First Experience of Simple Contact

[Pete]

I had someone do Simple Contact on me for the first time today. Very interesting it was too - I felt effortless and unexpected movement; not sure about warmth and softening.

One thing that struck me was the importance of having the person doing SC standing behind me. It's hard to describe, but it made them kind of impersonal - in a good way - and it's as if it freed up my consciousness and my body to respond to the touch without having to worry about interacting with them in any socially acceptable fashion - kind of bypasses the usual stuff about nodding and eye contact. Does that make sense? Do you always stand behind people when you do Simple Contact?

However, my knee is still sore - or rather the area around it is. This is most bizarre - yesterday it felt fine, today it was sore - with no apparent difference in activity levels (ie, minimal). It often feels cranky when I wake up in the morning - what's going on when I'm asleep that irritates my leg/knee? Any why do I get this one day good/one day bad cycle which doesn't seem to relate to activity levels?

And is Simple Contact a one shot attempt? ie, if it doesn't fix the problem, is it likely to be more successful next time?

For some reason, taping doesn't seem to help - thank you for your suggestions Diane - it's as if the area really doesn't like any kind of tight contact, whether it's tape or clothing.

The other thing that I don't understand is why it takes so long to settle down after flaring up - I overdid things 3 weeks ago (got a little ahead of myself with the graded progression) but it still hasn't calmed down. Any thoughts from you pain science people on why that might be the case?

Any insights would be welcome!

Pete

[nari]

I always stood behind the person when eliciting instinctive movement, or by their side. I know others don't, but to me it made sense. It is important to do what feels right for oneself and the patient.

Good cycles, bad cycles, worse pain in the morning (due to lack of movement in a system that is sensitive?) unpredictability....nothing unusual in the presentation, but it is annoying for you that it does not respond.

It may take several sessions of instinctive movement, and it would be useful for you to elicit this yourself. Have you tried yet?

Nari

[Barrett Dorko]

I always stand where the patient tells me to go, and they don't do that verbally.

NO treatment is a "one shot attempt" and Simple Contact isn't the treatment, it's the method used to reveal the ideomotion already present as an isometric. It's the ideomotion leading to a reduction in neural tension that forms the treatment.

It's no mystery why pain is present, acute, prolonged, recent, chronic whatever - it is there because the origin remains. Figure out the origin and do what you can for it.

Morning pain has the same origins as any other. Aside from the absence of corrective motion that may be responsible there's also the common increase sympathetic tone present through the night that lowers adaptive potential.

Get going on regularly dosing yourself with ideomotion. Don't wait for someone standing behind you to give you permission.

[BB]

Hi Pete,
I've been meaning to write something regarding the cause of pain for a bit, and this seems a good place to let it develop.

When people ask "what is the cause of my pain" I think a fair response would be, "Why are you afraid of snakes?"

As we often discuss, causation is very difficult to establish in most of our patients.

So, why are some of us afraid of snakes/why do we hurt?
1) inherited reasons
There is good evidence that we have inherent tendencies to respond to certain things more intensely than others. Maybe the slitheryness of the snake invokes this response of fear. Maybe in pain there are inherent responses to certain inputs, amount, direction, load, velocity of change, etc. As with fear, each of us will have large variety in this trait.

2) Experience
Maybe you have been bitten by a snake before or were with someone who was. This sharpens the response for the next time you might encounter such a beast. It is a survival mechanism. Same for pain, a certain painful event will be more likely to be painful if the event is encountered again. The senses have been sharpened to detect it, so to speak.

3) Association building
All of the above are influenced by context. A snake in a zoo will be less scary than a snake in the grass. A fall onto a trampoline will be less threatening than falling from a porch. Associations are built upon experiences.

So, in attempt to answer what causes your pain and its behavior I'll say:

Your pain is caused by your nervous system's reaction to a combination of factors including your genetic predisposition to what is threatening, your experiences with what has hurt in the past, and the associations you've developed with those previous painful times. It's waxing and waning results from the enormous variation in the processes on-going in your body and their relation to the above factors in context building.

(If people agree with this, help me whittle it down and/or expand to a simple analogy useful to the multitude of patients who ask this question.)

[Barrett Dorko]

I think this fits here: There's no reason to be fearful of snakes as long as we can see them. They don't chase people and can't strike any further than a third of their length. Knowing this, it's only important that we keep their presence in our awareness. If you're in a room with one, keep the light on in the room.

Many people turn the light off, not realizing that this means that the snake might be anywhere, thus turning their denial into an inordinate amount of vigilance. This lowers their adaptive potential to such a degree that painful situations are easily created and/or encountered.

[nari]

Barrett

A useful analogy about fear. I have met so many folk who have had pain for so long they have forgotten they fear and anticipate its existence. They know pain is always there in some form or the other, like part of themselves, and become perturbed when their perception rises.

Not to ruin your snake analogy, but in Australia we have snakes that chase you long before you can see them....however, your analogy is safe in North America.

Pete, on your good days are you aware that you think it will return again?

Nari

[BB]

Barrett,

Great addition. We can use consciousness to change the context into a non-threatening one, in this case by listing how the snake is not dangerous and keeping the light on.

Turning the light off removes the control of context that consciousness can provide and let's the non-conscious, which is still concerned about that snake, run free.

Why do you suppose people turn the light off?

[Barrett Dorko]

Cory,

People turn the light off because they're not thinking ahead. They're playing checkers and not chess. They don't live in Australia (Aboriginal for "the land of chasing snakes") and talk themselves into the relative comfort that denial provides. It's not a whole lot different than overeating, I guess.

Another analogy I've used comes from the End of Evaluation (http://www.barrettdorko.com/articles/end_of_evaluation.htm) essay I wrote a few years ago.

In short, complex systems are vitally dependent upon small things within them and their tendency to change rapidly is often a function of the underlying nature of the "ground" upon which they rest. Consider a forest. Isn't its ability to burn dependent upon the amount of fuel that's been laid down beneath the trees? Wouldn't a "controlled burn" (http://en.wikipedia.org/wiki/Controlled_burn) be a good idea?

I see ideomotion as a controlled burn and feel it should be used regularly in order to keep the nervous tissue from reaching a critical state. Unfortunately, many therapists equate the absence of pain and the presence of health. Not true in the heart - not true in the nervous tissue either.

I often ask, "How long can you sit without having to get up in order to relieve your pain?" PTs answer "15 minutes" or, "I don't sit very long - ever. I get up." Of course, some people are stuck with jobs that require prolonged sitting (mine, for instance) and this PT would be unable to do it. They are disabled and live in denial of that fact until I bring it up.

This isn't always welcome but an interrogation of reality often isn't.

[Pete]

This is all really interesting, and there are bits I don't fully understand. I very much appreciate people taking the time to share their experience.

Nari
Prompted by your suggestion, and by Barrett's, I've started off dosing myself with instinctive movement again. And a lightbulb went on in response to your point that when I'm asleep my oversensitised nervous system might not be getting the movement that it needs. You asked if on my good days I am aware of thinking that the pain might return. I think it varies. I have had days - weeks in fact - when I have been convinced that I have recovered and that the problem is behind me. During these periods I have danced, undertaken long hilly walks and up to 30 minutes of trail running without problem. Other times I'll be having a pain-free day but being 'careful' and aware that it could flare up. I'm curious as to your thinking behind the question.

Cory
If I have understood you correctly, the reason why we feel a particular pain can be hugely complex and hard to pin down. This fits with my experience. And your snake analogy prompted some very helpful reflections on the similiarities between phobias and pain. I hate croccodiles and have a very strong reaction to them even if they are in captivity (or indeed on television) and can't possibly harm me. I think my nervous system is having a similar OTT response to any sense of discomfort in my knee. The amplifier is turned way up, as described in 'Explain Pain'. An osteopath I saw described what's going on as being like the reaction of a hysterical child to some small discomfort or disappointment. She thinks that whenever I have some anxiety in my life my brain is causing my knee area to somehow 'get in on the act'. Part of my frustration, as described in another post, is I'm not having much luck persuading my brain that it doesn't need to do this.

Barrett
If I've understood your 'The End of Evaluation' essay correctly, I may never find the cause of my pain. Every clinician I have seen has ruled out any kind of mesodermal origin. My understanding is that I should proceed assuming there's a combination of mechanical deformation and central sensitisation and that regular dosing with ideomotion will start to address both of these factors. Am I missing anything there?

I don't quite understand your metaphor of maintaining awareness of the snake. Does the snake equate to pain? Does keeping the light on mean maintaining awareness that hurt does not equal harm? Why would someone turn the light off? I don't see how turning the light off would provide any kind of short-term comfort; but I suspect I have misunderstood the metaphor.

Pete

[Barrett Dorko]

Pete,

I wouldn't argue with your misunderstanding of the metaphor. It simply means that we sometimes turn away from that which we find unpleasant. Doing so, it becomes even more powerful and then shows up unexpectedly. Eating more than we need but instead as much as we think we want is a good example.

Here's an idea regarding the "cause" of your pain. Stop looking for it. This leads to problems (http://www.somasimple.com/forums/showthread.php?t=3885).

[Diane]

Pete, I wish I could apply the S1 hand map/kinsesthetic part of my brain to your problem. It's much more sensitive to physicality than the verbal part.

[nari]

From the land of chasing snakes (Barrett, I love your subtle humour):

Pete, you mention:
Other times I'll be having a pain-free day but being 'careful' and aware that it could flare up.

This may be a reason for the recurring pain perception. Why are you careful on some painfree days? You are reminding the brain of a long term virtual threat; it's fear avoidance activity, which is an efficient driver of pain generation.

If you can avoid being careful 100% of your waking time, you may break the cycle. During those 'careful' days, think:
pain = no harm or I can do whatever I wish, at any time and I cannot harm the knee.

If pain returns, think along the same lines. It's not particularly easy, after this length of time. Also, wondering about a 'cause' has the effect of "pain= harm".
Forget looking for the cause and consider the case of loopy pain generation which is harmless but disabling.

Time for some snake chasing.

Nari

[Pete]

Barrett
Thank you. I have the kind of mind that likes to really understand stuff. Maybe everyone does. But the shadow side of that in my case is an unhelpful obsessional focus.

Diane
I wish that too. From my end it seems like internet-mediated insights don't quite get through to my brain completely. Seems like touch, or at least physical presence, is important to the clinician and the patient - it 'educates' at a deeper level. I know you guys know this - I'm just thinking out loud.

Nari
That really resonates. I guess I'm struggling to reconcile graded exposure (monitor closely the amount you are doing and increase it very gradually) with not thinking about the knee. Fear and pain have got very entwined in my brain. I was reading Corey's 'Unified Theory' thread and the stuff about associations seemed to apply to my case.

Thanks again

Pete