I come from a background of manual therapy – my father before me weaned on the teachings of James Cyriax, as did I. My mentors, whom I have had the privilege to be trained by, in addition to James include Alan Stoddard, Gregory P Grieve, Brian C Edwards, Robin A McKenzie and Geoff Maitland to name but a few greats. I’m not blowing my own trumpet but I want to get across that it was no mean feat to convert me, back in 1994 to the thinking and knowledge being developed and spread by Neuro Orthopaedic Institute, then in its infancy.
We were all on a roll in the 80s having absorbed the quantum leap that Geoff Maitland and his superb clinical reasoning had given us. With this leap came a vast improvement in the results that we achieved in the historic pain sector. This was probably brought about by the improved clinical reasoning rather than the manual skills themselves, skills that have been around for centuries.
But we all still had those patients who didn’t get better – a further evolution was required in our therapy. The likes of David Butler (with some hair then) Louis Gifford (God rest his soul) Michael Shacklock (the quiet one) and the emerging Mick Thacker (still a young whippersnapper then) were responsible for my transition.
Now, on top of advanced clinical reasoning we had approaches that considered other bodily tissues – nerves came alive and became more than dumb conductors of messages to the brain; the brain itself came into play and education started to be more than a pamphlet handed to a patient on their way out; our thinking about pain deepened and took on ideas from evolutionary biology – with the whole organism considered; and the beginnings of the neuroimmune revolution were getting underway.
For those that seek it, we now have more knowledge about people and their bodies, brains, nervous and other systems than ever before. Treatment approaches have continued to evolve to include the methods of delivering this information to people in pain in a therapeutic manner. Deeply listening to patients seems to be (back?) in vogue, although for those of us lucky to learn from some of the pioneers in this game, we could say, humbly, that we noted from the very beginning that they were each much more than their techniques – they were exquisite listeners first, and powerful communicators second. And yet, there remains that group of patients who ‘stubbornly refuse’ to improve.
A Case History
Mrs Delight age 54 presented recently with a history of recurrent cervical events dating back to 1988. In the last 3 years, the situation evolved into constant life distressing variable pain radiating into the upper anterior chest and down the right arm to the wrist. I will not bore you with the full story other than to say Mrs delight bought in totally to the Explain Pain story, was using the laterality program regularly and the Protectometer was going down well.
All this combined with neural mobilisation and a manual package directed at the boggy, stiff, leather-feeling (palpation interpretations of a ‘Geoffy’) and painful to the touch, spinal segments on the right between C5 & T4.
The result after several weeks was one of little change.
Don’t throw the baby out with the bathwater
What was I missing? The neural mobilisation was now ‘clean’ and the patient was doing her ‘homework’? Maybe the other ‘issues in the tissues’ weren’t getting enough attention. Only when I stepped up the manual side directed at the palpation findings as I would have done in the 80s, combined still with the NOI package, did we see a breakthrough and an important improvement in her symptoms. This whilst her DIM count was high as her father who suffers dementia has just had a stroke.
In genetics speak, a gene or portion of a gene can be ‘evolutionarily conserved’ – this simply means that it is evident across a time span of evolution, and across different species. It points to both a common origin of the species and, most importantly, the vital and essential functional role of that gene. Changes in genes that are evolutionarily conserved are likely to be fatal to the species.
Touch, movement and manipulation of bodily tissues might be considered evolutionarily conserved traits in the many different species of manual therapies that now exist. These species certainly all share a common origin in millennia past and some have died out along the way – perhaps they messed with the trait too much? Despite the mapping of the human genome, we’re still some way off unlocking all the secrets of genetics. Similarly, we’re not always confident about how or why manual ministrations work, but their conservation might suggest that they still have an essential role; at the right time and place – remember that the evolution of treatment approaches also gave us clinical reasoning.
So let’s not forget those issues in the tissues. It isn’t a crime to use your basic manual and rehabilitative skills along with your new learnings and experiences.
Put another piece into the puzzle of your acquired knowledge and skills over the years. Don’t replace one puzzle with another, let the image form.
That’s what we call evolving clinical maturity.
THE 2017 NOI CALENDAR IS SHAPING UP, HERE ARE THE CONFIRMED DATES FOR NOW
Melbourne 31 March – 2 April EP and GMI
Adelaide 26-28 May EP and GMI
Darwin 4 – 6 August EP and GMI
Brisbane 25 – 27 August EP and GMI
Don’t worry NSW, we’re very close to confirming dates and locations to bring you some love too.
Check out our courses page for details and to enquire
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