Physiology

The Origins of Pain

Barrett L. Dorko, P.T. The neurologist Barry Wyke says, “Pain is a disordered affective state brought into being by chemical or mechanical changes in various tissues…” There’s more to the quote but I’d like to stop right there and point out that he only mentions two things- “chemical or mechanical changes.” I think this is important, and the rest of this essay will explain why. Origin: The source from which anything arises; the first stage of existence. Cause: A thing that exists in such a way that some specific thing happens as a result. I’ll often ask patients who’ve been…

The Persistence of Memory

Barrett L. Dorko, P.T. Seek out that particular mental attribute which makes you feel most deeply and vitally alive, along with which comes the inner voice which says, This is the real me, and when you have found that attitude, follow it. ~ William James There are many questions when I teach or write about the movement that I use in an effort to resolve abnormal neurodynamics. So many, that I feel I must make another effort to speak of this movement, hoping that at least one metaphor or classic explanation resonates with the therapist’s understanding and their experience with…

Discovery and Abduction

Barrett L. Dorko, P.T. I first came across the idea of neural tension while at dinner with the late David Lamb, one of the original architects of manual therapy education in Canada. He asked me if I’d ever heard of the work of Alf Breig, a Swedish neurosurgeon who had written a book several years earlier about his experience using surgery to resolve neurogenic pain. Breig proposed that many chronically painful conditions were due to the presence of mechanical tension within the neural structures, not compression. As it turns out, he was right. This concept of dysfunction remains largely unknown…

Without Volition: The Presence and Purpose of Ideomotor Movement

Barrett L. Dorko, P.T. The Presence of Ideomotor Movement Though it is rarely spoken of in discussions about human movement, descriptions of ideomotor activity are present in the medical literature beginning in 1852 when The Proceedings of the Royal Institution reprinted a lecture by William Carpenter. He identified ideomotor as a third category of nonconscious, instinctive behavior, which also included excitomotor (breathing and swallowing) and sensorimotor (startle reactions) activity. Ideomotor movement is secondary to thought, and it begins in the cerebrum. The discovery of its presence and descriptions of intricate studies demonstrating its manifestation conducted in the 19th and 20th…

Adaptive Potential: A new concept

Barrett L. Dorko, P.T. The term “flexibility” we commonly use in physical therapy means not only the quantity of movement available in a joint or group of joints but usually implies an easy excursion of periarticular structures in response to active or passive motion. In orthopaedics, establishing normal flexibility is commonly the goal of care when evaluation reveals a loss of normal, painless joint range and at least a theoretical connection between this loss and the patient’s complaint. Much has been made of the concepts of hypo and hypermobility;12 especially as related to spinal motion. More recently the additional problem…