Last week I travelled to Los Angeles to teach a workshop. The workshop went well and the visit was fun, but I'll spare you a detailed account of the double decker bus tour with the tour guide who pointed out all the hotels and nightclubs where stars had fallen from suicide, or drugs, or had been kicked out for being rowdy. Instead, I want to tell you about an inner experience at breakfast, at a nice little hole-in-the-wall bakery shop.
The twenty-something waitress came to take our order. She seemed sweet and had a beautiful smile. Her smile was nice, but hey, lots of people have beautiful smiles, and hers was no more beautiful than usual.
I was with the guy who hosted the class. We ordered lattes and something to eat.. we were busy chatting about this and that when the waitress arrived back with the lattes, and magic happened.
Suddenly, I became acutely aware that something beyond the usual was going on inside me. Something in there was responding to the waitress, or rather, to her movement. Suddenly 100% of my conscious awareness was watching her as she unbelievably, beautifully, placed two broad shallow cups of brimming latte on the table, gently, as though they were sleeping babies, not spilling one drop; the surface tension held the edge.
She smiled through this. Clearly this required making an effort, yet she graciously cancelled out any sense of this being effortful as she slowed and steadied her body to accomplish this feat, this feat which in the moment suddenly seemed as difficult a feat as anything Cirque has ever required of its performers.
Maybe the proximity was a factor as well - her arm was only a few inches away from me. Perhaps there was a small element of danger: had she lost focus, the coffee would have slid over the edge of the cup. It likely would not have spilled completely in my lap or anything, but it would have dripped off the edge, and that would have been mildly unpleasant. Instead, she rode that razor's edge of possibility, masterfully interacted with gravity in a most pleasing manner, and pulled off the impossible - laid that latte down with grace and style, but not in any way that could have been misconstrued as showboating. It was a beautiful moment.
Then she did it again, for my host.
But she wasn't done yet - she had flatware to put down. You know how waitresses usually lay down flatware after doing it a couple thousand times - kinda perfunctory, letting the weight of the flatware have its way, saving themselves a bit of energy by letting gravity win a bit too soon..
Not our waitress. She floated those six pieces down as carefully as though she were landing six small jet planes filled with precious breakables, merging them into gravity, not giving up until the very last nanosecond. She floated those pieces down. She succeeded in forcing time itself to elongate, slightly, just long enough to give my critter brain time to experience something in the outer world on its own terms, for once, and mount a surprise emotional response.
What was this response? It was awe, joy, appreciation. I actually could feel tears come to my eyes. She had created a moment of beauty with her movement that was remarkable for having occurred in so banal a setting, extraordinariness framed by ordinariness, the juxtaposition of which was extra delight in itself.
I do not feel that way very often. I have never felt that way while being served coffee by any other waitress, ever.
Both of us felt her.
I asked her name - it was Antoinette. I remarked how marvelous it was that she had managed to not spill a drop. She said, "I'm studying dance which is kind of funny because the reason I chose dance is that I'm naturally quite clumsy. In fact a lot of dancers are clumsy, and that's why we choose dance, so we can learn how to overcome it."
Well, Antoinette, all I can say is thank you for the amazing, unforgettable, closeup experience of witnessing your use of your physicality to create a moment of beauty. If you ever audition for So You Think You Can Dance, I'm pretty sure the judges will see your talent, your "it" factor, feel moved by you, and pick you for one of those tickets to Las Vegas.
You made me feel a moment of pleasure in this world, for free! - a world in which it seems I spend most of my life fending off displeasure, and I liked it. I really, really liked it.
If I had another life to live, I'd want you for my mom in that next life.
While I'm sure there are some who would like to see manual therapy destroyed and outlawed altogether, there are some, like me, who only want to see it cleaned up, objectionable explanatory models (noceboic to patients, intellectually offensive to therapists who have decluttered ourselves) removed, and practices which could maim people (high velocity or even just heavy neck manipulation, I'm looking at you..) outlawed.
I want to keep manual therapy, itself, alive. I want it to be antifragile. Well, in fact.. I think it already is solid. It's solid when defined properly. Here is the little list of antifragility principles I'd like to see manual therapy associated with. Many of them are the opposite of what the professions/culture/insurance companies demand.
Stick to simple rules
Don't try to be doctors of it - just go about helping people with their stress&pain, with physical contact, and kinesthetic reassurance.
Build in redundancy and layers (no single point of failure)
It is only what it is, nothing more. Nothing fancy. You can't lose anything by trying it, a few times at least.
Resist the urge to suppress randomness
Serendipitous ways of handling a problem will come to you in the moment, if you let it. Together you and the patient and both your nervous systems are 4 artists, physically making a work of art, in the moment. Let creativity come and play if it wants.
Make sure that you have your soul in the game
I'm not somebody who thinks in terms of "soul".. I do think in terms of critter brain, however. I'm pretty sure the two are indistinguishable. One is a human conceptualization of a set of qualities and behaviour and the other is a giant chunk of nervous system we share with all other vertebrates and without which we would be dead. So I would say, keep your own critter brain in the game. You have got to know your own, interact with it lots yourself before you can trust it to play nice with somebody else's.
Experiment and tinker — take lots of small risks
Make sure they are risks devoid of future harmful consequences, that's all. Usually smaller = slower and/or lighter.
We are connecting with nervous systems in other people. The surface of the body is so lively with info processing and conveying that you can pretty much get any message across to another nervous system without having to push hard, or fast, or perpendicularly.
Avoid risks that, if lost, would wipe you out completely
E.g., high velocity maiming, poking patients full of needles and collapsing a lung.
Don’t get consumed by data
Especially data on manual therapy, which just about always turns out to have effects that are nonspecific, at best, or else just random.
Keep your options open
As in, for example, the option to avoid certain bits that seem way too sensitive. Load in skin contact elsewhere instead. For example, a very sore or swollen ankle - you don't have to touch or "treat" the actual tender malleolus right off the bat. Twist the skin around the heel or do a balloon technique or something, stretch the skin somehow, by pulling skin toward the opposite malleolus instead. You'll get the human brain's attention without aggravating the critter brain.
Focus more on avoiding things that don’t work than trying to find out what does work
Absolutely. And the older you get the less you'll find yourself doing, and the better will be your results in the moment.
Respect the old — look for habits and rules that have been around for a long time
As far as I'm concerned, what has been around longest is that tendency vertebrate creatures have to conduct conspecific and interspecies social grooming, as long as there have been vertebrates. More recently primates took social grooming to a whole other level when they started exchanging it for not only bio (picking off bugs) reasons, but psychosocial ones as well (bringing individuals back into the troop, reducing stress after fights or someone got bossed unfairly, demonstrating caring behaviour). We are human primates and if we remember to do human primate social grooming first, that's all we usually have to do.
None of the above is the least bit incongruent with pain science.
I think we should be first responders to pain as expressed by another. Most of which is secondary to stress. Much of which is associated with muscle tension also secondary to stress, because spinal cord was the first part of the central nervous system to evolve, is the first responder to nociceptive input, and the spinal cord has never been famous for having much hard drive.
In fact the spinal cord hasn't changed a lot since fish invented it 500 million years ago. Come to think of it, that could be why vertebrates invented social grooming in such a cross species fashion.