A Theory of Practice

"In theory there is no difference between theory and practice. In practice there is."
Yogi Berra


People frequently ask me why I practice differently from other therapists they have experienced. Most seem appreciative of the approach. Others struggle to go where they think I want them to go. Expecting someone to tell them everything that is wrong with them and set about fixing it, they are taken aback when I begin with acceptance and follow their lead toward correction. The truth is, they know more about finding their way out of pain than I do. I just need to help them find that path. I decided long ago that since I rarely met anyone's expectations of therapy that I would have to try instead to exceed them. That is easier said than done.

In this thread on SomaSimple, a fellow moderator had this to say about our profession:
"Perhaps as a profession, we've been following the wrong directions so long that we've had to convince ourselves that where we ended up is where we wanted to go. I imagine it would be hard to convince someone that all the hard work used to get somewhere may have been wasted (or at least not used efficiently)."
I think he is exactly right. When one finds oneself somewhere they don't really want to be, they should change course. So, I guess my simplest answer to the question of why my practice is different is that I have corrected course many times.

A few years ago James Willis, MD, gave an address on the importance of science in medicine that I think everyone should read. In The Sea Monster and the Whirlpool, he discusses the difficulty and imperative of steering a course between pseudoscience (see my last post) and scientific fundamentalism. In physiotherapy these days, these two extremes are exemplified by the enthusiasm for alternative methods and the excitement about clinical prediction rules for manipulation. This is not all bad, of course, and one must carefully separate the wheat from the chaff. The main imperative for many, however, seems protection of traditional methods of practice. This makes no sense when the science is leading us in a different direction.

I spend every day encountering patients in pain, trying to figure out how to help them find greater comfort and how to function better in their every day lives. Thankfully, there has been a tremendous amount of work in neuroscience that has revolutionized our understanding of pain. It has charted a course for my profession that we simply must follow if we hope to help those in need of our care. It is time for new theories. And from new theories, new practice.

That is why I practice differently.