Wednesday, January 08, 2020

Manual therapy needs a new conceptual home

This is a facebook post I made on a thread that had to do with (so-called) craniosacral therapy. I've saved it because I don't want to have to rewrite it elsewhere/some other time.
 "I took a look at the post by ..... on the process of producing verifiable science and would propose some rabbit holes one must avoid/navigate in order to not waste one's time and effort when studying something as fraught as manual therapy. It's important to realize and embrace science as being a tool to DISprove, not prove. 
1. This involves confronting all one's own biases and wishful thinkings and inherited beliefs and burning them all to the ground. Yes, it hurts. But not for long, and not if you are doggedly determined to get to something that can stand on its own merit and be considered rational. 
2. It helps if you've fallen in love with and been carried away by pain science. This takes you into the nervous system right away, and away from mesodermally derived tissue. (Anywhere. Including any that may be found inside the head.) Also it will take you away from standard orthopaedic biomedical thinking, which place mesodermally-derived tissues first and foremost and have overshadowed manual therapy thinking for more than a century. 
3. And you have to deal with the idea that you are treating alive awake conscious humans, not some cadaver in a lab with its skin pre-removed. Or skulls that come apart so you can see what bones exist. Or maybe brain slices that show ventricles.Right away you realize that your own nervous system is interacting with another person and their own nervous system, not operating on some buried structure. It's a humbling but IMO way more accurate way to frame manual therapy. This realization helps one realize that there is way more to manual therapy than any of the existing operative models would ever suggest. And that it is not fair, really, to allow such a beautiful way of being in the world with other humans to be so denigrated because of the scientific backwater it has been assigned to due to its lack of rational rigor. Because people who study it routinely (still!) ask the wrong questions of it. Because of bias. 
4. Next step involves examining obvious confounds.The biggest one in my opinion, present and unaccounted for in manual therapy, is the fact (the bare, absolute, distressing fact) that none of the prevailing models of manual therapy have ever addressed the biggest of all elephant in the room, which is skin.Which is all we can *really* touch. It's as though it was mentally subtracted without any consideration whatsoever. Even though it has so MUCH neural content within it. Which is where I've been roaming around mentally ever since. 
5. When we take a long wide view of where manual therapy comes from we might want to consider it as (yet more humbling) human primate social grooming that we inherited for free just for being primates, and because we're human, has way too many indefensible thought constructs attached to it like barnacles on the hull of a ship, slowing it down, that (indefensibly!) most manual therapists are trying to "prove" or at least argue should be allowed to continue to exist. We can still be manual therapists without entertaining complicated erroneous ideas."

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