We all have a nervous system who is our boss and our buddy. One of it’s jobs, as an organ and part of the whole, is to protect us and alert us to danger. This is biologically advantageous, no doubt. We want some level of protection so we don’t ignore tissue and other damage. One way of protecting us is to limit movement in a predicted pain-causing manner, or to cause movement away from danger.
If you have too much vigilance, however, movements are stifled and restricted and life gets a little scary. The body environment becomes a little hostel while in this overly vigilant state. To illustrate this, let me paint an image for you…
The Metaphor: Under the appropriate vigilance, everything is peachy. Your willingness, free-ness in movement, muscles, etc can be represented as a child playing in the front yard. The neighborhood you live in can be your environment, internal or external. Now, your nervous system (whose job it is to protect you, your neighborhood, your child as they play) is represented as a police officer.
Now, under normal amounts of alertness we are free to go play and move and be loose and explore with the knowledge that the police are driving by and checking up on our neighborhood every now and again. S’all good, thanks nervous system!
Oh man!… now, due to history of events, an injury for example, we feel the need to protect ourselves even more now. We ramp up the alertness, the vigilance. ( Central Sensitization and allodynia come to mind here, although increases in protective behaviors are quite normal in acute pain as well.) This is equivalent to the SWAT team patrolling the neighborhood. So, while you may feel safe with the SWAT team or Nat’l Guard out front to protect you from a perceived threat, do you feel safe in your own yard? Would you let your child out front to play? (body, muscles, degrees of freedom) I think you would not.
Too much protection inhibits healing movements, can increase fears about movement and can give one the perception that the body needs more protecting. As I point out in my Motor Control Algorithm, some protective movement patterns are appropriate. We don’t need to cure normal here. Barrett Dorko puts it this way: Decide if the patient’s presentation is a Defense or a Defect. I love this idea in clinical reasoning. In this specific case, however, it is the defense that is the defect.
It is our job to identify these patients and attempt to understand their position and feelings of threat. (Example: when palpating you may notice that their paraspinals feel like two security guards on either side of the spine.) Listening first and educating the patient will likely help set up a therapeutic environment to address this issue. Provide non-threatening movements to give the SWAT Team reason to leave, and encourage play in the yard again.
This SWAT idea can be expressed to patients as well to help in their understanding, at least it is helpful for me. So try to have your own radar up. Does your patient have too much of a good thing?