Hodag Days

[smikolic]

Ok...now I really hope you are kidding.

[Barrett Dorko]

I’ve been through Whitesides’ video twice more recently and read again through this thread.

The title of my workshop in Rhinelander is Simplifying Manual Care so I’m hoping to incorporate more of this thinking into the weekend. I want to state something about the work and its connection to complexity and then make that same point in a simpler way.

I could use some help.

Point #1 - The nervous system in its geometry, nonlinear response to provocation and spontaneous expression is complex.

BUT

Simpler – Within the proper context, our instinct – guided by our nervous system – is designed to respond to provocation in a manner that sustains us, corrects us and enhances our comfort.

Getting there?

[smikolic]

OK, timidly, I will ask:

But is instinct sufficiently predictable, reliable and/or stackable?

Which, if I am understanding Whitesides' idea of simplicity, would make the below point simpler than the above statement, and more useable....

[Jono]

The word 'instinct' stuck out to me- if I was at your course I'd want that unpacked a little bit.

What is instinct? What differentiates an instinctive response from one which isn't instinctive? Does instinctive only mean non-conscious? Does an instinctive response have to be non-learned?

And for that matter is it true to say that instinct is 'guided' by the nervous system?

Hope that's helpful feedback.

[Barrett Dorko]

Jono,

Great questions.

Take at look at the Wikipedia entry for instinct, then we'll go from there.

[Diane]

I find that I can't teach anything to anyone (like instinct to PTs) without bringing evolution into the discussion.

It goes like this:
1. Single cells invented "life" - their whole reason for being seems to have been to reduce chemical gradients on the planet
2. They had a few billion years to work out all the processes of living (a list of these) - they invented everything about 'life,' i.e., biological processes, that we enjoy, like respiration, locomotion, metabolism, growth, reproduction, etc. - they had to do everything across a membrane barrier
3. Multi-cell life came along much later and humans even later
4. We still all come from single cells, our cells still conduct business across membranes
5. The human organism is like an ecosystem with a big membrane around it that is still chemosensitive and mechanosensitive

Then I talk about the difference between signaling tissue and structural tissue, ask why it's so different, talk about exaptation, talk about the energy costs of maintaining a electrical membrane differential, and other remarkable features of the human nervous system, and segue into a few minutes of embryology, how a human organism unfolds into a sensing moving human antigravity suit.

Maybe this is exactly where you do not want to bother going, or end up, however...

[smikolic]

What about, especially in light of learned instincts, if the context becomes the focus?

I realize Barrett, that you said, "in the proper context" regarding use of instinct, but what if the context is the point? Maybe making that the "simple" (reliable, predictable, repeatable/stackable) thing about the responses of the nervous system would be helpful.

Seems the situation of an instinctually incorrect response to the pt who says "ouch" (by poking around to find the pain source or by ignoring it or assuming the pt is exaggerating or lying is the real problem). And perhaps it is not just an incorrect habit, perhaps it is a learned instinctual response on the part of the therapist, that serves to create an environment/context for the pt that does not promote what we are looking for (the instinctual correction toward relief of pain).....just thinking.

Respectfully,
Steph

[Jono]

Originally Posted by Barrett Dorko

Take at look at the Wikipedia entry for instinct, then we'll go from there.

Done- the human instinct section is copied below. It appears that there is significant variation in how human instinct is conceptualized- how do you see it?

In humans

Some sociobiologists and ethologists have attempted to comprehend human and animal social behavior in terms of instincts. Psychoanalysts have stated that instinct refers to human motivational forces (such as sex and aggression), sometimes represented as life instinct and death instinct. This use of the term motivational forces has mainly been replaced by the term instinctual drives.
Instincts in humans can also be seen in what are called instinctive reflexes. Reflexes, such as the Babinski Reflex (fanning of the toes when the foot is stroked), are seen in babies and are indicative of stages of development. These reflexes can truly be considered instinctive because they are generally free of environmental influences or conditioning.
Additional human traits that have been looked at as instincts are: sleeping, altruism, disgust, face perception, language acquisitions, "fight or flight" and "subjugate or be subjugated". Some experiments in human and primate societies have also come to the conclusion that a sense of fairness could be considered instinctual, with humans and apes willing to harm their own interests in protesting unfair treatment of self or others.[2][3]
Many scientists consider that it is instinctual in children to put everything in their mouths, because this is how they tell their immune system about the environment and the surroundings, what the immune system should adapt to.[4]
Other sociologists argue that humans have no instincts, defining them as a "complex pattern of behavior present in every specimen of a particular species, that is innate, and that cannot be overridden." Said sociologists argue that drives such as sex and hunger cannot be considered instincts, as they can be overridden. This definitory argument is present in many introductory sociology and biology textbooks,[5] but is still hotly debated.
Psychologist Abraham Maslow argued that humans no longer have instincts because we have the ability to override them in certain situations. He felt that what is called instinct is often imprecisely defined, and really amounts to strong drives. For Maslow, an instinct is something which cannot be overridden, and therefore while it may have applied to humans in the past it no longer does.[6]
In the book An Instinct for Dragons[7] anthropologist David E. Jones suggests a hypothesis that humans just like monkeys have inherited instinctive reactions to snakes, large cats and birds of prey. Folklore dragons have features that are combinations of these three, which would explain why dragons with similar features occur in stories from independent cultures on all continents. Other authors have suggested that especially under the influence of drugs or in dreams, this instinct may give raise to fantasies about dragons, snakes, spiders, which makes these symbols popular in drug culture. The traditional mainstream explanation to the folklore dragons does however not rely on human instinct, but on the assumption that fossil remains of dinosaurus gave raise to similar speculations all over the world.

[Mary C]

Barrett,

Ya, you ask if they/how they prepared and wait for the excuses.....I get it. You expect that you will get excuses. Of course you will get excuses. So what? What is the purpose? To alienate or to inquire? To seek common ground or to demonstrate laziness in the audience?

My point is how you ask, the purpose of your asking matters. The tone too.

Steph


Oh, well, if that's what you're wondering. I always do everything I can to alienate the class.
__________________
Barrett L. Dorko P.T.

Yes, I remember the awkwardness of the moment.
Since then I've been changed. I may not prepare the stuff I'm asked to do but I'm always working on something. That question would never bother me now.

Besides that, Barrett, the stuff you write is really interesting to read.
Much more so than research papers.

Mary

[Barrett Dorko]

Mary,

Thank you.

Jono,

Reading this I am reminded of the Supernormal Stimuli thread and the contention that our instinct to do certain things can be manipulated by creating a context that reminds us of their presence and gives us an excuse to express them. A dragon would do.

From earlier in the Wiki entry:

Instinct is the inherent inclination of a living organism toward a particular behavior. The fixed action patterns are unlearned and inherited. The stimuli can be variable due to imprinting in a sensitive period or also genetically fixed. Instinctual actions have no learning curve, they are hard-wired and ready to use without learning. Some instinctual behaviors depend on maturational processes to appear.

Biological predispositions are innate biologically vectored behaviors that can be easily learned. For example in one hour, a baby colt can learn to stand, walk, glide, skip, hop and run. A biological predisposition may also mean that a person, because of his/her genetic makeup, is more prone to certain conditions or disease. Learning is required to fine tune the neurological wiring reflex like behavior. True reflexes can be distinguished from instincts by their seat in the nervous system; reflexes are controlled by spinal or other peripheral ganglia, but instincts are the province of the brain.

I’ve read this several times. Does it make sense to say that ideomotion is instinctive but that we have a biological predisposition to suppress its expression in favor of socialization?

[Jono]

Originally Posted by Barrett Dorko

Does it make sense to say that ideomotion is instinctive but that we have a biological predisposition to suppress its expression in favor of socialization?

Based on the given definitions I don't think you could say that suppression of ideomotion is a biological predisposition- unless you are aware of a genetic basis for this suppression?

I guess what stood out to me from the wikipaedia entry was that there is disagreement over whether humans have instincts and if we do to what extent. I think it's fine for you to use the word 'instinct' as long as you can clarify/defend what you would define as a human instinct.

[Bas Asselbergs]

I see the "biological suppression" as a result of the biological drive in us as social conformists - the need to belong to the human primate group. This suppresses the instinctive ideomotion that might make us stand apart.

[Barrett Dorko]

In 2006 I wrote On the day that one of Andy's men died. It remains one of my favorites.

In there I refer to Candice Millard's book, The River of Doubt, and how this brilliant scientist makes it clear that in an environment full of predation no species will survive without learning how to hide.

Humans carry this skill/instinct with them into the modern day despite the absence of lions in the suburbs. I propose that this biologic predisposition accounts for the fact that the vast majority of readers here at the moment remain silent and/or don't even register on the site.

It isn't cowardice, it's just a manifestation of that instinct within the context of the Internet - for many a terrifying place.

Those of us who step out of the crowd are, well, you know.

No doubt (pun intended) we have an instinct to correct called ideomotion. Unfortunately, we also posses a strong biological predisposition to hide. When the former is subservient to the latter the nervous system is sensitized, and painful output won't be far behind.

Take it to the bank.

[Jon Newman]

In lecture 22 (Motor 4: Rythmic Outputs), of the MIT OCW Neuroscience and Behavior lectures I heard the following (slightly paraphrased for easier reading and writing):

Speaking of fixed action patterns and reflexes:

When you get a startle (claps loudly)...the first thing you did, and you might not have noted it, but it was an eye blink. That's the first thing that happens. Then you get other facial muscles contracting and then, depending on how loud the stimulus is, you'll get neck flexion, arm flexion, and with very intense sound, the legs will flex (demonstrates person ducking). Now we can explain the timing of the movements in terms of conduction time which is affected by fiber size, synaptic delays and temporal summation times.

But, for longer patterns of movement, we can't use such explanations. I'm going to talk about the behavior of a fish (the stickleback and it's courtship pattern. (Niko) Tinbergen, 1951, did an analysis of these movements. Analyzed them as a series, basically a stimulus-response series, though he was really dealing with what we would probably call fixed action patterns but it could be broken up into these series of movements, each with a stimulus and a response that lead to the next stimulus....

Now in Tinbergen's studies he was dealing with movements in this pair of animals and not just one animal. The interesting thing about this movement..is that if you interrupt one step, the sequence stops. So each step is a necessary stimulus for triggering the next step.

[Diane]

Originally Posted by Bas

I see the "biological suppression" as a result of the biological drive in us as social conformists - the need to belong to the human primate group. This suppresses the instinctive ideomotion that might make us stand apart.

Except for performers, who learn to successfully exploit it. I'm thinking of Taylor Hicks.

Actually, watching him that season made me want him to change his name to Haylor Ticks. In the audition clip, you can see how Randy and Paula loved his (non-conscious ideo-)motions once he relaxed enough to show them (he needed their permission) while Simon thought the moves and Taylor himself didn't look like "star" material. He ended up winning the contest. Maybe people like to see each others' ideomotion after all.

[Diane]

On the Human: Control: conscious and otherwise by Christopher Suhler and Patricia Churchland. I think when they discuss "The co-evolution of control and situational responsiveness" they are talking instinct and behavioural inhibition.

[Bas Asselbergs]

Yes, Diane, you are right - performers sometimes stand out and make it their trademark - Joe Cocker.

[Jono]

Okay,

So now if I was in your class I'd be asking what aspects of ideomotion do you believe that this biological predisposition is suppressing? We all smile, frown, blink etc. In what way are these things being suppressed?

[Barrett Dorko]

Jono,

Helpful question.

I would say, "Those which are corrective of the abnormal neurodynamic when they become counter-cultural in appearance are suppressed in favor of social acceptance, make us stand out in a crowd and/or when they become visible to those who judge our appearance. Remember, ideomotion doesn't just express us, it also corrects us - two sides of the same coin."

[smikolic]

Originally Posted by Barrett Dorko

we have an instinct to correct called ideomotion. Unfortunately, we also posses a strong biological predisposition to hide. When the former is subservient to the latter the nervous system is sensitized, and painful output won't be far behind.

Take it to the bank.

Perfect.

Describes, to me anyway, the why's. As in why the person in pain didn't figure it out on their own and express it, and the why therapists need to change their presentation so the pt is not encouraged to hide, and to promote actually the opposite of hiding (expression).... why to change the context in order to see this instinct occur.

Thank you.

Steph

[Jon Newman]

From the same lecture I referenced in post #64 (again mildly edited):

But now what about the limbic system? It controls movement too. If we go into the hypothalamus, for example, and stimulate, we certainly get an animal changing its movements. In fact, we can get specific patterns of what looks like motivated behavior, fixed action patterns, and so forth by stimulating there. But we don't usually call that the motor system. We think we're affecting the urge to move and not the movement control itself. But you see, it's just the way we choose to talk about it.

[Jono]

Barrett,

Okay- I could buy the idea that many (all?) forms of ideomotion are instinctive.

Now I'm stuck on the idea that ideomotion is corrective of abnormal neurodynamics- how would you explain this to me?

[Barrett Dorko]

Jono,

Have you shifted in your chair lately? Have you tried to hold yourself perfectly still?

[smikolic]

Well, Gil's class went very well, and there was a good attendance (limit of 30 participants, with attendance of nearly that number), and a better initial response by the attendees.

Think a few minds were opened, but a few are stuck in non-belief of the method....which is why they don't believe, I think....stuck in the method too much to get the concept of what is really going on....oh well.

Gil was an amazing orator, and gave a very good argument for considering the nervous system in treating pt's with pain. His course was heavy on the neuroscience, lightened with bright humor, and enlighted with a generous sprinkling of hands-on treatment.

Highly encourage people to see his class. And to experience his hands. More on the feeling of ideomotion, when elicited through SC, later.

Steph

[Jono]

Originally Posted by Barrett Dorko

Have you shifted in your chair lately? Have you tried to hold yourself perfectly still?

It seems to me that shifting in a chair due to pressure discomfort is quite a different scenario to most of the complaints that we see in our clinics.

[Barrett Dorko]

But isn't "pressure discomfort" (mechanical deformation beyond our tolerance, and, more likely, neural tension and its consequent ischemia) the primary problem we face in the patient with chronically recurrent pain?

I usually begin my courses by speaking for nearly an hour. Many in the class will shift about for the first twenty minutes in order to maintain comfort. After that, they'd have to stand to obtain relief. Thing is, no one stands.

They don't even express Wall's first instinctive response; withdrawal. This is how powerful the culture is, and even that's beyond their awareness. MY job then is to "remove the culture" that forces them to primarily consider appearance. When I do, motions far more dramatic in size than simple shifting appear.

The unconsciously generated shifting with which we're all familiar is ideomotion's first and most common manifestation. Its expression is quickly suppressed especially if you're trying to look normal, posing, posturing, modeling or, in the extreme, playing poker.

My contention is that we're all playing poker.

[smikolic]

The unconsciously generated shifting with which we're all familiar is ideomotion's first and most common manifestation. Its expression is quickly suppressed especially if you're trying to look normal, posing, posturing, modeling or, in the extreme, playing poker.

Yeah, and when your therapist is telling you to sit up straight, go this way....not a good way to encourage the instinctual expression of movement toward relief.

[Jono]

Originally Posted by Barrett Dorko

But isn't "pressure discomfort" (mechanical deformation beyond our tolerance, and, more likely, neural tension and its consequent ischemia) the primary problem we face in the patient with chronically recurrent pain?

I wouldn't have thought so. So saying, I could be wrong- Are you aware of research or science that supports this?

The unconsciously generated shifting with which we're all familiar is ideomotion's first and most common manifestation. Its expression is quickly suppressed especially if you're trying to look normal, posing, posturing, modeling or, in the extreme, playing poker.

My contention is that we're all playing poker.

You could also look at what you're calling suppression as being contextually appropriate movt.

[Diane]

Are you aware of research or science that supports this?

Jono, what do you suppose would be "the primary problem we face in the patient with chronically recurrent pain" if you don't think ""pressure discomfort" (mechanical deformation beyond our tolerance, and, more likely, neural tension and its consequent ischemia)" is?

[Barrett Dorko]

Yea Jono, what Diane said.

I'm simply evoking the primary origin of pain treatable with movement. I think the research on this has been done.

[Jono]

Originally Posted by Diane

Jono, what do you suppose would be "the primary problem we face in the patient with chronically recurrent pain" if you don't think ""pressure discomfort" (mechanical deformation beyond our tolerance, and, more likely, neural tension and its consequent ischemia)" is?

I guess I don’t really know what the ‘primary problem’ in chronic pain is but I would have thought it was more related to central processing/regulation rather than peripheral nociceptive input.

If you think about pain as being the subjective experience correlated with a particular neurotag as per Moseley/Butler et al. The presence and ‘strength’ of this neurotag is the result of the interaction of many different inputs- both peripheral nociception (mechanical deformation of nervous tissue would fit in here) and central inputs (beliefs about how dangerous an event is etc).

I haven’t read the research showing that mechanical deformation of nerve tissue is either necessary or sufficient to cause pain (let alone of primary importance). If there’s research out there showing this I’m totally happy to be corrected- I’m very much still on the steep part of the learning curve.

[Jono]

Originally Posted by Barrett Dorko

I'm simply evoking the primary origin of pain treatable with movement. I think the research on this has been done.

So there is research showing that chronically recurrent pain treatable with movement is primarily caused by mechanical deformation of nervous tissue?

I'm genuinely interested to read it if you can post a link- this is honestly not what I understand with my (possibly limited) knowledge of this field.

[Barrett Dorko]

If you look carefully at the left side of Melzack's model you'll see the word "deformation". I tell my students to circle it in red.

Does that make things clearer?

[Diane]

Originally Posted by Jono

I guess I don’t really know what the ‘primary problem’ in chronic pain is but I would have thought it was more related to central processing/regulation rather than peripheral nociceptive input.

It's both/and, most of the time, probably. I.e., a large proportion of persisting pain patients have easily resolving "mechanical" pain, as evidenced by the fact they improve with movement, whether movement arrives self-induced or through facilitation via manual therapy/placebo/acupuncture, as opposed to purely central pain, which rarely improves with anything, period.

If you think about pain as being the subjective experience correlated with a particular neurotag as per Moseley/Butler et al. The presence and ‘strength’ of this neurotag is the result of the interaction of many different inputs- both peripheral nociception (mechanical deformation of nervous tissue would fit in here) and central inputs (beliefs about how dangerous an event is etc).

Sure.

I haven’t read the research showing that mechanical deformation of nerve tissue is either necessary or sufficient to cause pain (let alone of primary importance). If there’s research out there showing this I’m totally happy to be corrected- I’m very much still on the steep part of the learning curve.

Look at Remple for the whole physiological rundown. Look at Tunnel Syndromes for info re: sensory neurons/fibers being affected first.

[Jono]

Originally Posted by Barrett Dorko

If you look carefully at the left side of Melzack's model you'll see the word "deformation". I tell my students to circle it in red.

Does it say "deformation" or "deformities"?

[smikolic]

Jono,

Also, it may be helpful to make it clear that the mechanical deformation or deformities are a result of our pattern of withdrawal/protect responses.

We, in the effort to protect from the painful part and/or in the effort to remain socially acceptable (holding our stomachs in, sitting up straight, keeping still for the speaker, etc.) deform our own tissue in the process.

But, rather than move in ways that allow return of blood flow to the interested nerves and muscles and improves our ease and comfort, we hold them tightly bound, sufficating them (deformation/deformity) in the process, which only serves to hurt more, keeping the ugly cycle going:

damage > hurt > protect > attempt to move > hurt > protect (deoxygenation/deformation of n. tissues) > hurt > attempt to move or use the part in a functional way or a "prescribed" way> hurt > protect > hurt and so on.....

Can you see how this gets and keeps going?

Steph

[Barrett Dorko]

It says "deformities" which just means that something has been moved from its natural shape.

[Jason Silvernail]

Mechanical Pain Basic Science

Jono, I think this has what you're looking for.

[Jono]

Thanks Jason- that's excellent and it does help clarify a few things for me.

I guess where I think it gets messy though is that with many patients with chronic pain we also have to contend with central 'issues'. My understanding of spinal cord sensitization is that non-nociceptive afferents start triggering nociception- which means that any movt or benign afferent input can strengthen the px neurotag.

I'm also unclear on why an 'ideomotive' movt should/would/could be any more beneficial than a conscious movt.

I can see the logic in everything Barrett is saying- but just because something could work this way according to a particular model doesn't mean that it does. I guess what I'm angling for is a bit more evidence base as opposed to science base.

[Jason Silvernail]

Certainly there is some good evidence base for choreographed movement - trials of manual therapy and various exercise therapies. One of Barrett's strengths, in my opinion, is that he's never claimed any efficacy for his method like a guru does - he just says its a reasonable approach that makes sense and doesn't have the disadvantages that more passive or choreographed care can have.

I think all of physical medicine is short on outcomes evidence - ideomotor correction is just one more example of where work needs to be done.

I think most of us are intending to work in the periphery and influencing things directly from there. You could make a strong case that there are central effects to most of what we do peripherally, and Diane and I have certainly argued in the past about the relative contribution of physical therapy care to central vs peripheral processes. Right now I think this is anybody's guess.

On ideomotor being possibly better - to the best of my knowledge this possibility is linked to it's instinctive nature and the science base behind that. Though I believe Barrett also recommends some choreographed movement like Feldenkrais style exercises as well as part of Simple Contact.

[Barrett Dorko]

Jono,

I don't know where you might have gotten the impression that only one origin need be considered. Of course all four might contribute to the output of pain as it presents and any may dominate at any moment.

I contend that it is mechanical deformation within the nervous system itself that has been ignored despite the brilliant work done by Breig in the 70s and many others since. Without attending to this with movement therapy it will remain unless and until natural processes (read ideomotion) are sufficiently expressed.

I have used the verbal analogy (as in Body Counseling) for years to draw a parallel between common methods of communication and those that are non-verbal. What is more likely to resolve the hardening in the muscles that drive speech? Making up a speech consciously or speaking spontaneously?

Our profession's lack of familiarity with instinctive movement, and, what I say is our distrust of it, leads many to conclude that their choreographed exercise is better or just as good. How could that be the case?

[Gil Haight]

Have we ever concluded that ideomotion does not arise from M1? If so, can we then conclude it must have its origins in one if not all of the other 6 areas now identified as motor centers. These areas are part of the limbic system as well as what used to to be called premotor regions. These regions offer new possibilities for the consequences of motor expression. What is of most significance I think, is the absence of effort experienced with the expression of this activiy. That of course is certainly within the characteristics of instinct.
Gil

[Diane]

Hi Gil, congratulations on what sounds like a successfully taught course.

I was wondering if you had checked out the Somatosensation article yet. I still haven't digested it, but the diagram of the connection between S1 and M1 (or maybe it's SI and MI) is awfully interesting (I thought).. I think it's based on representation of the hand, but one can extrapolate to other areas of body - I often wonder about the trunk, how still and small people try to keep it, how much back pain there is in the population, how tiny the map is for the trunk. Then there is the issue of the back having two different kinds of evolved musculature. I'd like to see where investigation into that ends up, map-wise. If muscle spindle input (sensory) is gathered and represented in the crease, the "BA3a" zone, then it seems to me that it could get "smudged" same as any other part of the map.

The paper isn't about movement as such, but I think it pertains to treatment, and I'd love to see a paper with deeper motor brain parts connected up to more cortical motor brain parts, the way this paper has with sensory parts. Anyway, just a thought. Also what is your thinking about the habenula, and other deeper motor control zones? Are you ready to describe them in a thread yet, how you think they work, how what we do interacts with them?

[smikolic]

I like helping people "find" their pelvis again when they have back pain w/circles or whatever isolated, attentive activities we can come up with.

I like to describe it as getting "lost" in the brain partially because of all the effort to protect the back/LE area w/pain, but I might start describing it as getting smaller and smudged in with the back/upper legs in the brain as well......seems more accurate and descriptive of where it went exactly....and why it's so hard for brain to identify and move.

Steph

[Gil Haight]

Diane,
Sorry to say I have not tried to tackle the article yet. I hope to tonight. I do recall Bud Craig commenting on BA3a however. I believe he feels this is likely the region of the parietal lobe identified in fMRIs, the sensory part of the neuromatrix. His theory of course strongly associates this region with the insula. It is right there.
Gil

[Jono]

Originally Posted by Barrett Dorko

Jono,

I don't know where you might have gotten the impression that only one origin need be considered.

I was questioning your quote:

But isn't "pressure discomfort" (mechanical deformation beyond our tolerance, and, more likely, neural tension and its consequent ischemia) the primary problem we face in the patient with chronically recurrent pain?

I was wondering why you considered mechanical deformation of nerve tissue the primary problem in chronic pain. My question was do you have any evidence that this is the case.

Without attending to this with movement therapy it will remain unless and until natural processes (read ideomotion) are sufficiently expressed.

Why? Why should I accept that ideomotion is necessary for resolution of chronic pain?

What is more likely to resolve the hardening in the muscles that drive speech? Making up a speech consciously or speaking spontaneously?

Actually it's neither isn't it? Don't SLT's get people to read prepared texts to improve fluidity of speech.

[Barrett Dorko]

Jono,

If the answer to the question, "Can you alter your pain with position or use?" is "yes" then mechanical deformation is certainly one origin we should consider. Primary? Well, it's certainly the origin most effectively treated with the right movement. If you still think that this motion is as easily found by a therapist there's not much I can say, but I trust the patient's instinct to move a bit more.

I never said that ideomotion was necessary, but, being alive, it is inevitable. It stands to reason that context will affect its expression, and, without question, the therapist can change that.

SLTs? Did you read the link to Body Counseling?

[Jono]

Good points Barrett-

I guess I'd like to see a three arm study comparing 'ideomotor' movt therapy vs 'choreographed' movt therapy vs control.

It's an attractive theory that ideomotor movt being more 'instinctive' is more therapeutic- but instincts aren't always right or appropriate.

I'm guessing that this study hasn't been done yet.

[Barrett Dorko]

Perhaps I'm mistaken, but aren't instincts all present to support survival?

Please define "right" and "appropriate."

[Jono]

Yes they are. Could be a semantic misunderstanding about the word 'instinct' coming up...

Worrying about your mortgage increases your heart rate.

Instinct is geared to survival by activating the flight/fight mechanisms in response to any stressor- however this is an inappropriate (but evolutionarily understandable) reaction to financial stress.