Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
7: Is Pain Automatically Bad?
370 Plays3 years ago
Welcome to Episode 7 of the Movement Logic podcast! In this solo episode, Sarah tackles the tricky subject of pain, and whether it’s always bad if our clients and students have pain. She discusses the situations in which pain might be acceptable, and gives concrete tools and approaches for you to use with your clients who are having pain.
- What’s the difference between acute and chronic pain?
- When might it be ok - and when would it not be ok - for your students to have pain?
- How to avoid generating fear for your students around their pain experience
- How much pain would be acceptable for someone to have?
- How to tease out different sensations to help your client have greater discernment around what they’re feeling in their body
Reference links:
Explain Pain by David Butler and Lorimer Moseley
Pain is Really Strange by Steve Haines and Sophie Standing
Sign up here for the Movement Logic Newsletter for course discounts and sales and receive a free mini Pelvic Floor course!
Watch the video of this conversation at: www.movementlogictutorials.com/podcast
Want more Movement Logic?
- Follow us on IG: @movementlogictutorials
- Get on our mailing list for tons of free content
- Contact us (we're super friendly)
Thanks for listening!
Recommended
Transcript
Introduction to Hosts and Podcast
00:00:06
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaverstorff and physical therapist, Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
Understanding Pain: The Basics
00:00:38
Speaker
Welcome to episode seven of the Movement Logic podcast. I'm Dr. Sarah Court, physical therapist, and today it's just me and you. We are giving Laurel a well-earned break this week.
00:00:50
Speaker
So what I'd like to talk about today is pain, which is a topic that I teach a lot about both formally in classes and workshops and informally using teaching techniques with my patients and my clients who are experiencing pain. And that's actually really well researched as a way to help people decrease their pain. And the main question I want to discuss today is this, is pain always a bad thing?
00:01:17
Speaker
And should we always be concerned if it is happening with the work that we're doing with our clients? And if it's not a bad thing, how much is an acceptable amount?
00:01:30
Speaker
And here's my tiny spoiler. That's going to be, that last question is going to be, and it depends kind of a question, which is my favorite kind, but I know a lot of people's least favorite because they just would like an answer. They don't want, and it depends. They don't want it to have to depend.
Patient Evaluation Process
00:01:46
Speaker
But in the case of pain, it's such a subjective experience for people that it does very, very often depend.
00:01:53
Speaker
So before I get into it, I wanna tell you a little bit about my process whenever I'm considering a question like this or thinking about how I might want to work with a patient or with a client. And that is the physical therapy approach that I learned in school that we use whenever we're evaluating what we're going to do with a client or with a patient. And this approach consists of three different things, research,
00:02:23
Speaker
clinic experience and patient preference. And so that means we look into the research, we consider the research on a topic, we look at what studies have shown, but we also consider what have we seen with previous clients or patients and how they respond to different interventions. And sometimes my experience has been sometimes that is the exact opposite
00:02:49
Speaker
It directly contradicts what the research has said on a topic. So you sort of have to take both things into consideration. And the third piece always also is patient preference, which means not trying to jam some sort of solution down a patient's
00:03:06
Speaker
but making it more of a team effort where we are considering their needs and their capabilities and kind of using that as part of our approach, part of our multi-pronged approach to figuring out what we're going to do to help them feel better.
Acute vs. Chronic Pain
00:03:21
Speaker
So this week's question, our main question is, should we be avoiding painful movements at all costs always?
00:03:30
Speaker
So to answer this question properly, I need to make sure that we're all on the same page about our understanding of pain. And the most basic categorization that I want to make sure that everyone really gets is the difference between acute pain and chronic pain.
00:03:46
Speaker
So acute pain, there's some general parameters around it. It's usually considered to be something that's been going on for less than six months. Although it's not like there's a sudden like at the six month market switches over, but roughly about that amount of time. It's usually attributed to a specific event. Like I fell down and I sprained my ankle and now my ankle hurts.
00:04:10
Speaker
it usually is very, you can say, where does it hurt? And the person points to exactly where on their ankle it hurts. So there's a very sort of direct correlation between the experience and the damaged tissue.
00:04:24
Speaker
And in the case of acute pain, it's an entirely appropriate response for the body. Your body is trying to tell you, your nervous system is trying to tell you that part of your body has been injured. And as a result, probably you should rest it or you should help to rehab it when the time is right using kind of appropriate level interventions, right? But it's just a way for your body
00:04:49
Speaker
you to understand that there is some damage in your body to the tissue and your nervous system telling you or deciding that that is pain, which is how it works, is just another way for you to know, okay, well, something's going on and I need to be thoughtful about this part of my body so that it can repair.
00:05:13
Speaker
When we get into the second category of pain, which is chronic pain, everything gets a little topsy-turvy. Cried pain is usually something that's been going on for over six months, although again, it's not a specific date line that you cross or something.
00:05:27
Speaker
it may have had a physical source originally but now it tends to get a little bit fuzzy because of the different processes that have been going on inside your body, inside your brain, your nervous system so that when you say okay where does it hurt the person might kind of generally you know wave their hand over an area of the body but they can't say
00:05:49
Speaker
It's right here. It's this exact spot for various reasons. And I might talk a little bit about chronic pain in another episode, but for now I'm just going to kind of give you the broad brushstrokes of what's happening. And, you know, what is physiologically happening at this point is that
00:06:06
Speaker
it typically is no longer attached, let's say, to an actual physical injury. At this point, there's basically just some systems going on within your nervous system that have gotten sort of tripped into this habit of the pain experience. And so the tissue itself may be well healed, but the person is still experiencing pain, or there may not have even been tissue damage to that area to begin with.
00:06:37
Speaker
Generally, what the accepted idea around chronic pain movement interventions has been is that we want to create movement for the person.
Strategies for Pain-Free Movement
00:06:51
Speaker
We want the person to experience movement that has little to no pain attached to it.
00:06:58
Speaker
And the reason for this is we want the brain to start to make new associations and to quite literally make new neural pathways where the association is, oh, I moved my ankle and it didn't hurt.
00:07:17
Speaker
So then the sense of concern or fear or anxiety or avoidance around movement is going to now be replaced by this new experience, which says, oh, no, no, no, you can move your ankle. It doesn't hurt.
00:07:34
Speaker
And there are a lot of techniques for doing this that you can study in courses. But some of them are things like explaining, as I said at the beginning, explaining the mechanism of pain, helping somebody understand that their pain experience, their subjective personal pain experience is being created by their brain and their nervous system.
00:08:01
Speaker
and that it doesn't necessarily have anything to do with any actual damage in a part of a body, even though the pain they're experiencing is in that part of their body. I had a patient one time who was coming in with what they described as like, you know, nine out of 10, 10 out of 10 low back pain. And they had been diagnosed earlier, quite a while previously with a disc herniation.
Psychology of Pain Perception
00:08:27
Speaker
And we would have our sessions, and they would always feel better afterwards, what they told me. But then by the time they came in for their next session, it had gone all the way back up to where it was before.
00:08:39
Speaker
after a few sessions where it didn't seem like we were making much headway, I finally said to the person, well, you know that the disk itself is healed at this point. It's sort of scarred down. And they kind of looked at me blankly and they were like, what are you talking about? And I said, well, yeah, the disk itself is not
00:08:59
Speaker
still injured, it has healed. And we talked more. And as it turned out, what this person was walking around believing, and I have no idea where they got this from, but what they believed was that the injury to the disc was sort of festering and almost like putrid. Like they had this kind of
00:09:22
Speaker
really unhealthy and gross almost tissue inside their body. That was why they were having pain. When we had this conversation and we talked also about how their experience of pain is based on their belief system and their brain about what's going on and all these different factors that go into the experience of pain, they literally said after the conversation that their pain was now like a five.
00:09:47
Speaker
So over the course of a conversation, we got their pain cut in half. So I cannot overstate the importance of understanding the sort of pain mechanisms, the nervous system pain mechanisms. And there's a lot of detail to it, and you don't have to have all of it, but just a kind of basic understanding and being able to then turn around and explain that to your clients.
Techniques to Reduce Pain Perception
00:10:11
Speaker
or your students is hugely valuable. So that's a really good one to use. There's other techniques, you know, there's a lot of ways that we can tap into the parasympathetic nervous system, get somebody down regulated, especially if you're a yoga teacher, you probably have a lot of those techniques at hand. But something as simple as, you know, the kind of breath work or pranayama that is down regulating.
00:10:36
Speaker
you know, having your sessions in a room that is quiet or playing some music that is calming or, you know, dimming the lights, using your yoga teacher voice, which we all have, I think, in some way.
00:10:51
Speaker
This is my yoga teacher voice. I'm exaggerating. That's not my yoga teacher voice, but you can certainly modulate your voice in a way to make it more calming, more relaxing of a sound, things like that. Sometimes you can just move a different part of the body as a way to kind of sneak sideways, sneak your way into creating some movement in the part of the body that has pain.
00:11:17
Speaker
You can change the person's relationship to gravity, their position in space. If it hurts to do it standing up, have them do it lying down, things like that. You can change the effort level of how hard they're working. You can change the contraction type, an isometric contraction versus a consenting contraction, all that kind of stuff.
Pain Management in Early Injury Stages
00:11:40
Speaker
The most current research, however, says that if the person's pain has been going on for less than three months, you are not gonna make it worse if the person experiences pain while you're working with them. So let me say that again. So if the person has been having pain for less than three months, this is based on just some newer research in the past couple of years. If you do a session with them and the next time you see them, they come back and they say,
00:12:09
Speaker
I was in a lot of pain afterwards. You don't have to go into, oh God, I don't know what I'm doing. Heart attack, panic. I need to refer this person out. I messed up. I made it worse. None of those things are necessarily true. So that's, in my opinion, that's some really good news.
00:12:27
Speaker
Some things about it, you know, this is obviously silly. If we're talking about less than three months, we're still in that acute phase, right? We're not into the chronic phase. So it doesn't contradict anything about how we've been working, right? You know, it's not like we are talking about the chronic phase where we are trying to find movement that doesn't have pain attached. They may have a baseline of pain that is kind of unchanging still.
00:12:52
Speaker
So having pain with movement isn't necessarily any different than what they're already experiencing, but it's not necessarily a bad thing if it happens. But it can be scary. It can be
00:13:05
Speaker
We're in this industry because at a baseline, we're chronic helpers. That's my feeling. We're all chronic do-gooders. On whatever scale that we're working on, we want to help people feel better in their bodies. That's just the baseline. Anytime that you're doing your work and
00:13:25
Speaker
that's not what's happening or you've not only not helped them but you feel like you've made it worse that's a that's not a great feeling i mean i've had that happen more than once and it's it's not it's not the greatest you know and it can it can make you feel like you're out of your league or maybe you're out of your scope of practice and that you should be you know definitely referring this person out to somebody else but
00:13:48
Speaker
My feeling is this, if that's not necessarily the case, that might be the case, but one report from a client about we did some moves and it hurt, to me does not mean, okay, this is beyond you, you need to get out of here, stop trying to do something that you're not supposed to do. This is my territory as a PT, this is not your territory as a movement teacher. I don't think any of that is true. The bottom line I think is,
00:14:18
Speaker
The more often you have experiences of working with people with pain, and especially if their pain does not immediately go away, and but then maybe
When to Refer Clients to Clinicians
00:14:30
Speaker
a month later, they're feeling better, the more of those that you kind of have
00:14:35
Speaker
I think the less scary each one individually is or thus overwhelming it feels if it does happen. So some of it is just from experience, but I think there's also some techniques that you can use that help you make choices then that are thoughtful based off of this idea of your client came back and they said, what we did hurts. So we're gonna talk about that in a moment.
00:15:02
Speaker
The other thing I'll say is, you know, if there's some sort of movement, like if I know that there's a movement, like let's say I'm not
00:15:11
Speaker
I'm not trying to create movement that has paint attached. Like I really never am, but it's just a question of like, what is your own personal comfort level with it if it happens? But let's say, you know, I try something with somebody and we do it and they're like, that hurts. The one thing that I always try to emphasize is if we're going to not do that movement because it hurts, I'm very careful to say, well, we're not gonna do that movement right now.
00:15:38
Speaker
because I've seen more than one instance where somebody comes to me and they're like oh yeah my doctor said I should never do you know rotations in my trunk and I'll be like well when did they say that and they're like five years ago you know and this person has now like avoided turning their body for five years which may not actually be appropriate for them so
00:16:00
Speaker
You know, if it's a movement, if it is a type of exercise, like let's say they are runners, but they're, you know, we're dealing with something that's not letting them run at the moment. I always try to phrase it as, we're not going to do that yet. We're not going to do that right now. We're going to work on some other things. We're going to come back to it because
00:16:20
Speaker
a lot of people's pain in their body is predicated on having a fear of either a certain kind of movement or just movement in general and becoming very movement avoidant, which ultimately just makes everything worse. So I just am always very careful not to use any sort of like fear mongering language or
00:16:41
Speaker
you know like well you are very you know sensitive you are very delicate you should not be doing this thing kind of language i always try to emphasize more sort of like positive outcomes and and and working along a path right we might be at the beginning of this path and at the end of it is where we're going to be and this is what's going to happen so
00:17:00
Speaker
If we're working in this world now, this brand new world where it's okay if they're having pain, then at what point do I know that it's no longer okay, for example? You might be saying to yourself, okay, well, so Sarah said, under three months and they're having pain, it's okay, but I've been working with this person. Now it's four months and they're still having pain. What do I do now?
00:17:23
Speaker
And there was another, and I'll link to all of this research, but there was another research paper recently. It was speaking specifically about people with osteoarthritis in the hip, but I think it's actually just some good parameters probably overall. And this research said, as they were doing this movement program, if after between four to six weeks it's worse, then you refer them out to somebody else.
00:17:47
Speaker
if after eight to 10 weeks, there is no further improvement or no improvement, then you refer them out. So I think that can also be a good parameter. Like say, let's say you've started working with someone and you want to give them an idea of not only your scope, but sort of like what they're, you know, you want to help them have appropriate expectations around the timeline of how they're going to feel. And, you know,
00:18:17
Speaker
There's different timelines for different injuries, so I wouldn't go so far as to say like, okay, for your sprained ankle, it should feel better within da da da time, but I would say something more along the lines of you and I are going to work together on this for a month, and if it's getting worse in that time, I'm going to refer you to a clinician.
00:18:35
Speaker
And that is, you know, I'm a huge, huge fan of creating appropriate expectations for everybody. Because then they have a sense of you are not just like, you know, like seeing next week and taking their money. And they're like, I'm not feeling any better. Why, why am I still going to this person? And also you're sort of adequately expressing, you know, what you can offer. And then, you know, let's say,
00:18:58
Speaker
it's been feeling better, but then two months have gone by and you haven't seen any further change, it's sort of plateaued, then again, that's like when you might say, okay, about this time, if it's gotten a bit better, but it hasn't gotten completely better, I'm gonna refer you to a clinician. Now, that's not to say that certain injuries have long healing times and have longer pain periods, but that aspect to me
00:19:24
Speaker
that is the scope of practice for a clinician and really discussing that and working towards those goals. So that hopefully that gives you just sort of a good sense of, because let's say if you're working with someone for two months and it's not getting better, there is probably a level of complexity that is beyond your scope of practice. And that's just the truth of it, right? Okay.
Problem-Solving Client Pain Reports
00:19:50
Speaker
So let's say, okay, we're in this scenario where your client comes back and they say, you're like, how would you feel after last week? And I say, well, everything felt worse actually. Instead of having a huge freak out and running around being like, oh my God, I'm terrible. I don't know what to do to help this person. Instead of doing that,
00:20:13
Speaker
either externally or hopefully not externally or even internally. Here's what I think you should do. The first thing is, take them seriously. And they're going to know you're taking them seriously because you're going to ask them a bunch of follow-up questions about it because you are going to do some problem solving. But don't freak out about the fact that they had pain. Because first of all, if they're already having pain, nobody's pain feels better when someone goes, oh, god, I bet that really hurts.
00:20:43
Speaker
you know, that never makes anything feel better. And, but again, you're not trying to downplay their experience. So I might say something like, Oh, I'm really sorry to hear that. Let's talk about it and see if we can figure out why that happened. So that, you know, it comes across that you're taking them seriously, you're taking their pain seriously, but you're not trying to add to their pain experience, or you're not, you know, too freaked out by their response.
00:21:08
Speaker
And then you want to get more information out of them. So you might ask things like, was there a particular movement that they had a sense was the movement that irritated it? And they might be like, yeah, when we did that thing where we twisted and then we added the arm part, that felt like it really wasn't great. Cause sometimes they won't say it while it's happening. So that's good. So then, you know, okay, well, I'm not going to do that this time. And I might say that's where I might jump in and say, okay,
00:21:33
Speaker
We're not going to do that right now. We're going to build up your strength or your mobility or whatever, and then we'll return to that movement at a later time when your body's more prepared for it, right? Great. That sounds like a plan. I, as a client, feel good when I'm in the hands of somebody who sounds like they have a plan.
00:21:51
Speaker
What did another question might be? What did they do directly after the session they had with you? Did they go get in their car and drive for an hour? Which would, to me, set off a little bit of an alarm bell around. We did some whatever exercise, and then they were completely sedentary, not just sitting, but the kind of sitting that you do in a car, which is the kind of sitting where you're not moving at all for an hour.
00:22:17
Speaker
and maybe some inflammatory processes set in. And then when they got out of the car, they were like, oh, my back. Sometimes that happens to me if I did just do a workout and then I have to drive somewhere and I didn't get a chance to properly cool down. So that might be part of it.
00:22:32
Speaker
Or did they overdo it? Did they feel so good after the session with you that they went for a run? And then so you can talk about, not that you're blaming them for what they did, but just talk about the relationship of the work they're doing with you, the other exercise they're doing, and maybe having them understand like, okay, when we do this, that's all I want you to do for that day. I don't want you to then go and do your run tomorrow or do it two days later or something like that.
00:22:57
Speaker
And the other question that I always try to tease out, and sometimes people have a better sense of this than others, but I'll ask people, how long did it take before it felt better? So if the person's like, well, it kind of hurt the next day, but by the evening, it felt fine. That's decently okay from my perspective.
00:23:19
Speaker
What that means is, you know, the amount of irritation was relatively low. I mean, ideally, obviously, we're looking for none, but they felt it for the next day and then that was it. I'm okay with that, to be honest. But that's also me speaking from my perspective as a clinician.
00:23:35
Speaker
If they're like, well, it actually still hurts, then my perspective on that is I need to pump the brakes in a really big way. And what I mean by that is I need to completely change what I'm doing with this person. It might be that I'm trying to introduce something that is too hard too soon. It might be that this person actually really needs to work on their mobility.
00:24:00
Speaker
And they need to do a lot of stretching and foam rolling and mobility movement exercises first before they try to get into any strength or vice versa, right? When it's something where they were reporting like, oh yeah, no, it's been bad ever since, then I'm like, okay.
00:24:19
Speaker
whatever I was doing was too much and in a really major way too much and we need to you know completely change directions of what we're going and so the answers to those questions are what going to help you plan your your next session with this person maybe you decide for the person who was like it hurt a lot maybe like okay we're going to do a all down regulating we're going to do
00:24:43
Speaker
you know, legs up the wall and we're going to do some, you know, cat cow and we're, you know, just sort of like keeping it really gentle or you may, you know, avoid certain things with them, but keep working in other ways or finding new positions to try to create the kind of strength or movement that you want to create that doesn't involve the thing that then bothered them, things like that. So it's really a way just to help you even be more specific in the way that you plan your sessions with people.
00:25:15
Speaker
And my experience generally is that, you know, patients and clients, they're a lot of the time much more forgiving of something like this than we might be of ourselves. You know, they understand that we are human beings and that we're doing our best and we are not miracle workers who are going to make their pain go away in one session. And especially if it's the beginning of your time working with someone and you're still kind of figuring out
00:25:41
Speaker
what's going on with their body? What does their body respond to? Sometimes it's not completely clear. Sometimes it's super clear right away. And sometimes it's not. Sometimes it takes some sessions before you really kind of get it. Like, oh, this person, they do much better. If we do like 10 minutes of stretching and then we do the work, their body likes it so much better than if we don't or something like that.
Client Communication and Expectations
00:26:04
Speaker
And for the most part, I think clients understand that
00:26:07
Speaker
you know, the fact that something made something feel worse doesn't automatically mean you're the worst yoga teacher, movement teacher, Pilates instructor, personal trainer, physical therapist in the world. Especially if you are able to kind of create some of that follow through and follow up in the next session. If you're, if your only response in the next session is like, you know, shrug emoji, then you probably should refer them out to somebody else.
00:26:33
Speaker
And I do want to sort of state the obvious. If you have concerns, if you really feel like you are out of scope with someone, tell them that and refer them to a clinician, a physical therapist, an orthopedic doctor.
00:26:47
Speaker
you know, it is the smartest thing that you can do. It is the most appropriate thing that you can do. It might feel a little ego bruisey if you, you know, if your identity, if part of the, and it's part of my identity, it's part of how I see myself is that I'm someone who helps people feel better. And if someone's out of, you know, if there's something going on, you're like, I can't, I don't know what's going on here.
00:27:13
Speaker
you know, send them to a clinician. And ultimately, you then position yourself with them as someone who is not wasting their time, not claiming to do things they can't do, not working outside of their own scope of practice, but really being thoughtful about their needs and you're not stringing them along.
00:27:35
Speaker
This episode is brought to you by Movement Logic, a library of evidence-based movement therapy tutorials to help your students who are in pain and looking to you for help. What most movement teachers need are critical thinking skills to be able to respond to their students' needs in the moment. But let's face it, whether it's a private client or a student after class, questions about what to do about pain and discomfort can be challenging to address for a movement teacher.
00:28:00
Speaker
However, it's possible to be able to address students' needs skillfully, using evidence-based reasoning and tools, all while staying within scope of practice. This happens by becoming anatomically and biomechanically informed, gaining a deeper understanding around pain science, and acquiring a diverse set of teaching tools that you can apply immediately. With movement logic, you will do just that, all while building a foundation of critical thinking skills to reach a broader clientele.
00:28:30
Speaker
Want a free peek of what you'll learn in our tutorials? Right now on our website homepage at www.movementlogictutorials.com. You can sign up for our email list to receive updates on course sales and discounts. When you do, you'll also receive four free pelvic floor videos that take a movement-based approach to working with clients with an array of pelvic floor concerns.
00:28:54
Speaker
Within these videos, we help you understand specifically how the movement or breathing exercise can influence awareness of and connection to the pelvic floor specifically, as well as many other structures it directly influences. Go to movementlogictutorials.com, enter your first name and email address and get four free pelvic floor videos. And now back to our episode. So,
00:29:23
Speaker
If we are okay-ish with the idea that we might cause some pain, how much pain is acceptable? And this is our it depends question. It depends on a lot of things.
00:29:39
Speaker
Before I get into that, I was told, and some of you may have had this experience too, when I was starting out as a yoga teacher, I was told, and you know, I don't know if this is actually something that people do in yoga classes anymore. I haven't seen it as much recently. But certainly when I started out as a teacher, there was usually a moment at the beginning of the class where the teacher asked the room,
00:30:01
Speaker
Is there anybody in here with any injuries or anything I should know about? And then people were supposed to raise their hand and be like, I hurt my wrist or something like that. And then it was sort of like, there was a bit of, I think, sort of backlash to that idea. I kind of got frowned upon a little bit, partly because, frankly, if someone's like, I sprained my ankle, most in a movement class, you're probably just going to be like, well, don't do the things that hurt.
00:30:31
Speaker
you know, it's not like your knowledge of that is necessarily going to give you a ton of ways to work on their ankle in a group class setting, per se, apart from just don't do the things. And then I think there's also just a general sense of like, maybe people don't want to yell out in front of a bunch of strangers, like whatever is going on with their body, or maybe it's something really super complicated that they can't just raise their hand and explain, you know, and they may want some privacy around it. And, and
00:31:02
Speaker
So that might be a reason not to do it. One of the things I was told though is that
00:31:08
Speaker
that you don't wanna dwell, you don't wanna do it because you don't want people to dwell on their pain. And I'm just kind of laughing because, you know, while yes, talking about it can make it feel worse at the same time, maybe not in a group setting, but certainly in a private setting, if that's part of why the person is there, then you have to talk about it, right? It's not that you, you're not gonna do better work if you just are like,
00:31:35
Speaker
La la la, we're going to pretend it doesn't happen. But you want to talk about it in a really specific way, and I'm going to discuss that in a second. But part of the one of the things that, part of the one of the things, one of the things.
00:31:51
Speaker
One of the things that how much pain is acceptable depends on is your client's individual relationship to their pain experience. And you're not really going to know that until you start working with them and picking up on what they're putting down and picking up on some clues around it. For example, some people are really afraid of pain and their experience is that pain is a scary thing.
00:32:20
Speaker
And that's a legitimate response. So then, okay, if I'm working with somebody who seems really afraid of the pain that they're having, what do I do to make them feel better? Well, I try to begin by creating a situation where they feel that they can have confidence in me and in what we're going to do. I had somebody I was working with recently who had had severe
00:32:49
Speaker
and chronic neck and shoulder pain for, I think it was about four years or something. And when they came in, I mean, I'm not psychic. You could see it on their face that they were really worried about it and it was scary to them. And in this case, it impacted their career and their lifestyle and the recreational activities they wanted to do. And it negatively impacted so many components of their life.
00:33:19
Speaker
And so in the beginning, and part of this person's experience was that a lot of people had done a variety of hands-on work, whether spinal manipulations or massage or things like that, and that had made things worse. So that's an easy first step. And I was like, well, I'm just not gonna, I'm not touching this person's neck.
00:33:42
Speaker
now, I might later on, you know, but I want this person to trust me. And part of what makes you a trustworthy person is that you don't make things worse. Now, obviously, sometimes that happens. But if you know in the person's history that, like, let's say, the person said they worked with a trainer or something, and I'm not trying to malign trainers, they say they worked with a trainer, and they did some squats, and then they, you know, it really hurt their back.
00:34:08
Speaker
I would not start the session with squats, right? So some of it is helping them feel confident that you are a trustworthy person because you're listening to them and you're hearing them on what they're telling you has been problematic in the past.
00:34:24
Speaker
The other thing that I like to do is give them some autonomy. And while I am in charge of what's happening, I usually tell the person, OK, well, what we're going to do is I'm going to have you do some movements and just sort of look at them and see what they feel like. I'm going to test some range of motion in this area and this area. And then we're going to try a few exercises or something like that. And then I say, how does that sound?
00:34:52
Speaker
you want the person to have some buy-in and also that's an opportunity for them to say actually is it okay you know what really helps me is if we do this kind of thing first and they're like yes absolutely let's definitely do the thing that you already know feels good first and then we'll try some of my stuff.
00:35:11
Speaker
And that way as well, you're building this relationship with the person and you're working together in a way that makes it a team effort, right? So you're giving them some autonomy, you're creating buy-in for them, you're helping them sense that like you're a person that is working with them. You're not just tossing off like, oh, do some bridges, do some clams, see you in three weeks kind of a thing. There's also the people who like to ignore their pain.
00:35:39
Speaker
And that is the person that I lovingly call the, it's fine, it's fine, it's fine person because they'll do a movement and they'll wince maybe. And you'll say something like, you know, based on what you know, oh, is that your back that doesn't like this? And they're like, it's fine, it's fine, it's fine.
00:36:00
Speaker
you may want to try to convince this person that you can help them find another way to do the exercise that they're doing that is less painful. Or what if we try something else first and then come back to this and see if it's better?
00:36:17
Speaker
And, you know, sometimes with the it's fine, it's fine, it's fine people, there's kind of a stubbornness that you might have to kind of work through. And, you know, you may have to do a little bit of kind of, you know, let's call it a force quit. You might have to override what they're wanting to do and like literally put your hand on them and be like, let's have you stop just for a second. Let's just stop and talk for a second.
00:36:40
Speaker
you know, and then you put forth your idea, what if we do this, which is gonna get the same thing, but I think might feel better for your back, try this from, and I often paraphrase it as a like, do me a favor and try this, you know, so that then that person gets to be like, oh, I'm doing Sarah a favor, I'll totally try this, you know, as a way rather than like, stop what you're doing, I don't want you to do that, I want you to do this instead, kind of a thing, it's more that, and again, that way you're building sort of a team experience.
00:37:08
Speaker
I'm gonna try it for Sarah. I would actually feel better. I'll keep doing this one, right? And again, building confidence in your ability to help them move. The other thing is sometimes people have had their pain for so long that it's very hard for them to tell
00:37:23
Speaker
whether the pain they're experiencing is happening in that moment because of the movement, it can be hard for them to tell if there are periods of time where they're not having their pain because it's been going on for years. So even the idea that a movement could be not painful just can be mind-blowing for people sometimes.
00:37:46
Speaker
And then my other category is what I'm calling people who have an objective relationship to their pain. And by that, I mean, they're not giving the pain more meaning than is appropriate. It's not that they're ignoring it or it's fine, it's fine, it's fine, but they're able to put it in a perspective based on their experiences and based on what they want to do ahead of time.
00:38:12
Speaker
And it's not always the people who have only had pain for a brief period of time. I had a patient that I worked with for a long time who had a chronic condition that was very painful, who just kind of understood that it was going to be peaks and valleys. And we were able to make the peaks higher and longer, and the valleys shorter and lower. And this person ended up being a triathlete.
00:38:41
Speaker
helping people sort of put their sense of their pain into context is always helpful as well. So we've established that if someone's pain is getting worse, we refer them out. What do we do when it's getting better? And by that, I mean, how do we help people understand that it's getting better? Because sometimes it's easier for you to see from the outside than it is for them to tell from the inside.
00:39:10
Speaker
So you can tease out some differences based on things that you're seeing. Like is when they come back and they say, oh yeah, I could really feel my, you know, glutes after our last thing. And let's say they were having like piriformis pain or something like that. And then you can say, okay, well, does this feel like the pain you had before or does this feel like kind of workout soreness? And then they can go, oh yeah, it was kind of workout soreness. It was not, and then great, awesome. And let's like highlight that, right? And you know, make a point about it.
00:39:40
Speaker
Is it, you know, you're still having it, but you're only having it at the end of the day now instead of all day long. Fantastic. You know, it means your endurance is improving and it's only at the end of the day when you're more tired that the pain is coming back, which, you know, again, I'm always sort of like, oh, it's not fantastic that you're having your pain, but it's fantastic that we're reducing the amount of daytime that your pain is there.
00:40:09
Speaker
or just really like, is this your same pain that you've been having or is this a different kind of a feeling? And especially for people who are deconditioned and who maybe don't have a real good sense of what is like sort of workout pain feel like, let's say you're doing an exercise with them and they're like, ooh, that hurts. And you're like, well, is it your pain or is it effort? And sometimes that's really, I mean,
00:40:30
Speaker
These are a lot of things that for someone like myself or like a lot of listeners who've been moving their whole lives, you inherently understand the difference. You've been doing it forever, right? The difference between this is a workout effort feeling versus this is pain. That's not always the case for people and you may have to tease out the difference for them.
00:40:48
Speaker
And the other thing that I like to use, I don't love the pain scale, the zero to 10, because it's not very useful for comparing people to other people, but it is actually useful for comparing people to themselves. So you could say, okay, well, when I met you, you told me that your knee pain was a four out of 10. And today, three weeks later, you're telling me it's a two out of 10.
00:41:09
Speaker
Right? And again, just highlighting the changes that are happening so the person can see it so that they can feel optimistic and positive and know that their body is getting better. Okay. Well, I hope you have found my monologue. Not a conversation this time. Just me talking. I hope you found this interesting. I hope you found it useful.
00:41:30
Speaker
A note to you all, you can check out the show notes for links to references that I mentioned in this podcast. And I'm also going to include a couple of book references that are really great for helping to talk about pain with the people that you're seeing and helping them understand the neurological
00:41:48
Speaker
you know, things that are going on, the sequelae for, if I'm gonna use my fancy language. You can also visit the MovementLogic website where you can get on our mailing list and that way you can be in the know about our tutorials and sales on our tutorials. You can watch the video version of this episode at movementlogictutorials.com forward slash podcast if you wanna see what my face looks like when I'm talking to myself.
00:42:15
Speaker
And thank you so much for listening. And finally, it helps us out so much. If you liked this episode, please subscribe. That is the most helpful thing you can do. And then if you've got a little extra time and you feel like it, you can also rate and review on iTunes, on Stitcher, on wherever else I have us listed, which is a few places, wherever you get your podcasts. We hugely, hugely appreciate it. And join us next week for more of Laura and my
00:42:45
Speaker
strong opinions that we hold loosely. Bye, everybody.