What is a Sensory-Motor Concept and Why is it Important to Know?

Understanding sensory-motor concepts is the crucial element to moving well as we age or regain lost skills after an injury, trauma, or cerebral accident.  This understanding is not cognitive in the ordinary sense.  It requires sensing how we perform an action so that we can improve our motor skills with a deeper felt sense.  It’s called a sensory-motor concept because if we have not developed a sufficient felt sense of our own movements, we will have a much more difficult time coordinating any and all of our movements.  For example, if you don’t feel the difference between left and right, no amount of strengthening or stretching will help you.

Our fitness-crazed culture might suggest exercise—weight lifting or endurance exercises to strengthen muscles or stretching for our muscles and tendons—as the solution to our movement problems however they came to be, but without involving our brain in the way we organize our movements, all of the exercise in the world won’t restore our movement abilities in a lasting way.

The good news is that there are three primary sensory-motor concepts that we all mastered as babies.  These sensory-motor concepts determine how we organize all of our actions as well as how we orient ourselves in the environment.  The coordination that results from highly developed sensory-motor concepts is a matter of what occurs in your brain when you explore movement. 

The first and most critical sensory-motor concept is to fully feel and move in what’s called anterior-posterior directions, i.e. front and back.  Without this concept, reaching for something in front of you and bringing it back, to let’s say your mouth, could not occur.  Babies first learn the movement of front to back as they start to understand and connect with their environment.  For example, they see some food or a toy in front of them and bring it back to their mouth.  Discovering how to put things in the mouth is critical for survival, but also, for a baby, it means to understand something through the senses and to develop the movement skills involved to bring the world to the mouth so it could be understood.  Eventually as movements become more expansive, the baby brings the mouth to the world.

The second great sensory-motor concept is called vertically, i.e. moving up and down.  To move all your weight away from the ground to standing up is a complex activity.  It’s not only difficult, but also impossible to do without a developed sensory-motor concept of orienting ourselves vertically.  We can see babies learning this concept as they explore many different ways to bring themselves to standing or sitting.

The last of the three major sensory-motor concepts is laterality.  Laterality includes knowing left from right and being able to turn easily or rotate one’s body.  Infants learn this concept of laterality as they master how to turn, sidestep, or reach left or right.

Understanding these sensory-motor concepts is essential for survival.  With out the concept of front and back, we couldn’t feed ourselves.  Mastering the concepts of verticality and laterality is crucial in being able to flee danger or to seek pleasure or satisfaction.

Beyond survival, feeling and understanding these sensory-motor concepts can result in tremendously complex movements.  Imagine a high diver: You can’t jump off a high board or platform, do a triple somersault, half turn and hit the water perfectly without a felt understanding of your sensory-motor concepts.  If you make a mistake and hit the water at speed, you could break your neck.  You have to know when you jump off a board or platform where left and right is, where up and down is, and where front and back is.

Another example illustrating how this felt understanding of sensory-motor concepts works is getting up from a chair.  A person without a developed felt sense of verticality may awkwardly try to bring their head and body higher by pushing down on the armrests with their arms.  If you have a better feel for the concept of verticality, you may organize yourself to lean your torso forward to shift your weight over your legs and then push through your legs to raise your body up.  This would indicate a better understanding of how your body relates to gravity and how you might need to reorganize to move with less effort and greater clarity.

As we age or after an injury or trauma, we lose these sensory-motor concepts in the reverse order that we learned them as babies: First our lateral movement becomes more difficult or limited, then our ability to get up and down becomes compromised, and finally our movement options shrink to just dealing with what is in front of us.

With loss of laterality, you may experience an uneven gait, balance disorders, and the inability to play sports you once enjoyed like tennis.  You can live a good life but you might feel stiff, which no amount of stretching will improve.  Relearning the motor concept of laterality can melt this stiffness. 

If damage is so severe that the second sensory-motor concept of verticality is compromised, then the person would have to be in a care situation because getting up and down and walking towards objects would be difficult. 

If the damage were even worse so that the first sensory-motor concept of anterior-posterior disappeared, then the person would need to be in a total care situation, since without this sensory-motor concept, they would be unable to even feed themselves.

Happily we can reverse the loss of these sensory-motor concepts by relearning how to feel them.  Physical education, various forms of physical therapies, training, coaching, practicing (be it dance or sport of any kind) should be approached from a point of view that strongly involves sensory-motor skill development.  This is so completely different from our current fitness craze as to make the concept of conditioning, sculpting six-pack abs, and working out to your max actually artificial and unnatural.

Teenagers and adults need to re-learn sensory-motor concepts in the same style that we all originally learned as children.

My work with people of all ages and abilities focuses on developing coordination, offering the possibility of regaining forgotten movement skills and expanding our movement repertoires and improving our skills.  Both students in my programs as well as in my private practice have found themselves able to perform activities they gave up because they didn’t feel successful or found the activity hurt too much.  Many of them not only enjoy dancing again, playing tennis or golf again, but they also find themselves able to perform new skills that emerge out of a superior sensory-motor understanding.

This is the first part of series of articles on sensory-motor concepts.  More to follow.

-Frank Wildman, PhD

Transforming Pain into Pleasure

The following is a case study of a women I worked with as patient demonstration at one of my hospital-based courses for physical therapists. While I see my private clients in a studio rather than hospital setting, I address many of the same movement issues and challenges as I discuss here.

Following an accident, the patient, let’s call her Ann, had a difficult knee injury that was now infected.  She was in a lot of pain and tactilely defensive-- fearful of being touched or even approached.

Ann, who was around 25 years old, was wheeled in to me at a hospital.  She had an I.V. in her arm and a drainage tube in her right knee.  The infection was spreading to other parts of her body and she could no longer step on her right foot.

Ann had experienced so much pain in the hospital that she was in a state of alarm as to what I might do to her, especially in front of so many of the staff.  As I approached her from across the room, she winced with pain. What could I do?

We started by my asking Ann to tell me how close I could come to her and still have it be comfortable, and by my promising that I would do nothing to hurt her.  I said that under no circumstances would I touch her right knee of leg unless she begged me to.  This reassured her enough to allow me to get closer.  I maneuvered slowly around her body, looking for the areas where there were "windows of opportunity" to bring us closer.  I then got close enough to ask her if we could shake hands.  I asked her if that hurt.  She said "No," and I asked if we could shake hands for a longer time. 

And so, I began working with her through her right hand, then, up the right arm to the right shoulder.  I then asked for the other hand.  As she began to relax, I asked her if she wouldn't be more comfortable lying down.  This involved carefully transferring her to the table to avoid any pressure under her right foot.  She said she woke up in the morning on her back, so that's where we started.

I then began to play a game with Ann that she found intriguing.  I asked her if I could touch her head.  My question to her was, "On a scale on one to ten, ten being the most painful, how much does it hurt?"  She said that she liked it.  In fact, she was amazed that she liked it.  So I asked her to develop another scale--a pleasure scale.  Ten would be the most ecstatic pleasure she could imagine.  I began to explore her shoulders and ribs and I worked deep in her belly and diaphragm.  She began to appear larger.  Color came to her skin and I said to her, "Now could you smile please?" which made her laugh.  Her laugh immediately turned into crying because she hadn't laughed for so long.  I then asked her if I could touch her left (non-painful) leg.  She became nervous and said, "If you touch the bottom of my right foot, I couldn't bear the pain.  Please don't touch it."  So, I did lots of things with her left leg, her head and her pelvis, always asking her, "On a scale of one to ten, how much did it hurt or how much pleasure is there?"

I then asked Ann to help me make her feel good.  She learned how to breathe and to reorganize her tensions in very subtle but precise ways so that she didn't trigger or overreact to pain.  She then said, "I wish my right leg could feel like the rest of me."  I replied, "Doesn't it feel better?"  She confessed that it did, but attributed this to the fact that I had not been touching it.  I said that maybe if I touched it, it would feel better and she agreed to let me touch it.  I would not touch the foot until she asked me to, as we had agreed.  She laughed, now without tears.

Eventually, I touched the right foot and was able to push on it.  I touched the knee and taught her what to do with the rest of herself to make the knee feel better while I was touching it. For example, Ann learned how to lower her high-set startle tone throughout her body so she could lower her muscular stresses and not react so strongly to the fear of pain and the pain itself.  She was very impressed that she had control over the pain in her knee by using the rest of her body in particular ways.  In fact, she was delighted.  Ann first described the knee pain as a ten, and we were able to get down to two.

Basically, we re-created a map of her body so that rather than having all of herself feel stress and pain, especially her knee, she now had a body that felt good almost everywhere.  She had also differentiated the pain in her knee into several controllable stages that stayed compartmentalized at the area of the knee itself.  Ann no longer hurt -- she simply had a sore knee.

I then ended the session by moving her body through functional patterns that would be useful for walking such as relearning how to flex her hips and move her pelvis.  As I worked, I always made sure that whatever I did would reflect itself in movements of her right knee and feel very good.  She began to build a pleasure scale for her body, rather than an absence of pain scale.  Next, I had her contract the muscles of the right leg and learn what to do with her breathing so that she could actually have voluntary control of her extraordinarily thin muscles.

At the end, Ann was able to stand up and step in her right foot for the first time in many weeks.  With amazement, she walked several feet to her wheelchair.  But that was not the end.

Several days later, after returning home, I received a call from one of her attending physicians who told me that her knee had been undergoing an impressive healing.  They had been considering the possibility of amputating her leg but now decided that they certainly would not have to remove her leg and were already able to remove the drainage tube from her knee.  He also reported that she was starting to eat again and was beginning to go for short walks.  He thanked me and at the end of our conversation said, "How do you pronounce the name of this stuff, again?"

This lesson re-inspired an idea I have had for something I am calling a Pleasure/Pain Chart.  In pain clinics everywhere, there is often a stiff-looking body on paper, with painful words on the same page.  The clinic asks the patient to circle the painful words and draw an arrow to where he feels that pain.  (For example, if a client has a stabbing pain in a specific area of his back, he circles the word "stabbing" and draws a line to that part of the figure's back.)

In my Pleasure/Pain Chart, we had an artist draw a relaxed-looking person, standing in a natural pose.  To the left of the person are thirty words for pleasure, many of which we use during body scans in movement lessons.  To the right of the person are only eighteen words for pain.  The instructions are that for every painful word, the patient circles and relates to some part of his body, he must also circle two words from the pleasure scale and relate them to parts of his body.

What this does for the pain patient is remarkable.  Most people in extreme or long-standing pain feel their body as an undifferentiated mass of pain.  As in the lesson with Ann, people filling out the Pleasure/Pain Chart form a differentiated image of their body which both reduces the area of pain for them, and the intensity, by shifting their attention away from "things only hurt more or less," to very specific descriptions that they are forced to come up with in relation to pleasure.  I have seen people filling out this chart visibly alter their posture, muscle tone, respiration, and entire demeanor by the time they were finished, with an often desperate attempt to locate pleasure in their body.  For some people, especially pain patients, it may by the first time they have ever had the experience of their pain reframed.  For most people, it is a radical and startling experience to bring into language, and therefore into their field of attention, very specific pleasurable qualities throughout their body.

-Frank Wildman, PhD

Learning How to Fall. It Begins in Your Head.

The fear of falling is one of the most basic anxieties anyone can experience.  

For some people, if they walk on a trail by the edge of a cliff, they cannot look down from a height without feeling a little dizzy.  Sometimes people even freeze in their movement because the fear of another step near the edge will lead to a fall. This fear can even follow us while we sleep, as you know if you’ve ever dreamt of flying and woken up with a start at the moment of sudden descent or landing.

This fear of falling can carry over into our day-to-day lives, when we walk on uneven pavement, or even think about having to walk in the dark.  

Most people try to prevent themselves from falling by stiffening their hips and the muscles of their back in such a way as to pull themselves away from the ground.  But let me suggest another way to approach the movement.

Instead of crashing to the ground, imagine that in the moment of descent, you knew that you could trust your body to land safely and softly—without bruises or broken bones.

If you feel like you are going to fall, the safest thing is to learn how to do so.  If you stiffen the muscles of your back and hips, you are more likely to hit the ground harder.  

It would be helpful to anyone who feels afraid of falling to practice getting down to the floor and up again as a mind-body exercise. One of the best strategies would be to learn over time to move to the ground as quickly as possible so you have control of your landing.

By practicing going down to the ground, you will eventually be able to move faster.

In learning how to fall, you’ll learn to move as fast as gravity.

The first step to master these physical concepts is a simple thought experiment that asks you to imagine (rather than perform) movement.

Without actually moving, imagine going down and up from the floor. The next time you imagine going down, go all the way down to lying on your back. Not only will this imagined movement melt your old habits, but it will also enable you to create new movements by expanding your embodied imagination and adding new neurons to your brain.

Next bring your imagination to the physical movement: move from standing to the floor and back to standing as you saw yourself doing it in your mind. You might even find that it’s good exercise to go down to the floor and onto your back, then return to standing—something you could practice every day. Feel free to invent your own variations, as long as how you do them is clear to you.

Try going at various speeds so that you can go up and down from the floor without bumping. Feel how smooth the movement can be and how light you can make your return to standing.

Imagine if photographs were taken of you getting down to the floor and returning or coming up from the floor to standing and then returning to the floor.  If your movement was controlled, a viewer would not be able to distinguish from any given direction you are going because your movement, if controlled, would be completely reversible.

Once you’ve mastered each step, you can then speed it up as quickly as you want.  Then, starting on the floor and getting up, you’ll learn to reverse the trajectory perfectly when going back down to the floor.  This principle of reversibility in movement will help you control your body if you go at high speed.

This up and down movement is very stimulating to the inner ear, and sometimes we need to take time to adjust to that. When you increase your speed, you might find yourself getting dizzy. If so, simply rest sitting in the chair for a while. Eventually the exercise will strengthen your vestibular system and improve your balance. You’ll find yourself becoming less concerned about approaching and leaving the floor.

And your future, falling self, with thank you. If you find yourself in sudden descent (tripping over a tree root, or a uneven sidewalk), you’ll have the body/muscle memory that will help you avoid panic and move through your fall.

By learning how to fall in this way, you can overcome basic anxieties and lessen the chance of  injury with your new smooth landing.

-Frank Wildman, PhD

Upper and lower back pain: What you don’t know will hurt you

Difficulties with our backs can lead to a variety of problems—including pain in the upper and lower back, the sacro-iliac joint, and even the neck, as well as loss of work, large medical bills, and distress at not being able to live life in a comfortable way.  

The major contributors to back pain? Stress, poor posture, and a lack of body awareness.

Many years ago, I developed and conducted a back pain program for the University of California.  What I learned was that very few people sensed their back, how it moved, and how they used their back to do almost any activity.  In other words, there was a low level or even a completely absent sense of their back.  It’s as if pain was the only signal that provided the information that they even had a back.  

This lack of back awareness is understandable.  Most of us can easily see the front of ourselves and we might find it quite easy to touch the front or even the sides of our body with our hands.  We are naturally more aware of the front of our bodies.  But it’s difficult to see our back (barring eyes in the back of our heads) and for most people, not so easy to touch our back.  

What this means is that it’s difficult to notice when our muscles are overworking to simply sit or stand—or for many people, even to lie down.  I’ve seen this firsthand as a large number of people that I work with report waking up with back pain in the morning after a night that should have been rejuvenating their muscles.  

Over the decades, many exercises for the treatment of back pain have gone in and out of style.  Some decades ago, it was very fashionable in the world of medicine and physical therapy to promote the use of something called Williams’ Flexion Exercises (this involved folding the front of your body).  That worked for a small number of people, but for most people, it didn’t, and for some people, it worsened their condition.  Later the opposite idea took hold with McKenzie Extension Exercises (these involved bending backwards to wake up the back muscles and activate them more).  These exercises met with similar results: they worked for some people and they made some people worse.

The key insight: How we perform exercises is more critical than which ones we do.

No exercise, trendy or not, will be useful if you can’t feel what you are doing. Imagine you were told to walk in order to strengthen your back. You can walk around like you do everyday, but that won't improve the condition of your back; it will just strengthen your old habits of arranging your body in painful ways.  But if you sense what your back or body might be communicating-- "I'm holding my breath anticipating pain with each step" or "I'm not swinging my arms"-- you can begin to adjust the way you organize your body to move. You need to be attuned to the sensory information from your muscles and your joints, in exercise and in daily life.

A person who uses a lot of their back muscles while sitting and even more when moving may first receive signals from the back to the brain saying, “I feel tight, but I don’t hurt yet” and then “Now I hurt, but only a little ache.”  If those the messages from your back are ignored, if you don’t sense the amount of effort in your muscular use of yourself, your back will eventually signal, “Now I really hurt so badly that I am not going to let you move without pain.”

The best approach to back care is to provide as much sensory information as possible so the person can detect and change, for themselves, how much effort are they putting into their muscles when they move or rest.

Take, for example, sitting.

Electromyography (a measure of how much you are activating your muscles) has shown that some people at rest in a sitting position use only 2% of the muscle fibers in their back while others use up to 15%.  These people can go to workshops or meditation retreats for days—sometimes sitting in difficult positions, but experience no pain after a week of meditating.  Other folks drop out of these programs after the first day because of the pain in their back brought on by sitting.  

Once you start to move, there is no option but to use more of your muscles.  But how much more? or how little more do you need to accomplish your desired activity with ease?

My goal in working with people to deal with their back pain is to educate them to better sense their backs.

I’ve worked with many clients suffering from serious back problems.  I try to help clients sense whole new ways of moving while learning how to decrease effort with every movement. Rather than trying to relieve the pain, my approach has been to give them a heightened sense of the shape of their spine, the textures of their muscles, a clear feeling for how the spine is involved in movements of their body.  This may require first touching and moving the client in such a way that the person can feel the details of the shape of their back and the amount of effort their muscles habitually use.  

Very often, their back pain would disappear.  They would react with surprise at the results:  “But you didn’t do anything,” “I felt my bones and muscles so clearly,” or “I can’t figure out how the exercises you gave me would help, because they were so simple.  No hard stretching, no repetitive movements to strengthen muscles…but I feel so much better.”

I try to give another voice for the back to signal the brain with non-pain related messages like, “I feel myself more. I even feel good. I thought I needed to stretch and pull my muscles but now I know how to release excess tension because now I recognize it.”

The secret ingredient to dealing with back pain is to learn how to recognize and sense your back more thoroughly.  Without that, there’s not much you or any therapy can do on a lasting basis.

-Frank Wildman, PhD

How the age of specialization may be holding you back from healing your arm, shoulder, hand, or neck

In this age of specialization, there are many hand therapists and hand therapies, many therapists who specialize with what is called the upper extremity. There are special therapies for rotator cuff injuries of the shoulder, for elbow injuries, for muscle tears, as well as therapies for the general upper extremity of your arms.

With all this specialization and detailed knowledge of how these body parts work, why is it that more people are suffering from injuries and are taking overly large doses of opiates to deal with their pains? Well, there’s a good reason. Perhaps it is the overspecialization itself, which makes it more difficult to address how the whole body operates in an action. Perhaps it is time for a more generalized approach.

You may be suffering from some of these injuries and challenges and meeting with limited relief from all the specialized therapies. My approach is to work with the body and mind as a whole, not discrete body parts with specialized but limited solutions.

I want to help you improve the functionality of your hands, arms, shoulder and neck by involving your whole body in the process and, most importantly, your brain.

Do you think it is possible to hold something in your hand and pick it up just with your upper extremities? To lift something up, the weight has to go down through not only our backs, but also our pelvis and legs. In other words, to use our arms in the real world requires the use of our whole body. If that weren’t the case, every time you picked up a frying pan, you’d simply tip forwards. For every pound you carry in front of yourself, your back and your legs have to work to stop you from falling forwards.

But the issue of having functionality from our upper extremities is bigger than simple dynamics. To fully integrate all these different areas of your body and coordinate our body to perform actions in the world, we need a brain and in fact, the complete integration of the neuro-orthopedic body.  And even more, numerous studies on grip strength show that one of the key factors that will improve or fatigue grip strength is the condition of one’s heart and blood pressure.  We can have no strength in our upper extremities without that.  

Key factors for our muscles to be able to move us and for our organs to support those movements are our brain and our skeleton.  Nothing can move without a brain and a skeleton.

Since any issues you are facing with your hands, arms, shoulders and neck involve more than just those discrete body parts, perhaps it’s time to develop a more generalized field of inquiry and how to improve the full use of all of ourselves.

A baseball pitcher with a shoulder injury will of course have limitations.  If these limitations can be addressed therapeutically, great. But what if the pitcher could learn variations in throwing the ball that would not further damage the shoulder but could actually help heal the shoulder?  For example, learning to move from the back leg to the front leg and accelerate the trunk over the standing leg reduces the need to develop so much acceleration largely in the shoulder. In which case, learning to throw a ball with a better understanding of whole body use requires a different kind of analysis of motion and a deeper understanding of what a pitcher needs to learn to use their throws to help the tissue heal.

This approach is not a new notion. There are attempts to do this by sports coaches involved in different sports from all over the world, but it does require the skill to perceive what’s needed for each individual to learn to improve.

This is the kind of evaluation, strategic approach to healing, and improved coordination that most of my clients need regardless of how local their injury feels or how locally they’ve been conditioned to compartmentalize their bodies.

-Frank Wildman, PhD