Wednesday, June 13, 2012

Non-volitional movement

Yesterday I worked with a patient who has shoulder pain, longstanding for many many months, off work, attending a worker rehab program. He had surgery last summer, but the pain wasn't relieved. It's a gnawing kind of achy pain that just won't leave him be. I'm going to leave his details vague. What I want to describe is a treatment reaction he displayed.

I've treated him maybe a half dozen times, usually supine; he chats to me about this and that - bit of a worrywart, concerned about transitioning from 'worker' to 'disabled' label, is in his sixties, has worked hard all his life, etc.

Usually we manage to get the pain issue under control, but as soon as he goes back downstairs and starts working the program again, it returns.

Yesterday I asked him if he would like to lay prone instead. He agreed, and got up on the table face down, face in the face cradle, arms hanging freely at the sides of his body, comfortable everywhere. I put the bed way up and sat close to the floor on a little stool where I could comfortably treat his whole arm.

It was a lot more quiet in the room than usual. No chatting. He seemed to go immediately into some sort of nap mode.

I looked at his arms hanging down and noticed how they did not look to be hanging freely at all. The elbows couldn't relax, forearms couldn't dangle, hands looked hard and stiff.

I decided to start with the forearm.

All I did at first was put my hands on his forearm, slowly and gently. Twitches emerged, little ones. As I continued engaging with his arm, the hand movements became more fierce, like the movements cats and dogs often make with their legs as they lie dreaming.

I looked over to the other hand, and noticed it was moving the same way. It was like his motor system was dumping off a bunch of ballast it decided it didn't need. Kind of fascinating. I wondered if the patient was aware of any of this, but decided not to ask, to let him rest quietly. His hands moved at the wrists, fingers, mostly the thumbs. Twitch twitch twitch. His arm relaxed, softened. His hand felt less like beef jerky to me, and more like merely a jerky hand.

I worked with his nervous system this way for a good 45 minutes - it was a very very lively session indeed.

The patient was completely quiet the whole time. At the end, I asked him to sit up. He did, moved his shoulder around, announced his shoulder pain was gone. (He usually does, so I'll have to wait until I see him again next week to find out if it stayed away.) I asked him, what were you aware of during the session? He replied, nothing - I think I went to sleep. I told him that his arms and hands had both moved quite a bit throughout, and that it seemed like a good thing.

His immediate worry was, would it return as soon as he went back downstairs to start his exercise program again? I replied, you have as much time as you want - you can control the pace at which you do the schedule. Make sure it doesn't come back, by leaving enough space between the activities such that you can control the retaining of this new relief you feel. He said, But I can feel them watching me and expecting me to be able to do it. And I replied, Ah! but this is a great opportunity for you to realize that you can practice operating from a place inside yourself, and put up a boundary between the outside world, and you. You with your shoulder. Learn to be with it in a new way, from a new place.

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