Back when I was young, I had my very own Pinocchio puppet. While there’s nothing unusual about that, the puppet always seemed a bit unusual as its left foot didn’t work properly.
I noticed that when I made Pinocchio sit down it looked fine, but when standing up its foot would be stuck upward at a funny angle every time. No matter how many different times I tried it, standing the puppet up always made the left foot stick out. I couldn’t figure out what was wrong with it. So, naturally, I approached an engineer (my Dad) to take a look and give his professional opinion on poor Pinocchio’s squinty foot.
Immediately, my Dad noticed what was wrong. He laid the puppet out on the table and showed me how each part was connected, from the foot to the knee, the hip, the body, the shoulder and up to the head. It was there, in the string above the left side of the head that we could both see a small knot in the string. He showed me how that small knot had shortened the whole left side of the puppet and although it didn’t show when it was sitting, the string was too short when the puppet was standing for the foot to be positioned properly. After simply undoing the knot, the foot worked perfectly.
Many years later, this innocuous little toy repair as a child became surprisingly relevant to my career as a physiotherapist. As I learned about anatomy, I realised that the human body is made up of many connections between head and foot, just like the puppet. However, our “strings” (ligaments, bones, muscle, fascia, nerves etc.) are not so obvious. Nevertheless, the connections are there just the same.
Thinking back to how my Dad used his engineering knowledge and fatherly wisdom, I began to see my job as a physiotherapist as being the person who finds the “knots” in the human body and then loosens them to allow tissue to move freely again. While not the same as knots in a piece of string, these “knots” in body tissue are areas of tension that can be felt through the practice of “loading” tissue. This involves gentle pressure to reveal where the restrictions are the worst. I then use a wide selection of physiotherapy techniques to undo these knots and let the body’s tissues move freely again.
Another fascinating parallel with the Pinocchio puppet story is the fact that patients are often aware of a knot or area of tension somewhere in their body. However, it’s often so far away from where the symptoms are occurring that they don’t even imagine that the two are related.
An example of this was a past patient of mine; a 39-year-old man who had acute lower back pain, but had never directly hurt his back. Through chatting about his life and any past injuries, I discovered that as an 8-year-old he had broken his elbow above and below the joint in a bad accident. While initially seeking treatment with me for his intermittent, worsening back pain, it turned out that the main pull on his tissue was resulting from that same elbow. He had in fact never been able to straighten it for over 31 years! After working on the tissues from this elbow to the shoulder, through to his head and upper torso, I was able to work gently on his back, eventually easing the pain he had felt there.
What had happened is that over the course of this patient’s life, his brain had made minor adjustments to his skeleton in order to remove the strain from the once-fractured elbow. This gradually impacted his back after many years, resulting in the persistent pain that had affected him. After all, like the strings that connected the parts of my childhood puppet, everything in the human body is connected.
Whenever I tell people about this kind of connected pain, they often ask me if that could really relate to something that happened so long ago. Well, I tell them, if my engineer Dad hadn’t had the time to undo the knot above Pinocchio’s head, wouldn’t he still have the knot in his string and a misplaced foot? Just like the puppet needed a bit of tinkering, the “knots” that we feel in our bodies can’t undo themselves and require a bit of encouragement in order for us to keep moving normally and without discomfort.