Barrett L. Dorko, P.T.

Everything should be made as simple as possible,
but not simpler.
                                        Albert Einstein

          I read a physician's note recently regarding one of my patients; "Either time or physical therapy solved this problem."

          Great. Another reminder that many people continue to wonder if therapy really makes the difference we would like it to. Some of these people are my own patients. Sometimes, it's me.

          In our world full of outcome studies, evidence based practice and protocols for every diagnosis, we sometimes forget what kind of health our patients might like to have. If they're stronger, more flexible and complain less, we always document some success. Never mind that they don't actually feel any better. Such a goal might be high on the patient's list, but it's at the bottom of many others.

          I want to suggest that there is a least one simple aspect of health that my patients in pain would universally like to have; warmth.

          By this I mean the free, full, flow of blood that produces limbs that can tolerate a breeze painlessly. They want to go to bed without socks on and they want hands others are willing to hold or be touched by.

          Of course, this is the parasympathetic dominance so ardently sought by those who advocate relaxation as an antidote to stress. But I find quite often that these therapists only emphasize muscular softness and postural stillness. There is rarely any attention paid to the processes and positions that would insure warmth.

          In order to truly grow warmer, peripheral vasodilatation should arise from a corrective maneuver, or at least one that doesn't contribute to significant and adverse deformation of the nervous tissue. Whenever someone moves in a direction that enhances warmth, you can bet that they're correcting.

          Modalities that draw blood to the region in response to the application of external heat might promote healing, but once they are removed, there is no reason for this increased flow to remain. If healing is not required for relief, this kind of care is purely palliative.

          Although growing warmer in response to movement is the result of a complex series of chemical interactions, its manifestation is a simple blushing, an internal sense of flowing and a softening akin to melting in the muscles.

          Think of the competitive swimmer on the blocks. Their display of a floppy, pliable body is not the result of relaxation, but physiologic warmth. They go on to display during the course of their event that they can be repetitively deformed without pain.

          This is the kind of health I'm certain we need for any pain relief that is prolonged and profound. It arises in the presence of therapy that encourages spontaneous corrective movement, deep diaphragmatic breathing and instruction in resting postures that reduce neural tautness.

          None of these will necessarily occur if you just wait for them, they need the presence, handling and instruction of a therapist who understands that this seemingly simple aspect of functioning is essential for recovery.

          When it happens in our presence, we know that it was the therapy, and not just time, that truly helped. This is something the doctor is unlikely to ever know.