Posts Tagged ‘chronic pain’

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!

Dead Bug Variation to Regulate the Core

Wednesday, June 8th, 2022

The following is a Level B in the Pain-Free Movement Specialist Levels of Designation

The Dead Bug is a popular and effective core stabilization exercise. And although it is done supine on the floor, it has a level of difficulty that may be underestimated.

When working with chronic pain clients, particularly those with lower back related issues, the many common versions of the Dead Bug may actually be too challenging. With the version we share below, the degree of difficulty can be self regulated. This means the individual has a degree of control over the intensity of the exercise by way of the force that they apply with the upper body.

With this control, the client/patient has the ability to choose a level of difficulty within their capacity and reduce the sense of threat of further hurting themselves. They will also be able to better assess their success or lack their off with fewer moving parts to the exercise.

Scoring Your Wins and Beating Your Pain

Monday, April 11th, 2022

If I have had the pleasure of working with you, you have probably heard me speak of the need to score your “wins” as you move through the process of beating your pain. “Wins” are those smaller victories along the way to the ultimate goal of eliminating pain and doing all the things we physically want to do.

For so many of those challenged by chronic pain, their assessment of their pain is either they have it or they do not. This black and white view of the situation can be one of the most burdensome mindsets, hindering one’s progress. The reality is that there are many, many shades of grey in between.

If the view is black and white, there is no win unless the pain has been completely eliminated forever. Eliminating the pain forever is an achievable goal worth pursuing, but without a progress meter along the way, we do not know if the goal is right in front of us or 6 months or 6 years away.

Let us say that you have lower back pain and at its worst it is an 8 (on a scale of 1-10 with 10 being the worst). The back pain is an 8 whenever you stand too long. And when the pain reaches an 8, your back is aggravated for a couple of days afterwards. On average your pain is a 5/6 on most days if you take 400mg of Tylenol, twice a day.

You are frustrated and fed up and decide to begin a new program (Function First, chiropractic, physical therapy, acupuncture, etc.). At Function First, we would want to know more accurately what is “too long” for standing that gets you to an 8. Is it 5 minutes or 50 minutes? These are more objective time frames and easier to compare. We would also want to know more accurately how long afterward is your back pain aggravated? Is it 24, 36, 48 hours? If you do not know, this is a major reason why we ask you to track and journal your experiences. By journaling, you are not reflecting on a situation when you are in the throes of the emotions associated with the pain.

Scoring Wins

After two weeks of your new program, you still have pain that is an 8. In the black and white pain scenario, you are exactly where you were two weeks prior, minus the time and money you have spent. But in the finding wins on our way to the ultimate goal, progress is there if we look for it.

There are 3 fundamental ways we can gauge our progress. They might present individually or in combinations of two or more:

1. The overall level of pain is less. Your average pain of a 5/6 on most days is now a 2/3. Or your pain is still a 5/6 but you no longer need to take the Tylenol to control it. You still have pain but that is progress!

2. Your tolerance is greater. You could only stand for 15 minutes, and the pain was an 8. Now you can stand for 30 minutes, and the pain is an 8. Yes, the pain is still an 8, but you have increased your standing tolerance 100%. Another example might be your range of motion. You would squat to 45 degrees and your knee pain would be a 6. Now you can squat to 90 degrees before your knee pain is a 6.

3. Your recovery is faster. You stand for 15 minutes, and the pain is still an 8. However, you do your Function First exercises, and the pain is back down to a 5 within a couple of hours. You are no longer physically and emotionally burdened with the extended recovery time every time you push your body to stand. Or you love golf or tennis and could only play once a month, because your back needed that long to recover before you could play again. Now, your back still is painful after a round or a match, but because you are doing a strategic exercise program, you can now play once a week as your body gets more functional and stress is removed from the back.

As I share with all my clients, this is not something anyone should be convincing you of. It is simply recognizing progress (wins) that have occurred on your journey. This provides extremely valuable affirmation to the brain that you are on the right track and making progress. It provides hope and motivation to continue to strive for what is possible.

No one wants to be spinning their wheels hoping one day that magical door to a completely pain-free life will suddenly open. With the right intervention, supportive and educational coaching and acknowledging your wins, the path is clearer, and the goal is within reach.

Corrective Exercise Creates a Positive Cascade for Change with Chronic Pain

Thursday, October 28th, 2021

The pain itself is almost always the primary focus. But their are multiple inputs that can lead to a downward cascade in the quality of life of those challenged with chronic pain. And equally, the sum of many inputs can also lead to a positive cascade and opportunity for improvement.

This clip taken from a live webinar I did with the American Council on Exercise, sheds some light on how the right exercises, for the right person, at the right time can be a catalyst for positive change.

If we can appreciate and impact through exercise, more of the dynamic systems involved in the pain experience , we provide our clients with a path to positive change.

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

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.

The Four Seasons of Chronic Pain

Tuesday, January 22nd, 2019

Written By:
Kevin Murray M.A.(pending), CAFS
Movement Masterminds – CEO
Function First – Director of Education
2012 CSEP CPT of the Year

For individuals’ living with chronic pain, the long-range forecast is often filled with metaphorical rain storms, treacherous winds and long, dark nights. When pain is present, the most noticeable characteristic of a client’s changing climate often revolves around biomechanical restrictions and movement limitations. Perhaps not so obvious (yet often just as burdensome) are the emotional and psychological factors involved with experiencing pain on a regular basis.

As such, in order to create a truly unique, multidimensional strategy for individuals’ in pain, expanding beyond the optics of biomechanics and connective tissue principles alone a becomes imperative. Let’s take a walk through the four seasons of chronic pain and examine how you can help your clients transition smoothly through each one.

The First Season – Winter (fear)
Winter is the first season of chronic pain, where the radical change in climate significantly impacts an individual’s emotional and psychological well-being. The narrative chaperoning this season is generally one of fear; fear of movement, fear of pain worsening, fear of the unknown. This fear can reach such heightened states that just the anticipation of pain is enough to steer an individual away from doing the things that matter most to them. Imagine avoiding an activity altogether because of the anticipation of pain, rather than in response to it!
Screen Shot 2018-11-09 at 8.30.54 AM

When such avoidance behaviors manifest, it’s clear that approaching the chronic pain demographic solely from a biomechanical perspective is an incomplete approach. The neuromatrix theory of pain proposes that the output of pain is regulated by afferent sensory mechanisms in conjunction with cognitive inputs (Melzack, 2001). These cognitive inputs have the capacity to upregulate and exacerbate states of anxiety, apprehension, depression, self-doubt; all of which fall into the category of psychological/emotional stressors.

It’s these stressors which contribute significantly to winters burdensome climate. To clients in pain, winter’s dark and onerous atmosphere can sometimes seem like it’s going to endure indefinitely. Successfully helping clients’ transition out of winter requires an understanding of one critical distinction; the difference between a clients ‘external’ and ‘internal’ problem.

The Second Season – Spring (awareness)
The melting of snow, dissipating precipitation and the alchemy of animals awakening from hibernation are all welcomed signs that winter’s season is changing. To the health and exercise professional, guiding clients’ towards these more desirable climates lies in understanding each client’s internal problem.
Screen Shot 2018-11-09 at 8.37.58 AM

All clients in pain have two global problems. The ‘external problem’ is the biomechanical or anatomical concerns each client reveals during their initial consultation. Consider the client who has been experiencing knee pain for years. That’s the external problem – the knee pain. The ‘internal problem(s)’ however are the area’s in life which hold the most meaning to individuals negatively impacted by chronic pain. The internal problems are the emotional, psychological and social/environmental stressors that are 100% unique to the individual.

For example, consider a husband and wife who spend meaningful time together each day walking their dog. However, in recent months the husband’s knee pain (external problem) has become so problematic that it’s preventing him from participating in the most meaningful aspect of his day, which is connecting with his wife via their evening walk (internal problem).

A clients’ emotional transition from winter into spring begins with his or her health and exercise professionals’ gaining awareness into the clients’ internal problem(s). This awareness then provides an opportunity for both the coach and the client to begin scripting a new, more desirable narrative based on what the individual client values most.

The Third Season – Summer (possibility)
For any seed to blossom and reach its full potential, a conducive climate is required. To clients in pain – fear, anxiety, feelings of hopelessness and negative self-talk are the metaphorical weeds of cognition. If these weeds are ignored, they can uproot any forward progress. During the summer months, the seeds of possibility must be nurtured, and the cognitive weeds must be pulled on a regular basis.
Screen Shot 2018-11-09 at 8.45.38 AM

As with any journey, minor setbacks and moments of self-doubt are to be expected (particularly when chronic pain is present). Because of this, granting clients permission to steep themselves in the process of constructing future-oriented, growth-focused possibilities becomes essential.

The Yellow Brick Road refers to this process as a ‘Possibilities Paradigm’ and involves 4-chapters, each designed to amplify and reinforce a clients’ emotional and psychological resiliency & well-being. When successful, these 4-chapters begin to stir hope & optimism back into each clients’ current and future script.

The Forth Season – Fall (self-regulation)
The fourth and final season bears witness to clients’ returning to pain-free living. And while there are a host of ingredients chaperoning any given pain-free transformation (biomechanics included), a clients’ capacity to accurately assess and regulate their emotional states (self-regulation) is a primary contributor in overcoming his or her internal problem(s).
Screen Shot 2018-11-09 at 8.49.33 AM

Contrast the experiential difference in self-regulation between a client stating, “oh no, I just threw my back out again!” vs. “my back tightened up, but I know it’s just my body trying to protecting me.” These are two completely different emotional reactions, the former reverberating sentiments of fear and the latter signifying the perception of safety and protection.

Preventing clients from experiencing negative emotions is, of course, not possible. However, as health and exercise professionals, we can strive to cultivate a climate that enhances each client’s self-regulation competence and help them identify and overcome the emotional and psychological stressors that contribute to their pain. Importantly, you can begin this process with your client even before you have conducted his or her biomechanical evaluation.

Reference:
Melzack, R. (2001). Pain and the neuromatrix in the brain. Journal of Dental Education. Vol. 65. 12, pp. 1378-1382.

Health pros interested in learning more about the Yellow Brick Road curriculum through the American Council on Exercise can click on the image
Screen Shot 2019-01-10 at 2.50.11 PM

An Overview of a Function First Initial Visit

Sunday, June 3rd, 2018

We are regularly asked, “what does a visit at Function First look like?”.

Function First founder Anthony Carey takes you through an overview of what that first 2 hour appointment is all about and why it is so pivotal for so many.

Be sure to take note of the differences of how we approach our process compared to what you might experience elsewhere. Even if you are an existing Function First client, this video will be great to share with friends who you know can be helped by what we do.

Please pass along to those that are ready to take a powerful step forward with a movement based program that is backed by science.

The Department Store Approach to Pain

Sunday, November 6th, 2016

Written By
Kevin Murray, M.A. (pending)
Movement Masterminds – CEO
Function First – Director of Education
2012 CSEP CPT of the Year

THE SIZING APPEAL

The Small, Medium, Large concept to clothing that all department stores embody seems like a straightforward, pragmatic approach to sizing. If the article of clothing fits, you’re golden; If not, you’re either going up a size, or down. But what about those that fall between the cracks? Or above, or below those labels?

s-m-l

I constantly run into this predicament. Sometimes a small is too tight. Other times a medium drapes off my shoulders, which was a good look for me in the 90’s with skateboard in hand – not so cool anymore. I often wish there was a size “smedium”, right in between at that “sweet spot.”

Perhaps you can relate… maybe your frame deserves a “marge”, right in between medium and large.

ATTENTION ALL “SHOPPERS”:
DUALISTIC THINKING IS OUT-OF-DATE & NO LONGER IN STOCK!

Am I really posting up an article about clothing? As much as I dig fashion, the department store approach is actually a metaphor for the movement industry in many respects, and its modus operandi to complex pain problems.

For example, you may be familiar with conceptualized strategies such as:

• Tight hips = stretch em’
• Weak glutes = strengthen em’
• Noticeable swelling = ice that sh#t
• IT Band irritation = foam roll those puppies

A dualistic, department store approach emphasizes that although all individual’s move differently and come from different backgrounds and cultures, there are essentially only 3-types of people – small, medium and large. Chronic pain on the other hand is complex, embodying dynamic dimensions that encompass myriad variables expanding beyond the optics of biomechanical and connective tissue principles alone. A diverse approach to sizing is needed.

GEORGE ENGEL’s BPS APPROACH:
TAILORED FOR ALL SHAPES AND SIZES – SINCE 1977

Progressing beyond (but not excluding) biomechanics and connective tissue, a 3-dimensional approach to working with clients’ in pain include a vast variety of biopsychosocial ingredients and considerations:

• Systems theories
• Empathetic listening
• Uncovering client’s’ values and beliefs systems
• Establishing client trust
• Providing educational dividends around the context of pain
• Explaining the protective purpose that pain serves

are all in play when considering the Neuromatrix and its influence on how we collaborate with, and coach our clients’ in pain.

canstockphoto23418414

SUIT YOU, SIR

Working with the chronic pain demographic is much like being a tailor. Each individual comes in with unique dimensions and constraints; different outcomes and desires. A tailor is seeking to understand where specific attention needs to be placed. A tailor asks questions like:

Why doesn’t their clothing fit?
Have they ever been to a tailor before? If so, what was their experience?
How will we know when a successful amendment has taken effect?
What is their specific outcome?

A tailor considers multiple dimensions into his/her analysis and thought process, outside the shackles of unidimensional constraints. Instead, diversification is personified, driven by the uniqueness of each individual and their articles of clothing.

Individuals’ in pain each have their own unique articles of clothing (yes, we’re still talking metaphorically here) that need specific attention and consideration. If you can meet your clients’ unique needs, much like a tailor does, than you’ll have accomplished something truly special in your clients’ eyes.

Amidst the waves of uncertainty that accompany working with individuals’ experiencing chronic pain and relinquishing a dualistic/department store thought-process, above all remember you’re interacting with another individual – and not a mechanistic instrument. Be kind, be empathetic, and as often as possible seek to understand rather than judge.

“The quality of the therapeutic relationship appears to be more predictive of success than any theoretical approach of the helper.” John Nuttall