Another reason therapists don't know

[Barrett Dorko]

If you want to awaken all of humanity, then awaken all of yourself, if you want to eliminate the suffering in the world, then eliminate all that is negative in yourself. Truly, the greatest gift you have to give is that of your own self-transformation.

Lao Tzu

A little attention, awareness and mindfullness will reveal something that's always there – self-correction.

Those who play poker know all about our tendency to move unconsciously and, of course, they interpret this as something that has it origins in the brain, as all thought, well, you know. They use their observation to “read the mind” of their opponent. Books have been written about this and there's plenty on YouTube about “tells.” On this week's episode of Veep one character calls another's unconsciously generated movement a “William Tell.”

However, if you say anything about this to a colleague they'll probably say, “We don't get HBO.”

[advantage1]

What if the patient has been labelled as disabled? Or a pathoanatomical label has been given to them? I often see patients that so strongly believe their diagnosis that it appears to prevent self expression.

[Barrett Dorko]

Believe?

Education just might help patients understand the place their diagnosis plays in their sensation.

Do you suppose the therapist understands any of this?

[Barrett Dorko]

I'm fairly certain that this single idea, that we are self-corrective, is opposed by a large number of people. They probably don't know they're doing this, and, I'll be honest, I see this dismissal of the idea quite often when treatment is discussed by therapists I respect here.

But ideomotion exists, it emerges when context and interaction grows in the direction we often promote and it embraces the conceptual framework Melzack has offered us.

Why isn't it part of our care?

[Barrett Dorko]

I think that the specter of athetosis drives many, many otherwise wonderful therapists away from ideomotion. Sure, they'll deny its significance even while shifting in their seat but they won't make it a portion of their care for painful problems.

Hidden, the wall the culture has placed before them seems far too formidable, and it's full of spikes.

If I'm wrong, please indicate how that is so.

[advantage1]

You've brought the concept of self correction to my attention. I agree, many therapists haven't a clue about this concept. When I take the time to educate a patient and they then report improved ROM and reduced pain in a very short time frame (sometimes within session) I'm certain there has been self correction involving the nervous system. Unfortunatlely, many PTs would have placed a modality on the patient that day and attribute the improvements to it. What about those patients that firmly beleive their diagnostic label that has been attached to them? Add to this diagnostic tests that show normal degenerative findings. These people I'm afraid seem to have walls built up that don't allow them to recover. In some cases some seem to have a strong bond with their diagnostic label. It's as if it's part of their identity.

[Diane]

I read this yesterday: Ants Swarm Like Brains Think.

Both ants and brains actually rely on two types of feedback, held in a delicate balance: negative (or inhibitory) feedback, and positive (or excitatory) feedback. “Negative feedback tends to cause stability. Positive feedback tends to cause runaway behavior,” said Tomer Czaczkes, an ant biologist at the University of Regensburg in Germany. “These two simple rules make something very powerful.”

There are different signalling behaviours in different species of ants...

"The foraging response to food is an example of a positive feedback loop, and familiar to anyone who has had a picnic ruined by a line of ants marching in single file toward their meal. But knowing when not to leave the nest and risk predation and dehydration may be just as important as knowing when to take advantage of a windfall of seeds. At low levels of an input (a small amount of food, for example) positive feedback dominates. At high levels of input, negative feedback dominates, helping to prevent runaway processes.
"Czaczkes mentions a tale involving the South American army ant, which unlike the harvester ant, relies on pheromones for navigation. In 1936, ant biologist T.C. Schneirla watched a group of army ants fall into an “ant death spiral” as they created a pheromone trail completely around a large tree. The lead ants, Schneirla noted in a 1944 paper, discovered and followed their own pheromone trail. More and more ants joined in, following an endless positive feedback loop around the same tree, continuing for days through pouring rain until the ants began to die from exhaustion."

Anyway, the image of a bunch of ants circling the tree until they die reminded me of "circling the drain".
Then I thought about how multi-modal the brain is, comprised of dozens, possibly hundreds of modes, and probably thousands of cell types (ant species). I wondered about pain as the end result of some positive feedback loop, instead of the usual negative one.
If that's true, then of course interrupting it with some simple education would be like blocking the poor misguided ants from dying while marching endlessly around the tree, in a group, endlessly positively feedbacking themselves. Giving the patient the means by which they can get into their own cognitive neurons and start to weaken the neurotag, which is how Moseley would put it.

[Barrett Dorko]

advantage,

I'm seeking to understand the resistance to this word, ideomotor.

I can't get Butler to say it, and it's almost never mentioned as a tactic in our strategy.

If you Google ideomotor effect today you'll get 88,000 hits and something I wrote is on the second page.

Though described in a book in 1854, and, to my knowledge, never refuted as one of only three nonconsciously generated motions possessed by us, it remains not only unused, but unknown by the therapy community. It remains untaught.

Perhaps because it has been relegated to the world of magic, the paranormal, the largely illegal and questionable or suspect it has been ignored by the health professions. That's my best guess anyway. I've written a lot about how ideomotion and its use breaks the rules of the culture and is thought to exist in opposition to The Puritan Ethic as well.

Now, though it is increasingly admired for its appearance and its revelation among those who detect (Psych, Criminal Intent, Eye of the Needle and Elementary), it is also thought to be nearly invisible and thought to produce "micro-movements," only seen by those who are especially sensitive, well-trained and vastly experienced.

This simply isn't true.

[Barrett Dorko]

Diane,

I've nothing against education and feel about it much the same way that you do. I think. I'm pretty sure.

But what of instinctive, corrective movement?

Why such resistance to that?

[Diane]

Diane,

I've nothing against education and feel about it much the same way that you do. I think. I'm pretty sure.

But what of instinctive, corrective movement?

Why such resistance to that?

Probably because it's a verb, not a noun. So it isn't as easily grasped. And if turned to a noun, it doesn't move as easy.

[Barrett Dorko]

Okay. But Simple Contact is a noun, pretty much. Therapists run from that as well. My contention is because it requires understanding. Asking for that is a non-starter.

I'm guessing, but I think that correction, being creative, is rejected because people don't trust it. This certainly includes most therapists.

Instead, they are forced to consider function. I know I've written a lot about that.

These days, embarking on a fitness regimen without your physician's permission (as if they would know) and not consulting another (personal trainer and/or leader of the class) is considered a bad idea.

Is it?

[Johnny_Nada]

Without an understanding of basic exercise science, basic program design, basic progression and technique for loaded movements, yes it has the potential to be a bad idea.

[Barrett Dorko]

Oh.

Was it always so?

I thought at first you were talking about ideomotion, but then I realized otherwise.

Come to think of it, maybe we could use similar terminology to describe the idea of self-correction. What do you think?

[Diane]

Without an understanding of basic exercise science, basic program design, basic progression and technique for loaded movements, yes it has the potential to be a bad idea.

Without an understanding of basic exercise science, basic program design, basic progression and technique for loaded unloading movements, yes, it has the potential to be a bad good idea.

[Josh]

The concept of self-correction is one I can agree with, but I still have trouble with SC in my mind. I have a few questions.
Barrett if you aren't telling your patients how to move with SC, only creating context, is contact needed?
If you aren't helping them move in any way, do they really need to see a PT for this?
Don't you run the risk of your own ideomotor response unconsciously guiding the movement?
How would one test SC and sham SC?