Pain Quotes from Research

As you all may know by now, I am a little fascinated by the way pain works. The way I currently understand it (I say that with the assumption our understanding will evolve with time), pain is the response of an input to the brain and the brain determines whether or not that input is a threat. If it’s determined that there’s threat, there will be pain. If not, there will be no pain. This is why you can have no tissue damage, yet you’ll still have pain, and it’s why you can have tissue damage without feeling any pain at all.

The biopsychosocial model of pain is the latest model that I’m aware of that utilizes multiple factors of a person’s pain experience with less of an emphasis on their biomechanics. This means that it’s less likely for pain to be because of something such as a tight psoas, and more because of cognitive, emotional, and sensory input(s). Does that mean biomechanics don’t play a role? Of course not. The way you move is likely one of the factors under the pain “umbrella”, but it isn’t the whole story. This photo should help that make sense.

Neuromatrix

If you look under the sensory signaling systems under the “inputs” (left-hand side), you’ll notice musculoskeletal inputs play a role. It’s likely only a fraction of what was previously thought to be involved with a pain experience, though. This is one reason why I’ve started to be less aggressive with my manual therapy work and it’s also why I don’t really foam roll or use a lacrosse ball much anymore. If you’ve read my post on Sports Massage, you’ll understand that it takes a lot of force to actually deform tissue. While I probably agree less with what I wrote nowadays, it’s predominantly because of the influence on the nervous system – not on the fact that deep tissue/release work or IASTM is going to alter tissue or tissue function. And my thoughts on the biomechanical approach to pain have especially changed after I read THIS REVIEW of Becoming A Supple Leopard. I think preaching thoughtful, fearful movement approaches is much less effective at reducing threat than thoughtless, fearless movement. Especially when it comes to pain. It’s easier to negatively influence the emotion-related and cognitive-related brain areas in the neuromatrix picture above when you focus too much on the biomechanical approach, because this approach typically leads to using words that create fear, such as: “imbalance”, “dysfunction”, “asymmetry”, and “unstable.”

Some smart folks that I’ve friended or followed were recently tagged in a Facebook post by Lars Avamarie that listed a bunch of research articles and quote from much of the pain science that’s available. Here’s the link to that post: CLICK HERE. Here’s the list of quotes and references from that post for quick and easy viewing (and for me to save for myself):

“You must unlearn what you have learned… about pain…

Start your journey by reading this:

“Strictly speaking, pain is not in any organ, but in the mind, since only that can feel. When any nerve brings news to the brain of an injury, the mind refers the pain to the end of a nerve.” Dr. J. Dorman Steele, 1872

“Pain can no longer be regarded as merely a physical sensation of noxious stimulus and disease, but conscious experience of pain may be modulated by mental, emotional, and sensory mechanisms and includes both sensory and emotional components”

Ref.:
Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine (Phila Pa 1976). 1987 Sep;12(7):632-44.

“Pain is not simply the end product of a linear sensory transmission system; it is a dynamic process that involves continuous interactions among complex ascending and descending systems. The neuromatrix theory guides us away from the Cartesian concept of pain as a sensation produced by injury, inflammation, or other tissue pathology and toward the concept of pain as a multidimensional experience produced by multiple influences”

Ref:.
Melzack R., Katz J. (2013), Pain. WIREs Cogn Sci, 4: 1–15.

“Pain is not a simple sensation, and is rarely the result of a disorder in one system only. It is complex, involving multiple interactions. CWPS and FM cannot be considered to be solely a disorder of central pain modulation, and perhaps not even primarily so. Pain is the outcome of a complex interplay between the central modulation and peripheral pain input. “

Ref.:
Pain Med. 2013 Jun;14(6):777-8. Are peripheral pain generators important in fibromyalgia and chronic widespread pain? Gerwin R.

“The evidence that tissue pathology does not explain chronic pain is overwhelming (e.g., in back pain [11], neck pain [12] and knee osteoarthritis [13]). Yet we continue to avoid the truth that tissue damage, nociception and pain are distinct. I would go so far as to suggest that even the use of these erroneous terms – pain receptors, pain fibers and pain pathways – leaves the patient with chronic pain feeling illegitimate and betrayed, and leaves the rehabilitation team lacking credibility when they look beyond the tissues for a way to change pain.”

Ref.:
G Lorimer Moseley. Teaching people about pain: why do we keep beating around the bush? Pain Manage. (2012) 2(1), 1–3.

“Pain catastrophizing has been associated with heightened pain severity, emotional distress and pain-related disability, even when controlling for medical status variables [2,4]. Pain catastrophizing has also been shown to compromise the effectiveness of pharmacological and psychological pain management interventions. Several studies have shown that reduction in pain catastrophizing is the single best predictor of successful rehabilitation for pain-related conditions [5,6].”

Ref.:
Sullivan M L. What is the clinical value of assessing pain-related psychosocial risk factors?. Pain Manage. (2013) 3(6), 413–416

“Psychosocial factors are important in the development of low back pain and disability.7,8 Depression, passive coping strategies, fear avoidance beliefs (the avoidance of movement or activity resulting from fear of pain or injury), and low expectations of recovery are independently associated with poor outcome.9,10 A clinical guide to assessing psychosocial warning signs (yellow flags) developed in New Zealand has been adopted internationally.11 Patients’ beliefs need to be better understood to improve management of low back pain.”

Ref.:
Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med. 2013 Nov-Dec;11(6):527-34.

“Clinicians should not utilize patient education and counseling strategies that either directly or indirectly increase the perceived threat or fear associated with low back pain, such as education and counseling strategies that

(1) promote extended bed-rest or
(2) provide in-depth, pathoanatomical explanations for the specific cause of the patient’s low back pain. “

Ref.:
Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, Denninger TR, Godges JJ. Low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):A1-57. Epub 2012 Mar 30.

“To understand the way in which a person responds to persistent pain we must look not only at the physical parameters, but beyond to consider factors such as cognitions, coping strategies, life events, and personality. “

Ref.:
Asmundson GJ1, Norton PJ, Norton GR. Beyond pain: the role of fear and avoidance in chronicity. Clin Psychol Rev. 1999 Jan;19(1):97-119.

“Most education programs for orthopedic patient populations have used anatomic and biomechanical models for addressing pain,4,11-14 which not only have shown limited efficacy,4,11,12,15,16 but may even have increased patient fears, anxiety, and stress, thus negatively impacting their out-comes”

Ref.:
Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011 Dec;92(12):2041-56.

“The traditional biomedical model of sports medicine suggests that every disease process (dysfunction) can be explained in terms of an underlying deviation from normal function such as a pathogen or injury. The model suggests that pathology and symptoms are correlated such that a greater expression of symptoms in the athlete would indicate greater underlying pathology (Fig. 1A).

This model further proposes that a simple correction of the underlying pathology with a treatment (for example injection, surgery, manipulation or exercise) will result in elimination of the symptoms and subsequent restoration of normal function in the athlete (Fig. 1B). Clinical experience and epidemiological data on LBP often tells us otherwise, with many athletes demonstrating physical and diagnostic signs that they have recovered from injury and yet they will continue to experience symptoms/pain (Fig. 2C) (Iwamoto, Takeda, & Wakano, 2004).

Additionally, it has been well demonstrated that many people, including athletes often have significant tissue pathology (arthritis of the spine, bulging discs, bone spurs, etc.), yet experience little to no pain (Fig. 2D) (Alyas, Turner, & Connell, 2007; Waris, Eskelin, Hermunen, Kiviluoto, & Paajanen, 2007).

Ref.:
Phys Ther Sport. 2012 Aug;13(3):123-33. Epub 2011 Dec 27. A neuroscience approach to managing athletes with low back pain. Puentedura EJ1, Louw A.

“Occupations that seem to carry a higher risk are those requiring heavy lifting, maintaining a specific posture, or being exposed to vibrations [5]. However, the factor most strongly associated with a higher rate of reported low back pain is poor quality of relations with coworkers (limited cooperation among colleagues and lack of support from superiors); this association persists after adjustment for physical stress, as shown in a study of over 3000 male workers [6]. Low back pain is significantly associated with repetitive work, concern about making mistakes, and tight time constraints [7]. Other studies found that back pain was associated with common symptoms of work-related stress (nervousness, sleep disorders, and anxiety). “

Ref.:
Joint Bone Spine. 2005 May;72(3):193-5. Factors involved in progression to chronicity of mechanical low back pain. Valat JP.

“When radiographs are obtained, evidence of degenerative disease should be interpreted critically. Reassurance, with emphasis on the absence of nonmechanical lesions, is far better than a specific diagnosis (osteoarthritis, degenerative disk disease, scoliosis, lumbosacral transitional disorders) that may be interpreted by the patient as evidence that recovery cannot be achieved in the short or medium term.

In a 1995 Canadian study [16], a specific diagnosis (lesion to a vertebra or disk) given within the first 7 days of symptom onset was associated with a nearly five-fold increase in the risk of chronicity, as compared to nonspecific diagnoses (pain, strain, twisting, derangement).

Bed rest until complete resolution of the pain, once dogma, is now recognized as a serious mistake that undoubtedly explains part of the rise in low back pain-related disability over the last few decades. Inactivity, most notably bed rest, has been shown to promote chronicity in several studies con- ducted over the last 15 years [17].”

Ref.;
Joint Bone Spine. 2005 May;72(3):193-5. Factors involved in progression to chronicity of mechanical low back pain. Valat JP.

“The field of pain medicine has shifted from multidisciplinary rehabilitation to procedure-focused interventional pain medicine (IPM). Considerable controversy exists regarding the efficacy of IPM and its more narrow focus on nociception as an exclusive target of pain treatment. This topical review aims to examine pain research and treatment outcome studies that support a biopsychosocial model of pain, and to critique the clinical practice of IPM given its departure from the premises of a biopsychosocial model.

A modern definition of pain and findings from clinical and basic science studies indicate that pain-related psychological factors are integral to pain perception. The clinical viability of IPM is challenged based upon its biomedical view of peripheral nociception as a primary source of pain and the potential of this viewpoint to foster maladaptive pain attributions and discourage the use of pain coping strategies among chronic pain patients. IPM should adopt a biopsychosocial perspective on pain and operate within a framework of multidisciplinary pain rehabilitation to improve its effectiveness.”

Ref.:
Transl Behav Med. 2012 Mar;2(1):106-16. doi: 10.1007/s13142-011-0090-7. Interventional pain medicine: retreat from the biopsychosocial model of pain. Roth RS1, Geisser ME, Williams DA.

“Features of acute pain were examined in patients at an emergency clinic. Patients who had severe, life-threatening injuries or who were agitated, drunk, or ‘in shock’ were excluded from the study.

Of 138 patients who were alert, rational and coherent, 51 (37%) stated that they did not feel pain at the time of injury. The majority of these patients reported onset of pain within an hour of injury, although the delays were as long as 9 h or more in some patients.

The predominant emotions of the patients were embarrassment at appearing careless or worry about loss of wages. None expressed any pleasure or indicated any prospect of gain as a result of the injury. The occurrence of delays in pain onset was related to the nature of the injury. Of 46 patients whose injuries were limited to skin (lacerations, cuts, abrasions, burns), 53% had a pain-free period. Of 86 patients with deep-tissue injuries (fractures, sprains, bruises, amputation of a finger, stabs and crushes), only 28% had a pain-free period.

The McGill Pain Questionnaire was administered to patients who felt pain immediately after injury or after a delay, and revealed a normal distribution of sensory scores but very low affective scores compared to patients with chronic pain. The results indicate that the relationship between injury and pain is highly variable and complex.”

Ref.:
Melzack R, Wall PD, Ty TC. Acute pain in an emergency clinic: latency of onset and descriptor patterns related to different injuries. Pain. 1982 Sep;14(1):33-43

“Consider pain as a model. There is the physical stimulus that causes the irritation and there is the person reacting to the stimulus. The tremendous variation in the way different persons under different circumstances react to a similar pain stimulus is at times awesome and even baflling, Beecher [5) found that men who were wounded at the Anzio beach invasion in WWII required significantly less morphine than civilians who had suffered similar injuries in accidents.

Beecher’s work addresses the reactive component to pain. When an injury was severe enough to save a man from life-threatening combat experience, but not so severe as to impair his function in civilian life, the wound was associated with freedom and survival. The same degree of injury in civilian life was not interpreted as a welcome pathway to survival but rather as an unexpected catastrophe, usually accompanied by anger at whomever or whatever was to blame. “

Ref.:
Prev Med. 1997 Sep-Oct;26(5 Pt 1):616-21. Nocebo: the power of suggestibility. Spiegel H.

“The description of individuals with congenital insensitivity and indifference to pain provided one of the bases for Melzack and Casey’s (1968) seminal distinction between the sensory and affective components of pain.

In addition, the observation that these people often die in childhood because they fail to notice injuries and illnesses has been viewed as compelling evidence that the ability to perceive pain has great survival value. That is, the sensation of pain protects humans (and other species) from the tissue-damaging effects of dangerous stimuli, and appears to be critical for survival of the organism”

Ref.:
Congenital insensitivity to pain: an update. Nagasako EM, Oaklander AL, Dworkin RH. Pain. 2003 Feb;101(3):213-9.

“Pain catastrophizing has been associated with heightened pain severity, emotional distress and pain-related disability, even when controlling for medical status variables [2,4]. Pain catastrophizing has also been shown to compromise the effectiveness of pharmacological and psychological pain management interventions. Several studies have shown that reduction in pain catastrophizing is the single best predictor of successful rehabilitation for pain-related conditions [5,6].”

Ref.:
Sullivan M L. What is the clinical value of assessing pain-related psychosocial risk factors?. Pain Manage. (2013) 3(6), 413–416.

“Most education programs for orthopedic patient populations have used anatomic and biomechanical models for addressing pain,4,11-14 which not only have shown limited effi- cacy,4,11,12,15,16 but may even have increased patient fears, anxiety, and stress, thus negatively impacting their out-comes”

Ref.:
Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011 Dec;92(12):2041-56.

“Psychosocial factors are important in the development of low back pain and disability.7,8 Depression, passive coping strategies, fear avoidance beliefs (the avoidance of movement or activity resulting from fear of pain or injury), and low expectations of recovery are independently associated with poor outcome.9,10 A clinical guide to assessing psychosocial warning signs (yellow flags) developed in New Zealand has been adopted internationally.11 Patients’ beliefs need to be better understood to improve management of low back pain.”

Ref.:
Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med. 2013 Nov-Dec;11(6):527-34.”

 

If you’re interested in learning more, here’s some links via Zac Cupples: Explain Pain Therapy Notes & The Sensitive Nervous System Therapy Notes. Also, his course review of the Dermoneuromodulation course, which I’ve recently attended. Diane Jacobs posted this link today, which makes for good timing: Therapeutic Neuroscience Education: finally, a book that says it like it is. Lastly, I’ve purchased this Pain DVD (the download version), which is a great resource for this information, as Lorimer is one of today’s pioneers in pain research.

Jeromie

Adjusting a Session On The Fly

This is a guest post by Brad Gatens. I’ve been exchanging emails with him about programming and he offered me up this post to use as a guest post as he thought my readers would find value in this information. Also, it’s a way for me to have a place to reference the information. This reminds me of a recent post by Patrick Ward – Click Here. Nothing is linear.

“I couldn’t sleep last night.”
“I feel like I may be getting sick.”
“I had one too many at happy hour yesterday.”

As trainers we need to modify and adapt our client’s workout on the spot.  All that time spent on a well-planned workout program for your client that day is shot.   Gotta switch it up.  We set out with good intentions trying to make an organized plan for the workout, but problems and issues always seem to come up. Planning out weight, sets, reps, exercise selection and order can make our jobs easier when there are no issues with our client.  But more often than not, something is going to come up which throws our plans out the window.

Jon Goodman recently laid out a solid piece regarding this situation (this article wasn’t linked, but I assumed this was the one he was speaking of).  A planning template was presented in his article to provide trainers with a long-term guideline for their clients based off of their goals and needs.  Making use of this type of outline will keep you and your client focused on previously established goals. Creating a long-term periodization plan is necessary, but planning specific individual sessions probably isn’t.

GetUp

It’s up to you and your client to modify a workout when necessary.  What I would like to lay out is strategies to use when a client isn’t feeling well mentally or physically.  Coming down with a cold, feeling tired, under a lot of stress…. Modifying workouts based on injuries and soft-tissue complaints is a whole other topic that might need to be addressed.  Here’s how we can provide a quality training session and still get a training effect even when their having an off day.

  1. Continue as is.  They might surprise themselves and still have a great workout without any modifications.  Remember Michael Jordan playing with the flu against the Jazz?  Sure that’s an extreme example.  But he’s human just like us.  And if he can do something as absurd as that, we can muster up the strength for a couple higher intensity sets.
  2. Adjust the volume or adjust the intensity.   This is going to depend on the individual.  When some feel like crap, some will thrive on high intensity. They may not have the endurance and energy to maintain a normal pace and rest intervals, but they can maintain their strength.  Use this to your advantage as a trainer and program a couple of high intensity sets with long rest periods.  On the other hand, some simply cannot maintain their strength but can keep their work capacity.  As a professional, it’s important to explain this concept to our clients.  Dropping the intensity down does not mean we aren’t,
  3. Beach muscle day.  Arms, abs, some rows, traps for the guys, extra glute work for the women.  Think of this as an accessory day.  Many popular strength programs throw in an odds and ends day.  Single joint movements would work pretty well.  Anything seated would be a plus as well. This workout will provide a nice change of pace and will provide some catch up time on any neglected body-parts.

How do you know which approach will suit your client the best? Based on your history with this person, you should have an idea what the best strategy to take is.  Discuss this with your client.  Let them know that just because the method for the day has been adjusted, it is not going to take away from the workout.  Often times they may feel like they’re not going to get anything out of a “different” workout, but it’s our job as coaches to explain to them why this isn’t entirely true.

All we are doing here is providing a form of self(client)-regulation to our clients.  The best lifters in the world follow some type of self-regulation.  Programs shouldn’t be written in stone for anyone.  Especially when you have a trained professional available in real-time to guide you.  Working with a trainer provides two sets of eyes to monitor and adjust performance.  Use this to your advantage.

Brad

BGats

Brad has a CSCS certification and BA in exercise physiology.  Brad teaches physical education and works with guys looking to build strength and muscle.  Brad has gone from a body weight of 130 to 185, and has recently deadlifted over 3x his bodyweight.

Hamstring Stretch Modification

As many of you know by my previous post, I went to a pretty phenomenal seminar the other weekend. During the portion of the seminar discussing the hamstrings, Dr. Spina mentioned how he didn’t like typical hamstring stretch and proceeded to discuss why, and I wanted to share that with you all. First, let’s look behind the knee and discuss what’s there superficially (closer to the surface). We have the hamstrings coming off of the ischial tuberosity as one tendon, which then starts to separate into the three hamstrings about a third of the way down. As you get closer toward your knee, the hamstrings sort of head in opposite directions so the semitendinosus can blend in with the pes anserine on the medial side, the semimembranosus will blend in with the knee capsule, and the biceps femoris will attach to the fibular head on the lateral side. If you look at this as a triangle of sorts, the gastroc will make up the bottom of that triangle. The middle of that triangle right above the knee line in the back is where you’ll find the popliteal fossa. Here’s a picture that basically shows what my word-vomit is trying to describe:

Fig8_popliteal_fossaOkay, it’s not so much a triangle as it is an arrowhead.

Do this for me real quick: with your knee bent at a 90 degree angle or so (if you’re in a chair, just scoot forward in your chair so the back of your leg is exposed near the knee). Take both of your hands and grab the hamstring tendons on either side of the triangle. The big tendon(s) you feel on the inside of your leg is the semi brothers (and gracilis), and the tendon on the outside of your leg is your biceps femoris. I demonstrate what I mean in this video:

 Sweet socks, I know.

Go right between those two tendons and sink a little deeper into the popliteal fossa until you can feel some dense connective tissue, but be careful, there’s some arteries and veins of importance in there. That dense, cord-like tissue you may be able to feel is your sciatic nerve (before it splits to become the peroneal and tibial nerve down the lower leg).

Ever wonder what that burning feeling is right behind your knee with a typical hamstring stretch? Yeah, that’s your sciatic nerve. As with any connective tissue in the body, your sciatic nerve can adapt over time (SAID principle), but does that mean you’re effectively stretching the hamstrings if you’re feeling your nerve getting irritated instead of the belly of the muscle pulling tight? I am reconsidering the effectiveness of a typical hamstring stretch based on what Dr. Spina presented. So what is a more effective stretch? Slightly unlocking the knees while keeping a lordotic curve in your lumbar spine as you bend forward. Then you want to drive your butt away from your knee while trying to keep your chest tall. This should allow you to actually feel the stretch in the belly of your hamstrings instead of behind your knee, which we have now determined is just an irritation of your sciatic nerve (but that doesn’t mean you’ll eliminate that burning feeling right behind your knee if you’re really tight).

Here’s Dr. Spina with a 2 minute video showing his version of the hamstring stretch, which I will probably start adopting as the version I use on myself and with my clients. Give it a shot and let me know how this slight adjustment helps the effectiveness of your stretch.

Jeromie

FAP/FR® Lower Limb Review – Being Humbled

frr-logo-png1

I’ve been a trainer for 4 years and a massage therapist for 6 months. In the pursuit of being great at what I do, I know that continuing my education and applying those principles to my practice to the best of my ability and understanding is an ongoing process.

As I’ve been seeking information from some of the well-read folks in both the strength & condition, as well as the rehab and bodywork world, I’ve been able to find some rather interesting/intensive courses that really push my knowledge. It has also allowed me to really evolve as a trainer/therapist.

The Functional Anatomic Palpation™/Functional Range Release® lower limb course this weekend was phenomenal. I think it speaks volume of the quality of the course when the room has at least 5 people you know who are great at their craft (I even own one of the attendees DVD). On top of that, the host of course, Dr. Andreo Spina (Dre), is very well read and his content and passion express that knowledge. I also appreciated that this course is about principles, and the application of the principles will always depend on your findings. There is no “Step 1, do this. Step 2, do that.” Much of the principles of tensegrity model were incorporated into the course, and the way all of the principles were explained made complete sense to me.

The seminar began with palpation. How do we know what we’re treating if we don’t know what we’re contacting? Dre utilized reference structures to start the palpation and we were able to move medially or laterally based on those reference structures to find other structures. For example, using the adductor longus as a reference, we could easily palpate gracilis and pectineus depending on how we guided our palpation. I have never been that specific with any of the lower limb muscles before. Ever. This is the kind of specificity I wish I had in massage school.

Why so specific? The idea is to objectively make treatment-based outcome measures – what tissue is affected by the soft tissue release procedures and what is actually happening to the tissues we are targeting with our technique application? Then he asked, Can our manual ‘inputs’ lead to actual changes in the tissue structure? If so, how can we maximize said changes? And is rehab more successful with specificity or will general strength and conditioning suffice?

The answers and main takeaway of the whole weekend can be summed up with two words: specificity & force. Your body’s tissue will adapt to specific forces, or lack thereof, by strengthening your tissues and the neural input of those tissues in the lines of force that you use most. Therefore, if you try to use your body (whether intentional or unintentional) in a line of force that your body is not adapted to, you’re more likely to injure yourself. With force, there’s internal force (neural: you driving the force) and external force (mechanical: something external driving the force, like my hands or a massage tool that isn’t just compressing fascia – there needs to be inter-layer sliding).

By utilizing our palpation skills, we then sought after tissue tension within mid-ranges of motion. It should be common sense that end-range is going to create tension in the connective tissue, but if there’s a similar tension while the tissue is in its mid-range, then that tissue is the target tissue for treatment. If the tissue doesn’t respond to external force (mechanical force), then the more neurally driven internal force is the other option. This made sense, as I’ve come across circumstances where I thought massage would help, but the tissue tension never changed. My hands can’t override your brain, so we were given strategies to try to influence the CNS to unload its signaling to the tissue (proper time and frequency are necessary, as well).

Once we went over palpation, we were introduced to the release technique. I found it very helpful in not only positioning, but also in saving my hands. I also appreciated the emphasis on connecting with the client. I highly, highly recommend every therapist attend at least one of his courses and see what you might learn and takeaway from Dre’s concepts. Trainers can attend his Functional Range Conditioning™ course, too, which is another awesome concept. We played with some of the FRC™ stuff briefly and I couldn’t do some of the movements because the joint capsule of my hips need work.

Some gems from the seminar:

1. Change comes from neural drive/cueing
2. Training or treating is just adding force
3. The spine doesn’t move independently on itself, it bends as a unit
4. There is no tissue or system that responds to single inputs
5. Lack of joint motion = a lack of communication to muscle attachments
6. All connective tissue (muscles, bones, fascia, etc.) are all just different expressions of the same material
7. With pain upon waking (night pain) think inflammation
8. We want to promote independent motion in a normal range
9. Closing angle pain = joint problems
10. The threshold of the tissues is the amount that you can control (CNS)
11. Increasing range-of-motion without training that ROM will lead to a return of symptoms
12. Internal rotation is the first to go with degeneration
13. The typical hamstring stretch is just a sciatic nerve stretch
14. The typical piriformis stretch is really a gluteal fascia stretch
15. The longer the muscle is when it is contracted, the more force through the tendon/connective tissue at the attachment site
16. Movement is neurologically complicated
17. It’s not about muscle – it’s about connective tissue
18. The movement of superficial fascia is important for afferent feedback
19. The knee isn’t a hinge joint – it also does internal and external rotation
20. Your body is continuously working on itself – move as much as you can
21. Palpation is an art – you flow
22. Touch induced analgesia is why you feel better after you’ve rubbed a boo-boo – it doesn’t last
23. The best thing you can do for inflammation is move

There was a lot more specificity to the application of the technique and to the course as a whole, but I will leave it at that because you really need to sign up and learn the principles behind Dr. Spina’s madness in person. It’s amazing how little you know when you go to these things and realize your approach has been so narrow. Functional Range Conditioning™ is coming out here (Newberg) in January, so be sure to check into it and sign up if you can!

I look forward to the spine and upper limb courses. Hopefully soon.

Jeromie

Am I doing this exercise right?

On May 12th, 2012, Jason (my boss for both the gym and EPLifeFit) wrote an article for Everyday Paleo called “Learning Proper Form at EPLifeFit.”

This is what we (which has evolved to mostly I) do just about every day on EPLF. Members submit a link to their unlisted YouTube video(s) on a private forum (that only they and myself can see) so we can critique the movements we prescribe for them.

Since I do this so regularly, I wanted to make a proposal: I want to say, publicly, that anyone who wants to have their movements critiqued by me may do so – all for free. All you have to do is send me a video of a front view and side view, where I can see the whole person (feet and head position included).

Send them via email to Jeromie@unorthodoxmassage.com

Stipulation: this isn’t intended to deter folks from signing up for EPLF, as it’s a great resource beyond the video critiques (which is extremely valuable itself), with loads of information on our forums, so I have to put a limit on the submissions to only being available over the next 30 days. That means that on April 19th, 2014, I won’t accept any more free submissions (but I will continue to work with you on any movements you have already submitted and still need to progress). The nice part about that is for only $20/month you can have unlimited access to me and my critiques on EPLifeFit.

Also, I’d like to be able to blog about them – without showing any faces or saying any names, I’d like to show the screen captures of what your movement looked like, my response and suggestions, and the critiques to follow to show progress.

If this sounds like something you might be interested in, again, my email is jeromie@unorthodoxmassage.com

Jeromie

p.s. I work 2 other jobs besides EPLF, plus my own massage business, so I may not be able to critique videos right away. Just as a heads up.

2013 in Review

Thought I’d jump on the bandwagon since…

This has been a year of ups and downs in my life. I started my 29th year of life in January, yet I felt as though I hadn’t accomplished as much as my peers who are still in their mid-20s. It felt a little disheartening, but the process of making a career out of my passion hadn’t fully revealed itself until I was about 27.

Let’s start with the ups.

The beginning of this year was the start of my second quarter in massage school. That’s the quarter where we started to practice on more than just our cohort during class hours. It was intimidating, but the experience was necessary – as it is with any profession. My third quarter went well, as I participated in the sports massage clinical rotation for 7 of the 11 weeks, leaving just a few weeks of on-campus clinical that was dedicated to staff only. My fourth quarter I rotated an off-campus clinical with an oncology clinical, and I also volunteered for a full day of massage at the beach volleyball tournament at Seaside.

For continuing education, I took a NeuroKinetic Therapy™ Level 1 seminar (on my birthday weekend), RockTape, one or two of the Kinetic Integrations’ courses, and Postural Restoration Institutions’ Pelvis Restoration course. After the course, a colleague of mine and I started an NKT™ study group. It’s been a great learning experience. I’ve also attended some get-togethers with a group of practitioners and trainers/coaches who like to hang out, have beers, and talk about the body/movement. I don’t say much, but I am surrounded by people who’re way smarter than me, so I take some simple advice I’d only recently heard (at the group, actually): I only have 1 mouth, but I have 2 ears.

For my personal life, I asked my partner, support, and friend to marry me back in May. We’ve been in the planning process and have a venue, photographer, florist, officiant, and outfits pretty much done. Most of it is just the deposit, but it’s nice having much of it planned and out of the way to focus on working to pay for the rest of the bill later. And the Ducks won the Alamo Bowl.

1390685_538203539581734_1972086430_nThis one. I love this one. My favorite engagement photo.

The end of the year took a slightly unexpected turn after graduating, becoming licensed, and starting Unorthodox Massage LLC. Unexpected because a) I never thought I’d have my own business, because I am not a “business person” and I don’t know if I ever will be, and b) because I had expectations that weren’t met. With my students loans kicking into repayment (because the majority of which had already surpassed the 6 month grace period) and a wedding to pay for, I needed to be working more. The reason I haven’t been blogging much is because of the end of the school year, start of a new business, and the search for another job (and getting one) has kept me quite busy. The week before Christmas was a 60-70 hour work week for me. With the gym, EPLifeFit, my massage business, and my new job doing massage/aide work in a rehab clinic, my 4 jobs keep me pretty busy. At some point, I’ll be venturing into the rehab realm full-time.

2014 should be a great year for me. I turn 30 in January, I am getting married in September, I am taking a continuing education course in March from Dr. Andreo Spina that will probably be my most favorite thus far, and I’m participating in a sports massage internship at Portland State University (my Alma mater) with one of my massage teachers. I am also looking into applying for an athletic training program, as I really like working with athletes and think I would provide value to any athletic team in the process of injury recovery for both exercise and soft tissue therapies.

The downs seem quite trivial now that I’ve shared the ups. The downs in life are always a learning experience and I’ve had my fair share. Sometimes you wish you could press rewind and do it all over again, but you can’t and there’s only moving forward and that is what I’ll continue to do. It’s what I’ve always done.

Some people I’d like to thank:
Erin and future father- and mother-in-law: thanks for the ongoing support and help you’ve given me in 2013. It means a lot.

My parents and siblings: I don’t see you as much as I wish I could, but thanks for being who you are, supporting me, and entertaining me on social media.

To the fitness pros who have changed the way I think about the body and how it operates, or who have shown me exercises and techniques that have helped me grow as a professional over this last year: THANK YOU. This includes:
Andreo Spina
Greg Lehman
Erson Religioso III
Perry Nickelston
David Weinstock
Thomas Wells
Dean Somerset
Tony Gentilcore
Lee Boyce
Patrick Ward
Phillip Snell
Guido Van Ryssegem
Jim Laird
Gray Cook
Zac Cupples
Bill Hartman
Dave Dellanave
Bret Contreras
Tony Ingram
Jonathan Fass
Paul Ingraham
& Charlie Weingroff

I look forward to what 2014 has in store for both my personal life and my education. Happy New Year everyone.

Jeromie

SMRT Reads – Improper Movement

It’s been a while since I’ve posted, but I’ve been busy with a lot of little happenings in my life. I graduated from school. I went deer hunting for the first time, but wasn’t successful. I took my state practical exam for my license. I have been at the gym more for a combination of covering other trainers’ classes, on ramps, and personal training. I’ve been preparing my future massage room at the gym. I’ve been doing some of the wedding stuff, like putting a deposit on our location, meeting with an officiant, and getting an engagement/save-the-date photo shoot organized with my fiance. And napping. That always feels glorious.

Even though I’ve been busy, I still try to catch up on the interesting postings that appear on my social media. I also have certain blogs email me updates, so I’ve had to catch up on those, too. During this process, I’ve had some things cross my mind. Some are rhetorical, but some are me being genuinely curious.

It seems that every person has some sort of asymmetry or imperfection when it comes to movement. This is sort of the premise with PRI – to optimize the body’s natural asymmetries. Therefore:

1. Is it okay to train in what some would consider “improper” patterns to strengthen that line of movement? Dr. Andrea uses the example of a rock climber in this interview he did that he posted the other day. The body positioning necessary to make a climb will require things like hip and knee extension with your femur internally rotated. But wouldn’t many consider that pattern “improper”? I guess context matters.

2. Is always training neutral joint positions good? Imagine if your body was never prepared to tolerate forces that were outside of “neutral”. Taking the words of Ido Portal at the end of this clip and asking in question form, is there such a thing as improper alignment or just improper preparation?

3. Is it always beneficial to go full range-of-motion? I think it was a post by John Meadows on Facebook that got me thinking about this, so I did some Google searching and found this article he wrote titled: Only doing full ROM is crazy! It was after attending a RockTape seminar that I started thinking about full ROM. The host of the seminar, Dr. Le Cara, stated that he wouldn’t have his ball players perform full ROM of squats because of their long lever angles. Again, context matters, and posterior chain strengthening would be high on my priority list with squats that weren’t full ROM.

4. Thinking about movement and range of motion, it would seem to me that not being able to demonstrate a certain range-of-motion would be worse than training an improper ROM. Let’s go back to the rock climber. Let’s say the rock climber trained internal rotation of the hip. Is that worse than a rock climber who always trained in hip external rotation and abduction who had limited hip internal rotation? It would seem that a rock climber who can’t perform full hip internal rotation will end up injuring themselves climbing a mountain. Take, for example, this photo that I found using Google search.

rock-climbing-020_1Both of hips are in internal rotation. If she presses up with her left foot to make keep ascending up the side of this rock, and she lacked the necessary internal rotation to be capable of that, don’t you think she would injure herself? If you always train external rotation and lose the capacity to internally rotate, that leads me to my next point.

5. If one extreme is “bad”, why is the other extreme “good”? Let’s say you’re tying to work on your hip mobility and you’re trying to be a Supple Leopard with the goal to externally rotate your hips like a boss a the bottom of your squat. What if you end up losing some hip internal rotation range-of-motion because of it? Is one extreme okay because the other is labeled as “bad”? What if we went back to point #2: is it really about proper alignment or is more about proper preparation?

I don’t want it to seem like it’s okay to start training “improperly”, but that with proper progression over time (like any training adaptation), you can strengthen a certain movement pattern to be better prepared for handling a certain load. In this video, Dr. Spina says that injuries occur when the load imparted exceeds the load absorbing capabilities of the body.

How prepared are you for any unknown load that may be imparted to your body?

Jeromie