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Treatment Work

Proprioception, Muscle Memory and Unwinding

I’ve posted about some of this in the past but it wouldn’t hurt to reiterate and elaborate because it is absolutely critical for successfully treating long-term, chronic, conditions.

For those of you with anatomy/physiology/kinesiology training, consider this a refresher or just skip over it. For those of you without that training, however, here comes some basic A&P, followed by the significance of it.

There are cells in the body called proprioceptors that act like biological gyroscopes. They detect joint and muscle activity, help orient the body in space, and along with the inner ear, assist in maintaining balance. They are located in clusters, primarily in the joints. One type is spindle cells. Their function is to signal a contraction response whenever a muscle is excessively stretched or lengthened. Another type is called Golgi tendon, which performs the opposite response. These signal a relaxation response whenever excessive tension or contraction is detected. Most of the time, they function to prevent trauma or injury. They signal the appropriate reactive response to stop the body from doing whatever it is doing at the time, before it goes past the safe point and hurts itself.

There are obviously times, however, when an injury does occur. As one example, assume you are hiking down a steep trail and slip. You reach out and hook your arm around a tree to break your fall. Further assume that in doing so, your shoulder is violently wrenched posteriorly, excessively stretching your rotator cuff muscles, or even tearing the tendons.

Your body, your muscles, will remember that action and resulting injury. Even after the muscle tendons themselves have actually healed, the spindle cells in the rotator cuff tendons will automatically contract anytime your shoulder approaches the position it was in when the initial injury occurred. This is “muscle memory.” It is also commonly referred to as muscle guarding. The body does not like pain, it remembers, and it triggers that automatic response to avoid a subsequent injury. The end result is a dysfunctional joint.

One of the basic precepts of physical therapy rehabilitation or treatment oriented massage therapy is passive range of motion. The body, the muscles, must be retrained to remember that it is now safe to move past that “sticking” point. This is accomplished by the therapist passively moving the affected limb or joint through the necessary action or range of motion. This is primarily true for the chronic stage (there are other issues involved in the acute stage of injury that must also be addressed).

The tree example is one which would be fairly straight-forward in treating. Other situations are anything but straight-forward. Instead of hiking down a steep trail, now assume someone was in a violent, roll-over, automobile accident. Further assume they were not wearing their seat belt. Visualize their body being wrenched and tossed in multiple directions with severe force. There is a limit as to how successfully ANY therapist will be able to treat chronic dysfunctions arising from this scenario if they limit themselves to or are limited by standard treatment protocols.

Full, complete, healing REQUIRES that the body be put back into the position it was in when the injury occurred. For simple scenarios, this can be done with the aid or assistance of a therapist. More complex scenarios, however, require what is known as “unwinding.” The body itself does the unwinding. The therapist assists or facilitates, but does NOT do the actual unwinding; the body does that on its own. In the first place, there is no way that any therapist could even begin to visualize the necessary motions required. Secondly, there is no way that any therapist in their right mind would even attempt to put a body into the necessary positions.

Directly associated with this is the emotional or psychological “charge” that will almost certainly be attached to the physical muscle memory. Severe, chronic dysfunctions are notorious for disrupting lives at best and ruining them at worst. People can no longer perform activities as easily as in the past. They may even no longer be able to engage in activities at all, such as sports, ballet, or gymnastics that have much personal meaning and value to them. This reduced ability can have the same emotional impact as any form of grief or sense of loss.

The third component is compensatory postures to alleviate the pain and/or discomfort from the initial injury. Over time, these initial compensations become “set” in postural imbalances, causing their own succession of additional compensations.

Now multiply all of the above from a life-time of dysfunction causing traumas that have been inadequately evaluated, treated, or addressed. Instead of a single fall or auto accident, start with severe childhood physical abuse, such as being violently “yanked” by the arm when you are maybe six years old. Add to that several work related, over-use injuries. Throw in six or eight serious auto accidents between the ages of 18 and 50 for good measure, including a couple of rear-enders, a head-on, and two T-bones.

Far fetched? Not hardly. I just spent the last four days in Colorado doing extensive, intensive, treatment work with someone. The “history” I outlined above was not hypothetical. It was just a piece of the total picture I have been dealing with the last few days. More importantly, this is not an exceptional example. Where long-term, chronic, dysfunction is involved, this is the typical situation. It is not the exception; it is the norm.

How in the world, you now ask, can anyone even begin to treat this kind of situation? If you know what you are doing, it’s easy. If you don’t, it’s impossible. And even if you do know what you are doing, if you are locked into (or handcuffed by) the typical 30-45-60 minute traditional time slot model, even the best of knowledge, training, and intention will more often than not be doomed to failure from the start. Why? Because the body layers compensations and dysfunctions and removing them must be done in the same way as losing weight – in reverse order. It is impossible to “spot reduce.” You can’t just target a specific area, such as stomach, hips, or jowls. You take off weight or reduce in the reverse order in which the pounds went on in the first place: last on, first off.

Treatment work must be done in the same manner. You peel away the layers of compensating dysfunction like peeling an onion. And you must go all the way back to the first trauma. You break the chain, one link at a time. The traditional treatment model is symptom driven, focusing on the pain that is screaming the loudest at the time of treatment. The last link added is the one that gets treated. The problem is that all too frequently, that is all that gets treated. If the symptom of the day is simply the end result of an underlying compensation, the symptom WILL come back unless and until that underlying compensation is also treated. If the individual (person being treated) is lucky, the therapist will be able to work back two or three layers in a session and eventually over enough time or sessions get back to the underlying cause(s). At best, this is time consuming. At worst, it is a never ending cycle of constant repetition with no long-term gain. But it can be done. Doing so, however, requires a thorough understanding on the part of the therapist of the role that underlying compensations play in structural dysfunction and the various inter-relationships of muscles and fascia.

So just what IS an “unwinding?” It is exactly what it sounds like. The body puts itself back into the position it was in that caused the initial trauma or injury. It literally goes through whatever gyrations or contortions were involved. Putting it mildly, these are sometimes quite dramatic to watch. It is neither our role nor our right as practitioners/therapists to deliberately induce an unwinding, although that can be done. When the body is ready, it will do so on its own. Our role is simply to facilitate and support the process. One of the most important aspects of that support function is to assure that the client does not cause further injury to themselves while the unwinding is occurring. I do not mean by this that the unwinding itself will cause additional harm because it won’t. I am referring to things like supporting the body so it doesn’t fall off the table. It is also important to allow the unwinding to progress at its own pace until conclusion.

Assuming that the therapist does have that necessary understanding, how does the therapist know the precise order to follow? The therapist doesn’t, but the body being worked on does. And THAT is one of the real beauties of working energetically. By combining knowledge and technique with energy and intention, it is possible to peel away those layers of dysfunction to a degree that traditional approaches can’t even come close to approximating.

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