Thursday, 22 June 2017

Understanding Pain and Accumulative Strain

I've said it before, I'll say it again.
There are things that your brain has tagged as painful, long before you may recognise it yourself. I only started to understand this concept after studying and listening to Michael Ridgway, one of my mentors who revealed so much of what I once had no understanding of... the accumulative strain model and clearing neural irritation. 

Some of the background to catch you up. 
Stress (or strain) causes inflammation, inflammation leads to fatigue, injury and/or illness.

When we experience pain, there is usually a reason for it. Often the symptoms (pain, swelling, redness, loss in ROM, flexibility function or etc) are obvious and require some type of pain relief or treatment. The best place to start in my opinion is clearing the nervous system (as taught to me in the Ridgway Method). We do this technique in clinic, try and touch your toes --> if you get a neural sensation or pain --> book in and I'll show you why stretching aggravates you and potentially could be making your pains worse

But what about the stress/strain that we aren't consciously recognising as a problem or pain?

[This is the part I love to communicate and share with people]

That understanding, our bodies are always communicating with us. We have a language that we natively speak (our body language) but many of us have disconnected from it because of technology, behaviours and addictions that steal our attention and separate us from our inner voice and self-understanding. 

Many of us perform dysfunctional movement at work, school, sport, holiday without truly understand that those movements are causing stress/strains that eventuate in what seems like an acute injury, but actually was stress/strain building up over a long period of time. 

Michael Ridgway explains further: 
I was taught that if someone has no overt symptoms, such as pain and stiffness, then there is no musculoskeletal problem.

This seemed to make sense because my clients would always present with a problem that needed the help of a physiotherapist to resolve.

Nobody ever came in saying "I don't have any issues, can you still treat me"

So there was no need to question the apparent logic of what I was taught.

Yet when I do a whole body assessment on a client with a musculoskeletal condition (in response to Fundamental 2 "Local Symptoms often have Remote Causes"), I very rarely find a single problem such as 1 tight muscle or 1 stiff joint. I always find a multitude of problems throughout their body.

Did all of these problems occur at the exact same time as the symptom that caused this client to seek my help…or did these problems exist beforehand and potentially play a part in the appearance of the presenting symptom?

I decided that instead of only doing a Whole Body Assessment on clients who had already presented with a problem, I had to start testing by doing a Whole Body Assessment on people who apparently had no symptoms…and no reason to seek my help.

What did I find?

These apparently healthy people, with no apparent symptoms and no "reason" to seek the help of a Physiotherapist, just like my clients, had multiple problem areas of tight muscles and stiff joints and restricted movement throughout their body,

My conclusion?

That these healthy people with no apparent symptoms, suffered from an accumulation of strain (strain + resulting compensation, leading to a new strain + resulting new compensation and so on).

Just as my clients who presented with symptoms also suffered from an accumulation of strain, but that cycle of strain then compensation eventually became too much for the body to continue to compensate adequately for, and so there was a "straw that broke the camel's back" effect which resulted in the onset of more apparent symptoms, to motivate them to avoid activities that aggravate, and/or to seek help.

Why is this important for us to know?

Because if musculoskeletal conditions are the result of an accumulation of strain, then treating or removing only the presenting symptoms, and not ALL of the dysfunctions, will result in at best a short-term fix that leaves the client vulnerable to regular re-accumulation and re-aggravation.

It also helps us understand that we need to retrain the client in how to move in a more "ideal" way once the accumulation of strain has been reversed throughout the entire body, in order for the client to not immediately recommence the re-accumulation of strain and compensations cycle as soon as they complete treatment…and that they continue to get Tune-Ups…

See the image of the Accumulative Strain Model

My conclusion... musculoskeletal conditions, that are appropriate for physiotherapists to resolve, are the result of ACCUMULATIVE STRAIN.

With this understanding, there are no mismatches anymore, I enjoy my work a lot more and I get significantly better results with clients.

RM 5 Fundamentals:
1 Be objective
2 Local symptoms often have remote causes
3 The Single Best Intervention results in Resolution Of Multiple Dysfunctions
Throughout The Body [i.e. Conditions are Protective Mechanisms]
4 And result from accumulative strain
5 Behaviour change is required for sustaining the fix

These fundamentals guide the redesign of RM... making it more simple and easier for physiotherapists to understand and apply.

Actually, it's much easier for me now. Not just with simplifying RM systems for physiotherapists, but also helping me to deliver better outcomes for my clients.

* Quiroga, Q.R., Mukamel, R., Isham, E.A., Malach, R, Fried I. (2008) Human single-neuron responses at the threshold of conscious recognition. Proceedings of the National Academy of Sciences, Vol 105, p3599.
* Marras, Wm, S. (2003). The Case For Cumulative Trauma In Low Back Disorders. The Spine Journal, 3, 177.

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