??? Neil Pearson

[Diane]

I'm linking this thread to the thread to which Caro has added so much illumination on the topic of instinctive movement, Caro's Clarity.

[Jon Newman]

Originally Posted by Barrett Dorko

From the interview:

Why do you think instinctive movement plays no valuable role in pain reduction?

Maybe someone here can offer an explanation.

One explanation of body tension could come from Lewin's Field Theory. In the book Psychology of Goals Gordon Moskowitz writes (pp. 304-305)

...at the heart of understanding human motivation and goal pursuit is the discrepancy. The discrepancy in question is one between a desired state and one's current state, whether that discrepancy is physiological or psychological. For example, the body needs a certain level of sustenance, and the system may detect insufficient sustenance--a discrepancy between what is needed to operate well and what the system currently contains in terms of nutrients. As reviewed in chapters 6 and 8, discrepancies may result from consciously deliberating among goals, or from goals being implicitly primed. This issue of the source of the discrepancy may be important in determining which from among one's many goals (the many discrepancies detected) is selected to be pursued at a given moment. But the first feature of goal pursuit is simply that, regardless of its source, a discrepancy is experienced (whether consciously experienced by the person or not.)

The remaining features involve the way discrepancies motivate cognition and action. Features two through five involve processes that, on the surface, seem "cold" and mechanistic. The second feature is that when on experiences a discrepancy, a tension state arises. This can be a physiological state...The experienced tension may also be a psychological state...

[John W]

I'd like to address Neil's answer to the question about the fear-avoidance model, to which I think he provides a very informative and important answer. The question and answer:

7. I have heard you state that the fear avoidance model can lead clinicians to make the wrong treatment decisions. What do you mean?

I believe that understanding the fear avoidance model has benefits. The more perspectives about pain that we can understand the better we can research it, the better we can treat people, and the more compassion we can have for the people who ask us to help.
Understanding how a person in pain approaches and responds to activity/exercise only through the view of the fear avoidance model would be akin to understanding our autonomic processes by only knowing about flight. The fear avoidance model provides us with a discussion of how people avoid, flee from or escape their pain and suffering.
What about fight and freeze?
I would challenge any researcher or clinician to the task of simply asking their next 100 patients or subjects how they approach their daily activities. “When something needs to get done in your day, does this model (show them a diagram of the fear-avoidance model) illustrate how you behave?”

Maybe we could argue that freeze responses are also flight responses. They are a way to escape, but to escape through non-action and passivity.

How about fight responses? People often describe how their primary mode of functioning in daily activities is to push as hard as they can, and ignore the pain as best they can, so they can get the job done. This is not fear avoidance, it is fighting. Some call it endurance behaviour. Others call it boom-bust, and others consider it as the ability to be a masterful distractor.
When pain is acute, we can typically be tough, push through it, and come out the other side with less pain and better function. This doesn’t happen when the pain is chronic. Being tough and fighting is not the answer to chronic pain, and this behaviour is not explained by the fear-avoidance model.
Sometimes the job our patients need to complete is the exercises or activity we prescribe to them. If the primary coping strategy is to be tough and push through the pain, then the person will be practising ‘fight’. This will likely increase sympathetic activity, not decrease it. People are just as likely to fight if cornered by their pain.

Teaching people in pain how to pace activities is such a huge job for us. How can we not see the inconsistency between this and the fear-avoidance model?
Recent research showed that people with chronic LBP are not deconditioned. How can that be so if the fear avoidance model is correct?

The fear avoidance model is important. It may explain the behaviours we see experimentally much more than it explains the behaviours our patients admit to in their daily activities. If we don’t consider that people will fight at least as much as they will flee (avoid) then we will always be pushing people to try harder, when in fact there are many times we need our patient to avoid being tough and pushing with their strength of will.

The limitations of the fear-avoidance model were recently discussed at the BodyInMind blog in the context of a huge study (n=599!) on late recovery from whiplash led by Esther Williamson. This study found that fear-avoidance beliefs as measured by the Fear-Avoidance Beliefs Questionnaire and pain catastrophizing were NOT risk factors for poor recovery from whiplash.

Neil's answer above provides insight into why looking at fear-related avoidance behaviors as predictors of outcome may be so limited. It's easy to assume that avoidance behavior driven by fear will result in a gradual process of deconditioning and then increased likelihood of re-aggravation of symptoms when the patient attempts to resume a prior activity. However, as Neil points out with the recent study that failed to find deconditioning among patients with chronic LBP, avoidance behavior doesn't seem to explain a poor outcome in many patients.

I think it's possible that the same patient may vacillate between fight, flight or freeze at various times throughout their recovery. Furthermore, whichever behavior that predominates at any given time is likely context-dependent. Do you think it's more likely that a patient will be a bit trepidatious- given the popular impression of physical therapy- when they're asked to complete a Fear-Avoidance Beliefs Questionnaire on their first visit in PT? Might this influence their score?

PTs may be over-estimating the influence of fear-avoidance in persistent pain due to the popular impression of our profession we ourselves have created.

[CDano]

Before being introduced to Barrett's ideas, i'd never really considered unconscious movement.

Not speaking for Neil or his background in anyway, only mine. The use of yoga was always geared towards making movement more conscious, developing more awareness. The unconscious is almost treated as a negative thing, and that one needs to make the unconscious conscious, and this process is what leads to enlightenment.

My experience is too much of this put a sort of 'straight jacket' on me mentally as well as physically. Realizing that i could 'let the body take care of itself' was instrumental in my own self-treament. Doing some self-ideomotion treatments very quickly showed me it's efficacy as well.

I find great difficulty in expressing what i think is going on, i don't think it's an either or situation, but more of a feedback loop. Particularly with regard to 'sophisticated' movement, an athlete's, dancer's, etc. There is some sort of dance that occurs between the conscious and unconscious mind that leads to refined, beautiful, skillful movement.

But then there is this other thing i think Barrett is talking about. Oddly in my time around people who have developed this quality, very often when they are 'off stage' their movement totally changes, it's still natural, but the control is let off, they are very relaxed and their bodies assume all sorts of 'odd' forms, they will sometimes have atrocious posture, appear to be very lazy, etc. Yet they are very healthy and very mobile.

There seems to be some sort of organic integration between conscious and unconscious..

[Barrett Dorko]

I think this is remarkably insightful. I couldn't have said it better.

I note that the culture intrudes when the posturing we see is judged. Its power is evident and we need to keep in mind that it has just two objectives - according to me.

1) To control us

2) To sell us crap

[CDano]

Originally Posted by Barrett Dorko

I think this is remarkably insightful. I couldn't have said it better.

I note that the culture intrudes when the posturing we see is judged. Its power is evident and we need to keep in mind that it has just two objectives - according to me.

1) To control us

2) To sell us crap

Sadly i see the same.

Maybe Control / Feed Bigshot's Ego

Which is the root of my seeming anti-yoga posture on another thread.

[Sheffphysio]

I've never yet posted about ideomotion, mainly because even though I feel I understand it I'm yet to directly harness it. I shall have a ponder.......

I challenge culture how that poses strict right and wrong on patients and aim to change this I would still say I lead where I want them to go, to get freedom of movement.

[byronselorme]

Originally Posted by CDano

But then there is this other thing i think Barrett is talking about. Oddly in my time around people who have developed this quality, very often when they are 'off stage' their movement totally changes, it's still natural, but the control is let off, they are very relaxed and their bodies assume all sorts of 'odd' forms, they will sometimes have atrocious posture, appear to be very lazy, etc. Yet they are very healthy and very mobile.

There seems to be some sort of organic integration between conscious and unconscious..

I really really like this post of yours Cole and it has stayed with me since I read it a few days ago.