This article was originally published in Positive Health issue 52 – May 2000
Unless you are a masochist, avoidance of pain is a normal reaction. Nature, in its kindness, has provided us with reflexes that allow us to escape painful stimuli. Without these mechanisms life would be unbearable.
Imagine that you’ve just sprained your ankle. At the beginning, you avoid using your injured foot. But you are impatient to walk, and as soon as the pain has decreased you attempt to do so – with an odd gait. Walking normally would be painful, so you adopt, more or less consciously, a funny but painless walk. In Mézières parlance, you are under the influence of an Antalgic Reflex a posteriori. Antalgic means ‘alleviating pain’, and a posteriori means ‘from what comes after’. So, an antalgic reflex a posteriori represents the ‘grimaces’ the body makes after feeling pain, in order to alleviate it. It is a simple and well-known phenomenon.
Life is not always as simple, though. There are times when we use an antalgic reflex even before we perceive a pain. It is not hypochondriacal behaviour; a painful condition really exists, but before it can be felt consciously it is quickly and subconsciously avoided. Françoise Mézières, who, with her acute sense of observation, discovered this strange reflex and named it the Antalgic Reflex a priori (ARAP).
ARAP (which should not be mistaken with referred pain) offers the body a subterfuge from pain. Before you know it, without consulting you, the body can conceal a pain and preserve a fragile comfort. We can be in pain and yet not know it: a painless pain! That may sound very useful, but don’t congratulate yourself too quickly for having such a mechanism at your disposal. There is a price to pay.
It is quite true, as Harry Lindlhar (well-respected American Naturopath of the 1920s) said: “A repressed pain is a deferred pain.” Contrary to appearances, the ARAP is surely not the result of the body’s wisdom. It is not better than a pain killer since it does not remove any cause; but in the same way, it makes us ignore the cause, and ignorance is bliss only up to a point.
The comfort that ARAP affords us is unstable and precarious. To silence pain, the body will take extreme measures. It will resort to various forms of misalignments, distortions, twists, and deformations to gag the disturbing pain. It can also lead to hyper-active, fidgety, or other awkward behaviours. Things progressively worsen, developing into serious conditions such as pain, arthritis, atrophy, disability, contractures, ankylosis, numbness, pins and needles. Osteoarthritis of the hip, ‘frozen’ shoulder, and scoliosis, for example, are symptoms often deriving from ARAP. This pain-avoidance mechanism can even go as far as provoking pseudo-paralysis. Whatever the resulting symptoms are, pain usually results. The avoidance of pain in the end produces more pain!
The pathological outcome of ARAP always develops at a distance from the original site of the subterfuged pain; and to try unrelentingly to ‘cure’ these symptoms is a waste of effort which often aggravates the existing condition. Under the influence of ARAP, the cause is never where the pain or disability is. It is somewhere else and has to be found to ensure a successful treatment. Physical therapists who are unaware of the tricks played by ARAP, may be misled into erroneous diagnosis and misguided treatments.
A good example, chosen from Mézières’ case studies, will help you understand the complexity and importance of the workings of ARAP. A man crippled with sciatica is brought to Mézières. The patient cannot walk and needs help to get undressed and to lie down on the floor, in the supine position. Mézières then proceeded to lift up the legs in an attempt to lengthen the whole dorsal musculature, and in particular the lumbar region. The patient has great difficulty in extending his legs, he complains and become agitated. Mézières, noticing that his head is constantly leaning on one side, asks an assistant to hold the legs while she goes to the head. The palpation of the neck reveals that the 3rd cervical vertebra is seriously misaligned. After stretching the muscles that hold this vertebra in a wrong place, the patient stops complaining and his legs stop ‘fighting’. He can now get up, get dressed and walk, without any problem.
I am myself working now on a patient in his 30s who has no serious complaints, apart from occasional pain in the back of the thighs.
When he is in a supine position and I lift his straight legs to the vertical, his pelvis goes up as well. When I ask him to lower the pelvis to the floor, his knees bend, especially the left which keeps escaping all my attempts to correct it. If any progress is made, my patient automatically compensates by a shift of the pelvis to the right. When I succeed in making my patient lower his pelvis in a straight and vertical direction, his left leg shakes, bends, and turns inward. Apart from a slight discomfort in his stretched hamstrings, he does not feel any pain. On two occasions I succeeded in coaxing him close to a correct posture but he promptly managed to escape my efforts, as if fear was guiding his reactions. I am sure that this is the effects of an ARAP. The patient has a precognition that straightening his left leg will produce a sharp pain and this I suspect will come from the lower back. I am confident that the latent pain, hidden in the lower back, will be revealed once we manage to ‘brake’ the defence mechanism of the ARAP. Once expressed, the cause of the pain will be removed by the relaxation of the contracture in the lumbar region.
What is the origin of these phantom pains that hide behind the ARAP? Next month we will see whether there is any truth in the adage ‘no pain, no gain’!