Fixing vs Nurturing in Physical Therapy

The topic of "Fixing vs Nurturing" philosophy in practice came up recently in a discussion in this group. I have been surprised over the years by several eminent practitioners in our small circle expressing the view we do not fix. I have reviewed the conversation and argue we can and do fix clients.


"90% of ill health is emotionally based and 10% is due to accident." Prof Lun Wong OAM, 9th dan Tang So Do. I was first a patient and later a student of this man for a period of fourteen years. I was a bad student. I did not become a Chinese doctor...I was not ready to be a therapist at that time. Yet I did gain a palpable insight and understanding of Chi energy.


It is true much ill health is due to underlying emotional excess that can respond positively to "help them relax, feel safe and stimulate the body to self correct". You will find, however, that Traditional Chinese Medicine has an assessment, diagnostic and treatment protocol to aid illness and accelerate recovery plus, with ongoing regular treatment, optimise health in the long term. This is a highly sophisticated form of support and stimulation that is so effective it can be difficult to distinguish between nurturing and fixing.


While I talk about energy flow and will occasionally needle or use acupressure, I am not a Shiatsu style massage therapist. I decided early in my career that acupressure was relatively inefficient compared to acupuncture and clients would get better value from me receiving physical treatment and visit a TCM doctor for more advanced pulse, tongue and eye diagnosis and be treated accordingly with herbs and acupuncture.


Working as a Remedial therapist applying the fundamentals of Physiotherapy in assessing and treating conditions I have developed an understanding of postural anomalies and soft tissue dysfunction, and it's interrelationship to energy or Chi flow giving a better understanding of many common conditions of pain and suffering. This knowledge applied to treatment facilitates rapid resolution of chronic conditions such as Plantar Fasciitis, Compartment Syndrome, Achilles and Hamstring dysfunction, Piriformis Syndrome, etc., in the lower limbs and Repetitive Strain Injury or Carpal Tunnel in the upper limbs. More complex assessment and consideration for treatment frequently stems from the effect of an almost universal Short Right Leg in this respect too.


Similarly, "The Heart Story"...a purely emotional condition I describe having a direct affect on Chi flow and muscle insight to physical afflictions and dysfunction about the head, neck and shoulders. This is particularly useful dealing with anxiety cases and as a precursor to Craniosacral Therapy.


I digress slightly here from the topic of "Fixing vs Nurturing" as "The Heart Story" has a large footprint the latter and my argument is to prove the former is valid in our work. I frequently encounter chronic cases suffering conditions poorly understood by therapists of all types, that have received considerable treatment over the years giving only limited temporary relief but do not resolve the condition. In desperation many suffering these afflictions resort to crude and unnecessary surgical procedures that are less than totally effective. I am not wishing to demean other therapists but this has been my experience both as a patient and as a practitioner. 


Discussing the conditions listed above during Remedial training, there was no treatment plan leading to resolution offered by the University and there was little expectation anything other than temporary relief might be achieved. Where biomechanical or neurological anomalies cannot be identified, conventional Western practitioners fall back on physical training or work overloading as the cause for lack of a better understanding.


Because Chi does not have a scientific unit describing it, it is not discussed in training by Western medical therapists and it is not in their lexicon, they are literally blind to its existence. It is not considered in their assessment of conditions. Minor postural and muscle tone anomalies are disregarded and considered irrelevant where, in fact, they are often the underlying cause. Proximal anomalies block energetic flow distally. When energetic flow is blocked, thickening and tightening occurs through the connective tissue causing pain, dysfunction and injury. 


I had many years of martial training earlier in life and am able to feel or sense energetic blockage in a limb and the change that comes over it when cleared. However, it is not necessary to be able to do so to be an effective therapist. Anyone with good palpation skills will be able to identify the gristle like nature of flesh that is affected by an energetic blockage.


The key to successful treatment is often knowing where the blockage is. Because the pain is in the foot, do not assume that is where the block is occurring. Typically plantar fascia, calf, hamstring or gluteal issues are most commonly coming from the hip and SIJ and, less frequently, the lumbro-sacral area. Similarly, forearm issues come from the shoulder and torso. Unless I have reason to believe an actual injury has occurred at the pain site, I will initially focus treatment on rectifying postural anomalies and rigidity proximally at the torso. Intervention to clear blockages includes, deep tissue techniques to release tightness, Chinese cupping to remove/extract stagnant Chi and blood, Gua Sha to clear heat, direct stretching techniques including Static, PNF and MET's and, most importantly, indirect Osteopathic positional release techniques to release tightness deep in the hip, shoulder and torso. The nature of this treatment is highly physical. Targeted release and activation in the short term...maintenance exercise long term.


For cases requiring strengthening and mobilising, I give a few basic exercises. However, while I have an extensive athletic background, I am not a PT, Yoga guru or Pilates instructor and have no desire to take on that role. Where necessary, I encourage the client to pursue appropriate training.


Where the underlying cause is a leg length difference, some cases require a thin prosthetic adjusting wedge under the short leg. Incidentally, it is always the right leg. It is very common and the ramifications through the body are extensive. It is a complex condition I have begun to describe on my website at the Short Right Leg Syndrome tab.


Without intervention to clear energetic blocks and correct posture many chronic cases will not respond favourably to treatment. These cases will often be in acute pain and are unable to work effectively. No amount of relaxation and nurturing support will rectify their condition in the short term and being invalided out of the workforce is not acceptable. When addressed, resolution of the condition can be rapid, usually within one to three treatment sessions.  I call this a "Fix". I am inclined to think practitioners adopt the view we do not fix because of the limitations of conventional Western science’s glaring deficiency of not including energetic concepts.