Posts Tagged ‘lower back 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!
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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.
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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.
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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).
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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
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Corrective Exercise Wall Sit

Wednesday, January 9th, 2019

This exercise is most associated with frying the quads for skiing and boot camps. But it can be a powerful corrective exercise for those with lower back pain. In this video, we provide 3 variations that each offer their own unique benefits and challenges to the body.

Corrective Exercise Ankle Squeezes Prone

Thursday, August 16th, 2018

The Ankle Squeeze Prone is definitely one of our “go to” Level A exercises when it comes to addressing the posterior hip with the chronic pain client.

Proprioceptively, it can highlight left to right imbalances. Depending on the intention, this exercise is great for facilitating the posterior hip musculature or down regulating tone to those same muscles.

It’s also great for disassociating the lumbar musculature from the glutes/posterior hip by assisting in timing of the onset of contractions.

You will find this a great tool in your tool box for clients of all levels. The benefits to the chronic pain client is one of bio-psycho-social characteristics. But aren’t they all?

Leave your thoughts below on what you or your clients feel.

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?

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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.

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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

Stop Lower Back Tightness in 1:00 or Less

Monday, 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!

Are Biomechanics Still Relevant for the Client in Pain?

Friday, May 29th, 2015

This video shows a powerful sequence of 3 corrective exercises that we use at Function First that can positively effect lumbo-pelvic-hip function.

Here is the second installment of the “Understanding Pain” series

We hope you’re enjoying our Understanding Pain Series thus far.

Have you ever had a client in pain present no biomechanical “red flags”? What course of action did you take? How did you help them? Share you thoughts in the comment box at the bottom of the page.

Corrective Exercise Four Point Rotations

Friday, May 15th, 2015

When we prescribe a corrective exercise to our client, there are multiple factors that go into the decision making process. For an exercise to be appropriate for a client at any given time, we have to consider the 4 characteristics of every exercise:

*biomechanical
*physiological
*neurological
*psychological

The Four Point Rotations is an exercise when looked at analytically, can successfully address these characteristics for many client types. This is an effective exercise to emphasize hip motion while unloading the spine and decreasing the threat for those with lower back pain.

Weak back and lower back pain

Thursday, December 11th, 2014

The bio-psycho-social model to chronic pain is evidently clear in the literature and we have made great strides in applying this model to our clients and our teaching.

What is also evidently clear, is that if you do not include the “bio” in the conversation, you will have a very difficult time helping the client relate a “known”-the biology/biomechanics of the body-to an unknow-the psycho/social aspects of the model.

The bio is simply the known because that is what the paradigm has been for the hundreds of years now. The pysco/social aspect is still very new for the general public (and unfortunately many medical professionals).

The following video clip is from a presentation I did titled: 25 Things Your Client Needs to Know About Lower Back Pain. The talk was presented to address the many misconceptions our clients and potential clients have regarding lower back pain. This clip addresses a few of those misconceptions.

Why MRI Findings Don’t Mean Much to A Corrective Exercise Program

Monday, November 24th, 2014

The video below is taken from a live presentation that I did at the Fit Pro Convention at Loughborough University in England a little while back. The clip is from the presentation “25 Things Your Client Needs to Know about Lower Back Pain”.

In The Pain-Free Program I discuss people wanting to identify a “villain” to give them some sense of confirmation to their pain. Imaging studies such as an MRI is a route for many to try to find this villain. What most of our clients are surprised to hear is that the results of their MRI has very little to do with the exercise intervention.

Core-Tex Hip Circles

Friday, September 7th, 2012