*NOCEBO: a detrimental effect on health produced by psychological or psychosomatic factors such as negative expectations from prognosis.

This started with a post in an online movement research community I frequent:

“Hi guys,
Is yoga helpful for recovery of a bulging disc in the back?
What poses would you recommend or not recommend if so?”

Naturally my ears perked up!

The suggestions that followed were anything BUT what I’d expect from a forward thinking movement research group:

"No forward bends.
No twists."

Of course I couldn’t help but add my 2 cc in:

“Words are powerful. Be mindful of what you say.

We have to be extra careful with the words we use and movement suggestions that we make: while there's absolutely no scientific evidence that any type of movement should be actively avoided during recovery, there are enough studies that show that health providers' words that encourage movement limitation actually slow down and in some cases stall recovery.

"Avoid this or that movement" suggestion comes from an outdated theory that pain is induced by purely mechanical means, which is completely not the case.

So suggesting to students to move within the range of motion that feels safe to them is a much more empowering approach to helping them in their recovery.”

This comment sparked a great exchange.
In the end I felt that many of my subscribers – including you, , – might benefit from a conversation on this topic.

What follows is dedicated to those of you who've shared how suggestions such as, “ No forward bends. No twists,”  from your health providers have halted recovery, and created re-injure anxiety and fear of movement.

The suggestion to limit this or that movement comes from an outdated recovery algorithm called “ a biomedical model.”

This biomedical model assumes that pain is an indicator of tissue damage, or dysfunction. This is also the model that is most familiar to us, and also the one that has been taught in medical and physiotherapy schools since the dawn of times.

However, in the past two decades evidence has been building that this biomedical model – the idea that the human body functions like the clockwork machine – is not our best model for injury and rehabilitation.

Since 2003 the best practice, as defined by 15 national clinical guidelines from around the world has been to use what is called the biopsychosocial model.

The biopsychosocial model of injury and rehabilitation views pain as a complex  phenomenon, arising from an interactive combination of biological (e.g. tissue status), psychological (thoughts, emotions, beliefs) and social (social support, meaning, engagement) influences.

The current scientific understanding of pain acknowledges that there is almost never a single, linear cause and that most musculoskeletal pain is not related to tissue damage. For example around 90-95% of all back pain is unrelated to any identifiable tissue damage.

The current best practice for treating musculoskeletal pain, according to a 2010 review of 15 national clinical guidelines across the world, is (after screening for serious medical causes like fracture and cancer) to provide reassurance and advice to stay active.

Current best practice for treating musculoskeletal pain:

1.    Reassurance
2.    Advice to stay active

That’s it.

See you on the mat!