Full Circle

You don’t even need to leave your room, just sit at your table and wait.
Don’t even wait, just listen. Be quiet, be still, be solitary. The world
will offer itself to you, to be unmasked, it has no choice.
It will roll in ecstasy at your feet.
Franz Kafka

art_forest1In my physical therapy practice I get my best results with spinal pain patients when I do nothing. I follow the Taoist precept of “Wu Wei”. I’ve learned that the most effective strategy to help my patients is to get out of their way and allow them to move in an unconscious, instinctive manner. This unique kind of movement is an incredibly powerful means of pain resolution. This method of patient care, although very effective and rewarding, has left me isolated from my peers.

I now realize that my Tai Chi practice was instrumental in planting the “seeds” that made me receptive to this philosophy of care. It kept me on track throughout the years, in spite of the isolation.

A typical treatment session may start with a patient in a comfortable position either sitting, standing or lying. I gently place my hands on the patient’s head and wait. Usually after a few seconds, I start to perceive some movement, often before the patient does. I maintain gentle contact and follow the motion. As it grows larger and more evident the head may rotate, side bend, flex , extend or combinations of these. As movement becomes more pronounced, other parts of the body may come in to play. I do not guide or coerce. The movement arises spontaneously. It is always there, largely held in check, unrecognized. My hands give it permission to emerge, as well as providing the patient with feedback.

Often times as a result of this motion, pain is dramatically reduced and mobility is significantly improved. Patients are amazed at how they spontaneously move into positions that proved extremely painful when volition was involved. Dramatic changes often occur in a matter of minutes.

Suffering chronic pain can be likened to being lost in a dark, wooded forest. The sufferer tries to find the path out of the forest, but keeps bumping into trees because of the darkness. The result is continual pain. There are times when he/she is able to navigate part of the forest. The pain temporarily lessens. Perhaps it’s a weekend with less stress, or it may occur while engaging in an enjoyable creative activity. These are instances when bits of this unconscious movement may emerge, not visible, but definitely there. The therapist’s hands do not push the patient out of the forest. The hands provide the light necessary for the patient to see the path out. Each person has their own path. No two people will respond in the same manner.

The spontaneous motion that emerges from the patient was first described in the medical literature in 1852. It is known as ideomotor movement—unconscious movement that is associated with a thought or thoughts. “Psychics” are very skillful at observing this in their clients during a “cold” reading. They are alert for subtle unconscious clues from the client in response to broad open ended questions. It could be a change in breathing pattern, a blinking of the eye, a twitch, etc. The client is unaware, but the psychic uses this information to his/her advantage. Eventually the client unwittingly gives the psychic vital information.

The poker “tell” is another example. Expert players are very skilled at observing the unconscious “body language” of their opponents to determine whether or not they are bluffing. The experts in turn will take their own precautions—consciously limiting movement, wearing sun glasses to hide facial expressions, etc.

The “Amazing Kreskin”, a well known “mentalist” makes use of ideomotor movement to aid his “mind reading” act. Prior to the beginning of a performance he will ask his host to hide a check, his fee for the show. He forfeits payment if he cannot find the check. Later in the performance Kreskin and the host will hold a handkerchief stretched tautly between them. Kreskin then proceeds to lead the host to the hidden check. In actuality, the host is leading Kreskin. Kreskin is able to feel his host’s muscle intentions(ideomotion) through the taut handkerchief. It is a kinesthetic version of the hot/cold game that many of us played as youngsters.

Ideomotion is not only associated with our thoughts, but also serves the purpose of correction, reducing the mechanical stresses on pain sensitive structures in the body. Spontaneous fidgeting, stretching, bending, twisting, etc in response to pain are examples of ideomotion. These maneuvers aren’t planned. They emerge spontaneously as the result of the need to move for pain relief. Sadly the phenomenon of ideomotion remains ignored by the mainstream physical therapy community. Therapists view the problem of pain as a “hardware” malfunction; hence the reliance on externally applied coercive force, ie manipulation, stretching, strengthening, etc. to “fix” the problem. I’ve come to realize that the problem lies in faulty “software”. By means of gentle, non- threatening touch, the patient’s “software” can change, facilitating the emergence of instinctive, corrective movement—ideomotion.

One of the primary tenets of the internal arts is to blend with the adversary’s force. This leads to the opponent defeating him/herself. When I blend with my patients, they heal themselves. My Tai Chi practice reframed my thinking and body sense. It gave me a new appreciation for what could be accomplished by calming body and mind. Push hands, in particular was very instructive—it brought the point home. The more relaxed and “sensitive” I became, the easier it was to find my partner’s center. When I became too “enthusiastic” I usually found myself airborne. These instances served as valuable lessons about patience and ego. The lessons are repeated again and again in my daily physical therapy practice.

One of Nigel Sutton’s most influential teachers, Koh Ah Tee, writes, “In real taijiquan you receive, you don’t go out looking” “If you have a preconceived notion of what you are going to do to an opponent, then you are not doing taijiquan.” “In pushing hands, follow your opponent. Never pull him or interfere with his movement. Just follow with a light touch and an empty mind.” These passages succinctly mirror the principles of the manual care that I practice. When I touch a patient, I have no idea of how and which way they will move. I listen, adhere and follow. I do my best to get out of their way. I’ve always wanted to express gratitude to my Tai Chi instructor for planting the “seeds”. The opportunity presented itself when he came to New York to give a push hands workshop. One of the attendees was also physical therapist. During a break, we talked shop. I gave him a brief demonstration of my work. My instructor seemed interested, and I was eager to explain the similarity to Tai Chi principles. Much to my delight and surprise he asked me to treat his neck. He recently developed some problems, which he attributed to a worsening arthritic hip that forced his body to make major adaptations. He believed that his neck was compensating for these changes.

I gently placed my hands on his temples. Within a few seconds his head began to move. I followed his motion. The time spent was brief, the break came to an end. The next morning, before the class began, he asked me to resume the treatment. He told me that during the previous evening after the first session, he felt some ‘new’ activity in his neck. I didn’t exactly know what this meant, but I was glad to oblige.

It was time to resume class. After everyone paired off, he went from group to group, commenting, admonishing, touching, correcting. When he finally came to me, his first comment was “relax, relax”—nothing new for me. Then he said, “Relax—like you were when you were treating me”. He really understood. At that moment I felt that I had come full circle.

Gary Shapiro, married with two children, and is a former USAF navigator. He has been practicing Taiji for as long as he’s been a physical therapist—about 25 yrs—and is interested in applying the practical aspects of Taiji to benefit those with which he works.

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