Often, people with conditions such as back pain will visit their physician and be handed a list of exercises. Experienced therapists know that there are times when any sheet of exercises may be highly effective. There are other times when the same exercises may be, at best, of minimal help or, at worst, downright harmful. Why? What is right exercise?

We are all familiar with the maxim that one should “stretch what is short and strengthen what is weak.” Shorter or weaker than what? Since people’s bodies are different, since the cause and extent of their injuries are different, since their history and culture and psychology are different, what is short and what is weak will also be different. What is the referent we employ when we use such terms as appropriate length or strength?

Inevitably, in any discussion of the rehabilitative process, we must come to a central concept: the idea and the ideal of balance. In the body there is a constant interplay between mobility and stability, movement and strength. It is this interplay which is constantly being assessed during therapy. What the body gains in strength, it can sometimes lose in movement. Excessive mobility can be as much a problem as rigidity. The intention is to create stability which complements mobility. In a word, balance.

Balance is at the heart of all rehabilitation. The orthopedist who resets a bone, the podiatrist who prescribes a shoe lift, the surgeon who takes pressure off a nerve root, and the physical therapist who gives stretches to overcome rigidity or exercises to regain resiliency are all dealing in balance. Restoring balance is the method of healing.

Human physiology is predicated on maintaining balances. Dynamic balance in temperature, bone deposition, and mechanical forces, are primary to our understanding of the body’s workings. Homeostasis, the “steady state” is perhaps the fundamental physiological principle. Achieving balance is the goal of healing.

The expression therapists hear most often is “out of whack”. “I don’t know what happened. It’s just out of whack.” The Dictionary of Slang defines “out of whack” as “unbalanced, out of order.” Order is the balance between movement and strength, compression and tension, expansion and contraction. It is the optimum: the place of ultimate resiliency, where all forces are countered, where everything is empty and yet full. It is a place of stillness and potential; where things are not just “not bad,” they are good. Living in order is, in the largest sense, the reward of healing.

To the orthopedic researcher in his biomechanics lab, balance is determined with precision. To the athletic trainer, physical therapist, or Rolfer in his or her office, it is often determined with a different, but no less critical, kind of precision. Highly subjective in the reality of the rehabilitative process, it is something which we learn through experience. It is judged by sight and by “feel”. It can be taught; it must be learned.

If it is true that when injured we react to the traumatic event by withdrawing and collapsing, we must ask: withdrawing and collapsing from what? The referent is always the same: we withdraw and collapse in relation to a point of relative balance. No longer, in order, we are out of whack.

Since rehabilitation can be looked upon as a process of reestablishing balance and since balance can, through practice and awareness, be seen and felt, balance can, therefore, be employed as a guiding principle to help us understand where and how to work. In any given treatment, we know we are on the right track if we are restoring (or creating) order. Conversely, we know we have not accomplished what we are intending with any particular technique massage, joint mobilization, soft tissue manipulation if the technique’s employment does not result in the restoration of order. The question then becomes not how long do we work a particular area of the body, but how well we have worked it. Our rationale for a treatment strategy is the interconnectedness of the parts. Body parts working in balance promote healing; body parts out of balance, just as surely, inhibit the process.

Always the important point to remember is that balance is perceptible. We have what it takes to keep us from “working by the numbers”. It’s in our eyes; it’s in our hands.

Paul Gordon, MA. (Clinical Anatomy) has lectured on deep tissue techniques at Boston University, Northeastern and the State University of New York. An Advanced Certified Rolfer, he is on the faculty of the Rolf Institute and has led workshops for Rolfers and physical therapists throughout the United States. He is currently writing a book entitled Getting Better: The Healing Process and Chronic Back Pain.Crior and Collapse – Part II: Toward the Restoration of Order