Archive for the ‘Health and fitness professionals’ Category

Compartmentalizing Chronic Pain

Thursday, May 26th, 2016

When an individual’s identity and belief about who they are is based around their capacity to be active and athletic, we can predict his or her fears. So what happens when chronic pain no longer permits an active lifestyle?

What happens next is an internal dialog of perception and meaning begin to take root… and how well one can direct their own thoughts, beliefs, emotions and assumptions becomes significant.

Compartmentalization is an unconscious psychological defense mechanism used to avoid cognitive dissonance.
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Businessman with lots of choices

The question then becomes “what is Cognitive Dissonance ?”and how does chronic pain fit into the equation?

Cognitive Dissonance “is the mental stress or discomfort experienced by an individual who holds two or more contradictory beliefs, ideas, or values at the same time, or is confronted by new information that conflicts with existing beliefs, ideas, or values.”

For example, no matter how much an individual may believe… if they’re heading east looking for a sunset, that idea and belief will inevitably run up against irrefutable evidence. This naturally will manifest an internal conflict.

In the context of chronic pain, wanting to go to the mountains for an afternoon of skiing with friends & family may be high on an individuals values list. But a belief that skiing will lead to further knee damage or an increase in pain will surely create a conflict. These psychological inconsistencies (dissonance) and the inherent uncertainty they bring can become difficult to manage – overwhelming for many.

Conflicting beliefs and values evenutally feed into an individuals psyche’, establishing negative neuro-associations based around the context of pain that can contribute to the overall pain experience.

What’s more, physical and emotional pain can negatively influence an individuals’ thoughts, feelings and beliefs regarding movement and exercise, inhibiting one’s capacity to remain consistent with how they define themselves – known as their identity.
Connected puzzle pieces with words CONFLICT and RESOLUTION

Our role as movement professionals and coaches is NOT to change an individuals identity or belief structure, but rather create an environment to EXPAND their capacity to understand what pain is and what purpose it serves.

Arming each client with insight and knowledge into the latest in pain science can help them consciously direct their own thoughts, emotions, assumptions and beliefs regarding chronic pain, which can establish constructive psychological associations and increase their ability to effectively compartmentalize chronic pain.

Written by:

Kevin Murray
Movement Masterminds – CEO
Function First – Director of Education

Neck pain from your eyes?

Wednesday, April 27th, 2016

Chronic pain is complex, resulting from many inputs processed through the nervous system and the brain. As humans, we rely heavily on our vision to assess and navigate our environment and maintain balance.

Visual references are also one type of input the brain relies on to determine a potential threat to the organism. For example, have you ever found a bruise on your body that did not hurt until you noticed it there?

For those suffering from chronic neck pain, vision provides a great deal of feedback about cervical range of motion along with the mechano-receptors in the joints and soft tissue. The endpoint a person sees when turning his or her head and experiencing pain combines with a cluster of other information occurring at the same time to form the neuro-representation of the pain experience in the brain, or what Melzack (2001) calls a “neuro-signature.”

Harvie et al. (2015) investigated the role of visual feedback on neck pain. The researchers used a virtual-reality apparatus to alter the visual proprioceptive feedback that subjects received during cervical rotation. Subjects were seated with their torsos fixed to avoid contributing motion from the thoracic spine during cervical rotation. Twenty-four subjects with chronic neck pain were assessed for the onset of pain during cervical rotation to the left and right. They were asked to stop when they felt pain and to rate it on a scale of 0-10 at the point in the rotation where pain occurred. Each subject was then fitted with a virtual-reality headset that provided six different visual scenes for six trials. The image below is taken directly from the study by Harvie et al. (2015) and shows an illustration of the set up.

bogus vision article

Researchers manipulated the virtual-reality scenes so that the visual cues did not match the actual cervical-rotation distance that subjects achieved on all trials. The virtual rotation provided by the headsets was either:

• 20% more than the actual rotation
• the same as the actual rotation
• 20% less than the actual rotation

This bogus visual feedback of plus or minus 20% made the subjects perceive that they were rotating their cervical spines 20% more or less than they actually were.

The results showed that when rotation was understated (subjects perceived their rotation was less than it actually was), pain-free range of motion increased by 6%. When rotation was overstated (subjects perceived their rotation was more than it actually was), pain-free range of motion decreased by 7%.

This study provides additional evidence to support the findings that pain is not generated solely from tissue damage. The bio-pyscho-social model acknowledges multiple inputs contributing to the pain experience.

Vision is one of many contributing inputs that the brain processes when assessing a threat to the body and therefore produces pain. The association of a specific neck range of motion identified visually, coupled with information from the motor system and proprioceptive system, creates a confirmed reference for past pain experiences. In other words, we’ve always had pain with this set of circumstances (neuro signature of matched proprioception, motor function, vision, vestibular), so we are supposed to have now. Hello pain.

It is plausible that visual input can also influence pain in other areas. For example, if a client has lower-back pain, forward flexion of the spine will bring her eyes closer to the floor, possibly presenting a painful or pain-free experience, depending on the client.

When designing a corrective program for clients where you believe the visual field is a factor, you could vary the visual field to minimize the visual association related to painful movements. Or you could keep the head still and create the motion you want from the bottom up-creating relative movement of the cervical spine in relation to the thoracic spine.

Interested in learning more about how we, at Function First and the Pain-Free Movement Specialists work with the chronic pain population? Enrollment is available only until April 29th here.

Melzack, R. 2001. Pain and the neuromatrix in the brain. Journal of Dental Education 65(12), 1378-82.

Harvie, D.S., et al. 2015. Bogus visual feedback alters onset of movement-evoked pain in people with neck pain. Psychological Science. doi:10.1177/0956797614563339.

Dynamic Systems and the Function First Approach

Thursday, April 21st, 2016

It was truly an honor to be one of the invited speakers to the Meeting of the Minds held in London last summer. The Meeting of the Minds follows a TED format where each speaker has about 20 minutes to give a quick hitting, condensed presentation.

The following is a snippet from my talk on Dynamic Systems Theory. The chaotic nature of the human organism is something that we all have to begin to appreciate regardless of the type of clientele you work with. It’s time we stop trying to isolate individual cause and effect for our assessments and consider the broader picture.

The video clip of the starlings does not appear clearly in the video of my presentation, but you can see many beautiful examples on YouTube.

When your client says, “But my MRI says”, then you say……

Friday, April 15th, 2016

Magnetic resonance imaging (MRI) is one of the most sensitive diagnostics currently available. It has frequently been the “last word” on pain, surgery and recommended limitations on activity. But should your client really never lunge or squat again because their doctor took an MRI and it showed some pathological condition?

Consider this review I did of a couple of studies on the matter. You may change the conversation you have with your clients once finished reading this.

Guermazi et. al. (2012) used magnetic resonance imaging to look at knees where radiographic imaging (x-rays) showed no osteoarthritic (OA) changes. OA is generally diagnosed through examination and x-ray. X-rays can identify bony changes to the joint but they cannot identify soft tissue pathologies. The purpose was to use the more sensitive MRI to detect structural lesions associated with OA and their relationship to age, sex and obesity.
MRI
710 subjects age 50 or older participated in the study (mean age 62.3 years). Out of the 710 subjects, 206 (29%) had painful knees.

Overall, 610 (89%) of the subjects showed some abnormality of the knee. Three most common findings of abnormalities in the knee were osteophytes, cartilage damage and bone marrow lesions. These abnormalities increased with age.

The study concluded that 91% of those who did have pain in their knee also had abnormal MRI’s, leaving 9% of those with painful knees having normal MRI’s. And 88% of those with no pain in their knees showed abnormalities in the MRI. The authors also noted that those with the highest amount of abnormalities in their MRI were those identified with mild pain and not those with moderate or severe pain (emphasis mine).

Another study in European Spine Journal (Kato et al. 2012) looked at MRI’s of the cervical spine of 1211 asymptomatic patients. The subjects were both men and women equally distributed between the ages of 20 years to 70 years. All of the subjects had both an MRI and neurological exam by a spinal surgeon.

Findings from the MRI of spinal cord compression, spinal cord signal changes and disc compression were noted. Increased signals on an MRI are associated with an abnormal state of the tissue such as scarring of inflammation.

For a disc bulge to be considered pathological it had to measure more than 1 millimeter from the vertebral body.
cervical spine degeneration
Of the 1211 asymptomatic subjects studied, 64 (5.3%) had spinal cord compression. High intensity signal changes were seen in 28 (2.3%) and disc bulging was seen in 1061 (87.6%) of subjects. Prevalence of these findings was significantly higher in people over 40 years of age.

If we consider the findings of both these studies, it is now clear that degenerative changes to the body are a normal part of aging and do not directly correlate with pain. Clients may experience stress or fear when learning of abnormalities in any joint or soft tissue following imaging studies done on them. Even if they are not in pain but have experienced pain in the past, the knowledge of degenerative changes are often communicated by medical professionals and perceived by individuals as the sole source of their pain. These studies clearly demonstrate that an individual can have many abnormal finding in the neck and knees and have no pain.

Clients who believe that the degenerative changes on their imaging will lead to pain may potentially act with self-limiting and guarded movements as well as an expectation of pain. This has the potential to decrease their functional capacity, increase anxiety about certain exercises or activities and view surgery as a necessary step to resolution.

Although I’ve suggested that your conversation should change with your clients, when you understand what these studies (and others) are telling us, we must remember that your client’s paradigm may not easily change. Their beliefs may be entrenched in an outdated pain/imaging relationship, especially if their doctor leads them to believe that the MRI finding is the final word.

They need proof. And ultimately that proof is movement confidence.

Guermazi, Ali August 2012. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ, 345:e5339 doi: 10.1136/bmj.e5339).

Kato, Fumihiko et al. February 2012. Normal morphology, age-related changes and abnormal findings of the cervical spine. Part II: magnetic resonance imaging of over 1,200 asymptomatic subjects. Eur Spine J, DOI 10.1007/s00586-012-2176-4.

Beyond Biomechanics and Chronic Pain Clients

Thursday, April 7th, 2016

The following video is an exchange between Function First Director of Education Kevin Murray and myself on the critical portions of the bio-psycho-social model. These are aspects of the client that we have to respect, acknowledge and consider when working with those in chronic pain. Understanding the interplay between the 3 pieces of the BPS model help you provide the most effective intervention possible.

Corrective Exercise Sequencing Demo

Monday, September 14th, 2015

Understanding the best way to progress your corrective exercise program for the client in chronic pain is the foundation for creating powerful change. Watch how we demonstrate the flow of the exercises.

In this video our hypothetical client has had chronic right sided lumbo-sacral pain and has been diagnosed by several medical providers with sacroiliac joint dysfunction. Our postural and movement assessments allowed us to develop our 80-20 objectives. The summary of the 20% is as follows:

*Right posterior innominate rotation relative to the left
*Asymmetrical weight shift left in squat
*Increased right lumbo-sacral symptoms on right single leg stance
*Limited right hip extension in gait relative to left

From the PFMS perspective, our primary objective is to improve right hip weight acceptance/transfer. Through the appropriate progressions, introducing novelty and reducing the threat-our expectation is that she can comfortably and effectively load that right hip better after the completion of this program.

See if you can identify the sub routines within the program.

Are you ready to be the answer for hundreds of clients in chronic pain? Then join us now while you can. Registration is only open for a few days: https://movementmasterminds.leadpages.co/level-one-enrolment-/

Corrective Exercise Programming the Power of Sequencing

Tuesday, September 8th, 2015

Although there is no silver bullet to guarantee program design success, most would agree that selecting purposeful exercise with clear objectives is a key ingredient to successful programming.

To optimize “reception” from the nervous system, we must reduce the threat as we work toward our biomechanical objectives.

Corrective Exercise Program Design and the 80-20 Principle

Tuesday, September 1st, 2015

Where to start? After you have done your assessments how do you know where to begin and what to focus on?

Be sure to leave us your questions or comments in the area below, we welcome your thoughts.

The Power of Inquiry: 4 Core Questions of Maximum Influence

Tuesday, August 4th, 2015

How Does Change Occur?
By Kevin Murray

Is there a specific formula or process that brings about change faster than others? How is it for some, change is immediate and permanent? While for others change is illusive and lasts mere moments?

Questions change our thinking process, therefore the answers we ascertain are in direct result to the quality of the question.

Mastering the art of asking purposeful and powerful questions is an essential ingredient that’s necessary for accelerated change and client breakthroughs’. ALL change begins with the client questioning his or her own thoughts, feelings and beliefs regarding pain, and/or the story behind it.
Questions
The following are the ‘4 Core Questions’ created for each pain-free movement specialist to ask their clients’ experiencing chronic pain. Once answered, the clients’ psychological & sociological needs are reviled, yielding invaluable information:

1) “What specifically have you missed out on because of chronic pain?”
The answer to this question provides the pain-free movement specialist with a precise blueprint to the psychological downside that chronic pain has manifested specific to the individual, while synergistically allowing the practitioner to align with the desired outcomes of the client.

In addition, while evaluating this question, each client methodically strips away superficial layers and discovers his or her hidden aspirations to what’s really significant and worth pursuing, while simultaneously moving away from undesirable realities.

2) “How will you know when the corrective intervention has been a success?”
Here’s the truth, what matters to the client is not the overly-pronated sub-talar joint or valgus knee the practitioner may observe. Those phrases mean nothing to the individual in pain.

What really matters to the chronic pain sufferer needs to be uncovered and articulated, which this question is designed to achieve.

Interestingly, it’s often surprising the lack of clarity many clients exhibit when asked to define the specifics to what a successful intervention entails.

Therefore, this question requires each client to focus precisely on defining their “rules to success”. The pain-free movement specialist greatly enhances the probability of successfully navigating ‘unpredictable waters’ once the rules are clear and coherent.

3) “If chronic pain was no longer the reality, what would you do differently?”
This question subconsciously grants permission for each individual to begin crafting the mental framework of what a life that’s no longer interrupted by pain will look like, while simultaneously shifting their conscious intentions back towards the emotional states that are most meaningful in his or her life.

Painting a clear picture of the emotional and physical ambitions significant to the chronic pain sufferer is a critical ingredient in creating pain-free transformations. It’s during this process where uncertainty & apprehension shifts towards inspiration & possibility.

4) “What would a life without pain mean to you?”
We cannot force our beliefs or emotional values on clients.

This question provides a vital spark that begins the mapping process to each client’s exploration for meaning, which is essentially the catalyst to providing an environment that’s truly unique to the individual’s wants, desires, aspirations and goals.

The art of a successful intervention involves uncovering (through curious inquiry) which values and ethical conduct each client abides by, the belief system that guides them, and ultimately what’s most meaningful and worthwhile pursuing.

Question: Can you recall a time when a particular question had a positive impact on your personal or professional life? Do you have a powerful question that you ask each client? Please leave a comment below.

Written by:
Kevin Murray
Movement Masterminds – CEO
Function First – Director of Education

Understanding Pain Encore video

Thursday, June 18th, 2015

We hope you enjoyed the first 3 part series available to our subscribers. Please enjoy this encore video to further your insight into exercise and chronic pain.