The recent discussion about the "grades" of mobilization reminded me of a
passage from Deane Juhan's "Job's Body; A Handbook for Bodywork" (Station Hill
1987)
"It is extemely important when manipulating... that the fixation is not in the
tissues under my hands, but is deep in the unconscious processes of (their)
mind. My physical contact with the local tissues is merely a means of
generating new sensory input into the sensorimotor process; it is the mind
that is coordinating this process which must release its hold upon a fixed
position. ...only a growing trust and surrender in the mind of the patient can
succeed in calming exaggerated responses."
Juhan understands that the force or hoped-for result from the pressure the
practitioner applies is only one half of the treatment equation. The other
half includes the actual response in the mind of the patient, and, the joints
being incapable of movement without muscular reaction, passive movement cannot
be spoken of meaningfully without considering the non-linear reactions of
humans to any sort of coercion. Ultimately, "grades" of passive movement don't
offer us much in the way of clinical relevance when spoken of in isolation.
Unless of course there isn't a patient attached to them. This only happens in
lectures about care, not in actual care itself.
I refer to this problem as "the passive voice," and have added an essay
entitled that to my web site; <A HREF="http://qin.com/dorko/">"The
Clinician's Manual"<http://qin.com/dorko></A> in the "From Dorko's Desk"
section. I've also added a few words about my one day workshops in the "Simple
Contact" section.
Maybe this will generate a few comments to the list.
Barrett L. Dorko P.T.
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