We enjoy the clinical anecdotes that pour into NOI, especially when they are repeated and can be related to modern thoughts about brain science.
The wife of a dear friend, (let’s call him Seamus) wrote in about his ongoing arm pain following an accident where he was hit by a car.
“In the first year after the accident we were watching the British Open on TV… you know the usual suspects McIlroy, Woods etc…..every time Phil Michelson stepped up to the tee and took out the big driver, Seamus’s shoulder would go into the involuntary spasm with little /no warning. It just lasted a few seconds and then it would take a while for the pain to subside. After that I wondered if when Tiger came to take the big driver out of the bag would it happen again?….but nothing happened. Over the day while watching the golf it happened four more times but not with each drive off the tee. Then it hit me…. Phil Michelson is a leftie, and Seamus’s injury is on his left side. Presumably, every time he watched the leftie drive especially with the wood, his brain felt the threat and acted in his defense.?”
In further emails, the story gets even more interesting.
“Just recently Seamus mentioned to me that he doesn’t like sitting with a stranger on his left side , or even if it is someone he knows he has to move away and place his chair at an angle to them. If he is on public transport and he has to sit with someone on his left, his shoulder goes into involuntary spasm and he can feel it building up before it wallops him”.
Lastly he said to me “you are the only one who can sit on my left and it doesn’t happen”.
Well I guess that must be true love though a rather dramatic way of testing it! This is all about the notion of the space surrounding us coded variably into our neurosignatures. But rather than just thinking “that’s fascinating” as we did with phantom pains for decades, I am hoping readers can make suggestions for possible operant processes here as well as make suggestions for help, based on this clinical data. It all helps our work with graded motor imagery.
David Butler
www.noigroup.com
Interesting! Working with some of my client’s with CRPS they find that if they have to sit to stand from a chair and the chair is beside a wall so the limb (that they attribute the pain state to) is facing in to the room that they are unable to stand and yet turning the chair 180 degrees (or moving the chair across the room to the opposite wall) will change the visual processing contribution signficantly enough to allow the sit to stand movement to be expressed. Biomechanically in terms of force the movement is the same but at a processing level it’s different.
One fo my clients has practiced doing a sit to stand and progressively moving the chair from one wall (safe/able to move) incremently across the room until they were finally able to sit to stand when the chair was at the opposite (unsafe/unable to previously move) wall. Another client progressively rotated the chair from ‘safe’ wall/room combo through increments of positioning and able to express sit to stand until they’d gone through the 180 degrees and oriented to ‘unsafe’ wall/room postion (same wall but just on the other side of them). And another client found they could sit beside the ‘unsafe’ wall/room and as long as they turned their head 90 degrees to look over their shoulder at the room they were able to sit to stand and then practiced doing so until they had incremently brought their head to neutral. This is through a process of trial and error with each one
I wonder if ‘Seamus’ progressively sitting/standing so that he can actively incremently ‘lateralises’ people until they are on the ‘safe’ boundary of his visual field (so he is the active decider of where they are relative to him instead of the inverse relationship) would help or if he is ‘forced’ to sit with someone to his left in public he turned his head (as if to look out the window or even to strike up conversations with the ‘stranger’) so that he more centralises them in his visual field?
Starting point for Seamus; may benefit from doing head/neck/upper limb laterality assessment / programme (as well as maybe doing a bit of falling in love with Michelson & his left arm swing; plenty more golf watching with some education about afferent / efferent sensory / motor processing and pain multi system outputs) to see if that spasm can settle down 🙂
Juicy.
Sent from my iPhone
Interesting case, I once heard a similar story about a woman who experienced intense pain anytime she turned to the left.
First off, I should say that Phil Mickelson is one of the most maddeningly inconsistent players in golf. I think I’ve experienced a few involuntary twitches myself when watching him.
For Seamus, I would probably start with with simply having him spend a few minutes every day leaning to his left – keep watching golf, just maybe look away when Mickelson brings out the driver (he only hits the fairway half the time anyway…). It seems to me that his brain has begun to associate anything in the left side of his space as threatening (or neglecting it perhaps?), so doing anything to get his brain to recognize the left side of his environment as non-threatening should be a reasonable starting point. Have his wife sit on his left at the same time if it helps. Help networks associated with that map of space fire without triggering a pain tag.
Gradually increase the threat – have his wife AND a friend sit to his left. Spend a few minutes a day getting used to this. Gradually remove his wife from that side so he is just sitting next to someone else. If it is too much then allow him to set up at an angle – just enough so that he’s ok with it. Gradually shift the angle to the left as he gets more comfortable with it. When he’s ok with it in the safety of his own home, then go try sitting with a stranger to his left on the bus. Personally, I find buses a little frightening at the best of times, so maybe a park bench would be a better starting point.
As he gets better at differentiating between threatening and non-threatening inputs on the left side I think it would be a reasonable time to start some L/R recognition and progress to explicit motor imagery and then mirror therapy, although this may be reasonably started earlier in his recovery.
Reblogged this on CRPS UK.
Thanks for this input which has all been passed on. I am wondering how Seamus feels about falling in love with Phil!
David
Seamus here! Loved the blog “Love, Lefties, Golf and the Cortical Force Field” – and while I think I’m a long way from falling in love with Phil Mickelson, I have found the comments really interesting, and provide a new insight into my symptoms.
In particular, I think that I am subconsciously reacting to a threat on my left hand side almost all the time. I was at a meeting on Friday last, in a small room that could not possibly contain as many people as were attending. As a result, we were lined up against the walls like sardines, and I was closed in on my right and on my left, and I was aware that my left shoulder began twitching as if it wanted to escape. Interestingly, the greatest threat was to my right, in the form of a very senior surgeon in one of the Dublin teaching hospitals. He was a tutor of mine very briefly when I was a student: an unpredictable man, at times cold and impassive but also enormously fiery with students and nurses and anyone he felt to be subordinate to him – that is: everybody. As George Macdonald Fraser put it (talking about someone else of course): “One word sums him up: Bastard”.
So I have this geezer on my right; and on my left a young, humorous, intelligent and courteous Consultant in Emergency Medicine whom I have met on a few occasions and whose company I have enjoyed. And my left shoulder thinks it’s under attack?
I admit that there has been a lot of stress in my life in the last couple of years – what with a change in job, moving house, commuting to family, not to mention this recession that has slashed jobs, pensions and salaries in the public sector. I think that there may be a rising tide phenomenon in a general nervous system sensitised to a background level of stress that rises slowly, and kicks off the supersensitised local network in the neck and left shoulder.
There isn’t much that I can do about the background stress levels – but I realise that I have to teach the neural network on the left that I am not under constant threat of attack from that quarter. I found previously that exercise which stressed symmetrical movements of both arms was extremely beneficial: I was swimming for some time, and found that breaststroke was the perfect combination of symmetrical arm movement, and pulling the water aside being the equivalent of gentle weight training, but without the complication of gravity.
Knowing what you have to do is one thing; doing it quite another. Setting aside time to do the recognition exercises, or to take up swimming or pilates means that some other aspect of daily family life has to be put down the priority ladder. But I learnt this evening that my pain is not just affecting me: my gorgeous wife admitted that she is also living under the shadow of this “thing” that has steered me away permanently from certain activities, made other household activities extremely problematic (emptying the dishwasher – ouch!) and meant that I couldn’t do simple, but vitally important things like lifting the kids, or sticking them on my shoulders when going for a walk, or tumbling down sand dunes, or go horse-riding with them.
They are too big to lift onto my shoulders now, but I have my mind set on a certain juicy sand dune in Donegal, not to mention a beach in Kerry where you can take horses for a gallop. With thanks to yourself and your blog, with your contributors’ comments, with recognise, with education, and with getting back in the pool, I am hoping to be able to turn this “thing” around and relegate it to a “thing” of the past.
Seamus
Still not sure about Phil Mickelson, though …