TEXT NECK – IS IT A THING? NO. STOP FEEDING THE FEARS AND CARRY ON.

These guys get neck pain and back pain!   

I know, I once was the military Rehab Officer for London, and had the pleasure of looking after them and all the craziness that went with it. These so called great postures produced plenty of problems. 

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These guys don’t get neck pain.

We know because the reported incidents of neck related disorders in workers with a flexed neck posture is not particularly high compared to other issues and in fact other factors such as stress seem to be more of an issue. Maybe the modern world has more daily life stresses?

 

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There are no documented notes from Monks who spent their life copying books by hand, saying my “bloody neck hurts”. They do say things like how cold it is and about the food! So they documented things but not about neck pain. 

We do know that people get “sensitized” and then feel “pain” or other things due to altered interpretation. Some of this is due to believing that they are doing things “wrong” and will harm themselves. Are you sensitising anyone with your words? I used to say nocebic words like “keep you back straight”etc,  when I believed what I was told. Then got shown a better more evidenced based way, and try and avoid it now.  

Also maybe it is out “view” of how we should look. A slouched guardsman wouldn’t look alert, a laid back worker some view as not looking productive. But is that true or just a belief. Maybe this is a clue? 

Maybe it is those peddling these thoughts that are responsible for freaking people out and maintaining discomfort or pain, and maybe it is in teh interest of the people saying this too. Alignment specialist and so on, some of the theory is built on sand and doesn’t allow for people being different.

Is there any evidence for old biomechanics beliefs?

Well what about neck shape? A Swiss study showed that habitual loss of neck lordosis for example, didn’t mean that subjects got neck pain. They just lost the lordosis. 

What about feelings of fatigue? Is that just not being used t the position?…..we could argue we should train them to get used to it. We do this elsewhere, so why not? So text away progressively folk (just look where you are going please). images

 

 

 

Why do we ask people to work their muscle to get stronger and then randomly select some exercises as not appropriate? like holding your head forward.  There is plenty of flexion in pilates! 

If you want a strange choice, how about the horrible plank hold for example. Makes everyone stiff and is an isometric load. Yet people do it without saying things like you will get “plank spine”.  I see plenty of people in my physiotherapy practice and at the movement studio, who have become too stiff from doing plank and the old static “core” exercises. My movement reasoning doesn’t see a reason for this, unless you need to be that stiff and compressed. The guardsmen thought that, but we had less back pain with a spinal mobility and decompression exercise regime for them and that is why they do the marching routine when they need to move!

Some studies and people have said text neck exists. Famously the New York Surgeon, Dr. Hansraj, talked about load ( the famous bowling ball), of the head, being a load of 60 pounds in flexion, and causing tissue failure. He can’t produce the evidence and no one can reproduce the study. Seems he just said it !. But what an effect in the media.

Can the tissues fail …well, with difficulty… it takes a massive load to damage the neck structures. A Bristol research group showed that it took over 500 lbs to cause tissue damage to a flexed neck in cadavers. A bit more than the suggested limit.

Other studies often quoted, such as a Brazilian study in 2014, suggested text neck existed, but the methodology was shown to be flawed on deeper investigation. They only looked at people with pain.

An Iranian study of computer workers suggested work posture as the issue but failed to exclude work stress from its evaluation, So you cannot blame the posture. This is a common flaw in studies. Correlation does not mean causation. Of course google is not a reliable source for the answer either. 

Where does this leave us?

Well, in a great place. We moved away from all that postural alignment and plumb line stuff years ago. We recognise that pain is a sum of many things in life so we can’t just blame structure and load. 

So ignore the fear mongering and poor science and be reassured the neck and spine are robust. Don’t stay too long in one position, none of us like it and all get the urge to move. Don’t let someones false instructions or old paradigm of guidelines imprison your body.

We are movement people, so let’s get people moving in ALL directions and positions. Educate them to play with all directions, speeds and combinations. Educate them that there is no wrong posture and variety is the way forward. There are potential better strategies for some tasks and learn those skills to do them. 

The evidence is strong for moving with neck pain and  back pain especially. Indeed most issues with the human body we know should be moved. 

As movement teachers you have plenty of good evidence based things to teach. It’s a harder path than using “common media beliefs”, but rewarding and honest. 

We are in an era started over ten years ago of trying to overcome peoples fears with spinal and body issues. Don’t reinforce these but help people to reduce them and move fearlessly and joyfully.

Move them and reassure them.

Remember you should be giving people, Permission to Move.

Happy to chat over this one …………………..

Cameron 

The Healthy Neck workshop is a start 

Check out: 

www.ergotonics.com

References

1. Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head.

Surg Technol Int. 2014 Nov;25:277-9.

2. Przybyla AS, Skrzypiec D, Pollintine P, Dolan P, Adams MA. Strength of the cervical spine in compression and bending. Spine. 2007 Jul 1;32(15):1612-20.

3. Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. European Spine Journal. 2007;16(5):669-678. doi:10.1007/s00586-006-0254-1.

4. Kumagai G, Ono A, Numasawa T, et al. Association between roentgenographic findings of the cervical spine and neck symptoms in a Japanese community population. Journal of Orthopaedic Science. 2014;19(3):390-397. doi:10.1007/s00776-014-0549-8.

5. Richards KV, Beales DJ, Smith AJ, O’Sullivan PB, Straker LM. Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents. Phys Ther. 2016 Oct;96(10):1576-1587. Epub 2016 May 12.

6. Brink Y, Louw QA. A systematic review of the relationship between sitting and upper quadrant musculoskeletal pain in children and adolescents. Manual therapy. 2013;18(4):281-288.

7. Griegel-Morris P, Larson K, Mueller-Klaus K, Oatis CA. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Physical therapy.1992;72(6):425-431.

8. Ruivo RM, Pezarat-Correia P, Carita AI. Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain. Brazilian Journal of Physical Therapy. 2014;18(4):364-371. doi:10.1590/bjpt-rbf.2014.0027.

9. Nejati P, Lotfian S, Moezy A, Moezy A, Nejati M. The Relationship of Forward Head Posture and Rounded Shoulders with Neck Pain in Iranian Office Workers. Medical Journal of the Islamic Republic of Iran. 2014;28:26.

 

FEARLESS SPINE

Cameron Angus – Moving evidence based practice forward in the movement world.

The recognition of best practice for the treatment of  back pain has radically changed in the quality literature in the last ten years. The implementation of this has been slow as it challenges practitioner and client belief systems.

A biopsychosocial approach to tackling back pain is not new, but the implementation of it and the skills to deliver it, have proved difficult to implement, as many hold onto the familiar biomechanical ( structural) model alone. We recognise that those “ old discs”, dodgy facets, spines needing to be aligned every month etc, are just not a true story anymore, potentially scare our clients and make them reliant on passive interventions.  Along with our better understanding of pain science and how to explain it, we have better tools to act on best evidence and improve our clients lives. 

Clients / patients have been and still are sold a model that “scares” them. Don’t bend, sit straight, strengthen your core and more.

This often produces kinesiophobia, or fear of movement, which becomes more of an” issue” than any physical “issue with the tissues” problem. 

We all know someone who has been told to look after that 20 year old disc problem!  

Guarding against “ possible” pain, ironically potentially produces pain! Too much core can equal too much tension and worsen things.  

 

In practise I spend more time teaching a “ releasing, mobilising approach than strength and bracing!

The measurement of kinesiophobia is probably more relevant (and more accurately done) than how far someone can bend or not. There are some great tools to use that are fantastic outcomes for your practice. Measuring peoples attitude to movement is crucial.

Structuralism is crumbling on shaky foundations. The reliance on structuralism as an explanation and therefore cure for back pain is endemic. It conveniently fits the postural model that has been, and sadly is still frequently taught in isolation, it allows for a prescriptive solution …. even gets results ! But are the results from this or from other reasons? Other forces are at play. If you only have one view, then you only see what you want to see. 

Fearless spine helps you get comfortable with the letting go of the old model and recognising the human with all those emotions, beliefs and experiences in front of you. It recognises you as someone giving clients permission to move. The client who rolls like a ball because they trust their spine, not just because they can hold a shape. These clients will reap potential spinal freedom from your coaching confidence skills and better view of how the movements you teach are really working, to give them movement with fearless joy again.  

Cameron 

Teacher ? Fearless Spine is a programme for teachers of back pain sufferers which over two days reviews the evidence for this approach. Teaches improved language and cueing techniques and teaches movement progressions to build a fearless mover.

Come and do the fearless spine workshop and don’t look back…http://ergotonics.com/workshop/fearlessspine

Fearless Spine1 with Cameron Angus video for pilates teachers available here:

https://bodycontrolpilatescentral.vhx.tv/videos/tutorial-fearless-spine-part-one-with-cameron-angus

Back pain sufferer looking for a way forward ? Our client programme is an intense rehab three days working with an individual to teach and do our approach. Leaving them with an individualised programme to move forward with.

 Join us for an intense rehab period. More info at : info@ergotonics.com

MORE THAN THE CORE

MORE THAN THE CORE

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Cameron Angus

Pilates – “Oh that’s all about the core”. I often hear and read this as the summary of what Pilates is. Well when I do see or hear that I grasp the wonderful opportunity to respond with a smile and explain the understanding I have of Pilates.

Yes it has plenty of “core” work (a term means many things to different people). Pilates to me was always the controlled flowing movement education system, I know and teach. The one that dancers and movement people, flocked to, and still do.

 

It has guiding principles from its founder, of which centering and control, as in stabilize and work from the “core” are only two. It also has the principles of:

 

Breathing

Concentration

Precision

Flow

 

Pilates should be taught with breathing awareness, concentration on how you do it and “feel” it, precision and importantly FLOW.

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As a physiotherapist for over 30 years I saw myself and still see myself as a movement teacher. I have experienced and taught many movement systems but the Pilates I found 30 years ago, when some ballet dancers showed me their “Pilates”, has always resonated with me. I have been blessed with opportunities to teach and be taught around the world. To meet so many teachers and philosophies. I took what suited me, and my view with my scientific and artistic head, while respecting theirs. I think Pilates is a great approach to movement. There is no doubt that it has overlaps with many other named systems. I enjoy Yoga, Tai Chi and others.

 

When you watch a dancer move, we recognize the harmony of so many parts of the human jigsaw. Strength, mobility, control, efficiency, poise and joy.

Pilates in my view is about the journey to create that in ourselves. You don’t have to be a brilliant dancer. Just dance! I call it a flow state, those moments that we experience occasionally and then constantly seek. Our moves seem effortless and we experience something special. Have you danced when no one is watching? Had a spring in your step walking?

Some of us have longer journeys to achieve this, on roads with more twists than others, but whatever the journey, it should be a fabulous uplifting experience overall.

I have seen the trend in the rehab world of making people stiff and muscles “overactive” or always switched on! The “core” obsession. Most patients of mine (spine, pelvis etc) need to relax and move rather than strengthen. It is this component, movement, and reducing the fear of it, that helps most. The science supports us more and more in this approach.

 

Embrace Pilates as “some core”, but a whole lot more. You should be able to put what you learn into all aspects of life. Walking, sitting, reaching even sleeping are examples.

The smile of pleasure you break into as a result of feeling the pleasure of moving is an emotion we seek. That emotion itself is good for you. A legal drug rush! The mindbody word is used a lot nowadays, this is a good example. It’s not just about being stronger or more flexible. It is a complete experience that we seek.

A good teacher shows you a way to achieve this and lets you fly.

You should enjoy moving, being moved and showing your moves. Whether you dance alone or with a tribe……Pilates on

 

Cameron

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PERMISSION TO MOVE

PERMISSION TO MOVE

See the movement possibilities in all.

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Mary swears by Yoga as the thing that rid her of crippling backache, John enthuses that Pilates was the only thing that cured his spinal pain, Linda tells anyone who listens that the Alexander technique is the only way to resolve back pain.

The quest to find a holy grail, and then hold it up as THE reason why things work, has seen a myriad of answers. The biomechanical passion for blaming structures and giving appropriate solutions fits the popular story and common framework people have of their bodies. We have had the “core” army, the disc movers, the surgical slashers, the nerve obliterators, the muscle lengtheners, the trigger point pressers, balancing, lengthening, strengthening and releasing performers.

Reading another superb convincing story of why a certain popular movement “approach” has worked for back pain, or some new research shows another approach is effective for back pain, is becoming a regular story and a confusing diet of never ending back pain treatment possibilities.

All these success stories and evangelist messengers, along with an equal number seemingly prepared to say how each of these approaches made them worse, is confusing!

But a common theme runs though this.

People are only worried about their pain at first and not bringing it on again. After being shown scary “worn and prolapsing discs” pictures and being told scary “ don’t flex your spine of an 80 year old” stories. The scenario becomes one of not just the original pain, but also the concern that they have for these broken/maladjusted parts. If your car had a worn part you would drive carefully!!

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The fear of movement rises like a spook in the night. It is there waiting to pounce with the wrong movement, position or weather.

BUT whoa

Firstly pain is a sensation that you brain produces in response to the information it receives and more importantly, its interpretation of this information as a possible threat. (More on this in my blog on pain)

Secondly the “not looking like new” structures, whilst potentially mechanically limiting and altering movement, are often a natural consequence of aging (“the wrinkles inside”) and even if due to injury, the effect is the same. That is, altered mechanics, balance of tissues, altered nerve input to the brain. Some which will be nociceptive (trouble signals) and that is it.

Emotionally, if you have had explained to you, or more than likely, probably been surrounded by information that wear and tear and broken bits are bad and need fixing, then you are “on guard” and nursing the worn bits along. This sets up an often-subconscious reaction to guard against further damage, threat or pain.

And it is the right thing to look after your body ………..If the threat is real

SO many scientists present with what looks like on the surface, conflicting thoughts.

And there are so many practitioners who like to use the selective bits that supports their views, practice and aims.

I have always had a pragmatic view of research and what is actually said.

I was never comfortable with some of the evangelistic approaches in my profession and those around me. I struggled with so much of what surrounded me as “good practice”. And i am proud of the fact that I asked awkward questions of the system.

recently i observed yet again the debate in the spinal exercise world ( this was pilates) about the lovely perceived opposites of McGill and Hodges, brace or subtle timing. And saw yet again an example of taking what you want from the argument to support your beliefs, when actually there is lots of common ground. I wanted to say that they are both right.

Why? Because it is about the task at hand. If you want to push your car then you better brace your torso so you can transmit massive load and not buckle at the spine or elsewhere and transmit load. If you want to reach for a beer on the bar then you only need low spinal activity and not the big bruiser muscles, and you shouldn’t have to think about it ( automatic) It is inappropriate if you brace everytime to move. But if you have taught yourself to recruit one gang more than another then they will potentially kick in every time. That’s inappropriate too. (Death to the plank).

Overactive (guarding) muscle action stresses tissues/joints in a manner they are not supposed to be. It also influences how we move. It prevents a smooth synchronized action of all muscles.

If your brain is convinced of a threat to the body then it sets up a guarding reaction and potentially pain.

My Point

Pilates like so many approaches ( physio, yoga, dance) is a way to give people “permission to move” and teach them how. A road map for progressing the joy of movement. We now know that this is probably THE most important aspect of back pain and general health treatment and prevention.

I was never fussed about the obsession with the “core”, and the teachers I have had, and the good ones I have worked with, never were.

I liked them because I saw that they had a gift to get people moving well. Let me say that again “get people moving”.

I trained as a physiotherapist in the 80’s and had to be able to give all sorts of exercise classes to people in rehab. I recognized the gifted physios had the knack and skills to get people moving again. They overcame the fears and doubts they had. I knew technically proficient people who didn’t get results and less technically able achieve great results. I began to realize that it was a delicious mix of technical skill and more importantly cognitive skills that was getting success. The ability to communicate with a patient and get them to overcome their fear of moving.

I worked in large rehabilitation units where at the beginning of the day everyone “moved to music”.  The day was full of a positive atmosphere. The cognitive effect of this was massive and a major part of why the rehab worked.

I also recognised the “theatre” of a consultation and would often give acupuncture etc. to support the “occasion”, as I didn’t have the complete skills at the time to negotiate wellness. I didn’t completely understand, but I knew something else psychologically was going on. It was a legitimate experiment. We know even more now, that that is how these therapies work.

Recently we have seen much more research to support this “reducing fear” effect. More and more tools are appearing to help deal with is, Explain Pain, and cognitive therapy approaches to name a few.

Movement practitioners are  a mental as much as a physical coach. Understanding clients’ thought processes and beliefs is paramount; finding the clients particular “groove” is the key. The “snake oil” effect works like many therapies seems to work, via the positive talk and strong belief that it would work. A client presenting himself or herself to you has already made some decisions to try your “magic”. Don’t misunderstand me, appropriate treatment has its place, but not inappropriate and medicalising people.

It is important to use your paradigm. The movement theory is valid, just not “the” most important thing. People need to learn how to move /use their bodies but it is only one part of the jigsaw. The person in front of you expects a certain approach that’s why they chose your method. When you have them in front of you take the opportunity to reduce any fears and doubts and give them a positive belief in movement.

This is challenging if you have hung your hat firmly on a certain peg and invested lots of time and money on this. It has its place but maybe its time to come out of that box.

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MESSAGE
As a movementeer you are able to give people “permission to move”. Your ability to tune into a persons present beliefs about their movement and limitations and release them is the key to success. The science recognizes the fear of movement people have and importantly gives you Permission to move them

PILATES, NASTY DISCS, PAIN AND SCARY STORIES

PILATES, NASTY DISCS, PAIN AND SCARY STORIES

Cameron Angus http://www.ergotonics.com

I love seeing the power of social media to allow groups of like minded people, to interact and share their experiences. Life is life and we all have different experience and knowledge to share. Every now and then I feel it is important to contribute beyond teaching my workshops and lecturing. That’s what I did recently when I saw the dreaded ”pain nerve endings” quote. It’s one of those old sayings that is unhelpful, and in my view a “Health care Halloween” saying. I have always been involved in a robust professional world, where it is ok to challenge and help understanding. Not that I am always right. Especially as I was originally taught some complete rubbish (great stuff also) in physio college! We all can’t know everything, but some nuggets are important and pain science and advances in spinal care are. For the world of movementeers ( aka physio, pilates, etc) it is crucial. Recently on social media, I just agreed to have a different interpretation of things than a learned colleague who thought a knackered joint means pain without doubt. I also recently saw the dreaded pain nerve endings and horrible scary Halloween like “nasty bulging disc” pictures. Just to scare the shit (movement) out of people. So while I am all for “other” views, I am just putting another. It’s mine (and very eminent others). Peace and love to those who think otherwise.

Pain is an output. Plain and simple. It is the brains creation and response to its interpretation of a number of inputs. The nocioceptive or “potential harm” signals (a term invented by the famous neurologist, Sherrington) are the

common signals we think about as “pain producing”. These include for example, pressure, chemical irritation (inflammation), trauma and dysfunctional tissues (issue with tissues). But it is not conscious pain until you add emotion, past experience, cognition, and all manner of other sensory inputs. The “computing of threat” is the factor that translates these factors into pain, or not. If your past experience of the input is pain or threat to your health and safety, then good chance you are going to compute pain again. If you don’t see that bee sting as a threat then good chance it will not be so painful. Your movement client may have a known disc bulge and can do everything without worrying, whilst another is hypersensitive and reluctant to do certain things, as their interpretation is different.

The dominant paradigm is still a very biomedical model. We love to think of structures and mechanics, and things that go wrong. This is important but not necessary painful. This system makes sense, is logical and must be true! Injury or function can be easily explained that way and perpetuated in popular “olde world” speak. In fact most of us were trained like this originally and clients are still fed this story.

Whilst I am not saying that structures don’t break, wear down and stop functioning; that does not mean pain is inevitable. It will mean an input to the brain but it is still not pain until the inputs are computed as a pain response. You can read the Zen of motorcycle maintenance in different ways!!
Either the constant mechanical tuning or the confidence and mindfulness of the rider/machine relationship!

The person, who has a severe injury but is in a dangerous place, will tell a story that they had no pain, until they had become safe from that danger, or had maybe helped another. The overriding need for safety stopped the message of pain, at that time.

I have seen this first hand. I was a soldier, and saw first hand this response on people with brutal trauma. I didn’t need this to understand the body’s response, but it has certainly reinforced the knowledge I have. Similarly our brain can shout “pain” in a part of the body that physically doesn’t exist. Ask any amputee with phantom pain! Another example is the extreme worry about experiencing pain again and the hypervigalence that occurs. You can “light up” your nervous system easily or be so worried by the rubbish told to you about that “nasty “ disc or knackered joints that means you then go nowhere and do nothing, because of the cotton wool you are wrapped in.

The key point is that it is not just nociception (read damage, injury, malalignment etc.) that causes a pain response in the brain. It is not that bulging disc, worn joint or torn muscle alone. It is the perceived threat in your brain. The very powerfully perception of danger is the sum of many inputs. You have no “pain” nerve endings and this language has been debunked in the medical literature for a few years now. The old Descartes model of damage/input equals pain should not be on the radar anymore.

A study using MRI on individuals who had never suffered from low back pain revealed that one third had a substantial spinal abnormality and 20% under the age of 60 had a herniated disc.
SO a bulging disc on its own does not mean pain. Nocioceptors send “not as new signals” to the brain but they are not necessarily regarded as a threat or pain. This requires lots of other inputs to come into reckoning and then match a response that is appropriate. With movement it may be either get away from danger or don’t move, as it may make it worse. Overriding the signals that may cause an inappropriate pain response is where we can contribute as movement professionals. All of us have rubbed somewhere to alleviate pain, this works by crowding out the “potential pain producing” signals with something else. This is how non-threatening movement can help. You bombard the brain with “good juice” inputs from other movement feedback, and this reduces the threatening feedback. A common example is exercising the opposite limb. Every one can do something (even if it is only the hand jive!) Neural compromise in the spine is another thing and the subsequent results are the normal reason for surgery (e.g. cauda equine symptoms) Research shows that surgery is no better than conservative care a year later.

Peul et al found that operating relatively quickly on a herniated disc causing sciatica “roughly doubled the speed of recovery from sciatica compared with prolonged conservative care.” However, that sounds a lot better than it is, because a year later there is basically no difference between people who had surgery, and people who didn’t. In fact, “These relative benefits of surgery, however, were no longer significant by six months’ follow-up, and, even at eight weeks, the statistically significant difference between treatment groups in primary outcome scores was not sufficient to be clinically meaningful.”

In other words, the effect of surgery is pretty underwhelming. This graph shows this very clearly:

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I am a constant advocate of movement and the literature supports movement as best practice for so many health issues, especially spinal dysfunction. I love pilates because it gets people moving through full ranges and in all directions. Fingertips to toes and the use of opposition and brilliant movement cues are fabulous. The unfortunate “kidnap” of pilates by the core stability people, and the misunderstanding of what it is, is a shame. But we literaterally “move on”. We find clues and answers to pilates and movements effectiveness, when we look in the right places. For those with back issues it works on many levels, but very importantly it encourages movement. We know that the fear of movement or kinesiophobia, is probably the biggest problem they face. So it is already a great start when your client turns up! The willingness to instigate a movement programme, is half the battle in resolving back pain. It is already a part of the brain saying, “lets do it” and overriding the “lets not do it” or “maybe pain” response. Overcoming Kineseophobia or fear of movement and the positive cognitive effect are crucial.

The “talk “ given to patients or clients is one of the most important aspects of modern back care and pain management of any problem. If you paint a picture of pain nerve endings and badly damaged tissues (issues with the tissues) then that will be an issue in itself. It flys directly against the evidence of people with NO pain having similar MRI / damaged tissues pictures. It is why I cannot order X- rays / MRIs unless other factors present, as the evidence and guidelines are clear (although some professions ignore this). Plastic spine models with nasty red (read danger) prolapsed discs do a disservice and create fear. They are Halloween props! Cut off your “bulging angry” disc prolapses or paint them in a neutral colour now. As a caveat there are times to act with disc problems and these are when there are signs of neural compromise. Then and only then should

people be operated on. Oh and talking of Halloween, make sure you keep that warm friendly empathetic attitude. Love eases everything.

Things are not always what they seem!

The biomechanical model alone is out of date, and has been for a while. In fact we know it potentially worsens things and potentially creates chronic pain states and hyper vigelance.
So movement people, I am not saying ignore prolapsed discs or damaged tissues (issues with the tissues), but be aware, that they in themselves do not need to be the reason for pain, clients hesitancy to move, or in fact our own hesitancy to encourage.

Think about how you can explain, that these inputs do not have to mean pain. It is an art in itself. Make sure you recognize that the pain is real but is not solely for the mechanical reasons they believe or have been told. Explain that people with no pain have bulging discs and “ dodgy” MRIs. These inputs or scary pictures and terms do not mean disaster. The modern movement worker at the appropriate time, uses skills to initiate mindful, purposeful, non-threatening movement, which give powerful sensory, “okay” messages about an injured site.

Hip and ankle movements for an injured knee for example. If a client is referred to you or given the all clear, then that’s a green light. Twist the throttle and go!

Movement instructors should be less fearful, as their fear transmits to clients. You wind each other up! Be confidently cautious with clients and your support will go a long way to helping them.
Be truthful about pain and those “nasty” stories. Don’t sell “snake oil” or quackery either.

Respect for clients’ beliefs is important, the pain they get is real. I always enjoy the slow task of changing peoples beliefs in a positive enlightening way. The trick is not to challenge them too much, but just enough to warrant change. Let their achievements and increased understanding, help them along. As movement people we have the daily gift to get people moving. Such a fabulous job, and after over 30 years I personally still get a kick out of it. So go to it with I hope, another view of this field.

I can recommend the NOI blogs (www.noigroup.com) and the brilliant Explain Pain book plus the list below. It is not exhaustive, but a help to see my (and others) view on things. I hope this side of things helps explain my reason for disagreeing with others and it is my interpretation that I have and teach. Namaste

MYTHS

1. Pain comes from a ‘structure’ in the body — e.g./ a disc, a joint, a muscle.
2. The amount of pain suffered is related to the amount of damage or the extent of the injury.
3. Pain is in your mind if there is no obvious cause in the body — i.e./ via scans, x-rays etc.
4. There are pain signals from the body to the brain.
5. Pain is separate from how you feel or think.

You are directed too much more eloquent writers on pain. People and groups such as NOI, Body in mind, Butler, Lorimer Moseley, Peter O’Sullivan and my early reading with Louis Gifford.

1. Butler DS, Moseley GL. Explain pain. Noigroup Publications, 2003.

2. Koes BW, van Tulder M, Lin CW, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010;19:2075–94.

3. Waddell G, Nachemson AL, Phillips RB. The back pain revolution. Churchill 4.

4. Indahl A, Velund L, Reikeraas O. Good prognosis for low back pain when left untampered. A randomized clinical trial. Spine (Phila Pa 1976) 1995;20:473–7.

5. Teaching people about pain: Why do we keep beating around the bush? G Lorimer Moseley Pain Management
Vol. 2, No. 1, Pages 1-3 , DOI 10.2217/pmt.11.73
(doi:10.2217/pmt.11.73) http://www.futuremedicine.com/doi/full/10.2217/pmt.11.73

6. LORMER MOSELEY TED talk on pain

7. http://www.bodyinmind.org
8. O’Sullivan P – For some useful articles -www.pain-ed.com