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  • "I have pain, but I don't know where."
    I hear this not infrequently with long term or complex pain.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

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    • Then don't ask them where.

      Ask them, "Are there positions you'd rather not adopt and/or things you'd rather not do?"

      The patient's answer in the affirmative tells you that they can alter their pain with position and/or use.

      If I'm wrong, please tell me.
      Barrett L. Dorko

      Comment


      • Evanthis says:

        I don't think that we can purposely elicit true instinctual movement.
        Am I supposed to focus on the word "true" here? Suppose you swing at someone? Say certain things to them? Isn't their response instinctive?

        I wrote a seven part series of posts in 2011 titled Whence instinct that began with this one.

        It included this:
        I think that at this point I begin to diverge from the cultural norm. The issues that come to mind: How does this instinct on the patient’s part begin to meld with my own instinct to use it? Is what I possess in the way of a desire to understand it rightfully called an instinct?
        I'll have to reread the posts. What have you to say about this thing?
        Barrett L. Dorko

        Comment


        • Bas: After I educate the patient and hopefully reduce fear of movement, I ask the patient to move in a certain way. They initiate this movement and explore it, I think their brain is processing all sorts of info, does this hurt, why am I doing this, hey this is OK or holy crap this still hurts. This process is a conscious process for my patients, because I want them to understand why and how they can own this. During movements they will ask is this ok, or right.

          Lets say they have a sensitive shoulder and have adopted an upper trap substitution pattern. Is verbal, visual, proprioceptive feedback not assisting their conscious brain to learn that this is OK so that they may move it in the desired pain free fashion. People still limp after pain is gone, with awareness and feedback they learn to walk without a limp again. If all was instinctual and subconscious wouldn't this correct itself. Just like in a shoulder pt after a cuff repair. No pain, 12 weeks go by and still can't elevate their arm with a normal pattern. They need to consciously attend to this process with feedback to do it.

          As far as consciousness goes, if anyone feels this doesn't exist, we need new operational definitions in my opinion.

          My last questions: Why do we feel touch will restore instinctual corrective movement? Don't you think they have been touched by a loved one, themselves, a doctor, etc...Why didn't their touch unlock their instinctual movement?

          Comment


          • Context is what determines behavior. Touch may or not be part of that.

            Josh says:

            ...a normal pattern...
            What would that be?

            NO ONE has said that consciousness doesn't exist. If they have, I'd like to see a quote.

            Some movements are planned, some are not. The evidence indicates that "planning" in the usual way is illusory in any case.

            We seek to exert control because we're human. We struggle with that, because the world doesn't work like that.

            Josh, you also use the word "restore" when I've never used that word. I say, "Permit/catalyze greater expression." You understand the difference, don't you?
            Barrett L. Dorko

            Comment


            • Originally posted by Barrett Dorko View Post
              Then don't ask them where.

              Ask them, "Are there positions you'd rather not adopt and/or things you'd rather not do?"

              The patient's answer in the affirmative tells you that they can alter their pain with position and/or use.

              If I'm wrong, please tell me.
              I understand your statement Barrett, however, our culture or upbringing if you will, feels/believes/thinks my asking suggests greater specificity, knowledge and care (it doesn't). Insurance/payor non-sense requires I ask useless questions about pain and click boxes that have little to no impact on intervention choice or outcome. I may actually use a ruler thingy once in a while.

              Imagine the patient's thoughts in our society if I only asked 'can your pain be altered by position or use?' I don't disagree with your stance. I wish I could rule out red flags and ask only that question before initiating "treatment."
              "The views expressed here are my own and do not reflect the views of my employer."

              Comment


              • Originally posted by Barrett Dorko View Post

                Am I supposed to focus on the word "true" here? Suppose you swing at someone? Say certain things to them? Isn't their response instinctive?

                What might seem to be instinctual movement might not be instinctual. Instinct is not a learned behavior. (I expressed the same concern here http://www.somasimple.com/forums/sho...8&postcount=15).

                So ideomotion =/ instinctual movement in my mind. It’s movement generated by the subconscious, and it depends primarily on pre existing neural firing patterns that represent learned behaviors. What we observe or perceive (bring to our awareness) may or may not involve instinctual movement, but that information is unknowable IMO, especially if we are talking about beings with complex physiology like humans. I have to re think about my previous comments on ideomotion in the context of mental (we have choice in) vs. somatic (we have no choice in) models . This is not an easy topic.

                The definitions of ideomotion/ideomotor I found

                “Muscular movement executed under the influence of a dominant idea, being practically automatic and not volitional.”

                “adjective Psychology .
                of or pertaining to involuntary motor activity caused by an idea. “

                “physiol designating automatic muscular movements stimulated by ideas, as in absent-minded acts”
                -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                Comment


                • Matt says:

                  ...ask only that question...
                  Who said "only"? There are five things I want to know.

                  I haven't had a patient object to this question in my 40 years of asking it.

                  But, if you're having difficulty doing things in opposition to the culture therapy has become, I, again, despair for the future.

                  Evanthis,

                  All that I've read and written about it indicates that behavior is for more important than its origins in instinct or cultural imposition.
                  Barrett L. Dorko

                  Comment


                  • Looking at the above definitions, ideomotor behavior (involuntary motor activity caused by an idea) neither originates from instincts, nor it occurs at the unconscious level. It is created and expressed at the subconscious level and it’s expression depends on context. Furthermore, not all movement guided by the subconscious is ideomotion. I think it’s important to distinguish these concepts. Ideomotion (per definition) does not necessarily happen all the time. I also think that the therapeutic claims of ideomotion are difficult to accept, or argue for or against, not unlike many other concepts in therapy.
                    -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                    The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                    Comment


                    • Evan,
                      Can you clearly define the three levels of consciousness that you stated?
                      Unconscious; subconscious; conscious. I have never heard of three levels.

                      Nari

                      Comment


                      • in·stinct noun \ˈin-ˌstiŋ(k)t\
                        : a way of behaving, thinking, or feeling that is not learned : a natural desire or tendency that makes you want to act in a particular way
                        : something you know without learning it or thinking about it
                        (definition from Merriam-Webster)

                        Evan, I don't see any problem with saying ideomotion is instinctive movement. We are talking about a natural desire to move that is presumably suppressed by cultural / societal factors.

                        I do think that it is better to say "non-conscious" or "non-volitional" instead of "unconscious". The idea is that one is not deciding consciously how to move.

                        Comment


                        • Originally posted by nari View Post
                          Evan,
                          Can you clearly define the three levels of consciousness that you stated?
                          Unconscious; subconscious; conscious. I have never heard of three levels.

                          Nari
                          Unconscious has two meanings as far as I’m aware, 1. unconscious mind coined by Freud is that which we cannot access or bring to focal awareness, 2. the state of being unconscious which means having no capacity for awareness

                          Subconscious is that which is not currently in focal awareness, but we can bring it to focal awareness if we choose to do so. This is were ideomotion fits the best IMO.

                          Conscious awareness : the quality/state of being self-aware.
                          -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                          The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                          Comment


                          • Originally posted by gilbert View Post
                            (definition from Merriam-Webster)

                            Evan, I don't see any problem with saying ideomotion is instinctive movement. We are talking about a natural desire to move that is presumably suppressed by cultural / societal factors.

                            I do think that it is better to say "non-conscious" or "non-volitional" instead of "unconscious". The idea is that one is not deciding consciously how to move.
                            Hi Gilbert, the definitions actually contradict


                            ideomotion: “ involuntary motor activity caused by an idea”
                            instinctive: “something you know without learning it or thinking about it”

                            Non conscious implies that the capacity for conscious awareness is absent, but it can also imply that it was never present, like in non living things.
                            -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                            The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                            Comment


                            • Josh:
                              I ask the patient to move in a certain way.
                              What way? How determined? By what standards?

                              My questions are aimed at understanding how you think this is LESS convoluted than self-correction through ideomotion.
                              We don't see things as they are, we see things as WE are - Anais Nin

                              I suppose it's easier to believe something than it is to understand it.
                              Cmdr. Chris Hadfield on rise of poor / pseudo science

                              Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                              We don't need a body to feel a body. Ronald Melzack

                              Comment


                              • I always ask classes, "What's the most painful form of dance?"

                                Moshing is not included here.
                                Barrett L. Dorko

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