THE ART OF SOMATIC EDUCATION

DEALING WITH AN ESSENTIAL LIFE SIGNAL:
HOW DO BODYWORK AND MEDITATION HELP PAIN?

Joe Lee Griffin, Ph.D.

Traditionally, western medicine regards pain as something to be fixed. A trained expert, like a doctor, diagnoses a reason for the pain and proposes a chemical or physical intervention to stop it. This process requires training, knowledge, and follow up, as powerful tools can have unpredicted or multiple effects. Pain may be seen as an enemy to be attacked, leading to rejection of body signals and body parts.

Another way of seeing pain is as a useful functional signal, just as pleasure is a useful functional signal. If pain is an essential life signal, we'd logically want the signal to be as clear as possible and would certainly not want to get rid of it. Of course, logic and emotion often disagree, as one of the simplest learning games can reveal: Pretend to touch a hot stove, draw back your hand, look at the imagined hurting area and say, "Thank you, pain." Notice.

Once, the day before I was to talk at a nurse's conference and lead learning games on pain-as-enemy / pain-as-signal, an oral surgeon dug into my upper jaw and nipped the root tip from an aching tooth. I decided this was a signal that I should use the methods I was to talk about and did not take the recommended pain killer. You may not be surprised to hear that I did not become enlightened, but just hurt and was mean and grumpy with my wife and kids. Luckily, I need not be perfect to be useful.

So long as we operate in bodies (The only way I know of to operate in this reality.), we do need pain signals to get our attention when we're injured or at risk. When we hurt, we want not to, but we'd be in trouble if we were really pain free. Imagine that you had to wait for the smell to know you're touching a hot stove. An occasional rare individual is truly free of pain. A recent TV news magazine featured a young girl who jumped from high places and ran around with broken bones in her legs. Those who don't feel pain get no direct signals of cuts, strains, breaks, or appendicitis.

Functionally, pain signals are most useful as a clear signal against a clean background. Against a ground of chronic pain, emergency signals are not as clear. As with other biologic reactions, pain signals are most useful within an appropriate middle range. Two other examples of the biologic midrange: First, we need enough adjustable muscle tension to balance, breathe, and do what we intend, not tension so low as to cause weakness or staying so high as to stress joints, tendons, and ligaments. Second, our inflammatory defenses need to respond appropriately to infection, not be too low (AIDS, boy in the bubble) or so high they attack our own tissue (colitis, myositis).

A reasonable goal for personal pain signals is that they be low or absent much of the time, yet available to tell us of hot stoves, breaks, strains, or infections.

A MODEL OF PAIN-RELATED CYCLES

Much felt pain includes secondary pain resulting from pain-fear-tension cycles. Indirect actions that shift elements of the pain-fear-tension cycle or the related positive cycle are often able to decrease felt pain signals. By the time pained clients get to a bodyworker, it may be that most of the pain is secondary or that what started the cycle no longer exists
Primary pain or signal pain causes reflex holding, a splinting of injured or threatened parts by tight muscles, an early shift toward secondary pain cycles.

This double cycle summarizes the many ways we can lower or raise pain signals. Decreasing tension or fear can improve pain, just as tension and fear go down when pain stops. The linked positive cycle shows why gentle, pleasurable, rhythmic movement within your window of comfort not only leads to more effective body use, but can also decrease pain signals.

Physiologic background and assumptions:
In health, pain is a signal that something needs attention. Chronic pain also signals something needing attention, even when a response to stop the signal can't be found.

Secondary pain involves local muscle spasms, which limit circulation as tight muscles mash blood capillaries, cause waste products to accumulate, and produce pain signals. Holding against pain tightens muscles to create more tension, pain, and fear.

In the body, lower motor neurons (nerve cells) in the spinal cord extend out to the muscles and control contraction. Unless they are stroked and relaxed by signals from upper motor neurons in the brain, lower motor neurons fire all the time, causing muscle contraction, rigidity, and loss of control. In stroke, for example, loss of upper motor neurons results in rigidity and loss of relaxation ability in affected body parts. Tetanus produces rigidity because the nerve endings from upper centers are poisoned by tetanus toxin.

Increased sensory signals (like those from touch or gentle movement) give information about the body to the upper motor neurons of the functional mind. This sensory information lets these control centers automatically balance needed tension and release unneeded tension. Blocks to taking in sensory signals from the body are added pain, fear, tension, trying hard, tight goals, pressure, and thinking instead of feeling.

Positive assumptions are pain as signal, pain as message, pain as tool, pain as accepted (even if disliked). A negative assumption is pain as enemy. Even excessive, unwanted, unneeded pain, if assumed to be an enemy, is fought against and the rejection of hurting body parts creates disconnection and limits healing. Because body feedback is so important, signals not listened to will get stronger, not a response we want with pain signals.

The Problem of Chronic Pain
How does pain becomes a constant presence, an overwhelming enemy rather than an appropriate signal? One model is that there are one or more specific areas where muscles and their controlling nerves have an abnormally high sensitivity. These areas, called facilitated segments, drop into pain-fear-tension cycles easily and quickly, a hair-trigger response. Such increased sensitivity can develop after a single event, like an accident, or gradually.

Suppose you hit your elbow and whack your funny bone. Usually, you'd hold and nurse your arm for a bit, then shake it off and go on. However, suppose you'd been unable to sleep, were deeply tired, your shoulder hurt, and your job was at maximum stress? Could such a "small" signal pull a hair trigger for major pain-fear-tension cycles, even chronic pain? If the snow is piled just right, can one snowball start an avalanche?

What causes such hair trigger responses? The history often starts from an injury or chronic stress and involves strong pain-fear-tension cycles. How can we change the story? By changing attitude or interpretation, by strengthening the positive cycle, and by adding different experiences and feelings to enlarge the available pool of positive body memories.

BENIGN INTERVENTION
Role of Somatic Education or Body Learning
Somatic education is directed at the nonconscious functional mind. The functional mind handles most physical actions for us, because body operation is so complex the conscious mind can't do it well. You may recall, when you learned to drive, that you were safe and competent only after driving became automatic and non-thinking.

Bodywork done so gently that it doesn't add to pain signals can increase awareness, improve comfort and acceptance, and allow relaxation, thereby decreasing pain, fear, and tension. If joints are inflamed or pain or fear is high, imaginary movement or simple listening touch without movement may improve circuits. The role of the bodyworker is not to diagnose causes, but to be present and listen and trust the client's ability to notice pleasant signals and feed the positive cycle.

I like success stories like the former athlete who came in unable to sit up with back pain. He said he felt better after a session of gentle movement with light rocking, didn't remember his back had been hurting when I saw him the next week. His pain was acute, but short term. More unusual was the response of a woman with upper back pain and spasms, six years after whiplash injury. After some seated bodywork, my wife grounded her shoulders and we connected energetically through her. She blanked briefly, started sweating, and released the pain and spasms. This was notable because rare. The usual learning experience in letting go of long term pain is gradual, bit by bit, with time for integration of changes.

As a Trager® tutor, coaching practitioners who deal with pain, certain principles come up over and over. Be calm, centered, meditative. Accept, trust. Create pleasurable sensations for clients if possible. If not, avoid pain, fear. Each move is just a way to listen. Be comfortable in and enjoy your own body as an example. Don't try hard, don't "fix." Remember that trying hard, tight goals, and forcing are felt and produce reflex resistance. Lately, we've even played with balloons to create body memories of support, bounce, easy movement, and playfulness.

I've heard estimates that over 200 forms of movement education / bodywork are now being practiced. Some better-known gentle forms of somatic education are qi gong, t'ai chi, yoga, Trager, Feldenkrais, Alexander, Craniosacral, Continuum, Network Chiropractic, and Zero Balancing. I've also enjoyed Orthobionomy, Rosen and Bowen work. Methods that create some pain can also shift pain circuits if the pain generated is regarded as a signal and not an insult to be tightened against. Acupuncture, myofascial trigger point work, acupressure, some forms of massage, and Rolfing seem to me to use pain as tool. Shealy, in the reference below, notes that he always tried acupuncture for new chronic pain patients, as one in five had significant immediate improvement.

Meditation
Ray Stephens and the other chaplains who started the Walter Reed Wellness Center routinely divided daily sessions into half physical awareness, breathing, stretching, etc. and half meditation with music or guided imagery. I was comfortable with the same division during the five and a half years I led sessions there. Of course, body learning games are most effective done from a meditative state and meditation can directly involve physical activity, so the separation between physical and mental approaches often blurred.

Meditation, including imagery and other awareness procedures, can help lower tension, increase awareness and acceptance, and decrease fear, changes that decrease pain. To choose to focus on a pain, rather than block, fear, or tighten against it, can, in itself, have positive effects.

Four books including meditative approaches to pain are listed below.

References
With the computer search Grateful Med, in 3 and a half years, '91 to mid-94, there were 207 English language books on pain (32 on back pain) and many more articles. Fortunately, fully-informed, expert analysis is the job of the client's physician.

From the hundreds available, an arbitrary selection of five books , the first recent, the last four with meditative approaches to elements of the pain-fear tension circuits.

"From Fatigued to Fantastic: A manual for moving beyond chronic fatigue and fibromyalgia," by Jacob Teitelbaum, MD., Penguin/Avery. A multiple factor approach, including movement reeducation with medical tests and treatments, by an internist.
Update, 2002-http://www.endfatigue.com

"The Pain Game" by C. Norman Shealy, MD. A classic by a neurosurgeon who gave up the knife to head one of the first chronic pain centers in US. Good imagery meditations under label biogenics, a good chapter on your chances with back surgery, more.

"Mind Over Back Pain" by John Sarno, MD. Awareness and confidence building to change attitude, a bit like group therapy.

"The Brilliant Function of Pain" by Milton Ward. Optimus Books, NY. Ph 212-753-7680. An eastern, yogic approach to empowerment by honoring signals.

"Who Dies? by Stephen Levine. One nice meditation visualizes a fist tight around pain and then gradually releases the fist to let the pain float without holding. More.

Note: This article describes an attempt to understand how people learn to feel better and decrease pain by changing secondary pain cycles. It is not medical advice. For medical problems, please consult your physician.
© 1996, J.L. Griffin

Joe Griffin is a retired Trager® practitioner, tutor, movement leader, and intro workshop leader, also retired from Walter Reed, where he was a research biologist.

This article was written for PATHWAYS Magazine, Summer, 1996.

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ADDED NOTES October 2013

Shealy’s The Pain Game was published in 1976. It remains a useful classic, particularly to anyone considering back surgery.

Teitelbaum, Pain Free 1-2-3, 2005. This second book by Teitelbaum is added in part because I worked in his office for a while with fibromyalgia patients. A detailed, analytical, medically based book. Flow charts in appendix.

Pete Egoscue with Roger Gittines, The Egoscue Method of Health Through Motion, 1992. A direct approach to structural balance and body use. Jack Nicklaus attributes his longevity as a pro golfer to use of this method. Athletes accustomed to drills may prefer the approach of this “anatomical functionalist.”

Scott Brady with William Proctor, Pain Free for Life. The 6-week cure for chronic pain—without surgery or drugs. 2006. Three groups of people Brady identifies as subject to “autonomic overload syndrome” are perfectionists, people-pleasers, and the fearful. Adds to work of Sarno, above. Some spiritual elements in letting go of pain circuits.

The largest health institution in the world is said to be devoted to qi gong, located in China. Qi gong for health, used for thousands of years, is referenced in The Yellow Emperor’s Classic on Chinese Medicine. (Older than two thousand years)