In part one of this post I very simple reviewed some of the ideas behind core stability and how I questioned their relevance to a patient’s pain presentation. In this follow up post I will briefly review how people with pain have different function than those without pain and give an opinion on how core ‘stability” exercises may help with patients in pain in a manner that has nothing to do with stabilizing the spine.
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: 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
Audience: Patients and therapists
Purpose: A brief argument on why attempting to lengthen your IT Band with stretching or foam rolling is a waste of time and not possible.
Warning: I recently changed the title on this post (formerly Stop foam rolling your IT Band. It can not lengthen and it is NOT tight.) because a few colleagues have suggested that it is a bit strong. I agree and also think that such hyperbole will decrease a healthy discussion in the area. I don’t want that.
However, I have not changed the rest of the content and again recognize that some of it is a bit salty. Much of it is how I talk to myself and entertain myself. When reading this please just consider the arguments and not HOW they written. I never expected 40,000 people to read this thing.
Please note, I have always been open to the idea that foam rolling might have an influence on our nervous system and ultimately pain. My doubts have been around what many people say foam rolling does which I always found biological not possible. This post explores those ideas.
Original Post –
I am in the minority when I cringe at the rampant unjustified use of the ubiquitous, seemingly harmless but actually evil foam roller for IT Bands. I’ve seen their use climb in the past 5 years and I am sure that my success rate at convincing my patients to not roll the crap out of their IT Bands is less than 10%. Those rollers are WINNING. Perhaps this post will sway the voters. (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,