The Analgesia of Movement
In Wall's last text, "Pain-The Science of Suffering," he makes it clear that the three stages of motor response to painful sensation are in sequence, withdrawal, protection and resolution. If all three are instinctive, what would the last stage (resolution) look like and how might it be promoted?
My work seeks to answer these questions through the study of ideomotor activity, neurodynamics and manual methods of care. I've written of this extensively on my own web site, barrettdorko.com and elsewhere. I am hoping that this site might become yet another place where analgesic movement can be discussed. Perhaps the question above will help us get started.
Barrett
The Analgesia of Movement
I'm not referring to pain from injury necessarily, and equating the two is obviously a mistake (as Wall makes clear). I'm talking about pain secondary to mechanical deformation, the sort we see in the clinic rather than the battlefield.
The suppression of ideomotor activity is commonly seen in people who express that they feel the pain but are not moving as any other animal would. Wall cites brain imaging that demonstrates a large amount of motor planning but no motor activity. What do you suppose is the impediment if not a lack of awareness?
Barrett
barrettdorko.com
The Analgesia of Movement
I often refer to this work while teaching in order to demonstrate the presence of "central sensitization" and the novel way therapy might affect it. The original clinical trials were conducted by Nancy Byl, a brilliant PT in San Francisco.
However, this work is not related to ideomotor activity, an active though unconsciously driven movement whose purpose is to reduce mechanical deformation; not to significantly alter cellular changes in the brain.
With Simple Contact an effort is made to "play" with the creative activity generated instinctively and produced by the patient in an effort to relieve the mechanical deformation from which the problematic sensation originates.
I find myself repeatedly saying "mechanical deformation" in these posts. Is there a problem with our profession's understanding of this simple concept as it relates to painful sensation?
A very interesting discussion regarding creativity, play, induction and therapeutic movement that may help here can currently be found on Rehabedge.com in "Barrett's Bullypit." Look for the tread titled "Induction."
The Analgesia of Movement
I appreciate your joining in here but find your reply rather confusing. You put the word involuntary in quotes as if I said this. Would you please point out where I did so? I'm sure I've used the word in the past but having a context would be quite helpful.
Ideomotor activity is best described as instinctive rather than reflexive in that the latter implies great difficulty in our ability to suppress its expression. Consider the poker player who successfully bluffs for instance. This is an effective suppresion of ideomotor activity. You might also consider the fact that many people with a 20 minute sitting tolerance before experiencing pain remain in their seat long beyond this in a variety of situations wher standing is considered "improper." Both of these nonmovements represent a successful suppression of instinctive expression, and this is the very definition of domestication.
You say, "Surely pain is conscious and then withdrawal from pain is conscious." By this do you mean that we plan and willfully move with volition in this manner when stimulated painfully? Not according to Patrick Wall, who includes withdrawal as the first of three hard wired responses to painful sensation (the second being protection and the third resolution). Ideomotor movement (that which we use to achieve the third stage) is fairly easy to suppress if our "higher centers" deem it inappropriate, and I think they do so regularly.
The second paragraph doesn't quite make sense to me either. I don't know how you separate mechanical deformation of the sensory organ from mechanical deformation of, well, something else. What else but the former would be relevant to the painful experience? What is "the essence of pain"? Is pain a "thing" that has parts to you? The loss of sensory ability in a deformed limb presents us with well known problems and they are solved with procedures of care developed over many years. It is the deformation that produces pain in the normally sensitive tissue that concerns me. When the instinctive response to such a situation is suppressed therapists should come to understand how that is possible, what it looks and sounds like and how to handle patients in a way that changes the situation for the better.
The Analgesia of Movement
You seem to have arbitrarily chosen to focus on withdrawal alone despite the fact that this thread was explicitly begun as a discussion of resolution. Your inability to see all three stages of instinctive behavior confounds me. Of course if we stop at withdrawal we'll appear deformed-the question is; What should be done next? How can the therapist know what the next unique, instinctive and personal movement should be? Should it be the one that *appears* right? Is the path out of trouble always a straight line full of effort?
Depending upon Wall's opinion is not something that I feel requires any sort of defense. Can you name anyone more highly regarded? On page 18 of Ramachandran's latest book he expresses skepticism at the very study you previously cited regarding recovery with mirror techniques-then he sees Wall is one of the authors and immediately accepts it. (see "A Brief Tour of Human Consciousness")
Is anyone else out there?