Paradigm Shift: On changing the manual therapy zeitgeist
I think it is relatively safe to say that manual therapists historically have been the health care practitioners who best emphasize not only ‘sick care,’ but also ‘health care’ promotion. We seem to pride ourselves, or at least we claim, on finding the ‘root cause’ of the symptoms…or getting down to the root cause and treating problems at “the source.” Following this, contrary to the above stated ‘intent,’ many seem to fall into what can be coined a “maintenance care” philosophy following the resolution of a patients presenting complaint. “Come in monthly so I can check your spine for ‘x’…and then I can ‘correct you’ by doing ‘y’ on a regular basis,” or “come in monthly so I can assess for soft tissue problems and ‘correct them’ before they cause further issues” would be two common examples. Barring the idea that some may be doing/saying this for financial reasons, there can be some actual medical value to the idea of ongoing care. However, as with many things, the concept is good, but the execution is flawed.
To imply that “maintenance care” is needed is to imply that there exists a state of homeostasis in the human body. In other words, there is a state, or property of the human system that regulates its internal environment and tends to maintain a stable, relatively constant condition of properties. Does such a state exist in the human body? The answer imo is NO.
Borrowing from the physics principle that everything moves towards entropy, our bodies will change with the passage of time into a more disordered system unless actions are taken to quell, or at least slow this inevitability. Thus the concept of homeostasis is a myth. If it exists, it is only for a fleeting second where it then vanishes.
What does this have to do with manual care? Perhaps a paradigm shift is in order. One where we focus less on fixing problems (a necessary step in the process of course), and more on improving the current ‘state’ ….be it of the cells and tissues, or the parameters of more gross health measures like strength, balance, coordination, or my personal favorite, MOBILITY and movement capacity. Instead of continuing on with a patient as an expensive Band-Aid, where we look for deficiencies and act to ‘correct,’ why not move them further to the ‘right’ on the health continuum towards IMPROVED functionality?
Of course many of you are currently thinking… “I do that.” However I can assure you that many others do not. Or else I wouldn’t see shocked faces in the crowds at seminars and conferences when I discuss the squatting or deadlift technique that I assign many of my formally inactive patients…or further how I progress them into a full bridge, or into hand balancing practice, etc. I would also not see the same regimen of rehab exercises (bird-dogs, cat-camels, planks, for etc) being given to patients in the absence of progression towards higher levels of function.
I personally make this the focus of my practice as you can see by the natural progression of my seminars….teach to find and assess (F.A.P.), teach to correct and rehabilitate (F.R.), then teach to improve (FRC).