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

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.
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

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.

Stop Lower Back Tightness in 1:00 or Less

December 14th, 2015

Shopping is one of the activities that we most frequently hear about regarding aggravating our clients’ lower backs. And what do we do during the holiday season? We shop.

The stopping and starting and stopping again. The standing around in long lines with no reprieve for our back muscles.

Couple that with the other stresses associated with the holidays and the factors that can ramp up lower back pain/tightness can get the best of us. So if you are looking for a quick and effective way to reduce tension in your lower back, you’ll want to watch this video.

Derahn shows you how to relax your lower back muscles WITHOUT stretching. It is counter intuitive for most people but it gets the job done because it goes with the tightness instead of away from it.

That’s the good news. It will relax the back muscles and for many people reduce or eliminate upper and lower back pain.

The bad news is that this is not a long term solution. It does not address the many, many bio-psycho-social factors associated with pain.

However, any time you can mitigate the discomfort, keep it from escalating and take control-you are doing something very positive for your long term success.

Try it!

The Haunted House Effect and Your Chronic Pain

October 30th, 2015

By Anthony Carey M.A., CSCS, MES
Founder of Function First
halloween 1
(all photos are property of Nightmares Fear Factory http://www.nightmaresfearfactory.com/)

We’ve all heard the saying “frozen with fear”. It’s that brief but profound period of time where something is so shocking or terrifying that one can’t move. The body does not respond because the brain is overwhelmed with the danger at hand.

Or consider what happens to your body and your mind the moment you have the fright of your life in a haunted house. The image above is from the web site Nightmares Fear Factory. They are hugely popular images on the internet of visitors caught at a moment of time inside the Nightmares Fear Factory’s haunted house.

If we got a little “sciencey” here and thought about all the things that happen to the body as this photo is taken and for the short time thereafter, we would observe:

1. A huge dump of stress hormones enter the blood stream
2. The heart rate and blood pressure spike
3. Blood vessels dilate
4. Breathing gets rapid and shallow
5. Muscles all around the joints contract and stiffen the body
6. Posture instinctively goes into a flexed protection mode
7. Ensuing movement is guarded and apprehensive

Now let’s imagine these events happened within the first 5 minutes of a scheduled 30 minute tour through the haunted house. They still have 25 more minutes to take part in an experience where the tone has been clearly established as frighteningly intense.

So what happens when they approach that next corner that they can’t see past? Are they relaxed and at ease? Absolutely not! Their body will reproduce the identical events it did from the first scare. Except all of those responses will happen BEFORE they even get to the corner.

As they cautiously approach the blind corner and their body is in full anticipation mode-anticipation of the next blood curling scare-they ultimately see that there is nothing there. No threat exists at this corner. Yet their body and mind went through all the same events as if the next big scare actually took place. That pattern continues through the remainder of the tour with each anticipation of the scares almost as physically and mentally real as a scare itself.
halloween 2
The source (which we can’t see) that created those responses in the photos is not the only part of that scare experience. Although likely not as obvious to those in the photos, the entire experience includes the people they are with, the smell of the room, the temperature of the room, the sounds and even how their clothes fit. And as the remainder of the tour continues, they all become part of the biological, psychological and social contribution to that experience.

So what has this got to do with someone dealing with chronic pain? The scenarios can be almost identical except replace “scare” with “pain”. Let’s say for example that after a long flight you felt a pop in your back as you lowered your carryon from the overhead bin. You begin to feel your back tighten up and you experience the pain ramping up as you exit the plane. Beginning with the “pop” you felt, you would begin to experience those same 7 traits listed earlier. And whether you realized it or not, the physical pain itself is not the only part of the experience. The people you are with, the smell of the airplane and then the terminal, the temperature, the sounds and even how your clothes fit all become part of the biological, psychological and social contribution to that pain experience.
halloween 3
These combined elements begin to form a neuro signature or neuro representation in your brain. Over the next couple of days as you are recovering from this episode, you experience those 7 traits any time you anticipate potential threat to your back. This could be something as familiar as putting on your socks. Some movements may in fact provoke pain but others may not. Yet the net result is very similar in terms of your physical and mental response.

You can clearly see how patterns emerge that are counterproductive to your long term goals. And the reality of this is that we can’t and you can’t explain your way through process. Yes, you need an understanding but your body and brain also need proof. This is where a strategic and structured corrective exercise plan can create the movement confidence you need to no longer anticipate a threat when the threat is not valid.

Pain is a very complex experience for everyone. And many people will attempt to chase one aspect or another of their pain. The science now tells us that we have to look at the entire bio-pyscho-social context from which chronic pain is experienced.

Don’t live your life waiting for the next ghost or goblin around the corner.

Happy Halloween!

Corrective Exercise Sequencing Demo

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

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

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

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.
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

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

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.