I have pain. What do I do?
So you have pain with movement. You bounce from one physician to the next with guidance toward pills, surgery and or exercise therapy. It’s easy to gravitate toward the idea of a quick fix to rid yourself of the pain, but where should this path of treating the source truly begin? One should know, all treatment processes have their appropriate place and time. When considering the timeline of stopping the hurt, sure, pain-killers may be the quickest option. The potential of correcting damaged regions through surgery may bring people peace of mind as well, especially nowadays in the western medical world. The only problem with having various directions that may bring success is where to go first. The western medical industry is steadily improving its process of triage but has much room to improve. Triage is the preliminary assessment of a person’s current health status to determine the urgency of their need for treatment and which treatment they require for resolution. The safest and most appropriate beginning phase of the triage process is ruling out serious issues i.e through your primary care physician. If all possibility of “red flags” or serious issues are not present, the next step is to have a movement rehab expert evaluate you. Keep in mind that your pain is a signal created by the brain that warns us protection is needed. Some protection methods from the body perpetuate your pain so it’s important to gradually guide your body through progressive stages of improvement that disarm the body’s protective state for proper recovery with minimal aggravation of symptoms. That’s where IHS can help!
How does a Movement Rehab Expert Determine the Path to a Pain-Free Status?
Our physicians consider painful and dysfunctional movement as both a mechanical and behavioral nature. That leads them to consider all activities done daily that may contribute to the current issue. Morning routines, work, workouts, hobbies, etc. These are all considered through the process of determining root causes to one’s current presentation. Our bodies migrate toward predictable patterns of movement in response to injury, but also in the presence of weakness, tightness, or structural abnormality. The focus of our diagnosis process is to reveal these patterns, weaknesses and compensations by utilizing a systematic breakdown of movement. The examination process is a balance of the patient’s signs and symptoms: the patient communicating symptoms while the clinician observes the signs. The patient’s symptoms reflect descriptions of the primary concern and includes all things that hinder lifestyles and activities while being associated with pain. After these are expressed, the patient is taken through a series of movements allowing the body to display discrepancies and dysfunctions that are likely linked to the primary complaint. These movements are meant to provoke symptoms and demonstrate limitations and dysfunctions while deconstructing the movements into isolated testing. These isolated tests reveal specific regional joints and tissue to desensitize, mobilize and stabilize. To avoid chasing pain, a common mistake in the medical field, our physicians observe movement-based impairments and let these patterns determine a specific functional diagnosis. This process is called the Selective Functional Movement Assessment (SFMA). The SFMA will help the clinician use the most beneficial therapeutic and corrective exercise based upon the determined dysfunction. An important addition to the SFMA assessment is that it demonstrates how structures and functions far from the site of the symptoms affect and influence pain and utility. This is crucial because exercise plans are often incorrectly used, overly generalized, and deemed ineffective. The systematic process intentionally avoids the provocation of symptoms during exercise rehab so harmful muscle compensation is averted. It is “a model to integrate the concepts of posture, muscle balance and basic patterns of movement into contemporary medical and rehabilitative practice.”-Gray Cook.
What Determines the Need for a Movement Rehab Clinician?
Tissue, joint and bone pain is the reason why most people seek medical attention. Although this understanding has expanded to a modern explanation of cognitive and behavioral categories instead of the traditional tissue-based model of pain. Pain modifies coordination throughout functional movements. The interaction between pain and movement control depends on the task, and as of recent research the focus is on how pain alters the timing of muscle engagement and correct movement patterns. In other words, tissues that normally provide stability and mobility for joints are no longer in synchrony because of the pain that disrupts proper timing of function and reflex. The reason why tissue activation training has become so important is because movement dysfunction can begin in the nervous system before the brain tells the body to move. To avoid this issue tissue preparation is paramount. This idea of tissue preparation and proper tissue engagement is deemed “motor control”. Since pain alters motor control, this is why previous injury is the most obvious predictor of future injury. If a patient has chronic pain, there is likely a motor control dysfunction that needs to be properly rehabilitated for the sake of tissue timing, coordination, postural alignment, strength and muscle inhibition. In this case global muscles are being used to accomplish movement tasks which are more suitable for local muscles. This concept of stability and motor control dysfunction suggests that it may be necessary to break a dysfunctional movement pattern or manage the movement toward passive correction before exercises are implemented.
What is Corrective Exercise and its Goal?
Corrective exercise has a focus on positive physiological responses throughout proper quality of mobility, stability and movement within a single exercise session. The end goal is normalization of muscle tone, attention, length and freedom of movement. As physicians, we look to restore timing, motor control, normalization of asymmetry and restoration of previous limitations. Before each treatment it is necessary to test function and set small goals of regional mobility and stability before retesting at the end of treatment to find improvement and areas of further focus. All of this depends on the severity and complexity of the movement dysfunction although perfection is not necessarily the objective… Symmetry and adequate function is the goal. Corrective exercise should be flexible and dynamic. In many cases you can see change within one single session so physicians are prepared to progress activities and exercises on the fly depending on the response. Mobility is more important in the early phases of corrective exercise and then comes stabilization. The focus is to achieve full range of motion without pain and compensation but then engaging the tissue and joints properly to stabilize and protect to prevent injury. The process may be slow and steady or quick depending on the patient’s ability to recognize change, maintain the proper movement and replicate it until memorized. This makes home care and continued exercise crucial in the rehabilitative process. It is always encouraged to maintain healing progression with a 50/50 relationship between the physician’s efforts in the office and the patient’s commitment at home.
What Should End-Goal Movements and Posture Look Like?
The first thing you should note with proper movement is if the motion is easy and unrestricted. The performance of various movements our physicians guide patients through should take minimal to moderate effort. Next, we tune into how one’s breathing looks throughout the performance of motion. If the breathing is labored, choppy or they’re simply holding it in, this is a sign of the brain going into survival mode. Physicians have understood through experience that if labored breathing is present, patients will survive the proper movement, not learn it. Often, it’s the body’s stressors, tension and breathing that compromises movement so end-goal motion should be relaxed yet engaged. With posture, we see a common occurrence with “tech neck” for example, where patients have a forward head carriage. The muscles of the back of the neck and the upper shoulders are far too engaged because the brain has relearned to hold the head with mover muscles instead of stabilizer muscles. Physicians focus on turning down the mover muscle engagement and re-establishing proper activation of the stabilizers for neutral resting posture. Correct starting posture and alignment is the optimal beginning point for healthy motor control. When the start position is compromised, the entire pattern is compromised. An example of movement that hasn’t reached end-goal status is commonly the performance of the squat. The focus is to obtain hip positioning of 90+ degrees while keeping the low/midback from falling forward and properly driving body weight through the heels on your way up to the resting stance. Occasionally ankle movement won’t allow depth in the squat. Maybe it’s pain that limits the movement. Either way, patient feedback or anatomical feedback with indicate where the patient needs attention to achieve the movement pattern without strain.
Can I Conclude My Treatment Plan After the Pain is Gone?
The answer most people look for is yes. Unfortunately, the absence of pain is the halfway point for the optimal achievement of a pain-free lifestyle. At IHS we focus of the driver of pain to open the window of opportunity for engagement of the correct muscles utilized with daily movement. As said earlier: Desensitize, Mobilize and Stabilize. So, the pain is gone. Great! Now we have process of achieving full motion in the unloaded or passive state before engaging the correct tissue in the active state. This is achieved through the strategy of regional and inter-regional muscle utilization, making sure no compensatory muscles are overriding the primary movers of the area we are re-training. Once this is accomplished then the green light is flashing for stabilizing the regional tissue with the goal of minimizing the risk of re-injury. Our clinic uses resistance bands, kettle bells in various body positions to increase the challenge and gamify exercise to make the rehab process even more interesting. After stabilization we use the re-test method to show objective improvement in the patient’s care but more importantly to show the patient how far they’ve come throughout the treatment plan. If the re-test is waving the checkered flag then all goals (patient and physician-established) are accomplished and the plan is concluded.
Content provided by Dr. Parker Grundman
Cook, Gray. Movement: Functional Movement Systems: Screening, Assessment and Corrective Strategies. On Target Publications, 2017.
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