Practical Science on Movement and Pain
Practical Science on Movement and Pain
This post is a little philosophical, so I will apologize in advance and keep it mercifully short.
There are many ideas in manual therapy. Some are good, some are not so good. The subject of this post is ideas that are very obviously not good, but for some reason attractive, even in the face of good evidence of their wrongness.
These ideas seem to pop up everywhere, in different therapies that have different origins, like a weed that grows in any garden and always needs to be pulled. I will group these weeds into two basic patterns of thinking, and then reveal a deep philosophical connection between them. Try to control your excitement!
The first pattern is thinking of the body as a mindless piece of meat, while ignoring the brain’s role in giving the body all the qualities we actually care about, like how it moves and feels. This leads to treatment approaches that ignore the nervous system and focus exclusively on issues in the tissues. Eyal Lederman calls this the “postural structural model.” Paul Ingraham calls it structuralism, and Diane Jacobs calls it mesodermalism. I sometimes call it “all hardware no software.” Many physical therapists have expressed a lot of frustration that education for PTs remains mired in structuralism, and fails to incorporate new and interesting information from neuroscience and pain science.
A second common belief that is resistant to conflicting evidence (especially among massage therapists) is that clients can be treated with “energy” work. There are many different forms of this idea, but all embrace the philosophy of vitalism – the idea there is some essential force or energy (chi, prana, elan vital, the breath of life) that is unique to life, and that can be manipulated by a therapist to optimize health.
The belief in vital energy persists even in the face of massive evidence against its existence. Despite hundreds of years of looking, vital energy has never been discovered. And its discovery would be the most profound and shocking development in the history of science, requiring a major overhaul of physics, chemistry and biology. But this stuff is routinely taught at massage schools, alternative medicine schools, and even universities.
I have always wondered whether the tendency to think in structuralist or vitalist terms is due to some deep seated bias built into our thinking. So I was very excited to read a great quote the other day by Paul Bloom that helps explain the prevalence of both patterns of flawed thinking in one sentence.
Bloom’s quote is from this article, where he is attempting to explain why humans are very predisposed to create magical or supernatural explanations for observed phenomena.
According to Bloom, humans evolved separate cognitive mechanisms for understanding the physical behavior of inanimate objects, and the intentional acts of agents such as animals or humans. So humans have a built in hardwired intuitive sense of physics, and a completely separate intuitive sense of psychology:
[T]he separateness of these two mechanisms, one for understanding the physical world and one for understanding the social world, gives rise to a duality of experience. We experience the world of material things as separate from the world of goals and desires. The biggest consequence has to do with the way we think of ourselves and others. We are dualists; it seems intuitively obvious that a physical body and a conscious entity—a mind or soul—are genuinely distinct. We don’t feel that we are our bodies. Rather, we feel that we occupy them, we possess them, we own them.
And this means that:
we perceive the world of objects as essentially separate from the world of minds, making it possible for us to envision soulless bodies and bodiless souls.
This is a great description of why vitalism and structuralism are two sides of the same dualistic coin. Vitalism is essentially the belief in a “bodiless soul”: an animating force that exists outside the physical realm and is not reducible to it. And structuralism is the metaphorical flip side of the coin – the tendency to treat the body as a physical object, as opposed to an intelligent agent with feelings, thoughts and intentions.
For example, if we place our attention on correcting the biomechanics of a certain joint, we necessarily activate our intuitive sense of physics, which will tend to forget that the foot is animated by intelligence and intention. In this frame of mind, joint stiffness is the simple consequence of physically tight muscles, as opposed to an intelligent decision by the nervous system to protect the joint from perceived threat related to movement.
On the other side of the coin, when we place our attention on correcting the client’s conscious experience of suffering, we can’t help but activate our intuitive sense of psychology, which imagines a realm that is nonmaterial and outside the laws of physics. This frame of mind ignores neuroscience, which understands that conscious states are not determined by nonmaterial energies, but very real physical states of the brain, which can be predictably altered by subtle inputs.
You know what I like about Bloom’s way of looking at things? Both patterns of flawed thinking are cured by studying neuroscience and pain science. I think the reason we find these subjects so confusing, fascinating and illuminating is that they provide a way to understand how body is linked to mind, how psychology relates to physics, and to correct our natural tendency towards cognitive errors related to dualism.
There is a lot more I am tempted to say here, but I promised I would make this short, so I will leave it at that.
What do you think? Leave a comment and let me know. (But I reserve the right to not follow any comments that go too deep.)
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