Graded Motor Imagery in Spokane Valley
Most chronic pain treatment focuses on tissue. Stretch the muscle, mobilize the joint, take the medication, and get the injection. Graded Motor Imagery is different. It treats chronic pain at the level where chronic pain actually lives — the nervous system.
What GMI actually does
GMI is one of the most rigorously studied non-pharmacologic treatments for complex chronic pain conditions: Complex Regional Pain Syndrome (CRPS), phantom limb pain, and refractory chronic back and neck pain. It’s offered at Synergy Healthcare by Arch Harrison, PTA, who specializes in this work. It’s not a common service in the Spokane region, and it’s not what you’ll find at most outpatient PT clinics.
GMI moves through three stages, each designed to expose the brain to movement of the painful body part in a graded, non-threatening way.
Stage 1: Implicit motor imagery. You look at images and determine, as quickly as you can, whether the body part shown is a left or a right. The Recognise app — developed by the team that pioneered GMI — is the standard tool for this. It activates the motor cortex without requiring the painful body part to actually move. Improving accuracy and speed correlates with reduced pain.
Stage 2: Explicit motor imagery. You intentionally imagine moving the painful body part — visualizing the movement in detail without performing it. Imagined movement activates many of the same neural pathways as real movement, which begins to desensitize the brain’s protective response.
Stage 3: Mirror therapy. A mirror box hides the affected limb. The unaffected limb is positioned so its reflection appears in place of the affected one. As you move the unaffected side, your brain visually receives input that the affected side is moving — without pain. Over time, this can teach the nervous system that movement of the affected limb is safe, opening the door to actual movement without the protective pain response.
Each stage is paced. You stay in a stage as long as your brain needs to before moving to the next. Pushing through too quickly often re-triggers the protective response and sets progress back.
Why chronic pain isn't always a tissue problem
Pain is a brain output, not a body input.
That isn’t a metaphor. It’s how the nervous system actually works. Your body sends sensory information up the spinal cord. Your brain analyzes that information against context — history, expectation, stress, perceived threat — and your brain decides whether to produce the experience of pain. In acute injury, the system works exactly as intended. Pain stops you from doing more damage.
In chronic pain, the system can get stuck in a protective loop. The original injury heals. The pain remains. The brain has gotten so practiced at producing a pain response that it keeps producing it long after the tissue has recovered — often amplified by anxiety, fear of movement, and the entirely understandable expectation that pain will return.
This does not mean your pain is “in your head” or that you’re imagining anything. The pain is real. Every neuron is firing the way it does in any pain experience. It just means the pain signal is no longer tied to active tissue damage, and the way out is to teach the brain that movement is safe again.
Commonly Used Therapies:
Primary GMI Clinicians:
Arch Harrison
NOI-trained w/ 26 Yrs of Experience
What treatment looks like
GMI is patient work. The clinician’s role is to guide, calibrate, and coach. Your role is to do the daily practice.
A typical course looks like this:
- An initial assessment to determine where on the GMI continuum to start
- A home practice program — usually 5–10 minutes, several times per day, every day
- Weekly or twice-monthly check-ins to assess progress and adjust the program
- Progression through the stages over weeks to months, depending on how the nervous system responds
Most patients see meaningful change within 6–12 weeks of consistent practice. Some respond faster, some slower. The work doesn’t replace your other treatments — it integrates with them and often makes other treatments more effective than before.
Who benefits from GMI
GMI has the strongest evidence base for:
This is the gold-standard indication. Multiple randomized controlled trials have shown GMI to reduce pain and improve function in CRPS, often when other treatments have plateaued.
Mirror therapy and motor imagery are first-line non-pharmacologic interventions for phantom limb pain following amputation.
"Pre-hab" before a knee, hip, or abdominal surgery directly cuts recovery time. Patients who train with Cheryl before joint replacement consistently hit range-of-motion benchmarks ahead of schedule.
Desk workers, post-prolapse patients, men managing pelvic floor dysfunction — these are exactly the imbalances clinical Pilates is built to correct.