Paradoxical Failures

Under conditions of stress, however, the explicit system sometimes takes over. That’s what it means to choke. Choking is about thinking too much. Choking is about a loss of instinct…[a return] to the mechanical self-conscious applications of lessons [from the past].

I was fascinated as I watched a local sports star, who had an 87% free-throw shooting percentage, miss two consecutive free throws at the end of a close basketball game. In the end, his team won, but his exasperated expression said something to the contrary; it did not look that much different from the dejected look of a patient with “chronic pain”.

I wondered: what is it that made him choke? Could it somehow be related to my patients?

After visiting my favorite search engine, I came across this article, by Malcolm Gladwell. It discusses some of the most famous “choke-artists” in recent sports history including Jana Novotna at Wimbledon, Chuck Knoblauch’s inability to throw the ball to second base, and Greg Normans collapse at the Masters. In each instance, according to Mr. Gladwell, the athlete says to themselves, “Look, I’m going to be careful here. I’m not going to mess things up.’

Then, after having decided to take that strategy, they calm down and go through [a] task. But that’s not the way to succeed…The more you do that, the more you will get away from the intuitions that help you, the quick processing…The usual prescription for failure–to work harder and take [a task] more seriously–would only make their problems worse.

Reading the passage above, reminded me of the words of Barrett Dorko, PT who suggests that,“Without any trust in the ideomotor activity necessary for correction [away from mechanical deformation producing nocioception], anybody would withhold its expression.”

If the athlete has practiced for hours and hours and has learned, implicitly, how to perform, why over-analyze? Simply put, they lose confidence (or faith) in their implicit ability perform.

But what of the patient in pain? If the patient in pain were to possess (implicitly) within themselves the means by which to reduce mechanical deformation, why suppress it?

Mr. Dorko hypothesizes that our culture has idealized a posture that is largely static in nature due to its intellectual discomfort with bodily expression that is unique and non-consciously motivated. As a result, the culture praises us for ideal stillness and “good posture”. In the end, the culture (and its expectations) drive the individuals movement (or lack thereof) rather than the individuals intuitive, non-volitional, deformation reducing ideomotion. (1).

Mr. Gladwell might say the patient is choking. He suggests that the only way to prevent an athlete from choking is to change the environment. In the instance of Jana Novotna:

The only thing that could have saved her is if–at that critical moment in the third set–the television cameras had been turned off, the Duke and Duchess had gone home, and the spectators had been told to wait outside. In sports, of course, you can’t do that…Choking requires us to concern ourselves less with the performer and more with the situation in which the performance occurs.

Choking, like pain, is contextual (read: Neuromatrix). Unfortunately for the athlete, their environment is non-malleable; the crowd will not go home and the cameras will not turn off. Likewise, the patient in pain does not get to choose the culture they are a part of.

Fortunately for the patient in pain, however, they have greater control over the context of their pain experience. The athlete has to play their game or match at a predetermined time, at a predetermined location, against a predetermined opponent. Their choices are limited. The patient, on the other hand, can choose what they do, when they do it, and who they trust to do it with. This is where the skill of the clinician is important. After all, “If the motion necessary for relief must come from the patient, it is only likely to arise within an environment full of acceptance and faith in their inherent abilities.” (2)

How do you set up your therapeutic environment to assure that the negative influence of the culture is suppressed?

How do you help your patients learn to stop choking?


(1) The Characteristics of Correction
(2) The Analgesia of Movement: Ideomotor Activity and Manual Care


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