Posts Tagged ‘biopyschosocial’

Insights into Pain and the Brain

Tuesday, June 4th, 2024

I just recently came across this video even though it is a couple of years old. It is a great summary of the mysteries around chronic pain. I often suggest to many of my clients that they view Lorimer Moseley’s TED talk, because he is such an entertaining AND knowledgeable speaker. I’ll start recommending this one too.

It was interesting for me to see in this video that two of the examples he uses to help explain pain are two examples that I have used for years in my professional presentations. The construction worker’s boot and the blue/red cold study are the two that have helped me communicate these concepts.

The animation below is entertaining, and the content is scientifically accurate. Enjoy!

3 Pieces of Advice for Fitness Professionals and Chronic Pain Clients

Thursday, March 30th, 2023

It’s always an honor to be invited to speak on a podcast, and even more so when that podcast is for IDEA Health and Fitness Association. The interviewer, Sandy Todd Webster (Editor in Chief at IDEA) and I have known each other for years and Sandy was a client of mine at one time. Sandy truly knows the fitness industry inside and out and had some great questions that led to a fun exchange.

This is a short clip of our conversation where she asks me for any word of advice I would offer to fitness pros working with or wanting to work with clients dealing with chronic pain.

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