Graded Motor Imagery: ‘Tricking’ Your Brain Into Pain Relief, Increased Function


By: Dr. John Conde DC, DACNB Special to the Boca and Delray newspapers

The human brain is highly plastic or changeable. It is constantly being re-organized with some areas assuming more dense neurological connections and other areas becoming less dense. Sixty percent of the brain is genetically predetermined while forty percent is constantly changing according to environmental influences (work, home, exercise, food, etc.)

Graded motor imagery (GMI) is a form of rehabilitation that capitalizes on the core fundamental principles of neuroplasticity. The brain has a “map” of our entire body with certain areas of the body occupying larger sections of the brain with denser connections. This “map” is constantly changing, literally all the time. This understanding is pivotal for the application of GMI and for the possibility of re-mapping and re-organizing the brain when there is dysfunction manifesting as pain and or weakness.  GMI can be broke down into three unique stages of treatment techniques; right/left discrimination, explicit motor imagery, mirror therapy.

Right/left discrimination is the process of identifying one side of the anatomy as distinct from another.  The focus is the sidedness however the body part may be rotated or bent making the identification of left or right more difficult. The research demonstrates that patients with pain lose the ability to accurately identify right or left images of the painful body part. If able, patients with pain are usually much slower at identifying the sidedness of an image of the body part that is in pain. Through the concepts of neuroplasticity, we can re-train and enlarge the brain “map” of the body part that is in pain thus enhancing the descending pain inhibitory systems.

In reference to explicit motor imagery, a study was done focusing on the accuracy of shooting basketball free throws which demonstrates the efficacy of this therapeutic regimen. The test subjects were broken down into 2 groups; one group actually practiced shooting the free throws over and over, the other group just explicitly visualized the act of shooting the free throw for the same number of sets and repetitions.  The study concluded that there was no difference between the two groups in terms of the accuracy of the free throws, both groups made the same number in the goal. Explicit motor imagery is the process of thinking about moving without actually moving. Because 25 percent of the neurons in your brain are “mirror” neurons and actually get activated with visualizing activity or watching people in motion, imagining movements can actually be hard work if you are in pain. This example explains the power of motor imagery. Therefore, with visualizing movements you actually are working the same regions you would if you were performing the movement. Therapeutically, you can enhance the brain “map” for that body part by merely performing detailed motor imagery.

Lastly, mirror therapy is the act of using movements of the stronger body part to “trick” the brain into thinking the weaker body pat is moving. By placing the left hand in front of the mirror and the right hand behind the mirror, you can fool your brain into thinking the reflection of your left hand is your right hand.  Therefore, you are now working on the right hand in the brain. This will encourage the expansion of the brain “map” in the brain for the right hand and improve neuron activity for that limb. All three of these techniques and the overall premise of GMI provide new hope for patients with pain and weakness.

Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at 561-330-6096,, and at