Posts Tagged ‘understanding 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!

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.

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!

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.

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.

Yellow Brick Road PFMS Sister Curriculum

Friday, December 7th, 2018

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

An Evolution in Coaching Clients with Pain

Written within each client are specific events and circumstances that have significantly shaped what their chronic pain experience means to them.

Elite-level coaches are not only well versed in the realm of biomechanics, they’re also able to recognize, anticipate and consistently meet and exceed the deepest psychological and social needs of their clients; which are often revealed BEFORE the client ever steps foot onto the assessment or exercise floor.

The landscape of helping those in pain is expanding RAPIDLY… Yes, biomechanics are an important aspect of a client’s story, but with much of a clients’ suffering from chronic pain revolving around psychological and environmental factors, the consultation / intake phase becomes that much more imperative when coaching this demographic.

In this 2-min video clip, come behind-the-scenes of our latest collaboration & partnership where we discuss how one’s cognition’s (thoughts, feelings, perceptions, beliefs, values, etc) significantly contribute to an individual’s movement success – or lack there of.

So for the first time, a curriculum that centers solely on the psychological, emotional and environmental factors involved with coaching clients in pain is now available in an online format – exclusively through the American Council on Exercise.

Exclusive Partnership with the American Council on Exercise

The millions who live with & suffer from chronic pain are in desperate need of relief. Together with the American Council on Exercise, the Yellow Brick Road seeks to provide health and exercise professionals an online course that integrates:

• psychological theory,
• pain neuroscience,
• interpersonal relationship-building principles and
• client centered coaching essentials;

So whether you’re a personal trainer, strength & conditioning coach, corrective exercise specialist, health coach, physiotherapist, chiropractor, massage therapist… the entire framework is designed to compliment and fit into your specific area of movement expertise.

Enroll here

Working out with Function First

Thursday, August 11th, 2016

null59191463 - businesswoman running on a treadmill. business concept
Once you take the time to think about it, it is easy to make the connection to how better health and fitness increases productivity and happiness at work. According to Chron.com stress impacts everything in your life, including memory and processing new information towards analytical situations. These stressors not only impact concentration, but can also result in costly mistakes in any career field. Furthermore, energy around an office is contagious and employees with low energy and high stress will negatively impact the office atmosphere as a whole.

In addition, when we don’t feel well we are more likely to call in sick, thus getting further behind on our work and, in turn, creating more stress. It is a vicious cycle. Encouraging employees to work out with specific goals of increased functionality and mobility will help them to alleviate stress and increase focus and productivity at work.

This is just one example of how working out with Function First changed a life.

Before I found Function First, I was working out on a regular basis. However, I wasn’t seeing the results I was expecting. I still struggled with movements like squats and deadlifts. Lifting and running were painful so even when I attempted a solid workout, I often felt discouraged or unmotivated. I felt upset and annoyed with myself. I began to believe that working out was always going to be painful and started to wonder why I even bothered. Instead of the sense of happiness and stress relief that I wanted to get from working out, I was feeling more and more stress and fatigue after each session.

This frustration and stress combined with the pressures I was already experiencing at work. I was losing ground and I knew something had to change; not just for my own self-image, but also for my ability to grow my company and support my employees.

Enter Function First

After my first session I saw improvement and was already feeling like working out was something I wanted to do again. I was quickly shown how important it was to have specific, mindful goals during each workout. I gained an understanding that when a movement was painful, there was a reason and a solution. Staying focused on the proper movements quickly increased my mobility.

Soon the pain I had felt while running, lifting, and squatting began to disappear. I began to believe in myself again and began to believe that I was capable of working out in meaningful and productive ways. I was finally seeing the results I was after.

This energy carried over into my professional life as owner of SD Equity Partners. I was surprised to find that I was not only feeling less pain when working out, but was also feeling great throughout my day. The stress relief that workouts once provided me had returned. Currently, I find that I am better able to focus on my work to become a positive influence on those around me. I am able to find joy in my tasks and pride in my own creativity. This energy has also seemed to increase the enjoyment of the people that I work with. My positivity is contagious.

Looking back on my progress I cannot believe how much time I spent agonizing and putting myself through stressful workouts. The problem was that I was not working out with a clear goal in mind. My efforts were unfocused and the pain I felt just increased my stress and lessened my abilities to focus during my work day.

Thanks to the unique guidance of Function First I am not only stronger and feeling less pain, I am now more focused and productive in the office and growing my business more than ever before.

Written by:

Evan Harris
SD Equity Partners – Founder and Owner
Evan Harris

Understanding Pain Encore video

Thursday, June 18th, 2015

We hope you enjoyed the first 3 part series available to our subscribers. Please enjoy this encore video to further your insight into exercise and chronic pain.

Is Corrective Exercise Dead?

Tuesday, June 2nd, 2015

This short video will explain how the evolving corrective exercise specialist must be more than a corrective technician.

Below is a third and final installment of the Understanding Pain Series.