Posts Tagged ‘lower back pain’

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 Kneeling Aztec

Thursday, May 28th, 2020

Any exercise that requires you to match a force with a counter force to maintain stability, will be self regulating. In other words, you can only push or pull to a level that can be stabilized by your own internal force generation.

The opposite of this would be ground reaction forces (GRF). The limitations on force production would be strength issue because you can push through the ground. This is the case with most exercises when the force is moved vertically against gravity. But when the force applied is horizontally or perpendicular to the field of gravity, we don’t get the same benefits from the GRF that we get with a vertical load.

Instead, we must turn to our own internal stability from which to create an anchor point for force generation.

As such, this corrective exercise is an excellent core exercise predominantly for the sagittal plane that does just that. It’s also happens to have some great foot benefits too.

Leave your questions and comments below.

Corrective Exercise A-P Cat and Dog Rewind

Friday, October 4th, 2019

In one of our past newsletters where we talked about myofascial mobility with rhythm, timing and amplitude, we revisited the Anterior Posterior Cat and Dog as one of the examples of applying those principles.

In this exercise, we take the A-P Cat and Dog and progress it into a surprisingly challenging core exercise. We call it the A-P Cat and Dog Rewind.

You’ll see as the clients center of mass moves forward with the change and limits of base of support, the core has to switch on in a very novel way.

The beauty of this is that the response is reflexive with no feedforward response necessary by the client or patient.

This helps us move beyond the bracing and “keep your core tight” cues that are not part of our long term goals and authentic movement.

Try it, feel it and let us know what you think.

Corrective Exercise Wall Glute Bridge

Thursday, August 8th, 2019

This version of the glute bridge is a great corrective exercise for teaching the body the sequencing and synchronization from the ankle to the lumbar spine that is associated with triple flexion and squatting.

It will certainly challenge dorsi flexion in a pseudo closed chain environment as the knee moves over the toes. There is feedback from the wall and load placed into the wall, but no vertical forces acting on the joint.

The body gets comfortable with relative lumbar flexion in an unload position because it has to go through that motion to get the buttocks of the floor. The beauty is both the novelty and very limited load placed on the spine. So even those with lower back pain will find this a helpful exercise as it reduces the threat.

Additionally, it helps create some separation and distraction of the tissue at the thoraco-lumbar junction. The upper part of the body is fixed on the floor as the lower part moves away, creating the distraction.

Put it to good use and tell us how you did!

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

Corrective Exercise-Half Frog

Thursday, July 11th, 2019

This simple exercise can be quite challenging for those with a history of lower back pain, as well as the deconditioned client. The ability to disassociate the hip motion from the movement of the lower back and pelvis can be very helpful in removing stress from the lower back.

This “Level B” exercise from the PFMS is both a corrective and assessment opportunity. You will be able to see, and the client will be able to feel any control and/or range of motion differences between the two sides.

The Half Frog is also an exercise, that as a Level B allows for more intrinsic focus of attention for motor learning purposes. The client is able to concentrate on what muscles are engaging and the sensory feedback of those contractions.

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.
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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).
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
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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?

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