Barrett L. Dorko, P.T.

Everybody talks about the weather, but nobody does anything about it.
          Mark Twain

          I'm willing to admit that I'm not the kind of person that pays much attention to nature in general. I don't take hikes or gaze at the sky. When it comes to the beauty of the earth, I have a kind of blindness that I've never been able to overcome, but I've learned to accept it.

          But even I noticed what a mild Fall it's been here in Northeast Ohio. Two things brought this to my attention. I've yet to rake a leaf, and the Cuyahoga Falls Tiger Marching Band has not used their storm coats all football season. These are the kinds of things that pass for natural phenomena to me.

          Amazingly, this weather pattern for the midwest was predicted accurately a couple of months ago. It is the kind of thing that happens when you have an El Nino.

          I commonly see patients who wonder aloud at the suddenness and severity of their pain despite the fact that they can't think of anything unusual in their life to account for it.

          Examination might reveal patterns of restriction that are familiar or entirely new to them. They might comment that certain motions that we request are troublesome, but that since they never normally do them, they don't know if they're any different than they've ever been. Most experienced clinicians know that a very detailed exam is as likely to reveal irrelevant or confusing findings as it is to make the disability clear.

          But there is a conceit in orthopedics that exam done properly will reveal the problem, and that the path of care will be laid out before it actually begins.

          Sometimes this is true, especially when dealing with pathologic problems in the bones or articular structures. But we know that when there's no evident pathology, the patient's complaint and functioning might mysteriously disappear or hang around for a long time despite our best efforts to control it.

          Such a situation usually gives birth to esoteric and unconventional forms of care with a questionable theoretical basis. These forms thrive mainly because nobody else seems to know what to do and because the public is largely ignorant of scientific principles.

          But when a system is known to respond dramatically to seemingly small changes or provocations that would ordinarily be of little consequence, we have learned that this identifies it as "dynamical," and that attempts to control it are less important than our careful observation of its current state. Such a system is characterized by fractal geometry, non-linear dynamics, and solitonic wave forms within its energy transference.

          Parts of the body are like this, especially the neural and vascular systems. So is the weather, the stock market, the populations of animals and the turbulence of the ocean. During an El Nino year, the warm waters off the western coast of South America are blown north. Meteorologists predict that this will cause a drought in Australia and Asia, storms in California and a mild Fall in Ohio. They might as well have predicted that the Tiger Band could leave their storm coats in the closets.

          But once this passes, the leaves will fall in their own unpredictable pattern and I'd better be fit and pliable enough to rake them up.

          Sometimes therapy is mainly about preparing for the coming storm within our physiology. Sometimes the warm winds within us delay it, sometimes they hasten it. It depends on where they flow, and where many other factors beyond our notice have their effect.