Laurie's Blogs.

I came upon another great blog this week:  http://www.billhartman.net/blog/from-my-notebook-complexity-and-constraints/

The premise of the blog was that humans are complex adaptive systems, and that the system is modified by behaviours.  At any time that we want to impact the system, we are at a different starting point each time.  Additionally, there is a non-linear relationship between cause and effect.  What does that mean when it comes to physical therapy and treatment of ‘living beings’?

Essentially, complex adaptive systems (i.e. humans, and I will also add animals) may require unique and previously untested methods (i.e. treatments) to solve problems, because there are an unknown number of unknowns!  As such, it may be important to experiment.  Not just any sort of random experimentation, but rather ‘safe-to-fail’ experiments (this means that if your experiment fails, no harm is done).  In fact, without doing so, we wouldn’t learn, progress, or be able to establish ‘best practices’ when treating a patient or certain condition.  Let’s be honest, many times we don’t really know why a treatment works, just that it does.  Become okay with that!  It’s reality!

There are often many theories on how to solve a complex problem, because complex problems may have multiple successful solutions.  Our experiences are what will therefore influence our understanding and decisions.

Take for example a PT friend of mine.  She had a patient with pin-point mid-back.  She mobilized the vertebra and mobilized the rib.  No changes.  She did a manipulation.  No change.  She used ultrasound.  No change. She gave him exercises to work that area.  No change.  She confessed to me that she was so frustrated that on one appointment she just rubbed the area, a bit of a friction technique.  And that worked!  She exclaimed, “I was so ticked off, he got better after I just rubbed it!  I just fricking rubbed the area!”  The point of the story is that she tried and failed, tried and failed, multiple times until she experimented with a different technique, and it worked!

A recent canine patient of mine has what we all suspect to be a cancer of one of the metatarsals of his foot.  He’s been slowly getting worse.  A couple of weeks ago he hit his foot on the stairs when coming up them.  His foot swelled up even more.  He became 3-legged lame.  But then 1.5 weeks and also 2.5 weeks later, he looked better than ever.  The foot swelling had gone down and he barely looks lame!  WTF???  (What the Frick!)  Maybe the ‘injury’ stimulated the healing process again?  Will I suggest trauma to other osteosarcomas?  Not likely!  But it does get me thinking about systems in the body and the various ways that healing happens.  Would I try ‘irritating’ a tendinopathy to stimulate healing?  Yes!  But that’s a low risk / safe-to-fail experiment, and an already tried and true treatment.  I can tell you that the experience of this event will go into my brain as “save that bit of information, you may need it one day!”

Back on topic here:  So when looking at ‘experimenting’ with treatments or approaches to a case, the blog suggested the following:

1. Describe the present

2. Identify what can be changed

3. Determine where you can monitor the impact of the intervention

4. Where will the intervention produce a beneficial result

5. If the result is not beneficial, how can I learn from it

6. Move between the complex and complicated domains

7. As the new state emerges, increase constraints to exploit and magnify the result

Be aware of the breadth of complexity of a living body.  Our therapies may be affecting (or may need to affect) Energy, ANS, Immune, Endocrine, Respiration, Circulation, Emotion, Experience, Understanding, Memories, etc.  Not just the neuromusculoskeletal system.  One of the quotes from the blog that stood out for me was: “If you think you’re somehow treating a pathology (structural) as a PT, you’re probably wrong or you’re thinking like an orthopedic surgeon.”

So, stop using the recipe books and train yourself to become a chef!  Try a little experimentation with your therapies.  This will help you learn, grow, and expand exponentially a practitioner.  

Have fun with it!  Cheers!  Laurie