Submission Holds

[Barrett Dorko]

I’ve been thinking about submission holds lately. You know-those things you see martial artists apply that bring their opponent to their knees or pound the mat like a conga drum. Their faces also reflect the agony these things produce. I’ve always been struck by the speed and force with which a healthy, strong person can be moved by a certain turning. Now, I don’t have any desire to actually do this to another myself. I prefer to pound my adversaries verbally, as you know.

The reason I bring this subject up is because I want to talk about an aspect of clinical reasoning that I think is essential both for accurate assessment and management. Believe it or not.

Gary Shapiro, fellow Soma Simpler and long time friend is also a martial arts aficionado. Recently he sent me to a website devoted to Brazilian Jui Jitsu submission holds: http://bjj.org/articles/harris6.html It was just what I was looking for. I’m certain that the holds described “work” wonderfully, but I also saw that the effect was assigned to “joint” structures. I know these martial artists aren’t pretending to be experts on the sort of anatomy or physiologic processes we are, or, at least, that we pretend to be.

I’m wondering if those who apply submission holds and assign the effect to the joint structures-which, I assume, they feel is almost entirely connective tissue-are making the same mistake our colleagues who, as I say, “only hang out at the joint” are making. Might it be that they’ve discovered how to rapidly and effectively bring enough of the neural tissue into a compromised position that there is an irresistible instinctive response that moves their opponent in a desired direction? If they then deny them this motion wouldn’t submission follow?

I’ve more to say about how our patients might be held similarly but would like to see the response of others before I go on (and on and on).

[Diane]

I read the take the jujitsu guy has with interest. Positioning is something I do routinely in practice; it makes processes move along so much faster if you can get the right level of body container into the right torque, applying (in my mind anyway) the right amount of neural container stimulation in the right direction. Seeing the whole neural tree in the mind while treating helps a lot with this particular perceptual fantasy.
Barrett: Might it be that they’ve discovered how to rapidly and effectively bring enough of the neural tissue into a compromised position that there is an irresistible instinctive response that moves their opponent in a desired direction? If they then deny them this motion wouldn’t submission follow? I should think so, and I should think the process can happen in reverse, that neural tissue can come out of "holds" that the brain or some module of movement production within it has used to try to alleviate some pressure on some other nerve somewhere and it has backfired and pain has eventually resulted.

Strings of paper dolls are more mobile/stretchy than the sheets of paper were from which they are made, because of all the added holes. In treatment I visualize the bone going one way and the skin going the other, and everything in between opening like strings of paper dolls; in the body the "holes" are pre-formed and already exist at multiple levels to allow the neural and vascular trees to penetrate through the body regardless of what tissue they are sliding through. Nerves are mobile along and around joints, and embed eventually in skin. Slowness is key, or the brain/motor planning will object, but if the right "transitioning" is done, when the brain senses that the neural tree is finally unloaded, it's like the whole organism goes, "ahhhhh....." and everything tunes down a few notches in tone.

Too many people become focused upon the positions and the submissions and ignore the transition that occur between the two of them... Too true. The nervous system of the patient is sampling one's own every step of the way. Slow transitions and light grasps allow/invite it to cooperate rather than try to escape. Well some level will always want to escape, but one can learn (as you have) to pretty much choose to have that level be the most non-conscious level of them all. No skin nocioception. That has to be basic..

The next thing to train is the physical attribute of sensitivity.Well, I wouldn't call it a physical attribute.. more like a whole kinesthetic therapeutic approach, feeling the whole organism at all times while remaining in contact with the person inside, but still the statement applies big time.

Sensitivity is the ability to read and feel pressure. Once you obtain this attribute and can apply it from every position, it will make your game much easier. Especially against much larger and stronger opponents. Additionally, sensitivity is one of those attributes that is easily maintained. Unlike speed and power. True, or a non-physically conditioned/hate-exercise, feeble older (55) female person with little hands and no natural leverage, such as myself, would not still be in manual practice.:rolleyes:

When you apply a joint manipulation or choke, you are applying a certain amount of pressure on a specific location, at a specific angle. If you change the angle of pressure, you make the lock ineffective. If you change the position of leverage, you make the lock ineffective. Hmmnn.. sounds like advice for mobilipulators; I don't think this has much to do with me. Although pressure and angle through joints are important features, I'll continue to rely on sensitivity to guide my holds and their transitions.

learning how to effectively apply a submission hold is an uphill battle. You will encounter a variety of difficulties along the way. But keep going, it's worth the battle. When you can repeatedly make muscle bound guys tap with greatest of ease, you will feel proud of your accomplishments. I have spent my life learning to avoid making people tap. However, I love it when pain caves in and taps!

Learn and master your mechanics
Learn and master the positions of control
Learn and master the transitions that occur between the positions and submissions
Develop the physical attribute of sensitivity
Develop your understanding of principles
That's all good advice.

[Barrett Dorko]

Diane,

I wouldn't argue with any of this.

I'm reminded of a quote from Gifford: “Any threat to the nervous system is a potential disaster for the future efficiency of those afflicted. Far better, and more efficient to, whenever possible, adapt to a new posture that protects the nervous system, than to injure the nerve and suffer the consequences of neuropathy.”

I put this in my essay Asking Why-Evolutionary Reasoning and Manual Care on my site. There I also introduce the importance of interpreting signs and symptoms as either a defect or a defense in the body or a manifestation of such a thing elsewhere. Given what we know about the instinctive response of the brain to painful signals, especially when the nervous system is mechanically compromised, the muscular response must then be understood quite often as defensive-not defective. This means it should be amplified rather than ablated.

For clinicians, this realization-should they get it-leads to a massive alteration in handling and direction.

We certainly seem to need that.

[Jason Silvernail]

Well, as a practitioner of both PT and juijitsu, I like to think I have a personal take on this situation.
I would agree with everything that Barrett and Diane have said, for starters.

Also, I too have noted practitioners who seem to think this point of tapping or submission has something to do with the joint itself. While I don't doubt that that is the case, i also know that many times, you simply cannot judge someone's ability to withstand a certain submission position by their appearance or general demeanor. In fact, they may have a vastly different response to one hold than another.
I'll use myself as an example.

One particular hold, called the "heel hook" has you using your forearm to twist your captured opponents heel into internal rotation, while holding the femur still. This move is rather infamous for it's ability to damage the knee quickly, many times with no sensation of pain by the player.
I am rarely caught in a heel hook, but when it does happen and I cannot immediately escape, I signal submission by tapping before the other player even applies the technique. Indeed, my brain knows what might come of this technique and wants very much to prevent that!
Another hold, the "short arm scissors" involves you bending the player's elbow over your forearm, essentially causing pressure on the biceps muscle belly with your radius and ulna. It is sometimes referred to as the "biceps cutter" for obvious reasons. :) Now, this is a hold i can almost always squirm out of, as I am unafraid to fight through the pain since I know the discomfort is compressed soft tissue and not any joint injury.

I have long known that my knowledge of anatomy and healing is what makes me so careful both with my training partners and with my own body on the mat.

It is a continued interest of mine, the varying degree of resistance different people have for different holds. I am quite certain this has everything to do with our brains and not much to do with anything else. Though extra flexibility does give you a few extra seconds in which to effect an escape. In fact, experienced players often tap "early" before they feel any pain, on an area that has been injured in the past. As you can imagine, injuries in the sport are quite routine. :)

J

[Barrett Dorko]

Jason,

I was thinking you might join in on this subject. Randy Dixon too if he's around.

Your description fits wonderfully. It is also another reason why I keep conflict on a verbal level. There is this though from the movie Talk Radio: "Sticks and stones may break my bones but words cause permanent damage." I always liked that for some reason.

So, if your patient hurts from an abnormal neurodynamic, how do you interpret their muscular activity-defect or defense?

[christophb]

While not a jiu jitsu player (dabbled a little), I have been involved with martial arts for about 10 years in the Chinese styles. Now I don't see any difference between Chinese, Brazilian, Japanese (it's the human body eh?), other than specific techniques/applications/philosophies (in other words, I liked the article). In tai chi/kung fu there is a "joint locking" art called chin na. I have experienced this by many different levels of practitioners. The newbie who tries to power through the technique as if you are a piece of meat (fairly easy to relax and avoid being "locked" up), the beginner who has a better understanding of the technique and force application and "winds you up" (still thinking joint) and still uses more force than sensitivity. The intermediate level practitioner who understands their body seems to use equal force and sensitivity and can get you to tap out still causing pain to do so. The advanced people seem to use more sensitivity than force and you tap out (with less pain but just "feel uncomfortable") and the freaky masters who seem to use mainly sensitivity and move you around like a rag doll with no pain (brain just doesn't know what to do I guess). ***I just made up the different levels by the way for point of discussion***

This type of practice was significant for me in developing pt handling techniques, the goal being more sensitivity and less force... carried well over into manual therapy. With tai chi as main hobby, what I noticed is that feeling for ideomotor movement in pts seems to be the same as feeling for the "intention" in opponents while doing training ex. IIMHO 2 person tai chi practice is the ultimate in neuromodulation ; especially when it is cooperative with feedback provided. I try to practice PT this way... just make comfort the set sensation of focus vs pain

Chris

P.S. I have in nooooo way mastered this way of practicing PT (or tai chi for that matter)

[Barrett Dorko]

So let's assume that the patient has gotten themselves into a submission hold-maybe more than one. Nothing big or debilitating, just enough to elicit the instinctive response we agree must rise.

If this is the case, what should the therapist be looking for and assist?

Another question: What's keeping the one in the hold from solving the problem with their own movement? Given that choice in martial arts combat they would certainly do so.

[Jason Silvernail]

Well, Barrett, I assume we must interpret their response as a defense worth encouraging and not a defect to be supressed. We should be looking for that instinctive movement and encouraging it.

I had a young navy girl in the office recently with a raging case of TOS. She c/o of upper trapezius pain primarily. Has all the hallmarks of abnormal neurodynamic. Her previous therapist had been Estim-ing and massaging the muscle. While the ideomotor stuff didn't work out too well, she got near 75% relief of her "upper trap spasm" once I taped it to give her some support. Clearly, it was a defense to try to reduce the mechanical load on her nervous tissue. She asked why we weren't doing what the other therapist was doing. I thought to myself "why would I want to do that?". Perfect example of defect vs defense.

J

[christophb]

What's keeping the one in the hold from solving the problem with their own movement? Given that choice in martial arts combat they would certainly do so.

Good question, I wish I could figure it out in myself. In martial arts combat the threat is fairly obvious as you are clearly aware of who is creating the discomfort. But, with no one besides you and your thoughts I suppose the creator of discomfort is less obvious (though we can blame numerous physical things external to us). And as much as I think I'm immune to culture's influence, I still have a challenge getting myself out of trouble. For me it seems that it's an urge to want to "do" something and figure out a solution vs allowing instinctive movement.

Chris

[Diane]

Something drifted up into mind earlier today as I was treating that was in relation to this thread. Actually I was treating a martial arts guy, kickboxer, old shoulder injury.

Here's the thought; in judo, the deal is (if I remember correctly) if your opponent is coming at you, you move in such a way so as to help his/her momentum accelerate, i.e., help the opponent's body get there quicker. This puts you in charge of their movement, not them, and they get hurt, not you. Right?

In treatment, the brain is trying to move some part of the body in a certain direction. (Defence.) To treat, if you help the brain move whatever part of the body it would like to go in a given direction, into that given direction, the brain will be able to relax the part when it senses that the part has arrived at the desired destination. Pain decreases.

I'm not quite sure why these two things seem like the same thing to me just now, but they do. Or maybe they are complete mirror opposites. Hmmnn.

[Barrett Dorko]

Diane,

I think Aikido is a good example of this as well. Remember that my personal knowledge of this is purely theoretical. I was, after all, in the marching band.

And you're right, once the brain is allowed to take us where it unconsciously and instinctively wants and needs us to go the muscular contraction diminishes. The movement provides relief as it is meant to.

It isn't the movement through the air that hurts the opponent when an Aikido Master "allows" them to fly by instead of succesfully delivering a blow, it's the sudden stopping at the end. For our patients there is no such stopping.

The Aikido Master cannot be defeated or resisted as long as they do nothing and only react to their opponent's motion. This sounds like the "doing nothing" of Simple Contact to me and explains my personal irresistibility.

[gary s]

Barrett,
Here are some quotes from Koh Ah Tee, a Malaysian Tai ChI master:

"In real Tai Chi Chuan you receive, you don't go out looking".
" Tai Chi Chuan is all about taking advantage of the opponent's movement".
" In Tai Chi Chuan there is no attacking mind--rather you just wait for what your opponent wants to do"
"Movement comes from stillness."
"If you have a preconceived notion of what you are going to do to an opponent, then you are not doing Tai Chi Chuan".
"When pushing hands, keep your hands light and follow".
"In pushing hands follow your opponent. Never pull him or interfere with his movement. Just follow with a light touch and an empty mind".

Sounds a wee bit like the principles of SC.

Gary

[nari]

I don't know much at all about the basics of Tai Chi, and even less about the more energetic martial arts per se; but these posts are fascinating. Makes one want to go and try out Tai Chi for the heck of it.

gary, it does sound like ideomotion is part of Tai Chi action. Except that it is choreographed movement.....

Barrett? Your views?


Nari

[Synergy]

Nari,

If you want a general idea of mixed martial arts, try watching UFC (Ultimate Fighting Championship) or PRIDE Fighting. I'm an avid fan of both as I'll park my rear-end on the couch Monday nights to see guys nearly have their shoulders dislocated and/or faces pounded. UFC is not near as grueling as it used to be, but nevertheless, it's still intense and exciting to watch. I'll bet Jason watches it as well...right?

Jason,

If you do watch either UFC or PRIDE, do you happen to have a favorite fighter?

P.S. Hope I'm not hijacking the thread...please continue on. :)
P.S.S. <---- Is that not the cutest little girl you've ever seen? I had to change my avatar once I got her pictures developed.

[nari]

Chris

We get a lot of American stuff, (even NPR!) but only sitcoms amd movies on TV, really. I don't know about either of those shows...doubt if they're imported.

She is gorgeous, your little girl. And here I was thinking it was your baby photo...oh well.

Nari

[gary s]

gary, it does sound like ideomotion is part of Tai Chi action. Except that it is choreographed movement.....

Nari,
Yes and no. The goal of all martial arts is to act spontaneously, without thought to a situation, but the particular movements become ingrained from hours of choreographed practice. The quotes were meant to show how the martial aspects of tai chi share the same principles of the manual aspect of SC--listen, adhere, follow.

Gary

[Jason Silvernail]

I think Gary is really on to something here.
Many different systems (judo, juijitsu, Tai Chi Chaun, Wrestling) have this principle of following the movement without interference. I think the "sensitivity to intent" many of us in martial arts work hard to develop can serve us well when trying to implement simple contact. Or at least I'm hoping it can. Given my rather poor record of eliciting ideomotion, I could use any help I could get!

Chris- I watch those contests (he's referring to these no-holds-barred fighting events, they're rather harsh and brutal at times) only when they are free, I don't do pay-per-view. I tend to root for any player who has a humble approach, doesn't talk a lot of trash about his opponent, and is graceful in victory and in defeat. I guess it's not only sports that that personality type appeals, though.
J

[christophb]

Ting Jing... Roughly translates as listening power/energy. In tai chi it's a skill of knowing others through sensitive touch. The practice of the form is a way to "know yourself"

I just finished reading Diane's posts on Hare Brain Tortoise Mind and I thought the way of slow thinking accurately describes the mental state I get when I practice.

When I perform the 2 person drills the touch is aimed for the skin only, if you feel bone you're too hard.

[Disclaimer: For use in a street fight...probably not too practical (without thousands of hours of practice I suppose)]

This way of practice really takes the physicality out of any application and thus requires you to use chi.. Ok just kidding, really encourages your nervous system to step up. There usually is not much intention, in other words, you shouldn't try to do anything... just stay neutral and aware and react naturally.

The way of performing simple contact is much like this. Light contact, stay neutral and "listen" for their movement, which is toward correction. Then just make some space and don't get in the way.


Chris

[gary s]

Hi,
I asked a serious martial artist, Ted Mancuso, to elaborate general principles concerning escaping submission holds. Here is his answer. The second paragraph is really interesting--shows a lot of insight.

First, neutralize the force.
Second, identify the vector of power.
Third, extend the vector of power.
Fourth, spiral out of the vector of power.
Fifth, escape or counter.

If we were trying to look for analogies, we might say that since all the escapes are going with the force, pain inevitably rises from existence. It's like in Aikido, which is often touted as a "loving" martial art. You are supposed to only inflict torsion until the pain subdues the attacker. Trouble is, since most people can't read pain, they go in the opposite direction, increasing the torque and foiling both themselves and the Aikidoist. Pain makes people panic. Panic makes people pick the wrong choices.

BTW, Chris and Jason, you might want to check out his website:
www.plumpub.com

Gary

[Barrett Dorko]

Gary,

Thanks for this. This sort of exchange and offering of resources is increasingly rare on the various PT sites anymore. I visit them all, and SomaSimple is by far the one most likely to provide access to the variety and thoughfulness we find here now.

I was leaning in precisely this direction when I began this thread; that our patient's behavior in the case of an abnormal neurodynamic mirrors the person on the receiving end of a submission hold. Mancuso's correlation of pain and panic and the consequent "wrong choice" is, as you say, insightful. To me, our most important job is to help the patient recognize that there are other choices-instinctive ones-that they hadn't yet considered or had mistrusted. Ideomotor correction follows immediately upon this realization by both the therapist and patient.

There's another factor here I think. It is that our patients are being held by an "invisible" opponent. This adds to the fear of course, and requires of the therapist a deeper understanding of pain's origin than I normally hear of on my travels. PTs continually seek an explanation in causation, which is usually something distant in time and place from the patient's current reality. It's as if the therapist is also looking for an external opponent that they might outwit or forcefully vanguish. Typically, this is a waste of time though there's a chance that the PT might appear quite heroic during this epic battle. A lot of therapists like to appear heroic, I find.

Instead we need to look carefully at the patient's internal struggle, and I mean the one they are currently going through. A greater understanding of the disparity between corrective movement and the dictates of a culture that champions control, willful effort and appearance would lead us to see that the internal, invisible submission hold is being applied by an opponent to the whimsical dictates of a culture far more interested in appearance than health. This opponent (ideomotion) can become an ally, but only in the presence of of a therapist who understands its ways of expressing itself.

In the end, that's all I really teach.

[Diane]

Gary, "Fourth, spiral out of the vector of power." That just jumps out at me. So sensible. Everything in the body is constructed spirally to add increased strength/recoil without adding increased matter. It makes so much sense to move spirally/allow spiral movement to get out of a grip whether it be it inner or outer, visible or invisible.

Remember that my personal knowledge of this is purely theoretical. I was, after all, in the marching band. I walked, and was on a softball team for a season.