View Full Version : muscle, emotion and grief
Hi SSers
On NOI there was a topic raised on muscle control and emotion, but I think it had run its course. So I figured I would raise it here and challenge a few 'muscle' men (and women) as to how they might approach this particular case.
Female, in her 60s, very keen walker, C/O quite severe lower cervical and upper thoracic pain after about 2 hours of walking, which tended to ruin her normal 4-5 hour walks. She is into her 4th backpack, carries about 6-7 kg, and is most concerned that the love of her life , walking, is under threat. She does not develop pain under other circumstances.
No XRs, came of her own volition. Problem has existed for nearly 2 years, and she swallows mersyndol at the 1.5 hour mark to try and get herself through.
Yellow flags not obvious until she lay down, supine, so I could feel her neck. It was rigid. She had lost all ability to 'let go', because her rigid neck was 'normal' to her. The extensors were like two mountain ranges, and almost impossible to feel anything else. So when I achieved release, with OC1C2 passive F/E x 4, she ooo'd and ahhhd (almost embarrassingly) and said it was fantastic. Her ROM was nearly normal.
So I probed a little further. It turned out her husband had died 2 years ago, and was her constant walking companion.
The penny dropped.
This woman was still grieving, and at a considerable level.
Next time she brought in the back pack, we filled it to 6 kg and I looked at her walking with its weight. Could not fault anything, so I cleared the pack of any contributing factor. I then had her walking with verbal cues(the others in the centre were probably most curious) with my hand on her neck, and told her to release as soon as she stiffened up.
Eventually, she could do it alone, and could feel the difference.
I don't think she needs counselling - her ability to walk painfree should be sustainable. WE shall see the next time she comes in.
Is this the sort of thing Barrett and Servaas are talking about?
Nari
bernard
10-09-2004, 08:58 AM
Is this the sort of thing Barrett and Servaas are talking about?
Could you be more precise because I'm sure that Barrett and Servaas are not saying the same thing, in my view?
Bernard
I'm not sure what either of them are saying, but it seems to be a matter of awareness - recognition of tension/emotion and resolving it, by different methods.
Nari
If they do not reply, I would be interested in replies from yourself and others!
Nari
bernard
10-09-2004, 10:25 AM
Nari,
The ideomotor concept carried by Barrett is very obscur for me, actually. I'll say that it is more since I searched ideomotor on Pubmed. The definition is not congruent with the one given by Barrett. It is a problem for me!
The concept teached by Servaas is used at the office, every day, with very good results with chronic pain patients. I think that is an active reeducation which promotes a better usage of the body/mind connection.
OK, Bernard.
What would you have done with this woman? I would be interested in your approach because you and I do not see eye to eye on the muscle thing!
I maintain I never actively did anything with the muscles - but re-educated through a movement which she was not able to do herself at all.
So it was a re-education, of normal movement or function, and I do not think muscles had much to do with it. had she tried to do the movement actively, it would have been impossible for her.
What do you think?
Nari
bernard
10-09-2004, 02:27 PM
Holist Nurs Pract. (javascript:AL_get(this, 'jour', 'Holist Nurs Pract.');) 2003 Nov-Dec;17(6):309-19. Related Articles, (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=14650573&tool=ExternalSearch) Links (javascript:PopUpMenu2_Set(Menu14650573);) http://www.ncbi.nlm.nih.gov/entrez/query/egifs/http:--www.lwwonline.com-pt-pt-core-template-journal-lwwgateway-images-pmlogo.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3159&uid=14650573&db=pubmed&url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0887-9311&volume=17&issue=6&spage=309)
Meditation's impact on chronic illness.
Bonadonna R (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Bonadonna+R%22%5BAuthor%5D).
College of Nursing, Medical University of South Carolina, Charleston, SC, USA. holisticnursing@bellsouth.net
Meditation is becoming widely popular as an adjunct to conventional medical therapies. This article reviews the literature regarding the experience of chronic illness, theories about meditation, and clinical effects of this self-care practice. Eastern theories of meditation include Buddhist psychology. The word Buddha means the awakened one, and Buddhist meditators have been called the first scientists, alluding to more than 2500 years of precise, detailed observation of inner experience. The knowledge that comprises Buddhist psychology was derived inductively from the historical figure's (Prince Siddhartha Gautama) diligent self-inquiry. Western theories of meditation include Jungian, Benson's relaxation response, and transpersonal psychology. Clinical effects of meditation impact a broad spectrum of physical and psychological symptoms and syndromes, including reduced anxiety, pain, and depression, enhanced mood and self-esteem, and decreased stress. Meditation has been studied in populations with fibromyalgia, cancer, hypertension, and psoriasis. While earlier studies were small and lacked experimental controls, the quality and quantity of valid research is growing. Meditation practice can positively influence the experience of chronic illness and can serve as a primary, secondary, and/or tertiary prevention strategy. Health professionals demonstrate commitment to holistic practice by asking patients about use of meditation, and can encourage this self-care activity. Simple techniques for mindfulness can be taught in the clinical setting. Living mindfully with chronic illness is a fruitful area for research, and it can be predicted that evidence will grow to support the role of consciousness in the human experience of disease.
Publication Types:
Review (javascript:AL_get(this, 'ptyp', 'Review');)
PMID: 14650573 [PubMed - indexed for MEDLINE]
Diane
10-09-2004, 05:58 PM
Bernard, is there a better link to this article? The link you provided is an email address. I'd love to read more on this..
Nari, Barrett would probably just put his hands on her neck and shoulders, lightly, and wait for her to respond from some part of her brain.
Servaas would probably lie her down on her back and tell her about her muscles, bat her head gently to show her how tight they are (tight neck muscles pull the nose straight back up to the ceiling.. after somatics the nose stays turned in whatever direction the head is batted..)
... then he would start her off sensing her low back, arching and inhaling, flattening and exhaling, then he would ask her to include her neck in the process, ask her to make it mirror the action of the low back. He would likely help her feel her neck better by loading the paraspinals eccentrically (loading her as she lengthens, by "pulling" her into lengthening, but asking her to lengthen progressively and not suddenly) until she could feel extensibility come back. He would start with shoulders too, and treat upper traps before neck paraspinals.
I would tend to be more like Barrett in my approach, but throw in some slow passive movement to seek a position where my fingers could feel the tissues relax, keep here there for awhile, 4 -6 different positions, stretch her skin, add some flexion isometrics at the OA (turn off the extensors by reciprocal inhibition) and palpate/consider/treat her scalenes/SCM/hyoids as well, or at least the skin over them. Perhaps I would palpate her neck while moving her arms in strategic ways, to unload the traps/levators/omohyoid. And end with active movement, axial extension exercise, exercises where the head stays level slides forward, back, side to side (a movment never done in our movement impoverished culture.)
I really like your idea of having her bring in her backpack and teaching her to dance with it in a new way. And your way of being sensitive to her grief, while not actively going there, is how I try to be with people all the time, the ideal PT way I think, hopefully cognizant of as many layers of them as they choose to reveal.
bernard
10-09-2004, 06:14 PM
I knew that you'll be interested so I took the link!
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14650573
Hi Nari,
I really like the way you advanced her! I think that I would have done similar things. I probably would have started in supine (least gravity) and had her contract her paraspinals against my resistance then relax them to get the idea of the sensation. I may have progressed to having her do some active or active assisted cervical diagonal lifts focusing on recruiting the longus coli/cap. while continueing to relax the paraspinals.
Once she had the idea in supine I would switch to seated and work on the same things...then on to standing.
Some other things I would probably look at:
Scap position- are they depressed, tilted forward? How about with the pack on?
Cervical quality of motion- when she rotates her neck does she also extend? When she looks up does the motion start from the upper or lower spine? How about when she looks down?
Cory
Hi Nari!
In like your way holistic way of looking at people!
but how can you due to just the cervical tension conclude that"This woman was still grieving, and at a considerable level"
Did she tell you that she was grieving!
Couldent it just be a muscular reaction to the red light reflex.,wich is a muscular respons to distressful events.
what about her breathing,in supine and sittig standing position?
what is griev?anger anxiethy,<a href="http://www.ntsearch.com/search.php?q=depression&v=56">depression</a> ,fear?
At the moment she dosent have to be grieviing but in the early stadge she was and the red light reflexs was triggered.(The neck extensors will the increase their tension.)It is possible to loose body awareness over <a href="http://www.ntsearch.com/search.php?q=time&v=56">time</a> and still have this increased neck tension without nowing it .The grieving period can be over.
With this increased muscular tension she has little to go on when she is out bacpacking. It seems to me that she has lost her nevromuscularcontroll, body awareness.
RIN :wink: :wink: :wink:
Hi all
I am interested in the variety of replies, thank you.
Rolf:
When she spoke of her late husband, she was visibly struggling to be calm, and the fact the pain developed well into the trek, made me think again about what I was seeing. So when she is out walking, there must be a trigger that fires off pain in an already tense cervical spine. I do not think that trigger is anything to do with the backpack, and it would take me a lot to be convinced that it is physical at all. Association of walking and her late husband is neurotagged!
Cory:
I could not find anything in her posture that suggested a primary muscle problem. Her neck movements were quite good, and she had no pain when I saw her, but her response to touch, palpation and minimal yakking was quite remarkable; and she was tender all over the place, not that I take much notice of that anymore - tenderness can be normal.
I think your approach would be similar to mine.
Diane:
Your amazing approach to epidermis/muscle/fascia etc is probably extremely effective - but not many of us have that skill. Thanks for your details.
Bernard:
Good article. I know that emotions CAN cause muscle tension, definitely, but I still reckon it isn't necessarily so. In this lady, I think the primary cause of her problem is emotional, and the muscles are in there for the ride but only secondary in importance. I have to agree with Servaas' thinking, acknowledge the awareness factor so that control can be re-established from within the person her/himself.
Great replies, guys.
Nari
bernard
11-09-2004, 08:07 AM
Hi RIN,
Here is the correct links, the html tags are not allowed (security).
I give also the good way to write them.
depression (http://www.ntsearch.com/search.php?q=depression&v=56)
time (http://www.ntsearch.com/search.php?q=time&v=56)
[url=http://www.ntsearch.com/search.php?q=depression&v=56]depression[/url]
[url=http://www.ntsearch.com/search.php?q=time&v=56]time[/url]
bernard
11-09-2004, 08:15 AM
Nari,
Just a little questionning for your weekend :D
In your opinion, do you think that language (muscles) appeared prior or after body/facial expressions (muscles)?
Why are we amazed by poker's players, because they mask the facial emotions. It is hard for many of us.
Why Hollywood directors do not like botox, because the stars lose the ability to show facial emotions. (It is not good for movies!!!).
bernard
22-09-2004, 04:20 PM
I found that one cited on RE, and Barrett wasn't happy.
http://www.buqi.net/gb/1/spontaneous_movement.html
Diane
22-09-2004, 04:42 PM
Wow, that pretty much describes what Barrett says he can open up in people.
Hi
Very interesting indeed that there is a connection between muscle and emotion after all - glad that you are making those connections. After the MFR discussion I was not sure that you all thought there would be a connection. But wait a minute - Barrett says that there are never emotions when he treats, right? At least that is how I understood it.
So maybe the treatment you describe for this patient is really no different than the MFR treatment I was receiving for my pain - we just call it by different names! Certainly sounds that way.
Pia
There is a connection between muscle, emotion, pain and so on.
It's the brain, source of all goodies and all evils!
Nari
Walt Fritz
11-01-2006, 05:04 AM
Nari,
Let it be the brain, then. You did it, along with her brain, and your patient let you know it when the emotions were released!
Walt
Jon Newman
11-01-2006, 05:28 AM
Pia, Walt,
Where did you get the impression that we didn't think that emotions and muscular responses weren't associated? Isn't pain at least partly an emotion? What does this association have to do with "releasing"? Where are the emotions being release from? Where are they going once released? What does fascia have to do with any of it?
Walt
I don't understand your conclusions.
"Let it be the brain, then." What else on earth could it be???
Your patient let you know when the emotions were released
Did she? She improved, yes. She became aware that it wasn't tight muscles that were the origin of her problem. She realised her posture had nothing to do with it, nor did strength. But she did not "reveal" anything to me consciously. Nor did I do anything to encourage expression. I just noted that her pain experience changed a lot.
Of course there would be emotions when Barrett and others treat by SC and any sort of "successful" therapy..but as far as I am aware, emotions are not leaping out of myofascial structures.
Walt, it is the premise of your work and Barnes', that absent neurophysiological substrate, which bothers us.
Nari
Barrett Dorko
11-01-2006, 06:03 AM
Nari,
As far as I can tell, "emotion" to some means wailing, crying, screaming, drama; the more of this the greater the "release," which seems to be an all-purpose term for anything that progresses the patient in the desired direction though this path often includes worsening, also known as "a healing crisis." This seems kind of convenient to me, but maybe that's just me.
To others, me again for instance, emotion just means feeling stuff and not much more.
For the record, I'm pretty sure my patients feel stuff. They are after all alive. But there is no wailing in Cuyahoga Falls. For that they have to go to Cleveland.
Walt Fritz
11-01-2006, 06:08 AM
She became aware that it wasn't tight muscles that were the origin of her problem. She realised her posture had nothing to do with it, nor did strength. But she did not "reveal" anything to me consciously. Nor did I do anything to encourage expression. I just noted that her pain experience changed a lot.
Congrats! You say potaato, I say potato, let go of what she needed to while you were working with her.
Of course there would be emotions when Barrett and others treat by SC and any sort of "successful" therapy
I've not read where Barrett acknowledges this, does he know?
Walt
Jon Newman
11-01-2006, 06:38 AM
I'm starting to think I'm posting my questions in invisible ink. Bernard is that possible? You do have a lot of features available on this discussion forum and maybe I clicked on something.
Nari, congratulations! Because you acknowledge the neural correlates of emotion you also bestowed them on fascia. Somehow. I'm not sure how. I'm sure Walt will explain how what he is saying and what you are saying are identical.
Barrett
I did presume to speak on your behalf, which wasn't a bright idea, but you seemed to agree, anyway....and I agree that emotions are what people experience during waking hours (during sleep? maybe) and are part of being alive.
What happens in Cleveland?
Walt
Are you not at all interested in the origin of the 'release' mechanism?? OK, you will say it is fascia....silly me.
I am not at all certain, however, what I should be congratulated for (Walt, not jon) as I was simply doing what seemed to be the logical thing to do. I was not familiar with Simple Contact waaay back then...
Antoine de St Exupery's Little Prince never answered questions either. He actually met with a rather nasty ending, out of his own choice.
Hopefully this does not happen to you.
Nari
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