Central Nervous System Fatigue

When we're looking at mechanisms that can lead to injury or illness, we tend to to focus on the peripheral systems in the body: the muscles, the bones, the nerves around them. Less frequently is the central nervous system discussed. Interesting, considering that the CNS is what controls and dictates our entire body.

Most likely, people are stuck in the misconception that if we use our brain to tell the body to do something, and it doesn't happen properly, that it's the fault of the receiving mechanism of the signal on the way down. With the exception of when someone receives a traumatic brain injury, we don't often consider that it may be changes with the CNS itself that is leading to improper function.

However, central fatigue is a real occurrence that shouldn't be disregarded, whether it has to do with day-to-day function, training, or rehab.

By what central fatigue is, it involves a complex system of chemicals and neurotransmitters that affect the central nervous system, such as dopamine, seratonin, adrenaline, and more. I'm not well-educated in the biochemistry of the nervous system, so I won't try to go deeper than that. I will point out that, normally, central fatigue is a regular part of functioning physiology, as it's one of the signals that ensures that we allow the body to receive proper recovery.

It's shown quite often that central fatigue plays a role in increased perception of effort as well decreased electrical activity (and thus, strength) in muscles.

The problem is when that central fatigue is propagated by irregular factors, such as multiple sclerosis, cancer, and possibly even with mental illnesses as common as depression.

There`s very little research done directly regarding the effects of central fatigue on strength development, injury, and recovery as opposed to peripheral nervous system factors. However, simply being aware that these central changes can affect our peripheral function creates significant implications.

When it comes to treating or training clients who have concurrent physical mental illnesses, this is a good reminder to consider central nervous changes that may affect progress.

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Is There An Athletic Bias In Our Health Research?

I sat down for a conversation on health research with some friends and colleagues. We were looking at various topics regarding nutrition, exercise recovery, and weight-control, but throughout our discussions, one thing stuck out to me.

An incredible amount of our information pertaining to exercise, recovery and nutrition comes from research sources looking exclusively at athletes!

This occurred in the back of my mind a few months ago when I researching static stretching. I was trying to find information regarding the effects of stretching on injury rates and recovery. Using a research database, the first page consisted of 14 relevant articles on the topic.

TEN of these articles involved athletes or otherwise-healthy, young and active individuals.
Only three articles actually involved injured subjects.
Finally, one sole experiment looked specifically at non-athletic individuals.

This struck a chord which I revisited this week during our health nerd brainstorming research session. While trying to discuss proper nutrition for recovery after exercise, including for individuals attempting to lose weight, the majority of the information we were pulling kept using science from athletic populations.

What's more, a lot of the research tends to observe the effects of different stimuli on performance. Let's be frank; there's a BIG difference between athletic sport performance and health. This is why things like the female athlete triad exist.

I'm not saying that research on non-athletes is non-existent, or even hard to find, but there does seem to be a heavy bias on the test subjects for any topics that approach exercise science. There is some sense to be made of why this happens, however. Plus, athlete researcher is, by nature, very popular.

We need to remember that the general population will have different physiology and needs than an Olympic athlete. While many people may strive to have athletic and active lifestyles, the demands of a high-performance marathon runner don't necessarily apply to a weekend-warrior or everyday gym-goer who are just beginning the journey to shed some inches.

So is this a problem with health science, per se? I don't believe so. High-level athletes are one of the most readily available groups who are able to withstand extensive testing and endure some of the more-invasive methods of research. The data we collect from this population is valid for the sake of science. The thing to be careful of is how we apply this data. As researches and health professionals, we need to be responsible in the way that we relay information to the public and not use data from athletes to make sweeping generalizations for the public.

For example, Usain Bolt's body and chemistry not only varies from the average person, but also is going to be quite different from an elite level endurance runner or basketball player.  It is important to recognize that what may work for one person, may not be the best approach for another. Therefore it is important to learn from the research that exists, but recognize the limitations and that it can’t be applied to everyone.

What works for one does not work for all.

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Pain Psychology - Avoidance Habits

I've been clear on my stance that the sooner someone seeks rehab for their pain, whether it's an acute injury or an overuse condition, the quicker and easier the recovery will be. There are a multitude of reasons for this, one of which is avoidance habits. 

Consider the scenario where an individual suffers a low-back strain while working. Instead of doing something about it right away, he continues to work through it. As it becomes worse during the week, he begins to modify his work mechanics. After a while, the pain becomes such that he drops to light-duty tasks to try and allow himself to rest. Still not seeking help, he starts avoiding any heavy lifting at home as well. This entire time, his body becomes more and more deconditioned due to lack of use, propelling the amount of pain he's experiencing. Soon enough, the individual no longer feels comfortable attempting any work, now expecting pain should he try. 

These types of cases are extremely common, with essentially every person experiencing long-term pain developing habits to help them avoid that pain that they live in fear of. As the extremity of these habits progresses with the severity of issue, not only does the affected (and protected) area become weaker, but also does the individual become more unwilling to confront that pain in order to finally take action on it.

My knee hurts. I'm gonna stop adulting from now on.

Furthermore, it's likely that this conscious guarding of the body against pain has even more psychological implications that propagate pain. For instance, hyper-awareness of information regarding their pain is likely to exacerbate an individual's perception of it.

This ties in closely with the pain-identity occurrence that I wrote on before, in that avoidance habits quickly lead to development of that chronic state if being unable or even unwilling to return to a healthier state.

Like before, careful imagery and visualization of an improved quality of life is important, as it helps to reestablish the belief that recovery is attainable. Goal-setting, as usual, provides the framework to create a realistic view on the process. 

Clients should also be encouraged to gradually - and controllably - return to movements and activities. Exposure to "acceptable" levels of pain in this way will assist in helping those people in moving past their fear it and more willing to confront it to recover without damaging them more in the interim.

Protection methods are often necessary in early stages of injury, but preventing them from turning into avoidance habits is something that therapists need to be attentive toward. Individuals need to be encouraged to return to their activities after they heal, not to completely fear those activities and allow it to stonewall their recovery. 

This topic was written with consult and collaboration with Alison Quinlan, a Sports Behavioural Consultant in Victoria, BC who is also pursuing continued education in dietetics. Follow her on Twitter and visit her website and blog to see some of her own authored articles. 

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7 Athletic Therapy and Rehab Myths

Athletic Therapy is still a growing field, and one that the majority of the public is still not entirely aware or educated about. I can't act like we AT's are martyrs, though; I'm well aware that Physiotherapists and Massage Therapists are also fighting their own battle in trying to raise public awareness on the importance and benefits of their practices.

That being said, here are my top seven myths and misconceptions debunked, not only on Athletic Therapy, but also on rehab and recovery as a whole!

1) Athletic Therapy is only for athletes

It's obvious why this belief exists. Athletic Therapy has its roots in the world of athletic training (akin to the job title in the US) that works primarily with sports-teams. Since those early days, however, Athletic Therapy has branched and spread itself out to being able to address and care for any demographic. "Athletic" Therapy speaks more on the modality of exercise that we specialize in and use to help clients recover rather than on any misconceived exclusivity of target demographic.

2) My insurance won't cover Athletic Therapy

This one may have been more true even as recently as 5-10 years ago. As it stands now, however, Athletic Therapy is receiving more and more widespread coverage with major insurance providers. Great West Life, Manulife, Sunlife, and more are all now known to cover AT; if not all the time, then at least under the right circumstances or based on request.

3) You need a referral to see an Athletic Therapist

I'm going to say that this one is probably untrue. Granted, if your particular extended health plan requires you to attain a doctor's note in order to receive coverage to see an Athletic Therapist, then that's that. However, when it comes to simply seeing an AT on your own accord, any AT will welcome you into their clinic, referral note or not.

4) Athletic Therapy is only for accidents and acute injuries

Indeed, Athletic Therapy is excellent for treating acute injuries resulting from specific accidents. In fact, the sooner and more acute the injury is when we first see a client, the quicker the recovery will be! However, AT's are trained and experienced to work with clients experience chronic and overuse conditions that aren't necessarily labeled as "sports injuries", including long-term low back pain, arthritis, and tendinitis.

5) My x-rays showed that I have something that won't go away, even with rehab

This one is a message that I'm passionate about, but one that's tough to get out there as much as I'd like. As I've written before, x-rays and MRI results are very likely to reveal injuries and conditions that a doctor may be quick to label as a problem. The thing to remember is that, in almost every adult, there are going to be some natural aging changes in your joints that are overdiagnosed as arthritis or degeneration.

Numerous studies consistently show completely asymptomatic patients testing positive for disc bulges or other degenerative changes on imaging. It just goes to show that an Athletic Therapist can definitely return you to pain-free function, even with these occurrences.

6) I need surgery first

When it's been determined that surgery is a necessary intervention, many prospective clients assume that they have nothing to do but wait for the date. However, it's been shown that patients awaiting hip surgery are able to reduce their pain with rehab in the meantime and may be able to improve their post-surgical outcomes. This may have something to do with getting the nervous system trained early for the rehab that will come post-operation or by getting accessory muscles away from the surgical site stronger to support the area. 

On the flip side, perhaps you've been told you need a surgery that's statistically unsuccessful or unnecessary. Oftentimes, conservative rehab is more effective and successful than operating on the area. Granted, Athletic Therapists will always respect the recommendations of medical doctors, but it may still be worth receiving an additional opinion or trying out a few sessions first in order to help assist you in your decision-making.

7) I'm not quite ready to start exercising

Finally, too many individuals who are in a large amount of pain have a misconception that they need to wait until their pain, somehow, settles down on its own before commencing a rehab program. Unfortunately, this often results in further pain and dysfunction as they become less and less active.

Inversely, even if a great deal of pain is present, there is always something that an Athletic Therapist can prescribe a client to do, even if it's the tiniest movement with the neck, hip, or even eyes that will improve that client's condition and outcome.

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Overcoming Pain - Perception of Control

There are many psychological facets that result from or contribute to pain, one such as I described in last week's post. It's important to remember, though, that no trait is independent of one another; they'll occur concurrently and are interrelated. That being said, I'll continue to break it down to help both my readers and myself understand the psychology of pain better in order to overcome it.

After a large sample of patients were interviewed, another of one the biggest predictors of chronic pain that was found was poor perception of control.

In a nutshell, when individuals are in pain, (even if it's only acute pain) and they don't have high self-confidence in their ability to recover from it, the result can be that those misconceptions may come true. Why is this?

To quote the above study, perception of low personal control can "lead to passivity, inactivity, reduction or cessation of coping attempts, avoidance of specific behaviours and poor adherence with advice". It may sound like a deplorable attitude toward one's own body and wellbeing, but if you think about it, it makes sense. If you were a mechanic and were told by your boss to do everything you could to repair a car while every inherent ounce of your gut told you that it couldn't be done, would you still put in the same amount of effort in the attempt?

This fact isn't helped by the fact that so many individuals go through the rungs of  other medical professionals who use language that enforces these beliefs!

• "You'll have this for the rest of your life."
• "It's only going to get worse with time."
• "You have the knees of a 70 year old."
• "You need to see me every week if you want to keep walking."

"My elbow hurts."
"We'll have to cut it off."

No wonder why so many people plateau in their rehab! Everyone is telling them they can't do it and bringing them down!

As an Athletic Therapist, specializing in exercise rehab, I can provide one of the best methods to help my clients boost their confidence in their recovery. What better way is there to increase their perception of control over their health than by giving them the tools that allow them to do the work themselves? (In contrast, if an individual only sees a clinician that massages or adjusts them without any other intervention, that puts all the control of their recovery into that clinicians hands.)

To help the matter, I make very sure to educate my clients on what every single exercise that I prescribe is doing; which muscle it's helping, what this stretch will do, how it replicates their daily activities. Clients need to know exactly how much power they have in propelling their own recovery. They want to know how their bodies are working. They need to hear less about what their therapist can do for them and more what THEY can do for them.

At the same time, I'm careful with my language. Essentially, it's important to put an optimistic spin on things in order to maintain a positive outlook and efficacy.

• "This muscle could be stronger," instead of, "This muscle is weak."
• "We need to get your hip moving better," instead of, "Your hip keeps getting stuck.
• "You'll feel better the more you do your exercises," instead of, "If you don't do your exercises, you'll be in more pain."

See what I did there?

This topic was written with consult and collaboration with Alison Quinlan, a Sports Behavioural Consultant in Victoria, BC who is also pursuing continued education in dietetics. Follow her on Twitter and visit her website and blog to see some of her own authored articles. 

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