Why it matters...at least to me

Two weeks ago, I had the pleasure of travelling to the beautiful city of Vancouver to meet and learn from Diane Jacobs. Diane is a physiotherapist whose tireless investigation of neuroscience and pain has been generously shared online for several years. I first bumped into her in cyberspace several years ago and have followed the development of her thinking and practice on SomaSimple ever since. I think it is safe to say that few have done more studying and reflecting than Diane in order to build a scientific foundation under manual therapy for pain.

So why is a scientific foundation so important? For far too long, physiotherapists have settled for "whatever works" in treating pain. Understandably, whatever works is often acceptable for someone who is seeking relief from their suffering. But we can do better. Our understanding of the brain and the rest of the nervous system is growing every day and it is information desperately needed to update our professional body on knowledge. Medicine and therapy, in attempts to emerge from empircism and tradition, have taken up the mantle of Evidence-Based Medicine. While helpful in many ways, this editorial highlights the futility of lobbing outcomes studies at one another like grenades. Rothstein points to the importance of theory to guide our thinking and practice.

I have questioned outdated models of human function on this blog before. Critiquing theory does not necessarily mean I think these models offer nothing of use. Reading outcome studies that show questionable theories are effective in practice does not convince me that the theory is correct. Although much remains to be figured out, there are some concepts that do not meet the criteria of plausibility and do not warrant further consideration. Some explanations offered are little more than perceptual fantasy. If these are not informed with what science tells us, they become nothing more than belief systems and cults of personality.

Throughout her long career, Diane has both studied and subsequently deconstructed many such systems of treatment. She has worked hard to understand - in the light of neuroscience - what she feels under her hands and the changes induced in people's bodies. She understands the role of therapist as catalyst to help a person's nervous system do the necessary work of down-regulating persistent pain and she performs her task with the light hands of an experienced guide that knows the landscape well. All of this and she is still seeking better maps. Here's why it matters: science - the effort to discover and the method of perpetual inquiry - is our best hope of deepening our understanding. It requires informed theory and good research. It requires clinicians to bring it to the care of their patients.