Fighting The Pain

If it hurts, don’t do it.

Except do it a little.

That’s the working philosophy with rehab, and while it may seem to make sense to avoid painful movements completely when they bother us, there’s something at play that can make that a very counterproductive idea.

We’ve spoken on why too much resting when injured can complicate returning to activity. Movement restrictions develop, muscular strength is lost, the tissue might even heal inefficiently.

As well, we talk a lot about avoidance habits being created when in pain. If overhead movements with the shoulder hurt, for instance, it can become habitual to simply never reach for a top shelf for years to come, further deconditioning the joint for future use.

Now this becomes a problem because, as we avoid movement to protect an injury, we actually allow that injury to continue taking a little more away from us as time goes by.

You avoided overhead movements with your shoulder? Now simply up to shoulder height is starting to ache.

You don’t raise past your shoulders now? Now any sideways raise movement pinches.

Stopped moving your arm completely? Well, now your shoulder is meeting that demand.

It doesn’t need to happen like this, however. In a way, a fight back against the pain is often necessary. If the pain threatens to continue taking more movement away from you, then the clear solution is to push back and reclaim it.

We encourage clients to move and exercise through very mild and moderate levels of discomfort. Not because we simply need to “toughen up”, but because that allows us to work at a level that lets the body know where to accommodate and improve without causing a flare up.

This is the basic concept of how we improve physically, not just in active rehab, but in working and exercise in general. A safe level of stress on the body is required to initiate positive changes.

Be smart with an injury. Don’t push it, but maybe push it a bit.

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Why Your Hip Flexors Are So Tight

That tight feeling at the front of your hip. That pinch in your joint. Maybe even lower back pain to top it all off.

We have a high volume of clients who come to see us for conditions related to their hip flexors. Whether they've identified that muscle group specifically or they simply complain with generalized discomfort at the front of their hip, this is a very common affliction in both high- and low-activity individuals. From hockey players to desk workers, many of you readers may very well have been there.

Which brings us to the common solution for tight muscles: stretching! And believe me, every hip flexor client of ours has clocked several hours trying to stretch their discomfort away. 

But has that worked for anyone out there, yet?

As we know, muscles get tight for a reason other than simply being overused. More often, a muscle is tight because it's weak, creating an interesting case against static stretching as a fix.

With that being said, we see terrific results for hip flexor discomfort as soon as we begin strengthening those hip flexor muscles (combined with some modest manual treatment). Exercises as simple as high-knee raises have shown great effect.

It sometimes takes some work to identify the hip flexors as a culprit, and oftentimes more work to target the muscle group over other helpers, but once we find the right route, it creates a sure pathway to relieving that nagging discomfort.

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How Non-Athletes Can Still Benefit From Athletic Therapy

The “I’m not an athlete” explanation is still a barrier when it comes to members of the public seeing an Athletic Therapist for the first time.

The assumption is that Athletic Therapy will either be too intense or simply non-applicable to individuals who aren’t involved in sports or fitness. Allow us to help you understand why this isn’t true.

You May Not Lift Weights, But You Do Lift Boxes

I think that we can all agree that lifting is universal. Whether it’s boxes at work, furniture at home, or your newborn baby, lifting can be strenuous and be complicated by pain.

So while your Athletic Therapist isn’t going to try to convince you to start going to the gym to desdlift, if that’s not your jam, they will help to keep your back and hip muscles relaxed and pain-free and teach you proper technique to start picking up those heavier loads. (After all, your baby won’t wait for you before growing heavier.)

You Might Not Run Down A Track, But You Do Run After Your Kids

Like lifting, running tends to be a basic necessity of life. Running after your kids as they become more active, chasing after your dog, or simply sprinting for a bus; it’s good to know your body is up for the task for when the situations arise.

An Athletic Therapist can help you if you experience difficulties with your hips or knees that make running more of a challenge. Osteoarthritis, tendinosis, or other afflictions shouldn’t hold you back from these aspects of life.

You’re Not Reaching Up With A Racquet, But You Are Reaching For That Top Shelf

Athletes aren’t the only ones who work overhead. While you might not be hitting a badminton birdie or throwing a baseball, your shoulders still need to be healthy enough to reach for high objects, wash a window, or anything else at home or work involving working up high.

Your Athletic Therapist will help condition your shoulders to be strong with overhead and repetitive tasks. Learning proper use with your shoulders will also spare the smaller elbow and wrist joints from repetitive strain, allowing you to continue with your daily routine.


As you can see, all athletic movements are just higher-intensity versions of simpler activities involved in our daily lives. We don't expect to teach someone how to pitch a baseball or sprint down a track if they have no need. However, the same principles that we DO use with athletes for those purposes easily apply to each unique need of the non-athletic individual.

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3 Reasons To See An Athletic Therapist In The Most Acute Phase Of Injury

I see a lot of very long-term, persistent types of pain cases in my practice. Often, individuals come to see me to recover from complications of an injury that occurred weeks, months, or even years ago.

Oftentimes, these cases are complicated even further due to the time lapse between the initial injury and the point of first contact with a medical professional. As time passes, secondary conditions often develop, and the time for recovery will increase proportionately.

In contrast, individuals who see Athletic Therapists during the most acute phase of injury - and we're talking as early as within 24 hours of the incident - will benefit the most quickly and efficiently from treatment. Here's why.

1) Optimizing Inflammation

Contrary to popular belief, inflammation does not need to be completely eliminated. Being the active mechanism for initiating healing, an inflammation response should be allowed to occur during an injury, to an extent. What does need to be prevented is excessive swelling around the injury site, but outside of controlling that, there are always mild-level techniques and movements that can be done to maximize the bloodflow and metabolic activity that accompanies inflammation itself.

2) Maintaining Range of Motion

As many people try to "rest away" an injury and wait for it to "settle down" before initiating treatment, the joint is often kept immobilized in order to protect it from further injury and pain. We need to remember the body's strict use-it-or-lose-it policy, however.

By immobilizing an injured joint, the joint becomes conditioned to that state of low-movement. As a result, it creates an extra step in the rehab process where range needs to be reattained. By seeing a therapist in the acute phase, however, we can eliminate this step by making sure the range is maintained in as tolerable a volume as possible.

3) Activity-Specific Treatment from Day One

Every individual has their own unique life demands. As such, why would we treat every injury - even if it's a similar or identical type of injury - the same? 

Athletic Therapists gain a lot of experience working on-site with competitive athletes in order to fast-track them back to play as quickly as it is humanely possible by making the rehab as applicable and practical to their exact sport from the first day of treatment. This concept jumps immediately from sport to any other type of activity, occupation, and lifestyle. If a 30 year old construction worker and a middle-aged client who enjoys gardening have the same shoulder injury, the rehab processes still aren't going to look alike.

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The Reverse Domino Effect Of Health

"I sprained my ankle. Limping caused my hip to go out. Then I started getting back pain and it's traveled all the way up to my neck."

This is the domino effect occurring. We know for a fact that a dysfunction or injury left unattended long enough can lead to another. It's often small occurrences that begin individuals down a path toward long-term, wider-spread pain.

It's an unfortunate trend, but as we know, it's not necessarily a permanent one. Therapy and rehab, especially those involving movement and exercise, are proven to be able to address these dysfunctions and alleviate the symptoms.

However, it's also a trend for individuals who have experienced this sort of domino-collapse of their joints and muscular system that have a difficult time motivating themselves to begin making those changes for the better again. It can be easy to feel like the time and energy to address such a large number of different (albeit related) problems could be fruitless.

I like to remind clients, though, that it's not necessarily a matter of address every single ache and pain separately, though.

As a biological organism, the human body is good at organizing. In this I mean that this domino effect that we're considering can occur back in the OTHER direction!

I always start with broader corrective exercise when I first treat my clients, only narrowing the specificity down as needed. More often than not, broader changes with how the body moves are enough to begin making the mechanics that we want to see start clicking together. Addressing one area of dysfunction (not even necessarily in reverse of what order it occurred in) can lead to the body further correcting and managing other areas along the chain.

Not acknowledging this reverse domino effect is to not acknowledge the body's own ability to run operations on the most efficient manner that it can. We're a sophisticated system that is excellent at making do with what it has. Small changes CAN make a big difference, and only when those small changes hit a plateau in effect do we need to begin nitpicking for further progress.

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The Case For Pre-Surgical Rehab

We can fix most injuries conservatively and with exercise. But yes, sometimes surgery is the answer. Going under the knife does often become necessary, whether it's a hip replacement, ACL reconstruction, or labral repair.

I often encounter these individuals as they wait on the list for their operation. They say to me, "Oh, great, I can come see you after my surgery.

My answer: "Great, but why not see me now?"

This isn't just a personal plug. (Although I know that I make a lot of them, so it's hard to tell.) There are true benefits to beginning treatment and rehab BEFORE you get your surgery, however. By doing so, you're actually greatly improving the speed of your recovery and the overall outcome!

Firstly, let's remember that any injuries are seldom isolated to a single joint. Especially in the case of chronic issues, but also in acute ones, conditions result from a combination of mechanical deficits up and down the kinetic chain. Addressing these early on will alleviate the joint from aggravation both before the surgery as well as afterward as it works on recovering. Letting those issues remain, on the other hand, might cause them to excel and create an even tougher environment for your body to heal throughout after surgery.

But if keeping the joints above and below your surgical site is too much of a stretch, then let's consider the site itself. True, you may have an injury or degeneration in the area, but by keeping the musculature surrounding it as strong as possible and maintaining proprioceptive control, you're setting yourself up to have those facets return to you much more quickly after the operation.

And of course, there's no denying that overall fitness will greatly improve your body's ability to move, circulate blood, and heal more quickly as well.

If that's not enough, let's also just recall how significantly pre-surgical rehab is able to delay the need for surgery, potentially alleviating your symptoms enough to put the operation date off for years to come. (And sometimes, even eliminating the need for it altogether!) To me, that sounds like it's worth giving some early exercise a try.

So my advice to anyone who's waiting around for the phone to ring with a surgery date is to not simply sit around, allowing your body to decondition even further, and then expecting the surgery to be a final, quick fix. Get a head start on your recovery well before even stepping into that hospital room, start addressing your symptoms now, and minimize the complications following the operation later.

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Staying Involved - The Social Side Of Recovery

When pain or injury hits us, especially when it's severe, it's easy to become disconnected from the world around us.

An example might be of the elderly individual whose back pain has resulted in their inability to go out, see their friends or family, or be involved in their community anymore.

Another might be the athlete with the sprained ACL who hasn't been seen by any of the his friends on the team in months.

It could simply be the person who feels depressed in their month not getting to go to the gym while recovering from their muscle strain.

It's the reality; pain can often prevent us from remaining involved in the activity, communities, and social circles that make us part of who we are. And the tragedy is that this social isolation, as well as the often-prevailing depression and anxiety, are correlated closely to the increase of physical pain! Pain increases, depression worsens, pain increase further, and so on in an unfortunate cycle.

But it doesn't have to be this way! We tend to have an all-or-nothing approach to our activities and involvement, often writing our engagements altogether due to not being able to participate as fully as before. However, this is exactly what leads to that isolation!

Instead, it's crucial to keep individuals in pain involved in the world around them. Whether it's from pain, injury, or illness, we know that greater social support is strongly related to an increased chance of recovery.

With that being said, whether it's you, a friend, or family member, maintaining engagement in social circles is a major factor in recovery. If you're an athlete that sprained your knee, keep coming to practice and involving yourself as much as you can on the sideline. If you're missing out on hitting the trails with your running club, grab coffee with your fellow runners and stay up to date on their going-ons and lives. If your elderly mother hasn't been able to garden or walk with her neighbour, encourage her to have a friend or two to her own home for tea. There's always a way to modify the activity and environment to maintain one's place in the world outside.

Social isolation isn't fun. Add pain to the mix and it can become unbearable. Stay involved, call your friends, and engage in the world rather than let it pass by; you may find that it's what you need to propel yourself back to better health.

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The Secret In Simplicity

We’ve all witnessed the unfortunate reality of therapists who don’t look toward progressing an individual’s rehab program enough for it to be effective. You the know stories I’m talking about; the person who’s done clamshells for their hips or the one performing forward band flexions for the shoulders for the past eight months and for some reason still isn’t feeling better.

Has anyone not been given these?

On the flipside, I’m also privy to those practitioners who are overcomplicating what they prescribe to clients to the point that they’re either unable to perform their exercise effectively or just left totally confused and unclear as to what the goals of the plan are.

There are big hypes around new and fancy fitness and exercise methodologies, (such as DNS or Ido Portal’s training, for those of you in the know) and they are absolutely fantastic philosophies! I won’t argue against the scientific basis and benefits of any of these schools of thought and I’m eager to continue to study and learn from them more.

BUT, should a new client have all of that content thrown at them in the first few appointments?

I'll let your imagination run wild here.

I was listening to the Adam Meakins’ NAF Physio podcast and heard a great quote when they were discussing tendon health and exercise simplicity. “When treating an organism, let the organism organize.”

What this refers to is that the human body is an extremely sophisticated system. It works within itself incredibly well to perform its functions and adjust to its environment. Note that I never call the body a machine. It neither has a single manual on how to fix it, but neither does it need every single gear and function specifically programmed by us to work properly. Often, as soon as we make one or two adjustments to the faults that it’s experiencing, the body is intelligent enough to do the reprogramming and reorganizing on its own.

Going back to the quote, why it resonated is because it correctly suggests that the body has the potential to recover on its own accord with very simple changes or exercises. What’s more, simplicity translates to a better understanding for the client on how everything works, allowing them a better feeling of control for better treatment success.

So, absolutely, I will begin by showing a person a simple chamshell or forward shoulder flexion exercise to get them started, and sometimes that has actually been enough to get them feeling better! In the event that those simple measures are unsuccessful, then that’s our cue to compound and layer on top of the plan with more complexity. But, by having those simple changes first, we’re building a foundation for both the conditioning and the knowledge in order to most-effectively progress the plan.

You don’t teach a person to multiply without first showing them how to add. Remember the K.I.S.S. principal: Keep it simple, stupid!

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The Rehab Schedule and Exercise Frequency

How often did your last therapist tell you to do your rehab exercises? Twice a week? Three times? Every day?

If you answered 'every day', then you're likely of the majority of individuals. There's a trend among health professionals to make this rule absolute. If you want to get better, then the more you adhere to your exercise plan, the fast the recovery will be. Makes sense!

However, how often do you see someone make a seven-day-per-week behaviour change in a snap simply because a medical professional told them to do so one time?

Sorry, what?

A lot of my clients are self-motivated fitness enthusiasts, so if I tell them to do their rehab exercises every single day, adherence is high! However, expecting perfect compliance is rare among most demographics. I'm not talking about unhealthy shlobs who are unused to taking care of their bodies at all. I'm talking about recreational athletes, weekend warriors, avid gardeners, blue-collar labourers, and more. Telling just about anyone to add a 20-minute routine to every single one of their days might not sound like a lot, but it can be quite the feat.

A lot of therapists are aware of this and will still stick to the "daily dose" model, however, figuring that clients will still do a lesser amount of exercise when prescribed the more. But is this an effective measure? Or does the higher expectation lead to a greater rate of failure? If a client feels guilty because they did less work then they were instructed to, this could lead to a quicker loss of motivation and eventual overall noncompliance.

For this reason, I find it important to get a thorough understanding of each of my clients' lifestyles, schedule, and inherent motivation. If I feel like someone is going to be perfectly happy to exercise as told every single day, then great! For most, however, setting high standards is an easy way to make clients feel disappointed. Instead, I tailor each plan to each individual, whether it's alternating exercises on each day, having them exercise every other day, or simply doing their rehab plans just as warm-ups for their activities and sports.

We're not sacrificing quality of the program by decreasing the frequency. We're ensuring overall success by helping to create gradual habits. Besides, just a couple days of exercise per week is enough to start providing beneficial effects for just a wide variety of physical ailments.

I'll say this again before Nike sues me: "Just do it" doesn't work.

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Making Rehab Fun

Pain isn't fun. For many people who aren't accustomed to sport or fitness, exercise might not immediately be a fun thing either.

I find that many individuals struggle to adhere to their recovery plans due to the fact that the rehab process is perceived to be grueling and unenjoyable. Perhaps, even to the same extent as the pain itself!

Maybe the exercise is causing a different type of discomfort that the client is adverse to. Perhaps the rewards aren't immediate enough. Maybe the exercises being provided are just "lame". A lot of factors can play into the reasons why a client doesn't enjoy exercise, regardless of knowing the benefit behind it.

The difference between pain and the mental blocks of rehab is this: clients are often accustomed to the pain! That being said, it's sometimes easiest to simply deal with the pain rather than persevere through the work, as coping mechanisms for the former have already been developed.

So let's make the recovery process fun! Many therapists think that the fun factor is only applicable to making young children adhere to their pains, but why is it so absurd to think that adults might like a bit more enjoyment as well? People of all ages benefit from using fun to motivate their health behaviours.

Disclaimer: If you hate fun, don't book with me.

I'm not suggesting that every rehab exercises needs to be turned into a game. Regimented exercise has its necessary place and making fun out of everything is unrealistic. However, tedious sets and reps have a limit to holding interest and attention.

But how about using the activities that the clients are trying to get back to? Whether it's a sport, going for hikes, or gardening, there's bound to be an active activity that those individuals would like to get back to. Using a soccer ball as a piece of rehab equipment, walking or trails, or even simply incorporating light activities in the yard into the plan is going to go a long way to keep clients motivated. They'll enjoy the work, it will apply to their desired lifestyles, and it will act as a constant reminder of progress.

Many clients will thrive off of strict exercise plans and regular routines, but, like fitness, some people will need other alternatives to enjoy the process. As a therapist, it's my job to recognize which methods are going to be the most effective for each individual. At the end of the day, whatever works to get you feeling better.

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Do No Harm - Treatment Intensity And Consent

"This other therapist I saw just beat the crap out of me."

People seldom expect to see an Athletic Therapist, physiotherapist, RMT, or chiropractor without experiencing some level of discomfort during the treatment. After all, we, as the clinicians, are applying manual pressure into your body to exert some kind of physiological change. Things could get tender!

However, I hear, time and time again, stories of individuals who see practitioners that seem to have a particular level of sadism for making their treatments as excruciating as possible.

As I've covered before, pain tolerance is a very individualized factor when it comes to any treatment. Some people will be able to handle more pressure and discomfort than others, and as a result, those few may actually require a more intense treatment in order to attain the desired desensitization effect from it.

Inversely, if someone has a much lower tolerance to pain, they do not need to - nor should they - receive any treatment method that is more intense than they can handle. Remember, any therapeutic treatment is targeting the nervous system only, rather than causing any true physical change to the tissue. That being said, a client should only need to be taken to their personal threshold for the intensity of a technique to have an effect. What's more, exceeding that threshold may actually result in heightening that person's pain sensitivity.

With that in mind, I cringe when I see these photos - from both clients and clinicians - who are proudly showing off their treatment bruises. "More pain, more gain," is not a principle that applies to healthcare, and taking these extremes is unnecessary at the best and damaging at the worst!

In my view, these mistakes are being made both intentionally and unintentionally. While even the professionals may be prone to forgetting that higher intensity may not be necessary, there are definitely those cases out there where the clinician is trying to use that "more pain, more gain" belief as a placebo or a means of creating some sort of dependency for return-visits. (What can I say? Workers with shady ethics can be found in every field.)

So as a message to other clinicians, be mindful of your treatment and make sure to follow the first rule of your field by doing no harm! To clients, you have a right to tell your therapist to ease off, and if they're too insistent that, no, they need to go that hard, then you also have the right to leave their office. No one has a right to cause you pain without your consent.

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My Big 3 On Back Pain

In Canada, 1 in 5 individuals struggle with chronic lower back pain and, tragically, this condition is mistreated on a worldwide scale.

This being said, one of the most important tools we have in addressing this crisis is not in the techniques and machines at our disposal; rather, it's the knowledge and education on the nature of back pain itself. Here is a list of need-to-knows for your pain.

Imaging Often Gives Inaccurate Pain Diagnoses

A lot of people are sent straight to the x-ray lab upon seeing the doctor about their back pain. Unfortunately, the results of imaging often do not reflect the actual nature of their problem and can sometimes even make the problem worse.

Asymptomatic individuals have a high rate of having abnormal findings on their scans. This suggests that the actual cause of pain isn't necessarily the physical structure of the spine, shifting our need to focus on something other than just decompression and surgeries. Which leads us to...

Your Nervous System Is The Likely Culprit

Tissue heals. Muscle repairs. Bones regrow. But pain does not always go away, even after the body itself has otherwise bounced back.

The nervous system, itself, can runaway from us, releasing and propagating nerve signals once the initial injury or stimulus triggers them. And no, this does not mean that the pain is in your head; it means that the nervous system, while being integrated with the body's other systems, is still it's own entity that must be treated as well.

Flexibility Probably Isn't The Key

A lot of people assume that their persistent back pain is caused by "just being tight" and attempt to resolve the problem through an aggressive stretching routine. True, while yoga is suggested to offer some benefits in relieving back pain, the actual relationship between lack of flexibility and pain is comparable to that of the x-ray findings.

This is especially good to know for when it comes to those who attempt to fix their pain through aggressive self-massage. Sometimes, a lack of flexibility is there for a reason, and releasing a muscle too much could actually result in more pain.

This might tell us that the yoga benefits are more to do with the strength and postural control than anything regarding muscle lengthening, giving us a place to productively start looking for solutions.

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How Getting Past Pain Relapses Is Like Quitting Smoking

We made it to February!

How are those New Year's resolutions coming....?

Mmmhmmm!

Stepping aside from New Year's-specific goals (as you already know my opinion on them), let's discuss the realistic situation of regression.

Across the board, regressions and relapses occur in every type of behaviour or lifestyle change, whether it's recovery from pain, smoking, or weight loss. While the ideal is that we persevere through the road block or speed bump and continue on through the recovery process, often, hitting a point where pain returns, a cigarette is lit, or a few pounds are gained back are enough to shatter motivation and derail progress altogether.

One research group categorized pain relapse responses into four possibilities, some less ideal than others.

1) An unpleasant mystery that leaves negative feelings towards oneself and the situation.
2) A fact of life that should just be ignored.
3) A reminder to keep within physical limitations in order to avoid a future relapse.
4) An indication to change your behaviour to avoid another relapse.

You can probably assume that the first option is the least constructive, likely resulting in an ever-increasing level of negativity regarding the pain and loss of motivation to pursue further recovery.

The second option, ignoring the pain, is dangerous, as it may result in the individual becoming too content with their pain to the point of identifying with it.

The third possibility is good to a point. During a more acute phase of healing, learning to stay within limitations is vital, and sometimes the reminder is necessary. However, avoiding behaviours for too long can end up in a person simply using avoidance as a long-term coping mechanism.

Lastly, the fourth option is the most ideal in the long term. Understanding triggers or becoming aware of an increased need for self-work for your health is the most productive response to have if reexperiencing pain. However, sometimes coaching (whether it be self-coaching or help from a therapist) is necessary to reevaluate a relapse in order to maintain a positive foreseen outcome on the situation.

As it turns out, you can closely relate behaviour change relapses between health behaviours fairly well across the board! For instance, these tips of quitting smoking are amazingly applicable to this very process!

1) Focus on the next 24 hours:
Manage the acute phase of the relapse. Modify the environment so that further aggravation doesn't occur. Understand that this was an acute occurrence only and that you shouldn't become down on yourself and treat all the work up until this point as a failure.

2) Talk to someone:
Seek advice or support as needed. Seek your therapist or even consult a doctor if it puts your mind at ease that this wasn't a complete reset to square-one.

3) Analyze what happened:
Did you decide to get too aggressive with the weight you were squatting? Did you take a week off of your rehab exercises in too-early of a stage? Try and ask yourself exactly what may have caused this relapse to happen so that you can use that knowledge for future recovery.

4) Build a new plan:
This one is built straight into the basic rehab process. We're always modifying and changing pain-management and prevention strategies as needed, and having this relapse happen is a bit of a blessing in disguise, as it can help you and your therapist to further progress your long-term plan.

I try my best to ensure that my clients are ready for the possibility of their pain returning at some point, whether it's simply next week or a sudden reoccurrence in five years. Yes, it may happen. No, it is not the many steps back that you may think it is. And yes, there are steps that you can take to get right back on the train and continue to always get better.

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Life Doesn't Mirror Gym Movements (And Doesn't Have To)

No, I'm not telling you that the gym is bad and that you should stop going. There are many fantastic reasons why the gym is awesome.

However, there's a certain phenomenon among many of my clients that I'm noticing. Fear of movement.

The best example is the rounded-spine position. On one hand, many individuals who experience back pain are told by doctors, therapists, and more to absolutely avoid bending down and rounding their backs; that doing so will result in more pain. Having this fear of that movement instilled, however, does little to remove their pain, as these positions are, to say the least, inevitable. As a result, the nervous system, essentially, becomes primed and ready to guard against those movements, causing pain in those ranges and positions when pain wouldn't normally be a necessary response in that case. 

We call this kinesiophobia, the fear of movement due to pain which actually works to prolong pain and disability.

Here's the surprising thing. Active and healthy individuals experience this too! I've also seen this in very disciplined gym-goers who, for all intents and purposes, have nothing mechanical going on to suggest that they should be in pain. However, due to the immense emphasis on "good form" that active and athletic individuals may be bombarded with, I've been witness to the exact same avoidance-triggered pain. These are clients who are under the impression that it's necessary to square-up and keep a neutral spine curve every time that they so much as bend down to tie their shoes. And again, this belief that any other type of position is harmful is so strong that, just the same, they experience guarding and pain. Even so-called functional training isn't devoid of instilling these messages.

The takeaway from this is that the body has very natural movement patterns that it likes to use that don't necessarily reflect the strict and controlled form of the gym. Absolutely, if you're at the squat rack, moving in a single-plane only, and are loaded up with multiple plates per side, then you should definitely be observing "proper form". However, whether you're an active or inactive individual with or without formal training, the body is built for free and fluid movement. Don't let anyone, including Instagram personalities, magazines, or even doctors to tell you that dropping form as you live your life is a dangerous thing.

Credit: Greg Lehman

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Get Out Of Pain - 3 Steps For Maintaining Motivation

I tend to harp on New Year's resolutions a lot, mostly because of how well-documented it is that they don't work.

That's not to say that it's not possible to make changes at this time of year. However, "because it's January" is a reason for change with a rather abysmal success rate. I see many clients at this time of year who have looked at the calendar, groaned, and decided that it's time to deal with their back pain, and it often becomes my challenge to make sure that they take advantage of that temporary drive and turn it into a permanent one. Here are a few things to think about when you're considering taking the first step.

1) Determine Your Reasons Why

A lot of people will walk into a therapist's office saying that they want to get out of pain, but without much more reason in mind other than "knowing they should" or "have to". Especially in chronic pain cases, this attitude is very detrimental to the recovery process, as it reflects a kind of "going through the motions" approach.

If you've had severe back pain for years, it's easy to default to this attitude, but if you want to make an earnest attempt at progress, then you need earnest reasons for it. Try to find intrinsic, rewarding factors to motivate you such as family, quality of life, return to activity, or longevity to keep you adherent to the healing process.

2) Start Small And Create Goals

Next, those reasons you've determined are important, but going all in with only that end-goal in mind often leads to failure as well. Long-term plans are tough to keep to when the going gets tough and the end barely seems any closer.

If your long-term goal is to run a marathon in two years, remember that you need something to keep your motivation during all 24 of those months. Have a one-week goal, a one-month; two, half-a-year, and so on. Those steps are vital in order to maintain a sense of realism and attainability with the entire process.

3) Expect Speed Bumps (And Prepare For Them)

Clients can often be dismayed by the fact that they've been doing incredibly well in their rehab and feeling fantastic, then hitting a hump and experiencing a relapse in pain. They can often feel like this is an indicator of the treatment not working or that their condition is, in truth, there to stay with no hope of permanent recovery.

This is wrong, however, and it's important that clients know that these are only speed humps, not complete road blocks. Even in drug addiction rehab, a relapse is not considered to be a failed recovery; rather, it's a delayed one with a lesson learned.

If a perfectly healthy person can't expect to never experience an injury, then recovering pain clients don't need to expect to never experience reirritation. Just know that it's coming, have tools to help cope with that temporary increase in pain, and then be prepared to hop right back on the train.

One step back, but always two steps forward.

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The Stressful Effect Of Stress On Pain

It's the New Year! I hope your holidays were fantastic. However, now's the time for all of us to buckle down and get back to work. Don't let the stress get to you!

Stress! GAHHHHH!

If you read even the occasional post from myself, then by this point you know that pain is not a response that's simply caused by a physical lesion alone; it's a complex phenomenon with massive psychosocial and neurochemical contributors as well.

And just like how poor sleep can (indirectly) cause an increased sensitivity to pain, perhaps mental disstress can as well.

We all know negative stress as causing potentially negative effects on the body. Many of you may also have heard of cortisol, the stress hormone. Or, to get technical, the hormone released by your body in response to stress to take part in the fight-or-flight response, regardless of how major or minor.

Well, cortisol also has this interesting effect on pain, with several demonstrations showing an decreased pain threshold and increased sensitivity while subjects were under mental strain.

This can have huge implications from a rehab perspective, especially in chronic pain cases. Even as tissue heals and rehab programs are followed, negative stress can certainly interfere in the regression of pain symptoms. This is largely why conditions such as fibromyalgia are commonly looked into, at least in part, as a stress disorder.

This could be particularly problematic with progressive pain and stress before intervention occurs. As we are finding, chronic pain clients typically have an elevated cortisol level even when looking at them in absence of stress-specific factors. This implies that the body may be pumping out even more stress hormones simply in response to pain (as seems reasonable), resulting in a potential cycle of pain and cortisol continually causing one another to spike. (Hmm, haven't we seen a cycle like this before?)

Fortunately, this opens up more avenues of treatment as well. Simply doing mental relaxation exercises and activities is showing positive effects on many chronic pain conditions. This goes to show the importance of stress management when it comes to long-term or complicated pain cases. We often overlook this mental side of physical pain, but disregarding it means overlooking a crucial avenue for recovery.

Relax man!

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The Nocebo Effect - Why Belief In A Treatment Is Vital

We all know what the placebo effect is. It's the very real-world phenomenon of the body responding positively to an otherwise ineffective treatment or stimulus caused by the belief that there will be a positive outcome. The placebo effect is, in reality, a large reason for many success stories in the therapeutic world, believe it or not. In fact, some modalities actually rely on a patient's belief that it will decrease their pain.

Source

BUT.. did you ever stop to consider the opposite effect being a possibility as well?

The "nocebo" effect is classified as when a negative expectation results in a negative outcome, whether it's to do with movement, nutrition, a clinical treatment, or virtually anything else. Truly, it's the other far-side of the spectrum from the placebo.

This ties directly in with my past topics about how language selection and expectations of pain can propagate and cause more pain. Like I've said before, mental state has a huge effect on driving the body's outputs, whether it be pain, inflammation, or more.

This being said, the nocebo has a massive influence on the effectiveness of a therapy treatment. If a client does not believe in a certain type of treatment or modality or they think that it will cause them harm, then it absolutely can interfere with the treatment outcome!

For this reason, I do my best to thoroughly educate my clients in exactly what kind of processes are occurring in their body before, during, and after any treatment I provide in order to help them understand the targeted effect and increase the probability of success.

If a client simply doesn't believe in a modality at all, then that's ok! Therapists work for the client, not the other way around, and the client does not HAVE to subscribe to every philosophy. However, in absence of that belief, gears need to be switched with either a new approach or a new therapist, otherwise we're charging that client continually for treatments with no outcome. And that's where responsibility on the clinician's side comes in.

The brain is a funny thing, but it's the boss. We gotta work with it.

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