Lorraine Davis

September 26, 2023

Feldenkrais, Health and Wellness, Physical Therapy, Healing Pain

You Can Break the Cycle of Chronic Pain!

Lorraine Davis

September 26, 2023

Feldenkrais, Health and Wellness, Physical Therapy, Healing Pain

It’s All In Your Head: Your Brain & Pain

Many of us who experience pain might feel very offended if we were told that this pain was all in our head. However, all pain, as well as any other sensation, is created by the brain. This is because pain is a perceptual process- the experience of the pain is not actually happening in the part of your body that hurts, but rather it is happening in your brain. Sometimes this perception of pain can be a very useful process (Ouch, I just touched a hot stove, let me move my hand away as quick as possible!), but when it comes to chronic pain, this process can severely impact our quality of life.

In cases of chronic pain, the brain tends to get hypersensitized to the pain until we are in a constant state of high alert. A learning process occurs in which neural pathways involved in pain perception of a certain area (the low back, for example) become strengthened. The neural pathways responsible for chronic pain experience go far deeper than our acute pain pathways, such as in the stove top example. This is because over time, the neural pathways related to the chronic pain will be embedded into the memory and emotional centers of our brain, making chronic pain far more complex than pain from acute injuries.

As with any learning process, we form associations, such as... sitting = pain, long car rides = pain, exercise = pain. These associations can contribute to a self-perpetuating cycle in which we avoid certain activities because of the fear of pain, which decreases our quality of life, thereby contributing to depression, inactivity, limited social participation, and other factors that will actually make our pain worse over time.

How do we break this vicious cycle?!?

Pain is our brain's opinion of how much danger we are in, and we have to change that opinion. Our brain was capable of establishing these detrimental neural pathways that contributed to the chronic pain, and it is just as capable of creating new pathways that will help us get out of this situation. This is because our brain remains plastic for our entire lives, meaning we are always capable of learning. We must learn that we are safe, and that movement of the affected body part is safe and beneficial.

At The Wellness Station, we help those in chronic pain learn that they are safe.

By creating individualized movement programs, we help our clients learn ways of moving and relating to the body in a manner that will drive neuroplasticity. We will help to teach the little person in the control room (aka your brain) that movement can be associated with calm, pleasure, and ease, rather than movement = pain. The movements lessons are designed to help our clients move with greater efficiency to make movement easier and to decrease tension and tissue strain. We will also help with self-care tools necessary to calm down the nervous system to decrease pain sensitivity, and provide guidance regarding management of the psychosocial aspects of living chronic pain.

Do not let pain stop you from living life to the fullest. It is never too late to learn!

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

Lorraine Davis

August 8, 2023

Balance, Exercise, Health and Wellness, Movement, Physical Therapy

Balance Part II: Strategies for Improvement

Lorraine Davis

August 8, 2023

Balance, Exercise, Health and Wellness, Movement, Physical Therapy

Last month, we discussed factors that control and impact our balance. Consideration of these factors can help us become more aware of what to do to stay safe and prevent falls, as well as targeted exercises to improve our balance that are based on scientific principles.

How do we improve our balance and prevent falling?

If we recognize the influence that the physiological, psychological, and environmental factors have on our balance, we can be strategic in how we improve our balance and decrease our risk of falling.

Stay active, making sure you are keeping your muscles strong and healthy for life. Have a movement practice that incorporates functional strengthening and balance challenges.

Enhance your somatosensory system by regularly stimulating your feet. Think of your feet like antennas that provide messages to your brain about your balance. Massaging your feet with balance pods are a great way to keep the nerve endings responsive.
Consider more time spent barefoot, especially during balance exercises. This will allow your feet to feel the ground and your toes to spread out, creating wider points of contact with the ground. In daily life, consider shoes with a thinner, more flexible sole, and a wide toe box.

Ensure you are taking care of your eyes and vision by regularly visiting an ophthalmologist. Make sure you use a nightlight when going to the bathroom at night, and remove any trip hazards from your path.

You could also consider the role of vision to challenge your balance during exercises. Notice that keeping your gaze stable on an object in front of you helps your balance. Moving your eyes around will make balance more challenging. Closing your eyes will make it the most challenging!

Recall in Balance Part I, we discussed how being overly reliant on vision can contribute to a stooped posture, as many people will look down to the ground with their whole body rather than just with their eyes. When walking, practice looking down with just your eyeballs as needed to see the ground in front of you, rather than with your whole self. If you had a light shining from the tip of your nose, and a light from your chest bone, you should be able to maintain these lights at the level of the horizon while walking, rather than keeping the lights cast downwards.

Make sure your vestibular system is healthy, and recognize the impact that vertigo, seasickness, and certain medications can have on your balance.

Likewise, you can progress your balance exercises by introducing changes in your vestibular system. If standing on one leg has become easy, can you do it while slowly turning your head from side to side, or up and down?

Optimize your environment: Make sure your environment is conducive to not falling! If icy sidewalks, crowds, or uneven trails are not for you, make sure you modify appropriately, perhaps bringing an assistive device or a loved one to help you stay steady.

You can also use the environment to improve your balance, by intentionally walking on trails and standing on uneven or “squishy” surfaces.

Train your balance… but don’t overshoot it! A mistake many people make while training their balance is going past their edge. If standing on one leg consistently leads to excessive wiggles, wobbles, and you are unable to find your steadiness, then you are simply practicing being unsteady, rather than practicing finding steadiness. You want to be close to your edge, without going over it!

Find an exercise that feels moderately challenging, but you are able to find steadiness and ease with practice. If not, modify the activity to make it more or less challenging. Standing at the kitchen sink, by the counter, in the corner of a room, or in a door frame are excellent places to practice balance, as you have the option of supporting yourself with your arms as needed.

By finding this edge and achieving success with practice, not only can we improve the physiological components of balance, but we can also improve the confidence we have in ourselves, thereby decreasing our fear of falling and subsequent risk of actually falling!

Follow along with this video, which incorporates seven balance exercises and strategies, “Feldenkrais style”! It instructs in balance challenges including standing and walking with a narrow base of support, closing the eyes, getting up and down from the floor, dynamic weight shifting, and practice with “falling”. Best to do this video near something to hold on to as needed.

At the Wellness Station, we can help you recognize and make changes in the factors that could be impacting your balance. We will provide you with individualized recommendations and movement lessons to help you improve your balance, your confidence in yourself, and your ability to continue to do what you love.

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

Lorraine Davis

July 18, 2023

Balance, Movement, Physical Therapy

Balance Part I: The Science Behind our Steadiness

Lorraine Davis

July 18, 2023

Balance, Movement, Physical Therapy

A keen sense of balance is crucial for a full and healthy life. Our balance tends to decline as we age, but we can prevent this decline and even improve our balance over time if we equip ourselves with knowledge and targeted exercises.

Many people don’t realize that their balance has gotten significantly worse until they are put into a situation that reveals it. Older individuals may realize they are no longer able to get up and down from the floor, especially if they have nothing to hold on to. Or perhaps standing on one leg is no longer an option. Maybe we have become a “furniture walker”, always looking for the next piece of furniture to touch as we walk around. As balance declines, one’s life can get smaller and smaller, as fear of falling begins to impact decision making.

What controls our balance?

Our balance is an extremely complex interaction between many physiological, psychological, and environmental factors.

Physiologically speaking, balance depends on the strength and responsiveness of our neuromuscular system. How quickly, and with how much force are we able to respond to perturbations? Do we have the strength in our legs to balance on one of them, or the reaction time to catch ourselves if we fall?

Balance also depends on our somatosensory system, which are sensations that we receive and process from our skin, muscles, and joints. The ability to feel our feet on the ground, as well as the sense of proprioception (sensing the position of our joints in space) help us to stay balanced. This is why individuals with peripheral neuropathy (loss of sensation particularly in feet) have great challenges with their balance, because they can’t feel their feet too well.

Our vestibular system also controls our balance. This is the system in our inner ear that provides information to our brain regarding head position, motion, and orientation in space. We all know the feeling of being dizzy, perhaps due to a medication that affects the vestibular system, an amusement park ride that tosses your head around, or seasickness. When the vestibular system is impaired, balance is impaired.

Vision is a prime component of our balance system. This is why it is harder to balance in the dark, or with your eyes closed! However, some people become overly reliant on their vision for balance, and find themselves looking at the ground when they walk, as opposed to appropriately integrating information from the other systems. This is related to posture, as many people will adopt a stooped posture over time if frequently looking at the ground to maintain balance. Training your posture and training your balance can go hand in hand!

Psychological factors also greatly impact our balance. Of course, if we are feeling crummy, or perhaps are not well-rested, our balance will be worse. More significantly is the confidence we have in our balance. Any athlete will recognize the negative impact of anxiety/nervousness on performance, particularly in sports that require a keen sense of balance (e.g. gymnastics). Lacking confidence and having a fear of falling is actually the most significant predictor of a fall! Studies have shown that those with a fear of falling have more than twice the risk of falling than those who do not have this fear. With this fear comes diminished activity overtime. With diminished activity, a downwards spiral is set in motion that will negatively impact the functioning of all body systems.

Environmental factors also impact balance. What environment are we in, and how are we relative to our environment? Our base of support, and how we are able to keep our center of gravity balanced over our base of support will determine our stability (e.g. standing with your feet wide apart is far more balanced than standing on a tightrope).

The ground we are on will impact the position of our joints and contribute to perturbations that could throw us off center (e.g. sinking into the sand, walking on uneven rocks and roots, slippery ice, etc.) Additionally, disturbances from our environment (e.g. crowds with people rushing past you and bumping into you, high winds, loud noises) can create disorientation and perturbations that can throw us off center. In general, the less familiar we are with the territory in which we are engaging with, the worse our balance.

See Part II next month for specific strategies to improve your balance over time.

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

References:

https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03018-2#:~:text=Supporting%20this%20research%2C%20FoF%20is,those%20without%20FoF%20%5B6%5D.

Images:

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

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

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