Bracing

Lifting heavy weight is fun. It’s an empowering activity to get people to put trust in the physical mechanisms of their body to allow them to produce force. In order to lift effectively, one must brace effectively. The point of this article is to understand the bracing mechanism of the core and what to look for in order to be efficient. Bracing is the co-contraction of all the core muscles around your torso. The paradox is the core must be strong enough to resist force and elastic enough to transfer it. It is like a spring which allows you to transfer force efficiently from the lower body to the upper body and into the implement. Stability for load transfer in the brace is required through two systems of the core: the local system and global system.

The local system of the core is composed of the inner unit of deep muscles required for intrapelvic stabilization. Diane in her book The Pelvic Girdle: An Integration of Clinical Expertise and Research notes that there are significant neurophysiological differences in the timing of the contraction of these two systems of the core. The inner unit of the core, such as the transverse abdominis and internal oblique, are concerned with timing and anticipating the load. The local system contracts prior to the perturbation (in anticipation of load or stimulus) regardless of the direction of movement and provides the anticipatory intersegmental stiffness of the joints of the lumbar spine  (Hodges et al 2003 & Richardson et al 2002).  The local system basically provides stability to the pelvic girdle and lumbar spine by timing its contraction in preparation for literally anything. These inner core muscles act as the feedforward mechanism in the brace which is responsible for increasing intraabdominal pressure, increasing tension in the thoracodorsal fascia, and increasing articular stiffness. The intensity of the activity dictates how hard or casually soft the inner unit should fire. For instance, pressing a heavy weight for two is probably going to dial in more on the intensity of the feedforward mechanism of the inner unit than say flipping to the cool side of the pillow. You see it’s not just solely about strength and that’s why there have been certain studies showing why just back strengthening doesn’t help reduce injuries. Diane Lee explains this phenomenon perfectly with “The bracing deals with the timing of specific muscle activation and the pattern of muscular co-contraction (or lack thereof) in patients with low back pain further enhanced the force closure theory and suggested a crucial role for motor control” (Hides et al 2000).  You can be strong as all hell but if the timing isn’t there then what was the point of all that strength if you can’t even express it? Strength is still important but it isn’t the only solution in this case. Just like creating new neural networks in learning a new skill or activity, learning to brace is something that should be taught so it can be reflexive and automatic first rather than only strong. Doing it automatically is what the inner core muscles prepare the body for as well as additional loading from the global system.

While the inner unit activates regardless of the direction of any movement or activity, the global outer system of the core contracts in a direction-dependent manner. The outer global unit can be attributed to the fascial slings that Tom Meyers writes about in Anatomy Trains that stabilize you when you move and produce force by isometrically and eccentrically contracting (I think) to resist the load. Its required for regional stabilization between the ribcage and the pelvis. The fascial slings are the Posterior and Anterior Oblique sling, the Longitudinal sling, and the Lateral sling of each side. Image result for anterior and posterior oblique slings

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Lateral Sling

 

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Longitudinal Sling

These slings work together to stabilize your sacrum and lumbar spine when you move. It does this by force closure (muscles of that particular sling contracting) to augment the form closure (the structure of bones and ligaments of the joint itself within the sling) so there isn’t excessive shearing at the onset of the loading joints. For instance, your posterior sling of the lats and contralateral (opposite side) glutes make sure your spine limits the shearing when you deadlift or walk. If this wasn’t in effect the opposite corners of our hips and shoulders would pull away in opposite directions

So both units work synergistically together with the inner unit being concerned with timing and coordination in order move what needs to be moved while the outer unit adds to the stability on top of the inner unit to buttress force. The body uses both these systems together sometimes with more emphasis on one as a strategy for an for activity. They are either a low threshold or high threshold strategy. Lifting heavy or playing a demanding sport at the highest level would a good example of the body using a high threshold strategy while eating a sandwich would be low threshold strategy.

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High Threshold
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Low threshold…Unless its Meatball Parm again.

The problem that can happen which can be seen in daily life, clinic, or gym is the mismatch of when the strategy is used or constantly using only one. I can definitely attest to being guilty of using a high threshold strategy when it was not needed.

Image result for dom mazzetti brushing teeth

These are the people who can not shut off their tone and seem to always be “on”. They are using a high threshold strategy which is unnecessary because now their prime movers work both as mobilizers and stabilizers. These people seem to live in one constant strategy without ever switching to the other one.  I think it might be apparent in people who are highly ambitious and think that they need to constantly practice the brace all the time so it will transfer easily (Like this fool writing it). Here is the thing behind the core activation of low and high threshold activities. The low threshold strategy your body does should be reflexive, easy without thought, and the loads are predictable. The high threshold strategy is when you need to dial more and bring the heat to get after it.

Things could get more complicated if both systems aren’t working together. Obviously, if the inner regional unit is not timed well then we lost integrity in the pelvis and spine. No amount of exercises to strengthen your midsection will work because it is a timing issue and not a strength issue. To parallel this if your outer unit is weak as well then your base for your inner unit to dial harder and contract will be even more limited. The limited force closure of muscular slings of the outer unit will not be strong enough to protect your inner unit core muscles as well as the spine, joints, and discs.  Also, you will not have a good base to produce force in your limbs and transfer it whether it ben lifting or a sports action. In other words, it will impact your movement and susceptibility to injury.

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Yea Not today Jr.

Total bracing is not just a front to back stabilization of your body but a 360 expansion of stabilization. The entire core works to actually resist motion of your entire middle which consists of the pelvis and ribcage. It resists anti-flexion, anti-lateral flexion, anti-extension, and anti-rotation. If any part of this relationship of the pelvis or ribcage is not up to par we will see leaking and or what Mike Tuchscherer calls “squishing”. Easiest examples are those who squat with a massive global arch with a flairing ribcage as if your mooning someone with your stomach.

Image result for you like what you see gifNot only has a “squishing” occurred before you began but you’ve lost integrity. This posture is essentially impinging your vertebrae on top of another to find passive stability. This compromised ribcage position will mess with your diaphragm to efficiently function to plunge down and dome at full exhale or in other words you won’t be in a good position to take a full breath. Also, because your ribcage is flaired you’re already generating unnecessary excessive intrabdominal pressure and now the QL has to take the slack to stabilize you. Its the equivalent of starting five meters behind the starting line.

Bracing is the ultimate expression of the integrity of your ribcage and pelvis and it’s paramount that the two diaphragms (diaphragm and pelvic floor) are stacked on top of each other in alignment. Doing so will allow your pelvic floor and diaphragm to fire in unison and in opposition of each other and continue the body’s natural feedforward mechanism of generating intra-abdominal pressure via the inner unit.

The brace is expressed by a 360-degree expansion. That means stabilizing in all three planes of motion.

Image result for 360 degree of core stabilizationThe sagittal plane is maintained by keeping the ribcage and pelvis aligned and stacked on top of each other so there is no flairing or dumping of either one. The frontal plane is being stabilized by making sure there is no hiking of the hips or dropping of the ribs to one side and the transverse plane is stabilized when there is no shifting across or rotating of your hips or ribs to the left or right.

Learning from Mike Reinold and Dean Somerset’s advanced core training, the cues to brace effectively are “Reset, Brace, and Breath”.The cues will reinforce the integrity of your ribcage and pelvis and so you’ll be able to co-contract everything in your midsection and feel rock solid. The last cue of “breath” teaches you that although you are pretty solid and stable, your brain must still be comfortable to breathe so it can own the position.

Reset: Reset the position of ribcage and pelvis. This involves getting your diaphragms stacked on top of each other. The sagittal plane first.

Brace: “pull the ribs down and inflate your obliques”. This builds off the reset by getting your diaphragms stacked and by pulling your ribs down expresses that. The pelvic floor is something that is unconscious so you don’t have to cue it and the “Inflate the obliques” will stabilize the last part which are your sides. Frontal plane is next. I’m also playing with the cue “Make space between ribs and hips” with the intention of firing everything around your torso. I’m not sure what part the transverse plane is getting stabilized but its definetly somewhere in between the cues with also awareness.

Breathe: Own the position so you can get back to having lifting and hence “Breath behind the shield” comes from.  Remember if you can’t breathe in that position you don’t own it.

John Gaglione does a fantastic assessment of seeing his lifter brace in all the areas and planes of his core. He doesn’t just assess the front but also the lateral sides of his torso when he breathes.

 

Thanks to Hans Lindgren and the school of DNS, a good landmark to look for a correct total brace is the lower abdominal to take a slightly rounded appearance or convex.

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Caving at the sides of the top while bottom picture is uniformly round
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Uniformly round, Check

 

If there are concavities (bends in the middle) then the midsection is not properly braced. This is overdominance of abs and is exemplified as if trying to suck your stomach in.The abs are used as a crutch here and hence why Chris Duffin says “Inflate the obliques” so those external oblique can fire and finally we get a uniformly rounded appearance of the midsection. We must remember to maintain that slightly rounded brace the entire duration of the movement and be comfortable breathing there and hence where “Breath behind the shield” comes from. The question of “how should you breathe” becomes variable because the demands of the activity dictate the “it depends” statement.  The way you breathe during lifting heavy/maximally or doing metabolic conditioning require different strategies of breathing. As with many things in life, there are always tradeoffs. Lifting heavy and maximally will require emphasis on way more stabilization so breathing will be on the back burner. In that scenario you wouldn’t want to exhale all your air and lose airflow because you would lose the pressure to be tight enough to produce force. Endurance activities, on the other hand, will emphasize more on the breathing aspect with constant airflow than the stabilization so you could move effortlessly.

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References

http://www.aaronswansonpt.com/low-vs-high-threshold-strategy/

http://articles.reactivetrainingsystems.com/2017/11/14/what-is-squishing-in-powerlifting/#more-1216Dean Somerset: Advanced Core training

Diane Lee: The Pelvic Girdle: An Integration of Clinical Expertise and Research

https://kabukistrength.com/

Mike Reinold and Eric Cressey: Functional Stability Training Core

Tom Myers: Anatomy Trains

 

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Scapula Shmapula

With more than 15 different attachment points, the scapula is a major player in the upper body for sports and life. Having the ability to move your arm, especially overhead, is paramount to being a human.  The efficiency of your shoulder blade to slide, glide, and wrap around your rib cage is what separates those who have good shoulder health and have more  freedom to do activities and those who have pain

Image result for so much room for activities

   You see unlike most joints that come to mind, the scapula is not exactly a true joint. Instead, this devious flat shaped bone sits snug to our ribcage connected by only some ligaments and interacts with our ribcage which is coined the scapulothoracic joint. This false joint has a concave-convex relationship. Your shoulder blade is a concave surface (Here’s a good way to learn the difference between concave and convex; “Cave” is something you go into hence concave is a structure that has a bend in the middle and while convex would be the opposite where it bends to the outside)Image result for concave vs convex anatomyScapula                              Ribcage

What this means is your ribcage is perfectly anatomically shaped for your scapula to ride around on it like a train on a track. The scap then does its job allowing you to get your hands overhead and any other complex positions by wrapping around, sliding, and gliding across the ribcage. But what about the rotator cuff muscles that attach to the scapula? Mike Reinold explains it perfectly stating that they “Keep The Ball On The Tee”. They stabilize ball of the humerus on the glenoid fossa and make sure it doesn’t pop outImage result for ball on tee

Now where life isn’t fun and things don’t go according to plan with the shoulder are a couple of issues.  They could be thoracic position being influenced by less than stellar breathing, shoulder blade orientation in both static and dynamic movement, and shoulder pathologies that involve grinding against the capsule. Of course, this is not an end all be all but these issues are important, to say the least.

Enter T-spine!

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This issue should really be the first stop in understanding shoulder health since it serves as the foundation for the scap to move around on. An important issue within the t-spine which I’m sure people are going to roll their eyes and ignore is making sure the ribcage is in a good position and that you are able to breathe fully.

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Believe it or not, the inability to drive air into the top of your lungs can wreck shoulder mobility. Just like sides of the pelvis are able to move independently, so do the sides of the ribcage.  If you were to rotate your ribcage to your right, the left side of your rib cage would move down, in and back as air would get released from your right side. The right side of the ribs moves forward, out and up which opens up space to enter the right side.

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The problem comes in at the inability to achieve the FULL EXHALE that’s needed for proper rib kinematics. By exhaling fully the trunk will actually be able to rotate further because your eliminating the air that is caged in our hyperinflated chest all day from breathing inefficiently.

This excerpt from an excellent article Trunk Rotation NOT T-Spine Rotation from Darkside strength which explains perfectly of being able to rotate effectively from your T-spine.

“Try this experiment:  take in the biggest breath of air that you can, hold it, and then try to perform your favorite trunk rotation exercise.  Rotate as far as you can still holding your breath.  Now, exhale all the air out, continue to exhale until you feel like there’s no air left in your body, and then exhale some more.  Sigh out at the end as if you’re fogging up glass in the winter.  Try to rotate more.  You will find that you are immediately able to rotate your trunk further in the desired direction. To take this one step further, following your full exhale, feel your abs on the side of your body opposite of the direction you’re rotating (if you’re rotating right, feel lefts abs) and keep them slightly engaged to keep your ribs down on that side as you maintain position and take a breath in through your nose.  You should feel the air go into your chest wall on the side you’re rotating towards, and you should pick up, even more, rotation in that direction. It drives me nuts when I watch coaches and therapists teach and then stand there while their clients crank their way through compensations, usually by further driving their thorax and lumbar spine into extension as they hold their breath while performing various popular “t-spine rotation” exercises. /At the same time, the Internet is full of countless so-called “movement experts” advocating the need for these t-spine rotation activities performed by twisting the trunk as much as possible without any regard for airflow or rib position.”

So to recap off these important points in t-spine rotation

  • t-spine rotation = rib cage position with full exhale as you rotate (Ribcage is moving in all 3 planes. The full quality exhale is what’s allowing your ribcage to get back to the internally rotated position since it was stuck in an externally rotated position)Image result for you're welcome america will ferrell                                                        Moving the ribs in 3 planes. Your Welcome America!
  • The ability to fill one or both chest wall with a good breath is called Apical Expansion, regardless of whether you’re rotating or not.
  • DON”T HOLD YOUR BREATH
  • You will feel it in chest wall your rotating to and in the contralateral abdominal wall

Building off the base of the ribcage position is whether someone’s static or resting posture is overly extended or overly kyphotic. The reason I bring it up is because the posture of the ribcage affects the orientation of how the scapula sits on it.  The best example would be those population of people who sit with flat thoracic spine and basically looks like there is a rod going through their upper back.

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Yours’s truly

One might say “Wait, they have good posture and are not hunched over so they should be able to get overhead pretty easy right? What’s the beef…..jerky?  (I know its so bad that its good!)

Heres the thing, The notion of their posture looking “good” (Which by the way there is no real or ideal posture since posture is just a snapshot of position) isn’t actually that great because the front of the ribcage pops out in front which will not only affect your scapula position but also your ability to take a quality breath! Also, people with a way extended posture (like myself) have the appearance that the scapula is winging. It’s actually a false winging because if you get the ribcage in a better position with a full exhale and cue “Reach” with the arm, the ribcage will go back to its regular down, in, and back position. Now the medial border of scap won’t tempt you to grab it like your going rockclimbing up someone’s back.  Image result for climbing  funny

Here’s an excellent demonstration of improving the ribcage position using the wall, the ground, and a load to regain some kyphosis in a stable ribcage.

Another point is how the scapula sits on the ribcage. Shirley Sahrmann’s quote “Ideal alignment facilitates optimal movement” displays how we want to have a good position of our scapula on the ribcage as well as good ribcage position. What the ideal position of the scap is a posterior tilt and slight upward rotation. The low trap, upper trap, and serratus all work together to bring upward rotation which brings your arm overhead.

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The low trap posteriorly tilts the shoulder blade to the ribcage while the serratus allows it to move it across the ribcage so the bottom border of the scapula gets the armpit or axillary line. Finally, the upper trap allows some elevation for some clearance so the humerus overhead. All of these motions described are what makes up the ideal scapulothoracic rhythm of the shoulder.  It is different from excessive glenohumeral motion which is usually what you see where people move way too much through their arm and think they ‘re moving well

Image result for cowbell gif Except if you play the Cowbell

 Again all of this builds upon the base of having a stable t-spine position which is a normal kyphosis in your ribcage. Your t-spine is like the train track and your scapula is the train and if those tracks aren’t set then good luck going overhead.

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Another important part of the scapula orientation is the dynamic portion of the eccentric where one controls the down portion of a movement. Here is Eric Cressey explaining using the correct scapulothoracic rhythm of how your shoulder blade position sets your motion of your arms whether you go out to the side or up overhead.

 

He starts with the horizontal abduction or “T” and shows how the scap should move across as you go overhead such as a “Y”. You’ll notice the scap will actually wrap around the ribcage allowing your hand to get to the “Y” position from the “T”.

With many pathologies of the shoulder, if one can make better repositions to the scap then changes can be made to the symptoms experienced by those with the pathologies.  This Study by Pontin et al. supports that “alterations in scapular positioning at rest and in movement, called scapular dyskinesis, are associated with various diseases of the shoulder, such as the impingement syndrome, rotator cuff tear, instabilities and adhesive capsulitis” or in other words both static and dynamic positions of the shoulder blade on the back play HUGE parts to shoulder health.

For any impingement pathologies, it could mean (I say “it could mean” because again not every case and situation is the same) that your scap does not get enough upward rotation and so the humeral head is slamming into the AC joint or irritating your biceps tendon. Those with labral issues involve wear and tear of the labral fibers in our shoulder showing what parts of the movement gets grinded away the most and one could probably guess what motions or actions irritate it the most from it.

Here is the golden rule: Wherever your arm goes, so does your shoulder blade and vice versa! Also when your shoulder blade stops moving the motion should stop especially for rows and unilateral upper body exercises. Get it in a good position and then get it moving and grooving.

 

 

 

 

References

https://dsstrength.com/trunk-rotation-not-t-spine-rotation/

Pontin, José Carlos Baldocchi et al. “Static Evaluation of Scapular Positioning in Healthy Individuals.” Acta Ortopedica Brasileira 21.4 (2013): 208–212. PMC. Web. 12 Nov. 2017.

The Practical Plank

The Practical Plank

Ah, the plank! It’s easily the most identifiable exercise in most strength and fitness and even rehab programs. It’s the most expendable exercise since you don’t need a lot of space and can do it anywhere. There are an incalculable amount of articles on how to do it but this article won’t be about how to execute it, but instead the purpose of getting back to WHY the plank should be done. We can all do exercises we want but if we don’t know the purpose of why they are being done then what is the point? A good reason to use the plank should be a benchmark that everyone should strive for. The plank is an excellent indicator of core strength endurance and teaches full body tension needed for our other lifts. By reinforcing the full body tension, the plank also teaches the top and end positions of most exercises such as pushups and deadlifts.

Stu McGill’s work indicates that a person should be able to hold a plank for two minutes and thirty seconds. Now before we go chasing the challenge we must understand something. What’s the purpose of the plank anyway? The plank is an expression of the strength endurance of being in full alignment of our core, and all the total musculature connected to it in maintaining position. Expression of this stacked position of the core would be a line from the top of our head all the way down to the tailbone. If you were to look at it from the side the rib cage is locked on to the pelvis as one whole unit being propped up by the arms and legs.  In this position, we can allow our core to do what it is designed to do which is stabilize the spine and allow forces to be distributed evenly. By being on the ground we take gravity out of the equation. Once we master it then we can progress to programs in which we practice the top positions of deadlifting, swinging, and cleaning a kettlebell. Add in training the side plank and maintaining a quality position there and it reinforces other exercises such as farmer’s walks. Now your trip to the grocery store won’t be as dreadful since you’ll be strong enough to take the groceries in one sitting

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Planks are all about QUALITY over quantity. We could all suffer trying to hold it for five minutes so we could brag about it, but you don’t get better or stronger by basing how sore or how much of an ass kicking your training gave you. You get better in seeing improvements from one training session to the next and how you feel from week to week. The better you are at making sure your ribs don’t flare and your hips don’t sag, the better expression of your strength endurance of your midsection in the plank. While it seems like such minute things to overlook, the devil is really in the details. Imagine if one side of your car’s transmission was on looser, or sagging down lower on one side, and you felt it but just kept driving. That side would wear out faster and you’d be in a mechanic shop pretty soon. Do things right now so you don’t have to deal with the mechanic later.

We would first program for breaths before we worry about time. The reason for this is because if you can’t breathe in that position then you don’t own that position. We don’t want to simply survive an exercise; we want to thrive from it. Everything we do must have a purpose for why we do it. We want to train people to be successful in positions where they can own it and then progress accordingly. The long-term goal is to be able to maintain alignment for two minutes and thirty seconds. It’s key to manage how long one can maintain the position and then program accordingly. We can progressively add more breaths and then slowly go for time. The plank is a basis for many exercises and a baseline for strength-endurance.

Set up planks so you can get up the mountain friends.

On Pain And The Biopsychosocial Model

I wanted to write this article because I wanted to further my understanding of pain and take a stab at capturing it. It’s easy to say you have pain because of bone spurs, disc herniations, arthritis, joint degeneration, or because the Knicks haven’t traded Carmelo. While all of these things sound ominous, they are not the exact reason for why your certain pain exists. Pain is a highly complex part of being a human and there are many factors to it. A good analogy would be if you were to ask five economists how to fix an economy. You’re going to get five different answers. It’s not just physical loads but also social, psychological factors involved as well. This is where the Biopsychosocial model comes in. The Biopsychosocial model takes into account the dynamic and complex interactions among physiological, psychological and social factors that contribute to individual experiences of pain uniquely (https://www.futuremedicine.com/doi/abs/10.2217/ebo.13.469). Ironically this model has been around for more than 30 years and now is being taken into consideration. I’m going to do my best to explain first how pain is mapped out in our brain and how the complexity of these different factors overfill our metaphorical cup which could lead to pain

 

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There are quite a lot of variables involved

    Lorimer Mosely and David Butler, authors of Explain Pain, have explained that pain is an output by the neuromatrix in our brain. The brain has to take inputs from proprioceptive, vestibular, and visual information systems to report the positions of all the different body parts. As I write this, my mind is literally blown because that is a ton of responsibility and only our brain can do that.

 

 

Pain acts as an alarm system that the brain sends off to protect the individual from a supposed threat. While we know injury happens when a load exceeds the capacity of those tissues to withstand that load, there is more to pain than the simple biomechanical model. The neuromatrix in our brain is responsible for coding literally every conscious experience with a neurotag whether it’s eating a savory great cut of steak or feeling the need to stratch a poison ivy rash. It is the patterns of our brain activity that create pain (Lehman)

 

 

 

 

 

 

 

 

 

 

 

The neurotags that code for pain in our everyday conscious experience can either activate or not. This would help explain why those people who have MRI examinations of abnormal joint structures such as disc bulges and herniations could be completely asymptomatic to any pain. Here are some studies exemplifying it. Study 1, Study 2, Study 3.

The main difference between those who experience chronic pain and those who don’t experience it goes back to the software conditions of how the brains process it and make sense of it. The pain pathway that our brain sends out is individualized based upon how one maps out and associates things such as movement, feelings, and expectations. If one does not have a clear representation of how their brain maps specific regions of their body when they move such as not being aware or cognizant of one’s hip and where it is in space then we are given unclear signals. Add this to someone who has chronic pain, which actually changes the way the brain controls perception and movement, and the pain spreads. This pain spreads because of the imprecise input of the fuzzy and unclear body maps. The imprecision of the body map makes it difficult for one’s brain to locate or identify what is truly going on.

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Pain spreads because your body is trying to make sense out of nonsense so it might as well say “Might as well have pain here in your knee too since you have no awareness and or control of whats going on in your hip and ankle”.

This software fault of having unclear body maps exemplifies a concept known sensory motor mismatch. Sensory motor mismatch deals with how whenever we make a movement, the brain predicts the sensory information that will result and the predicted feedback is compared to the actual sensory result to determine if the movement was successful (Hardgrove). If the sensory data consistently conflicts with the prediction then the body maps are smudged or inaccurate. The confusion of sensory motor mismatch can cause the perception of threat and plays a role in chronic pain conditions.

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Just like regulating the body’s hormone levels, blood and temperature, the brain needs to regulate its ability to form clear pictures of what is actually going on in the body. Again, the brain takes in all the inputs from the different systems of the body and instantly processes and filters them. Once analyzed and integrated unconsciously, the brain asks two questions. The first is “How dangerous is this really?” and the second is “Is pain necessary for protection?” Pain is the result on how the questions are answered. Interestingly enough the brain doesn’t have to only choose pain as an output but can do other outputs which serve as protective behavior such as limping, flinching, muscle guarding or the fight or flight response. It definitely helps to develop a good relationship with how one maps movement and be aware of you move in space

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This is why Feldenkrais or any type of Somatics training is excellent because for the first time we are slowing things down and making people truly aware of their entire bodies in space and how they map their own movement. Image result for Somatics    The simple motions help people develop clear maps of the limb moving in the three-dimensional world that we inhabit. People who are not aware of their body maps don’t have a good perception or feel for their own basic movement. Those with chronic pain have been shown to have difficulty in various tasks that require good perception of body location and motor control including

  • locating the outline of the back and position of the spine
  • two-point discrimination
  • right/left discriminations of pictures of body parts
  • reducing postural sway in response to disturbance
  • control of pelvis and low back

https://pdfs.semanticscholar.org/4332/ca068f811ccf315b7a708cd2bcaae6515f78.pdf

    It’s a two-way street between perception and pain and much research has to be continued.  Do problems with perception and movement cause pain or is pain causing problems with perception and movement? These two questions need to be deciphered in order to understand whats going on in the body. Here is probably the most interesting and counter-intuitive notion regarding pain. Pain has more to do with sensitivity than about damage!

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Pain is an output depending on your sensitivity threshold to a specific movement or specific way of doing something. This could be flexing your spine or just the chronic anxiety in going to a job that you absolutely hate. Some key factors that go into that threshold are how much volume is being stressed, how ready are you, and if it is progressed too quickly. You don’t have to apply these key factors to just the weight room but also to situations in life as well. This threshold could be likened to the analogy of an overfilled cup.

Image result for overfilled cup analogy

Once that cup is filled to the brim and continues filling with liquid, it’s going to spill over. You might be filling that cup differently since pain is multidimensional. You can have a lot of physical, mechanical, emotional and social stressors and have no pain. But at some point, a sudden increase in one of those stressors or a new stressor puts you just over the edge and the water flows out and now you have pain. Often people will have more pain when there are changes in the stressors in their life. It is the inability to adapt to the new stressor that contributes to pain not necessarily the amount of the stressor in your life (Lehman)

To further expand upon the complexity of the pain we need to be aware of some of the psychological and social factors in The Biopsychosocial model. I believe they are the hardest to pin down because not only are they the most insidious and hard to see but also because it’s difficult to quantify them and test them out. You would need to walk in that person’s shoes or follow them around all day or weeks to know what dialogues they are having within themselves and understand the situations behind their lives. This goes more into more difficult waters to traverse such as the way they were brought up and the traditions, what they were made to believe, especially about themselves and many other things hard to quantify.

Image result for aint nobody got time for that

There are some statistics that we should be aware of and how they tie into pain into this model. Chronic pain is often associated with negative emotions and as many as 50% of patients with chronic pain have a co-morbid depressive disorder (Study on Depression and Pain). This study detailed that those with depression experienced their view of pain to be augmented larger than previously experienced. This has to be a display of changed neuro-pathway of pain and how largely sensitive they become to pain. Also, they stated one of the biggest factors in a cognitive process is negative expectancy. This is a self-fulfilling prophecy I like to call “always expecting bad stuff to happen to you so you can confirm your negative confirmation bias about yourself”. Many of us have probably in this situation by also telling ourselves “I told you so”. Anxiety is another negative emotion frequently seen in patients with chronic pain, and which may lead to maladaptive pain behaviors aggravating and maintaining pain and disability (Fear-avoidance model of chronic musculoskeletal pain).  Anxiety could be something that changes the way you move and could contribute to pain because of the patterns it causes you to partake in.

Some sociocultural contexts attributed to pain could deal with how one expresses pain. This would deal more with behaviors of how they were brought up by parents, significant others, and other operant learning process (http://www.jpain.org/article/S1526-5900(10)00746-7/fulltext).  Acculturation, which entails adaptation to a new set of cultural norms, beliefs, and values, (Rethinking the concept of acculturation: implications for theory and research)is inherently stressful, especially for first-generation immigrants (Generational differences in vulnerability to identity denial: The role of group identification). The stress of acculturation, in turn, may influence pain sensitivity (Ethnic differences in physical pain sensitivity: role of acculturation). An example could be the unnecessary pressures that parents put on their kids to get highly stable jobs or achieve and adopt all the cultural norms of that family because it’s expected of them. This was because they lived in a different time so they assume their children live in that same time as well. Another interesting study took into account personalities of subjects and found that certain personalities such as introversion and intuition dramatically increased spine loading compared with those with the opposite personality traits such as extroversion and sensing. Does this mean that introverts and those who are intuitive on the Myers Briggs scale are going to experience more pain compared to their counterparts? No but I think we have an understanding of a factor that fills their cup. Again, pain is a complicated matter and there are many variables that go into that sensitive threshold of experiencing it. The social emphasis and how it’s linked to pain is highly individualized and would need its own post to be elaborated further.

From Greg Lehman’s Recovery Strategies -pain-guidebook, he recommends three things to look at and or consider changing
1. How much you are doing
2. How quickly you progressed
3. What are you currently ready for.
#3 is very interesting. If you are fearful, hesitant or
believe that you can’t adapt then your readiness will                                                                    be decreased and this will influence what is too much                                                       (Lehman)

The body is an ecosystem. We are more than just some parts working together like a car. It’s amazing how we move and manifest our emotions in our muscular system. While pain is a not so pretty part of the experience in life, by learning how to desensitize to certain stressors and building the capacity to cope with them we can effectively limit and get out of pain. As humans, we are built to move and adapt.  To quote Thomas Hanna, the founder of Somatics, “If you can feel it, you can change it”

 

Good old Kenny Wayne Sheperd never hurt nobody.

Enjoy!

 

 

References

A Guide To Better Movement- Todd Hargrove

https://www.futuremedicine.com/doi/abs/10.2217/ebo.13.469

Recovery Strategies – Pain- Guidebook by Dr. Greg Lehman

https://spine.osu.edu/sites/spine.osu.edu/files/uploads/Publications/2000/Ergonomics_2000_43-7_880-902.pdf