Interesting effect on therapist

[krystos]

Hello all,

One of my patients returned for her second session since I attended the SC course. Her neck motion had improved and she felt more at ease following treatment the first time and with the self-corrections. This is the lady who, if you read my other thread, nearly fell over backwards onto me with her ideomotor activity. Anyway, to the point. We began with some SC and some light Feldenkrais activity. At the end of the session, she had improved further, but a statement she made to me was the most interesting part of my day. She said, "You sure seem to be more relaxed and at ease as well." I have been practicing self-correction daily for less than one week. I have noticed my sitting tolerance increasing and I feel more rested with the same amount of sleep (4-5 hours per night). But after I gave her comment some thought, I think that what she was picking up was not so much my pain relief as an attitudinal shift wherein I spend less time running about setting up exercise activities in the gym with my patients, and more time talking and touching. Prior to this course, manual therapy for me was manipulation and/or soft tissue mobilization along the lines of Greg and Vicky Johnson - Institute of Physical Art. Every patient received extensive exercise training. What has happened with more than half of my patients is that now we spend more time quietly sitting, breathing, and just being. I feel more at home and less conflicted working with my patients in a caring manner. I still have some comfort issues to deal with relevant to talking about ideomotor activity and not having some patients misunderstand that I am doing faith healing or energistic therapies, but part of that is more their interpretation of the work than what I say afterwards. Amazing what a difference four days makes!

[nari]

Chris,

Do you actually feel and think more like a PT should feel and think (ie, dealing with pain) than a gym instructor or exercise physiologist?

I had an interesting conversation today with a PT who has a great sense of humour and does hydrotherapy classes and women's health in a private practice. When we talked about hydrotherapy, we got onto nonconscious movements vs conscious and prescribed movements. Her response was: "They have to do the exercises I want them to do, but they can do them in any order and chat away as long as they please. They're doing nonconscious movements..."

After a pleasant educational exchange, she remained firm that if they enjoy themselves and do the movements without thinking about the routine, they're nonconscious movements, anyway.
I think it was a good example of how hard it is for PTs to comprehend the difference between conscious and nonconsciousness.

Sounds like you are off and flying into what some of us hope will be the "physical" therapy of the future.

Nari

[Barrett Dorko]

Nari,

Clearly your friend doesn't understand the difference between those motions that correct us and those we do with a certain amount of unconscious competence. She probably doesn't know what she's treating with the motion prescribed or the origin of her patient's complaint.

I'm sure she'd be thrilled to hear all of that, of course. I leave telling her up to you. We'llsee how good her sense of humor remains.

I'm convinced that therapy helpful to the patient is always in some sense helpful to the therapist as well. Chris, you may be coming to the same conclusion.

Why you from the San Antonio course and (apparently) no one else?

[nari]

Barrett,

She did say how happy and free-moving they are when they leave the pool.
But they do come back. Often.

I've done enough hydroTx in the past to know they feel tremendous when they leave the pool after their routines. Therapist is happy, patient is happy.
It doesn't last. They have to get into a car to get home....

I don't think she got the point of it, despite my explanation which was similar to yours in the above post, because like so many PTs, they are entrenched in movement --> flexibility --> pain relief.

And we know what movements are best for all those knees, backs, necks, shoulders, hips....

Sigh.


Nari

[Jason Silvernail]

Chris-

I struggled for a while with implementing ideomotor movement therapy also. Recently, I've been having a lot more consistent success, and only last week was I able to figure out why. Your thread here gives me the perfect opportunity to explain.

Barrett has always said that he feels modelling a certain physical authenticity in the clinic may help some of his patients do the same - that is, may help them start expressing who they really are and how they really want to move.

As I think about the two things that were the biggest factors for me in implementing this successfully, this is what I came up with:
1. I don't explain much until after characteristics of correction are felt. I was doing way too much explaining early on, trying to discuss the movements before I actually helped the patient express them. I think this had the effect of inducing some performance anxiety on the part of the patient as well as what appeared to be (judging from facial expression) thoughts of "what the hell is this guy talking about?"
2. Being more at ease and, to use Barrett's explanation "physically authentic" in the presence of the patient really seems to help. I think it is this relaxed approach - whether it helps create a safe place for the movement to emerge or it just makes the therapist seem confident and engenders trust - that makes a huge difference.

So, I wonder if that's what it's about as well.

[nari]

Chris,

I too found out that it's worth saying virtually nothing, and afterwards, explaining the reasons behind what they felt. Previously, I probably spent 5 minutes talking about noconscious expression; it actually scared them a bit.
They expected me to control them in some way,as is standard with the physiotherapists previously encountered; and the lack of that meant "exposure". They often asked: what if I do what you don't want me to do? and so on.
The first time with a patient I felt like excess furniture. I got over that; and learned to sit on the floor, usually behind them. That was quite relaxing, though one patient remarked was I alright. Standing next to a patient can be scary for them; especially the complex clients I dealt with. I wanted to be as invisible as possible. I kept thinking: What do I have to offer them? Nothing.

I have never seen a "normal" orthopaedic-type person and 'permitted' them to experience authenticity. It has to be easier, without all the years of painful baggage they have with them.

Self-correction for me works so well; but I don't have any chronic pain to begin with. I often self-correct when I have been doing stupid things like flexing in sustained positions for ages. Thoracic and lumbar aching just vanishes and doesn't return.
In that sense, the patients must see us as cool, calm and collected; we know what they feel.

Nari

[krystos]

Thanks for all the replies!

nari,
I've never felt like a gym instructor, because I have always realized that the important part of what we do is with our hands. There have been times when I have fallen into bad habits of complacency or frustration. Also, prior to this learning experience, I have experimented with a variety of approaches which I later discovered were just so much fluff. Craniosacral, visceral manipulation, mechanical link, etc. Fortunately, a strong grounding in science has always brought me back to rationality. I believe that I have always been searching for a better way to communicate with pain patients since I first started to work with physiatrists, pain management anesthesiologists, and neurologists more than orthopedists and sports medicine practitioners.

Barrett,
I think that some of what I mentioned above explains why I "got" it and others in the class did not. Like me, many of the attendees began with questions and remarks that were exclusionary to your theory as opposed to accepting of it. Some spark took root in my brain, and after I got the wife and kids to bed that night, I stayed up most of the night reading and thinking. I then jumped right in with both feet in the clinic the next day. I thinkthat the combination of having my own practice with no one to answer to and my particular patient population really made this all make sense.

Jason and nari,
I am going to try to say nothing at all today and see how it goes. I did this with one patient last night, but found myself wanting to explain as the process got going. I just need to shut up, let it happen, and then discuss later!

I love this new (to me) pathway and look forward to additional growth.

Thanks,
Chris

[Diane]

Chris, it could be that you have experienced one of these (http://www.homepages.indiana.edu/040805/text/avalanche.shtml), apparently useful for learning and storing new information.
Barrett, it could be that the rest of the students sense instability and move to shore up their defences so they don't experience it.
Would there be any way to teach students to welcome these without any ''cognitive nociception'?