How meditation can assist pain management in my opinion …..

I recently saw a meme going around the therapy social networks, that I quickly resonated with, it showed a great reflection of how it can some times feel when discussing pain science and pain education in general. I mean “Sheriff Woody’s” body language says a thousand words!

Screen Shot 2018-11-09 at 3.06.51 PM

Pain is complex, I guess because humans are complex. At the National Pain Summit in 2010 an explanation for pain was described as “An individual human experience that is entirely subjective and that can only be truly appreciated by the individual experiencing pain”.  I think humans are multidimensional beings and to think of pain as simply being a biological process is limiting. Pain is complex because there is a significant amount of social and emotional suffering that comes along with the physical aspects of pain. Often we talk about treating pain within a bio-psychosocial model, that is a model that understands that pain is a dance between the biological factors, psychological factors such as mood, personality, behaviour and social factors such as culture and familial. To simply just treat the symptoms alone, I have found with my experience, keeps you in a positive loop pattern that only leads to more pain.

Professor in neuroscience Lorimer Moseley (late physiotherapist turned neuroscientist) once said “what are the barriers to really deeply adopting the bio-psychosocial model? Often the application results in clinicians suggesting that pain is in the ‘bio’ and suffering and disability is the ‘psychosocial”. It really is a dance, this is where I feel meditation comes in. I think it is a great adjunct to therapy, I mean we really are mind & body and not just the body so why just treat the body?

Screen Shot 2018-11-09 at 3.57.24 PM

The way I see meditation used as a pain mediator; is that it allows us to see our thoughts & feelings in a non-reactive way. Sure it takes practice to get to this point, but so does everything. To be able to feel discomfort and watch your thoughts, decreases the chance of feeding the symptoms and inevitably increasing them. It allows us to practice being non-reactive to every sensation. This might sound wishy washy but luckily there has been more and more evidence to back this up. In 2016 Cherkin Et-al studied mindfulness and chronic back pain in 342 adults and found that mindfulness based stress therapy resulted in greater improvement in chronic low back pain and functional limitations at 26 weeks compared to usual care.

Another factor that is strongly correlated with chronic pain is fear! Fear avoidant patterns of movement can often keep you in a pain loop = You move with fear, these movements are not bio-mechanically efficient. This causes your body to work in unusual ways likely to cause more stiffness and pain. In the study from Schutze Et-al found that low mindfulness predicts pain catastrophizing in a fear avoidance model of chronic pain.

In my experience meditation allows you to see your thoughts and perhaps the patterns that are so repetitive you may have never realised they are there …. in a loop. I find by seeing this you immediately press the pause button on that loop.

Of course I don’t think meditation alone will alleviate all physical symptoms, however as and adjunct to movement, strength and manual therapy you are definitely giving your body an environment conducive to healing from a mind & body perspective.

Ericka has completed a meditation teacher training and is a daily meditator. Ask her how to include this in your therapy. Meditation.

 

References:

  1. Checkin et al. 2016, Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain. March 22/29. doi:10.1001/jama.2016.2323
  2. Schutze et al. 2010, Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. January vol 148, page 120-127. doi.org/10.1016/j.pain.2009.10.030

Core stability in my opinion ….

For more than a decade I have been teaching Pilates and movement based therapy as an adjunct to physiotherapy around Brisbane. For a considerable amount of time I (like many other physiotherapists out there) have had a belief system that engaging deep abdominal muscles were the key to improve spinal function and to think about these exercises before moving was important.

However over recent years there have been a number of clinicians including renowned physiotherapist Professor Peter O’Sullivan who have discovered that in fact there is little evidence that pre stiffening your trunk improves your “back strength”. He publicly discusses literature around how bracing and pre bracing before moving can in fact increase compression causing symptoms.

Peter O’Sullivan also has open the conversation around the idea of “core stability” one you have probably heard many times and discusses the fact our spine and trunk has a 3 dimensional movement system with the ability to move in many directions with the aide of many muscles and that in fact there is no such thing as “core stability”.

Peter is offering a new conversation, one around the idea that we need to trust our bodies and that even though there may have been some physiological damage in the recent or distant past that our bodies are a self healing mechanism and that our spines are robust. To be able to trust our bodies allows us to develop normal patterns of movement.

I have travelled the world and seen individuals working the land and using their bodies to the extreme that most of us in the western world would cringe at. In my recent trip to Bali I saw a rice farmer in the paddy’s in the hot sun leaning over planting rice for hours, I saw women carrying bags of sand on their heads up a massive stair case carrying what I would say was at least 10-20 kg bags. I don’t think they were thinking about stiffening their trunk ……. Because in actual fact this happens naturally!

full length of man on water

These days when I teach Pilates and movement based classes I endeavour to empower you to trust your body and allow you to feel movement that happens in all different directions. I use breathing and breathing exercises as well as some mindfulness practices to help with body awareness and coordination and perhaps bring some awareness in deep-seated movement patterns that may not be serving you.

Pilates and movement therapies are one on one or duo classes. Health rebates are available.

“What we understand from the literature, is that often the fear of pain causes people to make protective movements and as a result people’s movement patterns become really abnormal and act as a mechanism for self harm” Professor Peter O’Sullivan, PhD