As it appeared in Worldwide Spine, January 2002
What is your professional background and training?
I am a 1973 graduate of the Ohio State University with a bachelor s degree. Very early in my career I took all of Stan Paris workshops and was the first therapist hired to work at his clinic in Atlanta and teach courses on joint mobilization. For four years I was immersed in the world of manual therapy, spending time with many of the finest practitioners in North America and teaching with a number of them. I became interested in less coercive methods of management, opened a private practice in Ohio, and began to employ increasingly gentle technique while studying what I could find on the nature of pain and how it might change with movement. What I came to understand and actually do in the clinic was formed by my personal experience and endless reading. I’ve been very active on the Internet for several years and have found it is possible to learn a great deal there from some of the finest clinicians, researchers, and academicians around the world. In 1985 I began to write for the first time and I’ve never really stopped. I found that I was most comfortable writing essays on a variety of topics related to life in the clinic. Slack Inc. published my book Shallow Dive in 1995. With the demise of much of the print media during the past couple of years I’ve switched to writing for a few websites and leading discussions on clinical problems and various aspects of the research literature.
What course do you teach?
My course is entitled Simple Contact: Manual Management for People in Pain.
This presentation may or may not include demonstration and/or hands-on work. I speak specifically about spinal pain and how I treat that each day but also talk a great deal about pain in general.
What is unique to your course? What does your course provide that others do not?
I teach a method of handling that is very unlike anything I ever learned in school or in the many courses on manipulation I once participated in. The premise of this work is that movement designed specifically to correct the mechanical deformation responsible for pain will emerge from the patient in an instinctive and effortless manner. This activity, described in the vast literature on the subject, is called ideomotor, and it accounts for most of the spontaneous recovery we hear our patients describe every day. Understanding its presence, purpose, and nature has allowed me to develop a manual technique that promotes its emergence. Beyond that, I emphasize what I call the deep model of bodily function. This includes an examination of the most reliable literature concerning the neurobiology and physiology related to pain. I maintain that our technique should arise from our familiarity with the deep model, not that we should do something now that seems to work and come up with some tortured explanation later when pressed for it. I say to my classes, What I have is not a skill so much as it is an understanding, and you can have the same. Skillful movement toward correction and pain relief belongs to the patient, not the therapist. Ideally, the therapist facilitates awareness and understanding and then steps back in order to witness recovery. This is very different from the powerful coercion ordinarily taught in manual care.
What type of participant would benefit from the course?
I’ve never been anything other than a clinician in an outpatient orthopedic setting, so those PTs are the ones I relate to most readily. I’ve had many PTAs tell me that the course truly helped them understand more about what they might do manually without potentially hurting anyone, so I feel it is by no means beyond their skill level or ability to understand. I feel any professional attempting to understand the patient in pain will benefit from a lot of the reading I suggest and provide.
What is the length of the course (number of CEUs)?
This varies, I’ve done lectures lasting no more than an hour but have a full workshop extending to 14 hours, all approved by the Ohio board for CEUs.
Will the students be able to directly apply what is learned to their clinical setting?
Please describe your teaching philosophy?
I feel that preparation and honesty are vitally important. I don’t pretend to be something I’m not and I never teach things I don’t do and understand myself each and every day. I made a commitment long ago to learn whatever I was able about manual care and use that knowledge to make sense of what I saw and heard in my clinic. This is a lifelong task and has required a good deal of sacrifice to say nothing of how it has at times placed me at odds with my peers, teachers, and referral sources. I was never trained as an educator but I feel that my passion for the work, my attention to detail, and my absolute commitment to science as the source of our knowledge is something my students can sense and benefit from. People often pay a good deal for a workshop. I think they should get all that I can give them about what I do and why, given the time available. I don’t promise them the really good stuff at some future course after they’ve spent more money. They deserve it now.
Do you base your coursework on any particular research or treatment philosophy?
I have been strongly influenced by the literature on neurobiology beginning with Irvin Korr’s earliest work with the osteopaths in the 1950s. Alf Breig s text regarding neural tension and its consequences sent me searching for more on the subject, and I found all kinds of excellent thinking and research reading through Elvey, Shacklock, and Butler. All of these resources have led me to others too numerous to mention. I felt a strong attachment to Bobath very early in my career and subsequently to Feldenkrais. Ultimately, I became a therapist with a profound respect for the central and peripheral processes of neurology while clinically managing spinal pain. This goes a long way toward explaining the nature of my method and philosophy. I feel that the purely orthopedic model is inadequate when it comes to understanding these problems. I try to expand upon it rather than simply say that it’s entirely wrong.
What books are included on the recommended reading list for your course?
Aside from the newer texts on neurogenic pain such as Butler’s The Sensitive Nervous System and Topical Issues in Pain volumes I and 2 edited by Gifford, I try to point my students toward work they won’t hear of elsewhere but that I’ve found very useful in the clinic. I like all of Oliver Sacks work for his wonderfully human understanding of medical science. I recommend Captured by Aliens by Joel Achenbach for its explanation of the scientific community and how it progresses. I m a big fan of Carl Sagan and his fellow skeptics no matter what they might write. Wall’s Pain: The Science of Suffering and Spitz’s Nonconscious Movements are essential for anyone hoping to better understand what Simple Contact seeks to do and why my approach makes sense. Many, many more books come to mind and though I might mention others when I speak that have truly changed me, this list is what I think of first.