Below I have created neurodynamic nerve slider pictures. I use them in handouts for patients and now you can too! They are strongly inspired (ahem, completely based on) David Butler’s work.
Nutshell summary: People in pain have spines that function differently than those not in pain. Many treatments can influence pain. The spine stability model of low back pain does not explain how people have pain and takes an overly mechanical view of the pain experience. No test has ever shown that a spine is unstable or how “increasing stability” would lead to a decrease in pain. Thinking that our spines need more stability or control may be the completely wrong path in explaining how people have pain or how our exercises help them. Our treatment “corrections” occur not via one specific “corrective” mechanism (e.g. improving stability) but rather through global non-specific mechanisms that our better explained by our understanding of pain neuroscience. Making the shift from believing that “stability” is the issue with pain can thus free up to choose completely different exercise programs. Exercise and treatment prescription thus become simpler. We have preliminary evidence to support this view with the clinical studies that show benefits with the various exercise conditioning programs that train different schools of thought on stability or the just as effective programs that completely ignore any concepts of stability.
Purpose: To explain my treatment approach to Persistent Pain Problems.
Overview of the Treatment Program:
- Pain Physiology Education
- Movement (Graded exercise/activity exposure)
- Manual Therapy (more…)
Purpose: Fascia is everywhere, provides a fantastic structural support for the body and has the ability to transmit force from force generating muscles. But we as therapists tend to get ahead of ourselves and make statements about treatments and the body’s function that I am not sure make sense and haven’t made sense for the past decade that I’ve questioned it.
The fascial treatment fallacy. (more…)
Purpose: To highlight the poor link between the bogeymen found on imaging with pain or dysfunction.
Our current technology is amazing when it comes to viewing the insides of our body. The problem with this fantastic technology is that we can see something (e.g. a tear in a muscle or a joint with some osteoarthritis) and assume that there is something wrong or that this is the source of our pain. However, the link between tissue “abnormalities” on MRI, x-ray or Ultrasound is often quite poor. Many, if not most, people have “bad stuff” on their MRIs or x-rays yet have no pain. (more…)
Below are Tensioner videos for your irritated and sensitive peripheral nerves.
Warning: please only do this if your knowledgeable health care provider has taught these and specifically said that you should do these exercises.
Gentler “Slider” movements can be seen at a previous post here: Slider Videos
This article is purely conjecture. I have no hard data and would not even know how to create a study to test for it. BUT, I consider it biologically plausible.
Tightness is a common sensation for people with pain and for athletes during training. However, when someone reports being tight in a region I find that they often are not in terms of their mobility. Their range of motion will be wonderful, perceptually their tissue will feel “loose” upon palpation (warning: highly subjective on my part) yet they report a sense of tightness. Main point being there are no objective signs of tightness or limits in their range of motion. So why does the perception of tightness occur? (more…)
Purpose: Demonstrate simple movements to calm, move and make healthy some irritated nerves.
Disclaimer: Not to be done if painful. Do 5-6 to start. Always under health professional guidance.
Purpose: to provide some information about the pain experience
Why?: Understanding pain can help modify it
I don’t pretend to understand everything about pain. It is incredible complex and what we know is certainly involving. However, there is a lot of misinformation out there even from people that should know better. This article will link to a number of information sites that help explain pain. This is important because it helps you understand why things hurt. Understanding why something hurts can decrease pain but can also help you function better. Some basic concepts:
1. Pain is a perception. Signals (e.g. nociception or even pressure) come from the body and the brain creates an output that we perceive as pain. Ever heard of a soldier being shot and not feeling any pain until they were safe and out of harms way? If pain was some absolute thing that the brain has no choice to recognize than you would have no way but to feel pain any time a tissue was injured. We’ve all heard stories of people being injured but feeling nothing.
2. Your body does not have to be injured to feel pain. In fact you can lose a limb and later feel pain in that limb that no longer exists.
3. Tissue injuries (e.g. disc bulges, rotator cuff tears, tendinopathy) do not have to hurt. The body can have lots of so called “dysfunction” but this does not mean that you will feel pain. For example, 50% of people over fifty may have a rotator cuff tear but they experience no pain.
4. Emotions, beliefs, stress, past experiences etc can influence the pain that you feel. Pain is more than a punch in the arm.
5. The perception of pain can move around in your body and this does not mean that you are crazy. This is a normal finding when we experience persistent pain.
6. Pain changes how we move and how we function. Movement is often the key to resolving pain.
There is so much more than this but I will let the resources below provide better information.
1. The sensitive nervous system (D Butler): a great academic reference
2. Explain Pain (Butler and Moseley): a patient’s guide to pain
3. Painful Yarns: stories from people with pain
1. Neurotopian: Pain for Dummies a great site, you can read this and ignore everything I say.
1. Persistent pain described with pictures
2. Lorimer Moseley: Tedx Talks
3. Peter O’Sullivan explains how our fears and beliefs about our backs change how we move and contribute to the feeling of pain.
All the best,
Become invisible and walk into a Chiropractic, Physiotherapy or Massage Therapy office one day. Watch them speak with a patient who has back pain or maybe a little bit of knee pain. You may hear the following:
-you need stability exercises
-these muscles are very tight
-you need therapy as you don’t want this degeneration to progress
-no more running or arthritis will certainly flare up and you will have real problems down the road
-you have dysfunctional movement patterns
-your glut muscles don’t turn on
-oh, it hurts here (pressing on upper traps). There some adhesions in the muscle
-I need to see you 2-3 times a week for the next 4-6 weeks.
All of the above statements are from good, well meaning people. And some of these statements might even be appropriate under certain conditions. These statements typically are not from the quacks and crooks that look to exploit anyone who has been in a car accident or might have fallen off their bike when they were six (and therefore their spine is permanently in trouble because of this “trauma’).
My concern is how all of these things sound to our patients – which is different from what we hear. If you tell someone they need stability exercises they probable assume their spine is unstable. That probably does not sound good to a patient with an incredible amount of pain. When we poke on areas that are “tight” or “sore” in everyone (e.g. the upper traps, you can’t find someone who is not tender there) we catastrophize, comment on how tight it is and reinforce a pain belief with our poking and create beliefs in people that there is something wrong with their muscles.
Not encouraging patients to resume their normal activities and to keep active contributes to fear and movement avoidance.
Telling patients that the way they move is dysfunctional based on an arbitrary standard of how someone should move again creates the belief in people that something is seriously wrong when there is usually no serious dysfunction.
Seeing someone 3x/week for 6 weeks for whiplash or a simple backache. Come on. Common sense says this is bad practice even though it is somehow in many guidelines.
The bottom line is we need to watch our words. I am no exception, I catch myself doing this too often. An unstable spine means something completely different to a therapist than it does to a patient. The phrase degenerative joint disease should be banned – they have a joint that is changing like everyone’s joints and most minor symptoms have nothing to do with those normal changes.
Just some thoughts,