeable degree from some hypothetical ideal or universal model, despite the fact that any given motor problem may have more than one unique solution.

3. Assessment of posture is far too often based upon static measurements; very rarely is the topic of "situational" or "contextual" posture raised, nor is dynamic posture ever measured under a wide range of conditions. Just as some people display rather unaesthetic speaking voices, they may sing exquisitely. Similarly, someone may display unaesthetic static posture, but exceptional grace while in motion.

4. Sometimes individual posture is regarded as pathological, yet it has never been established exactly which is the optimal postural reference model for all static and dynamic situations.

5. It is too frequently proclaimed that the human body left to its own devices will simply perpetuate "imbalances" or "imperfections" -- only special therapeutic interventions will ever restore the body to its hypothetical ideal state. Yet, it is not uncommon for the body to spontaneously rectify so-called imbalances.

6. The concept of long lasting static posture runs contrary to how the body functions. Speeded up video studies have shown that our bodies are always indulging in subtle or gross movements to ensure that one precise posture is NOT held for prolonged periods, thereby ensuring that stresses are not imposed upon the same physical structures in exactly the same way. Even in sporting and other complex movement situations, the same external movement pattern may be produced by different musculoskeletal and neuromuscular strategies, so that the idea of an invariant, highly stable single posture is
misleading.

7. It can be very misleading to assess the validity of postural correction on the basis of changes in perception of pain, because absence of pain does not necessarily imply the absence of pathology and vice versa.

8. A given postural intervention may not be the direct effector of change; it might simply serve as the "last straw" in a long sequence of automatic and therapeutically mediated changes, especially since many processes in biological systems appear to be nonlinear in nature."

[Barrett Dorko]

Ken, Mel truly had a handle on this. No wonder he liked what I had written; he had the same thoughts, probably a lot earlier.

[Ken Jakalski]

Hey Barrett!

Mel wrote this about you almost twelve years ago:

"One of our prominent physio members, Barrett Dorko, wrote some kind words about or Supertraining group on the Rehab Edge Physical Therapy site:

Many thanks, Barrett! Our group is what it is because of all the interesting and excellent contributions from everyone. Thanks, all!"

By the way, even the locomotion guys would applaud youir insights, especiallty since you often link human movement to animal movement.

Here's one of your older ones from Supertraining:

"Aren't our patients animals as well? Aren't we? Doesn't the use of instinctive behavior imply that we are reaching into the reservoir of the unconscious direction that so brilliantly keeps animals so healthy? In "Wild Health", Engles points out that it is domestication that is the undoing of healthy behavior. Herman Melville put it this way, "There is this noteworthy difference between savage and civilized: that while a sick,
civilized man may be six months convalescing, generally speaking, a sick savage is almost half well again in a day."

Good stuff here.

[advantage1]

There is this noteworthy difference between savage and civilized: that while a sick, civilized man may be six months convalescing, generally speaking, a sick savage is almost half well again in a day

It was this quote that helped me think of how I create a context to promote a healthy environement for healing. I see patients that have chronic pain everyday. One common theme that I see is their confusion and lack of knowledge regarding why they are in pain. I try to allow patients to trust me and feel comfortable asking me questions about their pain. I try to make them feel that they are in control of their health and not me. I think that once this is establlished correction begins.

[advantage1]

Why do you think the savage recovers in a shorter time compared to the civilized?

[Barrett Dorko]

Thanks Mel.

It seems I keep saying the same thing over and over again, year after year.

It goes, but it goes slowly.

[ste5e]

Is it necessity?
The 'savage' hunts and gathers the food for the day. If they do not they starve. They are often in societies intolerant of carrying passengers.
Modern man has a social security net. Or in Melville's day the rich and middle classes had enough capital behind them to pay for servents to care. So convalesce at your leisure.
The brain weighs the choices. If it is death it will get on with the challenges of living. But if support is available it will take, take, take.
Which is why as gate keepers of social services funded by the taxes of the nation we should promote self-management approaches.
Kind thoughts,
Steev