Posts Tagged ‘biopyschosocial’

Corrective Exercise Frontal Plane Samurai Lunge

Thursday, February 11th, 2021

We have one of our Level D correctives from the PFMS library that is part of our educational website. Level D exercises are what I refer to as “top of the foodchain” in the corrective exercise world.

These highly integrated exercises carry extensive value beyond the biomechanical integrations. For some clientele, the Level D is the immediate segue to their more traditional fitness workout. For others, the Level D is an element of a workout itself.

Get more like this with your FREE 24 Hour Pass to the Function First Academy

Functional Purpose:
Improve Frontal/Transverse Plane Spinal Alignment

Biomechanical Outcomes:

• Momentum from desired pelvic list promotes lateral spinal flexion, which is enhanced throughout the vertebral column when torso and righting reflexes resist maintaining a level orientation to the horizon.
• Arm overhead act as an extension of the rib cage, creating a longer lever and greater mass to ensure that all vertebrae contribute to the lateral spinal flexion.
• Maintaining a pure frontal plane motion with thoracic extension counters any rotational tendencies of the torso.
• Slight rotation of the intervertebral joints are coupled with lateral flexion of the spine.
• Lateral trunk musculature on the lengthening side are eccentrically loaded & decelerate mass of the trunk in the side bend, then transition concentrically to return trunk to the vertical.

Neurological | Physiological Outcomes:

• Promotes connective tissue elasticity associated with dynamically loading / stabilizing sagittal, frontal and transverse plane motions of the thorax.
• Increase connective tissue compliance and resiliency through the promotion of tissue extensibility, amplifying the viscoelastic and force closure demand to uphold lumbar spine integrity and stability.
• Extensibility of the lateral hip musculature to allow for and additional hip adduction, flexion and internal rotation.
• Elicit a heightened somatosensory response due to the simultaneous bottom-up (lateral lunge) and top-down (lateral flexion / thoracic rotation) influence.

Psycho | Social Outcomes:

• Establish a multidimensional environment involving the neural-networks associated with managing heightened emotional states (anxiety, hyperviligence, etc) during the execution of a complex, autonomic motor task.

Modifications:
• Begin pre-positioned w/ both hips abducted, greatly reducing ground reaction forces.
• Remove ipsi-lateral glenohumeral abduction.

Contraindications:
• Subacromial impingement syndrome.
• Inability to control multi-segmental deceleration of descending body weight.

Anthony Carey on the LifeTime Fitness Podcast

Tuesday, December 22nd, 2020

From the show notes:
Join Industry Veteran Anthony Carey and Jason Stella Discuss…
1. Why he has spent the majority of your career working on how to help people decrease their pain.
2. Discuss his PRACTICAL book called: “The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder and Joint Pain.
3. WHAT have you found to be the best ways to help, staying within the scope of being a trainer?
4. Explain the following concepts in his book
1. The Body’s Interrelatedness
2. Our Self-Healing Bodies
3. The need to take responsibility
4. Anthony’s unique way of putting exercises is specific groups called Form & Category
– What’s the differences between them
– Show some of the exercises within each area and how they may be able to help specific people?
5. Explain and show your invention, The CORE-TEX.
a. Why and how did you come up with this?
b. Can you show us some of the common ways you use this to help clients improve
3. Explain the course that you put together called the “Pain Free Movement specialist

The Haunted House Effect, Fear and Chronic Pain

Friday, October 30th, 2020


Photos are the property of Nightmares Fear Factory
This is an update from a post originally shared October 2015

The most current science on pain, tells us pain is an experience and not a sensation. Yes, we use words to describe our pain in terms of sensation (stabbing, aching, dull, throbbing, nagging, etc.), but there are many factors that contribute to just exactly how each of us get to the point where this pain is demanding our attention. Associated with this pain event are the many biological, psychological, and social elements that were present before, during and after the “experience”.

Many of you will be familiar by now with the bio-psycho-social paradigm used to better understand the pain experience. This video interview I did will help explain if you are not familiar.

The “Haunted House Effect” is a brilliant metaphor to add insight into our own experience.

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

Similarly, consider what happens to your body and you 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 in 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 after, we would observe:

 A huge dump of stress hormones entering the blood stream (adrenaline, cortisol)
 The heart rate and blood pressure spike
 Blood vessels dilate
 Pupils dilate
 Breathing gets rapid and shallow
 Muscles all around the joints contract and stiffen the body
 Posture instinctively goes into a flexed protection mode
 Ensuing movement is guarded and apprehensive
 Language to express the experience are dramatic and emotionally charged

I purposely used boxes in the list above because I want you to think of “ticking the boxes”. In the haunted house examples, these are boxes that are “ticked” when an extreme scare has occurred. Now let us 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 cannot 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 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 turn the corner to see a unicorn and rainbows.

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.

The source (which we cannot 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.

Now consider this scenario. After the first scare event, the participants get to put on full body armor and carry a 4-foot taser wand that can keep anyone or anything at least 4 feet away. Do you think this would increase their confidence and decrease the threat as they approached the ensuing corners? I would suggest it does make them safer and more confident. Perhaps they will have some fear, but not nearly as intense now that they have these protective “tools”.

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 us 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.

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 9 traits (boxes to tick) 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 remarkably similar in terms of your physiological 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. The proper, strategic exercise program for you becomes your full body armor and 4-foot laser wand.

Pain is an extraordinarily 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 must 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. Suit up, educate yourself and show your brain that you are not broken.

Happy Halloween!

Corrective Exercise Static Wall Femur Rotations

Tuesday, October 27th, 2020

The following exercise is taken from our library available at www.functionfirsted.com

We share this example with you as an exercise that you might find useful as well as to add to your understanding of the bio-psycho-social considerations we apply during programming.

This Level B exercise can also be found in my book, The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder and Joint Pain.

Biomechanical Outcomes:
•Increase bi-lateral hip rotation autonomous from gravitational influence over the pelvis and entire upper body.
•Enhance transverse plane hip rotation independent from the pelvis and lumbar spine motion.

Neurological | Physiological Outcomes:
•Enhance cognitive processing mechanisms associated with the planning phase (evaluation) and motor unit recruitment involved during the execution of exercise.
•Promote connective tissue extensibility associated with internal and external hip rotation.

Psycho | Social Outcomes:
•The introduction of localized and independent hip rotation fosters a novel experiential awareness designed to help expand maladaptive appraisals and challenge any associated neurosignatures of hip rotation avoidance.

If you have not taken advantage of the 24 FREE PASS to Function First Academy to see all of the great stuff there, now is your chance!

30 – static wall with leg rotation.wav from Kevin Murray on Vimeo.

How PFMS Programming Excels

Thursday, August 13th, 2020

What drives your decision making when designing your client’s/patients exercise program? No doubt some of the decision is based on your client’s goals, as it should be. That is why they are seeing you.

But there are often many routes to a goal. And when we throw conquering pain into the equation, the route that is chosen becomes much more significant.

With the Function First Approach and its Pain-Free Movement Specialist curriculum, the sequencing of the exercises is critical. Much like a phone number, the same elements in a different order will often yield a different result.

With the client who has experienced or is experiencing chronic pain, the biomechanical, neurological and physiological characteristics of the exercise are critical. But those characteristics can be negated and potentially pain provoking if we have not acknowledged, validated and considered the psychological state (readiness, expectations, apprehensions, preconceived ideas, etc.) as it applies to the exercises we will provide.

And this is where the PFMS excels. Marrying the critical movement and mechanical needs to the psycho-social needs of the client at that time. Delivered with empathetic and confident coaching and you can see why Function First has served clients from around the globe who could not have their needs met elsewhere.

As such, I want to give you a peak into one of the many ways our Function First Academy can be a resource and support you in your mission to serve those challenged by chronic pain.
In the video below, I will walk you through a few of the aspects of the site that will change the way you program.

The Problem is the Problem

Wednesday, April 29th, 2020

It’s amazing how a few simple concepts can completely change the way we process and approach challenges.

That’s why were so excited to share with you this brief conversation that I had with Kevin Murray, our Director of Education.

Kevin brings a dual perspective to our work with clients in pain that most other practitioners do not. After almost 10 years of learning and growing with the Function First Approach, Kevin went on to complete is graduate studies in Counseling Psychology.

Set aside 30:00 for some incredible insight and actionable items that we can all experience massive value from.

Corrective Exercise Floor Glides with Leg Extension

Thursday, November 14th, 2019

In this video we are bringing you a very influential exercise that does a surprisingly effective job at lower back stabilization as it challenges the mobility of the shoulders and efficiency of the the thoracic spine in extension.
As you are probably acutely aware, when working with corrective exercises and the client in pain, it is more than just the exercise, it is a thorough understanding of:

“For Whom?”

“For What?

And “When”

Insight into the biomechanics, psychological mindset of the client and social setting/implications of the movement all come into play and are critical to the client’s success.

How Accurate Are Your MRI Findings?

Monday, July 15th, 2019

We all want the best, most accurate information we can get regarding our health. And when the doctors and therapists are not getting the results everybody wants, they will typically order imaging studies to gather more information and an “accurate” look at what is going on.

Many in the general public consider the MRI as the gold standard or best possible diagnostic available. What we must realize, however is that an MRI (magnetic resonance imaging) is an image or picture. And as such, its interpretation relies on the individual reading the image. This is generally a radiologist but may also be another medical doctor that is treating you.

The technology behind an MRI is quite amazing and is not in question. What is of concern is the accuracy of the conclusions reached and therefore the ensuing treatment plan, costs and expected outcome(s)that follow.
lumbar mri
A 2017 study in The Spine Journal, wanted to look at just how accurate and consistent MRI findings would be across 10 different MRI centers. A 63-year-old women with a history of lower back pain and nerve pain down her leg received 10 MRI’s at 10 different locations over the course of 3 weeks.

What they found were very large differences in what was reported as the findings on the MRI in both false positives and false negatives (see chart from study below). Using disc herniation for example, 47.5% had a false negative or miss rate. Meaning the herniated disc was there but missed by the radiologist.

For those of us that work with a population determined to overcome their pain, the MRI is a double-edged sword. Because, as you may know from some of my past posts, the findings on an MRI do not have a one-to-one correlation with pain. There are people who have MRI’s that looked like they have been hit by a bus and have no pain. And there are people who have no clear findings on an MRI and may have significant pain. The bio-psycho-social factors that contribute to the pain experience are numerous.

What Can We Do?

Most importantly be informed and question everything. Even if you are sure the MRI findings are accurate, they don’t equate to surgery. In the absence of any medical emergency (significant muscle weakness, bowel or bladder problems), conservative treatment has shown to be as good as surgery and in several studies having even better outcomes.

At Function First, we are not doctors or physical therapists. We are exercise and movement professionals who understand the pain experience and how important it is to provide exercises that remove mechanical stress from the body and restore movement confidence through a very systematic process of program design and coaching.

When you seek help from a practitioner, you always want to be the head coach. And appreciate that passive treatments (hands on therapy, modalities) and medications may be necessary to progress you to the next step. But a comprehensive exercise program is ultimately what translates to the real-life functions you seek to participate in and enjoy.
mri variability study

How does a client achieve success with Function First?

Monday, May 20th, 2019

In this part of the interview, Anthony shares several client success stories and what the transpires during the process. Exercise is the vehicle, but there are plenty of other elements that must be in alignment as well.

Neuroception, Relationships and Clients in Pain

Friday, May 10th, 2019

Originally written for ACE Certified by Kevin Murray

No doctor can write a prescription for creating relationships. They are hard-earned and complex undertakings, particularly with people in pain.

Part of what makes pain so distressing is its lack of predictability. Experiencing pain feeds into a negative reinforcing loop of uncertainty, up-regulating cognitive stressors such as fear, apprehension and anxiety. This often runs parallel with clients’ difficulties in regulating their emotions (Hamilton et al., 2004).

Woven into the fabric of all relationships is the principle of reciprocity. For the health and fitness professional, navigating the arena of pain and relationships requires one to become acquainted with the nervous systems role in analyzing risk and safety.

Neuroception: The Mind’s Mediator

Neuroscientist Stephen Porges coined the phrase neuroception to describe the neural mechanisms involved with subjective perception and evaluation (Van Der Kolk, 2015). Specifically, neuroception helps individuals distinguish whether a situation or individual is safe and trustworthy, or dangerous and distressing.

danger safety

To the individual experiencing pain, their unique view of the world is interpreted through a nervous system that has an altered perception or risk and safety. Every day situations can become fearful and ambiguous, often resulting in maladaptive appraisals of people who are unknown or unfamiliar.

Experiencing pain has one’s neuroceptive system on overdrive, constantly seeking out potentially threatening stimuli. This state of cognitive hypervigilance makes cultivating relationships exceptionally formidable. To combat such psychosocial stressors, successfully establishing relationships with clients in pain involves understanding the underlying mechanisms which enhance positive neuroception.

This process is governed by innate biological systems that once understood, becomes the inception of all meaningful, heartfelt and trusting relationships.

Mechanisms of the Mind

    Mirror me: Mirror you

Have you ever noticed that when someone is genuinely smiling (even if you don’t know them), you find yourself smiling back? What induces this instinctive mimicry? Why do we yawn when we see someone yawning, or wince when someone smacks their shin on a coffee table?

The neurobiological mechanisms responsible for such nonverbal imitation is regulated by highly sophisticated visuomotor neurons referred to as mirror neurons.

mirror neuron

This mirror neuron system (MNS) allows for two individuals, whether lifelong friends or two complete strangers, to simultaneously share neural activity as they attempt to decipher the meaning behind each others nonverbal gestures. The MNS is the gatekeeper of assurance and safety, escorting the manifestation of positive neuroception and is decisively involved in the emergence of all trustworthy relationships. As such, understanding the mirror neuron system’s innate bias towards familiarity and reciprocity becomes a crucial distinction with regards to clients in pain.

    Brain-to-Brain Dialog

For instance, when two people are in-sync and rapport is mutually harmonious, the MNS is fully engaged. People adopt one another’s facial expressions, hand gestures, postures. even acute motor movements without even knowing they’re doing so (Chartrand and van Baaren, 2009). This is known as automatic imitation. Interestingly, being deliberate and purposeful in the mirroring of others nonverbals (intentional imitation) can also facilitate this same mirrored neural activity between two people.

Similar neurobiological functioning ensues via verbal communication. As an illustration, when two individuals and their speech patterns converge, they adopt one another’s vocal qualities such as tone of voice, tempo of speech, even specific words and phrases. Once again, this takes place without any conscious awareness. These neural dynamics lead to mirrored neurological activity between the speaker’s brain and the listener’s brain. This is referred to as neural coupling (Stephens et al., 2010).

matching brains

In fact, have you ever experienced such high degrees of rapport where you almost knew what someone was going to say right before they said it? This is no fluke. Neural imagining via fMRI technology reveals that when two people are in-sync and engrossed socially, the delay between speech production and the listeners comprehension is so small that one can often anticipate what’s going to be said next (Hasson et al., 2011).

These anticipatory responses suggest as two individuals become acquainted with each others verbal propensities, the more attuned and mirrored their neurological activity is. Neural coupling highlights how verbal imitation can breed a sense of relatedness and commonality, ultimately nurturing the perception of safety and enhancing positive neuroception.

However, when two people are out-of-sync with their nonverbal mannerisms and verbal speech patterns, this brain-to-brain coupling vanishes (Stephans et al, 2010). When incongruencies are present, the perception of safety slowly fades and gives rise to uncertainty. If clients in pain fail to see aspects of themselves in their health and fitness professional, the more likely skepticism has the opportunity to settle in.

In-depth Analysis

The role mirroring plays in socials interactions is ubiquitous. In fact, visuomotor mimicry is so innately hard-wired that one-month-old infants display the mirroring tendencies of smiling, sticking their tongues out and opening their mouths when observing such behavior in others (Lakin et al., 2003).

As two people learn how to navigate the social complexities of interpersonal communication, what are the neurobiological intricacies involved in learning and interpreting the intended meaning of another individual’s linguistics / gestures? Let’s analyze the MNS in-action through a common example:

    Spoon Feeding and Neurobiology

As a mother brings a spoon to her infant son’s mouth for the first time, is the child aware of the next sequence required in this exchange? Does the baby open his mouth wide, accommodating for the size and shape of the spoon? Probably not.

Instead, a blank stare of bewilderment is undoubtedly written across the infant’s face. It’s not until the mother visually demonstrates the spoon-to-mouth action that the infant can comprehend what’s being asked of him.

    Sequence analysis

The infants MNS observes their parent demonstrate the action of spoon-to-mouth (intended outcome).
This creates a visuomotor representation and engages the infants own perceptual-motor circuitry.
The infant can then synthesize the visuomotor representation (action-potential) into motor execution, resulting in the reciprocation of the desired task: i.e. successfully transferring food from spoon-to-mouth for ingestion.

Here we witness the MNS and its architecture having the remarkable ability to transform passive observation, into perceptual understanding and then motor execution (Ferrari et al., 2005). Daily social exchanges such as handshakes, waving hello or goodbye, observing laughter or witnessing sadness all involve the MNS and neural coupling effects.

The mirroring of facial expressions can even result in actually adopting the emotions and moods of others (Lakin et al., 2003). This outcome is recognized as empathy, or having the capacity to understand the feelings of others and view the world through their unique perspective.

The interplay between biological and environmental factors requires more sophistication as our social surroundings increase in complexity. This makes congruent communication and mimicry as a medium for cultivating trusting relationships significant, particularly with clients in pain.

So how can you, the health and fitness professional apply these neurobiological insights with your clients in pain to enhance positive neuroception and ultimately establish relationships?

Integrating Neuroscience into Relationship Building

It’s essential to remember what distinguishes the client in pain from general clientele is their altered perception or risk and safety. Never forget, from the moment you meet your client in pain, they’re skeptically evaluating you and how you conduct yourself. As such, taking special care to remove as much uncertainty and unfamiliarity as possible becomes the primary focus. This process begins with the practice of adapting your own verbal and nonverbal mannerisms to match that of your clients.

For example, when communicating verbally, congruency is essential for positive neuroception. Suppose a client begins describing his story of musculoskeletal challenges with soft and gentle vocal qualities. He takes the time to articulate and pauses often. Attempting to mirror and reciprocate these vocal mannerisms follow the neurobiological prerequisites to manifest neural coupling

Should the client also be sitting on the edge of their seat and leaning forward, following suit and mimicking this seated posture engages the visuomotor neurons of their mirror neuron system. Intentionally integrating and reciprocating these verbal and nonverbal idiosyncrasies serves to enhance the possibility of cultivating positive neuroception.
Kevin coaching

IMAGE TAKEN FROM THE YELLOW BRICK ROAD: A 4-part framework for coaching clients in pain
The matrix of mirroring possibilities includes paying attention to your clients nonverbal features such as facial expressions, eye contact/gaze, body position and proxemics (personal space) and his or her idiosyncratic hand gestures.

Verbal and vocal aspects could encompass specific words or phrases they frequently use, paralinguistic qualities such as tone of voice, rate of speech, vocal modulation and volume, or demonstrating appropriate levels of silence should the client be reserved and introspective. Knowing which aspect(s) to mirror comes down to actively listening and observing the uniqueness of each clients’ communication tendencies.

As clients in pain begin experiencing coherence and familiarity in your communication conduct, their skepticism is superseded with impressions of trust and certainty. Their perception of safety and assurance increases as positive neuroception begins planting its roots.

And while the genesis of cultivating relationships varies from one individual to the next, attempting to enter each client’s world and speak their language helps to nurture the inception of meaningful, heartfelt and trusting relationships with your clients in pain.