Now as a disclaimer of sorts, I am going to straight out say that the following is purely qualitative & subjective. One is sure The New England Journal of Medicine won’t be calling to publish the following…
We are born to move!
Neuroscientists have hypothesized for years that we humans are prediction machines, we are born to move! Movement can even be seen in the early stages of gestation. The child learns by observing the mother’s facial expression(s) & fine motor cues, and learns from making errors.
But still, movement is regularly neglected as a first line agent for pain & even metabolic conditions. Often replaced with pharmacological interventions. Now, one can understand that a hypertension patient would be prescribed a angiotensin converting enzyme. But, we know MORE can be done!
Motivation for this blog is due to seeing more knee pathologies, and especially how correctives have been neglected for surgery as a frontline intervention. Now, I am not trying to put your ACL into excessive anterior translation (get it?). And I don’t need to discuss any sham stories.
Let me explain… Check out the schematic below
Without needing to be Wilder Penfield, you can see the highlighted blue & green regions in the cerebral cortex. This is your motor and sensory regions in your brain! Now, it doesn’t seem like your motor & sensory areas represent a huge amount of your cortex. But if you knew (or you may already know!) that the gyri & sulci (plural) are densely packed with neuronal cell bodies, millions in fact! And if I direct you to the tonotopic organization of the motor & sensory cortex; you can see how much dedication and richness there is to regions such as the hands & lips et cetera.
So, now you have brushed over some neuroanatomy…
What’s the big deal?
My argument is that are motor & sensory cortices are highly neglected as a conjunctive therapy to other modalities. One can manipulate another’s motor & sensory system to drastically improve pain, especially if there is maladaptation which is oftenly seen in chronic pain, but somehow neglected.
Don’t get me wrong, touch (which is somatosensory) is fundamental for the healing, learning process.
However, as humans, we are prediction machines. We hypothesize, use our narratives to justify our cognitive biases, plan, make executive decisions.
Sprinkle a little dopamine in the Ventral Tegmental Area and 3..2..1..GO!
I am really pushing a movement revolution!
One of my previous blogs, ‘Pain? It’s all in your head’ certainly caused quite a stir. I attribute this mostly to the tabloid-style title I gave it, which may have paled the complexity of our experience of pain. So I thought a little clarification was in order to help broaden our understanding of the physiology of pain, and also how our perception can influence our experience of pain, here goes.
(advertising) only feeds our society’s often skewed perspective on pain. This does nothing to empower us to change, in fact it intentionally intends to disempower us. (more…)
Contrary to popular belief, we do not handout homework exercises to you because we have a burning desire to nag you and impose ourselves upon your personal life. That forms only part of our motivation!
Homework exercise for many of our clients is imperative if they are to achieve their goals. I will explain why in the context of goals relating to chronic pain/injury.
We are each given this tremendously complex, fragile, adaptable machinery to go out and experience the world in, and it comes with no bloody instruction manual!
In my line of work, I often find myself repeating the same little spiel over the course of a week to a number of clients. This is simply because a lot of the concerns that my clients have regarding their health, fitness or their body are shared, and hopefully, the perspective or knowledge that I have to offer remains consistent (at least over the course of one week!). So I figure if I am going to be repeating myself I may as well get down in writing and share it freely!
The topic I want to cover this time is the development if injuries and how this can be avoided. The injuries that I am referring to are really any that develop slowly over a period of time, rather than sudden onset injuries, like falling over and breaking something. I will start by stating a few paradigms that almost always ring true in the development of overuse injuries- Firstly, that injury is a symptom of a more global dysfunction and is not the cause. Secondly, treating only the symptom may provide some short term benefit but reoccurrence, or manifestation into a different injury is almost inevitable
(remember the first point- the injury is just a symptom). Thirdly, there is a difference between pain and injury, and we often get a fair old warning about potential injury in the form of pain. I better hold up there and clarify, as you may be asking, surely if I am in pain, I am injured. No, that is often not the case. The word injury implies some sort of damage to the tissue/s of the body. We can experience pain without experiencing tissue damage, so in this instance, the pain is actually a valuable message that warns us of potential tissue damage and therefore injury, if we don’t do anything about it. My final paradigm is actually the spiel that I have been giving lately. Tightness often precedes pain, and pain often precedes injury. This means that the first thing you should do when you start to notice a little niggle in the front of your knee when you walk is investigate whether there is any tightness around the knee that may be increasing compression around the knee. If there is then you can take the appropriate action in relieving this tension through stretching, self-massage or having someone else massage the appropriate areas. This is the first step, and constitutes addressing the symptom to a certain extent. The next thing to do, is ask; why did this tightness develop in the first place? Be assured there is an answer. An Exercise Physiologist or Personal Trainer should have the skills to be able to help you answer this question, or refer you to someone who can. The most broad answer I can give you is that chronic tightness develops when some aspect of our neuromuscular system is out of balance and remedying chronic injuries or pain requires exercise designed to restore balance to this system.
So the main take home points are: pain and injuries are symptoms of more global neuromuscular dysfunction, and if a health professional that you employ to help you remedy chronic pain or injury is only focusing on the precise area of injury then they are not addressing the root cause of the problem and further investigation is needed for long-term relief.