Nature has given us a brain that survives in a changing world by changing itself. - Norman Doidge
If you have serious long term stubborn pain or physical limitations that have not responded well to other treatments, then this article, which explores Norman Doidge’s book The Brain That Changes Itself, could provide valuable new information for you. His book originally popularised the term Neuroplasticity.
“Change is the only constant in life.” - Heraclitus. Our world does change, and we have to adapt. Especially when we are injured or have a new health challenge. However, the good news is, no matter what’s going on, our brain can find new strategies and abilities to not only help us cope but possibly also to help us thrive.
Some people who have almost given up hope of improving their mobility, find they can achieve this with an effective neuroplastic method.
I have learned to help my patients access their neuroplastic capacity for change in ways that can help them recover from severe injury and physical limitations as well as support people with long-term stubborn pain that developed from no obvious cause.
When I studied neuroscience at UNSW in the late 1980s, I had never even come across the term neuroplasticity until I was offered a position as an honours candidate to research "Neuroplasticity in the Trigeminal System" of rats. Prior to that, universities still taught that the brain was unchanging and that, if damaged, it could not recover. This mindset limited the way treatments were designed and contributed to why so many people with injuries such as strokes or car accidents would have their treatment cut off too soon. I find this can certainly still happen, but armed with research similar to what Doidge presents in this book, I have been able to convince certain insurance companies and other third-party payers to approve further treatment in cases where they had previously stopped paying for treatment.
How To Increase Your Chance Of Making Deep, Long Lasting Stable Progress
At the time Doidge wrote The Brain That Changes Itself, he was a practicing psychiatrist, psychoanalyst, and researcher on the faculty at the Columbia University Centre for Psychoanalytic Training and Research.
Every joint in our body sends multiple messages every second to our brain for processing so it can maintain our balance. These messages must travel via the spine. Problems in the spine can interfere with these messages.
In chapter one, when I read Doidge's account of the woman who perpetually fell everytime she stood up, I learned two new terms that scientists use in the field neuroplasticity. It was exciting and a great relief to read about these terms because I had observed the processes they represent in numerous patients but did not have the terminology to describe or explain it.
Picture by Megan Ruth, http://Pexels.com
Refractory Period: The first term is refractory period, referring to the length of time the benefits from my particular neuroplastic treatment lasts. I found this exciting, not only because it helped me to understand what I had observed so many times with my patients, but also because I knew it would help me explain a common and very frustrating experience my patients often encounter. That experience is for them to feel like they are going backwards after noticing progress. People can get very excited when pain that has been present every minute for years disappears after a few NSA sessions, yet they can become quickly disillusioned, and even quite depressed a day or so later when some or all the pain returns. I find that to be very sad, as I have seen so many times how that kind of regression is usually followed by further progress if the person continues to receive the treatment consistently. However, until I read The Brain That Changes Itself, I did not know this aspect of the scientific understanding for why their progress can be so erratic. I felt excited when I read about the refractory period as I knew this new understanding would help me to encourage my patients stick with their treatment program long enough to get a better idea of whether or not I was going to be able to help them make deep, long lasting and stable progress.
Unfortunately, some people leave before I can explain all this, which is one of the reasons I have written this article. My goal is for you to understand this process of healing and recovery so that if you experience regression (i.e. your symptoms return), you will be less likely to conclude "This treatment is not going to help me after all." Please let me know if you do ever get frustrated in any way. I realise that for some people, the progress is rapid and does not go up and down much at all. For them, it is easy to stay motivated. For others, it is more challenging, not just in time and effort, but also cost. Please share any of your concerns with me before you get to the point where you feel the need to give up.
“There are no secrets to success. It is the result of preparation, hard, work, and learning from failure.”-Colin Powell
Period of consolidation: The second term I found helpful is the period of consolidation. Doidge explained this as a period of time where progress does not appear to be happening. For example, in sport, we often hear that the athlete has reached a plateau. I find this an unfortunate term because the shape of a plateau is a rise, then a flat area, and then a decline, whereas in sport and in healing, as well as at school, what we want is overall progress towards a goal. The term period of consolidation helps us understand that progress is usually not a consistently straight upward slope. Instead, it includes periods where the body and/or the nervous system are changing and developing in ways that will soon advance to the point where we will be able to notice the benefits of that change.
That unseen change is like trying to measure progress while watching a large building being erected. If we are just measuring progress by what we can see looking from a distance on the ground, we would not be aware of the dozens of people and machinery working hard below ground level to create a solid foundation. Once that is done, have you noticed how quickly the building progresses upward?
We can't always measure progress by what is above ground and obvious. During a program of care with neuroplastic treatment, your body will be working on construction of new neural pathways before you notice all the results.
Sometimes there will be months of work in the planning, negotiations around finance and approvals, deciding which contractors and subcontractors will be involved; all of that takes a tremendous amount of work, yet no progress appears to be made on the actual building. Then work starts and it requires digging the dirt and rock, putting in pipes and laying lots of cement to make sure the building stays upright for many decades. Without that solid foundation, the building will deteriorate much more quickly.
The term period of consolidation has been used in education for some time and by scientists studying memory. For example, a 2015 study states,
"Conscious memory for a new experience is initially dependent on information stored in both the hippocampus and neocortex. Systems consolidation is the process by which the hippocampus guides the reorganization of the information stored in the neocortex such that it eventually becomes independent of the hippocampus."
I know that sounds like scientific jargon, but it’s not as difficult as you may think. The hippocampus and neocortex are just the names for two different parts of the brain with different functions. My point is to give you a better idea of how much we do know about the way this process of consolidation works. Learning about this will perhaps make it easier for you to accept and be patient during times when it appears you’re not
The idea of being patient when getting well or recovering from injury is not new. After all, that is where the term 'patient' comes from!
making progress in whatever quest you are on, whether that's learning something new at work or embarking upon a treatment program to help you be and feel healthier.
Treatment frequency: The same scientists explain the temporary instability of new memories, and that helps us to understand why it’s important to have a sufficient level of treatment frequency. We all inherently know that if we learn a new task and don’t get back to it for a few weeks, it feels like starting all over again. Yet, if we repeat it frequently enough, we can learn the new task more quickly and not forget it. Learning a language is a great example of that. It’s better to study a new language three times a week for 15 minutes (a total of 45 minutes) than 90 minutes once a week.
Here's another quote about consolidation from the scientific article I quoted above:
"Memory consolidation refers to the process by which a temporary, labile memory is transformed into a more stable, long-lasting form."
Even with our best intentions we can still forget things. Our body also forgets what it has learned if it is not reminded. At the start of a neuroplastic treatment program it usually needs to be frequent, especially if the old patterns have been there a long time and are deeply hardwired.
This accounts for “the phenomenon of retroactive interference in humans, that is, the finding that learned material remains vulnerable to interference for a period of time after learning.” When I read that, it helped me further understand why it is that, if someone comes in for their first chiropractic session with me and is very pleased with the results, but waits an entire week before returning for the second session of neuroplastic treatment, their nervous system has usually forgotten so much of what they learned that they feel like they are starting from
square one again. This can make them come to the incorrect conclusion that “The treatment is not going to lead to long-lasting results, so there’s no point doing any more. A similar process of consolidation happens on and off during a treatment program. People usually notice great progress in short bursts with periods of apparent lack of progress in between. But Doidge points out in his book how these periods of consolidation, where the nervous system is building new networks that will enable it to take the next leap forward in function, may not produce noticeable progress. Even if unnoticed, progress is in fact occurring, and in time, with repeated treatment sessions will usually be noticed by the person receiving the treatment.
Working with Neurodiverse Brains
“I know the price of Success: dedication, hard work, and an unremitting devotion to the things you want to see happen.”-Frank Lloyd Wright
The Brain That Changes Itself has been a source of great encouragement to many people with serious challenges. For example, Doidge tells the story of Barbara. “It is rare that a person who makes an important discovery is the one with the deficit, but there are some exceptions. Barbara Aerosmith Young is one of these.” At school in the 1950’s, she was regarded as retarded in some areas of mental function while having brilliance in other areas.
As Doidge puts it, Barbara reported having had trouble with questions like “Is an elephant bigger than a fly?” He reports that she said, “All I could figure out was that a fly was small, and an elephant is big, but I didn’t understand the words bigger and smaller.” Doidge describes her journey of figuring out how to help her brain overcome these kinds of limitations. She went on to develop many brain exercises and in 1980 started a school to help children with learning disabilities. He writes, “At the school, children who, like Barbara, have been unable to read a clock now work at computer exercises, reading mind-numbingly complex ten-handed clocks (with hands not only for minutes, hours, and seconds but also for other time divisions such as days, months, years) in mere seconds… By the time they finish, they can read clocks far more complex than those any normal person has to read.”
That's me learning to garden with Grandpa.
Babara’s story is a particularly interesting and important one for me personally because as a child I had learning disabilities. I struggled with spelling and writing essays. I found it hard to get the words and concepts in order. Today I would likely be diagnosed as ADHD and dyslexic. To make matters worse, I had a prominent birthmark like a very large blister under my nose with blood vessels just under the skin with red and purple colours.
If I had not been blessed with parents who never gave up on me by providing constant encouragement as well as multiple costly tutors, I doubt I would have ended up being able to go to university, which turned out to be something I really enjoyed and excelled at. In my final year I achieved ten high distinctions, first class honours, and a university prize. Achieving that required a lot of extra practice in the art of study over many years. It also required a good supply of grit and determination that enabled me to get up extra early at ages 13 to 15 so I could walk to the local station, catch a train, and walk a couple of kilometres to my reading tutor. When finished, I would walk to high school. Having now read about the brand benefits of learning an instrument, I realise that playing guitar from early primary school also played a big part in developing my brain that later enabled me to overcome learning impairments.
This is Mum at age 95 reading to me while I garden.
Just writing that last paragraph brought back so much emotion that I could hardly read the page for tears — tears from being teased by the other kids, feelings of isolation in the playground because nobody wanted to play with me, tears of feeling stupid. I remember thinking, “I will beat this,” and so sat by myself under a comforting big pine tree in the playground and read the entire Alfred Hitchcock series while I was in fourth and fifth grades. Being different even led to being bullied for being gay in year 7 (although back then that was not the term they used).
Most of all, as I write this, I know these are tears of deep gratitude to my parents and all the love and guidance I received from incredibly devoted teachers starting very early through to the end of year 12. I can still play the scene in my head (one of my abilities) where my year 11 economics teacher explained to my parents that, while it took me a long time to complete my essays, the essays were getting really good, and while slowness made it hard for me during exams, she said, “He has aspects of brilliance and will do well at university.” I reminded myself about those words many times when needing to push myself to do more hours of study. Without those reminders it would have been easy to think, “What’s the point of trying?” just like the story below of the woman with two daughters.
I invented my own study scheduling system which I endeavoured to stick to. I somehow had a lot of optimism aided by an ability to forgive myself and promise to do better when I did not stick to the schedule. The schedule included getting up extra early in the morning to study. It also included precisely when I would start and stop studying different subjects as well as when I would exercise. For example, every 25 minutes, I would have a five-minute break and turn on some rock ‘n roll really loudly in the next room and do chin-ups on a beam that was part of the ceiling. It got to the point where I could do 20 full chin-ups in under 25 seconds.
“Success is a function of persistence and doggedness and the willingness to work hard for 22 minutes to make sense of something that most people would give up on after 30 seconds.“-Malcolm Gladwell
Just like muscles, the brain can also be trained to become more efficient and effective. That improved efficiency can be aimed at healing the body and resolving symptoms. As BJ Palmer, the developer of Chiropractic, said, "We never know how far reaching
Just like muscles, the brain can also be trained to become more efficient and effective.
something we may think, say or do today will affect the lives of millions tomorrow."I have appreciated that statement for decades and yet, on a less grand scale, I have appreciated that statement for decades and yet, on a less grand scale, I would say that... We never know how what we think, say or do today will benefit ourselves and others in the future. For example, doing all those chin-ups really built up my physique, which accomplished my goal of being noticed by girls.
“The best way to predict the future is to create it.”-Peter Drucker
I would not have done any of that if a sense of hope and possibility had not been provided by my parents and teachers. Setting myself goals and rewarding myself when they were achieved were also great drivers towards making further progress.
Doidge wrote the following about Barbara’s work:
Because so few others knew about or accepted neuroplasticity or believed that the brain might be exercised as though it were a muscle, there was seldom any context in which to understand her work. She was viewed by some critics as making claims – that learning disabilities were treatable – that couldn't be substantiated.
A Sense of Hopelessness
That example of Barbara being criticised for making unsubstantiated claims also describes what I have experienced many times, not only from critics but sometimes from new patients who have long-term stubborn pain, especially when combined with significant physical limitations. These people can develop a sense of hopelessness. Having talked with dozens of patients
Just because you've had spinal stiffness for a long time, and just because it has been getting worse, does not mean it can't be helped. Would it be worth the effort to find out?
with that sense of hopelessness, too many have either been told, “We have done all the tests and cannot find any problems, so it’s probably all in your head,” or “Your test results show some serious problems which you are going to have to live with because there are no treatments.” This experience can cause them to lose confidence in their own body’s ability to heal due to well-meaning practitioners who have only utilised what they know within the more traditional and well-understood approaches to treatment which work well for most but may not have worked for them.
In other cases, not following through with treatment is blamed on a lack of finances and resources. I have seen many cases where the insurance company or hospital protocol restricts treatment due to limitations from cost cutting measures. Doidge tells the story of a man who had a stroke and was only given several weeks of physiotherapy in the hospital and then sent home. He was told that was all that could be done for him. Yet he still had severe disability from the stoke. Decades later he applied himself diligently to a neuroplastic treatment approach over many months that helped him regain much of his lost function.
Unfortunately, too few people learn about the potential effectiveness of treatments with a strong neuroplastic component and continue to experience pain and/or physical limitation unnecessarily. I think it is particularly sad when this happens due to giving up as a result of developing a sense of hopelessness. A classic example of this was when two sisters in their thirties brought their mother (let’s call her Sandra) in to see me for a chiropractic assessment. Sandra had severe pain and difficulty walking. She also had serious sleep disturbance due to pain waking her up, and had been like that for so many years that she had decided nothing could help her. I do understand how people come to that conclusion when, as was true for Sandra, she had received all kinds of diagnostic studies such as x-rays, CT scans and MRIs and had been told by numerous doctors that she just needed to learn to live with it. After hearing that, she had understandably learned to accept her situation, but that meant not being open to trying any other types of treatment.
To the frustration of Sandra, here were her daughters suggesting that I might be able to help her. They told her about their own experience receiving neuroplastic treatment and wanted their mother to see it could help her. I performed a few tests on Sandra to see if certain dysfunctions were related to problems in her spine. That is something I still do as part of the Low-cost Initial Consultation. I discovered that at least some of her more significant problems were related to issues with her spine. I explained how these issues in her spine were affecting communication from her brain to her symptomatic areas. I also explained that my approach would not be to adjust (manipulate) those areas because, while that can be an incredibly effective way of helping spinal problems, she had already received that type of chiropractic care and it had not helped her.
Spinal stiffness is like water in a water logged field, pushing it out will usually mean it can return. Instead, I have found that stiffness is best reduced by teaching the nervous system how to let it go.
I then shared that I believed the reason why adjustments had not worked was because her primary issue appeared to be extremely high levels of guarding deep within the spine and spinal cord causing tremendous stiffness. To me, stiffness is like water in a swamp; you can't just pump it out and expect it to be gone, you must provide a constant drainage system; otherwise the water will come back. You can also correct the cause of the swamp by diverting the spring water somewhere else. For humans, the source of stiffness can be worry and stress, so that may also need to be worked on with assistance from other health professionals.
The residual effect of many years of worry and stress, as well as physical injuries on top of that stress, can often be released to a large extent utilising the strongly neuroplastic method I can provide. I explained to Sandra that in most cases (but not every case) on the very first detailed initial evaluation, I can objectively measure and demonstrate the release of that tension, as well as its positive ramifications in terms of reduced tenderness, muscle tightness, increased strength, and range of motion.
“That’s the problem with letting the light in—after it’s been taken away from you, it feels even darker than it was before.”― Kim Liggett, The Grace Year
I can still see and hear this dear woman’s response as well as the look of sadness and frustration on the faces of her two daughters when she said, “Oh Dr Barritt, you can’t help me, nobody can help me.” Sandra was so resigned to her condition that she would not even allow me to perform the initial thorough consultation. That consultation would have involved a detailed evaluation as well as neuroplastic treatment involving gentle touches to the spine and body. I then would have re-measured the same functional tests after treatment and have written it all up in a report to show and discuss any functional improvements at her follow-up visit.
To some extent, our ability to be active in our seniors years, may be increased and prolonged by our choices in our younger years.
We Can Create Our Own Sense of Optimism By Taking Action
“The price of Success is hard work, dedication to the job at hand, and the determination that whether we win or lose, we have applied the best of ourselves to the task at hand.“-Vince Lombardi
I shared Sandra’s and my personal stories with you in the hope that these may help you understand the way our mindset can get in the way of benefiting from a different approach to our health care. For example, my initial thorough consultation may be different to anything you have tried thus far and so might the type of treatment I provide. Also, I design my nitial thorough consultation to be able to document whether or not you have areas of dysfunction that could be contributing to your symptoms. If I am able to do that, I find this process can then be very encouraging so you may then find the motivation to keep working towards your health goals.
The most important message I hope you get out of this article, is that no matter what you want to achieve, if it involves overcoming a significant challenge, you’ll need to acquire at least some knowledge, seek assistance, make a plan, and accept the fact that it will usually require effort, consistency and persistence. To further ensure your success, I also recommend you find sources of encouragement and monitor your progress.
If your quest is to reduce long term severe chronic pain or physical limitations, I commit to supporting you to the best of my ability in many aspects of your healing journey.
Jason Barritt B Sc. (Hons), DC
Please check out this article where you will learn more about the main chiropractic method I used called NSA care and why it can be considered a powerful neuroplastric treatment
Click here to learn about my Low-cost Initial Consultation.
References:
Squire, L.R. et al. Cold Spring Harb Perspect Biol. V.7(8): 2015 Aug.