Welcome to the Knee-Hub - Module 4 - How To Move The Body In Pain
This module circles back to where we started - pain science.
My goal for today is to fill in the blank spots and help you connect the dots so you can move - and MOVE FORWARD - with more confidence.
Module 4 is a mix and match of movement and pain science concepts, with a bit of knee alignment exploration, and a long guided savasana to finish.
As usual - let's check in first: how is the material landing for you?
What roll out or stretch was your most favourite?
Least favourite?
I also want to remind you that I'm always (ALWAYS!) here to support you.
Here is our agenda for this module:
- Remember the movement rules (written and on your own)
- Explain Pain target concepts (written)
- Hurt does not equal harm (written)
- Red, green and yellow - when to move, and when to stop (written)
- Let's check out our knee tracking! (written and video)
- Savasana. Ahhhhhh...... (video)
Today's Review:
Ground rules for movement all come from pain science to help us find a way to move the body in pain. Can you remember some of these rules?
- Remember to breathe
- Look for smooth movement
- Work at your own edge - just in between comfort and challenge
- Go however far it feels safe
- Do however many reps you can
- Don't wait for me to tell you to stop
- Rest when you need!
Explain Pain Target Concepts
This next bit is sciency and longish, but I am including it for two big reasons:
One - to remind you (and myself; I doubt myself often, and when I doubt, I forget) that pain science is not only a real science, but also a thoroughly studied evidence-based approach to treating and curing persistent pain.
And two - to give you an glimpse of how much has been left out of this course. If the content of Knee - Hub hasn't made a difference for you, it is not because it doesn't work, but because we haven't yet found the right approach for you.
This is our first toe dip into "how to work with a body in pain" topic: there isn't one single universal way to get better. Usually we have to find an individual strategy that kinda makes sense and clicks for us. Often that involves several tries and a few different modalities. I guess the single universal principle does exist - it is "don't give up and keep on trying"!
Here is a list of Explain Pain Target Concepts.
Can you identify which ones we've worked with in the Knee - Hub?
- Pain is normal, personal, and always real.
- There are danger sensors, not pain sensors.
- Pain and tissue damage rarely relate.
- Pain depends on the balance of danger and safety.
- Pain relies on context.
- Pain is one of many protective outputs.
- We are bioplastic.
- Active treatment strategies promote recovery.
- Learning about pain can help both the individual and the society.
Module one talked about neuroplasticity and the way our brain can change itself (Concept #7 - we are bioplastic).
Module one also introduced strategies for sending the messages of safety to the nervous system via breathing and guided relaxation. Did you find that your pain level change after you've done those guided practices? (Concept #4 - pain depends on the balance of danger and safety; Concept #5 - pain relies on context).
Throughout the entire Knee-Hub course we looked at self-help movement strategies to reduce pain and improve movement. (Concept #8 - active treatment strategies promote recovery).
Module three talked about different ways the body can protect itself - what can the body do when faced with instability. (Concept #6 - pain is only one of the many protective outputs)
Learning about pain has been threaded through the entire course as well. (Concept # 9 - learning about pain can help both the individual and the society).
And finally, the
Explain Pain Video touched on the role of the brain and nervous system in producing pain (Concept #3 - pain and tissue damage rarely relate).
Compare how David talks to his patient with what you've heard from your medical care team. The messages of danger and safety are written in our language. Words we hear from doctors, surgeons, chiropractors, massage therapists - people we presume know more about our bodies than we do - can be especially powerful or especially harmful.
Hurt Does Not Equal Harm
To unpack this concept in its full measure would take a whole separate course. Even when it is intellectually understood, it still is really challenging to make it your own - probably because we are trained to believe that the opposite is true. I guess what I am trying to say here is that it takes time to truly embrace this concept. Be gentle with yourself and give it time.
Nonetheless - here is the short of it:
- When we experience pain for a long time, our brain and our entire nervous system undergoes a systematic change - our nervous system gets better at producing, sending, and receiving distress messages.
- It continues to produce, send and receive these danger messages even after the tissues completely recovered from an injury.
- It can continue to send danger messages even in the absence of damaged tissues - such is the case with amputees that experience phantom pain in their prosthetic limbs.
- It can also produce danger messages even in the absence of shock or injury.
As you can see now, our goal isn't just to help the soft tissues (fascia, muscle, ligaments etc.) to recover. It is to help our nervous system recover its sense of safety.
Here is how:
Red. Green. Yellow. When to Move. When to Stop.
Imagine a traffic light:
Green - you go
Yellow - maybe roll through, maybe stop - depending on circumstance
Red - definitely stop
What would happen if you decide to always go when the light is red?
Chances are you are gonna get in an accident, sooner than later.
What would happen if you decide to always go on yellow?
Something might happen, but if you are carefully watch the situation, you can be pretty safe.
Green is an absolute go light, but accidents sometimes happen even when you go on green.
Here is how to apply this same system to pain care:
Flare up is like an accident.
It can be a major flare up - something that lays you out for days or even months, makes you tired, destroys your sleep and digestion, makes you feel like even your hair hurts, and causes a fair amount of fear. This is the flare up that will make you desperate to find a solution, and often trap you in the endless circle of different practitioners.
For me, a major flare up inevitably follows in the footsteps of a really stressful life event, or a stretch of time when my schedule feels really full. So while I can't do anything to control wars, Covid or what my kids do at any given time, I do my absolute best to moderate my schedule. In fact, finding the pace of work (and life) that works for my nervous system is one of my most important pain management tools.
It can also be a minor flare up - something that makes you feel cranky and inflamed, but doesn't scare the living daylights out of you. We'd often get a hint of regret or disappointment with a minor flare up - as in we knew that we were doing too much, but didn't stop.
Depending on the type of your nervous system, a minor flare can last a week or so, and usually motivates you to commit to taking a better care of yourself. It also has a hidden learning curve - you start to notice the connection between "when I do this - I feel like that afterwards" and look for better ways to move and be.
Green is the amount of movement (or the kind of movement) you can do without feeling pain afterwards.
Yellow is so so - sometimes you will feel a little flare up, and sometimes not.
This often depends on what else is put on your plate at the same time. Remember - you nervous system doesn't just deal with pain. It also deals with your whole life experience, so a trip, an unexpected bad news, or a wrong credit card charge can all cause your nervous system to be more sensitive.
Red is type or amount of movement that will most certainly cause a flare up. Might be minor, might be major. You might get away with a few minor ones, but eventually a major one will get you.
Now let's put it all together:
If you always go on GREEN - which means you are only moving in the range of motion that doesn't ever cause pain or flare up - your nervous system will only consider this small range of motion to be your safe zone. This won't ever improve: studies show that people who avoid all discomfort when they move, eventually lose their range of motion. The short of it - over time, nervous
system begins to guard more and more and more.
If you always keep on pushing through RED - you are consistently loading your nervous system with way more that it can handle. Always driving on red is asking for trouble!
And YELLOW? Yellow is the growth zone.
This is where we push just into the edges of our discomfort. We challenge our fears just a little bit to get more comfortable with them - so that we can have a dialogue with our pain and with our fears, instead of having them scream into our face.
You might get a little flare up when working in YELLOW. Recognize the flare up as a learning opportunity - what is your body telling you?
It is a little scary to work in that YELLOW zone, but it is also so very rewarding because moving on the edge of our discomfort is how we get our discomfort to shift, and that's how we grow and get better.
You don't always have to do the YELLOW.
Just like at any intersection, check your surroundings: are you too tired? did you sleep OK last nite? are you working on a big project?
Stick with the GREEN for today!
And just a note here: if you don't have a pain-free zone to move in, consider the amount of movement that doesn't increase your pain levels to be your GREEN zone.
Phew! That's a lot!
I thought about including other info in this module - such as why ball rolling works, what is primary and secondary stability, and why tight muscle isn't a strong muscle - but I feel like this is already a lot. And as per usual, I end up with way more material than we have time for so I'll save it for the next course!
Now let's get moving!
Here is a short recap of the knee anatomy:
The thigh bone - the femur - has two bulbs (condyles) at its bottom.
These two bulbs rest over the shallow top of the shin bone, the tibia.
The kneecap - patella - glides between these condyles - bulbs - of the femur. That in-between space - a special groove through which the patella glides - is called "patellar groove".
Let's delve deeper!
Is yours tracking along or outside of patellar groove?
