Kinesthetic Dystonia or Sensory-Motor Amnesia?

by Lawrence Gold Credentials | Publications | Personal Page

Former Associate Instructor with
The Novato Institute for Somatic Research and Training

     Thomas Hanna coined a term to describe residual muscular tension and distortion of self-awareness of muscular activity:  sensory-motor amnesia.  The term indicates a loss of voluntary control of muscular activity, where no diagnosable neurological damage is present. The description of sensory-motor amnesia (SMA) could also fit the experience of Kinesthetic Dystonia.

    In all cases, SMA is a state of dissociation from ones own body and experience, rather than of integration of self, body and experience -- hence, the term, “amnesia”.

    This kind of disintegration has long been recognized in relation to emotional or psychological insult -- a shock of some kind -- and it has been the subject of many movies and works of fiction. It is the result of an unwillingness to experience something (repression) that leads to forgetting, while the disturbing symptoms of the experience persist.

    In brief, sensory-motor amnesia (SMA) can arise from

  • an injury, in which one disowns the injured area in ones desire not to feel it. This kind of withdrawal allows one to minimize the experience of injury, or
  • overconditioning oneself into repetitive patterns of motion -- in which one ignores the sensations of strain and fatigue such overconditioning produces -- which leads to so-called repetitive use injuries, or
  • long-term states of nervous tension of emotional origin, to which one becomes accustomed and habituated.

    Thomas Hanna recognized a physical manifestation of amnesia in relation to physical injuries, emotional distress, and self-abuse: a habitual response that involves tightening up in an action of guarding, self-protection.  We see this withdrawal as a physical pulling away of the injured part from the source of injury, as a shrinking into oneself, or as a substituting of sustained, heightened effort for precision-of-action (working harder, not smarter).  When such heightened tonus becomes chronic, the term, Kinesthetic Dystonia, is often applied, but this kind of amnesia is probably involved.

All SMA produces distortions of posture and movement irregularities of muscular control, usually with attendant pain and increased likelihood of re-injury.

    In my experience, people with SMA (or kinesthetic dystonia), usually report chronic pain along with a sense of mystery as to where it came from.  In cases of injury, the answer is usually that it came from the person’s simultaneous withdrawal from the sensory experience of pain (or shock) combined with a physical movement away from the source of pain (or shock) -- made habitual over time.  The habit forms when, during either a lengthy period of healing after injury or a protracted period of stress, the person maintains their guarding reaction against pain until their brain becomes conditioned to maintain it, automatically.  In some cases, the impression made upon the individual at the moment of injury (the shock of injury) is sufficiently intense that the habit of reflexive guarding begins immediately.  Dr. Hanna’s term for this response was “Trauma Reflex”.

    Dr. Hanna identified two other responses that, when either strongly or repeatedly triggered, lead to SMA -- the "overstress reaction" associated with the stress of “I've got to ... (fill in the blank)” (the Landau Reaction) and the withdrawal reaction associated with fear and anxiety (the Startle Reflex).  These neuromuscular reflexes of stress always involve heightened muscular tension. Such heightened tension, which is frequently the origin of stress-related disorders such as back trouble, headaches, and certain types of circulatory disorders, such as high blood pressure and heart trouble, also accounts for facial tics and breathing disorders.  The reflexes and symptoms of their habituation (stuck "on" state) are illuminated and clearly discussed at length in Dr. Hanna’s book, Somatics: Re-awakening the Mind’s Control of Movement, Flexibility, and Health.

    To these responses (Trauma Reflex, Landau Reaction, and Startle Reflex), we also add habituated muscular tension from overuse, which includes carpal tunnel syndrome, tennis elbow, writers cramp, and similar conditions of self-abuse and maladaptation.

    All SMA produces distortions of posture and movement and irregularities of muscular control, usually with attendant pain and increased likelihood of injury.

    Fortunately, Dr. Hanna’s discovery went beyond recognition of the condition to a practical way to recover from it.  He called his approach, “Hanna Somatic Education.”  He wanted to call it, “Somatic Education,” leaving the term generic, but he learned that he could not legally register the term (and thus differentiate it from other methods) in its generic form, so he added his name to satisfy legalities.

    This paper presents the case of one individual who developed SMA following a bone fracture, whom we shall call Mrs. B.  Mrs. B’s SMA began with a fall, was compounded by surgery, and was perpetuated by subsequent postural actions done to guard against pain and the possibility of falling.

The Case of Mrs. B

    Mrs. B. was eighty-three years old at the time of her fall and fracture of the neck of her left femur.  Most people are getting stiff at that age, and Mrs. B was also scoliotic; her fall had resulted from a lack of balance (worsened by scoliosis). Surgical repair of the fracture by installing a prosthesis repaired the bone break, but it did nothing to ameliorate the shock of injury and its effects on her movement, nor did it restore her sense of balance.  Consequently, about a year later, she suffered a second fall and fractured her other femur.  Prosthesis number two was installed.

    When I met her, she said she was in such pain that she told me she wasn’t sure she wanted to live.  Physical therapy wasn’t helping and pain medication wasn’t enough.  Upon examination, it became clear to me that her pain originated from muscular spasticity surrounding the fracture.  Her gluteus muscles (minimus, medius and maximus), external rotators of the thigh, quadriceps muscles, and adductors were all spastic and painful, more on the right side (her second surgery) than on the left.  This made sense, as she had favored the left side (her first fracture) by shifting her weight to the right side, conditioning those muscles into a heightened state of tonus.  When the second fracture occurred, those muscles contracted with a vengeance.  At the time, she could barely get around, using a walker.  I assured her that all she was suffering was muscle spasms and that we could end them.

    Hanna Somatic Education proceeds on the premise that muscular activity that has been relegated to involuntary levels of the central nervous system (by habit formation) can be returned to voluntary control by voluntarily doing what is otherwise being done involuntarily.  The act restores sensory awareness to the disowned (injured) area, recovers voluntary control of the guarding reaction.  Sensory awareness is voluntarily reintegrated with motor control.  Oddly enough, the process can be done with little or no discomfort to the client -- although their full participation is necessary.

    In Mrs. B’s case, the easiest first step was to integrate, and thus free, her quadriceps muscles.  As their natural function is to extend the lower leg (straighten the knee), and secondarily to perform hip flexion (via the rectus femoris muscle), I had her do just that, in a sitting position, as I provided matching resistance to the action with my hand at her ankle.  The purpose of the matching resistance is to increase the amount of kinesthetic feedback (feeling) from doing the action.  Then, I had her relax the effort of straightening her knee, very slowly, as I provided continuous resistance and feedback, to enable her to sense her movement and position throughout the entire range of motion.

    The cascade of neural impulses that results from such an action is sufficient to activate nerve pathways necessary for sensory awareness and voluntary control.  Control shifts from involuntary to voluntary levels of the central nervous system.  A few, slow repetitions are usually sufficient to get a very substantial, if not total, return of natural muscular control.  With that, pain and spasticity end.

    Mrs. B’s case was a bit more complicated, owing to her limited stamina and caution about using the afflicted area, so we did no more than ten to fifteen minutes at a time.  With people in better shape, sessions of thirty to forty minutes are common.  Dealing with the other areas of the musculature required using movements and positions that replicated the actions of those areas.  In a few sessions over about two weeks, each of which produced some improvement, her pain was gone.

    But the story was not over.  Her injuries had shaken her confidence in her balance; she was constantly afraid of falling and walked somewhat stooped over, as if to minimize the distance she might fall, if she were to fall.  Soon, thereafter, she caught her walker on the edge of a carpet and did fall.  I happened to be visiting and was able to attend to her within minutes of her fall.

    After ascertaining that no physical injury was involved, we got her on her feet again.  But now, she had a new problem:  sciatica.  Her scoliosis, originating in part from spasticity of her lumbar spinal extensors, and in part from uneven leg length, due to orthopedic surgery, had predisposed her to entrapment of her sciatic nerve at its roots.

    To get to the point, her sciatica disappeared in three sessions of ten to fifteen minutes and has not returned.  To get the results, we had to address the muscular component of her scoliosis, with the result that her balance and walking substantially improved.  A bit of guided exploration in the effects of posture on balance convinced her that her balance was more secure if she was fully upright, and some instruction in the use of stairs in developing balance (going up and down stairs forward, backward, and sideways -- holding the banister behind her), developed a sufficient improvement in balance that she abandoned the walker for a cane and abandoned the cane at home, using it only for going about town.  She has her mobility back and, through she complains of being stiff, the pain of her injuries is gone.

A Comparison to Proprioceptive Neuromuscular Facilitation (PNF)

    For some, these descriptions of Hanna Somatic Education may sound like the methods of Proprioceptive Neuromuscular Facilitation (PNF).  There are significant differences.  One difference I have discerned from reading the 13th Edition of the book by that title and observing PNF in action, is that is seems to have been designed from an analysis of biomechanics, rather than by kinesthetic explorations that reveal which movements combine to produce familiar sensations of strength, coordination, and balance. PNF is reductionistic, not holistic: it reduces movement to anatomy without regard for the mind-body connection to muscular tension; the mood of PNF seems to be more one of mechanical performance of the therapist's instructions than of exploration of the sensations of movements. The proprioceptive side of that method is weak.

    Another difference has to do with the regulation of the speed at which the movements are performed; PNF "stretches" are done statically, in "stop action", in a series of positions; HSE maneuvers are done slowly, smoothly and continuously in motion. This continuity of movement allows the brain the register motion and to gain control of motion.

    With certain basic changes of technique, recognition of inherent coordination patterns present in humans, and certain added insights into the origins of neuromuscular maladaptations, PNF would be identical to Hanna Somatic Education.  But, in their present forms, the two are significantly different.

Sensory-Motor Amnesia or Kinesthetic Dystonia?

Hanna Somatic Education proceeds on the premise that control of muscular activity that has been lost to involuntary levels of the central nervous system (by habit formation) can be reclaimed via adequate sensory-motor learning.
    In my experience, persons with certain types of kinesthetic dystonia did not respond to the methods of Hanna Somatic Education:  notably torticollis and spasmodic dysphonia.  It may be that other factors, including psychological factors outside the easy reach of HSE, are involved.  However, the overwhelming majority of people have lost their symptoms and regained their natural self-control.

    So, what of SMA?  It is dispeled by voluntarily doing the actions (movements) that are being maintained involuntarily.  As a practical matter, the maneuvers of Hanna Somatic Education work best when they either replicate muscular actions being done involuntarily (which must be discovered through observation) or when they use patterns of movement that involve and integrate synergistic movements throughout the body as a self-sensing movement system.

    Hanna Somatic Education has about it both theoretical and empirical aspects.  Its theory is consistent with the findings of neurophysiology, neuroanatomy, and kinesiology, as regards nerve pathways, reflex loops,  postural reflexes, and voluntary muscular control.  However, its application relies heavily upon empirical discoveries as to which of the vast range of movement patterns and muscular actions are synergistic and integrative, leading to a more complete sense of wholeness and of self.

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