Unhealthy Client Paradigms leading to Professional Paralysis

In addressing pain throughout my time as a movement professional I have ran into ‘professional paralysis’ countless times.  Being thwarted in my suggestions toward movement and exercise with the common response of ‘oh that hurts’, or, ‘I am going to pay for this tomorrow’.

In addressing these pitfalls I find it essential to transfer ownership to the client/patient.  I feel as though a large part of ‘professional paralysis’ stems from the paradigm that it is the role of the provider to ‘fix’ the person.  If you are seeking help for chronic pain, the bitter pill to swallow yet less disappointing paradigm to operate from, is that ‘no one can fix you’.

The good news is that ‘you can fix you‘.  The ‘fix’ happens from the inside out as with all ‘fixes’ in the body.  The path is not easy, oftentimes does not make sense, strategies will fail many times, but you will not see results by being a passenger in this car.

As a movement professional I have to be flexible often initially allowing for self-selection strategies with loose guidelines about the type of movement that I am after.  Developing this ownership and vestment into treatment begins to help break this unhealthy idea of ‘I am here for you to fix me’.

You CAN exercise.  No matter your pain state you CAN do something.  Are you falling victim to cyclical arguments that ENABLE being a ‘passenger’ along for the ride? “I can’t walk it hurts my back…” how about exercising your arms?  “I have a shoulder problem”  well how about working your ankles a bit “well I’ll try but I have a busy schedule”.

Be careful of the often caring but toxic enabling partner.  “I wouldn’t do that if I were you…” they’ll say.  “Oh, let me get that for you…” will be the response.  I have even heard the divine enabling partner, “God doesn’t give me more than I can handle”.  Continuing the cycle of being a ‘passenger’ in the chronic pain journey.

Checks for introspection…  Is this me?

  1. I am waiting for someone to ‘fix me’
  2. Cyclical arguments  that enable no change in behavior
  3. Enabling relationships

Western medicine essentially offers 3 options of intervention.  Needles, knives, and pills all utilized in the hopes of facilitating the body to HEAL ITSELF.  Your body by adulthood has been estimated by some accounts to have up to 100 trillion cells, which make up specialized tissues, which make up specialized organs, which make up organ systems, which combined create us as an organism.  This wonderfully complex system is awaiting the orders of one ‘owner’ namely you to get in the ‘drivers seat’ and direct the outcome of your current challenge.

You are in control.  You have the power to make change.  Empower yourself with knowledge and action.

Why Exercise for Chronic Pain?

Here is a hard science reason for utilizing exercise to address pain.

Beta-Endorphin.  Beta-Endorphin is produced within the body and plays a powerful role in controlling pain.  In fact it’s power to control pain is several times that of morphine.  Of the endogenous opioids, Beta-Endorphin also produces the greatest sensation of euphoria.

So how can I get prescribed Beta-Endorphin?  Through sustained exercise.

The body produces Beta-Endorphins in large amounts through SUSTAINED EXERCISE which in turn binds to receptors to produce euphoria and modulate pain.

The initial research connecting exercise to production of ‘endorphins’ involved runners participating in running for two hours.  Through imaging, there was observed a positive correlation between sensation of euphoria and distribution of ‘endorphins’ in the brain.

So how long do I need to exercise to receive the benefit?

The relationship between endorphin release and exercise seems to be related to the intensity of the exercise.  A recent study entitled ‘Opioid Release after High-Intensity Interval Training in Healthy Human Subjects’ observed a higher production of endorphin release with Anaerobic interval training.  Positive mood was noted after 60 minutes of moderate aerobic treadmill training suggesting endorphin production but not at the observed concentration that HIIT produced.  It was hypothesized that the increase in endorphin production was in proportion to the discomfort of the exercise.  ‘Feel the burn’.

Therefore as a guideline, endorphin facilitation workouts are more efficient when producing uncomfortable but safe muscular fatigue.  This fatigue occurs most efficiently during a workout facilitating an anaerobic environment.

What does this mean?  It means if you can sustain the exercise such that you do not require a rest secondary to muscular fatigue, or ‘burn’, then you  may not be producing the stimulus required to most efficiently produce endorphins through exercise.   So this begs the question.

Endorphin facilitation in the body is a natural process stimulated by many things besides exercise.  Concerning movement and exercise this post attempts to empower you though new ideas and research.  So, concerning exercises and endorphins, are you working out the ‘right way’ to achieve the goals you are after?

Pool Exercises: Pressure inhibits pain

Whats the difference between exercising in water vs. out of water?  Most people will point to buoyancy.  For example when water is at waist height 50% body weight is removed from limbs submerged.  When water is at chest height approximately 75% of body weight is removed from submerged limbs/torso.

So why do people say, Ahhhh!  When initially immersing in water?  Possibly pressure.

  1.  COMPRESSION INHIBITS PAIN!! Hydrostatic pressure

A study entitled “Nonpainful wide-area compression inhibits experimental pain”, found that compression inhibited pain in a clinical setting.

How much compression does water provide?  At around 3 feet of freshwater depth, pressure will equate to approximately 75mmHg.  What does this compare to?  A medical class 3 compression garment is measured between 40-50 mmHg.

Do you hurt on rainy days?  The Barometric pressure difference from record high to record low was 75mmHg.  This low pressure pain can be offset by hydrostatic pressure in a freshwater depth ~3 feet.

So take some weight off of those painful regions by getting in your local pool and experience the freedom of buoyancy and pain inhibition to improve, restore, and preserve your  mobility!

Becoming the Victim: Pain and Hyperalgesia

Hyper-sensitivity of the nervous system, hyperalgesia, complex regional pain syndrome, when the duration of Pain exceeds expected healing times is an Epidemic.  Extrapolating paradigms for treatment from current data is ongoing and cutting edge in current pain approaches.  Here are some interesting statistics and snippets of studies that relate to the title.

… results support a specific association between major sexual abuse and chronic pelvic pain and a more general association between physical abuse and chronic pain.

…Genetic factors, as well as chronic pain in a partner or spouse, contribute substantially to the risk of chronic pain for an individual. Chronic pain is genetically correlated with MDD (major depressive disorder), has a polygenic architecture, and is associated with polygenic risk of MDD.

…42% stressful life event near onset of complex regional pain syndrome.

…54% had a workers compensation claim related to complex regional pain syndrome.  

…47% had physician imposed immobilization.

…66% had myofascial component present at evaluation

1 in 3 women and 1 in 4 men experience intimate partner physical violence, intimate partner sexual violence, and/or intimate partner stalking in their lifetime.

It seems after reflecting the findings from several studies we could infer a genetic component meaning some individuals have greater risk, although not predisposed.  Environmental factors seem to play a significant role as well along with fear and apprehension of one’s own body, i.e. fearful movement.  Environmental factors are significant and highly prevalent seeming to have a positive correlation with an event that creates a victim, i.e. workplace injury, abuse, motor vehicle accident…

This is most certainly food for thought.  Being a blog emphasizing movement, I feel as though addressing pain and apprehension to movement is essential.  Implementing strategies for empowerment and focus on an internal locus becomes critical to the movement professional.  The movement professional should view professional dependencies as unhealthy i.e., external locus, while addressing the high prevalence of myofascial dysfunctions commonly present from someone fearful of movement.  Incorporating an emphasis on reconnecting with the body without shame, fear, and avoidance becomes critical in pursuing function over pain.

—————-

Genetic and Environmental Risk for Chronic Pain and the Contribution of Risk Variants for Major Depressive Disorder: A Family-Based Mixed-Model Analysis
Published: August 16, 2016
—————–
 1994 Aug;84(2):193-9.
Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse.
Walling MK1Reiter RCO’Hara MWMilburn AKLilly GVincent SD.
—————-
 1999 Apr;80(3):539-44.
Epidemiology of complex regional pain syndrome: a retrospective chart review of 134 patients.
Allen G1Galer BSSchwartz L.

 

Healing time and chronic pain.

Often I hear individuals suffering from pain lasting > 1 year seeking a ‘fix’ from a healthcare provider.  It is good to know of some general time spans for musculoskeletal healing to better understand possibly if exercise may be harmful or worth the discomfort.

Generally bone takes 6 weeks to form a callus whereby a person can perform some form of exercises and weight bearing.

Tendon generally takes 8 weeks.

Ligament generally takes 12 weeks.  As I have seen orders from surgeons to initiate straight line jogging 3 months after anterior cruciate repair <strength permitting>.

So if you have been hurting > 1 year, chances are time has allowed compromised tissue to mend.  So why the continued pain?

-Possibly never providing the tissue with correct nourishment to encourage healing. i.e. MOVEMENT (bone needs weight bearing, disc needs compression/distraction, tendon likes moderate tension along line of orientation, etc.)

-Possibly the tissue or region in question is moving too much.

-Possibly the nervous system has become hyper-vigilant.

This post is only meant to provide enough information to warrant further exploration along these lines.  Good things to ponder.

Image result for healing time and pain

Robin Hood, Movement dysfunction, and Pain

Robin Hood is a story where the hero ‘robbed from the rich to give to the poor’.  I think of movement dysfunction in the same manner.  If a hip is stiff and unable to rotate it will ‘rob’ that motion of rotation from somewhere either above or below itself.  If the hip ‘robs’ rotation from the low back then there is a high probability of creating dysfunction.  Some literature suggests disc tears happen with rotation > 5 degrees between motion segments in the low back.

Hopefully by having a general understanding of movement responsibilities in the body we can avoid the ‘Robin Hood’ scenario and avoid movement dysfunction and subsequent pain.