The varieties of care recommended for the single diagnosis of spinal pain have not decreased in the 25 years I’ve been in practice. In fact, I’m pretty sure most things we no longer do have been replaced by two or three new procedures. New essential diagnoses implying specific dysfunction in certain tissues create more procedures and these give rise to new regimes and protocols.
In turn, specialists, specialty clinics, and certification for competency through continuing education courses became necessary for conditions not known to exist a decade earlier.
Many therapists are critical of care offered in clinics other than their own and I’m no exception. I have trouble with care pursued just because it “works” or when I find its theory illogical. I am not satisfied with traditional methods just because they fulfill the expectations of the physician or the patient. This has gotten me into trouble more than once, but I get around, and I know I’m not alone.
But I have a very high regard for many therapists treating the same conditions that I see in ways I wouldn’t dream of using. Notice I said that I admire the therapists, not the therapy.
Many of the therapists at workshops or conferences I attend take careful notes and watch me work with remarkable intensity. I know what they are hoping for, because I did much the same the first few years of my career. I was hoping that a certain lecture or technique would make things clear in the clinic. I was wishing that when I returned to handling patients they would respond as they did for Paris, Mennell, Kaltenborn, Grimsby, or Rocabado. I even taught courses with all of those men. I always wished my patients had been there.
But exposure to a variety of techniques taught me more about perception than skill. I came to understand that every patient, in fact every person, could display dysfunction in any way I chose to see it. One way or another, testing revealed my bias and treatment simply followed suit.
Ralph Strauch states in The Reality Illusion, (Station Hill; 1983)
If this is true, and I believe it is, then my desire for clarity through testing would only rarely be fulfilled. Maybe this is why intertester reliability in manual care is so commonly poor.
The therapists I admire have not abandoned their efforts to know what is wrong, but they know whatever they think they see is just a small part of the total picture. They know the patient they don’t help might have done well elsewhere, and even the ones they help might need more than they can offer.
After some period of experimentation, during which they discovered many ways therapy does not work, they came upon a method and philosophy that resonated with their unique experience of others. These therapists then deepened their understanding of how a certain theory leads to outcome, and how a technique accounts for relief.
Prior to that moment, each course attended was like a wishing well. They stood at the rim and looked in, throwing coins, hoping for all the answers. But sometimes a therapist is compelled to stop throwing coins and jumps in instead. Such a leap is followed by the courage to authorize our own experience, our own perceptions. When we choose this, we study and deepen what we do more each day. The profession can only benefit from such a leap.