This book explores the benefits of RiVision®, an innovative physical therapy method that is designed to treat musculoskeletal injuries and chronic pain. This method uniquely combines physical therapy, dance/movement therapy (DMT) and guided imagery so that, working together, they can be more effective than they would be if used separately. The RiVision® method stands for one's ability to envision her body differently; to see, identify and revise the way she relates to and treats her chronic pain.
In 2000, I completed my doctoral dissertation from the New York University Physical Therapy Department, where I examined a new treatment intervention for people with chronic neck pain. My work was to compare neck exercises combined with either dance/movement therapy (DMT—a form of intervention that uses dance as a process which furthers the emotional and physical integration of the individual) or with aerobic training (AT). Treatment outcome in each group was measured by the effect on mood state, pain perception and cervical range of motion (CROM).
My findings indicated that DMT was as effective in improving mood state, decreasing pain perception, and increasing CROM as AT. In addition, it is postulated that in DMT, the spontaneous, pleasurable expenditure of energy offers relaxation and the sublimation of worries (Payne, 1992). The effects of DMT on mood can be explained by the theory of catharsis and spontaneous expression through movement. Leste and Rust (1984) theorized that the cathartic nature of dance, with its concomitant emotional expression, release of tension, anger or frustration, can alter the individual's mood state. Therefore, DMT has the potential to offer greater benefits than AT.2
In my practice I incorporate guided imagery exercises that have been shown to be effective for patients with pain conditions, such as imagining a healing light. My study results, along with 33 years of experience treating patients with various musculoskeletal disorders and chronic pain, led me to develop and implement RiVision®, which combines physical therapy, DMT and guided imagery.
Chronic pain is not merely a physical sensation resulting from a physical injury; it is a multifaceted experience influenced by emotional factors, such as depression, stress, anger and anxiety. The use of physical therapy and psychological services is common practice in these cases. In 1983, after graduating from physical therapy school, I often observed that patients needed to express their emotions while receiving conventional physical therapy treatment. The patients would lie on the treatment bed letting out a wide array of feelings, including negative personal experiences from their lives.
At first I was reluctant to respond to these emotions since I was not equipped with the appropriate educational background. As time progressed I realized that I needed to enhance my knowledge of pain in all its manifestations by studying psychology and exposing myself to various integrated forms of therapy related to chronic pain. Recognizing the influences affecting those with chronic pain, I have come to understand that health caregivers need to be able to relate a patient's symptoms to what is happening simultaneously in their body and mind. I learned that DMT and guided imagery are the best ways to address a patient's psychological presentation, which often manifested in their posture, gestures and movements.
My training began with a Bachelor of Physical Therapy (BPT) degree, followed by a Master of Science (MS) degree in DMT. The latter is a form of intervention that uses dance/movement rather than words/talking as the main mode of treatment to facilitate the emotional and physical integration of the individual.
It was my intention to incorporate the knowledge and experience I acquired in these professional preparation programs, along with my training in guided imagery, to further benefit those patients who sought help due to various musculoskeletal disorders such as lower back pain. However, for many years I was puzzled by just how to integrate these different yet complementary therapies. I wanted 3to be able to look at an individual through a broader spectrum than one that is used in or as independent physical entities, but as entities connected to an individual's emotional issues. The idea is that behind the painful, injured body parts there is a human being with an untold story. Pain can be the body's way of expressing that story.
In cases where the traditional physical therapy approach does not suffice for alleviating pain, we must look for other treatment solutions for the complex and mysterious ways a body cries for help. Despite the idea that there are psychological benefits to physical therapeutic exercises, conventional therapy typically does not address the subconscious processes involved in chronic pain. In my work, I have found that the simultaneous usage of physical exercises and modalities relating to the subconscious is superior to the usage of physical interventions alone.
During my training in DMT, I studied the work of Warren Lamb, whose work influenced my final thesis titled, The Psychological Implications of Moving in Different Planes (Har-El, 1991). In my thesis I explored the relationships between body movement style and three personality traits: (1) risk-taking, (2) level of self-esteem and (3) social participation. An analysis of the test results from a group of DMT students supported a correlation between an individual's movement pattern and certain personality traits. The main findings were:
- People who move their body back and forth (the sagittal plane) more often than up and down or side-to-side (vertical and horizontal planes) are more likely to have a higher score in risk-taking than in self-esteem and social participation.
- People who use up and down motions (vertical plane) more often than the back and forth and side-to-side motions (sagittal and horizontal planes) are more likely to have a higher score in self-esteem than in risk-taking and social participation.
These findings imply that there is a relationship between the way people move their bodies and their state of mind or well-being. Patients may develop body misalignment, pain and discomfort for various reasons. When they seek help from a physical therapist they expect to receive traditional therapy involving physical modalities such as massage and therapeutic exercises to treat the injured area. 4However, when I observed my patients’ movement patterns and postures it became obvious to me that I should consider their movement behavior and general well-being as part of their treatment as well as their physical complaint. I realized, based on my patients’ personal verbal and nonverbal communication with me, that the patients’ movement patterns/movement characteristics could reveal further information leading to the source of the pain.
The material presented to you is a culmination of this research supported by 33 years of practice and my PhD dissertation. In this book, I introduce the RiVision® method (Chapter 1) followed by the need to observe the entire body manifestation and movement (Chapter 2). I explain the three components of RiVision® (Chapter 3): (1) physical therapy, (2) DMT and (3) guided imagery. Then I discuss the seven treatment protocols used in RiVision® (Chapter 4) and the five underlying principles (motion factors)—awareness, grounding, pacing, orienting and muscle tension—using several principles of the Action Profiling theory (for further details see Appendix).
This section is followed by four case studies detailing the stories and treatment paths of four patients (Chapter 5). Each patient's treatment includes the treatment goal and the exercises tailored to achieve that goal. These stories show how RiVision® helped one patient to overcome chronic physical and emotional pain, and learn how to respect and love oneself. You will learn about another patient who suffered from asthma while her body posture was concaved, as if to protect herself. With therapy she was able to open up her movement (erect her body and open her chest), which led to her gradual opening up emotionally. She was also able to use her inhaler less frequently, and her posture and upper body flexibility improved significantly. I also show how a man in a stressful and demanding profession, that manifested in chronic neck pain and rigidity, was eventually able to move his entire upper body and neck without pain as a result of the use of imagery and physical movement. Lastly, another story shows how someone extremely frail can develop her self-esteem and inner strength, and learn to protect herself and her body so that she is able to face life with greater stamina and endurance.5
In Chapter 6, I explain how to apply the RiVision® method by finding the reader's “Repetitive Stress Pattern” (RSP) and analyzing it. Last is a summary and conclusion (Chapter 7). In the Appendix, I include more technical details geared toward the practitioner.
This book is for chronic pain sufferers who have not been completely helped by traditional therapies. RiVision® offers a thorough treatment approach that is not a quick fix, but rather a comprehensive approach to a long lasting condition. The purpose of this book is to familiarize you, the reader, with the core principles of RiVision®. The RiVision® principles presented in this book may also enrich practitioners who are interested in learning about an innovative treatment for their patients. RiVision® offers both patients and practitioners a method for overcoming pain by uniquely combining physical therapy, DMT and guided imagery.6