Movement Science Podcast

Rod Henderson, a PT in Texas, recently began podcasting about various topics in movement science. Rod is a passionate researcher and interrogator committed to raising the bar in the rehab world. He recently interviewed one of my most important clinical influences, Barrett Dorko, a brilliant writer, thinker, and physical therapist from Ohio. I highly recommend listening to their enlightening discussion.

Through careful observation and extensive study, Barrett has developed and shared a perspective that is essential for understanding movement, particularly as it relates to dealing with pain. He has described, in multiple essays and reflections, the potential impact of more complete expression of something we all ordinarily keep hidden: ideomotion. Ideomotor activity is a category of nonconscious movement. It sometimes sounds a bit surreal or even purposely ambiguous, but it is really quite a simple concept once you understand a few basics of neurophysiology. Unfortunately, the rehab and medical world has somehow mostly disconnected the pieces between pain and the nervous system. Once grasped, the connection is beyond obvious, but many still languish in the realm of muscles and joints without realizing they are little more than hunks of meat without being animated by their puppetmaster - the brain.

The concept Barrett introduces is nothing less than a complete reinterpretation of the meaning of muscular activity. Here it is as I currently understand it:
(1) Muscles do nothing that the brain is not telling them to do (okay, that the nervous system is not telling them to do - they can contract via local reflex action).
(2) Although we consider skeletal muscle "voluntary", muscle tension is most often involunary. For instance, think about tension in your neck and shoulders. No one chooses to be tight there, but many frequently are.
(3) Most people think the solution to this problem is to just relax. Physios can often be heard complaining, "I can't treat her; she just won't relax." Many treatments have been devised to try to make that muscle tension go away, but few are successful in the long-term.
(4) Consider for a moment that the nonconscious part of the brain - the part that generates involuntary muscle tension - causes muscles to tighten up for a reason and, far from being the problem, this tension is actually part of the solution.
(5) A muscle that is tight (because the brain is sending excitatory signals) is contracting. A muscle that contracts will either remain tight (isometric contraction where there is no movement) or produce movement (isotonic contraction where the muscle shortens). Movement can be, and frequently is, easily inhibited. However, willingness to allow this movement to be expressed results in decreased tension, increased freedom of movement, and less pain.
(6) Non-volitional movement is ideomotor in origin and arises in the presence of increased mechanical tension in the nervous system. This often results from sustained positions, repetitive motion, or excessive force. The right movement is always the solution to mechanical pain.

Physiotherapists fashion themselves as movement experts, yet almost no attention is ever given to the most basic reactions of human physiology. Nonconscious movements have huge implications for our patients. They can no longer be ignored.