Using the concept of ideomotor therapy in the treatment of a patient with chronic neck pain: A single system research design

BackgroundA contemporary understanding of pain neurophysiology describes the experience of pain as a multi-system output mechanism in which the perception and localisation of pain sensations cannot be separated from concurrent motor output responses generated to resolve a perceived threat to tissues. It has been suggested that the resolution of pain is dependant on an appropriate motor response, and that such a response should proceed as the result of instinctive, in-built mechanisms. Ideomotor movements constitute the prevailing expression of instinctive movement response in humans. The enhancement of corrective ideomotor movement expression may lead to improvements in pain intensity and disability in symptomatic patients whose instinctive responses have been suppressed. A manual technique can be employed therapeutically to elicit fuller expression of ideomotor movement in patients suffering pain.ObjectivesTo document the outcome of short-term pain and disability in a patient with chronic neck and shoulder girdle pain treated with ideomotor-based manual therapy and self-management exercise using a single system experimental design.MethodsA prospective A–B–C single system experimental design consisting of a 3-week baseline data collection phase (A), a 3-week treatment and self-management phase (B), and a 3-week self-management phase (C). Treatment and self-management were provided using a light touch technique based on ideomotor principles. Five validated outcome measures were recorded weekly and displayed graphically for visual inspection and analysis.ResultsVisual analysis of the plotted outcome measures as a function of time indicated a reduction in pain intensity and perceived disability concurrent with the introduction of treatment (Phase B). These changes appear to be clinically relevant.ConclusionsThe results imply a relationship between the introduction of ideomotor-based manual therapy and self-management, and clinically relevant reductions in pain intensity and perceived disability in a patient suffering severe chronic neck and shoulder girdle pain. It is hoped that this study will provoke further interest in this concept and draw attention to a possible mechanism and explanation for some of the effects of commonly used indirect manual therapy techniques.