Wednesday, May 26, 2010


Perhaps because of the ease of defaulting into speaking English in a foreign country, I had an unprecedented opportunity to have a couple of extended conversations with two people in PT who work very hard at the delivery system of PT and developing the science which backs it. PT definitely needs these kinds of people or it would cease to exist as a profession, probably.

Both of the conversations were mostly about trying to find common ground and not finding much, really, in my opinion. I had a bit of trouble, actually, figuring out why they were at a manual therapy congress in the first place, as they clearly were not interested in manual therapy. I think they imagine themselves and the profession to have moved beyond it, some how, or if it hasn't, that it should. I got the impression that they find the entirety of manual therapy a bit unseemly somehow, a bit disreputable. They certainly have a right to think that, and I'd have to agree with them that the entire field of endeavor has become progressively botched, both in practice and in concept, more and more as time has gone by.

My position is that there is something about it worth saving. My presentations were all about what and why and perhaps how. Neither of these two people saw both presentations and one of them saw neither, so I can't blame them for not getting what they were about. I guess my status within the profession as being on the lowest-possible rung of the ladder, or maybe even under one of the feet of the ladder being pressed down into the earth, may have been duly noted and registered by them, before, during and after.

It is almost certain that had we not been in Brazil, with the peculiar circumstances of
a) none of us being fluent in Portuguese
b) having been put together by amazingly socially facilitative and forgiving hosts (forgiving because we rudely nattered away in English almost the whole time)
c) having a built-in time limit, end point, and a bit of time to kill in between, over meals...

.... none of these conversations could have transpired. I mean, I would never have gained direct access to prominent individuals or what they think or their apparent attitudes; I would have had to fight my way through a whole PT food chain of handlers/admirers/devotees, would not have bothered. In Brazil I could pick their brains on artificially equal footing, for a brief window of time. This is simply a reflection of the nature of the world, and how PT has evolved, or rather, been culturally selected for, nothing to do with either of these individuals, personally.

So, what on earth is she talking about, one might wonder, reading this...

I'll tackle the conversation with Sarah Mottram first, as I met her first. It transpired over about 4 days and as many meals. She is the one who saw neither of my presentations. My impression after seeing both of hers and our conversations, is that:
a) she wants to see the profession advance (as we all do)
b) she focuses on PT as a delivery system
c) she wouldn't mind if manual therapy stayed completely invisible, unknowable, even unexplored from a neuroscientific perspective.

She said she herself sees manual therapists, from the osteopathic branch of the human primate social grooming troop, whenever she happens to have a pain problem, but seems to think somehow, that this has nothing to do with PT, or any inherent deficiency therein, or that it suggests inherent contradiction. She thinks "motor control" is what PT is supposed to be about, and nice, pain-relieving, contactful interaction as something outside of it. I don't agree. If we are PTs who deal with nervous systems, then I do not think it's appropriate for us to chop them up into culturally convenient and professionally designated categories. A nervous system is fundamentally a biological phenomenon, not a cultural one. Categorization of nervous systems into broad baskets of "we'll deal with this and you deal with that" was a mistake from the start: now pain science/modern neuroscience has come along, like a big mirror, to show us what a colossal mistake it really was.

When I asked her why motor control didn't work for her own personal pain issues, she replied that motor control was more about preventing pain problems than it was about solving them after they had arisen. Well, that's nice (if true), but it won't help those who already have pain then.. will it?

I honestly couldn't figure out what she was doing at a manual therapy conference, other than she possessed credentials as a manipulative therapist, had been involved in a manipulative therapy organization at some point, which I guess has provided her a lifelong passport. But manual therapy or understanding it or redefining it is clearly not where her heart rests.

She acted as if she was interested in my stuff... but I think this was mostly just to be polite. I do not think she is anyone particularly interested in pain science or in examining or thinking about what happens at a skin or nervous system level between two neuromatrices therapeutically in contact with one another, one of which has constructed a pain experience which needs replacing by a new, non-pain experience. To become interested in such a modest question would take her too far off her current trajectory, probably.

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