Barrett L. Dorko, P.T.
When Scott came in today I had no idea what to expect. This is a large, very strong young man who stars on a local Division I track team, throwing the shot and the discus. Up until six weeks ago the various aches and pains that he acquired pursuing contact sports had resolved with a bit of care and a little rest. But since his auto accident he has days when his entire spine hurts him, and days when he feels fine.Nothing consistently produces it or relieves it, and I believe him.
Most therapists know that such a situation is not especially rare. It remains confusing and frustrating however, and I’m not convinced that many of the traditional explanations for Scott s symptoms and behavior are adequate. I prefer instead to understand this problem from the perspective of dynamic systems theory that has its origins in the science of chaos.
In an essay referring to this, Mark Reese writes, The term chaos refers to behaviors that are highly unpredictable in their fine details, but which exhibit high degrees of regularity when observed at a macro level. Chaos theory draws attention to the self-organizing properties of nature, both animate and inanimate, and, indeed, has provided a theoretical language in which to discuss both.Nature s floating clouds, swirling eddies, spiral galaxies, growing leaves and animals-all are patterns of chaotic complexity. Chaos theory can likewise give us insights about human posture, movement, cognition, emotions and learning.
Dynamic systems theory gives us the opportunity to understand Scott s recurrent symptoms as a function of an internal attractor; When systems self-organize under the influence of an order parameter, they settle into one or a few modes of behavior (which themselves may be quite complex) that the system prefers over all the possible modes.In dynamic terminology, this behavioral mode is in attractor state, as the system-under certain conditions-has an affinity for that state… attractors may have varying degrees of stability and instability… while some attractor states are so unstable as to almost never be observed, other attractor states are so stable that they look like they are inevitable… but they are dynamic and changeable nonetheless.
This gives us a lot to think about, but I want to choose one detail from the previous paragraph; the varying degrees of stability and instability that are reflected in Scott s symptoms. I feel that we can separate the body s anatomy into two basic categories; linear and fractal. Connective tissue is part of the former category and nervous tissue part of the latter. Quite simply, the former is remarkably stable and the latter is capable of remarkable change in response to very small provocations. I presume that the auto accident had a major effect on Scott s nervous tissue, and that his current difficulty with recurrent symptoms has mainly to do with an attractor, an acquired behavior that is both subtle and deeply embedded.This pattern, when it emerges, creates enough deformation and sympathetic tone to hurt, and all of Scott s strength and connective tissue flexibility isn’t going to have much impact on that.
Scott needs to learn something, he needs to sense things below the threshold of pain that he ordinarily ignores and mistrusts.If therapy is to be successful, it must enhance his instinctive ability to do this and to choose patterns of behavior that help him. Ultimately, therapy must make Scott aware of the complexity of his own nature and help him discover the corrective patterns he carries with him always.
A dynamic systems approach to the development of cognition and action by Thelan Smith (MIT Press Cambridge, MA)