OVERCOMING THE FEAR TO MOVE

Presented By

Yousuf SYED

12 YEAR CAREER - SPORTS MEDICINEFOUNDER/DIRECTOR OF SPINE & SPORTS PHYSIO

OVER 30,000 TREATMENTS SPORTS INJURIES & PERFORMANCE

OVERCOMING THE FEAR TO MOVE

Do you have a client who is in a persistent pain cycle

Is your patient an over achiever Does your patient work more on good days

and less on bad days Is your client a people pleaser and finds hard

to say NO Is your client a Can’t Do Person

SCULPTING BRAIN & BEHAVIOUR

EXPLAIN PAIN• More they understand it is easier for them to cope with pain • Complex • Sensitized Central nervous system• Soft Tissue healing 3-6months• Pain Tissue Damage

EXPLAIN PAIN

Your brain has the final say about what is painful.

You do not feel pain in your tissues. You feel pain in your brain. “Are you saying that the pain is all in my

head?”

EXPLAIN PAIN

Yep, no brain, no pain! But, your pain is very real. As your time living with pain increases, the

involvement of the tissues reduces and the involvement of the nervous system increases.

EXPLAIN PAIN

PAIN

AMPLIFICATION

SPASM

INJURY

(ILLNESS)

Physical

Stressor/s

Emotional

Stressor/s

MINDBODY

Restricted Movement

Guarding Postural

Changes

Muscle Tension

PAINThought

s

Feelings

Chronic Pain

Pain Signal

Emotions – Fear, anger may amplify pain signal

Thoughts- Self defeating thoughts “I can’t stand this” –Giving up make experience worse

Behaviours – feed back to brain about severity of problem- Eg asking help for simple tasks, giving up enjoyable activity

turning down invitations, staying in bed

Social Responses – negative messages “you are a burden”extra help – if told sick, helpless difficult to not feel that way

INVESTIGATIONS

After the age of 25, most of us will have some NORMAL degenerative changes. One study showed that up to 35% of people who have never experienced low back pain had herniated discs (Weishaupt D et al). Instead of dwelling on what was seen on the image, we should be more concerned about dysfunctional joints and muscles. Maybe it’s bad posture, joint restriction, poor lifting habits, or instability that needs rehabilitation.

SELF MANAGEMENT

1. Acceptance of pain …… the moving on2. Building a Support Group – friends, family, Dr,

PT, OT, Dietician, Psycologist, Pain Support Groups.

3. Pacing Goal Setting Being Patient with themselves Learn to prioritise and plan out everyday Activity – Exercises and Stretches Dairy – Track progress Have a set back Plan

4. Learn Relaxation Skills , Distraction, Mindfulness, Cognitive Behavioural Therapy

5. Keeping it up

GOAL SETTING Activity goals should be set in three separate domains.

The physical domain is the exercise program the patient follows and includes the number of exercises to be performed, the duration of exercise, and the level of difficulty.

The functional domain involves tasks of everyday living such as housework or hobbies.

The social domain relates to pleasurable social activities (e.g., visiting friends, going to church or the movies, going for a walk). Goals must be personally relevant, interesting, measurable, and achievable.

Goal setting should be a matter of negotiation between the patient and the therapist.

GOAL SETTING The use of goal-setting charts is essential Set a target for activities each week Record your achievements on the chart, Note the nature of any difficulties and how these

will be tackled next time, and make other comments.

For example, comment on your performance or on the appropriateness of the goals you had set. In this manner you and your PT can monitor your progress and improve you accuracy in goal setting

PACING

• Pacing involvesa daily activity routine that is easily achievable.

• Discuss activities pts used to enjoy doing but avoid due to pain

• Activities can be gradually increased by number of movements, distance or time.

PACING

Gradual, controlled increases in general activity level will avert triggering sudden increases of pain that lead to reduction of activity.

Eg. Can be used for any type of physical activity including specific exercises, household tasks, hobbies or work duties.

ACTIVITY Can do on a BAD DAY

Can do on a GOOD DAY BASELINE

Walking 1km 2km 1.4km

Sitting at a computer 10min 15min 11min

Bending forwards

Reaches hand to mid

thigh

Reaches hand to floor

Reaches hand to knee

PACING Pain is not directly

related to strength of pain signal, disease severity and tissue damage

Don’t Use- no Pain no Gain, let pain be your guide

UNDERSTAND YOUR PAIN so you don’t fear it

Hurt does not always equal harm but doesn’t mean you go do a marathon

EFFECTIVE PACING

Too Much ActivityIn order to catch-up

NO ActivityIn order to recover

SET BACK PLAN It is almost inevitable as CNS is so sensitive and

trying to “protect body” Relapse may be due to an individual physical

event or it may result from cumulative physical and psychological stresses

Patients must Discuss with GP, nurse, PT to help to identify situations that are challenging and develop strategies to cope with them.

Strategies may include setting criteria to visit health professionals, to use pain medication, or to briefly rest and relax, meditation.

SET BACK SELF-MANAGEMENT Activity modification (e.g. changing the pacing

parameters, altering the time of day, even the room and other contexts),

Active rest periods (breaking up activities into sections including having rest breaks),

Relaxation (e.g. breathing, music, gentle stretches),

Mindfulness based stress reduction and distraction.

Remember : flare-ups end and more angst triggers further physical responses and pain.

Short Term & Long Term

Goal Setting

What is patient’s baseline?

Create the

Pacing Diary

Start Pacing

Include progression

+ Set Back

Management

REFERENCES

Butler, David S., and Mosley, C. Lorimer. Explain Pain, First Edition. Australia: Noigroup Publications, 2003.

Doidge, Norman. The Brain that Changes Itself. USA: Penguin Books, 2007.

OUR VALUES

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cease to exist

We sports.

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