Manual Therapy And Context: Where Is The Connection?

Not too long ago, I was watching a child on the subway platform walking with a pelvic torsion (that’s a ‘misalignment’ of the pelvis that injured adults walk with sometimes), and I thought- why would a normally functioning child walk with a pelvic torsion? I was looking from the lens of a manual therapist. 

But, then I looked up.  And soon I realized that the child’s mother was leading her by the hand- and so she was adapting her body to the force and direction that was pulling her, like how a plant twists toward the sun.  In other words, her movement was completely appropriate to the task.  And the lesson is: Context matters. 

What drives a pelvic torsion? Many things, actually. Everything I have learned about the mechanics of the pelvis, I owe to the brilliance of @DianeLee. She has mapped out an incredibly comprehensive system for how to properly evaluate and treat a host of Sacroiliac dysfunctions. But, my biggest lesson from Diane was discovering that in order to help someone with pelvic dysfunction, I need to understand the movement that triggers it.  To a patient, often it hurts “all of the time,” until I ask them a series of questions and they discover, “it hurts when I roll out of bed,” or it hurts “when I get out of the car.” In an orthopedic setting, not only does context matter, but it becomes the treatment.

I love to teach people how to roll out of bed or how to transition in and out of a car without triggering pain. It is hard to believe, but most torsions usually iron themselves out with proper awareness- this I have learned from the Feldenkrais Method. 

Think of a baby whose habit it is to turn to only one side. A Pediatric PT would be cautious to turn a baby’s neck against all of the baby’s instincts to look the other direction. Instead, the PT would move the baby’s toy to support his “learning” to move in the opposite direction. A pediatric PT is constantly seeing the forest from the trees this way, and this is such an important responsibility for us all as manual therapists- PTs, chiropractors, osteopaths and the like.

This is where imagination counts. It’s not just about how C7 would rotate when turning to the right. It’s actually about, “How would you turn if you really wanted to see something over your right shoulder?”    

Today, I asked a patient, “when would you be most likely to stand on your toes?,”  and she gave me an answer that once again our pediatric friends know so well, she said “when reaching for something.” Then she demonstrated with perfect elegance, after lifting her heels had once seemed so difficult.