As I speak about very often in my articles on this site, and in person with every patient, much of the body's pain and overall ‘symptoms’ are a way to tell your conscious brain that there is danger or some kind of built up stress that the body feels threatened by. It’s a signal that something is wrong and a request for change. So much of how the body works outside of its ‘factory settings,’ is an ‘avoidance/withdrawal’ strategy to get away from this threatening stimulus. Postural changes, changes in how we walk (where some people won’t move their torso at all and instead swivel their hips heavily, or seem to sway left and right as they walk, etc.), and pain itself, are all ways to avoid potentially damaging (threatening) situations and get you to do something about the problem.
A lot of what we do in-office is to approach the reason the body feels threatened. This means a specific approach in stimulating the nerve receptors that were triggered by previous traumatic events (like a torn ACL ligament in the knee detecting the stretch we put on it, putting a light force into a bone that was previously broken, and so on) to show the body these ‘red flags,’ are no longer dangerous. This is a very direct therapy, and deals with a lot of what’s causing the patient's complaints at the source. We will also mix that with dealing with any secondary issues that are contributing (such as your brain interpreting bending the back forwards or backwards as threatening after a spinal injury, or breathing being a problem after a C-section, or simple auditory stimulus after an injury around the ear).
For most people this is enough, with maybe some supporting ‘symptom work’ tossed in to help calm down the nervous system and support the body’s transition away from its protective mechanisms. But for those with severe situations and/or years of pain and other symptoms, it can need more. The body has been protecting itself for so long that it’s protective strategies now dominate how it holds itself and moves. It, on some level, is constantly looking out for danger and movement itself is commonly threatening, either bringing up pain or discomfort fairly quickly, or seemingly inevitably leading to an injury. This can be quite the hole to dig yourself out of, even after we’ve dealt with how you got there in the first place.
We approach this part of the recovery process in a conceptually simple fashion. We find movements the body can go through which do not cause pain, or feel threatening/anxiety producing, and we work on those every day. We like starting with a general movement, which can be as simple to start as going on daily short walks, never getting to the point of pain or more than the most minor discomfort or fatigue. It has nothing to do with how far or how fast you can do the movement, but showing the brain that it can have pain free, non-threatening movement. So we start small, and build and expand on that one movement to include a range of others.
We eventually get more specific once there’s a foundation of pain free movement, and add something specific to the area(s) of pain/symptom complaint. That said, with area of complaint situations we will generally start with positive stimulus first, like the person rubbing their low back slowly and gently on and off during the day so that the brain can realize that the area can in fact have non-painful/threatening stimulus and experiences in the first place. Then we’d start adding in isometric contractions (holding pressure without moving, like holding a can of beans in front of you instead of raising or lowering it), which lets the body use that part in a very controlled way that feels safer. We would then progress to controlled movements for that area, which can vary a lot depending on what the part of the body is and what the problem it’s had is, but anything that’s low speed, low resistance (ideally a natural movement, not an ‘exercise’) and very controlled works to give the brain and body a chance to see it can use that part safely, and that it can go back to business as usual.
I am hoping over time to build up a library of movements that can be used for these purposes, but I am always happy to discuss with people what movements we can pursue to help them work their way out of pain in their specific situation. For most situations, the simpler, the better to start, and then complexity can be added later when appropriate.
Our process in summary, as well as a bit more specific detail and directions:
First Stage
Some generalized movement, at an amount and intensity which is not painful at all, and once discomfort or notable fatigue appears, we stop. Best to do once daily to start, then eventually throughout the day if possible. A walk, for example. Start with only a little bit, and once or twice a week, we can make our daily practice a bit longer to see if it’s within tolerance still, backing off if it causes discomfort.
Add some ‘positive stimulation’ to the area that does hurt. Like soft, slow rubbing of the area. It should feel good, or at least neutral, and not painful or irritating at all. If it does, it will have to wait for later.
Second Stage (we can continue first stage activities even when beginning these)
We start adding ‘isometric’ actions to the area of complaint. When this happens really depends on the specific situation, based on what caused the pain, how long it’s been going on, severity, and the progress of our first stage activities. I’d give the first stage a few weeks at least, and then start trying out really brief, very low weight/intensity isometrics. If it was front of the shoulder pain, I’d just hold my arm out in front of me empty at first (or pushing it gently forward into a wall, without moving), for ten seconds or less at a time, a couple of times a day and give that a few days to check for pain. If no pain occurs/increases, I’d start holding my phone, for the same amount of time 2-3x a day (or add a bit of pressure into the wall-push). As mentioned above, I’m not looking to put on strength or endurance here, but starting simply and working to progress towards normal use of the area is important.
Third Stage (Again, we can keep up the previous stage activities at the same time)
A week or two of the second stage completed, with no pain at all, and we can start playing with a third stage: controlled movements. In the front of the shoulder example, I would then be raising the arm slowly upwards in a controlled manner, then back down and making sure there was no pain, carrying out a few repetitions. I would progress it in the same way as our isometrics, making sure no pain is present, and stopping the moment there is discomfort, or any significant fatigue. We don’t want to show the brain failure in these movements, but show it some confidence that we can in fact do them successfully, and safely.
Fourth Stage (same added commentary as above)
Here we start doing ‘integrating movements. This is moving away from very simple movements including the specific area of complaint by doing more complex movements which incorporate that body part. Baby crawls are a personal favorite, as it’s a very important fundamental movement, and tends to be very safe if you can get up and down from the ground. “Vertical bird dogs” are also a good choice, for many situations (The weight is not needed, as we see it in this video).
Important Points
Remember, at all stages, these movements and actions should not be painful at all. If it is, back off until it isn’t, or choose something else.
Similarly, discomfort can be met, but the activity must stop immediately at that point. Any notable fatigue should also be a stopping point.
Any movement you carry out should be fully controlled. This isn’t the time to try out something complex that you can’t really do well. It may not look like the graceful ease of an Olympian, but it needs to be a very controlled movement.
Whether in movement, or in rubbing a painful spot, etc. nothing should be done quickly. Quick movements or vibrating stimulation can easily be threatening, and ‘excitatory’ to the brain, just making things worse, so need to be avoided for this particular approach to work.
So what about working on multiple areas at once? This can definitely be done, as long as the load altogether isn’t causing pain or discomfort. We want the brain to have the ability to experience these sensory inputs and process them, and not feel overloaded and overwhelmed. So multiple areas can be started at once, or added on as you go, as long as each area isn’t pushed farther than it should be before it’s ready (like using integrating movements which your low back is ready for, but causes discomfort for your shoulder).
Wrapping Up
On the whole, there’s a lot more that can be said on this topic for this approach, and we can get very specific for each person’s situation. I am happy to help each of you choose some specifics that fit you for best success, and as mentioned above, hope to start building up a library of resources which can help these situations.
I’ve never had a time in my adult life, really, that I’ve not had pain which on top of being a nuisance, limited me and made me feel vulnerable in general, and I’ve certainly had periods of crippling pain where I was bed bound for days, a couple occasions where I’ve had to crawl to get around the house, and well, the list goes on. Corey’s work has dealt with all those severe bouts of pain and disability (most important to me has been the crippling back pain, the fun leavings of a bad back injury when I was in my early twenties), which by itself has been miraculous, I’m getting my life back for the first time since my childhood. But perhaps some of the more impressive parts of the process to me has been finishing dusting off the last ‘residue’ of my pain and limitations, while building up what I can do for the first time, successfully. Starting with simple daily walks, and some specific basic movements each day, I’ve felt my body get stronger, less stiff, I have more energy and endurance (in every situation), and the last dregs of pain and vulnerability have been disappearing. At first my walks and basic movements could leave me a bit sore, and a bit worried for my back, especially the more specific movements for my pain, but now the movements and walking just feels good. I feel my abilities improving, but I also feel this drive, this thirst in my body for more. Like someone who has just had their hearing restored and now wants to hear everything! It’s been so invigorating, and has given me so much more than just being out of pain. Seeing Corey guide me through this process, in all of its different stages and approaches, each at just the right time, has been so incredibly effective, and shows how deeply knowledgeable and capable he is.
-C.S.L.
One related side note: we have a part of the brain (part of the brain stem) called the PMRF (Ponto medullary reticular formation) which in its many roles includes raising the threshold that ‘pain cells*’ need to meet so that pain is lower or less likely. To avoid getting deep into the physiology, we can summarize the technique as saying that by stimulating the opposite side of the body to the area of complaint (say, an opposite arm/shoulder when you’re having hip pain) we can actually raise the activity of the PMRF on the side of the body which causes pain, thereby lowering pain. I will go into this in more detail in a video, which I will link here once it has been completed.
*’Pain cells’ do not actually exist, though we have many nerve cells which can be thought of as excitatory cells which the brain often uses for creating a pain response. In this situation though, it’s simplest to refer to them conversationally as pain cells.