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Looking back at the roots of orthopaedic manual therapy takes you through the streets of osteopathy and in some instances, chiropractic. These streets, to an extent, helped paved the manual therapy path for our past legends especially, but also current practitioners and future leaders. Even though we have not stayed on these roads directly, we can’t deny our current practices on these professions’ history; both the positives and negatives.

That being said, it is interesting to read about the roots of Andrew Still and Daniel Palmer & their respected concepts. These guys looked at treating the patient through the joint and we now know their philosophies are flawed, I am assuming it was somewhat of a breakthrough in the late 19th century. They had the, well male body parts, to come up with “Laws” to define their work. Osteopathy was known as the “Law of the Artery”, whilst Chiropactic was known as “Law of the Nerve”. These theoretical basis are the cornerstones of what was wrong with patients and how their treatments healed them.

The question to myself after learning this is, “what is the law of physical therapy”. Considering our field is very broad, I will rephrase this to, “what is the law of orthopaedic manual physical therapy”. In one word, can we come up with a phrase?

I am recommending, “Law of Compensation”. I say majority of my spine pain cases do not have a direct mechanism of injury, it simply arises out of thin air. Patients wake up with it one day but have known for years on one side of the spectrum that they should have been more active or on the other side of the spectrum, cross trained to avoid overuse. For simplicity sake, our bodies are always in survival mode. We have a niche to be in homeostasis and some areas will compensate to cover others. Simple examples are shoulder shrug sign while trying to elevate the arm and compensated trendelenburg during gait. In reference to sports, this is similar to someone on the team stepping up and “carrying the other members on their back”; no pun intended. One day it will have enough, boil over and let the brain know it is time to seek help. Pain hits the clock alarm and wakes the patient out of deep sleep. Hopefully the brain will also send the patient to a physical therapist to find this compensation or ugly ducking of the group. It is our job to provide instant, rapid relief; but dig deep to find the weakest link. If you just crack, needle, massage or mob without finding the mole; you might as well keep the book closed as you are not in shape to move on to the next chapter.

The initial philosophies of these guys may be what we will see on late night TV now, but it did give them a framework that has allowed these professions to stand for over a hundred years. Even though the TV tray’s legs may be wobbly, patients still seek out their care. Unfortunately for us, it is sought out more frequently and their history gives them more substance in treating musculoskeletal pain.

Maybe we need a Law?

What do you think should be our Law? What do you think of Compensation?

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6 comments

  1. I like the “Law of Compensation” and suggest a second or slightly different phrasing… What do you think about the “Law of Flawed Mobility”? At the end of the day we are movement specialists. Whether it be compensatory movements, aberrant movements, etc. We are the specialists to correct this conditions.

    Maybe our new laws will get us on TV too…..

    1. Absolutely, I love it! This is exactly what I want, for comments like this to arise on what we do and what our “laws” are. Flawed movements may be even better and can be an umbrella for all movements that are dysfunctional.

      Now how many years will it take for us to get society to think of us as movement specialists and not post-rehab personal torturers, massagers and heat packers ?

      1. Haha.. agreed! If I do any “massage” it hardly resembles what people think of as the feel good fluff and I always call it something different.
        I like being a post-rehab physical torturer, but I always make sure to educate them that this is only a very small part of what we do.
        I’m working in a direct access area, so I’ve been going out to local high schools and colleges to offer my services to help get away from those labels..

  2. Let me disclaim right now, I’m not a PT, but an osteopath! (UK trained, purely mentioned given the differences in training). I loved reading your explanation of the “Law of compensation”, which was one of the different models taught to us to evaluate/diagnose and treat patients. As for how long it takes to get that message out to the public, just don’t hold your breath….

    1. Hey Philippe,
      Firstly, thanks for reading! I appreciate you commenting as well.

      The model is easy to explain and well taken by current patients, but yes, it would be difficult to bring in patients based on it.

      We’re still at the model of treating when pain arises, prior to prevention. But no way to surely predict future pain so I would be skeptical too if a patient (just like I am with mechanics saying this and that about my car…)

      Hv

  3. Hi Harrison,

    Let me start off by saying I liked your article very much. Very insightful, well wrote and to the point. My issue is concerning your thoughts on Osteopathy. I am a Classical Osteopath, not a technique memorizing eclectic. Dr. Still made no reference to the artery being the be all end all and instead simply stated that with the removal of restriction to the nerve/artery/vein/lymphatic supply of a tissue, there is no reason why the health of that tissue should not improve. Muscles do not just contract or spasm for no reason, they have to be told to do that by a nerve and a nerve requires proper and unrestricted blood supply to function; this seems to be where Dr. still is misinterpreted all the time. A structural abnormality is usually present causing the nervous system to instruct the muscle to contract to compensate for the abnormality. Remove the abnormality and allow the person to load the skeleton properly under gravity and that muscle should return to normal function (very simplified but a lot of the time the case). The persons subjective feelings of pain may have seemed to appear out of nowhere but it may be that their body finally ran out of ways to compensate for the abnormality and said enough is enough. Diseases do not appear out of nowhere, they build over time due to abnormal anatomy which affects physiology. A person constantly side bent right and putting pressure on the liver may over years of that abnormality cause a cyst or some other disease. This can be true of any organ or disease in the body (minus the very small percentage that are genetic, and of course environmental factors must be considered).

    If you have never read it, I strongly suggest reading Research and Practice. It very simply and elegantly lays out the principles (not laws) of Osteopathy. It does not pretend to cure all or be better then any other non-drug, natural therapy. It simply takes the in-depth understanding of functional anatomy and physiology to find health and allow the body to cure itself. If it has gone too far then surgery or drug therapy will be required but we leave that to the allopaths. It was once said that everyone should give Osteopathy a chance, just make sure its not the last chance.

    Cheers!

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