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2 Tricks For Using Imagining When It Doesn’t Come Easy To You

October 8th, 2010 · 11 Comments

A reader Tim asks this intriguing question:

I have a chronic pain condition similar to CRPS, along with some nasty allodynia.  Most mornings I feel like I’m 120 years old.  I’m a big believer in graded motor imagery (GMI).  However, I’m one of many people out there who have never seen a visual image in my mind.  Almost always when somebody says “imagine”, they mean “visualize”.  When someone asks me to imagine something, I have no idea what they’re talking about.  This certainly gets in the way of any kind of motor imagery tasks.

I’m working with a very competent physical therapist, but this problem is intractable for him also.  I have contacted Lorimer Moseley, and he doesn’t have any ideas on this either.  Can you provide any guidance, information, etc. towards resolving this?

Thanks, Tim, for your really interesting question.  I have several thoughts about it.

First, as you know, graded motor imagery is a step-wise program to retrain the brain away from pain.  The steps are: 1) right/left discrimination, 2) imagining movement, and finally, 3) actually performing movement.  It sounds like you’re asking how to do step #2 when it seems you can’t imagine movement.

When I prepare patients for step 2, I tell to look at, let’s say, their hand, and to imagine what it would feel like to move their hand into a certain position.  When I do this myself, it’s sort of like the feeling of “willing” my hand to move, but without actually moving it.  I try to “feel” the movement, more than imagine it.  The looking at your body part is also an important part of the exercise – this step gives your brain reinforcement about paying attention to the part of your body, and being aware of where it is in space.

This step is not about looking off and imagining some abstract hand moving into position, and not really about imagining movement in your mind’s eye.  So it really is imagining the movement itself, not visualizing movement.  You may be more able to do step #2 with these instructions.

2.  If imagining  movement was still hard for you, however, I would ask you to imagine doing a specific, well-known activity which is similar to the position you’re supposed to imagine.  Let’s say you were using this picture for step #2 in GMI.

I might ask you to imagine raising your hand in class to answer a question.  That gives you more of a context to use as guidance.  You could even add specifics:

  • notice how much you’re imagining your shoulder stretching when you raise your hand
  • notice how far apart you’re imagining your fingers to be

A patient I worked with had a hard time imagining some movements.  So I asked what movements were second nature to her, very well ingrained.  She had played the piano for years and years, so we used particular movements involved with playing the piano. This was much easier for her to “feel”.

3.  Lastly, there are other paths to get where you want to go besides “visualizing.”  For example:

  • I would also have you do work in other brain re-training techniques, such as tactile discrimination, using repetitive normal movement, using a mirror, etc.  This can get you some of the same benefit as GMI.
  • You can use other senses, such as hearing and touch.  If you’re doing relaxation exercises, instead of “seeing” a beach, you could imagine bird sounds, or the sounds of the beach.

I’d be interested in your response.  Thanks again for your question.

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11 responses so far ↓

  • Judy // Oct 8, 2010 at 9:18 am

    My daughter has RSD/CRPS and allodynia in the affected leg, as well as non-healing lesions. She is also working with a NOI Group (Lorimer Moseley’s programme) physiotherapist, working slowly up to the mirror box therapy (we hope she gets there some day).
    Imagining or visualizing the injured limb (right leg in her case) causes a great deal of pain, and we found that even looking at pictures of left and right feet is difficult. With some pictures, she cannot distinguish left and right, especially if the feet are twisted in some way – viewed from the back, or pigeon-toed, and so on.
    My husband, an engineer, is very analytical in his work, and he cannot “imagine” a structure either – it has to be on paper. My daughter has the same kind of mind. The physiotherapist did not ask her to imagine or visualize anything; instead, he asked to her to cut out pictures of feet from magazines (fashion and yoga magazines, so the feet were in different positions and in different shoes, etc.) and to paste them into a scrapbook.
    She is slowly going through the scrapbook, looking at pictures of feet until her brain will no longer say “pain” but will say “picture of feet”.
    Rather than trying to “imagine” your affected limb, perhaps looking at real pictures may be of some use.
    Best wishes for recovery.

  • Nickie // Oct 9, 2010 at 6:24 am

    This is all great! One other thing I’ve done is use dolls and feel the feet in different positions. We recorded a guided imagery session on my iPod which goes through all of the different positions. For me it’s all about touch.

  • Trudy // Oct 9, 2010 at 11:55 am

    I also use mirrorbox therapy. I cannot visualize however when I see my “good” limb in the mirror, I am actually seeing something. My brain sees 2 good limbs: the bad one is always hidden from view. You see your good limb and a reflection of your good limb…2 functioning limbs. I find it very effective with practice. It takes time and practice but it is well worth the effort.

  • njanuary // Oct 9, 2010 at 9:22 pm

    I wonder if changing the terminology might help — saying “think about” instead of using “imagine” or “vizulalize.”

  • John // Oct 11, 2010 at 6:36 am

    Dear Tim,
    It would seem to me that the main purpose of visualization is to activate the mirror neurons in order to do stealth exercise, i.e. to do all of the mental work required during normal movement without doing the movement. Why worry if you think you cannot actively visualize the movement? If you ever learned a skill, enjoyed a silent movie, laughed at the Three Stooges, you used the mirror neurons. Anytime you watch someone else moving, the mirror neurons will be activated and you will accomplish the overall goal of visualization. Watch a movie or movement and then replay it in your mind. The important thing is to activate and use the mirror neurons, not how you activate them. There are several ways to do it. Remember we are dealing with the brain. Beliefs can be more of an impediment to recovery than the actual problem. Relax. Watch a Marx Brothers movie and concentrate on Groucho’s movements or better yet watch Robin Williams. JOhnB

  • jeisea // Oct 13, 2010 at 8:27 pm

    The teacher in me would think that individuals have various learning styles. Some are visual, some are doers etc. If this were appropriate here I would suggest trying to feel yourself doing some action rather than trying to “see” it. However as mirror neurons tap into the “monkey see, monkey do” acitvation of neurons seeing in this situation is all important. There is quite a bit of research, including Ramachandran’s monkey example, which suggest that watching someone else perform the action is sufficient to stimulate mirror neurons. My thoughts, therfore, are to watch your therapist doing the movements. Perhaps video the movements (maybe on your phone) and watch several times a day (or as suggested by therapist). My thoughts are also that you could enrich the experience by watching adding different stimuli eg under a fan, heater, chewing, listening to various things (think of the senses) Varying the experience slightly changes the inputs so to speak. Just a thought.

  • How to Cope with Pain // Oct 13, 2010 at 9:19 pm

    Excellent suggestions from all! Thanks for the input.

  • Lorimer // Oct 14, 2010 at 3:06 pm

    Well this is just such an excellent exchange from wise folk indeed. The only thoughts that came to mind and that are relevant although I don’t know how helpful are these: I suspect that the capacity to activate movements without doing them is fundamental to a living human, so I imagine that the suggestions that have been proposed would be having the kind of brain activations we think should help, even if you don’t feel like they are. I love Sarah’s ideas at helping you imagine things and I agree it is NOT about imagining seeing it, but it is about imagining doing it and feeling it. I did send around some emails to the gang of interested scientists after I heard but we are all coming up with not much. I do think that imagining is like attending – one can get better and better at it if one practises and practises and…Anyway, I think it is an excellent conversation to have and I really REALLY appreciate the contributions from everyone – great site this Sarah. Well done.

  • Tim // Oct 20, 2010 at 8:03 am

    This is Tim, the submitter of the original question. First off — this has been very useful. Thank you- to everyone!! I am just like Judy’s husband and daughter — Judy says:

    ……….My husband, an engineer, is very analytical in his work, and he cannot “imagine” a structure either – it has to be on paper……..
    ..…..Imagining or visualizing the injured limb (right leg in her case) causes a great deal of pain, and we found that even looking at pictures of left and right feet is difficult…………..

    That is me! An issue for me is when I tried to “imagine” (think about) moving my fingers or raising an arm or moving my left leg, there is physical pain (nerve pain) accompanying the thought.

    for you practitioners out there — I kind of thought it was humorous when John said:

    Beliefs can be more of an impediment to recovery than the actual problem.

    The last time I saw my physical therapist, we had a pretty animated discussion about “my beliefs”. It is my contention that I am not afraid to do these motions — they cause pain – but I still do these motions every day, every hour, etc. — but if I am trying to “change the pain”, then I should start with some technique that does not invoke physical pain.

    There are some great suggestions here and I will contact my PT and have him read your wonderful ideas and I will give an update. Some of the most painful movements for me are handwriting or typing – it affects both on hands and arms (I use voice dictation — and I have time periods were even using voice dictation and accompanying necessary mouse movements, etc. don’t allow me to access the Internet, etc.). I like the suggestions from John and Jesisa. It kind of looks like I should get a bunch of pictures and videos of people doing these activities and other similar activities that cause pain and start staring and watching under different conditions!
    On a theoretical level – I think I get it!! The purpose underlying the use of the word “imagine” is that we are just trying to get the brain to activate without accompanying pain. I need to start at a level that does not cause pain — which is what I kept on thinking — but I couldn’t figure out what to do more where to start. For people like me, it means starting with staring at the pictures or videos of people performing the actions that cause me pain. Then I need to vary the conditions/stimulations/sensations while I stare at the pictures or watch videos or other people. I’m sure that it’s probably hard for some you out there to realize that this wasn’t obvious to me, but there are people like me that are so densely literal!!
    I have one additional question. If there is bilateral pain — as in the case of my upper body — how does one make the transition from brain activation without physical movement to physical movement without pain (or less pain)?
    Thanks to all of you — this is been such an intractable problem for me for 15+ years, and it’s the combination of the responses at the site that has opened a path for me to explore. And I love to explore!

  • How to Cope with Pain // Oct 20, 2010 at 8:22 am

    Tim, you’re right in not wanting to do things which significantly increase your pain. However, if a step is slightly or somewhat bothersome to a patient, but the increased pain doesn’t last and doesn’t keep increasing after stopping the exercise, I will have patients continue to try it. Sometimes that helps remind the brain that it’s really ok to do the step. Sort of “de-sensitization.”

    Regarding your “both sides” question…
    You can progress through steps regardless. I would use the side with less pain as the “healthy” side. It depends why there is 2-sided pain.

    Second, if movement causes pain, there are other techniques to use, such as mirrors, tactile discrimination, etc.

  • John // Oct 20, 2010 at 2:34 pm

    Great comments Tim especially about me. I support How to Cope with Pain’s comment but I would like to add one more. When that pain occurs, remember ” you did nothing of such an intensity that any tissue should have been injured” This is pain from the brain not from tissue damage. That may not provide any short term solace but it is tremendously helpful to make that discrimination for the long term. Remember that this is just your silly brain trying to be over protective. Try laughing it at bit.

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