Had a tough case lately. She's had tightness/stiffness/soreness for six years, no particular incident that started it, used to be a runner and so on, can't now, has been everywhere and seen everyone for everything, including IMS. Nada. No help. This was her 3rd visit to see me. Last time I saw her I did a great job on her leg, pain all gone, taped her here and there, she left in a relatively painfree state, but the next visit she came in and said, it started hurting again as I walked down the street.
I thought to myself, gosh, how adverse can a nervous system be tensioned (i.e., how much arbitarily fluctuating pain can someone endure) and the person still be coping with life?
We started with simple contact/simple continuous movement for a good ten minutes or so; after, I asked her, so how did that feel, how do you feel, and she gave me the WESS answers (warming, effortless, surprising, softening) but she seemed oddly unenthusiastic for some reason. It was apparent to me that even though her body had responded, and her brain, she hadn't. In fact she seemed defeated. She said she felt sad. She, her sense of self, wasn't getting any joy out of having moved so easily and restoratively.
So I switched hats a bit.
While she lay face up and I handled her neck, we chatted, and I asked her why she felt sad.. she said she felt she couldn't do this sort of movement, that she felt obliged to prevent herself doing it.
I won't relate the entire story, but it turns out she's had lots of cognitive therapy, but nothing that ever helped her be in her body before. She has apparently been trying to embody 'the big split' for a very long time. It is being maintained, of course, by her practice of taking her body off to see body people and her mind off to see mind people. She said she felt driven by a big inner cop who is always teling her to move along, move along, and a sense of fear, so that she actually feels safer if she never relaxes.
I talked to her a bit about culture and how if we let it, it will impose itself on our bodies.
I told her my little vision of the body, how it's the only sovereign bit of ourselves we really have, that we can't afford to let culture interfere with our relationship to our inner ecosystem. I went on for awhile about the right we have to exist however "we" want, at least part of the time, "we" referring not to some constructed idea we have of ourselves and how we think we should want to move, but rather letting 'the inner creature' move us instead.
I told her about how evolution has never thrown away anything that proves useful; about how non-monolithic our brain is, how it is comprised of bits of all these different creatures and nervous systems we've evolved through, how we can let those parts move us, how we can develop a new relationship to them, how important they are, how they've been around for a great deal longer than we have had human layers patched in, how they keep us alive by making sure our breath and heart beat and digestion take place, how those parts of our brain share our bodies with the human bits, and we could do worse than to let them have a chance to stretch our bodies for us.
I suggested that she has full right to take control away from the inner robocop (culture) and give it back to herself (her body and brain). That is wasn't only her right, it was a duty too.
It turned into a discussion of what individuation means, what it could accomplish. I asked her if she'd ever read anything about Jung and depth psychology, all the inner characters that our culture imposes on us and that we have to come to terms with to be "free" in ourselves. To me, "free" means even-tensioned, not too much, not too little; it means taking up our space, taking back our right to co-exist with existance itself, both culturally (broadly speaking, emotionally and interpersonally) and physically (emotionally and intrapersonally).
By the end of the session she could see the point of practicing some loose, unchoreographed, pleasurable, ideomotor movement every day, not just for the physical feel good side of it, the reoxygenation of her peripheral nervous system, the stress release, but also as a symbolic act of taking back her Self, dancing for a few minutes a day with the idea that she didn't need to suffer with the pain of too much tension, extracting herself gradually from this trap, this illusory prison in her mind that projected itself out onto her body, caging her in much too small and much too painful a space. I reminded her that every second of her life, ten million of her body cells died and ten million new innocent ones were born, who knew nothing about inner cops. That these new cells would give her a fresh start if she allowed them to experience a few minutes of movement freedom daily. That she could build a sense of freedom of movement in to herSelf and into all these cells and their existance, in just a a few minutes of practice every day.
At the end of our session together she seemed a lot less sad about the idea and more animated, enthused. I have no idea if she will be able to follow through, but we made a "therapeutic contract" where she promised me she would do a bit every day, and would report to me in a week's time, and we'd see where we were at. (I'll be the good cop on the outside, for awhile.)
I offer this little story as an example of how sometimes as physiotherapists we might need to provide a bit more in the way of therapeutic containment than merely a physical solution to an ostensibly physical pain problem. We must remain aware that however hard people may struggle to comply with outer expectations imposed by their context (in this case a therapeutic situation with a supposed physical therapist) there may well be gargantuan conflicts raging within them just below the surface, appearing as physical pain states. They may or not be aware of them: It isn't usually our place to reveal them to people.. in this case, I was lucky because this woman was already so aware of her own issues. Sometimes we are physical therapists, other times we have to shift focus slightly and become physical therapists.