Maybe Today

Barrett L. Dorko, P.T.

Every once in awhile,
I sense a shift in my vision of the clinic

Either I'm less often surprised,
or I've come to accept
not knowing what to expect

I don't know which

          My fascination with the modern science of chaos theory has led me to conclude that it is impossible to know enough about the present to make a completely accurate prediction about the future. This is not to say that the present doesn't determine the future, just that my perception of the present contains too little relevant information.

          Reasonably enough, my patients want me to tell them when they will be able to do one thing or another, when they will feel normal again.

          If I'm dealing with the simple post-operative rehabilitation of their connective tissue or supervising a regimen of strengthening, I can reliably predict when certain activities will be tolerated. Healing and strengthening are relatively finite processes that can be measured in a number of ways.

          But my patients with complaints of pain don't often display any break in the tissue or relevant weakness. They don't need some certain period of time in order to improve, but, rather a certain kind of movement. When they reduce the mechanical deformation responsible for their pain sufficiently, they'll feel better. I don't think it's possible to know at what point that "when" will be.

          I liken corrective movement to a walk through a forest. While it is essential that we walk past the trees, this will not necessarily mean that there won't be some brambles on the path. We might have to endure some discomfort, but it will pass if we keep moving with care. I'm also convinced that the most efficient navigation of the body through the forest is instinctive and, therefore, unplanned. I tell my patients that there's a meadow somewhere ahead, a place where they can move freely and painlessly. I just don't know how far away it is from their current location.

          Chaos theory is full of terms that represent transient situations or shifting circumstances. Within a chaotic system nothing happens in isolation, but the effect of a change in one aspect does not alter the system in a linear way. Because so many tiny factors may (or may not) influence the present and future of the system's behavior, plans have a way of falling apart. I'm reminded of a line by the comedian George Carlin; "There will be a rain dance on Friday, weather permitting."

          That neural functioning is chaotic in nature can hardly be disputed. Its geometry alone (fractal)* defines it as such. But in clinical life its cranky and unpredictable response to protocols (read, "plans") drives most practitioners to distraction. This is why most orthopedists hate to see spinal pain.

          But I think that in some unpredictable period of time our patients can make their way into the "meadow" where it's warm and there is freedom to move. I say to them, "Maybe today you'll move far enough through your own forest. Maybe today if you keep on letting corrective maneuvers emerge, you'll arrive in a place that allows rest."

          "When will I feel better?" they ask. And the best I have to offer is, "Maybe today."

* "Fractal Geometry and Manual Care" by Barrett L. Dorko
Copies available from the author