07/07/2023
The Natural Unfolding of the Manual Conversation.
3 MIN READ
Perhaps a manual therapy session could unfold like a conversation between two people. Through verbal dialogue, we listen to words and other cues in order to understand how we can help. During a manual therapy session, we listen with our hands and interpret tactile sensations to understand how to best offer support. Often, listening to words with mind and heart open is enough for a patient to find a solution for themselves – offering them a valuable and empowering opportunity for self-discovery and self-healing. Through manual therapy, when we listen through contact using a similar non-judgemental, empathetic presence, we offer the body a chance to lean on us so it can change. Both verbal and manual listening can be profoundly therapeutic, since they invite change from within. Sometimes, though, merely offering listening support isn't enough; someone may need actual advice to move forward. In a verbal conversation, we then may make a suggestion. If our advice is accepted, we have helped our friend or patient or client in a way that they could not on their own. Here, only after allowing change to occur using their own embodied resources, did we intervene with external aid. Similarly, during manual therapy, when supportive listening is insufficient, we may offer a suggestion, but in the form of an induction or mobilization. If the body accepts this manual advice, we have helped it change in a way that it could not on its own. When offered with the right intentions and in the correct order, both listening and suggesting are integral parts of an empowering therapeutic alliance between people. When we begin to uncover these and other parallels between verbal and manual dialogue, we may glean important insight into our therapeutic relationships. For example, this “support-first-advice-second” approach may help us understand how certain types of inertial fulcrums rank in the body, and about how treatments should unfold around them. From my experience, certain fulcrums respond better to either a biodynamic approach and/or a biomechanical one. Could this mean that the inertial fulcrums which respond better to supportive listening are more biodynamic in nature, whereas those that respond better to suggestive mobilization are more biomechanical? And if so, could the shift from offering manual support to offering manual advice be the point where manual therapy moves from a predominantly “supportive” biodynamic craniosacral-type dialogue to a more “suggestive” classical biomechanical intervention – even during a single technique? Thanks to the wonderful complexities of human physiology and to the variability of each and every therapeutic interaction, the answers here depend, of course, on a range of criteria and are far from straight-forward, but perhaps deserve a fresh think.
Scott Sternthal, D.O., is an osteopath based in Montreal and the author of "Melting Bone, Healing Tide".
