Archive for the ‘Health and fitness professionals’ Category

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.

Pain-Free Movement Specialist testimonial

Friday, June 5th, 2015

We are grateful to have Reyci Martorell-PFMS Level II Practitioner share with you what going through the PFMS has meant to his professional development.

Reyci gives a great example of how he has used the skills he learned in the PFMS and was even able to apply the principles in a small group setting to clients who were not in pain, but were showing signs of degrading movement with fatigue.

Top 5 Pain-Free Movement Specialist Curriculum Questions

Wednesday, June 3rd, 2015

TOP FIVE Frequently Asked Questions:
Level 1 Online Platform

Is there a timeline to complete Level 1?

There is no timeline… you can move as quickly as your heart desires. Or take as long as you’d like, and re-watch as much of the video content as you’d like. It’s been designed to fit multiple learning styles and environments.

Can I receive Continuing Education Units/Credits for Level 1?

Obtaining CEC credits for Level 1 is entirely dependent upon the organization you’re certified through. All organizations have slightly different and unique requirements, and will look at our curriculum differently. Thus far, none of our Level 1 grads have been denied CEU/CEC’s from their respective providers.

Upon completion, can I enroll in the subsequent live events?

The live events all build off the foundational framework received in Level 1, with each level going deeper and deeper into mastering all elements of the Function First Approach and working with people in pain.

Do I need to complete all 4 levels if I enroll in Level 1?
You can stop at any level you wish. Enroll in level 1 only; go all the way to level 4, or stop anywhere in between. It’s your choice.

Are there specific education credentials or requirements to enroll in Level 1?

No post-secondary or continuing education requirements are needed to enroll. If you do have the aforementioned, we have a ‘Bridging Track’ for approved designations.

If you have any inquires that were not answered above, leave your question in the comment box below.

Is Corrective Exercise Dead?

Tuesday, June 2nd, 2015

This short video will explain how the evolving corrective exercise specialist must be more than a corrective technician.

Below is a third and final installment of the Understanding Pain Series.