Lorraine Davis

June 13, 2023

Exercise, Healing Pain, Health and Wellness, Holistic Body, Movement, Physical Therapy

Exercise and Chronic Pain: A Guide

Lorraine Davis

June 13, 2023

Exercise, Healing Pain, Health and Wellness, Holistic Body, Movement, Physical Therapy

It is well known that exercise is an extremely beneficial activity that can elicit substantial improvements in many different measures of health, well-being and fitness.

Exercise is a broad category, as there are many different types and manners in which exercise can be carried out. (See Movement, Physical Activity, & Exercise blog for more information.)

There are many factors to consider when determining what kind of exercise might be best for an individual. These individual considerations might include health conditions, fitness level and experience with exercise, injuries, goals, cultural factors, socioeconomic status, access to safe spaces to exercise, personality, and the existence of chronic pain. One size does not fit all when it comes to exercise.

At the Wellness Station, we provide holistic care based on the biopsychosocial model, which takes these differences into account to create individualized movement programs.

Can Exercise Help with Pain?

Pain is an extremely complex, subjective experience, it is difficult to apply generalizations to this topic. That being said, exercise can be extremely helpful for individuals with chronic pain for several reasons.

However, individuals with chronic pain may become more physically inactive which may be due to fear-avoidant behavior (they may avoid movement for fear of triggering their pain), depression, or many other reasons.

Inactivity can make chronic pain worse, as the tissues of the body will become deconditioned, inflammatory processes may increase, and weakened tissues may become more likely to be irritated and strained from acute stressors.
Exercise, when performed appropriately, can have tremendous health benefits for all individuals, those with chronic pain included. Engaging in intentional exercise can help improve metabolic, cardiorespiratory, and musculoskeletal functioning, and also triggers the release of endogenous hormones (endorphins) that help us to feel good and decrease our sensitivity to pain.

Exercise can improve the confidence we have in ourselves and in our painful body parts, which can also help with our experience of pain. This confidence helps us feel empowered to make positive changes, and less limited by fear of movement.

Targeted exercise can help to nourish tissues with fresh blood and nutrients and improve tissue strength and resilience.

It is clear that exercise is helpful for pain both directly and indirectly, but one must consider how exercise might be applied differently for someone experiencing chronic pain compared to an individual using exercise solely for fitness gains.

An Exercise Program with Chronic Pain: Factors to Consider

The interventions chosen at the Wellness Station are highly individualized, as the intervention will depend on the unique characteristics of the individual.

The individual will be encouraged to be generally more active in physical activities that are enjoyable and do not trigger pain.

If the activities (such as walking) do trigger pain, it is a matter of changing the movement patterns involved in the activity. Often, people with chronic pain experience a pain pattern during specific activities because they have adopted compensatory, stressful and inefficient movement patterns. Unless these patterns of movement change, the pain cycle may continue. It is our job at the Wellness Station to identify these movement patterns and help you to change them.

In addition to changing movement patterns, we can also make changes in the parameters of the activity (including the frequency, intensity, or duration of the activity). For example, engaging in several shorter walks throughout the day rather than a longer walk, if long walks trigger pain.
The individual will learn not to push into pain, as this oftentimes will reinforce the pain pattern, contributing to flare ups. Rather than pushing into pain, the individual should learn how to listen and respond to the pain, as pain is your body’s way of communicating information to you. Contrary to the popular mentality of “no pain no gain”, “it’s got to hurt to be effective” when it comes to exercise, if you want exercise to be helpful for your pain you must take a different path.

The movement program should also include specific, intentional practices that directly and/or indirectly involve the affected body area. If low back pain is the problem, the movement program will most likely involve the low back, whether that is performing movements that improve mobility, strength and control of the low back, or perhaps improving the movement capacity of a related body area (e.g. mid back or hips) to help spread out the forces of movement over more of the body. Engaging with the involved body part in this way is helpful not just biomechanically, but also psychologically, as it will improve the confidence you have in this area.

The movement program for an individual with chronic pain will likely be progressive, meaning it will increase in complexity over time, but the progressions will often be much more gradual than a program that is more oriented towards fitness gains. The parameters of the program and the decision to progress will be based on evidence of neuromuscular learning, comfort, and effect on the pain pattern. By contrast, progressions for a program solely for fitness would likely be based more on the subjective challenge of the activity (e.g. it begins to feel too easy).

Enhance your Fitness for a Better Life

Physical fitness can be described as the ability for all body systems to work together in order for us to maintain health, and perform daily tasks with ease. Strength, balance, agility, cardiorespiratory endurance, and body composition are all components of fitness. It is extremely important for all of us, including those of us with chronic pain, to maintain our fitness through exercise. As we age, it becomes harder to maintain our fitness, as our muscle mass and bone density begin to fade unless we regularly strengthen ourselves. Maintaining and enhancing our fitness will help us stay independent, active and involved in the activities we love, while helping us avoid falls, fractures, metabolic diseases, and more. Pain is often a huge barrier that discourages people from exercising, so addressing the pain as described above can contribute to improvements in fitness overtime.

At the Wellness Station, we use movement to empower people with and without chronic pain to take control in order to live happier, healthier lives.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

Images:

Lorraine Davis

May 16, 2023

Health and Wellness, Holistic Body, Movement, Exercise

Guide to Structuring Your Home Exercise Program

Lorraine Davis

May 16, 2023

Health and Wellness, Holistic Body, Movement, Exercise

Throughout engagement in the process of physical therapy, many individuals struggle with parameters of their home program. How often should I do the exercises? How many sets and reps should I do? Should I feel pain or stay away from pain completely?

Notice what all of these questions have in common: “Should”

Traditional physical therapy tends to be very prescriptive. Pre-filled templates with “3 sets of 10” of this, “2 sets of 20” of that. For many individuals, this cut and dry prescription makes sense, and creates a clear structure for engagement with the exercises at home. However, consider what this rigid structure deprives you of.

By the therapist deciding on the exact parameters of your home program, agency may be removed from the individual. The performance of the home program becomes less about facilitating a positive engagement with one’s body, and more about what you should be doing- a task to check off the to-do list.

Okay, so… there shouldn’t be any structure to my home program?

Our lives are a constant dance between rigidity and chaos. Too much structure, we have rigidity, close-mindedness, decreased spontaneity, and limited options. Not enough structure, we have chaos, confusion, and a loss of direction. How do we find a healthy balance?

The structure of one’s home program is highly individualized based on person, environment, and goals. What works for one person may not work for another. What works for you today may not work for you tomorrow.

Sometimes life is busy. Sometimes our environment is not conducive to completing our home program. Sometimes we don’t feel good. Rather than seeing the completion of your home program as all or nothing, how can you modify it to fit into your day regardless of what is going on in your life?

Consider creating a loose structure, with room for adding and subtracting

Perhaps practicing the whole series of movements in your routine can only happen three times this week. However, what about five minutes here and five minutes there to engage with the movements in a way that fits in with the rhythms of your day?

You find yourself lying in bed for a few extra minutes and you try bringing your knees to your chest, or rotating from side to side.

You are standing in the kitchen waiting for the water to boil, and you find your hips gliding.
You are getting up and down from a chair, and you decide to practice three additional sit to stands with awareness of your body mechanics.

Questions to ask yourself

Learning how to direct your own care is ultimately what we aim to teach you at the Wellness Station. Consider asking yourself the following questions to enhance this ability-

If I were my therapist, what might I want to know more information about?

Consider a situation in which you are engaging with physical therapy, but you feel that you “aren’t getting better”, or the exercises aren’t “working”. If you were your own therapist, what would you want to know more about?

How often do I spend time with the movements?

When our home program is a to-do list item, it can be very easy to rush through it and let it slip through the cracks. If you are spending no more than 10 minutes total each day engaging with yourself through mindful movement, and wonder why the therapy is not more effective, then the answer may be that you are not spending enough time with it. If you want to learn the language of your body more fluently, you have to practice.

It may be helpful to have a goal of how long you would like to engage in the movements, perhaps at a specific time each day. For example, 20 minutes in the morning before breakfast.

To further enhance the therapeutic effects, take 10 minutes here, five minutes there, two minutes here, five minutes there, to re-engage with the movements throughout the day.

Am I working “on” my body, or working “with” my body?

We could spend all the time in the world on our home programs, but if we are not doing the movements as intended, they will have little therapeutic benefit. If the way you are engaging in your movements is to accomplish a task, push through pain, or to just do what you think you’re supposed to be doing, then the intention is missed. The completion of the movements is less important than the manner in which they are performed.

The intention of the movements are to be able to pick up on the signals from your body with greater sensitivity, bring stimulation and change into your tissues, and grant agency to know how to respond to pain and discomfort. Keep asking yourself as you perform the movements… “Am I working on my body, or learning how to work with my body?”

In addition to a designated time for my home program, how am I implementing what I’ve learned into what I’m already doing throughout the day?

We live in our bodies 24/7, and we are already moving our bodies throughout the day, whether we are mindful about that or not. This grants us the ability to be engaging mindfully with our bodies pretty much all the time.

Getting out of bed or out of a chair- think about your body mechanics.

Standing in the kitchen- turn it into a dance.
Walking to and from rooms- what is that light from your chest doing?
Picking up a box from the floor- send your bottom back and tuck your pelvis when you come up.

By considering these concepts, your home program will likely become more rewarding, enjoyable, and instrumental in moving towards success in your therapeutic journey.

At the Wellness Station, we will guide you to creating an adaptable structuring that empowers you to direct your care and enhance your wellness, fitness and beyond.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Lorraine Davis

March 28, 2023

Feldenkrais, Holistic Body, Health and Wellness, Movement, Physical Therapy, Yoga

How Your Spine Moves: Connecting the Planes of Motion (Part 2)

Lorraine Davis

March 28, 2023

Feldenkrais, Holistic Body, Health and Wellness, Movement, Physical Therapy, Yoga

On the last blog How Your Spine Moves, we discussed the three directions of spinal movement, and the importance of regular movement. It is great to be aware of these three movements, and know how to incorporate them into your life and daily practices.

Recall that the planes of movement are flexion & extension, side bending (right and left), and rotation (right and left).

Although it is helpful to understand these movements individually, note that these movements do not happen in isolation, but rather our movement is typically moving in some combination of flexion/extension, side bending, and rotation. Our bodies move in patterns, rather than in a series of isolated movements. This speaks to the importance of practicing moving in a variety of directions, feeling the different shapes your spine can make.

Connecting the Planes into 3D Movement

From the hands and knees position, making circles with the spine is a great way to dynamically move through all three planes. This movement is more advanced than single plane movements, and it may take some time and practice to find ease with this pattern. With a keen awareness of an imaginary light from your tailbone, draw circles with that light on the wall behind you. Be sure to switch directions every so often! Just remember it doesn’t have to be perfect. Now that you can make circles, what other shapes can you make?

Another option for three dimensional movement would be making circles with your thigh, as demonstrated in this video. Engaging in these movements is an opportunity for you to feel and sense yourself without judgment, rather than trying to “achieve” something.

The bias towards one-dimensional movement

Just as our life can be biased towards movement involving forward flexion, our movement and exercise routines can also be biased in this way. If all of our movement practice involves moving primarily in one plane (e.g. the sagittal plane), we can sell ourselves short. While strength training machines at the gym can be very helpful for developing strength and muscle mass, they are typically constricted into one of the above described planes and thereby restrict our spine’s ability to move three dimensionally.

To be clear, we believe that strength training machines are brilliant at isolating muscles and enhancing overall conditioning. But the downside is that our nervous system, the little woman or the little guy in the control room of our brain gets more and more biased to think in terms of isolated movements rather than whole body patterns.

Think of throwing a ball and only moving your arm, rather than your whole body. Contrast that with turning first, flinging the arm back in the direction we are turning and then reversing the whole movement so that the arm is like a whip sending the ball so much further without strain on any one particular joint. Knowing how to integrate the movements of your body into three-dimensional patterns will improve the efficiency of your movement and thereby decrease the likelihood of strain and injury.

At the Wellness Station, we will teach you how your spine moves, and help you to expand your movement repertoire. We will encourage you to get involved in a regular movement practice that will include three-dimensional movements of your spine, such as Feldenkrais or yoga classes. Supporting the health and movement capacity of your spine will help you find a greater sense of ease and comfort in your body, while preparing you for successful participation in the unpredictable demands of life.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Images:

Lorraine Davis

March 14, 2023

Holistic Body, Movement, Yoga

How Your Spine Moves And The Importance of Moving It (Part 1)

Lorraine Davis

March 14, 2023

Holistic Body, Movement, Yoga

We live in a three-dimensional world, and our body is meant to move in all three dimensions (See our past blog post, Moving in Three Dimensions). Our spine, which contains 24 moveable vertebrae, has the capability of moving in these three planes.

The facet joints of your spine are the joints at which point each vertebrae meets the one above and below on the side. These are synovial joints, they require regular movement in order to stay lubricated and nourished with nutrient-rich fluids.

By understanding how the spine moves, and regularly moving it in a variety of ways, we can keep our spines healthy, the tissues nourished and supple.

Life can be unpredictable, and we might find ourselves in random shapes in order to meet the needs of our environment. Reaching for that pan located awkwardly in the back of the cabinet? Your spine needs to change its shape. Turning towards your backseat to pick up the glove you dropped last week? Again, your spine needs to change its shape. Having trouble reaching overhead to get the glass from the highest shelf? Again, shape change is required.

If we can train our spine to change shapes with ease and comfort, daily tasks are easier and less likely to contribute to strain. The mobility of our spine is so interconnected with our quality of life, as the loss of mobility can make these daily tasks that much more difficult.

The process of engaging in mindful spinal movements can help ease tension, improve tissue health, enhance body awareness, and feel really good!

As we go through life, we might gradually incorporate less variety or spontaneity in what we do. This goes along with our spinal joints moving with less variability, and thereby becoming less supple and possibly stiff in certain directions and ranges of motion (use it or lose it phenomenon). Most of our lives are biased towards activities that bring us down and forward, so over time it can become more difficult to extend, rotate, and bend from side to side. Imagine how you feel after sitting, hunched over a computer for several hours. Or perhaps after a long car drive. Can you feel the relief that moving your spine the opposite direction (extension) can bring- such as by reaching to the sky and following your hands with your face and eyes?

Our tissues do not like to be stuck in the same position for extended times or do the same repetitive task without variations. Without incorporating variety into how we are moving, our spines will not move as comfortably as they once did. Take a look at our Movement Snacks blog for some ideas on how to move your spine in different directions, the perfect antidote to prolonged sitting.

Directions of Motion

The 24 moveable joints of the spine permit movement in three planes, as described below. The joints that move are located through the neck (cervical spine), upper and mid back (thoracic spine), and lower back (lumbar spine), and below are the sacrum and coccyx (tailbone) which contain fused (non-moving) joints. The moveable regions of the spine have different capabilities in how much they can move in each direction, but are all capable of flexion, extension, side bending, and rotation, as described below.

Flexion and extension

Flexion and extension are movements that happen in the sagittal plane, which includes forward and backward movements. Flexion (AKA rounding) involves a forward bending of the spine, which often happens when we look down, bend down, and reach down to tie our shoes.

Extension (AKA arching) is involved in looking up and reaching up. Typically, we can flex much further than we can extend, and our cervical and lumbar spine tend to have more sagittal plane range of motion than our thoracic spine. The mid back, the rib cage/thoracic area, is designed more to flex, thus the tendency for many of us as we age to present a more rounded/slumped posture.

The cat cow, also known as the hill and valley, are a great way to feel your spine moving through a range of flexion and extension. Try to notice how you are initiating flexion and extension, and where in your body you can feel the movement happening (e.g. regions of the spine). Imagine there is a light shining from the end of your tailbone (coccyx). When doing a slow, easy cat cow, can you notice that light would be moving up and down throughout the movement?

Side Bending (Right and Left)

Side bending movements happen in the frontal plane. These movements involve one side of our body (e.g. right vs left) getting longer as the other gets shorter. Side bending may be involved in reaching, stairs, and lifting an object from one side of our body. Our cervical spine tends to have the most capability of side bending, followed by our lumbar, then our thoracic.

Lateral cat cow, also known as tail wagging, is a great way to feel your spine’s ability to bend side to side. Considering the light from your tailbone, can you perceive that the light would be moving from side to side, like wagging your imaginary tail right and left?

Rotation (Right and Left)

Movement in the transverse plane involves rotational movements, rotating to the right and left. These movements can be involved in turning around, looking from side to side, reaching behind or to the side, repositioning in bed, and more. Our cervical spine tends to have the most capability of rotation, followed by our thoracic, then our lumbar.

A thread-the-needle type of movement on hands and knees is a great way to feel rotation of your spine, and to sense how rotation is connected to the reaching of our arms. Notice an imaginary light shining from your chest bone. Where does this light move?

Now that you know the three directions of spinal movement, try to pay attention to your movements throughout the day or during your exercise routine. What plane do you move in most often? What plane do you move the least in? What parts of your spine feel more freedom of movement within each plane? The process of self-study will support mindfulness and self-awareness, and begin to harness your ability to listen to your body and respond accordingly. This ability will guide you towards making substantial improvements in function, patterns of pain, and will help you stay comfortable in your body as you move through life.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Images:

Lorraine Davis

January 31, 2023

Physical Therapy, Movement, Feldenkrais, Holistic Body

Posture Part II: Strategies for Improvement

Lorraine Davis

January 31, 2023

Physical Therapy, Movement, Feldenkrais, Holistic Body

On a previous blog post titled Posture: Does it Matter?, we discussed some of the nuances of posture, breaking down “good” and “bad” posture related to both psychosocial and biomechanical/physiology principles, how the dynamic nature of posture might be more aptly named as acture, and what factors could potentially influence a downward spiral into inefficient postural tendencies.

With a more clear idea of what posture is and is not, we can now discuss some practical ways to improve our posture from the inside out as well as the outside in.

Many of us with postural issues require hands on, neuromuscular training facilitated by a professional to help to relearn efficient movement patterns from the ground up. However, there are also regular strategies that all of us can bring into our daily lives to help enhance our postural awareness, comfort, and prevent issues arising from our habitual posturing.

Change Positions, Move Often

We have the wonderful ability to choose what posture is best for us in any given situation. Sometimes being in more of a flexed position will be desirable, sometimes being more upright will be desirable. Consider cycling between three or four shapes throughout the day rather than always trying to find one “correct” position. What works for us in one moment will not be the best choice in another, and what works best for one person will not be the same as what is best for a different individual. When a specific posture is desired for a prolonged period of time, consider what will allow for the greatest sense of comfort, ease, and support. Notice what your ease of movement is when you are turning and reaching for things, trying to find a position where you can have more freedom of motion. Generally speaking, the most efficient posture will be an upright carriage in which the bones of our spine are stacked, so each bone is able to receive support from the bone that is beneath it.

Another strategy is to move more often throughout the day, establishing a system of movement breaks, stretches and short walks throughout the day. By dynamically changing the length, tension, and blood flow into a variety of tissues, it is less likely that any particular area will get sore, tired and overworked, and less likely that habitual postures will become an issue over time. See our Movement Snacks blog for some ideas on how to bring small movement breaks into the rhythm of your daily routine. A regular, well-rounded fitness routine will also help, which might include a blend of activities that promote cardiorespiratory and musculoskeletal health (e.g. aerobics, strength-training, yoga). Additionally, here are some gentle yoga stretches that you could do throughout the work day-

***Consider putting up sticky note reminders to move, stretch, walk around, and change positions throughout the day.***

Tips for Finding Effortless Sitting Posture

The following description includes some tips for sitting ergonomics to help support an upright carriage. While most people find these strategies to be helpful and comfortable, keep in mind that one size does not fit all.

Feet flat on the ground

A chair with some degree of firmness, with hips at least as high as knees.
Back support behind low to mid back. A partially deflated children’s ball, folded towel or blanket, or any other object that is comfortable can provide this support
Head on top of rib cage, rather than significantly protruding forward. Vision and size of text on the screen can play into a forward head tendency, so check that you can see the screen well without craning your head forward.
It may be helpful for your screen to be directly forward of eye level, rather than higher or lower.

Enhance body awareness

If we are not aware of our body position, we have much less ability to change it. To further enhance your ability to feel and sense your posture and choose efficient options, consider regularly practicing embodied practices such as yoga, qi-gong, tai chi, body scans, and Feldenkrais lessons, which will help improve postural awareness. Becoming familiar with some “landmarks” of our body can be helpful, such as awareness of where on our pelvic bones we are sitting, where on our feet we are standing, where our chest bone, nose, and eyes are oriented towards. Some lessons that may be helpful for posture that most Wellness Station clients will be familiar with are the pelvic clock, easy turning, and shoulder elevators. Here is an example of the pelvic clock lesson to help you bring a better sense of ease and awareness into your sitting posture.

To become more aware of your standing posture and ability, use a protruding corner in your house or a door frame to feel the back of your body. Stand against the corner or the edge of a door frame with knees slightly bent, feet slightly in front. First, get a general sense of how much of you can make effortless contact with the edge from the back of your pelvis to the back of your head. Then, tuck your pelvis under so your low back makes contact with the edge. Keep your low back in contact with the edge, as you try to bring your mid and upper back in contact with the edge. Roll your upper back up and down the edge a few times, keeping your low back in firm contact. How much of your upper back can easily contact the edge? Bra strap level? Top of shoulder blades? Regularly checking this can give you a sense of your posture and any changes over time that might be occurring in your ease of effortless stacking.

Ask your Wellness Station practitioner to provide you with additional lessons to help enhance your senses with consideration of your individual needs, limitations, and goals.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

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