Every so often something crosses my path which cheers me up. Recently I found this blog by an ex-chiropractor who no longer tolerates wool pulled down over his eyes or his mind. Good for him. Here's another.
The sooner hucksterism leaves my field of endeavor the sooner I'll be way more happy. To get hucksterism out of this field requires that individuals like this begin to save themselves from replicating it, and then talk about it.
Really, it comes down to just this: Someone in pain, Person A, goes to see someone, Person B, about it. Hopefully Person B has been trained to be ethical and scientifically respectful. Hopefully Person B does not take on a hero's role. Hopefully Person B has been around long enough to have discarded uselessness in favor of honesty. Hopefully Person B is current with pain science.
Person B will do what he or she can to provide a favorable no nonsense context for the patient to conduct his or her own exploration. There will be usually some provision of exteroceptive input of some kind. There will be no funny business - Person A will be told what is expected of them, taught what to look for, asked to proceed at their own rate. It will have been made clear, one way or another, in some way Person A can understand, that it's their job to get themselves better, and that Person B is a helper.
Person B will realize all along that he or she is nothing but a catalyst. Person A will be doing all the hard work of sensing and learning, changing their own nervous system (or rather, allowing their own nervous system to change itself) to something more optimal. The desired reaction occurs entirely within the patient, and the only reagent is the patient and all their inTRA-relationships. None of this is a simple thing to understand at a scientific level, but progress is being made and the science base is growing; maybe one day the physical contact aspect of human primate social grooming will be not only stripped of flimflam but will have vindicated itself.
Changes occur, usually in the direction of improved function and decreased pain. But not always, and not in any sort of predictable way or speed. All this depends on the patient, the context, and on the quality of therapeutic contact within a treatment room.
Let's discuss "crucible". On the surface it means a container such as the ones used in chemical labs, able to stand high heat etc. A deeper level of meaning (without being religious in any way) is "cross", an intersection or crossroads, a place where a change of direction can take place. Other words contain the same root, words such as "crucial", or something that is the "crux" of a matter.
A treatment room is, then, a metaphoric crucible. As such it should be able to stand the metaphoric equivalent of "high heat" - the patient should sense that the room they are in is safe for them to be who they are, express whatever they want. And they may well need to.
Not only should the room be designed to take the "heat", the therapist should be "fireproof" as well, able to tolerate whatever sorts of pain offerings a patient might bring, emotional or physical, without flinching. Flinching is a non-conscious, mirror-neuron, socially connective, social behavior. To NOT flinch and still retain good therapeutic contact is definitely a learned behavior. Here, I must confess, I am still working on getting the right proportions of non-flinch combined with solid connection during the interview. I'll never be perfect - no therapist will ever be perfect. It keeps one humble and honest. I would like to add, however, that not very many people are "high heat" people - most cases of persistent pain are very straightforward.
The therapist will have tried to eliminate as many distractions and noceboic elements as possible from the crucible. He or she will have made it as clear as possible that the pain issue is something the patient must permit themselves to work through. This needn't mean having to experience more pain. In fact, the less the process "hurts" the better. No point in reinforcing the pathways associated with the very thing the patient has come in to try to learn how to deal with, get rid of.
Eventually the time will come for the reaction. I usually spend a half hour or so, interviewing, examining, explaining, which leaves a half hour for the patient to experience a sample of what happens on the table. Subsequent visits are much more tabletime. Usually at least two visits, sometimes as many as 4, are required to complete the process. (A few of my patients come in long term for various reasons, but very few indeed. It is not encouraged.)
Hands-on is definitely involved - for most people who come. Anything that sounds like wind-up pain, I like to leave alone, at least in visit one. I've had people leave disappointed, people who just didn't get that they would require more prep time, and who didn't return. C'est la vie. Better they leave in the same shape they came in, than feeling worse. I'm happy to say this is so rare it's only happened twice. I learned my lesson with a patient one time whose pain flared suspiciously with the sort of hands-on I do, so I learned to spot the signs, and do not use manual therapy in the first visit with a patient who says something like, "I've always noticed, whenever I get an injury and it heals, even just a scratch, it always feels painful after that - the pain never goes away." Fortunately these sorts of patients (highly sensitized ones with abnormal pain processing) are pretty rare. Most people just have regular persistent pain, good processing, but need some assistance so they can connect dots within their own nervous systems.
Finally, the hands-on part is nothing more than contact with skin, at varying pressures and angles, but mostly lateral stretch. This does nothing TO a person's "body", or TO any of the mesodermal derivatives that lie within it, rather it sets up volleys of firing sequences that have been mapped and studied by neurophysiologists and other curious people, and documented scientifically (by Simon Gandevia and others). One can predict that if one has chosen one's patients wisely, and guided the therapeutic relationship appropriately, Person A will let their own non-conscious system take over all the heavy lifting, let it will change itself/its output into something easier to live with, something less mechanosensitive, less painful, with easier movement to follow.
Like any catalyst, the therapist will have added nothing to this reaction, will have only functioned to help speed it up, and will leave nothing of themselves in the final product.