Barrett L. Dorko, P.T.

I live near the banks of the Cuyahoga River which runs north from here, through Cleveland, where it empties into Lake Erie. It was immortalized by Randy Newman in his song "Burn on Big River," referring to an unfortunate incident involving some pollution and a match back in the sixties. Actually, it caught fire twice back then.

In my small practice I see patients that suffer primarily from pain that seems to have no frank pathologic origin and whose joint dysfunction is unrelated to their complaint. I reason that their increased sympathetic state and spreading discomfort comes mainly from a nervous irritation, and find that it is typically mechanical in nature. My task is clear: I have to alter the orientation of the nervous tissue. My problem is getting to it, and getting to it safely.

Cuyahoga is the Indian word for "crooked," and there are, in fact, few places you can see any significant distance along its length before it leans around another corner. Like the nervous tissue, it undulates and glides through the landscape effortlessly. It floats over rocks and debris until it disappears into the Great Lakes. And like the nerves within me, significant disruption of its ordinary flow or shape can have effects on the surrounding structures that cannot be ignored. The brain is very interested in any alteration in nerve mechanics beyond a certain tolerance, and it will marshall all its forces to avoid any strain in this system. It knows that the muscles and connective tissue can withstand tensional forces without a problem, but it wants the nerves to float.

The literature about the consequences of neural tension has grown remarkably in the past ten years. I wrote an essay about its clinical significance for the therapy community in 1985 and now I can no longer keep up with the relevant writing in the journals. It confirms my old suspicion that joint mechanics often have little to do with problems of painful movement or positioning. If we only attend to the bony articulation and ignore the movement between the nervous tissue and its interface with the rest of the body, many of our patient's complaints will remain mysterious. Like any changes in the flow of the Cuyahoga, we have to consider they might be a consequence of several factors. And some of these things can't be seen on an x-ray.

Rivers have a way of being in and affecting the surrounding landscape that we find difficult to control or predict. Benoit Mandelbrot, the inventor of fractal geometry and one of the original theorists in chaos theory, studied records kept for thousands of years of the height of the Nile. He found in the numbers many examples of sudden and dramatic change for which there was no warning, and he also found a periodic fluctuation that seemed unrelated to obvious influences. He called the sudden changes the "Noah" effect, and the periodic shifts the "Joseph" effect, after the biblical references that apply.

So, we have near my home a structure that undulates and is essentially not visible beneath the surface. It flows between structures of various shapes and may alter its rate of flow unpredictably with remarkable speed.

Within my patients is a structure with the same qualities, and it is often intimately involved with their problems of pain and movement. But unlike the Cuyahoga, I can't place my hands directly on it. If I want to influence it I have to find some way of altering something that leads directly to it; a tributary.

I know where the most accessible tributary to the nervous tissue exists in my patients, and I think I know how to influence it therapeutically with my hands.

That's the subject of my next column: Tributary - Part II.