Invited response: (without science, there must be art)

Abstract

In the target article, Lederman reminds us we do not know the causes of back pain. Further, we cannot count on perceived asymmetry, biomechanical dysfunction and muscle imbalance to guide treatment. Early osteopaths and chiropractors believed where there is no science, there must be fervor. This reviewer suggests where there is no science, there must be art. We can train ourselves, as Professor Lederman has done, to read widely, think deeply and debate well. We can open communication between scientists and clinicians. And, we also can find inspiration in artistry. Artists spend decades discovering how to steer their craft. An early student of movement control, Nicholai Bernstein showed that expert blacksmiths have neither intra-operator nor inter-operator repeatability. They never swing their arms exactly the same yet every expert predictably produces the desired outcome. This paper encourages learning from the artistry of expert massage therapists. Instead of a narrow focus detecting diagnoses and dysfunction, they have a softer and wider focus. They create a comfortable ambiance and they tend to spend more time with their clients. In addition to learning from bodyworkers and movement therapists, cultivation of the arts may also deepen empathy, communication skills and personal conviction in ways that wordlessly help patients find our work trustworthy.