I wanted to create a quick post about an article entitled, Pain Series: A look at the role of movement in relation to pain (Click for link). The article was written for the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) student special interest group (a physical therapy tour de force in the orthapedic world).
Here is an excerpt
Pain does not give us a measure on the current state of the tissue.
This has been shown through numerous studies on both animal and human subjects. These data have shown that pain, nociceptor activity and the state of the tissue are not isomorphically related at all but are modulated by a variety of factors.
Nociception is neither sufficient or even necessary for the experience of pain even though it is the most common driver of the pain experience.
Pain is modulated by a number of different factors including those from the somatic, psychological, and social domains.
The influences on pain are varied and seem to be heavily dependent on the context that the noxious input is evaluated under. Some areas that have been shown to modulate pain include:
- Inflammatory mediators.
- Tissue temperature.
- Blood flow.
- Attention (results are mixed)
- Social context.
As pain persists the relationship between the perception of pain and the state of the tissue becomes even more imprecise.
The number of changes that occur in response to activity of the system are large and the list of those identified is growing at a rapid rate. As nociception persists the neurons transmitting nociception and the pain networks in the brain become sensitized. Clinically these changes manifest as hyperalgesia and allodynia not only in relation to tactile stimuli but also movement. This is a key concept in understanding the role of movement in pain. Persistent pain can result in changes in the proprioceptive representation of the painful body part in the primary sensory cortex. This can have implications for motor control since it is known that experimental disruption of these maps results in disrupted motor planning. There is a mounting body of evidence that these changes can become part of the overall issue.
Pain can be ‘conceptualized as a conscious correlate of the implicit perception that tissue is in danger.’
The neuromatrix theory fits our current knowledge of biology and neuroscience and is flexible enough to grow with the research. Two very important components to the theory. Pain is just one of various outputs from the CNS in response to perceived threat and it is this threat perception that drives the outputs – not the actual threat.
In summary, pain changes the way we move and the way our brain interprets the information going to it as a result of our movements. Sometimes (many times), to fix movement patterns, we have to help reduce the level of threat detected by your brain so that your output of pain decreases. That’s all for today!Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Movement, or more specifically, novel movements can be quite useful for pain relief. They are an opportunity to create a new impression in your nervous system.
There is no guarantee that this new impression will be a favorable one; if you’re not careful the impression may cause an output of pain from your brain. If you’re careful, the impression may help to “convince” your brain and nervous system that movement should not be interpreted as dangerous and therefore, offer some pain relief.
If the impression causes yet another output of pain, there will most likely be some protection, and therefore limited or limiting movement. In order to change things for the better and create a pain-free impression you need to nudge your painless range of motion in the right direction. One way to stack the deck in your favor is to pair the new or novel movements with something that already has produced a favorable impression by your brain and nervous system.
This is creating context to obtain pain-free movement. Context is important when talking about pain and can be used in your favor.
Do you need to perform specific movements or movement patterns for this to occur? People often worry that imperfect movements create patterns of strain that can cause pain at any moment. In fact there are those in the functional movement camps that insist this will happen (I know, I used to be one of those people). Is this based on fact? Will “improper” movement cause us to break down, will this result in pain?
Consider these questions and points:
- Why don’t people with cerebral palsy hurt constantly at every joint even though movement is often difficult to control and where movement and postural asymmetry are very common.?
- How do you explain why so many people display these imperfect and asymmetrical movement patterns but have no pain?
- Why are so many of us walking around with herniated discs, meniscus tears, rotator cuff tears, and/or arthritis without knowing it? There is actual tissue damage in these people and yet they don’t hurt. The research documenting all of these findings exists….. in large quantities.
- How can we explain phantom limb pain; even in individuals who were born without a limb?
What about the countless stories of how people (maybe you) have had pain relief by changing movement patterns and/or posture?
Body mechanics and movement are important and useful to consider clinically, but my argument is that I would not be helping my patients by convincing them that their body mechanics and movement patterns are going to lead to them falling apart, injuring themselves and/or leading to degeneration or arthritis. Not only would this be harmful to my patients, but this is clearly not the case in any way.
Now this is flies in the face of what many in my profession as well as the physical therapy, athletic training and personal training profession, as gospel. Am I denouncing my own profession as well as many others? Well, in this case….. yes!
Body mechanics clearly play a role in the treatment of my patients and I use movement every day to help people with pain. When pain is present, movement and body mechanics can change drastically, but movement patterns and body mechanics are not useful as a pain predictor even though they can be a useful in pain relief.
Regardless of how you move you will all hurt at times during your life and pain may correspond to certain movements.
Neuroscientist, V.S. Ramachandran said that “pain is an opinion.” Painful movement means that our body is acting on the opinion that we are under threat and should therefore be protected. So, how can we change this “opinion”?
Movement patterns and postures should be thought of as tendencies or movement habits. They develop over time and therefore can give me a glimpse at your movement history. If you do something new, something outside of your normal movement regiment (I will call this novel movement), you give your nervous system something to form a new opinion about. If you perform this novel movement in a non-threatening context, a context of safety, a context of expansion, your nervous system is not likely to come to an opinion hat this is threatening and therefor not output pain.
Pain relief that occurs with postural changes, specific exercises or prescribed movements likely helps to reduce pain because they are all novel movements and is another example of the power of novelty. It likely has nothing to do with attaining perfect posture or perfect movements patterns or reducing musculoskeletal strain reduction, but has everything to do with non-threatening movement variability.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
This post has been adapted from information posted by, Byron Selorme – Science Based Yoga Educator, on Soma Simple. People need to read this, this information is what each and every person needs to understand about pain.
- Despite all the impact demolition derby drivers sustain, they have ultra low incidence of chronic whiplash/ crash. It has nothing to do with the forces (they get blind sided too) but everything to do with the meaning and context of what happens. http://www.ncbi.nlm.nih.gov/m/pubmed/15827919/
- If you treat your body like it is fragile and damaged, it will become more so.
- Being afraid of the pain getting worse makes you fearful of movement.
- Working through pain and ignoring flare ups will negatively impact your nervous system. You are more likely to develop chronic pain when your nervous system is not “happy”.
- You can’t stretch out your pain; strengthening only indirectly affects the pain. So forget about weak muscles and asymmetry as being the cause of your pain.
- Treatments that are painful are more likely to perpetuate an environment in which your brain outputs pain; meaning, predominantly painful treatments can amplify your pain.
- Getting imaging like MRIs and X-rays should be an absolutely last resort. Unless there is evidence of serious red flags, chances are any findings on MRI’s, X-rays etc will just cause you to worry about something unnecessarily. Many people have no pain and would have plenty of abnormal findings n X-rays and MRIs.
- Your brain is in complete control of the pain experience. Pain is produced as a pain experience just like hunger and thirst. Only with pain, it is similar to a smoke alarm. Sometimes the alarm may go off because you took a shower or burnt some toast. With pain, there doesn’t have to be anything wrong for the experience to occur. This one is the most vexing because it feels so real. And it often has a distinct location. You would swear that something is wrong “right there”.
- Your brain extends throughout your entire body; there is almost 45 miles of nerves in your body. All nervous tissues have their own blood supply and they can get very cranky if they are not well fed. This is where you may need the help of a competent health care provider, and the earlier the better.
I have been putting together some resources on pain education; here’s a link to the page on my website Pain Relief. On this page, you will find handouts used to help those in pain as well as a pain presentation I gave at NCNM.
This morning, I find Todd Hargrove’s blog about a pain and performance presentation he gave at a Parkour gym in Seattle, here’s a link Todd Hargrove’s Talk on Threat and Performance
Todd does an excellent job talking about updated information about pain and how it can guide (and negatively affect) your athletic performance. Reducing the threat, or, rather, convincing your nervous system that there is not threat when performing athletic tasks like Parkour, is often the goal with any therapy that touts pain relief; even if the person performing the therapy is unaware of this.
Enjoy Todd’s video and blog post and stay tuned for more recorded talks from me on this subject. If anyone is interested in having me talk about this subject in person feel free to contact me.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Every pain relief therapy and interaction should leave patients with:
- A better understanding of pain, how important their pain system is, and how it’s not always directly related to anything that’s broken, torn, misplaced, squished or damaged.
- A better understanding of what the therapy can and can’t do.
- Some consideration for their own pain system as an important phenomenon with a past, present and future. This allows it to view every input in the context of past, present and future experiences.
Some facts to ponder about our skin, our brains, their relationship to each other, the rest of our nervous system and their involvement in pain relief :
- Through the nervous system, our skin has a plethora of connections straight to your brain
- Skin plays a HUGE role in how we sense where we are in space, where we are going and all the subtle movements in between.
- We (us primates) have a grooming instinct and the responses are programmed in our brains. It’s instinctual to touch, rub and push on things that hurt for pain relief
- When we place our hands on someone else, there is a large amount of activity in both people’s brains.
- When we are in pain, it often requires near-full or full attention, this means that a large part of your brain function is devoted to paying attention to and trying to figure out how to relieve pain.
- Oxygen levels are incredibly important to our nerves, especially the of small nerves in your skin. Gentle contact increases blood and oxygen to these nerves; this decreases any level of threat input to our brains
- Relaxing under the gentle hands of another deepens breathing (very important) and decreases general tension through an interaction between our brains and muscles
If you’ve seen me in my office for nutritional advice, chances are I’ve told you how important it is to get a wide array of foods in your diet; we might call this “nutrient variability”.
We know that the more variable your heart rate is, the healthier your cardiovascular system is; this is called” heart rate variability”
Well, guess what…. there is a concept called, “movement variability” that seems to be the key component in pain relief for conditions like upper back pain and low back pain.
What is “movement variability”?
It is creating slightly different movements to perform certain tasks. In a 2010 study entitled, ”People with chronic low back pain exhibit decreased variability in the timing of their anticipatory postural adjustments“, authors found that people with low back pain had decreased movement variability when it came to postural adjustments. In another study (click here), upper back and neck pain was linked to the same decrease in movement variability.
Many clinicians and therapists (myself included) see this as one of the main reasons functional movement, functional training, joint manipulation and mobilization, massage and many other soft tissue and rehabilitative techniques help people in pain. What do all of these treatments have in common? Novel Movements.
Novel movements are movements that vary from those that you produce regularly throughout the day. Movements that exit outside of a stereotypical pattern. Novel movements help to increase your movement variability and also stimulate your brain to produce dopamine. Not only is dopamine a “pleasure” chemical, it is also part of our internal reward system. An increase in dopamine from novel movements and movement variability is like a messenger to the rest of the brain saying,
“Hey, good job! Everybody, wake up and pay attention, this is something new and good for us.”
Novel movements and increased movement variability creates an opportunity for your body to experience movements that are non-threatening and non-painful; this can help to decrease the pain signals from the brain with chronic pain problems.
We would be correct if we categorized decreased movement variability as our movement habits. To increase our movement variability and therefore, possibly find relief from chronic pain, low back pain, upper back pain and more, we should change our movement habits and introduce novel movements into your daily routine.
In other words, you need to improve your “Movement Diet” (I stole this phrase from Cory Blickenstaff, a PT in Vancouver Washington). Improve the variety of movements in your “movement diet” so that you have options for pain relief and finding comfortable ways to move.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Pain education can help reduce pain and disability; often, good pain education reduces your nervous system’s identification of various signals as “threatening”. If you’ve been following my recent blog posts, our brains can perceive many things as threatening and therefore, output pain as a result. These things may be nociception, emotions, ideas, memories and more. In addition, I have written about how some health care providers, unknowingly, pass on messages that can be threatening. This is particularly true when well meaning health care providers ascribe too much importance to some alleged injury to your muscles, ligaments, tendons and joints as the cause of the pain. For example, many massage therapists, chiropractors, physical therapists and trainers talk about muscle knots; there really are no such things, well….. they’re not knots.
How many times has your chiropractor or massage therapist told you that you had extensive muscle knots and scar tissue, and that was the cause of your pain? This idea may have caused you to think you had caused some damage to your body. In turn, even sub-consciously, this may have caused you to lose confidence in your ability to heal.
And what was “prescribed” for these “knots”? Probably, lots of massage, chiropractic adjustments, stretching, foam rolling, joint mobilizations and more. Why?
No one knows the answer, it certainly isn’t because all of these things have been proven to help with tender spots in our bodies. Please, read that again…… This last sentence may be a shock to some of you as most providers pass their recommendations off as scientific facts. Try this as an experiment, see what happens when you perform, fun, novel movements within and pain free range without foam rolling, rolling on lacrosse balls, using trigger point sticks, knobs, without getting adjusted and without constant stretching. Chances are, you’ll feel pretty good.
Often, as a health care provider myself, I find that some of my recommendations to patients become obsessions; so I need to be certain that my recommendations are rooted in science. Doctors and therapists can cause patients a lot of anxiety by making them feel like they defects in their body when there is no evidence of them. Many of my patients have been told that their back is “out”, that they have the “neck of a seventy year old”, or that their knee is “bone on bone.” These statements can increase the perception of threat, cause disability and pain, and lead to treatments that are unnecessary or even harmful. Yes, these statements can be interpreted as threatening by our brains and actually cause pain and disability.
I have to share a video that has been circulating recently showing physical therapist Peter O’Sullivan, working with a former client, Jack, about his dramatic recovery from debilitating back pain. The successful therapy involved dealing with Jack’s fears that forward bending was unsafe, which stemmed in part from hearing previous therapists tell him that he had the “back of a seventy year old”, that his back was “in pieces” and that “he couldn’t do nothing.” But O’Sullivan showed him otherwise, and the results were amazing to say the least. This guy went from not being able to ride in a car to digging ditches pain free in short order. I have been showing this to my students lately and hope you too will find it a bit mind-blowing:
The results Jack experienced are pretty amazing and I can tell you, from my clinical experience, his were pretty extreme. I have seen patients leave my office in quite a bit less pain and some, pain free, after a good “dose” of pain education. For more information on this topic and to se some of the pain education tools I use in practice, go here, Pain relief Portland, OregonYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
I am very excited to announce the latest evolution of treatments at Optimum Function!
Over the last 12 years, I have integrated massage, chiropractic, myofascial therapies, neurodynamics, nutrition and more. In addition, an, in my opinion, more importantly, I have also been paying very close attention to research, evidence and am constantly seeking out the truth, as best as possible, and questioning the so-called gurus of nutrition and manual medicine.
It’s been a long and sometimes lonely 12 years! This latest evolution of Optimum Function is a reflection of the last 12 years; but it’s also a work in progress.
I know, some of you have contacted me about the recent changes in the info on my main site, www.OptFunction.com. A few of you have asked where the pages for Fascial Manipulation, The Graston Technique and other named techniques have gone. Well, I can now say that the mechanisms behind MANY named techniques out there, especially when they seem overly complex and far-fetched….. are.
What I have found is that, through updating my knowledge on neurophysiology and pain sciences, nerve mobility and mobilizations and how our body views and uses movements for pain reduction, Many of the successful named techniques share common effects in our bodies:
- They mobilize nerves
- They produce novel stimuli which help to improve movement and reduce pain
- They encourage you to keep moving in novel and therapeutic ways
- They empower you by teaching you about the benefits of your pain system, rather than fearing it or thinking it is a reflection of damage in your body
Well, this is what I am aiming to do at Optimum Function from here on out. In addition, you will notice new pages at the Optimum Function Website:
These new pages were created to help educate you about various ideas that I will use during your appointments. I used the term “Myofascial” because it is a commonly-searched keyword for manual medicine. This is NOT to represent a technique, or even a propensity toward treating fascia, just that, through movement and hands-on work, I will help to encourage mobility of your nervous system. This system travels on and through fascia and muscles and may be affected by these structures. “Myofascial”, at Optimum Function, means that, through neurodynamics and nerve mobilization, I will work to eliminate pain and dysfunction in your “neuromyofascial” system. The “Pain Relief” page is all about education; pain education is paramount to pain relief. This will be a big component of your appointments at Optimum Function and you will get handouts and even “homework” to help your pain knowledge be as current and accurate as possible.
My Twitter and Facebook pages will reflect this too, please click on the links to the right to follow me on various social media venues to stay current. I pass along great, current and accurate articles on topics relevant to physical medicine and nutrition. In addition go to the main site to browse through the new pages and learn more about Optimum Function 2.0
So, if you currently have pain; whether it’s upper back pain, lower back pain, muscle pain and dysfunction or need someone to help you with your diet and nutrition to live pain-free and functional, Optimum Function is your place in Portland, Oregon.
I am currently offering 2 tiers of visits. The initial visit will be the same for everyone, follow-up visits are usually 20-30 minutes but I am also offering 1hr follow-up visits for those of you who would benefit from more hands-on soft-tissue work and massage. For more info about prices, click here: Prices at Optimum Function
As always, you will leave your visits knowing more about what’s going on with you and understanding what you can do and what I can do to help reduce your pain and get you moving better, more functionally and more often.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health