Clinical Somatic Education Practitioner and Training Instructor
Certified Practitioner, Dr. Ida P. Rolf Method of Structural Integration
pain, muscular hypertonicity, contracture, neuro-muscular, sensory-motor amnesia, sensory-motor learning, Trauma Reflex, pandicular response, muscle-movement memory
Perhaps fifty-percent of cases of chronic pain results not from tissue damage or disease but from chronic muscular contractions maintained by sub-cortical levels of the central nervous system (CNS). In many cases, neuromuscular training (i.e., somatic education) can restore voluntary muscular control, end chronic muscular hypertonicity and eliminate the need for drugs or therapy to alleviate pain.
This essay contrasts manipulative and pharmacological methods of pain-control with learning-based methods, using the analogy of "hardware" (living tissue) and "software" (brain-mediated, learned responses); it explains how muscular hypertonicity creates a variety of chronic pain conditions; and it introduces the clinical use of the pandicular response as a way to improve voluntary muscular control and relieve pain.
While the prospect of eliminating pain via a learning process may seem hopeful, at best, a large percentage of chronic pain arises from maladaptive physiological conditioning that can be reversed through sensory-motor learning. The brain, largely an organ of learning, controls most motor behavior. We humans learn nearly all of our movement patterns, except for certain primitive reflexes. For that reason, certain forms of neuromuscular education can, in many cases, provide faster and more complete recovery from musculo-skeletal dysfunctions than can conventional therapeutic methods, alone.
Pain of neuromuscular origin includes tension headaches, low back pain, regional muscular illnesses and TMJ syndrome. It also includes much of the pain of whiplash injuries, arthritis and other joint pain. Post-surgical pain, the chronic pains and stiffness of aging, and spasm- induced nerve impingement conditions such as sciatica, carpal tunnel syndrome, and thoracic outlet syndrome also arise from neuromuscular origins.
Somatic Education cannot replace therapies appropriate for tissue healing; nor can it erase the pain of tissue damage (though it can often reduce it by relieving mechanical stresses on injured tissue). It can , however, provide the relief otherwise sought through analgesics, muscle relaxants, stretching, strengthening exercises, and massage. Moreover, certain forms of somatic education can bring relief faster and more completely than these other methods.
Claims to relieve such a wide variety of conditions through sensory-motor learning -- or to get functional improvements, rather than merely symptomatic relief -- may seem exaggerated; that possibility is understandable. A closer look at actual mechanisms can clarify the matter.
Most methods of pain control can be reduced to three basic approaches that correspond to the three embryonic germ layers: ectoderm (nervous system/electrical), mesoderm (connective tissues/mechanical) and endoderm (glandular/chemical). For example, herbs and drugs (e.g., muscle relaxants and analgesics) address the chemical/endodermal aspect; skeletal adjustments and surgery address the mechanical/mesodermal aspect, and biofeedback, acupuncture, and electrical stimulation address the electrical/ectodermal aspect --to affect the other two aspects.
Most methods of pain-control treat pain as an electrical (neurological), chemical (dietary/hormonal), or mechanical (musculo-skeletal) problem that must be corrected through intervention; something must be done to the patient to correct the problem because he or she seems unable to correct it by him- or herself. However, the functioning of these three aspects of our living organism is controlled largely by our conditioning and voluntary learning. Functional problems also arise from our conditioning and learning. Let's consider how that may be so.
MECHANISMS OF MUSCULAR HYPERTONICITY AND PAIN
The human brain is, primarily, an organ of learning -- of learning to distinguish one thing from another (to sense) and to move in coordinated ways. (This simplification can easily be extended to include physiological responses, such as breathing and heart rate -- but such considerations are beyond the immediate scope of this discussion about pain.)
The brain, as an organ of learning, acquires patterns of response over a lifetime, some of which persist beyond their useful term (such as guarding after injury) and produce the wide variety of problems named earlier. Such conditions are not merely psychological, but psycho-physical states; they are the effects of life-level learning on physiological adaptation. The works of Hans Selye (Selye, 1974, 1978) document such effects.
Chronic contraction occurs under three basic conditions: injury, insult, and repetitive conditioning, all of which lead to habituations of neuromuscular activity. In the following discussion, I exclude contractures that result from nerve damage.
With injury, a person tenses and restricts movement to avoid pain and to permit healing. This psycho-physiological behavior (and postural reflex) known as the "Trauma Reflex" (Hanna, 1988), which occurs at an involuntary level, guards against further injury and permits healing over the long term. Habituation can occur instantly in the case of injury or even intensely shocking events (e.g., whiplash injuries).
For many people, the insult of an injury persists far beyond the time of healing. This persistence happens when a person tightens in Trauma Reflex during a long period of healing, during which time the brain learns a "tension habit" and the sensation of muscular tension moves from "foreground" to "background". In that case, not only are the muscles contracted, but the CNS is potentiated (i.e., tends) to contract them further at the first signs of stress and to release them last, when the stressful situation is past. Thus, the insult of long-past injury can predispose a person to mysterious crises of pain from seemingly unrelated causes. Such pain may then be mis-diagnosed as arising from tissue damage or from genetic malformation, sometimes with unnecessary surgical consequences.
One can often see habituated Trauma Reflex as a postural distortion; the person can feel it as pain, stiffness, and sometimes, as unstable balance. In all cases, habituated contraction prevents relaxation past a certain point; residual tension remains, often enough to create soreness or stiffness, and other physiological effects.
With intense insult or long-term emotional stress, hypertonicity may develop over time in response to numerous conditions to which the person responds by getting tense: money or relationship problems, fear of loss of employment, or from a sudden shock (e.g., automobile accident), apart from physical injury. In such cases, the Startle Reflex, another postural reflex, recognizable as cringing, is involved and has become habituated (and potentiated).
Finally, under long-term conditions that involve repetitive motions or that require prolonged vigilance and performance, tension of the involved muscle groups often becomes habituated. Such habituation accounts for most cases of back trouble, which involves excessive tonus of the spinal extensors, which contract during arousal into heightened vigilance. (The name for this latter response is "The Landau Reaction".)
Though hypertonicity may result from pain, it also generates pain: muscles get chronically sore, joints get over-compressed and degenerate over time, and nerves get trapped either within the soft tissue at the site of contracture or at neighboring bony prominences. So where pain may have begun from injury, it often continues long beyond the time of injury; ordinary functional responses, when habituated, become a pain problem.
Whereas clinicians refer to the muscular evidence of habituation as a contracture or as spasticity and treat it as a muscular problem, somatic educators call the condition, "sensory-motor amnesia" (Hanna, 1988), and treat it as a learned condition that can be dispelled through sensory- motor learning.
My central point is this: the brain controls the musculature, and learning, to a large extent, modifies brain functioning. And we can control our learning. The big, gaping question, "How can learning relieve pain?" is answered "By learning better voluntary control of the involved muscles." A person can break the tension-habit underlying their pain. End the hypertonicity, end the pain. This method may require closer consideration to be appreciated.
RE-WRITING SENSORY-MOTOR 'SOFTWARE'
Let's begin with an analogy: you know that a computer system consists of two elements: hardware and software. The physical computer, which is essentially a memory device, is the hardware; what makes the computer able to function in useful ways is a set of memories and instructions -- "software".
Computers and human beings have certain similarities (one being derived from the perceptual/conceptual framework of the other). A computer consists of a central, electronic "brain" connected to peripheral devices, such as a monitor screen, printer, or other robotic devices -- something like a neuro-musculo-skeletal system. Our body is our "hardware" and our memories and skills are our "software."
We humans learn nearly all of our movement skills rather than being born with them. Even our walking and eating patterns bear the stamp of our learning, our skill in movement, and our restrictions to movement. We also learn nearly all of our perceptual abilities, filtered as they are by our interests and beliefs as to what is important.
Once learned, our software/conditioning predisposes us to a way of doing things, subject to self-correction according to the situation (fine tuning). For example, people tend to have a recognizable postural set; this postural set reveals a muscular tension pattern maintained, for the most part, without much sensory awareness. People get set in their ways. The recognizable, stooped posture and stiffness of an "older" person form in this way.
A person could, with persistent practice, gradually improve their muscular control through "trial, error, and self-correction." However, few people possess sufficient discipline or understanding of how to do so. Fortunately, such learning can be systematically accelerated and enhanced by a variety of neuromuscular education techniques, each with its own special virtues and degree of effectiveness. Some examples include Proprioceptive Neuromuscular Facilitation (PNF), Feldenkrais Somatic (formerly "Functional") Integration, Trager Psycho-physical Integration, muscle-energy techniques, Hanna Somatic Education, and biofeedback training. The key difference of these methods from manipulative therapies is that they improve the ability to sense the body more clearly and to control the tensions of muscular system. They provide a missing link in the treatment of pain of neuromuscular origin, which otherwise tends to be chronic and refractory.
In many of these systems, a client/patient can be taught to rehearse appropriate movement patterns on a frequent basis -- as a part of their regular grooming/exercise regimen -- to erase the cumulative tensions of daily life. Thus, the educational nature of these approaches empowers the client/patient to become self-sufficient.
PAIN CONTROL BY USING THE PANDICULAR RESPONSE
Genetically encoded into the neuro-muscular software of every vertebrate's brain is a response whose function is to refresh sensory awareness and to bring about relaxation. It is triggered by the feeling of stiffness and fatigue, and also occurs spontaneously as part of awakening from sleep. This response, known as "the pandicular response", consists of a strong, steady, voluntary contraction followed by relaxation and movement. Most people have seen that response in action: the "stretching" of cats, dogs, and children upon arising from sleep. Astute observers of bird behavior have observed this response as "wing and leg stretching". Yawning, laughter, and orgasm are specialized versions of this response. It is part of the "operating system" by which vertebrates maintain flexibility and health.
The pandicular response can be triggered voluntarily to relax muscular hypertonicity -- and it can be assisted and enhanced to bring about unusually rapid sensory-motor learning and relief from muscular hypertonicity and pain. To date, one system of neuro-muscular re-education is known to use the pandicular response: Hanna Somatic Education.
A broad spectrum of chronic pain conditions results from muscular hypertonicity and can be resolved through sensory-motor learning (somatic education). Numerous approaches to somatic education exist; the methods of one, in particular, Hanna Somatic Education, systematically uses the pandicular response to speed the learning process. Once the tension-habit in the involved neuromuscular region is broken, the associated complaint tends not to return. Tensions that accumulate in daily life can thereafter be managed by the client, and further problems, prevented. Thus, somatic education can resolve pain and leave the client able to maintain their own comfort.
I pay my respect to the late Thomas Hanna, Ph.D., whose writings and personal instruction provided a structure for my personal somatic explorations and for my work with others.
Hanna, Thomas L. Somatics: Re-Awakening the Mind's Control of Movement, Flexibility, and Health. Reading, MA: Addison-Wesley, 1988
Selye, Hans. The Stress of Life. New York: McGraw-Hill, 1978
Selye, Hans. Stress Without Distress. Philadelphia: Lippincott, 1974.