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?